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Miscellaneous - 33 BEAVER BROOK ROAD 4/30/2018 (2)
O Sv MAP # PARCEL # {d4fYv" NO YES r , NO YES YE NO NO DATE• DY: STREET^ HAS PLAN REVIEW FEE .BEEN PAID? c6I3I YES NO PLAN APPROVAL: DATE APP. BY_�L�LL�-1 DESIGNER:S?'//-)-V,'eA) PLAN DA"iE. _ CONDITIONS WATER SUPPLY: TOWN WELL WELL RERMI7`-�-- DRILLER WELL TESTS: CH Mi -GAL DAZE APPRUVED BACTERIA -I a IE 11PPRUVEU BACTERIA II DAT -E AF -P COMMENTS: FORM U APPROVAL: `�Z� APPROVAL 1-0 ISSUE YES NO DATE ISSUED BY CONDITIONS: �f FINAL APPROVAL:. ALL PERMITS PAID WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO YES NO YES NO YES YE NO NO DATE• DY: 11 I .:,', ; �E���SY�Z.�L"1._Z.NSSflI,.�T�4Ll _ • t it •� 1 i • . , _ : f rh" ;i. ... 9 • ., ,;., a[ t f -• ,, x_ IS THE • INSTALLER LICENSED? _�� ;� f / NO TYPE a OF i1CONSTRUCTION . ? t' — REPAIR NEW CONSTRUCTION: CERTIFIED PLOT -PLAN REVIEW YES NO CONDITIONS OF:. APPROVAL YES NO (FROM FORM U)... ` '' `. '� , i , ';sem y.. ' J•�:,::. .*•: ,,.�_ r `—ISSUANCE OF DWC PERMIT NO 1 DWC PERMITNO. `" "l�lo INSTALLER: 17 BEG I N INSPECTION EXCAVATION. INSPECTION: ;NEEDED: PASSEDBy <--CONSTRUCTION INSPECTIONS NEEDED: AS BUILT KLAN SATISFACTORY �:. YES - APPROVAL TO BACKFILL. DATE: BY 1 " `<.FINAL.GRADING APPROVAL: DATE: BY DATE FINAL CONSTRUCTION APPROVAL: Ot ,NORT •,M . 4867 . O * Town of North Andover HEALTH DEPARTMENT ,$•S�CNUStt CHECK #: TE: LOCATION: /l H/O NAME 1 . >' CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ` itle 5 Report $�• ❑ Other: (Indicate) '`Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer RAGGS, IN6'" • DB/A'E.A. COMEAU Vendor: .Town of N. Andover r INVOICE NO. t5 DATE 8/12/10 CHECK NUMBER 0 24247 CHECK AMOUNT 50.00 REFERENCE AMOUNT verb / 7/28/10 50.00 Memo: title5fee pessinis 33beaverbrk Au0 17 2010 OMANDOM 024247 DISCOUNT NET AMT. 50.00 $50.00 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. raD Property Address STEPHEN AND DIANE PESSINIS Owner's Name NORTH ANDOVER MA City/Town State Inspection results must be sub way. A. General Informatior-__ _ - 1. Inspector: HAROLD T. LINCOLN, JR Name of Inspector RAGGS, INC. Company Name P.O. BOX 1027 Company Address -- - CONCORD City/Town -- - 978-369-1100 Telephone Number B. Certification 01845 JULY 28, 2010 Zip Code Date of Inspection I certify that I have personally ins information reported below is true lection was performed based on my trair site sewage disposal systems. I am a` --- - -- - - — — -of Title 5 (310 CMR 15.000). The s,, X Passes ❑ Needs Further Evaluatioi--- InfectoLVSignature The system inspector shall submit a copy of this inspection report to the Approving`Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. PESSINIS NANDOVERINSP.doc - 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 15 Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rab renes i J � Commonwealth of Massachusetts �rr G� Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ( CJ -Z'5' -0 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address ©� STEPHEN AND DIANE PESSINIS Owner's Name NORTH ANDOVER MA 01845 JULY 28, 2010 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: HAROLD T. LINCOLN, JR Name of Inspector RAGGS, INC. Company Name P.O. BOX 1027. Company Address CONCORD City/Town 978-369-1100 Telephone Number B. Certification MA State 4162 License Number 01742 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: 4 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Infecto&Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. PESSINIS NANDOVERINSP.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 JULY 28, 2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: FOOTING FOR DECK IS TOUCHING THE CORNER OF THE SEPTIC TANK. RECOMMEND CHECKING WITH BOARD OF HEALTH TO DETERMINE IF IT SHOULD BE MOVED. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If "not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): C FE - broken pipe(s) are replaced obstruction is removed PESSINIS NANDOVERINSP.doc - 03108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 JULY 28, 2010 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. PESSINIS NANDOVERINSP.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 JULY 28, 2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. PESSINIS NANDOVERINSP.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 15 A Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 JULY 28, 2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. PESSINIS NANDOVERINSP.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 15 L Commonwealth of Massachusetts 42) Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner information is required for every page. Owner's Name NORTH ANDOVER City/Town C. Checklist A A A AAAA I JULY 28, 2010 Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] PESSINIS_NANDOVERINSP.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner's Name NORTH ANDOVER MA 01845 City/Town State Zip Code D. System Information Residential Flow Conditions: JULY 28, 2010 Date of Inspection Number of bedrooms (design): 4 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? [if yes separate inspection required] Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Last date of occupancy/use: Other (describe): Gallons per day (gpd) Date 4 ❑ Yes ® No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No 230.94 AVGGPD 6/5/08-6/7/10 ❑ Yes ® No OCCUPIED Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No PESSINIS_NANDOVERINSP.doc - 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 15 Owner information is required for every page. } Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner's Name NORTH ANDOVER MA 01845 City/Town State Zip Code D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: JULY 28, 2010 Date of Inspection PUMPED EVERY OTHER YEAR PER OWNER - NO RECORDS AT BOARD OF HEALTH OFFICE ® Yes ❑ No 1,500 gallons FIELD ESTIMATE TANK AND TEE INSPECTION Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: CIRCA 1999 -SEE RECORD AS -BUILT Were sewage odors detected when arriving at the site? ❑ Yes ® No PESSINIS_NANDOVERINSP.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M m 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 JULY 28, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer (locate on site plan): Depth below grade: 1.5feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): GOOD; OK; NONE Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 10' X 5'X 5' Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness 6" — Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? FIELD ESTIMATE PESSINIS_NANDOVERINSP.doc - 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 15 i�— Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner's Name NORTH ANDOVER MA 01845 JULY 28, 2010 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): RECOMMEND ANNUAL PUMPING; TEES IN PLACE; APPEARED STRUCTURALLY SOUND AT TIME OF INSPECTION; LIQUID LEVE AT OUTLET INVER; NO LEAKAGE; SEE COMMEND ON PAGE 2 OF REPORT REGARDING FOOTING Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: . ❑ concrete ❑ metal PESSINIS NANDOVERINSP.doc • 03/08 ❑ fiberglass ❑ polyethylene ❑ other (explain): Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 JULY 28, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX APPEARED LEVEL WITH EQUAL DISTRIBUTION; SOME CARRYOVER; NO LEAKAGE Pump Chamber (locate on site plan): Pumps in working order: Alarms in working order: ❑ Yes ❑ No ❑ Yes ❑ No PESSINIS_NANDOVERINSP.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 15 Owner information is required for every page. Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner's Name NORTH ANDOVER City/Town D. System Information (cont.) JULY 28, 2010 Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAND: NO SIGNS OF HYDRAULIC FAILURE OR PONDING ABOVE GROUND: DRY: GRASS PESSINIS_NANDOVERINSP.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 15 Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 6 - 16'X 41' SEE RECORD ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAND: NO SIGNS OF HYDRAULIC FAILURE OR PONDING ABOVE GROUND: DRY: GRASS PESSINIS_NANDOVERINSP.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner Owner's Name information is required for NORTH ANDOVER every page. City/Town D. System Information (cont.) R A n n A n A r JULY 28, 2010 Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PESSINIS_NANDOVERINSP.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner Owner's Name information is NORTH ANDOVER MA 01845 JULY 28, 2010 required for every page. City/Toyvn State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 BEAVER BROOK ROAD, NORTH ANDOVER, MA 01845 Property Address STEPHEN AND DIANE PESSINIS Owner's Name NORTH ANDOVER City/Town D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: MD n1AAR oidia uN �.uuc JULY 28, 2010 Date of Inspection 4' MIN. BELOW SAS feet Please indicate all methods used to determine the high ground water elevation: 1001 U C Obtained from system design plans on record If checked, date of design plan reviewed: 1999, AND CHECKED TEST LOG INFO Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: ❑ . Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation CHECK CELLAR -DRY WITH NO SUMP PUMP. REGULATIONS IN EFFECT AT TIME OF DESIGN AND CONSTRUCTION REQUIRED A MINIMUM FOUR FOOT OFFSET BETWEEN THE BOTTOM OF THE SYSTEM AND GROUNDWATER. AS -BUILT ELEVATION OF BOTTOM OF GALLERIES IS 124.00. PESSINIS_NANDOVER INS P.doc • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 15 .. - V!'li\IJII/`71�JL1a� ..+...•vi•v• , ,,.••v ._.. ..� INSPECTOR: SANDY STARR SUSAN FORD TEST PIT 2.1-1 DATE: 4/7/95 , dlq Cl 90X. mHol z1 BW: FINE I BC: FINE SANDY LOAM I C 1 r FINE LOAMY SAND 119.9 GWO36 C2: GRAVELLY, COBBLY LOAMY, SANO,FIRM, CEMENTED 115.5 89 // E.S.H.W.T. ® 36": MOTTLING / SEEPAGE ® 83" TEST PIT 21-2 120.4 118.8 24 117.1 GW®44 114.6 75 DATE: 4/7/95 DESCRIPTION A' B: FINE SANDY LOAM C: GRAVELLY LOAMY SAND, FIRM, CEMENTED E:S.H.W.T. ® 44": M6ifLI1 TEST PIT 9.8.--21-1 DATE: 3/27/98 z 0 W O DESCRIPTION 120.8 0 DATE: SUMACE . 122.9 6. A 8W: SANDY LOAM 121.6 I8 1OYR5/6 12" C: VERY STONEY SANDY LOAM 33"V4rl 2.5Y514 _ g" 11.48 j/// WEEP. 060" 120.9 75 /./ STANDING WATER075 " PERC TEST NO. 21-1 DATE: 7/ 122 SOAK: 1:49 12" 2:05 30" 119.5 9" 2:17 6" 2:38 51"11775.PERC.RAT£: 7 MI PERC TEST N0. 21-2 DATE: 7/ 121 SOAK. 10:54 12" 11:09 33"V4rl 8.25 g" 11.48 6" 12:52 REQUIRES OVERP PERC TEST N0. 21-3 DA TE: 6/ 00.0 121.75 SOAK: 1:05 48" 117.75. 12". 9" 1:20 1:55 6" 3:20 66' 116.25 REQUIRES OVER, LARGE BOULDER JUST BELOW PERC TEST N0. 21-2A DATE: 91 121.75 SOAK. 1:06 " 12' 1:21 41 118.33 9" 1:32 6" 1:49 57" 117 PERC RATE: 6 1 PERC TEST N0. 98-21— DATE: 3i 111.75 SOAK: 12:2 12' 12:4 36' 118.33 9" 1:05 6" 1:33 18" 117 PERC RATE: 10 /+H rvv.: yr vcuKvvm� g . DESIGN FLOW 440 GAL/DAY ' . PERC RAVE USED 20 MIN IN SOIL CLASS CLASS ll. LOADINGRATE 0.53 GPD/Sr GALLERY PERIMETER 112FT GALLERY SIDEWALL 2.0 FT SIDEWALL AREA 224 SF 95 BOTTOM AREA 640 SF LEACH AREA PROVIDED 864. SF SEPTIC TANK . USED 1500 GAL... 7 CALCULATIONS . LEACHING. CAPACITY = 864 S.F. ' x 0.53 GAL/S.F.. _. 458 GAL/DAY 95 SEPTIC. TANK, CAPACITY REQUIRED 440 GPD. x 2009' = 880. GALLONS SOAK X96 /+H 7 3 y.'tr.itS j YENVN - all wyawV, c L u1 h -` r(#' R4s S47 rpt' > T� r it 3t 4 r yt !t• 'C t `� a ^' INV 7MAG too": all ISAT {{{ ' a d iyy�:+v. ' ,� j1f Y :,y..,L._. '_,•,y� t L.r.L •+ f L 2 jv MI Towey of North Andover '120 Main Street North Andover, MA 01845 (978) 688-9550 PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 OFFICE HOURS Monday to Friday 8:30am to 4:30pm Billing Information: (978)688-9550 PAYMENT ON OR BEFORE 08/1612010 •- 08/16/2010 I $211.47 MI. 4t'....F,..i'��C�sOVtl�,mr.:� 3170518 07/1512010 E_R1it2010TEE6603108/201 M v al Reading Information: W , ,_ S`Et ;UiCE` itITS"; _ ri (978)6W9570 33 BEAVER BROOK ROAD RETAIN THIS PORTION FOR YOUR -RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NS OF Current Type Date DAYS 45430607 1,744 Actual 06/07/2010 43 91 SERIAL # READINGS USAGE NB OF Previous Type Date DAYS 45430607 1,701 Actual 03/08/2010 17 88 45430607 1,684 Actual 12/10/2009 17 91 PREVIOUS BALANCE $72.42 PAYMENTS THROUGH 07/1.5/2010 ($72.42) ADJUSTMENTS THROUGH 07/15/2010 $0.00 INTEREST AS OF 08/16/2010 $0.00 BALANCE FORWARD $0.60 CURRENT BILL DETAIL USAGE/UNIT AMOUNT WATER USAGE 43 $203.65 ADMINISTRATIVE FEE $7.82 Sub -Total TOTAL $211.47 NOTE ` PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE:. FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 BYPASS METER WATER RATE: ALL UNITS @.$5.55 Please return this portion with your payment by 0811612010 Town of North Andover 120 Main Street 414890 North Andover, MA 01845 11111111111111111101111(978) 688-9550 . Z01659-000001 If your address has changed, correct it below. PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 Any amount which is not paid by due date will be subject to interest charges of 14°x, Per Year Billing Information: OFFICE HOURS (978)688-9550 Reading Information: Monday to Friday (978) 688-9570 8:30am to 4:30pm Pte' �� 2:x:a93e�1'''r 3170518 07/1512010 33 BEAVER BROOK ROAD PLEASE PAY ON OR BEFORE 09/16/2010 I $211.47 AMOUNT 1 00004148902010000000000000031705180403170518000000021147004 A ` ' Town of North Andover - 120 Main Street North Andover, MA 01845 (978)688-9550 PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 OFFICE HOURS ON OR BEFORE 05/14/2010 MA Monday to Friday 8:30am to 4:30pm �0 'a0t 3170518 4`0421 Billing Information: SER\ff)Gw , . ffl7aEA. A7,E a„� (978) 688-9550 112/10/2009-03/08/20101..._05/14/2010 Reading Information: u (978) 668-9570 33 BEAVER BROOK ROAD RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NB OF Current Type Date DAYS 45430607 1,701 Actual 03/08/2010 17 88 PREVIOUS BALANCE $72.42 PAYMENTS THROUGH 04/14/2010 ($72.42) ADJUSTMENTS THROUGH 04/14/2010 $0.00 INTEREST AS OF 05/14/2010 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGE/UNIT AMOUNT WATER USAGE 17 $64.60 ADMINISTRATIVE FEE $7.82 SERIAL li READINGS USAGE NB OF\�v Previous Type Date DAYS \ Sub -Total $72.42 45430607 1.684 Actual 12/10/2009 17 91 f� 45430607 1,667 Actual 09/10/2009 48. 97 TOTAL r \� C, MESSAGES * NOTE * PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 BYPASS METER WATER RATE: ALL UNITS @ $5.55 Please return this portion with your payment by 0511412010 Town of North Andover 120 Main Street 414890 North Andover, MA 01845 1111111 I�III VIII VIII 11111111111111 IN (978) 688-9550 Z01664400001 If your address has changed, correct it below. PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 Any amount which is not paid by due date will be subject to interest charges of 14% Per Year Billing Information: OFFICE HOURS (978)688-9550 Reading Information: Monday to Friday (978) 688-9570 8:30am to 4:30pm 010 PLEASE PAY ON OR BEFORE 05/14/2010 AMOUNT PAID 00004148902010000000000000031?051804031?051800000000?242004 RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NB OF f Current Type Date DAYS 45430607 1,684 Actual 12/10/2009 17 91 I SERIAL # READINGS USAGE NB OF Previous Type Date DAYS 45430607 1,667 Actual 09/10/2009 48 97 45430607 1,619 Actual 06105/2009 21 85 MESSAGES PAYMENT ON OR BEFORE Town of North Andover OFFICE HOURS 120 Main Street North Andover, MA 01845 Monday to Friday Y Y (978) 688-9550 8:30am to 4:30pm 1• 1 11' 1 11 Billing Information: PESSINIS, DIANE (978)688-9550 33 BEAVER BROOK ROAD Reading Information: NORTH ANDOVER, MA (978) 688-9570 01845 RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NB OF f Current Type Date DAYS 45430607 1,684 Actual 12/10/2009 17 91 I SERIAL # READINGS USAGE NB OF Previous Type Date DAYS 45430607 1,667 Actual 09/10/2009 48 97 45430607 1,619 Actual 06105/2009 21 85 MESSAGES PAYMENT ON OR BEFORE 1 1 1 1 1 1 1 1• 1 11' 1 11 02/11/2010 'aloe ;gym BROOK33 BEAVER ROAD PREVIOUS BALANCE $236.91 PAYMENTS THROUGH 01/12/2010 ($236.91) ADJUSTMENTS THROUGH 01/12/2010 $0.00 INTEREST AS OF 02/11/2010 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGE/UNIT AMOUNT WATER USAGE 17 $64.60 ADMINISTRATIVE FEE $7.82 �0 Sub -Total $72.42 TOTAL , NOTE " PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 BYPASS METER WATER RATE: ALL UNITS @ $5.55 Please return this portion with your payment by 0211112010 Town of North Andover -.' 120 Main Street 414890 North Andover, MA 01845 i lillll 11111 11111 11111 11111 llili 1111 1111 (978) 688-9550 Z01661-000001 If your address has changed, correct it below. PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 Any amount which is not paid by due date will be subject to interest charges of 14% Per Year Billing Information: (978) 688-9550 Reading Information (978) 688-9570 OFFICE HOURS Monday to Friday 8:30am to 4:30pm 6 `max ` =10-1 N ="r r E(4_Is. 1 II 11 1 - 3g p 77t R 17 - BROOK ROAD PLEASE PAY ON OR BEFORE 02/11/2010 AMOUNT PAID 00004148902010000000000000031705180403170518000000007242004 Town of North Andover T20 Main Street North Andover, MA 01845 (978)688-9550 PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 OFFICE HOURS PAYMENT ON OR BEFORE 12/07/2009 .91 $236_ Monday to Friday Current Type 8:30am to 4:30pm.wN' s�' .:ft�f��� � DAYS 3170518 10/15/2009 Billing Information: r EFfG a "' req 2i-'E�t1E (978) 658-9550 06/05/2009-09/1012009 12/07/2009 Reading Information: _ QRE1354 - (978) 688-9570 33 BEAVER BROOK ROAD RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NB OF Current Type Date DAYS 45430607 1,667 Actual 09/10/2009 48 97 SERIAL # READINGS USAGE NB OF Previous Type Date DAYS 45430607 1,619 .Actual 06/05/2009 21 85 45430607 1,598 Actual 03/12/2009 15 97 MESSAGES PREVIOUS BALANCE $80.58 PAYMENTS THROUGH 10/15/2009 ($80.58) ADJUSTMENTS THROUGH 10/15/2009 $0.00 INTEREST AS OF 12/07/2009 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGE/UNIT AMOUNT WATER USAGE ADMINISTRATIVE FEE I' Sub -Total TOTAL IV 48 $229.09 $7.82 $0.00 $0.00 $0.00 $236.91 * NOTE * PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 3YPASS METER WATER RATE: ALL UNITS @ $5.55 Please return this portion with your payment by 12/07/2009 Town of North Andover 120 Main Street 414890 North Andover, (98) 88-9550 MA 01845 ������ 11111111111111111111111111111 IN 000001-001851 If your address has changed, correct it below. PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 Any amount which is not paid- bj due'dafe wilf b& ---------- subject ---------subject to interest charges of 14% Per Year Billing Information: OFFICE HOURS (978)688-9550 Reading Information: Monday to Friday (978) 688-9570 8:30am to 4:30pm 3170518 10/15/2009 i 33 BEAVER BROOK ROAD PLEASE PAY ON OR BEFORE 12/07/2009 $236.91 AMOUNT PAID MEN MIMINJ 00004148902010000000000000031705180403170518000000023691006 OF NSR Town of North Andover "12 ' Main Street w ` . • .. (978) 688-9550 PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 OFFICE HOURS- PAYMENT ON OR = • Monday to Friday 08/19/2009 $80.58 8:30am to 4:30pm�f4eca _ A . AT .UN 3170518 07/20/2009 Billing Information:EX11CpATES�>:DUED , E (978) 688-9550 0311212009-06/05/2009 08/19/2009 ReadingInformation -• SER[G1A�bRESS .- (978) 688-9570 33 BEAVER BROOK ROAD RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # Current 45430607 1,619 SERIAL # Previous 45430607 1,598 45430607 1,583 MESSAGES PREVIOUS BALANCE $58.67 PAYMENTS THROUGH 07/20/2009 ($58.67) ADJUSTMENTS THROUGH 07/20/2009 $0.00 INTEREST AS.OF 08/19/2009 $0.00 BALANCE FORWARD $0.00 READINGS USAGE NB OF I I CURRENT BILL DETAIL USAGE/UNIT AMOUNT Type Date DA' Actual 06/05/2009 21 85 READINGS Type Date Actual 03/12/2009 Actual 12/05/2008 USAGE 15 15 NB OF DAYS 97 87 WATER USAGE ADMINISTRATIVE FEE /�A O � c�\ Sub -Total TOTAL 21 $72.76 $7.82 $0.00 $0.00 $0.00 $80.58 NOTE * PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.39 OVER 20 UNITS @ $4.96 SEWER RATE: FIRST 20 UNITS @ $4.96 OVER 20 UNITS @ $7.07 BYPASS METER WATER RATE: ALL UNITS @ $4.96 Please return this portion with your payment by 08/19/2009 Town of North Andover 120 Main Street 414890 North Andover, MA 01845 (978) 688-9550 000001-001853 If your address has changed, correct it below. PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 Any amount which is not paid by due date will be subject to interest charges of 14% Per Year Billing Information: OFFICE HOURS (978) 688-9550 Reading Information: Monday to Friday (978) 688-9570 8:30am to 4:30pm 10 I_ 3170518 07120/2009 33 BEAVER BROOK ROAD PLEASE PAY ON OR BEFORE 08/19/2009 $80.58 AMOUNT 00004148902009000000000000031705180403170518000000008058008 PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 OFFICE HOURS PAYMENT ON • - BEFORE (978)688-9550 05/29/2009 $58.67 Monday to Friday 8:30am to 4:30pm x."i'^� .%i •` a O�N.7" �,s�iN _ f�[G�3As • � r ;r� s 8:30am to 4:30pm cc 9. IN- "t C►N' ml� 33 BEAVER BROOK ROAD 3170518 04/29/2009 Billing Information: :SERV C.- µ7{i- 'T fl4 -ESD (978) 688-9550 112/05/2008-03/12/20091 05/29/2009 Reading Information:' ERa f.s'tDfR �. (978) 688-9570 33 BEAVER BROOK ROAD RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NS OF Current Type Date DAYS 45430607 1,598 Actual 03/12/2009 15 97 SERIAL # READINGS Previous Type Date 45430607 1,583 Actual 12/05/2008 45430607 1,568 Actual 09/09/2008 MESSAGES PREVIOUS BALANCE $58.67 PAYMENTS THROUGH 04/29/2009 ($58.67) ADJUSTMENTS THROUGH 04/29/2009 $0.00 INTEREST.AS OF 05/29/2009 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGE/UNIT AMOUNT WATER USAGE ADMINISTRATIVE FEE USAGE NB OF DAYS 15 87 Sub -Total 50 96 TOTAL 15 $50.85 $7.82 $0.00 $0.00 $0.00 $58.67 * NOTE * PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR SY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.39 OVER 20 UNITS @ $4.96 1 OCA O SEWER RATE: FIRST 20 UNITS @ $4.96 OVER 20 UNITS @ $7.07 BYPASS METER WATER RATE: ALL UNITS @ $4.96 �\ Please return this portion with your payment by 0512912009 Town of North Andover 120 Main Street 414890 North ANdover, (9 8) 68-9550 MA 01845 i 1111111111111111111111111111111 ill/ ill/ 000001-001857 If your address has changed, correct it below. PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 Any amount which is not paid by due date will be subject to interest charges of 14% Per Year Billing Information: OFFICE HOURS (978)688-9550 Reading Information: Monday to Friday (978) 688.9570 8:30am to 4:30pm x."i'^� .%i •` a O�N.7" �,s�iN _ f�[G�3As • � r ;r� s 3170518 04/29/2009 33 BEAVER BROOK ROAD PLEASE PAY ON OR BEFORE 05/29/2009 $58.67 AMOUNT.. 00004148902009000000000000000000000403170518000000005867008 IvIHnC Y 85JlultN I, 1 U - �i..t'P".ri' ubl Y "P F �tar+:rix 02/19/09 Billing Reading Information Information (978)688-9550 TOWN OF NORTH ANDOVER Information .. 120 MAIN STREET (978)688-9570 * 4 NORTH ANDOVER MA 01845 Reading Information 978-688-9550 (978)688-9570 sS�Fctu�� OFFICE HOURS IN IIII Mon to Fri. 8:30am to 4:30prri RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL 978-688-9570 W ADVANCE PESSII`IIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 r z Bali:, dtn zi5±a•� {,��'�i�eadixr�,,�v, t',��'4.�� i �3�tq�'z � +uM`is^�z_ ��v$.r^�• 'q-,i��fs;�Rlz :?a}:r+,'mL47.vi�.a�1x�5.s�.P�'�Lat.,xL'�'Yro �b'.`��-�,.; +o- .a•3 -,.s tt?�Y �F :�., ��bv? .-�•..: Z.3�, cam'.'-� WATER USAGE ,x9;0a 12/5/08 1568 1583 15 Actual 87 MESSAGE ON OR BEFORE 02/19/09 , $58.67 .49 3170518-414890 1/20/2009 Nf Y3.' s'•5'� T sY - P - �i..t'P".ri' ubl Y "P F 10/1/2008 -12/31/2008 02/19/09 ?g .` 33 BEAVER BROOK ROAD 7J?tE�N[�I. E$It33,:s'� afi Previous Balance 222.69 Payments Through 01/20/2009 (222.69) Adjustments / Late Charges - Interest as of 2/19/2009 - Balance Forward - WATER ADMIN FEE 15 50.85 7.82 Sub -Total 58.67 Total PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 Water rate: First 20 units@ $3.39 Over 20 units @ $4.96 Sewer rate: First 20 units ® $4.96 Over 20 units ® $7.07 Bypass Meter Water rate: all units @ $4.96 MA iQ : T$01W OF NORTH ANDOVER PLEASE RETURN THIS PORTION WITH PAY1VMEN T S Billing } 4 120 MAIN STREET NORTH ANDOVER MA 01845 Reading Information Information (978)688-9550 .;'., (978)688-9570 . 978-688-9550 "`+wP 414890 y�SACt4USF'� 11111111111111111111 IN IIII 1 r,11,1?+r�.�m iY��F y.:N,, ,•c� w �R+;r r <x k#�� �x ,. ..«,....�....-,....rv,rs;.K,l�aar.>iS},jxi�%�'w.S;:Fd�.. i.`}iL„_.. 'a�"r.r &`E .v 5,�.s::t Yr�....��•,�d��?.EO.}s ., STYi �s z> ����C�.`�:. 33 BEAVER BROOK ROAD 3170518414890 =BEFORE PESSINIS, DIANE 2/19/09 , $58.67 33 BEAVER BROOK ROAD NORTH ANDOVER, MA AMOUNT PAID 01845 859 1,387 1,390 00004148902009000000000000000000000403170518000000005867008 MAKE PAYMENTS TO 820 Billing 31705181414890 Information TOWN OF NORTH ANDOVER (978)688-9570 120 MAIN STREET NORTH ANDOVER MA 01845 Reading Information (978)688-9570 018-688-9550 OFFICE HOURS Mon to Fri. 8:30am to 4:30pm RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL 978-688-9570 IN ADVANCE PESSINIS, DIANE 33 BEAVER BROOK ROAD NORTH ANDOVER, MA 01845 WATER USAGE 6.1,51,011 919/08 1518 1568 50 Actual 96 MESSAGE ON OR :$222.6]9 11/10/08 NO - BEFORE 7/1/2008 - 9/30/2008 11/10108 33 BEAVER BROOK ROAD Previous Balance 12J.50 Payments Through 10/10/2008 (123.86) Adjustments / Late Charges interest as of 11/10/2008 Balance Forward WATER 50 214.87 ADMIN FEE 7.82 Sub -Total 222.69 Total PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 Water rate: First 20 units@ $3.39 Over 20 units $4.96 Sewer rate: First 20 units @ $4.96 Over 20 units 3 $7.07 Bypass Meter Water rate: all units @ $4.96 3 a VIA " N A OR 07,WTAX, IM ztwhk�. 31705181414890 10/10/2008 7/1/2008 - 9/30/2008 11/10108 33 BEAVER BROOK ROAD Previous Balance 12J.50 Payments Through 10/10/2008 (123.86) Adjustments / Late Charges interest as of 11/10/2008 Balance Forward WATER 50 214.87 ADMIN FEE 7.82 Sub -Total 222.69 Total PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 Water rate: First 20 units@ $3.39 Over 20 units $4.96 Sewer rate: First 20 units @ $4.96 Over 20 units 3 $7.07 Bypass Meter Water rate: all units @ $4.96 3 a VIA " N A OR 07,WTAX, IM ztwhk�. General Maintenance Recommendations Proper maintenance of your septic system can help prevent premature failure of your soil absorption system. RAGGS, INC. recommends the following: 4 DO PUMP your system on a regular basis, preferably ANNUALLY for most households. Larger systems, such as those serving multi -family locations or commerical properties, may require more frequent pumping. The purpose of pumping is to remove solid material and scum material from the tank. This will help prevent unwanted material floating out to the leaching facility. 4 DO OPEN your D -Box every THREE TO FOUR YEARS. This is a good way to spot little problems before they grow into bigger ones. 4 DO ensure that your VENT PIPES are INSTALLED properly. Vent pipes are used to allow oxygen into the system, thereby allowing bacteria to breathe and grow. 4 DO make sure you know WHERE your TANK is LOCATED. Check the covers to make sure that they are not deteriorating and causing a potential hazard. 4 DO make sure you know WHERE your LEACHING FIELD is LOCATED. If the field ever goes into failure and "break out", it would be necessary to isolate the area for health protection. 4 DO look for GREEN STRIPES over leaching field. If you see this, it is indicative a field starting to back-up. Act immediately when you see this warning sign. 4 DO check to determine if you can smell any ODORS from field location. Odors can indicate that the leaching facility is having a problem. 4 DO raise the tank COVERS up to WITHIN 6" OF GRADE. 4 DO USE LIQUID DETERGENTS and USE SMALL AMOUNTS OF BLEACH when cleaning toilets, etc.. 4 DO USE NON-ABRASIVE HOUSEHOLD CLEANING PRODUCTS. RAGGS SEPTIC SERVICE, INC. d.b.a. E.A. COMEAU SEPTIC P.O. Box 1027 Concord, Massachusetts 01742 (978) 369.1100 (800) 287-5541 FAX (978) 897.3848 website: http://www.raggsinc-com e-mail: info@raggsinc.com �LIv1EA =i 4 DO USE ENVIRONMENTALLY SAFE PRODUCTS. 4 DO INSTALL WATER SAVING DEVICES, where appropriate. 4 DO AVOID having roof gutters and downspouts DRAIN ONTO the LEACHING FIELD. THE DON'TS 4 DON'T DISPOSE any. NON -BIODEGRADABLE MATTER IN TOILETS. Foreign items can cause blockages in the lines and back-ups. (i.e.: cigarettes, sanitary napkins, diapers) 4 DON'T wash paint brushes used in latex or oil PAINT. Paint residues are not broken down by a leaching system. In fact, they will travel out to the leaching facility and impede its ability to function. 4 DON'T allow any PAINT, THINNERS, OR ANY OTHER TOXIC OR CAUSTIC LIQUIDS, to go down sink or toilets. 4 DON'T allow ANY GREASE or FAT to enter system. Residential sites do not have grease traps. Therefore, if grease is allowed into the system it will congeal and travel out to the leaching facility leading to damage. 4 DON'T DISPOSE BONES, EGG SHELLS, COFFEE GROUNDS, DENTAL FLOSS, OR FIBROUS MATERIAL, etc. when using a garbage disposal. However, it is recommended that garbage disposals aren't used at all. 4 DON'T use POWDERED DETERGENTS with phosphates. They don't break down and can re -solidify. 4 DON'T use any DRAIN CLEANERS, such as Drano®, LiquidPlumbr®. Call a rooter professional or buy a small rooter snake at the hardware store. Drain cleaners KILL bacteria. Bacteria keeps your system alive. RAGGS SEPTIC SERVICE, INC. d.b.a. E.A. COMEAU SEPTIC P.O. Box 1027 Concord, Massachusetts 01742 (978) 369.1100 (800) 287-5541 FAX (978) 897.3848 website: http://www.raggaine.com e-mail: info@raggsinc.com 4e IfrouSince�G. AGGS,1 (S) THE DON'TS DON'T use any ENZYMES or BACTERIAL ADDITIVES. These products usually have too low a pH to be effective. Often they are sitting on a shelf too long. Normal activity and proper use of a septic system should provide plenty of bacteria naturally. 4 DON'T use any GREASE DISSOLVERS. Degreasers allow grease to flow out of the tank and into your field. 4 DO NOT ADD ANY ADDITIVES TO YOUR SYSTEM FOR ANY REASON. In the event of a clog or other plumbing problem, contact your local plumber, rooter or pumper. 4 DON'T PLANT any trees or shrubs WITHIN 10 FT. OF THE LEACHING FIELD. Root systems can cause damage to the piping in the leaching facility. 4 DON'T ALLOW SPRINKLER SYSTEMS or other WATERING DEVICES OVER the LEACHING FIELD. Doing so will saturate the field, damaging the system's performance. Systems are designed to handle up to a certain quantity of flow. DON'T DRIVE any VEHICLES or place any HEAVY OBJECTS ON TOP of the LEACHING FIELD. Damage to piping could result. DON'T INSTALL a swimming pool, a patio, or a driveway over the tank or leaching field. If installing a swimming pool, ensure that the backwash does not enter the leaching system. Do not obstruct access to the tank otherwise it will be difficult to maintain. DON'T CONNECT a basement SUMP PUMP to a household DRAIN. DON'T ALLOW WATER USAGE to EXCEED the DESIGN FLOW OF YOUR SYSTEM. DON'T ALLOW a WATER SOFTENER TO BE HOOKED UP to a SEPTIC SYSTEM. Check with the local authority to see if an alternative place for the backwash can be used. RAGGS SEPTIC SERVICE, INC. d.b.a. E.A. COMEAU SEPTIC P.O. Bog 1027 Concord, Massachusetts 01742 (978) 369.1100 (800) 287-5541 FAX (978) 897-3848 website: httpd/www.raggaine.com e-mail: infoWaggsinc,com CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830-6318 April 6, 1999 Ms. Sandy Starr North Andover Board of Health 27 Charles Street North Andover MA 01845 Re: Lot 21 A Evergreen Estates Wall Construction Dear Sandy: (978}�U3:Q31O...,.F4X:J-gZBJ 37-2-3960 TOWN OF NORTH ANDOVER/ BOARD OF HEALTH E 9 1 4 The wall required for the septic system grading, on the above referenced lot, has been properly backfilled. With the completion of the backfill the wall has been constructed as required by the approved plan. Al Couillard asks that you conduct the system inspection so that the system can be backfilled. Very /, e Christiansen �� � f �4 � t � � J R.y -L. 1� {T \,� � � �' �� �� , H S .• �'!0 Town of North Andover NORTH OFFICE OF 3�0`�..o '•°�ooc COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street to North Andover, Massachusetts 01845�9ssACNus12 WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 March 1, 1999 RE: Lot 21 A Pheasant Brook Road/Evergreen Estates George Henderson 280 Chandler Road Andover, MA 01810 Dear Mr. Henderson: On December 4, 1998 a Disposal Works Construction Permit was issued to you for the installation of the septic system at Lot 21 Pheasant Brook Road. Prior to installation the concrete retaining wall was to be built, certified by a structural engineer or the design engineer, and inspected by the Board of Health, after which the installation could proceed. Upon review of the file, it has come to my attention that this process was not carried out, and installation of the septic system proceeded, regardless. This is a violation of the terms of agreement discussed prior to issuance of the Construction Permit as well as of 310 CMR 15.255(2)(c &d). There can be no Certificate of Compliance issued by this office until the conditions of certification of the retaining wall and its inspection by Health Department staff have been carried out. In addition, please be aware that these violations jeopardize the continuance of your license to operate as a septic installer in North Andover. Please do not hesitate to call the Health office should you have any questions. Sincerely,`�``''/� A "i Sandra Starr, R.S. Health Administrator Cc: DECM Essex Wm. Scott BOH File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 y C � `C CA n 10 0 CD n z y CD o = CL cm c � � c CL = CO) > Cc O n o ® CD . Q CD CD C) ca w G CD y CL v y = o CD I = D y 1CD Z C") O CD 0 C CD ij 1 n� d ccn cn W co n oo O 0 �xO ra �cy �or- r� w G 0 c r� w G 0 c PLAN REVIEW CHECKLIST ADDRESS�V646466VL-) ENGINEER GENERAL 3 COPIESSTAMPS LOCUS L""' NORTH ARROWy SCALE CONTOURS PROFILE t --(Sc) SECTION BENCHMARK '-� SOIL & PERCS ✓ ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED? -A- DRIVEWAY L --"WATER LINE FDN DRAIN M&P SCH40 TESTS CURRENT? SOIL EVAL T�����SG oo 561-1 C-UY3G. r—o.ep-2,5 SEPTIC TANK �� r0! a��3J Co �� c.Ls)qr6A"TF ZZ/(i) MIN 1500G '-� .17 INVERT DROPL/ GARB. GRINDER_,Llb (2 comps +200) 10' TO FDN +fes MANHOLEk ELEV GW # COMPS. GB D -BOX J o l c CCS ryi Po'Z' (9) / 6 `1 5 r6 A,' &- (LL/)Cl, -1.1197-6Xn r6- ZZ- l C 1J SIZE # LINES FIRST 2' LEVEL STATEMENT OUTLET -/7 ( 2" OR .17 FT) TEE REQ' D?_ LEACHING MIN 440 GPD? �/ RESERVE AREA 4' FROM PRIMARY? �2% SLOPE 100' TO WETLANDS x'100' TO WELLS C/ 4' TO S.H.GW L---' /IN) 20' TO FND & INTRCPTR DRAINS L400' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER BREAKOUT MET? -' TRENCHES MIN 440 gpd SLOPE (min .005 or 6"/1001) SIDEWALL DIST. 3X EFF. W OR D (MIN 6') RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? VENT? (>3' COVER; LINES >501) BOT + SIDE = X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright 0 1996 by S.L. Starr _ ,. _ z � - ., � �, �� .. ., � , _ ,. _ z � - ., � �, I TS MIN 440 LEACHING MIN 1 (13'x16') PIT MANHOLE/PIT GW MIN 4' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x ##) (2x(L+W)xD x ##) (G/ft2) CHAMBERS 0/1, 13GG�5s /v1 i�NNo�G' S�IG� MIN 440 LEACHING t� GW MIN 4" BELOW `� COVER >3 FT - VENT MANHOLES 12"-48" STONE t--' SPLASH PADS SLOPE .005 BED/TRENCCH_L---j Bed max. 60' X 601) MIN 13' X 16' PIT C ---- BOT CO 7z/ + SIDE as¢ X LOAD= TOTAL *V (L x W x ##) (2 x (L+W)xD x ##) (G/ft2) FIELD MIN 440 GPD 900 ft2 BED GW MIN 4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 4" PEA STONE? DIST LINE SLOPE .005? >3'COVER-VENT SCH 40 MIN 12" COVER RATE ( X ) X = TOTAL L W LDG DOSING TANKS AND PUMPS DIMENSIONS X X - PUMP CAPACITY 9Pm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME 9Pm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH ENUF STORAGE? TDH WEIGHTED? Copyright ® 1996 by S.L. Starr TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 06/23/99 This is to certify that the individual subsurface disposal system constructed ( X ) or repaired ( ) by George Henderson at Lot 21A Evergreen Estate has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # 1028 dated 12/04/98. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Ile Board of Health Inspector TCAA JUN 1 71999 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System Y constructed; ( ) repaired; by C7 _<,Z -- located at /-,) i r4 - was was installed in conformance with the North Andover Board of Health approved plan, System Design Permit #/y 2 Y dated y — f with an approved design flow of AW gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: ` Eng" r Representative Final inspection date: AZ/57 4 .-ei & /I/ /3 Engineer Representative Installer Design Date: Date: Sent by:6 APP -07-99 12:47 from 9783723968 588 688 9542 Page 2r 2 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830.61318, (978) 373-0310 FAX: (978) 372.3960 April 6, 1999 Ms. Sandy Starr North Andover Board of Health 27 Charles Street North Andover MA 01945 Re:. Lot 21,A Evergreen Estates Wall Construction Dear Sandy: The wall required for the septic system grading, on the above referenced lot, has been properly backfilled. With the completion of the backfill the wall has been constructed as required by the approved plan. Al Couillard asks that you conduct the system inspection so that the system can be backfilled. Vea y JA Christiansen QER Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 9A - Enforcement Order Massachusetts Wetlands Protection Act M.G. L. c. 131, §40 Violation Information This Enforcement Order is issued by: LAr,44,1-q<j_o vCg- Conwvatlon Commission (Issuing Authority) To: AlCo��i II��c� . CCal 1r)C',. Name of Violator J Location of Violation: 6e6weio� 1fSrwk Poll C, Srred Add s /y Di1 I�ndI,yyk c:ryffeWn ivl � Assessors Map1Plat.d Parceb'Loi,t Date of Issuance: 0/ `I Date Findings The Issuing Authority has determined that the activity described above is in violation of the Wetlands Protection Act (M.G.L. c. 131, §40) and its regulations (310 CMR 10.00), because: ❑ the activity has been/is being conducted without a valid Order of Conditions. Vthe activity has beerVis being conducted in violation of the Order of Conditions issued to: i - Name - r%_i�_ lL Dated File Number � r12 q � �5 Condition numbe-(s) DEP File Number / aya- a for DEP use only and North Andover Wetland Protection Bylaw. � Extent and type of activity: r 4ade S�vCK0IIle- i A-tiLi ❑ Other (specify): n..,..., ,rn Massachusetis Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 9A - Enforcement Order and North Andover Wetland Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Protection Bylaw. 13 Order / The Issuing Authority hereby orders the following (check all The property owner shall take the following action to that apply): prevent further violations of the Act: 0_11d l iJ u "S6mit 4�l�c�QfiOh lccr'L f—Ca-�d+fico C—_ The property owner, his agents, permittees, and all 3 U others shall immediately cease and desist from the further U G n I activity affecting the Buffer Zone and/or wetland resource th rt LUI�hfVt� �xC2 77c�Y1 � � S areas on is grope y. ���, s-i�cK.o, le hum rI �1' h�SU n Erdm ❑ Wetland a tera' (ting said activity shall be C 0 tri r t,) i ia4p - corrected and the site returned to its original condition. vr�1. � I cell fD MG� ❑ Complete the attached Notice of Intent. The completed application and plans for all proposed work as required by the Act and regulations shall be filed with the Issuing Authority on or before (date). No further work shall be performed until a public hearing has been held and an Order of Conditions has been issued to regulate said work. Appeals/Signatures An Enforcement Order issued by a conservation commission cannot be appealed to the Department of Environmental Protection, but may be filed in Superior Court. Failure to comply with this Order may constitute grounds for additional legal action. Massachusetts General Laws Chapter 131, Section 40 provides: "Whoever violates any provisions of this section shall be punished by a fine of not more than twenty-five thousand dollars or by imprisonment for not more than two years or both. Each day or portion thereof of continuing violation shall constitute a separate offense." Signatures: / J Questions regarding this Enforcement Order should be directed t i A he UL Name 3 //_�- once Numou i1 HourJDays kvadab(1tj Issued by ! V o r--bk 6 nd ,,-- Conservation Commission In a situation requiring immediate action, an Enforcement Order may be signed by a single member or agent of the commission and ratified by a majority of the members at the next scheduled meeting of the commission. f'�(,�j 1(oC/ �C)C Signature of delivery person or cc, tr6ed mail number n...... n,.r" TOWN OF NORTH ANDOVER NOTICE OF VIOLATION OF WETLAND BYLAW DATE OF TRI ICE 1 ' NAME OF OPN[) jj I ADDRESS OF OFFENDER Zn C, 'qfS DATE OF BIRTH OF OFFENDER CIiTSATE. ZIP CODE / /� �� aMPERATOR UCENSE NUMBER MV M8 REGISTRATION NUMBER OFFtN C O rJ e41 —moi �e(t1-7c 0 h� I�Codzu`� N doVfit E AND GATE F VIOLAT10W ON LOCATION OF VIOLATI N AT a ail r E RCING DEPARTMENT iSIGN FE NFORCING PERSO I HEREBY ACKNOWLEDGE RECEIPT OF THE FOREGOING CITATION X (-] able to obtain signature of offender. Date Mailed G Citation mailed to offender dYA ►rLLreh U u4 ryiA4 1 THE FINE FOR THIS NON -CRIMINAL OFFENSE IS $ IOD D YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO j DISPOSITION OF THIS MATTER. (1) You may elect to pay the above fine, either by appearing in person between 8:30 A.M. and 4:30 P.M., Monday through Friday, legal holidays excepted, before: The Conservation Office, Town Hall, 27 Charles St., North Andover, MA 01845 OR by mailing a check, money order or postal note to the Conservation Office WITHIN TWENTY-ONE (21) DAYS OF THE DATE OF THIS NOTICE. This will operate as a final disposition of the matter, with no resulting criminal record. (2) If you desire to contest this matter in a non -criminal proceeding, you may do so by making a written request, and enclosing a copy of this citation WITHIN TWENTY-ONE (21) DAYS OF THE DATE OF THIS NOTICE TO: The Clerk -Magistrate, Lawrence District Court 380 Common St., Lawrence, MA 01840 ATTN: 21 D non -criminal (3) If you fail to pay the above fine or to appear as specified, a criminal complaint may be issued against you. 0 A. I HEREBY ELECT the first option above, confess to the offense charged, and enclose payment in the amount of $ B. I HEREBY REQUEST a non -criminal hearing on this matter. i Signature WHITE: OPiNK POLI ECOPY COPYYELLOW: CONSERVATION COPY GOLD: COURT COPY rtti AS -BUILT CHECKLIST L --'' LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER t/ LOT LINES & LOCATION OF DWELLINGS LOCATION & DIMENSIONS OF SYSTEM; INCLUDINGIESERVE TIES TO OTT LINES` & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS —'' ELEVATIONS OF DISPOSAL SYSTEM y' TOP OF FDN ELEVATION LOCATIONS OF WELLSDRAINS WATERCOURSES WAN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE 1OF DISTANCES FROM CORNERS OF HOUSE TO CENTER TANK & D -BOX STAMP & SIGNATURE IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW FINAL CONTOURS v� LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN 1141e-? �, — No f-N(s ®,6o--Z3O/ A / a. -O -/C/ � �GL-- - Town of North Andover NORTH OFFICE OF Of 1 i� y`4 6'6 4" L COMMUNITY DEVELOPMENT AND SERVICES ° A 27 Charles Street : �o North Andover, Massachusetts 01845�y 0*ATE0'•P ty WILLIAM J. SCOTT SSACHUS� Director (978)688-9531 Fax(978)688-9542 Dec 10, 1998 Christiansen & Sergi, Inc. 160 Summer St Haverhill, MA 01830 Re: 21 Pheasant Brook Road Dear Mr. Christiansen: This is to inform you that the proposed plans for the site referenced above have been approved conditional upon the approval of the bottom of bed inspection. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, RS. Health Administrator SS/eoh cc: Mr. Couillard File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WMLIAM J. SCOTT Director October 6, 1998 Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 Re: 2 1 A Evergreen Dear Phil: 30 School Street North Andover, Massachusetts 01845 This is to inform you that the proposed plans for the site referenced above have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, 7)Sandr" a Stan, R.S. Health Administrator SS/cjp I BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ll CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830-6318 t� (978) 373-0310 FAX: (978) 372-3960 July 24, 1998 Ms. Sandy Starr, R.S. Health Administrator North Andover Board of Health 30 School St. N. Andover, MA. 01845 Re: lot 21 A Evergreen Estates Dear Ms. Starr: We are in receipt of your letter dated July 21, 1998. Please find enclosed a revised plan which includes: 1. Foundation perimeter drain 2. Manhole at septic tank 3. 20" manholes specified at chambers 4. Soil compaction and 6" stone specified beneath septic tank and D- box 5. Septic tank and D -box specified as watertight 6. Addition of retaining wall detail to sheet 1 Also find enclosed requested soil evaluation forms. Should you have any further questions in the above matter, we are available at your convenience and can be reached by phone at, 978-373-0310. Sincerely, Philip G. Christiansen, P.E. PGC/epw cc: File Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 30 School Street WILLIAM J. SCO17 North :-kndover, Massachusetts 0 1845 Direelor July 21, 1998 have been ►CMR h Office at the BOARD, -9540 PLANNING 688-9535 Town of North Andover, Massachusetts Form No, z MORTq BOARD OF HEALTH C'tau I1ti0 � 3:._.. ..., , 19 -.LO - 1 L H � t i i DESIGN APPROVAL FOR SACHUS SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant n • E - (�, • M . ESS -e-* _ OC . Test No. <:�� Site Location 1 -11,�4 4jj=9Jln i Reference Plans and Specs - ENGINEER ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee Lp 0 - CHAIRMAN, BOARD OF HEALTH Site System Permit No. /U o g� , x k,` FORM .0 - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT 21Z COC4121,(,frez PHONE_3'2> LOCATION: Assessors Map.Number PARCEL SUBDIVISION ee ki _ LOT (S)/_ T 2l 13 STREET P��r %�^pn �l ST. NUMBER ***""'"OFFICIAL USE ONLY*************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER a4 I COMMENTS DATE APPROVED DATE REJECTED- INSPECTOR-HEALTH EJECTED_ FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED IN PECTOR-HEALTH COMMENT DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 AIK .. _..�:�. Date: � � � °► ��G� No. Commonwealth of Massachusetts nl o,z.T U rq rFou u v C , Massachusetts •1_Z�r_.... A clovcrtnP.nt for On-site Sewa a is osal ��� ���.`1r.-.�7Gvn:S....................... Date: ................. Performed By:.......................s . d g : sc�,-�d �.:..:..:. :Y..u.....ffN� �'�.....�v�a-rte.. �.F...H �"...i.. ........................... witnessed y owrer'+Nam. M�S51 L u,,n Ad&=$ Of L Q't'r '� Q r2,v01� <� Address. aW � Loc 1 8�v�� Telephom 1 'lam l��-T "� i�.t 13v,c F�2b;�+. vrg z� ew Construction Repair ❑ Office Review ❑ Yes 0 Published Soil Survey Available. No Year Published ftt. �j...... . Publication Scale Drainage Class (I'&" Soil Limitations Surficial Geologic Report Available: No Q Yes /S..r..�*0 Soil Map Unit GrC............. IYl i-b.ce........................... V(gYLG ......5. !..b GS �...U. ................ .%r -o Year Published Publication Scale Unit)....................................................:................................... Geologic Material (Map Landform...................................................................... ................. Flood Insurance Rate Map: year flood boundary No ❑Yes Above 500 y ❑ - - Within 500 year flood boundary No []Yes Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit). Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Belc,.•r Normal ❑ Other References Reviewed: DEP APPROVED FORM - 12107195 s FORM 11 - SOIL EVALUATOR'FORM Page ? of 3 Location Address or Lo( Ivo. On-site Review Deep Hole Number Date: Time: Weather Location (identify on site plan) n �� Land Use IV 00i�5 Siooe (°%1 g-1� `DSurface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE .OG* I Depth from Surtace (Inches) Sod Horizon Soli 'exture Soil Color (USDA) I (Munsell) Soil Mottling I Other (Structure, Stones, Boulders. Consistency, % Gravel) // llo ' � � �S• �- RCS` f r� Cr, MINI IV[ Vr L - --- Parent Material (geologic) T 1'L_L.. C)epthtoBeorock: 7 8'9 Depth to Groundwater: Standing Water in the Hole: ? Weeping from Pit Face: Estimated Seasonal High Ground Water: �J l DEP APPROVED F0101 - 1:107195 FORM 11 - SOIL 'EVALUATOR FORM Parc 3 u('_3 Location Address or Lot Ivo. -21 6 �yn /iCoi2 On-site Review Deep Hole Number Z Date: �;/7/� Time: Location (identify on site plan) Land Use 4000W Slope (%) �'� Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Possible Wet Area feet Drinking Water Well feet Drainage way feet Property Line feet Other DEEP OBSERVATION HOLE _OG* Weather Deoth from I Soil Horizon I Soli Texture i Soil Color I Soil Other Surtace (Inches) (StructureSton es) (USDA) (Munsell) Mottling , es, Boulders. Consistency, /o Gravel) I miiVlmUm Ur L r1ULCJ Mr-UU Ir1CU h I CV Cn T rr%UrUJCU UIorUJHL AMCH Parent Material (geologic) DepthroSedrock: 7,S Deoth to Groundwater: Standing Water in the Hole: /) O /20. _ Weeping from Pit Face: Estimated Seasonal High Ground Water: 1qq i1 DEP APPROVED FORM - I2107195 2- 2 'Z miiVlmUm Ur L r1ULCJ Mr-UU Ir1CU h I CV Cn T rr%UrUJCU UIorUJHL AMCH Parent Material (geologic) DepthroSedrock: 7,S Deoth to Groundwater: Standing Water in the Hole: /) O /20. _ Weeping from Pit Face: Estimated Seasonal High Ground Water: 1qq i1 DEP APPROVED FORM - I2107195 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 2 / �<9'u�r ZrOd k "Zi - Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ................... inches _❑, D th weeping from side of observation hole .............. . inches epth to soil mottles .....:::.:.... inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date ................... Index well level ............... Adjustment factor ................... Adjusted ground water level ........................................... ._........ . -Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout .the area proposed for the -soil absorption system? If not,..what is the depth of naturally occurring pervious material? Certification I certify that on G (date) I have passed the soil evaluator examination approved by the Departent of Environ ental Protection and that the above analysis was performed by me consist t wit quired training, expertise and experience described in 310 CMR X15.0 Signature DEP APPROVED FORM - 12/07/95 to �Z:L�z 4 FORM L- PERCOLATION TEST Location Address or Lot No. l 6, AP fid COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test" Date: 7�1��/5. Time: Observation Hole 2-1-1 21-279 Depth of Perc ,. sr 57 Start Pre-soak , End Pre-soak Time at 1.2" Time at 9" j Time at 6" Time (9"-6") Z 1 mn Rate Min./Inch ' Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed [E"" Site Failed [❑ Performed By: P.'x'r � Witnessed By:', SMzly&a S-�"Y • Comments: OV ar OVIED roams • UMM FORM 12 - PERCOLATION TEST. Location Address or Lot No. -21A &VeT_6)C&-,=7k) &-S-77472-5 COMMONWEALTH OF MASSACHUSETTS Noe—,n A-Ajc)ot),F1L , Massachusetts Percolation Test* Date: Observation Hole # 2-1 Depth of Perc Start Pre-soak Via: 5__ End Pre-soak Time at 12" Time at 9" Time at 6" -33 Time (9"-6") Z8, rn;4 Rate Min./inch Minimum of 1 Dercolation test must bo peffformiaG' in both the primary area AND reserve area. Site Passed 2' Site Failed Performed By: -t Witnessed By: z; Fz;, z 17 Comments: )7 ........ .... ... . . . ..... .... DEP APPROVED FORM - 12/07195 FORM.Q. - IAT REZLF ASE FORM. INSTRUCTIONS : This. ' form is used ,.to, verify that all necessary approvals,/permits from Boards and Departments having jurisdiction. have been -obtained-.. This does not relieve, the applicant and/or landowner from compliance with any app icable local- or state law, regulations or requirements. *t<x**�*pi71i"cant.Lills'ou� this. �4CANT I "tC //i�i� ' ° I �G ' Phone 0 -`APPLI . LOCATION: Assessor''s Map Nu.-aber ...,parcel t~Subeivison - Lat(`s)'�+ Streets'. �% St.' Number ****X***O,fficial-UseEonly****`******xx**x <-RECOMMENDATIONS;OF,TOWN ;AGENTS j Date Approved -t Conservation_,Adm nistrator �' Date Rejected, ..'Comments-.� 4 L4_a F,. Date Approved, =Town Planner__ .:.Date. Rejected-' � ti Comments . ,. .- Date Approved Food Inspector_ -Health Date Rej ected. '1- Date Approved `eptic. Inspector_. Health . - Date -R-ejected,- _ 'Comments.x a..w Public. Works .- sewer/mater connections .r -. driveway permit -:F re Department, - 1 .Received by Budding Inspector Date i CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508) 373-0310 FAX: (508) 372-3960 TO»r : C� ^,RtH ANDOVER/ TO: Ms. Sandra Starr9;F F!l.ALTH Board of Health_ North Andover i 2 519% 4 � RE: Septic System Design Plans Date: Attached are plans for Zl �—� x� This design is : a new submittal a revision with the following changes PLAN REVIEW CHECKLIST ADDRESS_. o1/ /JG7A(/( t 6, 6r-1 ENGINEER GENERAL 3 COPIESy STAMP `� LOCUS NORTH ARROW L"" SCALE 6" CONTOURS t/ PROFILE �� SECTION BENCHMARK C-' SOIL & PERCS '� ELEVATIONS WETS. DISCLAIMER WELLS & WETSy/ WATERSHED? A DRIVEWAY �(E1ev) WATER LINE L--' FDN DRAIN--' SCH40 ✓ TESTS CURRENT? SOIL EVAL 1 CA2/6r1,4US&-/y SEPTIC TANK / MIN 150OGy .17 INVERT DROP Z-� GARB. GRINDER_ZfO(2 comps +200) ,q(--25' (/25' TO FDNy MANHOLE ELEV GW # COMPS. / GB c-' D -BOX SIZE # LINES V FIRST 2' LEVEL STATEMENT INLET - OUTLET ( 2" OR .17 FT) TEE REQ' D?1C� 5 ,� 3-, �j-' 1 1 1 7 ry d LEACHING q MIN 660 GPD? ESERVE AREA -f 4' FROM PRIMARY? SLOPE Lam' 100' TO WETLANDS 100' TO WELLSL� 4' TO S.H.GW (5'>2M/IN) 35' TO FND & INTRCPTR DRAINS 1----'400' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY f�MIN 12" COVEk'�ILL? (151) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/1001) SIDEWALL DIST. 3X EFF. W OR D (MIN 6') RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? VENT? (>3' COVER; LINES >501) BOT + SIDE X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright 0 1995 by S.L. Starr PITS MIN 660 LEACHING MIN 1 (13'x16') PIT MANHOLE/PIT GW MIN 4' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT, MANHOLES 12"-48" STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 60') MIN 13' X 16' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS MIN 660 GPD_Z 900 ft2 BED GW MIN 4' BELOW BOTTOM OF FIELD/ PIPE ENDS JOINED? L---4- PEA STONE? DIST LINE SLOPE .005? �-- / >3'COVER-VENT CSCH 40 1 MIN 12" COVER RATE LDG X 660 =4 D X �� T 0 T A L 4 45L G/ft2 REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY 9Pm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME 9Pm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. l' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH ENUF STORAGE? Copyright 0 1995 by S.L. Starr NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: � PERMIT # 7 DATE RECEIVED ao 9 APPLICANT N&-t5-6(51NA Z)&V f MAP PARCEL ADDRESS 4l'- (s"A5;9T fQAJA DA, &lAe6 LOT ## 0'7,/ STREET # ENG. ,2j�S��i9/U5�✓u STREET'���1/��,eGY�.� ENG. ADDRESS /c/o0 501t-l"6�;C -57, (:f PLAN DATE zz/& ?0�; REV. DATE CONDITIONS OF APPROVAL APPROVED REASONS FOR DISAPPROVAL: DISAPPROVED is GESS 77�a,� AI)e I -q) 3a�eo���Ee�oc`Z5ao ;r-1,14.0 90o FT ov 0/-- /910,3) /--i9,a3 i„J �I::�Yc - 7 ��iAv ail`4 Town of North Andover E NORTI� OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street • .o North Andover, Massachusetts 01845 �q_�gAT,D-•PP c° WILLIAM J. SCOTT Director September 23, 1996 Chrisitiansen & Sergi 160 Summer Street Haverhill, MA 01930 Re: Lot 21 Beaver Brook Dear Phil: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Rserve area is less than 20 feet from the foundation. (3 10 CMR 15.211 (1)) & (N.A. 4,18) 2. Groundwater not 4 feet below bottom of system. (3 10 CMR 15.212) & (N.A. 18.03) 3. Leaching field is less than 900 sq. ft. (N.A. 2.14 (1)) 4. Distance from leach area to drain in easement less than 50 feet. (310 CMR 15.211) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R. S., Health Administrator BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 September 19, 1996 North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 21 Beaver Brook Road (Evergreen Estates) Septic System Design Dear Board of Health Members: L (508) 373-0310 FAX: .(508) 372-3960 On behalf of my client, Messina Development Corp., I would like to appear before the Board at the scheduled September 26, 1996 meeting to request variances from the Town of North Andover's Minimum Requirements for the Subsurface Disposal of Sanitary Sewage for a proposed septic system at the above referenced location The variances requested are as follows: 1. North Andover Regulation 2.14.4 Minimum Capacity The variance requested is to allow for the minimum capacity of the disposal system to be reduced from the required 660 gallons per day to the design flow of 440 gallons per day. 2. North Andover Regulation 2.14 Sewage Flow Estimates The variance requested is to allow for the estimated daily flow per bedroom to be reduced from the North Andover requirement of 165 gallons per day to the Title V requirement of 110 gallons per day. Enclosed are three copies of the septic system design for this lot. Please notify me when you have scheduled a hearing to consider this request for variances. f ly Y sChristiansen Town of North Andover, Massachusetts Form No. 2 f 140RTh BOARD OF HEALTH o � F w F t � DESIGN APPROVAL FOR 'ri7 b4rm rr'"�y ssACN°SE` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant �r, j fLo Test No. Site Location (421 ZI Reference Plans and Specs._ l_X S ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. N Fee _1P _ CHAIRMAN, BOARD OF HEALTH Site System Permit No.eG,?- SEPTIC PLAN SUBMITTALS LOCATION: NEW PLANS: ( YES ) $60.00/Plan REVISED PLANS: YES $25.00/Plan DATE: DESIGN ENGINEER: When the submission is all in place, route to the Health Secretary CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508) 373-0310 FAX: (508) 372-3960 T0: Ms. Sandra Starr Board of Health North Andover RE: Septic System Design Plans -' 20 1995 :attached are plans for This design is l/ /a new submittal a revision with the following changes • I No. FORM 11 - SOIL EVALUATOR �eFORM I of 3 Commonwealth of Massachusetts T,, .af4l\(Iub',? Massachusetts Date: � / 111 Cm� �� fi` ......Gj.... _ . �....... Date: Performed By:....... . ' ssed BY: ��d��.:..:..:..�..�....�.F...H��rN.......................... Witne oww's Name. 1"F-S5i1V:q b1gUF-L,0i0--Me-(1r tawioo AddMs a (. o — Al (ab AM G v 1.« r B %1/ I L' (� �o1C 2.� Teiegam / L4. C -.q, 4 7 ��t,f� L'2.�v ia.STG4 N ui2.Tyl w 4NUi ew Construction Repair ❑ Office Review Yes 0 _ Published Soil Survey Available: No ❑ Gr . . ; /5..�.,.���.� Soil Map Unit ����������� Year Published ftj. . t...... _Publication Scale / i� �� rLG' IUNGS ........................... ..0 gYLu4l!!�41..�. Soil Limitations �'.........¢......5................}...U.f�°...................................... Drainage Class lN� Surficial Geologic Report Available: No 2_ Yes ❑ Year Published Publication Scale Unit).......................................................................................................... Geologic Material (Map ........ Landform......................................... ........................................................... Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Belc,.•1 Normal ❑ Other References Reviewed: enDEP APPROVED FORM - 12/07195 FORM 11 - SOIL EVALUATOR FORM Page ? of 3 Location ?address or Lot Ivo. .2-1 &W*9 ie&4-) On-site Review Deep Hole Number al—I Date: �`-� Time: Weather Location (identify on site plan) Land Use IV00 Slope !°%) F^/j 7DSurface Stones TCW Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE _OG' Depth from I Surface !!riches! I Soil Horizon Soil Texture (USDA) I Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) (o 1=SL 3- C r Parent Material (geologic) TIL -Z- De thtoBedrock: r/ Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: O � 1% r/ Estimated Seasonal High Ground Water: `�Jl� DEP APPROVED F0101 . 12/07/95 r FORM 11 - SOIL EVALUATOR FORM Pate 2 of 3 Location ,address or Lot ,vo. --2 Et,y4 206 e On-site Review Deep Hole Number °�7 1 � Z Date: Location (identify on site plan) Land Use 60p6Ds. Slope M Y'6� Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Possible Wet Area feet Drinking Water Well feet Time:. Weather Surface Stones )P(w Drainage way feet Property Line feet Other DEEP OBSERVATION HOLE _OG' Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) S- 2 r 5 ` 2�-7J C s. L. Parent Material (geologic) T/LL DepthtaBedrock: % 7,S Depth to Groundwater: Standing Water in the Hole: X10 /7� Weeping from Pit Face: _ Estimated Seasonal High Ground Water: DEP APPROVED FORM - 12!07/95 T FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 21 zwy k 'a - Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ............. inches ❑ Depth weeping from side of observation hole ................. inches a--1 epth to soil mottles inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date ................... Index well level ................. Adjustment factor Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,.what is the depth of naturally occurring pervious material? Certification I certify that on. /0q (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistgAquired training, expertise and experience described in 310 CMR 15.0 twit Signature DEP APPROVED FORTE - 12/07/95 to -� FORM 12 - PERCOLATION TEST Location Address or Lot No. 64 1f f -Y) COMMONWEALTH OF MASSACHUSETTS -i Massachusetts Percolation Test' Date: �`Yf 79-n Time: z 9� Observation Hole # Z / _ 2,1-279 Depth of Perc Start Pre-soak /. q 57 d 11194 End Pre-soak Z -� J� Time at 12" Time at 9" a /7 Time at 6" Time (9"-8") a;39 21 /?1 l 7 rn%✓I Rate Min./inch 7 ' Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed R"' Site Failed ❑ Performed By: ®k k p J ' Witnessed By:`Sa„d�u sl"r Comments: 11 00 APftOv= roams • UW192 No................ ........ Rg............... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TD u) M........... _ O F..../V ............. Atilt11ratiilt fir j1i.i1lis ld R11010 (91111ptrltrtiott 11frtoit Application is hereby made for a Permit to Construct ( x) or Repair ( ) all Individual Sewage Disposal System at: ................ .. Iv 7- Aevok 8619 ...............•--..........•--••----...--- Location - Addrrss • or Lot No a _.44 f�:.... '..c' �.. y .. m 7— ... Pam) .... r��1 ��//r� ;;\\ �r9o�9�/ owner --------....Cl.....mw .......... Address ------------------------•---•---•--•--•------- -- .q._..f� Insta- - - T ller .-------------•--.............--`-----------------------.. Type of Building Size • / U QCT' YP g STze I_ot..... ----------�-----------� t Dwelling — No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons___-- ...................... Showers ( ) — Cafeteria ( ) Other fixtures ...---...---•-------- ---------=----i_ Design Flow............................................gallons per person per day. Total daily flow ......... -----:::...-:._rZ� ......gallons. Septic Tanl/- i iquid capacity.t!�.W..-..gallons Lengtl✓.Q..'�. ��..... "'i(IIIi ..�.Y...... Diameter .............._ De )th:�.��s`..�. Disposal C -- No ..................... width-_....��.__--- Total Length -------- Total leaching area-. --- 14_1�__...sq. ft. Seepage Pit No ..................... Diameter.................... Depth below inlet.................... Total leaching area .................. sq. ft. Other Distribution box ( if Dosing t7nk-12/1S Percolation Test Results Performed by.._...._.'l�.%jC�rilC,yt.....e,�r�------------------- Date..��t•-��/�l,r-... s�j2� Test Pit No. I ........ ._._ininutes per inch Depth of "rest Pit .... RJ ........... Depth to ground water. ?S..'.�.............. Test Pit No. 2$ ------- 7 --- minittes per inch, Depth of Test, Pit..... ---- Depth to ground water ...... 0 ............... ---------------------------------------------------•-------•----......-...--.-....------•----------• --------------------------------------------------------- Descriptionof Soil -•-----------------1------•--......-•------•--...........-----•--------.....---._...------...._...----........-----.......-----•------------.----•-•------•---•-------• /lv�.. sA?S!Q. ... 4.o Vii.!!? --•........................................••------...---.......------=------.......------------ ----------------------------------------------------------------•------ .................. Nature of Repairs or Alterations — Answer when applicable Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLI 5 of the State Sanitary Code — The undersigned fluther agrees not to place the system in operation until a Certificate of Compliance has been issu dy t to board of health. F1Sigucd..........4................................. Date Application Approved 13Y.................................................................................................. ------------------------ ---------------- Date Application Disapproved for the following reasons: ................ ...................................................................................... ........ .................................................................................................................................................................. easons:.............................•---•-•---•-------........--------------------............---•-----------..---••- ............................•-----------...------.....-----•----.....----•---------...........------.......----------........------......-------•---•------....... ---......------....---..........•----- Date PermitNo ......................................................... Issued......................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... OF Taiifirttte of Tonittliattrr.. THIS IS TO CPRTIFY, That the Individual Sewage Disposal System constructed bY..................................................................................................... Installer ) or Repaired ( ) at---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application -for Disposal Works Construction Permit No ......................................... dated................................................ THE ISSUANCE OF TiIIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ IT spector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ...................................................... No ......................... ........................................ OF.......................... .... FEE........................ Ropowll IV, tirltif C9111titr urtiolt If irrtttit Permissionis hereby granted .........:.........:.......................... .......... ....................................................... .............................. to Construct ( ) or Repair ( ) an Individltal Sewage Disposal System at No ............. :...._...... Strcet as shown on the application for Disposal Works Construction Permit No ..................... Dated .......................................... --------------------------------------------------------------------------------•--..................... DATE..................................................................... ....................... Uoard of ifealth roRM 1255 1-401313S & WARREN, INC.. PUBLISHERS CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508) 373-0310 FAX: (508) 372-3960 September 20, 1996 Ms. Sandra Starr North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 21 Beaver Brook Road (Evergreen Estates Subdivision) Dear Ms. Starr: A leaching field has been specified for this lot rather than leaching trenches because of area limitations. Due to the Title V requirement that the spacing between trenches shall be at least three times the effective width or depth of the trench, a leaching field system uses less area than a leaching trenches system. The limited area available between the proposed house and the existing detention area would make it impractical to use leaching trenches. The area available for the leaching facilty on this lot is so restricted that we have asked for a variance from the required minimum design flow and per bedroom flow rates to reduce the required size of the system. Enclosed are 3 copies of the Septic System Design for Lot 21. Please contact me if you have any comments regarding this design. Ve Truly Y ur , C istlansen BOARD OF HEALTH 30 SCHOOL STREET Tft 6.85-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS'----'- DATE: ESTS -'-DATE: LOCATION OF SOIL TESTS: 1.0)A g-( 09 j! Assessor's map & parcel number: OWNER: JimTF_L. N0.:� ADDRESS: r (to 0 Or S4 ENGINEERCR CERTIFIED SOIL EVALUATOR: TEL. NO.:22 F -,3 �>Z ~6,R> 16 Intended use of land: residential subdivision, sin family home, c mmercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $175.00 per lot forr nwQnstruction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1 "-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. a) m c� a O U �W M in I a� E fu a� 0 c m I c 0 V) E E 0 U c 0. 5 LO C: O U I fu O m ::c Q V f o f _o Q 0 E u ' 0 Q 0 m H O e. L 7 a L O � � C O = � o 0 � � O � O O 43 C O E C �7 O .� D � Q F r _O V Q � E C U O D C , I a� E fu a� 0 c m I c 0 V) E E 0 U c 0. 5 LO C: O U I fu O m ::c Q Applican Town of North Andover, Massachusetts Form No. 1 BOARD OF HEALTH 19 95 APPLICATION FOR SITE TESTING/INSPECTION Site Location Engineer- -5 C2/V��GZ.2�y`� `�'Jv�✓U NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee 16-} CHMMAN,B-OARDOFITEALTH Test No. 651 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 19 Applicant - NAME ADDRESS TELEPHONE Site Location r Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee_ ' - S.S. Permit No. D.W.C. No. C.C. Date Test No. Plbg. Permit No.