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Miscellaneous - 55 BEAVER BROOK ROAD 4/30/2018 (2)
55 BEAVER BROOK ROAD �� 21ol106.B-0237-0000.0 I� I I' f r i a f • ' y' tt f.. '.r R'1 j},IIt[$ {:^ '�• „y 01.'� n,•.r a.� r' MAP # ° LOT # PARCEL # STREETS_ CONSTRUCTI O.N_APPROVAL, HAS PLAN REVIEW FEE .BEEN PAID? YES NO PLAN APPROVAL= DATE a /w/ -I-6A / lcla APP. BY a DESIGNER: C�2i`JT//�/US � 9� S�iECo / PLAN DATE. /a h-/�'��– CONDITIONS Sh1l)& -576 ,P6 , 7UG/yE5 D� C�dSs WATER S ppR .Y: TOWN J WELL WELL PERMIT— DRILLER WELL TESTS: ----CHE TCAL DALE APPROVED BACTERIA I DA 1 E (IPPRUVED BACTERIA II DAT 'PROVED COMMENTS: FORM U APPROVAL: APPROVAL T ISSUEE5 4 DATE ISSUEDS % T `� 7 —BY- CONDITIONS: YCONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID NO WELL CONSTRUCTION APPROVAL NU SEPTIC- SYSTEM CONSTRUCTION APPROVAL E NO OTHER ES NU ANY VARIANCE NEEDED YES 1 ) FINAL BOARD OF HEALTH APPROVAL: DATE: BY: r SE� G�S�L�ZMNSI841,AT Sy.K,r ••: 'i. � r r .:'' •?r-: --�-., '.. .r».., y'". :.r ., {I.-__\-+^` ti.. J. 1. X D ISTHEINSTALLER LICENSED? + ;' `. � - YESNO TYPE. OF- CONSTRUCTION: - _ _ RE PAI CW R PAI R NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO � CONDITIONS OF:.APPROVAL YES NO �{ (FROM FORM U) !: r _ ..ISSUANCEOF DWC PERMIT O�E NO •DWC 'PERMIT ND. y• INSTALLER: BEGIN INSPECTION YES NOs } � EXCAVATION , INSPECTION: : NEEDED: t a PASSED = �: BY 'rCONSTRUCTION INSPECTIONS NEEDED: = AS BUILT PLAN SATISFACTORY� ES: / APPROVAL TO BACKFILL: DATE: / .a BY �FINAL . GRADING APPROVAL: DATE I�Z BY FINAL CONSTRUCTION APPROVAL- DATE. AV BY Cj(-C'A TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby'certify that the Sewage Disposal System( constructed; ( )repaired; by 62. hle i2�G?r s'o h i20 located at .S 3'' )?,v iza a hr„o k A:Z L2 was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# , dated with an approved design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and a •ilatio�c and the final grading agees suvstantially with the prover nlan. All ivork is 1GCai regulations, .... gr g..b.,, � �I✓'r-�� r- accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Final inspection date: . U&Fe_ ter Installer: � � - off.o Lic. #: Date: A Design Engineer: ,�j o,�� �, � ,� Date: Z2 3r Town of North Andover, Massachusetts BOARD OF HEALTH Date: July 27, 1998 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (X ) or repaired ( ) by, G. Henderson Co., at 55 Beaverbrook Road (Lot#19), North Andover, MA 01845 has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit#813 dated 2-06-96. The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health SS/cjp Revised: 7/20/98 : Town of North Andover, Massachusetts Form No.2 : 'A 'trot BOARD OF HEALTH w P DESIGN APPROVAL FOR • �,SACMUS t� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant Test No. : Site Location u) Q_T 'y--tk nn Q-t iv". Lit- Reference Plans and Specs. A/6/96 • ENGINEER DESIGN DATE : Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH : FeelL Site System Permit No. 3 Town of North Andover, Massachusetts Form No.3 : HARTh BOARD OF HEALTH O pL —I -. p 19 DISPOSAL WORKS CONSTRUCTION PERMIT i SSACMus�t Applicant NAME ADDRESS TELEPHONE Site Location �D7`/�1 �UC�C•�fi(� �'��igT�,- — Permission is hereby granted to Construct or Repair ( ) an Individual Soil Absorption / ...:_ • Sewage Disposal System as shown on the Design Approval S.S. No.— CHAIRMAN, o.CHAIRMAN BOARD O OF HEALTH FeeD.W.C. No. lo� Town of North Andover NORTH 1 f OFFICE OF o O� gc. ...•e O� COMMUNITY DEVELOPMENT AND SERVICES 30 School Street • _ ! n WILLIAM J. SCOTT North Andover,Massachusetts 01845 ,'` 9SSAGfHUSE�( Director March 9, 1998 DECM Essex Inc. 660 Rogers Street Lowell, MA 01852 VIA FACSIMILE and CERTIFIED MAIL RE: ENFORCEMENT ORDERS Resulting From Site Inspections @ Lots 12,18, and 19 Beaver Brook Rd-Evergreen Estates (DEP #242-850, #242-835, and #242-851). Dear Mr. Couillard: On March 6, 1998, this department conducted inspections at the above referenced lots. As a result, Enforcement Orders have been issued, and the outstanding issues on each lot need to be addressed and properly corrected by no later than Tuesday,March 17, 1998. In addition, these items have been placed on the March 18, 1998 agenda before the North Andover Conservation Commission (NACC). The meeting commences at 7 PM and takes place at the Department of Public Works (DPW) located at 384 Osgood Street. A representative from DECM Essex, Inc. is required to attend this event. I offer the following comments: Lot 12 Beaver Brook Road(DEP #242-850) ♦ Under the Order of Conditions, #22, it states that the erosion control barrier (i.e. silt fence and haybales) shall remain intact until all disturbed areas have been permanently stabilized to prevent erosion. The silt fence on site is inadequate. It needs to be re-stapled in some areas,and fully re-trenched in others. The haybales in certain locations were noted as being deteriorated. Using your emergency stockpile of haybales,please replace the deteriorated haybales where necessary. By doing so, you will most likely need to obtain extra haybales to fulfill condition #23, requiring a minimum of 20 haybales on site. ♦ Under the Order of Conditions, #26, it states that the applicant shall submit written progress reports every month detailing what work has been done in or near resource areas, and what work is anticipated to be done over the next period. This department has yet to receive this document. Please submit this detailed document by 317/98. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 • I l Lot 18 Beaver Brook Road (DEP #242-835) ♦ Under the Order of Conditions, #24, it states that the erosion control barrier (i.e. silt fence and haybales) shall remain intact until all areas are permanently stabilized to prevent erosion. Directly in the back of the house, at the top of the slope, haybales only were approved in lieu of silt fence and haybales due to installation problems with ledge. These haybales were noted as being deteriorated, and need to be replaced due to the condition of the site. ♦ Under the Order of Conditions, #25, it states that the applicant shall have on hand a minimum of 20 haybales used only for the control of emergency erosion problems. The extra supply on site was noted as being deteriorated, and a new supply of 20 haybales needs to be obtained. Covering the extra supply with a tarp will prevent deterioration. ♦ Under the Order of Conditions, #27, it states that immediately upon completion of the dwelling foundation, and prior to further construction activities associated with the site, the applicant shall complete a plan prepared by a R.P.L.S. which accurately depicts the foundation location and it's proximity to wetland resource areas as approved under this OOC. This department has yet to receive this document, and it should be submitted by no later than 3/17/98. ♦ Under the Order of Conditions, #28, it states that the applicant shall submit written progress reports every two (2) months detailing what work has been done in or near resource areas, and what work is anticipated to be done over the next period. This department has yet to receive this document, and it should be submitted by no later than 3/17/98. Lot 19 Beaver Brook Road DEP #242-851). ♦ Under the Order of Conditions, #18, it states that a DEP sign shall be displayed at the site bearing the words "Massachusetts Department of Environmental Protection, File Number 242-851)." This sign was absent in the field and needs to be displayed. ♦ Under the Order of Conditions, #23, it states that the erosion control shall remain intact until all disturbed areas have been permanently stabilized to prevent erosion. The erosion control on site has been covered by large boulders and is inadequate. It is extremely important that the erosion control on site remains intact. The erosion control barrier needs to be reinstalled throughout the site. Complete this task by 3/17/98. ♦ Under the Order of Conditions, #24, it states that the applicant shall have on hand a minimum of 20 haybales. This extra supply was not noted in the field and needs to be obtained. i ♦ Under the Order of Conditions, #27, it states that the applicant shall submit written progress reports every two (2) months detailing what work has been done in or near resource areas, and what work is anticipated to be done over the next period. This department has yet to receive this report. Please submit this detailed document by 3%17/98. Should you have any comments, questions, or concerns, feel free to contact me at (978)688-9530. Thank you for your anticipated cooperation. Sincerely, Richelle Martin Conservation Associate Cc: Michael D. Howard, Conservation Administrator NACC members Files Babu Patel, 12 Ash St., Amesbury, MA., Lot 12 Beaver Brook Rd. Resident of Lot 18, #71, Beaver Brook Rd. Dep-Nero O` T0VM e ®ver - -_-- - _ No. ~ `" dower, Mass., '� 19 -0c"C_EWICK , i D- BOARD OF HEALTH Food/Kitchen PERMIT .T Septic System t � / THIS CERTIFIES THAT...................:................................. �.... ...;... ..A..../"V.,... ....��.. `�...`�� ; B7ILDING INSPECTOR ............................. ........ Foundation has permission to erect.................../................... buildingA on ......... 'Nx.......� �......� ��Q, �'� .�"a t 4l �� l .................................. oug to be occupied as.. . . .. . . . . . ... . . .. .' ".. p .. . . .S/� �.r�..C":'............ ..(... ... ....................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPEC OR VIOLATION of the Zoning or Building Regulations Voids this Permit. Gojh C7 /1�0 PERMIT EXPIRES IN 6 MONTHS ..� Final UNLESS CONSTRUCTION STARTS . ELECTRICAL l PECTOR ough <. 1.r'4✓ ..'4 .......................................... Service LDING INSPECTOR � - Lf na-,, Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Final FIRE DEPARTMENT Until Inspected. and Approved by the Building 'Inspector. Burner Street No. Smoke Det. J r Town of North Andover, Massachusetts BOARD OF HEALTH Date: July 27, 1998 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( X ) or repaired ( ) by, G. Henderson Co., at 55 Beaverbrook Road-(Lot #19), North Andover, MA 01845 has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit#813 dated 2-06-96. The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health SS/cjp Revised: 7/20/98 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: / �J S�Z `� CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER: , P SIGNATURE: ,, tet TELEPHONE# YS— Gj CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only �366� $75.00 Fee Attached? Yes �� No Foundation As-built? Yes t"' /U�lW No ✓ /Akf Floor plans on file? Yes No °mss ApprovalDate: 1� Gt pIca r r r a � ,1 it 0 EXIST.FND. T.0.F.=128.6' ti� o LOT 19 y , !� EASEMENT j STRUCTURE FO UNDA TION LOCATION PLAN THE HORIZONTAL SETBACKA RY REQUIREMENTS OFOWN THE LOCALRMS TO APPLICABLE ZONING BY—LAWS IN EFFECT WHEN CONSTRUCTED- (THIS NSTRUCTED. Nor CONSIDER ANOTHER RESTRCT7ONSCSUCH ASE COVENANTS,WETLANDSYEAS£MNTS, C D. . �,,YI/�. ORDERS OF CONDMONS,£TC.) CLIENT: L V THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY TH/S CERTIF/CAT/ON /S MADE AND LIMITED PURPOSE OTHER THAN THAT OUTLINED ABOVE;EKCEPT WITH THE WRITTEN PERMISSION OF CHRISYMNSEN & SERGI INC. TO THE ABOVE CLIENT. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRIS77ANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIBITED.CHRIS71ANSEN & SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR— MA77ON CONTAINED HEREON. LOCATION:LOT '19 "EVERGREEN ESTATES" NORTH ANDOVF_RNA. AL�H OF Afq,c A^a of d SCALE. I"=80' DA TE.7/10/97 MIC E No { . r Ap CHRI S TIA NSEN ,SERGI PROFESSIONAL ENGINEERS ;y LAND SURVEYORS 160 SUMMER ST. HAVERNILL,MA. 01830 TEL 508-373-0310 ®1997 BY CHRISTUNSEN & SERGI INC. DVVfsM.: 94036076 S; I Town of North Andover t NORTh OFFICE OF 3?0 `" ,+o0L COMMUNITY DEVELOPMENT AND SERVICES ° . 146 Main Street + s. . o North Andover,Massachusetts 01845 WILLIAM J.SCOTT 9SS�c►+us�t Director It March 24, 1997 a Mr. Roland A. Coulliard D.E.C.M. Essex Inc. 660 Rogers Street Lowell, MA 01852 Re: Septic testing-Evergreen Estates Dear Mr. Coulliard, I am writing to remind you that some of the lots in the Evergreen Estates subdivision require additional septic testing prior to Building Permit issuance per the decision of the Planning Board. I have had several applicants come into my office seeking a building permit who were unaware of these conditions. The leaching bed must be excavated on lots 4, 5, 19, and 20 before a building permit can be issued. If the leaching bed has not been excavated, the applicant may choose to place a note on the deed for the lot stating that the septic system must be installed, inspected and approved by the Board of Health in accordance with all state and local regulations before construction of the primary building is begun. This includes the pouring of foundation walls. A certified copy of the recorded deed must be submitted to the Planning Department and Board of Health. If you have any questions please do not hesitate to call me at 688-98535. Very truly yours, Kathleen Bradley Colwell Town Planner cc. W. Scott,Dir. CD&S S. Starr,Health Adm. BOARD OF APPEALS 688-9541 BUMDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 33 I3.............................. THE COMMONWEALTH OF MASSACHUSET _ TOWN OF NORTH ANDOVER/ BOARD OF HEALTH BOARD OF HEALTH "feu- 'JU _..... .... OF..N '71 ....... .A/ t4'E.....- ........................ �1ft tlirttfiott fou• 11't�;�Ioottl iiorlto Cgotto# •ttr hu c pxiitt Application is hereby made fora Permit to Construct or Repair ) an Individual Sewage D sposal System at IJE1<_ !�! �:�1�,...._A.[?t7G� E^►/(CGS t-1 &;_s 3r ,.................•-•-... ................... ......................................... ...--•--••-•-._.._.............._.._........._•-_..... oration-Address or Lot o. __�►�lnss%:n.�....n14,I/C ��jree'ml...._.r'�x ... f � .__ �-> ',_.._ I��l,� �.� tiff.. ,�0.i40 owner Address W Installer Address Gine Type of Building Size I-,ot....." .' .5......_._._S Dwelling— No. of Bedroorns............:..1._--------:...............iLxpansion Attic ( ) Garbage Grinder ( ) 4, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) PA Other fixtures ............................... ............................................ Design Flow...........................................gallons per person per day. Total daily flow............�P..6 ....__- • ._._.__.gal s. Septic Tank— Liquid capacity/ ...gallons L igth.0.,E..._.. ��idth..�''.._ �._. Diameter................ Depth.5........... �+ Disposal Trench -- No. ....... ......... �Vidth_.........`t .._._ Total Length..���_.�i� .... Total leaching area.... 0x_..sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( yam Dosing tank ( ) 6/6/9 S! a Percolation Test Results Performed by..--S..C.?H.ad(S7.._SY' Q_. /!.Sd._........ Date............. ?�y .3/ Test lit 1'�,�1................minutes per inch Depth of Test Pit.�9.._10�.__ Depth to ground water.... ................... tz, .3,.9 Test Pit U@--f.......;!7.....ininutes per inch. Depth of Fest,Pit, /-.......". Depth to ground water.... ........... M .....................................•--•--•-----...•---•-.............----•--------•-••----•---•---......................................................... D Description of Soil......SiYt�tst_..,5<tnt f..__.�IJa 1----------------------------------------------- W ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ....................................................................................•-•-----....------------------------------..--•-----------.....----------------..........._.....---••-...---•--••--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code = The undersigned hu Cher agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed------------------------------------------------------- -----------•--••-----------_.. ----------- ..................... Date ApplicationApproved By........................•-----.....---------•--......_...----------------------•---•------------• Date Application Disapproved for the following reasons:................................................................................................................ ............................-................................................. -------•..............-•--.................................................................. ............................ Date PermitNo......................................................... Issued............................... ........................ Date .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Ta F...................................................................................-- Ta ifirtite of Totttfttittttrts THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............................•...---•-•...._........----•------.....................-•---•...............----.._....------------....----•-------...-•-------......----------•-•--•-•......---•---•••- Installer at......................................................................................--------------------------...-...------.---...-------------------•--------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Consiruction Permit No......................................... dated................................................ THE 15SUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. h DATE.....................................••---•-......_.... -----•--....------•---- Ir s,pector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................I..........OF..................................................................................... No......................... FEE........................ Moftovtui IV, orlm Cgottotrttrtiott jlpruti# Permissionis hereby granted..................................... .........---r---------------............................................................................ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo................................................................................................................................................................................................. street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... -------------- ............................13oa•---n1 o--• -f...-il-calth--................-----------------• .......... DATE........................•----..-•-....................................------_... roRft 1255 HOBBS & WARREN. INC.. PUBLISHERS Town of North Andover, Massachusetts Form No. 1 NORTH ••�� BOARD OF HEALTH 1 6 �,ED 1 ,'10 6 19q o01, APPLICATION FOR SITE TESTING/INSPECTION AORATED PPP' ,�°J �SSACHUS�� Applicant— NAME ADDRESS TELEPHONE Site Location T 9 1--eA W=4 Engineer � �� ��-Q/l"-' AAA , NAME ADDRESS TELEPHONE Test/Inspection Date and Time �p CHAIRMAN,BOARD OF HEALTH Fee � -� Test No. 6,57 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH ^�ED ib 6 0� 19 0 APPLICATION FOR SITE TESTING/INSPECTION 2. '°RarE°pPa�5 �SSACHUS�' Applicant NAME ADDRESS TELEPHONE Site Location ` + ~ Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. y Lot# Date Plans Date Date Form Notes: Submitted Plans "U Sign Off Approved IA 6/13/96 9/19/96 9/19/96 - SS 2A 6/13/96 1/9/96- 9/19/96 - SS 7/23/96 3A 2/20/96 4/2/96 8/5/96- SS 4 3/25/96 5/28/96 see note 1 5 10/1/95 11/1/95 see note 1 6 8/30/96 9/3/96 9/3/96 - SS 7 6/17/96 6/25/96 8/5/96 - SS 8 4/1/96 4/15/96 8/5/96 SS 9 9/20/96 9/27/96 9/27/96 see note 3- 9/26/96 10 2/28/96 4/2/96 8/5/96 - SS 11 2/29/96 4/2/96 8/5/96 - SS 12 1 9/18/96 9/20/96 9/20/96 - SS 13 9/18/96 9/27/96 9/27/96 see note 3 - 9/26/96 14 12/4/95 8/1/96 8/29/96 - SS 15A 1/31/95 3/19/96 8/5/96 - SS 16A 6/14/96 7/29/96 8/26/96 - SS 17 8/2/96 5/24/96 8/19/96 - SS 18 10/1/95 11/26/95 see note 1 19 12/19/95 2/6/96 see note 1 20 2/20/96 4/2/96 see note 1 21 9/20/96 9/27/96 9/27/96 see note 3 - 9/26/96 22 8/8/96 9/3/96 1 9/3/96 1 -Excavation needed 2 -Additional tests needed. Previous tests either did not pass or are incomplete. 3 -Plans require variance(s)from Board of Health. TABLE #2 FORM C APPLICATION FOR APPROVAL OF DEFINITIVE PUCE t. OWN CI.ERY 14ORTti ANDOVER January 17 i;- �9 95 jAN To the Planning Board of the Town of North Andover: The undersigned, being the applicant as defined under Chapter 41, Section 81—L, for approval of a proposed subdivision shown on a plan entitled Definitive Subdivision Plan "Evergreen Estates" located in North Andover by Christiansen & Sergi , Inc . dated December 28 . 1994 being land bounded as follows:Northerly bt Com of MA , land of Steer and Fried ; easterly by land of Fried , Deadde,r , Rough , Green , Galeassi , Yourre , Mateja , iaaT AlneL �g nad P�a..:.'rST�e.al9F& SE . , 809- F''afr! _! at2t+ Farr and Com of MA ; westerly by Com of MA,. hereby submits said plan as a DEFINITIVE plan in accordance with the Rules and Regulations of the North Andover Planning Board and makes application to -the Board for approval of said plan. 1087 314 Title Reference: North Essex Deeds, Book 2901 , Page 13 ; or Certificate of Title No. , Registration Book , page ; or Other: Said plan has( x) has not( ) evolved from a preliminary plan submitted to the Board of Aug 24 19 94 - and approved (with modifications) ( ) disapproved (X on 0 c t _4_j 1994 ; The undersigned hereby applies for the approval of said DEFINITIVE plan by the Board, and in furtherance thereof hereby agrees to abide by the Board's :Rules and Regulations. The undersigned hereby further covenants and agrees with the Town of North Andover, upon approval of said DEFINITIVE plan by the Board: 1. To install utilities in accordance urith the rules and regulations of the Planning Board, the Public Works Department, the Highway Surveyor, the Board of Health, and all general as well as zoning by—laws of said Town, as are applicable to the installation of utilities within the limits of 'ways and streets; 2. To complete and construct the streets or Kays and other improvements shown thereon in accordance with Sections Iv and V of the Rules and Regulations of the Planning Board and the approved DEFINITIVE plan, profiles and cross sections of the same. Said plan, profiles, cross sections and construction specifications are specifically, by reference, incorporated herein and made a part of this application. This application and the covenants and agree— ments herein shall be binding upon all heirs, executors, administrators, successors, grantees of the whole or part of said land, and assigns of the undersigned; and 3. To complete the aforesaid installations and construction within two (2) years from the date hereof. Received by Town Clerk: Date: Signature of Applicant Messina Development Corp . , 805 Winter St . Time: North Andover , MA 01845 Signature: Address Notice to APYL1CAW/1 V CLERK and Certification of A on of Planning Board on Definitive Subdivioion Plan entitled: Evergreen Estates By: Christiansen s Sergi dated 19 94 The North Andover Planning Board has voted to APPROVE said plan, subject to the following conditions: 1. That the record owners of the subject land forthwith execute and record a "covenant running with the land", or otherwise provide security for the con— struction of ways and the installation of municipal services within said sub— division, all as provided by G.L. c. 41, S. 81—U. 2. That all such construction and installations shall in all respects conform to the governing rules and regulations of this Board. 3. That, as required by the North Andover Board of Health in its report to this Board, no building or other structure shall be built or placed upon Lots No. as shown on said Plan without the prior consent of said Board of Health. 4. 'Other .conditions: �r See attached —�grnrn Lo tr• In the event that no appeal shall have been taken from said approval within twenty days from this date, the North Andover Planning Board will forthwith thereafter endorse its formal approval upon said plan. The North Andover Planning Board has DISAPPROVED said plan, for the following reasons: NORTH ANDOVER PLAOM BOARD I' Date: August 15, i995 By: Josepi, V. Mahoney, Chairman Y a. A complete set of signed plans, a copy of the Planning Board decision, and a copy of the Conservation Commission Order of Condition must be on file at the Division of Public Works prior to issuance of permits for connections to utilities. The subdivision construction and installation shall in all respects conform to the rules and regulations and specifications of the Division of Public Works. b. All site erosion control measures required to protect off site properties from the effects of work on the lot proposed to be released must be in place. The Town Planning Staff shall determine whether the applicant has satisfied the requirements of this provision prior to each lot release and shall report to the Planning Board prior to a vote to release said lot. C. The applicant must submit a lot release FORM J to the Planning Board for signature. d. A Performance Security (Roadway Bond) in an amount to be determined by the Planning Board, upon the recommendation of the Department of Public Works, shall be posted to ensure completion of the work in accordance with the Plans approved as part of this conditional approval. The bond must be in the form of a check made out to the Town of North Andover. This check will then be placed in an interest bearing escrow account held by the Town. Items covered by the Bond may include, but shall not be limited to: i. as-built drawings ii. sewers and utilities iii. roadway construction and maintenance iv. lot and site erosion control V. site screening and street trees vi. drainage facilities vii. site restoration viii. final site cleanup e. Three (3) complete copies of the endorsed and recorded plans and two (2) certified copies of the recorded subdivision approval, Covenant (FORM I) , Right of Way easements, and FORM M must be submitted to the Town Planner as proof of filing. 4 . Prior to a FORM U verification for an individual lot, the following information is required by the Planning Department: a. All lots must be approved by the Board of Health. The Board of Health has determined that Lots 6 9, 12, 13 , and 21 cannot be used for building sites without injury 4 M to the public health without further testing. No building or structure shall be placed upon these lots without consent by the Board of Health. b. Due to the large amount of rock on the site which may interfere with the amount of parent material available for leaching, the Board of Health will require that the leaching area for each lot be completely excavated to insure that there is the requisite four feet of parent material present throughout the entire location proposed for the leaching area. C. The applicant must submit to the Town Planner proof that the FORM J referred to in Condition 3 (c) above, was filed with the Registry of Deeds office. d. A plot plan for the lot in question must be submitted, which includes all of the following: i. location of the structure, ii. location of the driveways, location of the septic systems if applicable, iv. location of all water and sewer lines, V. location of wetlands and any site improvements required under a NACC order of condition, vi. any grading called for on the lot, vii. all required zoning setbacks, viii. location of any drainage, utility and other easements. e. All appropriate erosion control measures for the lot shall be in place. Final determination of appropriate measures shall be made by the Planning Board or Staff. f. All catch basins shall be protected and maintained with hay bales to prevent siltation into the drain lines during construction. g. The lot in question shall be staked in the field. The location of any major departures from the plan must be shown. The Town Planner shall verify this information. h. Lot numbers, visible from the roadways must be posted on all lots. 5 . Prior to a Certificate of Occupancy being requested for an individual lot, the following shall be required: a. A stop sign must be placed at end of Pheasant Brook Road where it intersects with Salem Street. b. A driveway easement across Lot 22 must be granted to Ian 5 NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: �46 PERMIT ## DATE RECEIVED 10111 '115- APPLICANT -EoB AX5�/5/ MAP PARCEL ADDRESS LOT ## /2 ( Gum, 6,ftlEA-) ENG. Cif'/ST/MUS IC/9G S �J STREET --5E/91/4 ;� -(> ADDRESS PLAN DATE /Z /��/l-S REV. DATE CONDITIONS OF APPROVAL APPROVED (/ DISAPPROVED F REASONS FOR DISAPPOVAZ-.--,, p a r UA�),o Ltd/-Tee I r CoDb PLAN REVIEW CHECKLIST �f ADDRESS ENGINEER T//�i�J GENERAL 3 COPIES (j' STAMP LOCUS j// NORTH ARROW C/ SCALE CONTOURS PROFILE C/' SECTION_L.,,,,- BENCHMARK �` SOIL & PERCS ELEVATIONS WETS. DISCLAIMER L,"� WELLS & WETS v WATERSHED?'& DRIVEWAY r/ (Eley) WATER LINE 61� FDN DRAIN cam' SCH40 c/ TESTS CURRENT? q-f- f`j.5- SOIL EVAL 5. S 5, Ue p SEPTIC TANK / MIN 1500G t// . 17 INVERT DROP v GARB. GRINDER(+200% EDF) 25 ' TO CELLAR 6'-�MANHOLE_QC._ ELEV GW # COMPS. D-BOX SIZE # LINES p�- FIRST 2 ' LEVEL STATEMENT INLET OUTLETS _ 7 (2 11 OR . 17 FT) TEE REQ'D? A� LEACHING MIN 660 GPD? RESERVE AREA/ 4 ' FROM PRIMARY? `' 2% SLOPE 100 ' TO WETLANDS c- 100 ' TO WELLS L-� 4 ' TO S. 35 ' TO FND & INTRCPTR DRAINS L, 325 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY ✓' MIN 12" COVER yr FILL? 25 ' if above natural elev; ` y' if be ow) BREAKOUT MET? L/'r TRENCHES MIN 660 gpd v SLOPE (min . 005 or 6"/1001 ) y SIDEWALL DIST. EFF. W OR D (MIN 61 ) RESERVE BETWEEN TRENCHES? (/ IN FILL? MUST BE 10 ' MIN. b,-'4" PEA STONE? VENT? (>3 ' COVER; LINES >501 ) BOT L306 + SIDE /w/,8 X LDNG Kl o (L x W x #) (DxLx2x#) (ii% ) 336zo Copyright© 1995 by S.L.Starr SS- --PS- 2 tA-4— A� z APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: & _/, CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER: 7- 05OK SIGNATURE: �� TELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: 4Z IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. f, `� , T _ > 4 /OI- Administrative Use Only $75.00 Fee Attached? Yes No Foundation As-Built? Yes No Approval Date: Add rJ': /4-0S r2 13k0p t� 40, n Title of File Page 9 of Date File Open: Date fele closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action Department Y Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department G� COMMONWEALTH OF MASSACHUSETTS r SETTS EXEC,.UTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A .CERTIFICATION Property Addms! 5j5; Baver $r ok R_ ` N. Andover. MA 01 10 Owner's Name: Mike Lundeen Owner's Address:1.Sam as � Date of Inspection: 11 /2 6TO`f01 OF NOR:r`!A,�sQo . ,-k Name of Inspector.(please print)..John......T �qni,rNr � -- Company Names-qn„� ' PWQ.r.�G.=-mice Mailing Address.�'TS' � DEC 14 2001 T18YA7k s hitt rz.r-X n..:�7 6 Telephone Number: 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 Section 15.340 of Title 5(310 CMR 15.000). The system: XX •Passes nditionally Passes Needs Further valuation by the Local Approving Authority Fails Inspector's.Signature. Date: 11— •O( The system inspector shall submit copy of this ins ection ,port to the Approving Authority(Board of Health or DEP)within 30 days of comple ' g 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 hpw 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 INSPECTIONTORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: _55 Beaver Brook Rd 11i_ Anclover, MA 01810 Owner:Mi ka TainAaan Date of Inspection:jj, 6.1 a 1 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX 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. 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): 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: 55 Beaver Brook Rd. N_ And{wer#• MA 01810 Owner: Mi kcz Ta nrlPan ' Date of Inspection: 1 1 f ti j tL1 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(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 P P vy 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�safetyan d 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: s3 . Page 4 of 11 . OFFICIAL INSPECTIONYORM:-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION.(continued) Property Address: 55 �Beaver Brook , Rd, N..._.AA!di?Yp 810 Owner: M;kA T.,inr3aA10 Date of Inspection: /n� ^•.���. D. System Yste Failure Criteria.applicable Ucabl e to all PP 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 — i* Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool . XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool XX Liquid depth in cesspool is less than 6"below invert or available volume is less than''/s day flow XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ XX. Any portion of the SAS,cesspool or privy is below-high ground water elevation. XX Any portion of cesspool or privy is within 100 feet of a surface water supply 1 or ' tribu to a surface . water supply:..: . ; .... . _.. , ._ XX Any portion of a.cesspool orprivy is.within a Zone 1 of a public well. _ _xx Any portion of a cesspool or privy is within 50 feet of a private water supply well. XX 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.] NO (Yes/No)The system fails.I have4etermined 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: NSA 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 feet_of a tributary to a surface drinking water supply _ the system is located in a nitrogen.sensitive area(Interim Wellhead Protection Area–I WPA)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 "Yee'in Section D `Y above the large system has failed.The owner oro operator of p 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 ARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST .Property Address: 55Beaver Brook Rd. N,Andover, . MA 01810 Owner:_ m i k es r. �1asie�n ,: - Date of Inspection: 1261.0 Check if the following have been done.You'must indicate"yes"or"no"as to each of the following Yes No u Pumping informoo(.pu was provided by the owner,occupant,or Board of Health XX. Were any of the system componentsum d out in the p Pe previous two weeks? XX _ Has the system received normal flows in the previous two week period? XX _ Have large volumes of water been introduced to the system recently or as part of this inspection? XX _ Were as built plans Of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwellin,__ g inspected petted for signs of sewage back up? XX Was the site.ins inspected for si p gns of break out? X_X_ _. 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 ft 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 _XX T Existing information.For example,a plan at the Board of Health. _%X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)J 5 Page 6 of 11 OFFICIAL INSPECTION-FORM'-NOT FOR-VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION Property Address: .S S RPa ,or Rr�d n.,ary,or�...MA._W 810 Owner: 1 -Y e—� c�esti Date of Inspection• RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design):;a_�.t:.Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 4 4 0 Number of current residents: 4�� . Does residence have a garbage grinder(yes or no):__UO 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)'--fi�gg� Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy.--,C`arr.ent COof MME RCIIAIJINDUSTRIAL, N/A Design flow(based on 310 CMR 15.203): sad Basis of design flow(seats/persons/sgft,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; •' + !; is as ��t� i�t;�'t; + � OTHER(desl;00: GENERAL INFORMATION PumpingRecords Source of information: pumopd 11 /27/01 Was system pumped as part of the inspection(yes or no): YES If yes,volume pumped: gallons—How was quantity pumped determined?gage on truck Reason for pumping: - nna i*±tPnanro end i nloect interior of tank. TYPE OF SYSTEM _X4eptic tank,distribution box,soil absorption system —Single cesspool Overflow cesspool ;. T 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): Approximate age of all components,date installed(if known)and source of information: 1998 Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 5 Beaver Brook Rd. N Andover, MA 01 81 0 Owner: A4jk® Lundeinn Date of Inspection: 9 1 j 2 6.1 n 1 BUILDING SEWER(locate on site plan) Depth below grade:2 0 Materials of construction:,cast iron X40 PVC_other(explain): Distance from private water supply well or suction line: tTA Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:m(locate on site plan) Depth below grade: '8 ' Material of construction: concretemetal_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: 6 ' X 11 Sludge depth: -1" Distance from top of sludge to bottom of outlet tee or baffle: 6" Scum thickness: 1 if Distance from top of scum to top of outlet tee or baffle: g�� Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined:Tape and sluge tool. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Pump annual 1 y no garbage disposal. GREASE TRAP:NLI(locate 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 8 of 11 r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _ u,QaVev Brook Rd. Owner: . 01810 Date of pec ion: - 1 TIGHT or HOLDING.TANK: N/A(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(yes 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: ,(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.): Float checked O.K. PUMP CHAMBER:N/A (location site plan) Pumps in working order(yes or no): Alarms in woiking order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 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: Rd. Owner: N— nrt Andover,r—..A 01810 ns Date of pection•.iTre-1 SOIL ABSORPTION SYSTEM(SAS):XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: 2 41 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.): CESSPOOLS: cesspool must be pumped as part of ins ection)(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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:_NJ-Xlocate 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 -...J >«K.&f� •) r ;i •r r•f5 1iFt t��Wi.'J' _' 'Nb'7d wt )IN V1 OlJd3S • yt� 'G t Vi ' .,. .' J:•t ( A�tL�r r � f��'"i mita,• '. . Y s , fc,179 4 �-•� i f • e �> r 4kt• iy; . r iiaNWWW����a 1{�yY 'n. • ., t . fir't � 'n, ' '• r - + ��°t•, ;�K� •~f � ,xSt�"a�+t���,Pt r'yr!qq 4�.. .; . ,,r t , ♦ 41i'fAl+'�'+b.Y�M '.elk". -�" '.lR;, i�, s- a .r r _icy ,'Xj 4 it" '.a �. ..� .., .. fin•ti:Krf � k'.t 1 . v ,,..n;�4 tit,*♦t�.7��i.ty in[,,�� �' t^' �L�aw. , ul I /,J�k '��{'r,�-««Y���t7J�•}$ (�•t��S; A9 1 " wnnro 0091 j, a r xrt M,, ■f . t P •, � 3 "�u ,+�fJ�e��rYwq',f^y'" a rl • � ,li •>f q f t ,»^ ♦ �[ � 4 � 5 /'��..may' y y� .,. _���� , ;F���lr � T',• � tA,4"'�fi4 n -,�+, '„t f�J”�i ��s{�6 4 4 '..V /•. tf,��tpye�A �at t-wl. �(• yY�.pf ` ., .L ` « ,i:•r 1 } h. �Q ����i/a �"" �+ .11,A t ' F�' r 'I, }.r:, ago s��iapw� a�uoaa�uod optI aK► Ot.1M m aledz IMAM . ,• is, r t'' 'I't u � CIO • . •,+hs Y�'*C�p R` 6lp 4{' � q'i4�S}yt."_i�t'` .1TT 2�J�� � r•t;�yf 1•�?�It,4 ....i:k f t •1. f t+YV�3 6 a It WWI un , t i ^ .• . ,- .e a +r',iY. > f Il r, l f. � r( -' , x x .,p , r •, , �(� `S�'} >�,��j ��a� F {Lr> ,: + W"�•fy)�sfj w[, 1' 1 , .� p ' t+i t• 'I•t�:} J k'r r A mod mouzaam va S'.41mm o Iil�I"�;�11ZIQi�� S811S dANT.., a `sirt ,�-�i:°h�! N �,'4 � - �• '�}: r ' � .'�, ..� 6fY'•f � '�tr(CJ1J4"a•'r1'Y �7 r~� ? �'Fr' .,.�'r' h. ?i;.Iti .r ' .., • 'i` ?Ja,'4 {��O` Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:. 55. Re_..e_ r___, Rd. Owner• r01810 •—M�_kA . ,.,a_ ea Date of InspecUoa: 1 1 2 6 9 4- SITE EXAM Slope Surface water Check cellar XX Shallow wells Estimated depth to ground waterA 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) 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: Obtained gY ad -tor gn lens 11 l � .._ .. _ !r r w ' r -_- 34-LUIHDEEty CINDY RETER q1: 31/8134 y WATER BILLING HISTORY 31781 -- _ 55 BEf1tIER BROOK RD '- - - - - it CYCLE- - SERVICE PRIOR CIlRRENfi USE WATEIR SEWER FEES TOTAL o 1 2890-13 10/01/1999 126 232 106 289.38 0.06 0_09 289.38 0 2 2090-23 01/06/2000 232 264 32 87.36 8.99 8.09 87.36 O7 3 2090-33 93/29/2080 264 283 19 51.87 9.00 0.08 51.87 4 2090-43 96/1612000 283 302 19 51.87 9.09 0.60 51_87 w + 5 2001-13 99/22/2080 302 363 61 166.53 9.90 11.00 177.53 -:: 6 2801 -23 ®11I12f2001 363 390 27 73_71 0.0 3 11 .90 84.71 :P 10 7 2801-33 03/38/2001 390 413 23 62.79 0.80 11.00 73.79 = 8 2001-43 86/18/2001 413 458 4S 122.85 0.00 11.08 133.85 9 2002-13 09/18/2001 458 533 75 246.85 4.00 5.5'5 252_4 0 z d 0 REUIEW CHOICE # or <ENTER), MORE HISTORY: � _- ____ __ __ ___ '_1!:•-• _-_-_ 'dry_.., -___ _- _-_ - F -- 4 Q Q r }