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Miscellaneous - 542 SHARPNERS POND ROAD 4/30/2018 (2)
�.s _ -- --_-- 542 SHARPNERS POND}ROAD d Road _ 2101090 000. _:- _T--- Department of Environmental Management/Division of Water Resources til WATER WELL COMPLETION REPORT WELL LOCATION Address S ,P r ay-j nt Rnvld, R1,14 01 #7 ICity/Town I(.VU. Ani wet- MA G.S.Quadrangle Map Grid Location OwnerS-81-10n,^ 7,�,r. Address P.j. Lg-)X 39Q All. 4,22, Igr M WELL USE CONSOLIDATED WELL 4 Domestic® Public ❑ Industrial ❑ Type of Water-bearing Rock Other 0 Water-bearing Zones �To �?0 Method Drilled T/� Ste] 1) From 21 From 9,qO To �6 0 Date Drilled 3) From Tc 4) From-To CASING Depth to Bedrock Length e2n, Diameter- Type iameterType S&tt --/5 /h UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing.Materials Feet below land surface .;O Sand: fine❑ medium❑ coarse❑ Date measured .3 Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL Slot# length from to_ Yes [] No 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 0 ro 6 � 'P m DRILLER Firm A-I. M4,AAk /A Address /10• Ay City /}& .Q",k,,na /1/1 Registration No. -J Operator's ignature Please print rrm y BOARD OF HEALTH COPY 25M•10.85-807101 Board of Health SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT # 7 Si1AWlE�SP . ovED DATE i i- � DISAPPROVED DATE_ ,j 76 Provided: Reasons: A R Title V FAIL OK Reg 2.5 The submitted plan must show as a minim-im: a} the lot to be served-area,dimensions lot #,abutters . � b location and log deep observation hoes-distance to ties +. c location and results percolation tests-distance to ties __-- - d design calculations do calculations showing -required leaching area (e) location and dimensions of system-including reserve area f) existing and proposed contours g) location any wet areas within 100' of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 1001 of sewage disposal systema or disclaimer-Planning Hoard files (3) known sources of water supply within 2001 of sewage disposal d system or disclaimer �- (k) location of axW proposed well to serve lot-1001 from leaching facile (1) location of water lines on property-101 from leaching facility (m) location of benchmark (n) driveways { (o) garbage disposals (p no PVC to be used in construction (q) profile of system-elevations of basement, plumb, pipe, septic tank, -- ---- distribution. box,inlets and outletes distribution field piping and Other elevations (r) =uimam ground water elevation in area sewage disposal system (s) plan mast be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Septic Tanks (a) capacities-1507, of flow, water table, tees.* depth of tees, acceass pumping (b) cleanout (c) 101 from cellar wall or inground swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes (a) Wpe greater than 0.08 Reg 10.4 b) sung • 00 ~ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A . p/ CERTIFICATION Property Address- 28 Owner's Name: Q+ Owner's Address: Date of Inspection:T/)YO p1__ Name of Inspector• (please print) $ Company Name: S' Mailing Address: ' Telephone Number: 99,39 - 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 7tSeion 15.340 of Title 5(310 CMR 15.000). The system: es onditionally Passes eeds Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall sub a copy s inspect' n report to the Approving Authority(Board of Health or DEP)within 30 days of comp mg this inspe tion.If a 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. ---- TOWN OF NORTH AfVD6i,°F�/ y BOARD OF HEALTH Notes and Comments x JUN 13 2001 r ****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 wi Il 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: 0 • eV Owner: rvi Date of Inspectio Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy em Passes: I have not found an y 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. Answer yes,no or not determined(Y,N,ND)in the explain. for the following statements.If"not determined"please The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally III 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): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: �d O , a Owner: A Date of Inspecti C. Further Evaluation is Required by the Board of Health: r 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. I 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: x/a pond 0- Owner: r, Date of Inspecti ,x;71 Vol D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No . fBackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool . Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow 2 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. 3;"Any y portion of a cesspool or privy is within 50 feet of a private water supply well. ✓' portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private supply well with no acceptable water quality analysis. [This system passes if the well ater 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.] I Q (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 PP1 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Pond [-d Owner: I n I a Date of Inspectibi? Q Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Y7 No — Pumping information was provided by the owner,occupant,or Board of Health I — / 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? ave 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 signsof sewage back � g up . Was the site inspected for signs of break out? Were all system em com onent s,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 anof the failure criteria na related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r SYSTEM INFORMATION Property Address: yacn& PA . Owner: n rr,c4,�a Date of InspectQ.135'//g401 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 C 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: r �� Does residence have a garbage grinder(yes or no): N Is laundry on a separate sewage system(yes or no):ID[if yes separate inspection required] Laundry system inspected(yes or no): J(J Seasonal use:(yes or no): Water meter readings,if ayilable(last 2 years usage(gpd)): Sump pump(yes or no): CJ Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203). Lypd Basis of design flow(seats/personslsgl3,etc.): Grease trap present(yes or no):_ Industrial waste 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 ccupancy/use:OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: •T�y,, weko PAkWpa Was system pumped as part of the' pection(yes or no). If yes,volume pumped_ /.gallons—How was quanti pumped determined? j Reason for pumping: TY^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/Altemative 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): Approximate a e of all components,date ins lleknown if ( )and source of information: Were sewage odors detected when arriving at the site(yes or no): Q 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: nA&t F"D Pm t� Owner: or14'�ct Date of Inspecti(A: BUILDING SEWER(locate on site plan) Depth below grade: aqq Materials of construction:_cast iron 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) 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) 1 Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 'N6 Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet to or baffle: How were dimensions determined:_ Comments(on pumping recommendations,inlet and let tee or baffle condition,Atructural integrity,liquid levels as related to outlet invert,evidence of leakage,a)f.): j GREASE TRAP:ORocate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: Pbra Owner: Len p/ „x-0. Date of Inspectitin:11 TIGHT or HOLDING TANK:M�i tank must be pumped at time of inspection)(locate on site plan) M P ) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: eallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): I DISTRIBUTION BOX:Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): i PUMP CHAMBER: `(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I 8 Page 9 of l l . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 0 9RXNA �a Owner: %y)mX;7 Date of Inspectio SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Ty "' leaching pits,number: leaching chambers,numbe . leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): vti. C ` h , D-2 o- Dv a� CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) \V\ 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 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 condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): .: 9 Page 10 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Add]ress• Owner: 0. ' Date of Inspecti : _Qn SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system includ' ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Loca where public water supply enters the building. 1> oil �r . v t } t t IWOw cyl off ,.. ,Fv ity fvOT� » r `' 'I' ;., y,:eIC�`ptli �Y! AREA Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Add ress: Y,Q R� . Owner: q Date.of Inspecti 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: —141 ,.,,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) 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 elevati n: I� i i 11 uL,u4i�xol l Lt;Ub y 7B-hba-3J TO M`O,RAT, INC. PAGE 02 I. PER COI.A'T oN I' E S"T �.•/►S P E R C'CNt M E V (1N t4 AND AN15E'(A'Vf.lt 0 FOR THE N;;e'Z'r.c•t ANl�4,:I6.• DEPT, 1 /(; AL1N >l. PERCpLATION RATE k" IN 7 MINUTES II DESIGN FLOW: -* i5rko 'toomS X ISQ r*AL. F'E.R DEO+�oOM. PER DAY, E�UALS 6t1.- D. _•I 4. S8l•TIC TANK REOUIR D: DESIC;td F'1.Qw; f.Oc.'► l'si'V y l X 150 % E QU^LS V oc.) GAL. S. SErTIC TANK SELECTED: rSol., GAL � � 1 6, C.YL.INUNK.AL LEA(;N. PIT CAPAIC ITY FOR tHE C7CS16Nuw FERC RATE ABOVE, EQ b j SOI'TpM CAPACITY • IG 3`,t F. A 0..67 0S"LSF �tt3.7.a'. �L is w t SkOGWAII L CAV^iLiTY. 19G4-aF [ 1,4V GAL IS F ? TOTAL CAPACITY PF.R PIT ► 40a,7(t AL- NO. L8y.5Gt,Al W I 'Y. lA%f-I T 1 NITS REOUIFtf.0"1 r r;t>;,SI6N Fl.11vv •- Tri! . c� { CA`r'^CITv, NIT' • 2 r'ITS SCLE.C.'TEU ([VrALCAP.� 1. i^OIZ +�vSt:US N�CSr, SAE". $1'Sr'L•.Nl t.>po1..,16. ek ►►t.Ui�C;(t? S tvU Os{ Vu rt.t.T '; F,I•I• ., ,, . .. to. USF I1Toa•V�.Ic rc.>MP = � '. r!hRclv�i')E N..Tr,F+t,I;.►.t i t�l/NL� t..uNnAE(..'r IC��.�`� !'i) ,..+ tSF.P's +r 1',�hv1• �.f. 't 3U c ► (i.�:a :r►LCIS • 11, t►11� 'SYS► k C ►.' IS NCT IA `S",.A1Fn F,Cq� At S stiHAG[. x tZ. MAI 0)o,t % Ar1ri 1l"►5.! •I I Alts'•14 04ALt. BE !t•1 ACC-'.I►'tl�.�•It�ts wltl.l TGIF. f.lA $ S C►1 .tr,I :,1►,�I r..lt'Awt Ui'•r :t I t 1, �: 5) AMO t l It. S ANI'tAFll S'.t`DA tl!' A1. ' !4 DIP.p t'. t�, THE. tie S1Gn► kr1t;,Nf.E 1i , I1,1 111E �`FeE ail rJe:f t:)I. r'rr� I I•IF. rc:rvW ►�E A�LrI t AGF.N t. '>F1A►t.t. F`l� Rf L�Ptit -..1 Rt: 14'rP+IC 0,15PE1.1 IC) E T►4 NJ N:i 0J T'N15 Or T►•iE CON S I Rt.lr r 1;�r.►. i f+t- �'�',�'�.�` n ttG '►.ICEI� SMA4l ttt=TIF Y TktA.r tHI : . J WAg MAGIk 11 .I A(CV�iC.' 4y(' ( s -y ►.. t ' 14 ►-Ioi f!t. ytGhl. 14. Ntl L)►liJi.WAti. S SIlnl.s. eE C.gjJ*',I►%jiTt.() W11I-ll►v d ILLY t1C q�sY ►h�RT'14P� t11r TI4110 '0jAh/,t'AJ1R'* O►SnA6Atiwk!S?F ty.r?.tr'M, . NO "01ATlpl.j og I ITIS . SANIT.kfltlt r++►•:.I. $L WIrHIN t5 PCt;r Or' ;aA, `• '>It M .. '�+!•i t.R SLFtVIt;C, N'' t,11vD1 RLIC. i'k G . . NA i .�. Y OFT' 1'M 1 °I` GUARAA► t• ► t'.t!►':.1RM4AICE. THIS SYSTCtvt E SYS7C.M5 W�- Or'4, 104 ANNUAL_ FSA xjIS I't� I SHALL bf.. Sf FtVECFU •. ► L E XPEC'1 NNCY'. NC f7E. .vSE_ t r5 nvl:.l2 AL.t. �^. ti. Y a�. 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S M ai'�} : 'q` 3 � i s rt a a���1Ly .r ° x �r R r r ^ Q. 1+ 't r t t1. `r T (� 4.+t r cb vrl r " , pp1 ry r } + ,xr z 4�,. '., : 'i� )` ll l:.Ytl4 Q N :iP1* f G.' [ r ! N Y R 2A Y'U r i'"`„ ^ I 5�. 3 t,mkY _ F tr. � n Y :1y t 3: z t { �fx� I: t a i E k, c ,� ft S i- .rs5 1'"". .:,t r w r 1,,-a=iur,7 t y..T 4 ;, i.*y y . . - ` ..r.� -r Y i - - , y.¢ r t - TOd f�r ,3 , /e)/e r0 eve ... ,sF�O lv J X 0 , FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. I APPLICANT FILLS OUT THIS SECTION oo-ISIS, V/APPLICANaVI)eS-4-sy� �r�:C. w PHONE ! ✓ LOCATION: Assessor's Map Number PARCEL I VSUBDIVISION LOT S) STREET Sk Z Sbr4nryc Pon x--/w ST. NUMBER XYZ_ OFFICIAL USE ONLY REC NDATIONS OF TOWN AGENTS: -- !/C SERVATION ADMINISTRATOR DATE APPROVED_ DATE REJECTED COMMENTS UZC i TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS_ FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED i DATE REJECTED COMMENTS_ }I/61 D -I—/sty - TO 66_,°TiC_ T`/-�iU.� I � PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT I, RECEIVED BY BUILDING INSPECTOR DATE . r a e • 4 j r , ' b Stevens Water Analysis 38 Montvale Avenue •.Stoneham, MA 02180 • Mass. (617) 438-6114 ,*. Salem, N.H. (603) 893-3106 LABORATORY NUMBER: .2445_ SAMPLE DATE: 3/17/86 SUBMITTED BY: #"' r+WILMINGTON PUMP' SUPPLS'. •.r,p„ �639`Woburn` Street ° !`"`Wilmington, MA 01887 ` SAMPLE SOURCE: New Well - S.B. HOMES, INC. , No. Andover, MA � 'ANALYSIS: 4I-Accbrding-to`Standard Methods-:of Water and Wastewater Analysis, ,15th Ed g r ' Total Col.if;orm 0 per 100 ml + Chlorides• . . . . . • . . . . . . . 5 mg/L + ry Hardness '•+ . . . . . . . . . . . . 98 mg/L rr Man anewt . 0.11 mg/L • y •� t !a; ,,6 , i � S�`_yC , . i'.1• k*._ � rr r�r x# r. '. `j 10 mg/L Iron 0.04 mg/L less than 0.10 mg/L ;,yi..� .k } $S�i'� Vit# '."� ,` a a , }`.._ - }i• s �" .". R � , Nitride. ', �.. .. �. ` . . . . . . . . . . . less than 0.10 mg/L . a 5 COt�IMETt'� ° 'Tl�e reiaults of"these analyses meet the required federal and" ” r state standards for drinking water. However,'the manganese ' +' �tocicenCrationyexceeds 'the recommended standard: 'A1 though iriarianese" is not harmful to your health, it `can ' � r affect the iaate, '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. klmw— CheXfsefffc-r-o-biol ,t TOWN OF NORTH ANDOVER a NORTq ' Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ' 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 'SswcHuget 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.9542—FAX Public Health Director E-MAIL:healthdept@townofnorthaiidover.com WEBSITE:http://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. (B): Plastic bags shall be used to store garbage or mixed rubbish and garbage 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 part of the passageway or right-of-way which abuts his property and which he or the occupants under his control have the right to use, or are in fact using, or which he owns. * 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: hitp://www.northandoverrecycles.com. Please contact the Health Department if you have any additional questions. Thank you. Sincere �` � E / an Y. Sawyer, REHS/RS Public Health Director File a,�{�`s�r�•:pr '� l4�'����rp�i fi`NN'.. 'i `5t f; ''°1 Ti t�`"W l i5 yl�'; i4�•�o- 5 a ri4�•= P �```�!) rY 'Fr S ,a "'fttp r3i�t )r'e t x }t 1p 1di 3 N{ z R't1,1 Y 7f ,rd 7g Lt t r i.�,k ,c i C. ft P S'C 1 9 Prd �,in v y� 1 1 c�. I;ix r eA'� P �s § - 1 i t + r a at r + r }' r 1 IVi r��'a��!i��°��rtS�#1�� �4sjJ 3 Yard. 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