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Miscellaneous - 380 SUMMER STREET 4/30/2018 (2)
c) m rrte�,, . w, r, r jn �' 'ry�.. v ,V>': :b b`�✓ Wi MAP # PARCEL # �� �' STREET._:„ r QONSTRUCTIO.N—APPROVAL, . HAS PLAN REVIEW FEE .BEEN PAID? YES NO PLAN APPROVAL: / 6 DATE /0 /2 l l A PP. BY� DESIGNER: --- PLAN DA,CEo/, CONDITIONS WATER SU -PO -LY: TOWN WELL WELL PERMIT DRILLER WELL TESTS: L ICAL —DA IE APPROVED BACTERIA I DAIE ()PNRUVED BACTERIA II DA* APPROVED COMMENTS: FORM U APPROVAL-: APPROVAL l -U I5ilUE YES NO DATE ISSUED 1kl?"16, EY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE:,,...,- ...- ....BY:... i Town of North Andover �7 *�'��� OFFICE OF 1NI H COMMDEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director August 12, 1996 Mr. Steven D'urso 22 Lilly Pond Road West Boxford, MA 01921 RE: NOTICE OF INTENT: Lot 8113 Summer Street Dear Steve: O A ♦ s �94 a i .► 9_ < As you are aware, the above referenced permit application is currently before the North Andover Conservation Commission (NACC). The applicant is seeking an Order of Conditions authorizing construction of a single family dwelling with associated grading and utilities within the Buffer Zone of a Bordering Vegetated Wetland (BVW). On Wednesday, August 7, 1996 1 performed a preliminary inspection of the delineated wetland resource area(s) with the intent of approving it's location or otherwise modifying it accordingly. While I agree with your assertion that the "ditch", as depicted on the enclosed plan, may be classified as an "up gradient intermittent stream" and therefore not subject to protection under the Act or ByLaw, I am not convinced that the remaining portion is the actual limit of BVW. As a result, lam requesting that a series of soil borings be performed along the proposed up gradient side of flags B1 through 136; 1 am of the opinion that greater than 50% wetland vegetation exists throughout this perimeter. Please submit the appropriate number of BVW data sheets to this office at your earliest convenience so that I may attempt to approve the delineation prior to the August 21, 1996 public hearing. "Wetland Series A" is satisfactory. Enclosed please find a plan with the desired number of soil borings and their approximate location. If I can be of further assistance or if clarification is warranted please do not hesitate to contact this Department. Sincerely, s Michael. D. Howar Conservation Administrator encl. CC: Neve Associates BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage DisposaLSystem Form - Not for Voluntary Assessments ,Owner information is required for every page. V 1 a�g state Zip Code . Date of Inspef Inspection results must be submitted on this form. Inspection forms may not be way. Please see completeness checklist at the end of the form. Important A. General Information When filling out fortes on the computer, use 1. Inspector r only the tab key to move your Na cursor - do not Name of Inspector 1r kuseey the return N a de e 5 Vy x Company Name Company Address �--- � � 'e L0 uY I " c'tyR°r"' -4- Teleph ne Number B. Certification zp r W' Mfl o?2/L — state Zip Code License Number 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: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation b the Local Approving Authority In o s 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. 77119 5 Oficial Inspection Forme Subsurface Sewage Disposal System • Pape 1 of 77 t5ins - 03113 Owner Information is required for every page. t5ins • 03/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments rroperry Huoress Owner's Name City/Town B. Certification (cont.) State Zip Code Date of. Inspection Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: [rI 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. CAmments: r'AUA 1 /0 Z) rim IV\ B) System Conditionally Passes: M ❑ 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. Check the box for "yes", "no" or "not determined" (Y, N, ND) for thefolio g statyements. If "not determined, " please explain. The septic tank is metal and over 20 years old; or the septic tan whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltra ' n or tank failure is imminent. System will pass inspection if the existing tank is replaced with ac plying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is str turally sound, not leaking and if a Certificate of Compliance indicating that the tank is lessthan 0 years old is available. ❑ Y ❑ N ElND (Exp In below): Tide 5 Official Inspection Forth Subsurface Sewage Disposal System • Page 2 of 17 =N11� Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments d— Property Address Owner's Name City/Town B. Certification (cont.) B) System Conditionally Passes (cont.); State Zip Code Date of Inspection ❑ 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): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ NND (Explain below): ❑ The System required /ed times a year due to broken or obstructed pipe(s). The system will pass inspeof the Board of Health): ❑ broken pipe(s❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is ❑ Y ❑ N ❑ ND (Explain below): 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 Healt etermines in accordance with 310 CMR 15.303(1)(b) that the system is not functi ing in a manner which will protect public health, safety and the environment: 1:1 Cesspool or privy is withi 0 feet of a surface water ❑ Cesspool or privy is yin 50 feet of a bordering vegetated wetland or a salt march t5ins • 03113 Title 5 Official Inspection Form Subsurface Sewage Disposal System • Page 3 of 17 Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments WS -M Mey- Property Address Owner's Name City/Town B. Certification (cont.) State Zip Code Date of Inspection 2. System will fail unless the Board of Health (and Public Water Supplier, if any) deterimes 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 wate upply. ❑ The system has a septic tank and SAS and the SAS is withi Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is hin 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SA 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 analysi performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence o ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other fail a 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 ❑ Lf Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ E 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 invertor available volume is less than % day flow t5ins .03/13 TIOe 5 Official Inspee0on Form Subsurface Sewane Dismsal Svslem • Pace 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t Property Address Owner Information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes rN-o� El�i1 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. ❑ Er Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 2"' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ l_'1 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.] ❑ I� This system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ LTJ 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 ch of the following, in addition to the questions in Section D. Yes No 1:1 11. the system is within 40 eet of a surface drinkiing water supply ❑ ❑ the system is wit ' 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system ' ocated in a nitrogen sensitive area (Interim Wellhead Protection Area - I A or a mapped Zone II of a public water supply well If you have answered "y to any question in Section E the system is condidered a significant threat, or answered "yes" in ction D above the large system has failed. The owner or operator of any large system considered 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. t5ins • 03113 Title 5 official Inspection Form Subsurface Sewage Disposal System - Page 5 of 17 Commonwealth of Massachusetts Title 5 Official nspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �Svinn pry Property Address Owner Information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection C Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yeses No u ❑ 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? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? Q/ ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) H' ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? 21/ ❑ Were all system components, excluding the SAS, located on site? 2- ❑ 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? �i ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? This 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)1 D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): t5ins • 03/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System • Pape 6 of 17 - - Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,! 550MM eI-5-� Property Address Owner's City/Town D. System Information Description: Number of current residents: Does residence have a garbage grinder? State Zip Code Date of Inspection ❑ Yes 1_71' No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes 0 No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)):�'' j Ute' Detail: I _ Sump pump? ❑ Yes No Last date of occupancy: C� Commercial/Industrial Flow Conditions:. Date Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq. .,etc.): Grease trap present? Industrial waste holding tank Non -sanitary waste Water meter readings, to the Title 5 system? Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 03113 TlOe 6 Official trrspeetipn Form Subsurface Sewage Disposal System . Page 7 0117 Ism Owner Information Is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ��SS0M��r ��- Property Address Owner's Name City/Town D. System Information (cont.) Last date of occupancy/use: Other (describe below): state Zip Code General Information Date Date of Inspection Pumping Records: - 5 - / 4) Source of information: Was system pumped as part of the inspection? ❑ Yes d No If yes, volume pumped: gallons How was quantity pumped determined? ( Reason for pumping: Type of System: dSeptic 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): Title 5 Oficial Inspection Form Subsurface Sewage oisposat system • Page B of 17 t5ins • 03113 Owner Information Is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !2 Z(f)'SUM Property Address Owner's Name Cityfrown D. System Information (cont.) State Zip Code Date of Inspection Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes 12" No Building Sewer (locate on site plan): Depth below grade:., feet Material of construction: ❑ cast iron d 40 PVC ❑ other (explain) Distance from private water supply well or suction line: JJ 1 feet —fA Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 0 Teat Material of construction: 12 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: // % 0 X Sludge depth • S Title 5 Official Inspection Form Subsurface Sewage Disposal System - Pape 9 M 77 Sine .f1111 Owner Information is required for every page. t5ins . 03/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address CityrFown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness , Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined?Q- Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity liquid levels as related to outlet invert, evidence of leakage, etc.): 22 1vI lice yw Lo-KA� Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness Distance from top of Distance from bottor Date of last pumping: feet 5*rglass ❑ polyethylene ❑ other (explain) 7 110 top of outlet tee or baffle scum to bottom of outlet tee or baffle Date A a r� Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39dSuriWVf-,5" Property Address Owner's Name City/Town D. System Information (cont.) state Zip Code Date of Inspection 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 ❑ fiberglass ❑ polyethy ne ❑ other (explain) Dimensions: Capacity: gallons Design Flow: Alarm present: Alarm level: Date of last pumping: Comments (condition of alarm a is per Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date switches, etc.): " Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Title 5 Official Inspection Form Subsurface Sewage Disposal System • Page 11 of 17 Owner Information is required for every page. t5ins - 03113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner's Name City/Town D. System Information (cont.) State Zip Code Date of Inspection Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): I�DX I °F' r o y� dPs v e 'A I'M q l o w f -- Pump Chamber (locate on site plan): Pumps in working order: Alarms in working order: Comments (note condition of pump ❑ Yes ❑ No ❑ Yes ❑ No condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, If SAS not located, explain why: not required): TIOe 5 official Inspection Form Subsurface Sewage Disposal System . Page 12 of 17 Owner Information is required for every page. (Sins • 03/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments J �?o Sri WI iM � Y' Jf Property Address Owner's Name Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: r leaching trenches number, length: �J J ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of itechnology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): YJ�a I1 1 11 b 0 UV 'a. I nYIS PrA4 Cesspools (cesspool must be pumped as part of inspection) 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 on site plan): ❑ Yes ❑ No Title 5 Official Inspection Form Subsurface Sewage DISpOsal Svstem - Paae 1s of 17 • i� ug l Owner Information Is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner's Name City/Town D. System Information (cont.) State Zip Code Date of Inspection 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 Araulic failure, level of ponding, condition of vegetation, etc.): / t5ins • 03113 Title 5 Official Inspection Form Subsurface Sewage Disposal S�atem • Page 114 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora a Subsurface Sewage Dispbsal System Form - Not for Voluntary Assessments Property Address Owner Information is Owner's Name required for eve a e Ci R J,p g, own State Zip Code Date of Inspection D. system Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: hand -sketch in the area below ❑ drawing attached separately t5ins - 031'13 Title 5 Official Inspection Form Subsurface sewage Disposal System • Page 15 of 17 r` Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System f=orm - Not for Voluntary Assessments Property Address Owner's CityfTown D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar V ❑ Shallow wells Estimated depth to high ground water: State Zip Code feet Date of Inspection Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record c If checked, date of design plan reviewed: 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 USG$ database - explain: You must describe how you established the high ground water elevation: I 6),S C --- Before filling this Inspection Report, please see Report Completeness Checklist on next page. Title 5 official Inspection Forth Subsurface Sewage Disposal System • Page 16 of 17 Owner Information is required for every page. t5ins - 03113 Commonwealth of Massachusetts Title 5 Official Inspection Foran Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "; 207�t )1M V1/l `Pf Property Address uwners Name City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked Inspection Summary, D (System Failure Criteria Applicable to All Systems) completed System Information - Estimated depth to high groundwater Q� Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Title 5 official Inspection Form Subsurface Sewage Disposal System • Page 17 of 17 „4 Jul.1U iuDr $ WMMVV; erxa%t7itigmiare�3G Prim, of NOrt1h r"Widover Tax faflrap # 249 0.107.A=01 64-0000.0 Parcel id 17990� 380 SUMMER BTREET THOMAS MANNI � l.. KATHLEEN MANNING 386 SUMMER STREET 114ORT, %4 ANDDVF-R, MA 01846 0#653 1016:40 Familly 1 !PuldenW �ralat�8. 1.��3±>;�t ��it�� � Ra3sidenda{ meei2 sinal 2.122#I*=5 , iy 2015 US Mailina Ina wit Nime(AddMt. ° Y06 Loan Number Aavaf act �Wlm UAW THOMAS MANNING Owner KATHIJEEN r'SQ v9iH1�'i��.r'rwcK7 NORTH APi0 R. AAR 01$AG :'`S,1.MA. PETER 711 3M. UAWAIdEN:SriwS.T. .N6R7'M ANDOV EP, MA 01843 UL on s=of t Slag 1d_ 14246-0 39-$ SUMMER BTRi=E i' 211 235 02 Oyda 02 UB 3—sr-ficas yi int €}�,omwit 1,+10_ 21%Rr2 S ea vice- ratio WSOFFEEADMINFEIE wm WATER owupent Name ActiiieM. aWve L@A 5i9 tflg Dt8145f4r2QI5 Aakb. Rift Ch" mumpualusm 0-63610" 7,62 31 0i AU MIE rFR WE GUO 11 5f 1 164 �LOl.af.1-Y A=unt Pio. z1ows $e3iw 09 MAW LaE:.al"m Braid I'm 35441045 a Add" ERT mi b Badger w U1lafer Data 1?sfto Codes i,:ii8 suptoon Famfod Date fil5ml s 831 mA aml V. wMa1s 2rimLm§fi X14 aAduO 24. 3=201f, ll(3,'3um 790 aAGual 34 12flSI2014 V412014 160 a Actual 68 90112014 UWD14 lits 7aACWW 28 30 SM212014 311712914 2W2014 rvI9 a ctvW 1t:(311--bil 343 akt" 41 1212bt2t3'i8 1if 13 X17 aAr--total 47 gf111f6013 ;1 13 5511 8Actuai 27 t21?812013 21712413 533 jpAclu„i r: d1,312D13 '9Q,=12.012 $0- iBami s�t13t2ai2 8133=12. 463 z— A -Mai 41 Q;'Q612 WPM aAc 31 25 i2 2131202 74t1x5n 390 aActiai 27 fw4i�x i{i Q+W12 1ii1J ;; 3 aAcs9ti8i 33 92f16)2511 81;+ltiiil. �3Q eAct� al 1130 91142-011 �vi�f 31 �St? a A7:tus1 '� 1;+13;2t?1'! 214=1 202 aAC1411 24 3f13f2911 W192010 JIS aA+ 7sai 70 121131211113 1?13i1i 4A8, AACIU01 81 9193(20111 a13133 o 27 aiAduai 21 X1312 'D 211/2010 6 uft ual s ►j_ 3{91rwic '-�'�iT2i1j9_ 9(aliSaFi� � 7;h;��j?�-� 3402- r,;i (What 12 30712510 4370 0.53 %G3 YTD>uans B25 vAlfiff-ftep, 2g% -230A o a7% 0% m3t¢/7iY -i7 jn f� -10% -17% -»% -21% .Q 245% 9A3�. 3993 important When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 4. mnun Commonwealth of Massachusetts City/Town of Noah Andover ,Sys Pumping Record Form 4 *___'VX 9 'rte tXM—W�'i`C�'PnNP4111N1fPta"II DEP has provided this form for use by local Boards of Health. Other'forms-mab'e�usedka,c: the your information must be substantially the same as that provided here. Before using thisform, check with ted o local Board of Health to determine the form they use. The System Pumping .s the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. f=acility Information 1. System LL`ocation: ` OU Address 01886 North Andover Ma State Zip Code CiltyfTown 2. System Owner: 117 Name Address (if different from location) State Cityrown Telephone Number B. Pumping Record �7 2. Quantity Pumped: 1. Date of Pumping Date Cesspool(s)x Septic Tank ❑ Tight Tank 3. Type of system: ❑ ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: Zip Code /5�w Gallons ❑ Grease Trap If.yes, was it cleaned? ❑ Yes ❑ No 6. System Pumped By: Vehicle License Number Name Stewart's Septic Service Company 7. Location where contents were disposed". Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc- 03/06 System Pumping Record - Page .. . ...... Commonwealth of Massachusetts `CI W. Q\A of NORTH ANDOVER MASSACHUSETTSe� D System Pumping Record �' 5 : Form 4 OCT 1 2 2006 DEP has provided this form for use by local Boards of Health. The SystemrPum;pin,g,\Renard mu; be submitted to the local Board of Health or other approving authodrity:iL ,t rH e�,IAR-rMENT A. Facility Information - Important: When filling out 1. System Location: forms on the . computer, use J�(J -- — ---...._-- _.—......_._..... to move your only the tab key Address - ----- - - - .. - ---- cursor • do not Clty/Town � . State -.._--. use the return Zip Code , key. Y, 2. system Owner: Name —-,__._........ ._.--- ►�I---_.._....._-_ _ _-- __-- ..._.._. -—._..__..--- - Addres,s (If different from location) City/TownStat����_'-/_—� �p Code --- - Telephone Number B. Pumping Record - -- 1. Date of Pumping Dat S-- 2. Quantity Pumped: �-— ---- -. \ Gallons 3' Type of system: ❑ Cesspool(s) M-Me-p`tic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes L9 o If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: /7 6. Lyem Pumped By: ame Vehicle License Number - Cyt Q Company 7. Location where contents were disposed: CA0 \L3 Si ature of Hsu Date - -- ---- - http://www,mas§�gov/dep/water/ proyals/t5forms.htm#inspect 15form4.doc- 06103 System Pumping Record • Page t of Ln rc N Q p N O Ln W U 00 01 blo b w 7 r z � U 2 b4 ;; `° Q m U F J :5: > z a> Q > cJ) a. LLI O I Vi > S C 'AJ JQ S U O v O LL OO O a V) ° o c W Z W Ln o i Q U N m co c Os Z m u. H 3 s �_ t V) W o U Z Q) 3 U '� ro � v •�-J L N L 0 � � L � U Q un •L .�� V) N (A O � VlU Vi C fA N a> > > L L^0 C O LA V) CLC a z ao 3 o ... L V1 O >C v t rz \ ui V1 u V) M b L 2 Q) W n p N U- � t U Z o \ 001 b o _c ro J .7FLU T z t L > 2 O U LJ. N W J a� Q=.. O _ W i7 0 p U oa Q o 4- u Q W O V) J O s� f' •vi � z FLO � O Q Q V N C Nm OD Z m o cn 3 ce W o 3 U O O ..O O L i ON O N N�0 O M N Urt ... W V) a v t gORTq • r. _. of f w a i SSACHUSEt Town of North Andover, Massachusetts BOARD OF HEALTH DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant 7'21W-0 t' Test No. Site Location_ 1.,-r W' e) A Reference Plans and Specs. Form No. 2 Now Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee bb CHAIRMAN, BOARD OF HEALTH Site System Permit No. 1 NORTH • p� ° ;aa 4, pA F 9 3 CHU Applicant_ Site Location, Form No. 3 Town of North Andover, Massachusetts BOARD OF HEALTH G19 .� DISPOSAL WORKS CONSTRUCTION PERMIT I Absorption or Repair ( ) an Individual Soi Permission is hereby granted to Construct ( ) royal S.S. No. Sewage Disposal System as shown on the Design App ' CHAIRAN,OARRD��DOF HEALTH 6v D.W.C. No. c Fee • 4p q r uj z 5 0 •m a c a 0 F0 U O w p w 7 w \ C L O � w Cu C.J I O m aC/) a2C/ a a Or - v �° 0 is a is w �' 0 W n+ C7 m co w z Q v o C w° cn w° a�4 U w w a�' cn w w wn ci) cn uj z V 2 O 5 0 •m I c O cc 7 L \ C L O � w Cu C.J I Z a3 CL V O G nAII: tlGt '•aC CO) .O R y di mm C CL }. s y C 'S m 0 O \; BM Lm 2. C a .� o a y td O Q EL •CO) Q O Z Q Q. :mss Q CL t; cm :mom 4. CO) C O 131 . fr C:p, 3 yr : Cf m y 3 v �- m i A = C y y C _• A 0 y E m � `m o c :at.� m y m 9cr- :=z o cm :�w c oQ ;mom m : wy O i cs•�Z o .: coo c_ H m : y m C •C _ m m=o N ~ 0 H m ym, ~ m r=.+ w• •N m ac •E as C = , CD y Z o C.3 CD cm H = a mco � 0:0 .a p vi •= p eya nim V 2 O I O \ C L O � w I Z a3 CL O G y C O cm CO) .O y di mm CL }. O CL 0 O CL C a td O Q EL •CO) Q O Z Q Q CL u CO) C O 131 . fr V � Q. y 4 i v v 9 FORM U - VERIFICATION 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** SFR Realty Trust/ 475-9100 APPLICANT: Belford Construction, Inc. Phone 975-5752 LOCATION: Assessor's Map Number 107A See Plan recorded in the Essex North Subdivision Registry as Plan 412952 Parcel /G Lots) :: Street Summer St. St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved / 71e � Date Rejected Received by Building Inspector Date FOR -NI 11 - SOIL EVALUATOR FOR:tii Page 1 of 3 Commonwealth of yiassachusetts , Massachusetts ►tnhility Assessment for On-site Sewa e Date Performed Bv: Witnessed By: Jar ... .._.................. Q�rcr , n.MC. 4, f ;< . C? Tdrnom ! Date: isvosal -=vorl Ate_ Of SUn meati Sr � C�n;iP IXi Oice Review Published Soil Survey Available: No F-1 Yes �3.. Year Published � Soil Vtap Unit r �� - ----- � -- Publication Scale � -- - � � Drainage Class %'`'' pr' - --- . Soil Limitations Surficial Geologic Report Available: No Z;` Yes Publication Scale Year Published - GeologicMaterial (Map Unit) ..........................................................................................................._.............._... rt Gr o rz� a s d-, .............._ .... —._. Landform ICG........................................................................................................... ........................................................ Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes ❑ _ Within 500 year flood boundary No ❑yes ❑ Within 100 year flood boundary No [ayes ❑ Wetland Area: National Wetland Inventory Map (map unit) ..................................... Wetlands Conservancy Program Map (map unit) ............................ . Current Water Resource Conditions (USGS): Month Range :Above Normal &ormal ❑ Be!cw Normal ❑ Other References Reviewed: pEP AMOVEJ FORA . 12107/95 ri- ZzIrda zerlD FORA1 11 - SOIL EVALUATOR FORM Page ? of 3 Locction address or Lot :vo. ?513 arL-CC l5?g �U On-site Review Deep Hole Number Date:. Time: �� ' ( Weather Location (identify on site plan) Land Use /S/�'+I fICtC� Slope (91o) g�Surface Stones Vecetation eye,2 Lanoform 0ZP17vrd,1, — Position on landscape (sketch on the back) �e P. /��/7 Distances from: T Open Water Body /46 feet Drainaae way /00-r'- feet Possible Wet Area /OZJ i feet Property Line /a ' feet owio;. Drinkina Water Well /00 t- feet Other DEEP OBSERVATION HOLE LOG' Death from S urtace (Inches) Sod Horizon I I Soil -exture (USDA) Soil Color (Munsell) A Soil Mottling I Other (Structure. Stones. Soulders, Consistency, Gravel) ,#1,0-1e) A -P FSL- /6 yp 41316-21,4 vK *2 e-/� �f S L� A,/ //-/6 amu, L %yrz¢/3 �a �• �. %CS lie -r, /d -q GS� DYE-� -7 97-/$ 0 G5� Zfys/g G'30 4 ,,v �''r' G GSA 3FFi�t� T s - - yr Z�z / %pGX �oy,WC. C 17, G 5 2.Sr P/ T /o y, a/ - F5 12B -z c, 7,5y s/¢ I &S ��.MINIMUM OF 2 H Lt_S A I e c =,,i A A Parent Material (geologic) Deorhto8edrock• nUn� Death to Groundwater: Standing Water in the Hale: S / Weeping from Pit Face: _ Estimated Seasonal High Ground Water: DEP APPROVED FOR.11 - 12107/95 s FORM 11 - SOIL LVALU.aTOR FOR:ti-1 Page 3 of 3 Location .address or Lot No. 5 &&MN6t Determination for Seasonal High Water Table Method Used: Depth observed standing in observation hole.......... inches Depth weeping from side of observation hole ....... inches Depth to soil mottles ... inches Ground water adjustment .................. feet Index Well Number ........... Reading Date ..... . . Index well level adjustment factor ................ rdjusted ground water level :.. ............. Deoth of Naturally Occurrina Pervious Material Does at least four feet of naturally occurring pervious material existin a I ares observed throughout the area proposed for the 'soil absorption system? P a S ^ If not, what is the depth of naturally occurring pervious material? Certification I certify that on /Y �7 (date) I have passed the soil evaluator examination approved by the De artment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature � Date DEP APPROVED FORM - 1=/07/95 03-21-LSGS 14:35 517 932 7515 Q5P NUR i Y=E:� I w� s FOKM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS Massachusetts Date: Percolation Test' Time: Observation Hole Depth of Perc ` I Start Pre-soak End Pre-soak I I i Time at 12" t i I Time at 9 I Time at 6" I i Time (9"-6") ' I Rats Min./inch �C I ��2 �AA • Minimum of 1 percolation test must be performed in bath the primary area AND reserve area. Site Passed X, Site Failed r Performed By: Witnessed BY: f Comments: 11 oQ M7%ovm MRM - uwnnf Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 June 27, 1996 Dave & Joanne Perry 59 Johnnycake Street North Andover, MA 01845 Re: 370 Summer Street Dear Mr. & Mrs. Perry: L7ioo 9 4�Tf0-��a.4y/ The Board of Heath has read your correspondence relative to your concerns about the proposed location for the septic system repair on 370 Summer Street. We have also reviewed a preliminary plan from the engineering firm and had discussions with Sandra Stan, Health Administrator. We recognize and sympathize with your concerns. However, due to the wetlands on the site and the lack of any other acceptable area, the area behind the existing house is the. only area available for the septic system. We must abide by regulatory and statutory requirements. Please be assured that the Board of Health will take every possible precaution to prevent a negative impact on your property as a result of this repair. Sincerely, BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 , PLANNING 688-9535 September 25, 1996 Ms. Sandra Starr, R.S. Board of Health 146 Main Street North Andover, MA 01845 Re: Lot 8B Summer Street Dear Sandy: Per your conversation with Mr. Neve, please accept this letter as a request for the following waivers from the local Board of Health regulations to be heard at their next scheduled meeting on Thursday, September 26, 1996. Design Flow: Use 110 gallons/bedroom/day vs. 165 gallons/bedroom/day Setback to foundation drains: Design on Title V requirements instead of 35' and 25' required by local Board of Health. It is our understanding that if your proposed new Board of Health regulations pass Thursday night these waivers will not be required. Thank you for your time and if you have any questions please do not hesitate to call. Very truly yours, THOMAS E. NEVE ASSOCIATES, INC. John Morin, E.I.T. Civil Engineering Consultant JM/km • ENGINEERS • • LAND SURVEYORS • • LAND USE PLANNERS • 447 Old Boston Road U.S. Route #1 Topsfield, MA 01983 (508) 887-8586 FAX (508) 887-3480 1., QED Applic Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 1 APPLICATION FOR SITE TESTING/INSPECTION Site LocationTY(1 JLP� Engineer �- NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee IS'� CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH qA BOARD OF HEALTH \j��- QSLED /6 'YO t t ` { l 1\ �• 19 •__sem � ,f APPLICATION FOR SITE TESTING/INSPECTION Applicant NAME ADDRESS TELEPHONE Site Location I')_ Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time N/ CHAIRMAN, BOARD OF HEALTH Fee i �Test No. IJj S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. ,.�*�m.'''°c ASOIAN, TU LLY & GILMAN P.C. ATTORNEYS AT LAW 12 ESSEX STREET POST OFFICE BOX 39 R, MASSACHUSETTS 01810 RICHARD G. ASOI N IUVVN OF NORi MARK E. TULLY BOARD OF HEALTH AARON A. GILMAN ROBERT W. LAVOI NICHOLAS FORGIC NE wwl�:w ^ MARK J. SAM P50 !'dJIr'��\j L ROBERT J. AHEAR JOHN R. BLAKE, J PATRICK G. SULLI N MICHAEL DANA R SEN Town of North Andover Health Department Attn: Sandy Starr Town Hall North Andover, MA 01845 March 20, 1996 Re: Applicant: Rockw Trustee of SER Realty Trust Ma 107 Parcel 16 ew and 16 2/27/95 Dear Ms. Starr: ANDOVER (508) 475-9100 BOSTON (617) 942-0932 TELEFAX (508)470-0618 ?' J\ �s This will confirm that Thomas Neve with offices in Topsfield, Massachusetts_ 'has, been engaged by SFR Realty Trust to prepare and seek approval for Septic System Designs for the above -referenced parcels. Enclosed herewith please find a check in the amount of $15 which represents the remaining fee due for soil testing. (Also attached hereto for your convenience is a copy of our February 27, 1945 �correspon ence to you which was sent last year along with a check for $450.00; in 1995, septic designs were submitted and approved for Parcel 162 and 167, leaving a credit balance of $150.00 for Parcel 164.) On the attached Deed, Parcel 2 is Assessor's Map 107A, Parcel 163 which contains the house and the barn. Parcel 3 on the Deed is Assessor's Map 107A, Parcel 164, which is a vacant,.. parcel of land. Should you have any questions, please do not hesitate to contact us. Very truly yours, ASOIAN, TULLY & GILMAN P.C. RWL/lm Enclosures cc: Thomas Neve g: \common\rwl\letters\starr. ltr RICHARD G. ASOIAN MARK E. TULLY AARON A. GILMAN ROBERT W. LAVOIE NICHOLAS FORGIONE JAMES H. KRUMSIEK MARK J. SAMPSON ROBERT J. AHEARN KATHLEEN M. CONNELLY JOHN R. BLAKE, JR. Town of North Andover Board of Health Town Hall North Andover, MA 01845 ASOIAN, TU LLY & GILMAN P.C. ATTORNEYS AT LAW 12 ESSEX STREET POST OFFICE BOX 39 ANDOVER, MASSACHUSETTS 01810 February 27, 1995 RE: Applicant: Rockwell, Trustee of SFR Realty Trust Map 107A, Parcels 162;�1� and 167 Dear Sir: ANDOVER (SOB) 475-9100 BOSTON (617) 942-0932 TELEFAX (SO8) 470-0616 Enclosed herewith please find a check in the amount of $450.00 which represents the fee due for soil testing and a copy of the deed relative to the above. Should you have any questions, please do not hesitate to contact us. Very truly yours, ASOIAN, TULLY & GILMAN P.C. Robert W. avoie RWL: jm Encl. rock.1tr iE COMMONWEALTH OF MASSACHUSETTS TO;JIJ 01' NORTH ANDOVER OFFICE OF THE COLLECTOR OF TAXES pan [ITR _ I)tK FCA 1-_1 a4 TAX RATE%/////%////////////,1 =E= TdFir'L 1 C PER S1009 TOT TAX RATE PROPERTY IDENTIFICATIONLAND I• AREA 1.6x0 A LAND LDG 'MAP:107A 0163 00000 pule PAGE (723101 16320 LOCATION I PAGE/LINE 1065 4 37] SUMMER STREET THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE SFR FEALTY TRUST S FORRES ROCKWELL,JR, TR, 370 SUMMER STREET NORTH ANDOVER MA 01845 COPYRIGHT 1995. ARLINGTON DATA CORP, __ -__ FISCAL YEAR 1996 REAL ESTATE TAX BILL Based on assessments as of January i. !995 your REAL ESTATE TAX for ''n= ,';seal ;ear bemmnina July '. '995 and ending ,:ur,e 30. 1996 on the parcel of REAL ESTATE c scn3ed nelo•.a r as foilu'r+s: MAIL: PO BX 124,NO ANDOVER MA 01845 OFF HRS: MON-FRI 8:30AM-4:30PM BILL NUMBER MONDAYS TO 7:30PM PRIORRS BALAIN-CES NOT INCLUDED 6893 SPECIAL ASSESSMENTS TOT. TAX & SPEC. ASSESS. DUE 1 3546-14 PRELIMINARY TAX i PRELIMINARY CREDITS 1 —1709.47 I PRELIMINARY OUTSTANDING EXE`+1PTION - 3RD OTR. TAX PYMT. DUE FEB 1 . TGT. SP ASSESSMENTS CURRENT CREDITS TOT. REAL ESTATE TAX 3 5 4 _ . 141 CURRENT OUTSTANDING PRELIMINARY TAX 1,7 , . 4 BALANCE DUE 3RD QUARTER PAYMENT 4 4TH QUARTER PAYMENT 918-33 COLLECTOR OF TAXES I INTEREST KEVIN F. MAHONEY Interest at the rate of iao/o per nnum _re— overdue TAXPAYER'S COPY payments from the due date until ayment is m de. rCt 115 96 06893000.1 0000091834 9 THE COMMONWEALTH OF MASSACHUSETTS FISCAL YEAR 1996 REAL ESTATE TAX BILL TOWN OF N 0 R TH AND 0 V E Based on assessments as of January 1, 1995 your REAL ESTATE TAX for the fiscal year beginning July 1. x OFFICE OF THE COLLECTOR OF TAXES 1995 and ending June 30, 1996 on the parcel of REAL ESTATE described belowis as follows: MAIL: PO 9X 124,NO ANDOVER MA 01845 3RD QTR - DUE FEB 1,1996 OFF HRS: MON-FRI 8:30AM-4:30PM BILL NUMBER CLA55 1 CLA55 2 7GLALASS TAX RATE RESIDENTIAL OPEN SPACE MONDAYS TO 7 ' 3 0 P M ER $10001 TOT. TAX RATE . 6 PRIOR YEARS BALANCES NOT INCLUDED 6894 PROPERTY IDENTIFICATION D S RcuS A E VSPECIAL ASSESSMENTS TOT. TAX & SPEC. ASSESS. DUE 1 e IJ 3 . LAND PRELIMINARY TAX. AREA PRELIMINARY CREDITS -580-14 ty l A P• , o 0000 1117 j 11 ( 7j A Up�� PRELIMINARY OUTSTANDING O1174�/'`r 00n00 n EXEMPTION BOOK 0 3 4 6 3 3RD OTR. TAX PYMT. DUE FEB 1 3 ?AGE 0231 D/D 05/r1A/92 1LC'CATION I PAGE/LINE 6 'iUMMER STREET THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE SFR REALTY TRUST S FORBE3 ROCKWELL,JR. TR 370 SUMMER STREET NORTH ANDOVER MA 01845 I COPYRIGHT 1995 ARLINGTON DATA CORP. TOT. SP_ ASSESSMENTS TOT. REAL ESTATE TAX , PRELIMINARY TAX 3RD QUARTER PAYMENT 4TH QUARTER PAYMENT COLLECTOR OF TAXES KEVIN F. MAHONEY TAXPAYER'S COPY CURRENT CREDITS CURRENT OUTSTANDING BALANCE DUE INTEREST Interest at the rate of 14% per a will payments from the due date until pa e 1 ..ate c ((S1q� 115 96 06894000 0 0000031166 9 Fl M ^ M co I ' h J cc aV rn0 cD M Q 0, CD a 10 1 LL 0 LU j IOUr � W o y � OO f. a 0 3 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIROl\TMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 3 g n .� jJMIIJr1p S7 Al 441001/6(� 014 ()9RZ5 Owner's Name: �IICKELLE -DESILVA Owner's Address: 380 SUNJ1 ER S7 N ANDOVER NA 01845 Date of Inspection: 114RCK 24, 2004 Name of Inspector: (please print) Company Name: R. a. INSPEC71ONS, INC. Mailing Address: (N) F O.SGC)017 S7 l]FiZdll I 44 nyg44 Telephone Number:g Z R —� � zTg CERTIFICATION STATEMENT 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 Se 'on 15.340 of Title 5 (310 CMR 15.000). The system: Passes Inspector's Signatu (� Conditionally Passes l Needs Further Evaluation by the Local Approving Authority Date: The system inspector,sYall 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. Notes and Comments ""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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 380 SUNNER S7 N. ANDOVER NA 01844 Owner: MICHELLE DESILVA Date of Inspection: 3124104 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: B. Svstem 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): broken pipe(s) are replaced obstruction is removed 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): ND explain: broken pipe(s) are replaced obstruction is removed 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 380 _SlINII ER _ S7 Owner: IUCIZELLF DF, SILVA Date of Inspection: _31,)4104 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. 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 and volatile organic compounds indicates that the well is free from pollution from that facility 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: Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE -DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 380 SlMIER ST N.4NDQVQ� 114 09845 Owner: UCIIELLC DESILVA Date of Inspection: 3 / 2 4 / 4 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No/ $acicup 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 �ogged SAS or cesspool _ '� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or (,,,/� cesspool _/%,j iquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number Anytimes pumped y portion of the SAS, cesspool or privy is below high ground water elevation. portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ater supply. Auy portion of a cesspool or privy is within a Zone I 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] r (Yes/No) 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. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 fee ary to a surface drinking water supply i _ the system is located4 a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a p is 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 ti -treat 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 38Q ,S//MI! F/? .ST 11L. ANDOVER IM ,LZ845 Owner: D(SSZLVA Date of Inspection: 4,10 i 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 t e owner, otyupant, or Board of Health 11--W-, Were any of the system components pumped out in the previous two weeks e/ _ Has the system received normal flows in the previous two week period ? s/ 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 ? �N 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: Yes no 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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 380 SU(gN g C7 N, A1VDQVFR /m 01845 Owner: NTCHF/ / F DP -C u V!1 Date of Inspection: 31,241()4 FLOW CONDITIONS RESIDENTIAL L/ Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 05.203 (for example: 110 gpd x # of bedrooms): Number of current residents: Does residence have a garbage grinder (yes or no): Is laundry on a separate sewage system (yes or no): �[if yes separate inspection required) Laundry system .inspected (yes or no):_ Seasonal use: (yes or no): Water meter readings, if ava'lable (last 2 years usage (gpd)): �/ L'r/%��'L �✓ Sump pump (yes Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 gpd Basis of design flow Cs�at?; rsons/sgft,etc.): Grease trap preseff (yes or no): _ Industrial w. erste holding tank present (yes or no): _ Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection (yes or no): If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: TYJ'.E'C)F 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) __ Tight tank _ Attach a copy of the DEP approval _ Other (describe): ate age of all com onents, date stalled (if known) andource of information: Were sewage odors detected•when arriving at the site (yes or no): /'� Page 8 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 380 SIMMER S% —_N_ 41120VER N4 01845 Owner: l7LCHL /F DESZLVA Date of Inspection: 2 4,1 () 4 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(y or no): Alarm level Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: �resent must be opened)(locate on site plan) Depth of liquid level above outlet invert: :1 Comments (note if box is level and distn ton tooutlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order-( es or no) Alarms in wor ' order (yes or no): Comments,4-610-te condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Page 7 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31U) Q1444Q— z N 4NOLT I'1W 09845 Owner: NIC><IFLLE DESILVR Date of Inspection: 7/124/04 BUILDING SEWER (locate on site plan) Depth below grade: Z— Materials of construction: _cast iron t' 40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: _ (locate on site plan) r' Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene —other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) _ Dimensions: X c X l d Sludge depth: f/ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: / � /// Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: a z« j/?7 Z Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outle invert, evidence of leakage, etc.): _ GREASE TRAP: _(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass polyethylene _other (explain): Dimensions: Scum thickness: Distance from toi of scum to top o tlet tee or baffle: Distance from bottom of scum ottom of out tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 9 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: lu- ,41 OUR MA 01845 Owner: 47 LUf f LE DESILVA. Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: aching galleries, number: leaching trenches, number, length: �s _ 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.): _ ./l/ 6� ' S/r5 rt- f /I// -- 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 cesspoo Materials of construction: Indication of groundwater inflow (yes or 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 conditio of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 380 QIOULEQ �T iV IVDUVEi2 ( 001844 Owner: NT( FLLE DESILVA Date of Inspection: 31,)41()4 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benclunarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 10 Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: N sNV4?1/4J4 l )1845 Owner: '2ucaLLE DESILVA Date of Inspection: 311--14,1 9 4 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) - decked with local Board of Health-explain: —h6cked with local excavators, installers- (attach documentation) ./" Accessed USGS database -explain: You must describe how you established�he high ground waterelevation: 1D http://ma.water.usgs.gov/current-cOnNdata/2UU4_UZ.txt a SUMMARY OF GROUND -WATER LEVELS FEBRUARY 2004 PROVISIONAL (NOTE: Wells with * also available in real-time at top of Ground -Water Data page) WELL L START NET CHANGE DEPARTURE WATER LEVEL T I YEAR IN MONTH IN ONE FROM BELOW LAND - 0 T OF YEAR MONTHLY SURFACE P H RECORD 25 MEDIAN DATUM 0 0 0.19 - 0.64 (OWC) 0.51 3.99 26 (FEET) (FEET) (FEET) (FEET) DAY MASSACHUSETTS ACTON 158 * TS 1965 - 0.63 + 0.30 + 0.29 18.57 29 ANDOVER 462 VS 1968 - 0.43 - 0.27 - 0.68 15.45 25 ATTLEBORO 83 VS 1964 - 0.19 - 0.64 - 0.51 3.99 26 BARNSTABLE 230 FS 1957 ----- ----- ----- ----- BARNSTABLE 247 FS 1962 + 0.00 + 1.35 + 0.36 24.30 23 BECKET 12 TS 1986 + 0.00 - 0.68 + 0.00 3.53 18 BILLERICA 363 HS 1962 - 0.81 - 1.25 - 3.99 9.83 24 BLANDFORD 9 VS 1986 - 0.14 - 0.45 - 0.06 2.37 19 BOURNE 198 FS 1962 - 0.03 - 0.34 - 0.45 33.46 26 BREWSTER 21 FS 1962 + 0.00 + 1.78 + 0.26 10.30 25 BREWSTER 22 * FS 1962 - 0.04 + 0.82 + 0.14 31.22 .29 CHATHAM 138 FS 1962 - 0.06 + 0.23 + 0.86 23.12 25 CHESHIRE 2 HT 1951 - 3.00 ----- - 2.16 8.19 17 CHICOPEE 95 TS 1984 - 0.36 + 2.29 + 0.52 21.32 18 COLRAIN 8 VS 1965 - 1.04 ----- + 1.14 18.36 18 CONCORD 165 TS 1965 -- 0.19 + 1.64 - 1.03 43.31 24 CONCORD 167 TS 1965 - 0.89 - 1.15 - 1.48 8.50 24 CUMMINGTON 13 VS 1986 - 0.53 - 0.48 - 0.40 5.25 18 DEDHAM 231 ST 1965 ----- ----- ----- ----- DEERFIELD 44 VS 1965 + 1.00 ----- + 0.11 2.50 17 DOVER 10 TS 1965 ----- ----- ----- ----- DUXBURY 79 * VS 1965 - 0.25 - 0.68 - 0.56 8.15 29 DUXBURY 80 VR 1965 - 0.95 - 0.53 - 0.51 21.55 24 EAST BRIDGEWATER 30 HT 1958 - 2.00 - 1.77 - 2.17 9.10 24 EDGARTOWN 52 VS 1976 - 0.01 + 1.06 + 1.26 17.74 26 FOXBOROUGH 3 TS 1965 - 0.47 - 0.26 - 0.31 18.90 24 FREETOWN 23 TS 1964 - 0.42 + 0.63 - 0.15 13.55 26 GEORGETOWN 168 VS 1965 - 0.23 - 0.92 - 0.63 4.77 25 GRANBY 68 VS 1954 - 0.81 + 0.37 + 0.21 7.29 18 GRANVILLE 5 TS 1965 - 0.53 + 3.12 + 2.56 31.00 18 GRANVILLE 6 SS 1965 - 0.34 - 2.04 - 1.30 6.00 18 GREAT BARRINGTON 2 VT 1951 - 0.28 + 0.64 - 0.34 10.63 18 HANSON 76 VS 1964 + 0.07 - 0.56 - 0.55 4.79 24 HARDWICK 1 TS 1965 - 1.52 - 0.19 - 0.32 15.09 22 HARDWICK 31 TS 1984 ----- ----- ----- ----- HAVERHILL 23 TS 1960 - 0.71 - 0.15 - 0.59 12.66 25 HAWLEY 8 ST 1986 - 0.06 ----- + 0.40 3.50 18 LAKEVILLE 14 * TS 1964 - 0.75 + 3.30 + 1.48 13.67 29 LEXINGTON 104 VS 1965 + 0.21 - 1.27 - 0.25 2.43 24 MASHPEE 29 FS 1976 - 0.24 - 0.87 + 0.16 8.31 26 MIDDLEBOROUGH 82 VT 1965 - 2.95 - 0.68 - 3.27 8.81 24 MONTGOMERY 19 SS 1986 - 0.35 + 0.00 - 0.14 1.46 19 NANTUCKET 228 FS 1976 ----- + 1.21 + 0.68 25.02 26 NEW BEDFORD 116 VS 1964 + 0.28 ----- - 0.49 4.23 25 NEWBURY 27 VT 1965 - 2.06 - 2.05 - 1.80 7.49 23 SUMMARY OF GROUND -WATER LEVELS FEBRUARY 2004 PROVISIONAL (NOTE: Wells with * also available in real-time at top of Ground -Water Data page) WELL L START NET CHANGE DEPARTURE WATER LEVEL T I OF IN MONTH IN ONE FROM BELOW LAND - 0 T RECORD YEAR MONTHLY SURFACE 1 of 4 3/25/2004 9:53 AM A RICHARD G. ASOIAN MARK E. TULLY AARON A. GILMAN ROBERT W. LAVOIE NICHOLAS FORGIONE JAMES H. KRUMSIEK MARK J. SAMPSON ROBERT J. AHEARN KATHLEEN M. CONNELLY JOHN R. BLAKE. JR. Town of North Andover Board of Health Town Hall North Andover, MA 01845 ASOIAN, TULLY & GILMAN P.C. ATTORNEYS AT LAW 12 ESSEX STREET POST OFFICE BOX 39 ANDOVER, MASSACHUSETTS 01810 February 27, 1995 ANDOVER (508) 475-9100 BOSTON (617) 942-0932 TELEFAX (508) 470-0618 RE: Applicant: Rockwell, Trustee of SFR Realty Trust Map 107A, Parcels 162, 164 and 167 Dear Sir: Enclosed herewith please find a check in the amount of $450.00 which represents the fee due for soil testing and a copy of the deed relative to the above. Should you have any questions, please do not hesitate to contact us. Very truly yours, ASOIAN, TULLY & GILMAN P.C. Robert W. Lavoie RWL: jm Encl. rock.1tr S. FORBES ROCKWELL, JR. TTEE S. FORBES ROCKWELL, JR. TR DTD 312is� 370 SUMMER ST0225 ' NORTH ANDOVER, MA 01845-5638 PAYT0 71,1E 02/2725-80/440 19 9 5 ORDER OF Town of North Andover Four hundred fifty$ 450.00 %J DE,1N 14T7TER and 0 0 / 10 0 REYNOLDS INC. B4NK=gyE ABCDEFG KLMIN PDorsAvu BA"oW eowmsus.ru RST UIVIWIYIZ MEMO I:044000B041: 48444490 r 231 QUITCLAIM DEED I, S. Forbes Rockwell, Jr. of North Andover, Essex County, Massachusetts for consideration paid of less than One Hundred ($100.00) Dollars grant to S. Forbes Rockwell, Jr., Trustee of SFR Realty Trust, under Declaration of Trust dated May 7, 1992 and recorded with the Essex North District Registry of Deeds prior hereto with a mailing address of 370 Summer Street, North Andover, MA 01845 with QUITCLAIM COVENANTS the following parcels four (4) of land with the buildings thereon situated on Summer Street in North Andover, Essex County, Massachusetts: PARCEL ONE: -� s� o �-4 The land with the buildings thereon situated on the o easterly side of Summer Street shown as Lot 8AA on a plan of �--- rland entitled "Plan of Land in North Andover, MA for S. Forbes Rockwell, Scale 1"=40' Date: February 13, 1978 Revised 7/19/78 Frank C. Gelinas and Associates" which Plan is recorded in the m <4 Essex North District Registry of Deeds as Plan No. 7879 and to N z which Plan 7879 reference is made for a more particular .� 4 o � o description of said premises. v Said Lot 8AA contains 80,121 square feet, all according to Co r° said Plan. v PARCEL TWO. �a a The land with the buildings thereon situated on the o easterly side of Summer Street shown as Lot 9AA on a plan of H land entitled "Plan of Land in.North Andover, MA for S. Forbes Rockwell, Scale 1"=40' Date: February 13, 1978 Revised 7/19/78 a Frank C.. Gelinas and Associates" which -Plan is recorded in the Essex North District Registry of Deeds as Plan No. 7879 and to which Plan 7879 reference is made for a more particular odescription of said premises; x z � � ° Said Lot 9AA contains 70,777 square feet, all according to o ?n said Plan. PARCEL THREE: O The land with the buildings thereon situated on the .. m easterly side of Summer Street shown as Lot 10A on a plan of C_ land entitled "Plan of Land in North Andover, MA for S. Forbes Rockwell, Scale 1"=40' Date: February 13, 1978 Revised 7/19/78 Frank C. Gelinas and Associates" which Plan is recorded in the Essex North District Registry of Deeds as Plan No. 7879 and to which Plan 7879 reference is made for a more particular description o.f said premises. '232 Said Lot 10A contains 43,593 square feet, all according to said Plan.. PARCEL FOUR: The land with the buildings thereon situated on the westerly side of Summer Street shown as Lot 3A on a plan of land entitled "Plan of Land in North Andover, MA for S. Forbes Rockwell, Scale 1"=40' Date: December 15, 1977, Frank C. Gelinas and Associates" which Plan is recorded in the Essex North District Registry of Deeds as Plan No. 7764 and to which Plan 7764 reference is made for a more particular description of said premises. Said Lot 3A contains 43,864 square feet, all according to said Plan. For title reference, see deeds to the Grantor dated November 7, 1950 and recorded with. said Deeds at Book 744, Page 481 and deed dated April 26, 1974 recorded with said Deeds at Book 1240, Page 389. -Signed as a sealed instrument this 7th day of May , 1992. Essex, ss. S. Forbes Rockwell, Jr.r. COMMONWEALTH OF MASSACHUSETTS o May 7 , 1992 Then personally appeared the above named S. Forbes Rockwell, Jr. and acknowledged the foregoing instrument to be his free act and deed, before me, ;No/;I'a'4y- Publ Robert W. Lavoie Commission Expires: 7t12,194 9205R —2— r 0 G810 S113snHOVSSM 'U3AOCINV 6E X08 301.U01SOd 133!!15 X3SS3 tl Myl IV SA3Na011V 'O'd AITU V NVIOSY "Piz, l Cl V l Ul Z U y J � C7 oe Ln � �o Z U y J � C7 oe � �o 8� 'ON IV-ld 33S TO THOMAS E. NEVE ASSOCIATES, INC. ENGINEERS • LAND SURVEYORS • LAND USE PLANNER 447 BOSTON ST. = ROUTE 1 t'' b TOPSFIELD, MA 01983 k)o (50 W7400 SUBJECT 01 � � _m� R L&n 7 o USP ITEM # ML72L The Drawing Board, Dallas, Texas 75266-0429 Fold At (—) To Fit Drawing Board Envelope #EW9DW © Wheeler Group, Inc., 1982 N 20'd 6T: TZ S6`02 DPW 02-Z8—Z8£ 209'ON 131 llamj3o�j ufiloip.- Commonwealth of Massachusetts REd'j�;® City/Town of North Andover System Pumping Record TOW,.NI OF NORTH Form 4 HEALTH DEPAR jvNTER M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out forms 1. System Location: . on the computer, use only the tab key to move your Address cursor - do not North Andover use the return City/Town key. 2. rab System Owner: fyy Name ienan Address (if different from location) City/Town Ma State State Telephone Number B. Pumping Record Au� i L 1. Date of Pumping -Date 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Zip Code Zip Code /a) Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑ No Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant. 20 So. Mill Bradford, Ma 01835 ,5Si,nakleof Hauler Date of Receiving Facility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1