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Miscellaneous - 540 SHARPNERS POND ROAD 4/30/2018
540 SHARPNERS POND ROAD d Road 1 F v 210/090.B-0038-0000.0 J 1► Z-- �` Date . . !. . .�. . . . . • • �egy7`i' 31y, TOWN OF NORTH ANDOVER PERMIT FOR WIRING r This certifies that . . .1.�.r �.,. . �?�1. �r--. . . . . . . . . . . . . . . . . . . . `s . . . �. . . .. . .c . . ` . . has permission to perform . .Q. . _. . . . . . . . . . wiring in the building of . ....l. Z -2 2A . . . . . . . . . . . . at . . . . . . . .zp. .c—�!�1. -.ei`".?! . . o?rth Andover, Mass � 1`� Fee �l`� . . . . Lic. No. f"1 . . . . . . . .. G ELECTRICAL INSPECTOR Check# _ �i 1(P 11260 •a / Official Use Onl .%'} Cornrrconwea[th o aeeachweffd [[Rev. ermit No.-:-,, ' / 60 c� •� _ oUeParfmznf or��ire erviee9 ;�, _•.;,.•, ' _ ccupancy and•pee Chec(<ed BOARD OF FIRE PREVENTION REGULATIONS 1/071 (leave blank) PERFORM EL ECTRICAL. WORK APPLICATION FOR PERMIT TO ' All work to be performed in accordance with the Y[assachusetts Electrical Code(MEC),527 Civ[R 12.00 (PLEJSEPRINT1YLffK OR TYPE ALL RVFORILl.4TION) Date: ' NOV; 3O — 2012 '' To the Ins ector o M7-es: Ci or Town of: P By this application the 1.4dersigned gives o his or her intention to perform the electrical work described below. Location(Street&Number) 520 SWARM= POND }ROAD Owner or Tenant F:=j2W RAL. Telephone iNo,CM 62iq b�330 owner's Address' A - m Z Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No, Existing Service Amps / Volts Overhead❑ Undgrd❑ No,of Meters New Service Amps / Volts Overhej4❑ Undgrd❑ No.,of Meters Number of Feeders and Ampacity e Location and Nature of Proposed Electrical Work: V K _ �N Completion o the followin• table mav he waived by the Inspector of Wires, No,of Recessed Luminaires No,of Ceil.Susp,(Paddle)Fans No.of Total Transformers.. KVA No,of Luminaire Outlets No.of Hot Tubs ' Generators KVA Above In- o,of ling No.of Luminaires Swimming Pool grnd. ❑' grnd., Q mergency igBatter Units a • No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones ' No.of Switches No.of Gas Burners No'.of Detection and Initiating Devices Total No.of Ranges No.of Air Cond. Tons No,of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KyV..._.... No.ofSel#=Contained. r P Totals:. Detection/Alerting Devices No, of Dishwashers Space/Area Heating I{W Local[IMunicipal ❑ Other Connection No.of Dryers Heating Appliances Security Systems:*. No,of Devices or Equivalent No.of Water KW JNo.of No:a#' Data Wiring: Heaters Si ns Ballasts . No, of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP, Telecommunications Wiring: No,of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector oj'Mres, Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee;orovides proof of liabilityinsurance including"completed operation"coverage or its substantial equivalent, The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE:'INSURANCE.❑ BOND ❑ OTHER ❑ (Sgeciry:) I cern,ander the pains andpenalties ofperjury,that the information on this application is tate and complete. FIRM NAME: LIC,NO.: Licensee: - lm -•W y N�►`� Signature .ur,� Vc yWtQ LIC,NO.: � `J ' (If applicable,enter"exemggt' in the license number line. Rus.Tel,No,: Address: LI 0(p 13r�2Upt1 wn4 aV—t?ttY- J MA 0/832 Alt.Tel.No,: *Per M.01,c. 147,s.57-61,security work-requires Department of Public Safety"S"License: Lie,No. OWNER'S INSM--UNCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law/.-By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PE21111T FEE,S �' ,�� , . <�' s � :.. .f .� i y ."� ? x { ` /,• F _ • s _ " . _':The Co>�nonwealtla of Mm�ac/utsEttc : : . x Department n,f I�dustrietAccider�c- Office of Imestigadoxs Boston,MA 62111 �'1 wwtv;mas�gov/dao � . wot'kers'Coltpe= 1%,bshmnei ASidavW Bw't uWCoatractorsMectriaa idPtambers nr aformation . Please Print Lekibly_ Name.(BWhNM lorgassz$a,nATtOhiaasl)• __ .1"' M V.I`•1 1�9 Address:_ 1�.h C,.. : tib ADyJ Lim 1 ►� cityt 'Z�p Op Are yoo an z1hplayer7 Cheetc.the appropriate bow., TyPe Of prgleet(r ,� ❑ I'am a employee`.with 4. Q I anti a genetiaf contactor and I employees(full and/or part-time* have Fired the qui acxors 6 ldew conqbuction 2. I am asole prnprieoor.Or partner- .Iismd.on the-ap W sttet:i. 7. Q Re�madeliag ship and have no employees 't9tese snb-eontraoWzs have 8. Q Pmnofid t- workietg liar me in any capacity, workers' comp.rosin . 9. Q [No workers'comp.hmnnce 5.•Q_ We are a`corporation W.its But7dit�edition 9 .1 'officers have dwbised their IQ•❑Electrical repairs.oradditions 3.❑ 1 sin a homeowner doing 211 Work right of exeinprteon l MOL I I:Q Phetobing repairs or additions myself[No-workems comp: c, UZ §I(41-`and we have no 12.[:]Roof.c�spaire inste=ca.eetltmed ja employees.[No workers' t3.Q.Qther. . . . . . .. comp.ii�stttantx r+�ttircd. - 7 ; •My appifoeut c ohackalw t#1=M also fill oWrft scWon bdow showing theiraimkeo;• oalim,Pot!e�e mfium�ation, t HIM ".#sthfs aiiitlavit hafiedtng they:aM"S all work a nd;O hiss etOSW conusetore 06Wnu8mitn newaffidavit iudumtiog tConoridtont;6►at�d�t Ibis box ft&W an WftO rel. such. 9 s M.mm�e of tlro aab• :+pul ttadrvroiia�•o�Ro�Y ion. 1 ant an a loyer.&ax Js v g x►prketat'Con on hMn=W for tag'a lg, ; °Brtow Is Ute p�plicy and job sly irejortrroA. . , Insurance Company Name:' Pohcy#or Self--ins.Lic.#: _ yob s to aade 2,� s ►RnN E R Pb&nCmy/s�zm • Attach a copy of the worliera'ooatpeosatioo policy dechtratiou page(showing the policy n�bar and expiration datx). Fai'Itae to assure coverage as:rcgni tmtlei Setxion 25A.of lVIC3I,c. 152 can lead.to the imposifron_of cu�ainal penalties of a fine up°to.$1,50Q.00 aitdloe one-year imprisonment;as well ns civil m the foem of a S'POP WORK;ORDER and a fine of upto$250.00'a .'a 'ifist the violater. .13e advised,dw a eopy of this statBment may.be forwarded to the OW=of Investigations of the DIA for rres u'm=coverage verificatkm. I.do ' .IY«oder the pa tic and pwahtas of perjury' Nle h&'MWOn pmvMed a"w is am and Comm Phone#: ESQQ L (n .21 n O lrial trse obly. Do n&antero this wvag .m.be caPttr*ed. or Own City or TowtC Permit/u=se# Issuing Authority(circle one): . I.Boars{of Health 2..Building Department 3.City/Town Clerk. 4.EfectrFca!Inspector S.Plumbing Inspector 6.Other J Contact Person: Phone#: PERC E y J P <�FiF .' / ,'j q l Cf) ke {;•J�".. \:' __ _ .. 1 I ... Vie..-3:� •' ��� . ...._....--' tr-� fix`* .._�,..;'�; $ S � 1 i �c-owr:t Yf>j ti � � / low;- ;rj T Is I.,t`t j •/r �`� \.> �(�.%•`I t 1' ,{,.,,cam},..'). 1-4,S I_Lll taivk �u� ,J� q•/3 QoX /N G3 ASSq, JMAP AR3AG��t.0 E ^ j� I ( , # �•/ AC'RF r I �,f SS f e . � SHA!/off( /5o o GH/• 2e O N f� `�_ f-�sFph ,ER Town of North Andover Page 1 of 1 . - FIL . . Base Map Zoning 2005 Aerials Watershed Zone Utilities E, size u�� Selection Legend Location Markup Help Scale 1"= 183^ R Select fi ',Parcels l� I•. t. - , > (OwnerI Prop_ID I Address HORN,BENJAMIN G. 105.D-0125-0000.0544 SHARPNERS PC #544 Baty .i, i` / 5JM126 105.80125 M2 090JM037 , 40 1 selected To Mailing Labels To Spreadsheet ❑ Property Building Permits Planning Septic Pujij #1542 040J3-0038 __. •.�.,tc I`� Print !rm H BENJAMIN X0.11-00A Owned HORN, G. Owner2 HORN,MARY it -... .....,.� .. .., - - Address 544 SHARPNERS POND ROAD PropertyID 105.D-0125-0000.0 090,$-0042 105.80124 Lot Size 4.6 A Fiscal Year 2010 Land Use 101 10_S U 012 ~ Code t ►_sit nvt�i�nna Get Pictometry Go v3.2.0 AppGeo Save MaA as Im 1 •'" t;"� Merthnmk Wl FlAAnrdn tamm�ian Coes rot make wa!ra ey 9 any my,edor Mapfed.rwr ewum+e any MpILaWlayarespastonty for thsarsurtkyCV'nCIL"etteae.. or rSE!ttne5a a the Geagraphic lmormmt Systan(=I Data cr any omen data pnmtled herein.i'he[IaL7�.not Leta tare paMae d e prAtesYscvt�YY mrd tt5e rto ft-A ttes.: an is i t annalicn e a oarnpa t,d eAatfute of a to fts sa h. fmtu'e.?r Mm the,alLy e[al ng Ccn iss 'ss.m- l balky makes no C r yjes`C t requ'�.s m�any 1C:e of tn$itffo�rrfotlm be acoomd eya rEfeigtcC W It95aU Ce aM the A4erHmxk Vatlay i�1amring GCrtxnissiaYec.+veetmet a ntak2S rKl uf@rraMJesOr repawftaSens as to the accu=y of Said iMcemabam Any useot INs Wonnattan 1s;*ate r em aO dstc http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx 5/23/2012 t 6141 . J D s �,f • 'own of North Andover , HEALTH DEPARTMENT ,s SA U56t CHECK#: 11,9 ® DATE: LOCATION: H/O NAME: CONTRACTOR NAME Tyne 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) $ ❑�TitleSpectoreport $ ❑ Other:(Indicate) $ ealth Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts Title 5 Official Inspection Form tz,-l� z Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 12012 page. 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. Please see completeness checklist at the end of the form. Important:When A. General Information M filling out forms on the computer, use only the tab 1. Inspector: f key to move your JUN A �1 cursor-do not SEAN MCGONAGLE use the returnName of Inspector -rom OF NCS FIRTr key. MCGONAGLE SEPTIC HEALTH DPART�EN Company Name P.O. BOX 142 Company Address HUMAROCK MA 02047 Cityrrown State Zip Code 781 7104586 S14281 Telephone Number License Number B. Certification 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 by the Local Approving Authority JUNE 12012 spector's Sig. ure 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r e Cgmmonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. Citylrown 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: 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. Check the box for"yes", "no"or"not determined"(Y, N, ND)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. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Cgmm.onwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ 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 ❑ N ❑ ND(Explain below): i i ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ 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 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 t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) 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, f environment: safety and en nment:o ❑ 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 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 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 Y2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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. ❑ ® 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. Cityrown 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: 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 :,_ . Commonwea_ith of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is NORTH ANDOVER required for every MA 01845 JUNE 1 2012 page. CityCrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): WELL Detail: WELL MUCH GREATER THAN 100' FROM S.A.S. i Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Ownef's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: UNKNOWN Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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 IIA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: AS BUILT DATED 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 10"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >100' Comments(on condition of joints, venting, evidence of leakage, etc.): JOINTS TIGH, VENTING NORMAL, NO LEAKS Septic Tank(locate on site plan): Depth below grade: 11" 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: 1500 GALLON Sludge depth: 2" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. Cityrrown 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 32" Scum thickness TRACE 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 12" How were dimensions determined? DIPPERSTICK, TAPE MEASURE Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): INLET BAFFLE, OUTLET TEE,TANK SOUND,PROPER LIQUID LEVEL,NO LEAKS, 11" BELOW GRADE,REAR OF PROPERTY SLOPES DOWN AWAY FROM HOUSE Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: 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 Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is NORTH ANDOVER MA 01845 JUNE 1 2012 required for every page. Cityrrown 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.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: i Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): 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 t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Flame information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert O 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.): D-BOX LEVEL,DISTRIBUTION EEQUAL, 2 OUTLETS, 17" BELOW GRADE Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection forth:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: I ❑ 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.): SILTY GRAVEL,NO HYDRAULIC FAILURE OR PONDING, GRASSY AREA 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is NORTH ANDOVER MA 01845 JUNE 1 2012 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. Cityrrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope ® Surface water Check cellar ® Shallow wells Estimated depth to high ground water: 138" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1984 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: SOIL TESTING PROVIDED WITH REPORT B.O.H. RECORDS Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 1 T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 540 SHARPNERS POND ROAD Property Address BROSNAN REALTY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 1 2012 page. 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 ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i I t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 v--:s...of;.non�r..nR�ssA¢s'[��a+iY^e::�tMVt:roY+oEu.F..Mettt:t¢rRSF O.�nwai'aea+A'nr[r.�.a:>sAtt'1RK1Sai+s:xl:CvYbsvir-Z4:G.1:.Y"=::..',..:��::_�..�.-IC:::.:::::':._'.:::��:;:��Y:t_��a^R.N.➢':;' !+." f IQ,S //V G R 0 U Aloe? eft tgnik tp 11913 Liox /N /23 �G3 pF MASS 9 QoX ctx � Izx •�S �P`' FN r ss' T 1 . //o �0 p//✓�+r lY1 SS ER;S P oN.D RD . TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: I SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) o DATE OF PUMPING: A 13 QUANTITY PUMPED San GALLONS I CESSPOOL: NO YES SEPTIC TANK: NO YES I i NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION I N FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY. COMMENTS: CONTENTS TRANSFERRED TO: r.,rte9�- �R � �- :x' �-�n`���'h` � y1 aR _ DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, May 24, 2012 5:01 PM To: 'ridge@brosnanrealty.com' Subject: I.R. -540 Sharpners Pond Road, North Andover Attachments: 20120524161807645.pdf To: Christina Brosnan Realty 617-787-2860 Dear Christina, Here is the information I had in the file for 540 Sharpners Pond Road. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaieCcDtownofnorthandover.com Web www.TownofNorthAndover.com 2 Watershed Septic System Servicing Report Dater Homeowner: — - � Pumper Street C Phone ._ Address: '° -d-��- t-02 Phone 1�/1 OF NOR FHWE Mg �H Nature of Servic,y: Rorti:ne J( .�p�lN�o�RpO Em urgency . 31985 Observations: Good Condition Fu: l to Cover Bal f les in Place g9S— Lea.chf ield Runback , Excessive Solids Heavy Grease AJ6 Roots N6 Oth ar (Explain) E t do Desc.._� ' i p n of Work. Comments: P TOWNA� 0 ANDOVER SEPTIC SYSTEM SERVICING Date: REPORT �(� �7 Homeowner:_ Street Pumper Phone Gf 'l -[Cl1 cess: Ph on e Nature (Df S,, l _ry ' c • e ROutlne Emergency Observations : Good Condition � • Full to Cover Baffles in Place Leachfield Runback _ Excessive Solids Heavy Grease Roots Other (Explain) i Description of r;`or},; Comments : TC'Wie��i ted € RTI -for"r i TOWN OF NORTH ANDOVERN°RTM Office of COMMUNITY DEVELOPMENT AND SERVICES o: HEALTH DEPARTMENT 400 OSGOOD STREET `", . •r�' NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.9542—FAX Public Health Director E-MAIL: healthdept@townoftiorthaiidover.com WEBSITE:hitp://www.townofnorthandover.com April 11, 2005 To all Sharpeners Pond Road Residents: Please note that it has come to the attention of the Health Department that many residents are leaving their trash barrels and trash bags out at the curbside for days, or weeks at a time. Empty trash barrels blowing about in the road are a safety hazard, and trash and debris along the roadway is a health hazard. Please be mindful of this, as the Health Department will conduct periodic inspections of the area to determine who is in violation, and fines will be issued if protocol is not followed. The Board of Health follows the State Sanitary Code regarding Human Habitation, 105.CMR.410, Section 1: 410.600 (A): Garbage or mixed garbage and rubbish shall be stored in watertight receptacles with tight- fitting covers. Said receptacles and covers shall be of metal or other durable, rodent-proof material. Rubbish shall be stored in receptacles of metal or other durable,rodent-proof material. Garbage and rubbish shall be put out for collection no earlier than the day of collection. i (B): Plastic bags shall be used to store garbage or mixed rubbish andgarbage only if used as a liner in watertight receptacles with tight-fitting covers as required in 105 CMR 410.600(A), provided that the plastic bags may be put out for collection except in those places where such practice is prohibited by local rule or ordinance or except in those cases where the Department of Public Health determines that such practice constitutes a health problem. For purposes of the preceding sentence in making its determination the Department shall consider, among other things, evidence of strewn garbage, torn garbage bags, or evidence of rodents. 410.602 (A) Land. The owner of any parcel of land,vacant or otherwise, shall be responsible for maintaining such parcel of land in a clean and sanitary condition and free from garbage, rubbish or other refuse. The owner of such parcel of land shall correct any condition caused by or on such parcel or its appurtenance which affects the health or safety, and well-being of the occupants of any dwelling or of the general public. (D) Common Areas. The owner of any dwelling abutting a private passageway or right-of-way owned or used in common with other dwellings or which the owner or occupants under his control have the right to use or are in fact using shall be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth or causes of sickness that art of the I p passageway or right-of-way which abuts his property yand which he or the occupants under his control have the right to use, or are in fact using, or which he owns. r Residents should know the following: • The Town has a mandatory paper and cardboard recycling ordinance that requires residents to separate these items from their household trash. Paper and cardboard are collected every other week on the same day as the household's normal trash. Residents can call the DPW at 978.685.0950 to get their recycling schedule. • Residents are responsible for picking up loose trash left at the curb after collection. Banned Items and Recycling Requirements: Please refer to the DPW website for a complete list of all the recycling requirements: http://www.northandoverrecycles.com. Please contact the Health Department if you have any additional questions. Thank you. SZanY. awyer, REHS/RS Public Health Director File i Board of fleal,tn Ncrtk 'mdover,Mass r. , SUBSURFACE DISPOSAL DESIGN CHECK Lt ST rc�&-6- LOT APPROVED DATE1-a 12DISAPPROVED DATE' S 5 3 7 9 Provided: Reasons: .^/ J f1Evv�i;SG v Title V FAIL OK Reg 2.5 The submitted plan must show as a mdnimum: a) the lot to be served-area,dimensions lot #,abutters ,16- b location and log deep observation hoes-distance to ties ,lu(� c location and' results percolation testa-distance to ties rE Ed design calculations & calculations showing required leaching area '��,� (e) location and dimensions of system-including reserve area ' L (f) existing and proposed contours A� (g) location any ,let areas Athin 1001 of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 1001 of sewage disposal system or disclaimer (i) location any drainage easements within 1001 of sewage disposal ystem or disclaimer-Planning Board files s (3) known sources of water"supply within 2001 of sewage disposal e system or disclaimer; (k) location of any proposed well to serve lot-1001 from leaching .facility (1) location.;of water 'lines 'on property-101 from leaching facility (m) location of benchmark (n) dri*eways (o) garbage disposals (p) no PVC to be ,used in construction (q) profile of system-elevations of basement, plumbp pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations (r) maximum ground water elevation in area sewage disposal system (s) plan mist be prepared by a Professional Engineer or. other professional authorized by law to prepare such plans Reg 6 Septic Tanks (a) capacities-150)6 of flow, water table, tees, depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes (a) -slope greater 0.08 Reg 10.4 b} stup F-llwJ OF N T I I.OT 11 st I �NE�5 ��pN1� ;,.MA, w TCi� Sc�P►�'�7 ,., �P�ouCD lYJT'CC 5 S StPT'1 c Sy S i EA j j,-)ESl C APR�ovlNG /ullioj;�1Ty < oO UJPITi owS UI SAPPR4VEp 1A-6 Dw� 3 SGPT c� S/STEM, t J ST4 U-A- 't OAJ v�Tr �� )� �c���.�►�a� U/JrG Ll-Zz.17 { P45S F4 RNAL l V5pF� lona 4PfN0vED D/ATE ���� ��7 /SP�r�U�►^�G �l�r�tOr���y � y N cA-'DcKSOQ ���IT�OJJAL� I��-i IIONj X11=A►--�y) DIS/11071;�Uv�D D,a i C R�So NS � ML APPROVAL 1 APPROXI VJ6 /6 iH OP,I �j ro a Massachusetts Water esources Commission/Division of Water Resources WATEFiN"IELL COMPLETION REPORT WELL LOCA FON Address n/ �+h,� R A " f ill City/Town Alli 4,,, L,11A#- la. G.S.Quadrangle Map Grid Location Owner <'.A .c 'T,,,1 Address R-.,v -N 9' rlln fl n Ilrai��- X41:4 /1/2tl ay WELL USE CONSOLIDATED WELL Domestic© Public ❑ _Industrial❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From 4/) To Rotary(type) Ti4 1:�5 Cable❑ 2) From art To 7"I'r Other 3) From To 4) From To CASING Depth to Bedrock ft Length .11 Diameter. � Type r4p..I 1�7, 14 UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface /.5 Sand: fine❑ medium❑ coarse❑ Date measured ,-3/-3-QIAI_ Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: Yes ❑ No Q Slot# length from to Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Slot length from to Chemical ❑ Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To A9A4 9 / o Cb DRILLER y Cb Firm _A z m Address City Ah, a.Mlsa �l/rf Registration No. �J petator'7 Please print irm y 9 gnature 1OM-8181-164843 e e e --Stevens Wafter Analysis 38 Montvale Avenue * Stoneham, MA 02180 Mass. (617) 438-6114 * Salem, N.H. (603) 893-3106 LABORATORY NUMBER: 2446 SAMPLE DATE: 3117186 SUBMITTED BY: WILMINGTON PUMP SUPPLY 639 Woburn Street Wilmington. MA 01887 SAMPLE SOURCE: New Well - S.B. HOMES, INC. , No. Andover, MA - Lot #11 ANALYSIS: According to Standard Methods of Water and Wastewater Analysis, 15th Ed. Total Coliform . . . . . . . . . . . . 0 per 100 ml Chlorides. . . . . . . . . . . . . . . 7 mg/L _ I p}I . . . . . . . . . . . . . . . . . 7.6 Hardness . . . . . . . . . . . . . . . 60 m g/L Manganese. . . . . . . . . . . . . 0.07 mg/L Sodium . . . . . . . . . . . . . . . . 4.9 mg/L Iron . . . . . . . . . . . . . . . . . 0.05 mg/L Nitrate. . . . . . . . . . . . . . . . less than 0.10 mg/L Nitrite. . . . . . . . . . . . . . less than 0.10 mg/L COMMENT: The results of these analyses meet the required federal and state standards for drinking water. However, the manganese concentration exceeds the recommended standard. Although manganese is not harmful to your health, it can affect the taste, color and odor of your water. Manganese is frequently found at elevated levels in new wells% however, it is .likely that the concentration will decrease when the well is put into regular use. )Voll Chemist/ crob olo at