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HomeMy WebLinkAboutMiscellaneous - 60 SUNSET ROCK ROAD 4/30/2018 1 60 SUNSET ROCK ROAD 210/106.A-0224-0000.0 - Road 1 V I I r t Kj - PON . PARCEL # � s � �RUCTION.�PPROVAF4 1 HAS PLAN REVIEW FEE BEEN PAID? :. YE NO KLAN APPROVAL: DATE tesla APP. BY DESIGNER: PLAN DA'CE: /�¢ CONDITIONS 70 S�7 WATER SUPPL k WELL WELL PERMIT DRILLER WELL TESTS: CHEMICAL DAZE APPRUVED ACTERIA I Ufa I (1F PRUVED BAC RIA II DAi'E APPROVED COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YE5 NO DATE ISSUED BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: DY: _ �� t IS 4'THE- INSTALLER LICENSED? '` rr'. Y y YES NO �TYPE. OF CONSTRUCTION: .. ?� EW REPAIR' . . NEW CONSTRUCTION: ,.. CERTIFIED PLOT. PLAN 'REVIEW NO CONDITIONS OF..APPROVAL. ' ... YES NO (FROM FORM U) ,. .. t: . ,ISSUANCE OF DWC PERMIT YES NO --DWC PERMIT N0. — INSTALLER. 9j t' : - BEGIN INSPECTION ' EXCAVATION INSPECTION: : NEEDED: •1 ' PASSED BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: YES i APPROVAL TO BACKFILL: DATE: BY - FINAL .GRADINGe. APPROVAL: DATE BY —BY .FINAL CONSTRUCTION APPROVAL: DATE: /�') NorthAndoverBoardofAssessorsPublic Access Page 1 of 1 Parcel ID: 210/106.A-0224-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge T =j [11 z L 60 L-12 SUNSET ROCK ROAD L•.� J Location: 60 SUNSET ROCK ROAD Owner Name: BROWN, TIMOTHY M SUSAN H BROWN Owner Address: 60 SUNSET ROCK ROAD City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 8 - 8 Land Area: 0.92 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 3540 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 823,600 770,700 Building Value: 610,000 573,000 Land Value. 213,600 197,700 Market Land Value: 213,600 Chapter Land Value: LATEST SALE Sale Price: 479,900 Sale Date: 12/05/1996 Arms Length Sale Code: Y-YES-VALID Grantor: COPLEY DEV Cert Doc: DOC 64257 Book: 00096 Page: 0145 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=808760 6/29/2006 Residential Property Record Card PARCEL ID:210/106.A-0224-0000.0 MAP:106.A BLOCK:0224 LOT:0000.0 PARCEL ADDRESS:60 SUNSET ROCK ROAD PARCEL INFORMATION Use-Code: 101 Sale Price: 479,900 Book: 00096 Road Type: T Inspect Date: 04/25/1997 Tax Class: T Sale Date: 12/05/1996 Page: 0145 Rd Condition: P Meas Date: 04/25/1997 Owner: Tot Fin Area: 3540 Sale Type: P Cert/Doc: DOC 64257 Traffic: M Entrance: X BROWN,TIMOTHY M Tot Land Area: 0.92 Sale Valid: Y Water: Collect Id: RB SUSAN H BROWN Grantor: COPLEY DEV Sewer: Inspect Reas: S Address: 60 SUNSET ROCK ROAD Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LOW Indust-B/L% 0/0 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 10 Main Fn Area: 1336 Attic: N NBHD CODE: 8 NBHD CLASS: 8 ZONE: R1 Story Height: 2 Bedrooms: 4 Up Fn Area: 2204 Bsmt Area: 1256 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: H Full Baths: 3 Add Fn Area: Fn Bsmt Area: 1 P 101 S 40224 0.92 213,563 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: VALUATION INFORMATION Masonry Trim: Ext Bath Fix: Tot Fin Area: 3540 Current Total: 823,600 Bldg: 610,000 Land: 213,600 MktLnd: 213,600 Foundation: CN Bath Qual: M RCNLD: 554514 Prior Total: 770,700 Bldg: 573,000 Land: 197,700 MktLnd: 197,700 Kitch Qual: M Eff Yr Built: 1996 Mkt Adj: 1.1 Heat Type: FA Ext Kitch: Year Built: 1996 Sound Value: Fuel Type: G Grade: VE Cost Bldg: 610,000 Fireplace: 1 Bsmt Gar Cap: Condition: V Att Str Val 1: Central AC: Y Bsmt Gar SF: Pct Complete: Att Str Va12: Att Gar SF: 912%Good P/F/E/R: ///98 Porch Type Porch Area Porch Grade Factor P 36 W 246 SKETCH PHOTO is 24 15 246 Sq.R. 15 2 - FU IG 912 Sq.R. FUL6/FM 38 38 12556 Sq.R. p ALI 28 28 60 L-12 SUNSET ROCK ROAD = ' Parcel ID:210/106.A-0224-0000.0 as of 6/29/06 Page 1 of 1 : Commonwealth of Massachusetts Cityffown of RECEIVED i System Pumping.Record 5.• Form 4 ASG C 2015 x l U NOM"ANDOVER DEP has provided this form for use by local Boards of Health.Other forrr;ImayTbe used;but�the information must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left Al i ht front of hous Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Rig rout of building, Left/Right rear of building, Under deck Address _61b(4k,, Cayfrown State Tap Code 2. System Owner. Name Address(if different from location) i CitylTown • ��� p C. �5 Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Canons 3. Type-of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ago If yes,was it cleaned? ❑ Yes ❑ No, 5. Condition of System: �JAII� 6.- System Pumped By. Neil.Bateson F5821 Name Vehicle Uoense Number Bateson Enterprises Inc Company 7. 7Loca ere-contents-were disposed: S. Lowell Waste Water Signitufe HaulwU Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts a: r City/Town of NORTH ANDOVER, MASSACHUSETTS — System Pumping Record Form 4 'M4 Fhe ECEIVED DEP has provided this form for use by local Boards of Health. stem Pumping Re ord must be submitted to the local Board of Health or other approving a . _ S 2006 A. Facility Information TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Important: When filling out 1. System Location: forms on the computer,use �e only the tab key Address to move your �Vol cursor-do not — use the return City/Town State Zip Code key. 2 System Owner: Name Address(if different from location) V — City/Town State Zip Code _':!YLY 7� ( G 3_� Telephone Number B. Pumping Record 1. Date of Pumping Date( 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ,Septic Tank ❑ Tight Tank ❑ Other(describe): — 4. Effluent Tee Filter present? ❑ Yes Flo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumjed By: Name Vehicle License Number Company 7. Locationwherecontents were disposed: Signature of Hauler Hate http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Septic System Information 60 SUNSET ROCK ROAD Printed On: Thursday,June 29, 2006 System/D: BHS-2002-1732 General System Information Latest Permit Information Ca►ca►uted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity: Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder: No No Soil Type: Depth: Laundry: No No Inspections: Inspected: Expires: Inspector: Status: 06/22/2006 Brian S.Murphy Passes Comments: Title 5 ` GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 T,pwn of North Ando r d 9 O Health Deparrt�ment Date: 4 Location: CP (Indicate Address,if Residential,or Name o Business Check Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type. $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Tras4lSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) Health Agent Initials 1645 White-Applicant Yellow-Health Pink-Treasurer T,pwn of North An r Health Department Date: Location: (Indicate Address, if Residential,or Name Xf Business Check#: `ellq Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) Health Agent Initials 164 White-Applicant Yellow-Health Pink-Treasurer f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION i V� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 60 sunGPt Ronk Rnad North AndnvPrOMa .01 $45 Owner's Name: Tim, Brown Owner's Address: SAME RECEIVEn Date of Inspection: 6/21/06 JUN 2 9 2006 Name of Inspector: (please print) Brian S.Murphy TOWN OF NVRHAMU0VERComPanyName: B&D Septic InsPections -HEALTHDEA TMENT Mailing Address: P.0.Box 47 Hull ,Ma.02045 Telephone Number: (78 1 ) .g 0—A 4 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ate: 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 Sunset Rock Rd. N.Andover,Ma. Owner: Tim Brown Date of Inspection: 6/21/06 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: Page 3 of I OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL_ SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 Sunset Rock Rd. N.Andover,Ma. Owner: Tim Brown Date of Inspection: 6121/06 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: I The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a sur_face water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of*I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 Sunset Rock Rd. N.Andover,Ma. Owner: Tim Brown Date of Inspection: 6/21/06 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number X of times pumped _ Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface X water supply. Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. —.X 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. f 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 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 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. • Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 60 Sunset Rock Rd. N.Andover,Ma. Owner: Tim Brown Date of Inspection: 6/21/06 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period X Have large volumes of water been introduced to the system recently or as part of this inspection X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS, located on site X _ 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 X _ 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 X _ 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)[3 10 CMR 15.302(3)(b)] i Page 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 60 Sunset Rock Rd. N.Andover,Ma. Owner: Tim Brown Date of Inspection: 6/21/0 6 FLOW CONDITIONS RESIDENTIAL 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): 16 5 x 4 = 6 6 0 g d p. Number of current residents: 5 Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no):no [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no): no Water meter readings,if available(last 2 years usage(gpd)): please see attached usage report Sump pump(yes or no): n o Last date of occupancy: pre s e n t COMMERCIAL(INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgtetc.): 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(describe): GENERAL INFORMATION Pumping Records Source of information: system pumped every year, (homeowner) Was system pumped as part of the inspection(yes or no): no If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM x Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) -Innovative/Alternative technology_Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 10+ yrs. system installed 11/95 ,local BOH records. 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: 60 Sunset: Rack Rd. N.Andover,Ma. Owner: Tim Brown Date of Inspection: 6/21/0 6 BUILDING SEWER(locate on site plan) !� Depth below de: 15 11 P Materials of construction:_cast iron 2L_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: X (locate on site plan) Depth below grade: 10" Material of construction: concrete_metal_fiberglass polyethylene _othcr(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10 'x 5 'x 5 ' 1 5 0 0 q a 1 _ Sludge depth: 0 1' Distance from top of sludge to bottom of outlet tee or baffle: 3 6 ' Scum thickness: 0 it Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: i n f i e l d Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tank and tee ' s in good condition,outlet tee has gas baffle present, liquid level with outlet,tank appears soup ,no signs of leakage. GREASE TRAP:_(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.): Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS S NTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Sunset Rock Rd. N_AndnvPr,Ma _ Owner: Tim Brown Date of Inspection: 6/21/06 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in workingorder o (yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-box in fair condition,box shows some signs of deterioration, liquid leveiis ri u ion equa ,no signs of carryover or ieaKage. 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 I • Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Sunset Rock Rd. N.Andover,Ma. Owner: Tim Brown Date of Inspection: 6/21/06 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: X leaching trenches,number,length: 5 C 2 'x 65 ' 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.): Soil conditions normal ,no signs of hydraulic failure,vegetation normal . 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 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.): i i Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Sunset Rock Rd. N.Andover,Ma. Owner: Tim Brown Date of Inspection: 6/21/06 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. PLEASE SEE ATTACHED AS—BUILT PROVIDED BY LOCAL BOH. Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Sunset Rock Rd. N.Andover,Ma . owner: Tim Brown Date of Inspection: 6,171 /()6 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 10 feet Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed: 1/26/95 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: Ground water determined from design plan on record C localBOH, water encountered C 10 ' on perk test dated 5/19/93 . SEPTIC SYSTEM AS- BUILT CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. h SCALE:1"=50' DATE:9/14/95 REV. 11/4/95 I , 1 Scott L. Giles R.P.L_S. 50 Deer Meadow Road �j► North Andover, Mass. LOT #2 `n I .� A 2 s \ v? a- (f) �'°�� ` ` �* LOT #12 mi \�Z 40,244 S.F. LO 6�, O N-A x• TABLE OF ELEVATIONS � N � INV.OUT HSE.—_ 157.13 a5 � �� � N IN TANK=156.36 ® OUT TANK=156.13 J IN D.BOX=155.77 OUT'Q.BOX=155.59/1-5 Q R=30.00 ~�'' _ ,p L-27. 0 "END TRENCH 1-'155.01 2=154.99 3=155.04 4=155.02 jOj CO jj, 5=155.05 180-91. LOT #13 I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USEor THE OFFSETS ��►�`,� OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY J' AND SUCH USE IS FOR THE `3a WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF a NORTH ANDOVER CONFORMITY OR NON-CONFORMITY WHEN BUILT WHEN CONSTRUCTED. Ic ��(IS Summary Record Card generated on 6/21/2006 11:36:38 AM by Lisa Warren page 1 Town of North Andover Tax Map # 210-106.A-0224-0000.0 60 SUNSET ROCK ROAD BROWN, TIM 60 SUNSET ROCK ROAD NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 0.92 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until BROWN,TIM Payor 60 SUNSET ROCK ROAD NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id. 17676.0-60 SUNSET ROCK ROAD Last Billing Date 4/10/2006 3170346 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 120.80 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 40746550 a Active ENC RT ? w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 6/14/2006 1639 a Actual 34 -11% 3/8/2006 1605 a Actual 30 4/17/2006 28% 12/21/2005 1575 a Actual 28 1/17/2006 -54% 9/20/2005 1547 a Actual 65 10/14/2005 46°% 6/13/2005 1482 a Actual 36 7/15/2005 11% 3/25/2005 1446 a Actual 41 4/5/2005 6% 12/14/2004 1405 a Actual 31 1/14/2005 -24% 9/24/2004 1374 a Actual 53 10/8/2004 -6% 6/11/2004 1321 m Manual estimate 30 7/30/2004 22°% 4/16/2004 1291 a Actual 54 5/17/2004 0% 12/15/2003 1237 n New Meter 0 12/15/2003 0°% BUTTERWORTH & O'TOOLE, INC. P.O. BOX 8294 SALEM, MA 01971-8294 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY TELEPHONE (978)741-5731 FAX (978)740-9109 March 28, 2002 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Timothy Brown Address: 60 Sunset Rock North Andover, MA 01845 Policy No. : H000008840 Loss of: 03/27/02 File or Claim No. : 27-0311 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000 . 00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws Ch. 139, Sec. 31B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. David Vincent Adjuster kc c� AIAk(41 Pte( CUMER SEPTIC EUMpING RECORD 107 FOREST STREET; ������� FORM q-SYSTM p T; MIDDLE`1`ON, MA 01 X49 (978) 774-2772 C MMONWEAL OF MASSACHUSETTS MASSACHUSETTS SYS7'E M PrJA/,rPl1VG p ECop SYSTEM OWNER: SYSTEM LOCATION: Zz � DATE OF PUMPING: _ Z NTTITY PUMPED: _- -Q6C3 GALLONS CESSPOOL: NOYES �'; SEPTIC TANK: NO YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: L� J ��r� DATE: INSPECT!) � 5 i CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE:1"=50' DATE:9/14/95 Scott L. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. V pF RO�F NEPDOH gpA LOT #2 SSP g 1995 C 9) cn + Z o LOT #12 40,244 S.F. c0 CD O oN R=30.00 O L=27.40 `� o 10111� w 180.91' LOT #13 I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE Of 4 THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY g4 AND SUCH USE IS FOR THE WITH THE ZONING 39 2 c DETERMINATION OF ZONING BY LAWS OF c1sTEREo NORTH ANDOVER CONFORMITY OR NON-CONFORMITY IL Laapso WHEN BUILT WHEN CONSTRUCTED. Town of North Andover, Massachusetts Form No.3 • f NORTp BOARD OF HEALTH 14,0 �)c V 1 FO 9 � '°•,.o �' DISPOSAL WORKS CONSTRUCTION PERMIT • ,SgACHUSEt Applicant NAME I ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct V--�or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. R , O F1rA� ',N Fee D.W.C. No. /0 CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE:1"=50' DATE:9/14/95 Scott L. Giles R.P.L.S. � 50 Deer Meadow Road North Andover, Mass. -Ori LOT #2 ma LOT #12 40,244 S.F. co �0 a C. R=30.00 w L=27.40 101 1j, CO 180.91' LOT #13 1 CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE 0i k THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE - N WITH THE ZONING 4 DETERMINATION OF ZONING 1BY LAWS OFc NORTH ANDOVER CONFORMITY OR NON-CONFORMITY �Lg WHEN BUILT WHEN CONSTRUCTED. to Ito /g,5 FORM U - IAT 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone ZJLJ T LOCATION: Assessor's Map Number Parcel Subdivision 757erj� Lots) Street _SUn � C"�C St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Date Approved Date Rejected Comments Date Approved Town Planner Date Dejected Comments Food Inspector-Health Date Approved Date Rejected ' '� Date Approved /D Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date Town of North Andover, Massachusetts Form No.2 f NORTh BOARD OF HEALTH O'���.e Q-19 9 p i DESIGN APPROVAL FOR sS�CNU SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant &ft-t— 11 Test No. WT Site Location # 1 1 24 r-k- Lz,1 Reference Plans and Specs. w� 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. /J/ AMli,'A j A ;,L4-j CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. ,AORTq 3?°° 10 BOARD OF HEALTH r 9 120 MAIN STREET TEL. 682.6483 �9SSAC`HUSEtty NORTH ANDOVER, MASS. 01845 Ext23 January 30, 1995 Mr. Thomas Neve 447 Boston Road Topsfield, MA 01983 Re: Lots #1, #2 & #12 Sunset Rock Road Dear Tom: I have reviewed and approved lots #1 and # 12 Sunset Rock Road. Lot #2 can also be approved if the water line is shifted to the south side of the lot. If you have any questions, please do not hesitate to call me. Thank you. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp DATE Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSA//L DESIGN REVIEW FEE PERMIT # // ,tel (C� DATE RECEIVED/- 1 7 7`� V / ._. _. 57- APPLICANT- J 74V US z ASSESSOR' S MAP ADDRESS PARCEL # LOT # STREET ENGINEER ADDRESS PLAN DATE REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED f PLAN REVIEW CHECKLIST ADDRESS/--2 ENGINEER 7 V , GENERAL 3 COPIES �/ STAMP ✓' LOCUS NORTH ARROW SCALE �� CONTOURS C/ PROFILE SECTION BENCHMARK SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER WELLS & WETLANDS L,""' , WATERSHED? IVQ DRIVEWAY -, (Elev) WATER LINE FDN DRAIN L,� SCH40 ✓ TESTS CURRENT? SEPTIC TANK MIN 150OG (/ . 17 INVERT DROP (/ GARB. GRINDER(+200% EDF) 251 TO CELLARy MANHOLE TO GRADE ELEV GW D-BOX SIZE # LINES FIRST 21 LEVEL STATEMENT INLET - OUTLET Js.S��b'_ �b (2 11 OR . 17 FT) TEE REQ'D?AL LEACHING / MIN 660 GPD? 6/ /RESERVE AREA t 41 FROM PRIMARY? f/ 2% SLOPE 100 ' TO WETLANDS -� 100 ' TO WELLS ;-� 4 ' TO S.H.GW 351 TO FND & INTRCPTR DRAINSC)4 3251 TO SURFACE H2O SUPP 41 PERM. SOIL BELOW FACILITY- MIN 1211 COVER FILL? -7/ (25 ' if above natural elev 101if below) BREAKOUT MET? TRENCHES I / / MIN 660 gpd SLOPE (min . 005 or 611/1001 ) ✓ >31COVER?-VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) x/ IS RESERVE BETWEEN TRENCHES? (/ IN FILL? &,,-' MUST BE 10 ' MIN. ✓4" PEA STONE? BOT �p , X LDNG + SIDE p�4 X LDNG.2�= TOT ,O (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) Copyright 0 1993 by S.L.Starr CURRIEFORM 4-SYSTEM PUMPING RECORD SEPTIC & DRAIN SERVICE 107 FOREST STREET;MIDDLETON,MA 01949 (978),774-2772 . COMMONWEALTH OF MASSACHUSETTS ----- ,MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: SYSTEM LOCATION: 1�kocvA/ dC-4Ao-l"'�. ZZ 1-C7/,C/- A 60 5 ukls�1 ytocled d fe DATE OF PUMPING: /Q'2 y^� QUANTITY PUMPED: �SGALLONS CESSPOOL: NO YES SEPTIC TANK: NOYES a SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: DATE: �U� Z �� . INSPECTOR: Form 4-- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Record System Owner System Location ` lro,/u Tt:7othy r!n iTy u 'r,rn ,t b )rk Fd 0 gunjot Rock Pd forth Ai-IQvtr MA 01- 11, 1 itth And(,-,.,,*L "..k. 01345 97dj ci87-1635 x q7R) -68? -1bR) x Type: Emergency Routine Cesspool: No Yes Septic tank: No Yes Date of Pumping: �q— ` ©�— Quantity Pumped: i��Gallons System Pumped By: Wind River Environmental, LLC Permit#: Contents transferred to: Contents Disposed at: Date. Pumper Signature: Condition of SysterWOther Comments Dep Approved Form - 12/07/95 Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumving Record System Owner System Location 7 I M 1�r DtAi tJ �Q A n Type: Emergency Routine Cesspool: No Yes Septic took: W 0Yes i/� Date of Pumping: I(`� U— C ) Qniantity Pumped: Gallons `—r--+ System Pumped By: Wind River Enw ronmental, LLC Permit#: Contents transferred to: Contents Disposed at: Waste Water Plants Date: Pumper Signature: Condition of System/Other Comments Dep Approved from - 12107/95 Commonwealth of Massachusetts City/Town of System Pumping Record RECEIVED Form 4 JUL 0 3 2007 DEP has provided this form for use by local Boards of Health.Cather fca may be used,but the information must be substantially the same as that provided here. Beforelt6i Wh1 b-wc a � your local Board of Health to determine the form they use.The System Pumpihgizi�.Imns4��^ b�x1' to the local Board of Health or other approving authority. A. Facility Information Important When filling out 1. System Location: forms on the computer,use ) move e tab key Address to to move your cursor-do not Cityrrown State Tip Code use the return key' 2. System Owner. Name ram Address(if different from location) City/Town Stat � p, Pio r Telephone Number `� 1 B. Pumping Record 1. Date of Pumping Date Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of V s. Syst Pum By: Name Vehicle License Number Company 7. Location 14*—re contenttre osed: ��r ^` 4 V/ - J Signatu of a ler Date v / t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of NI-A a . System Pumping RecordF JUL 2 2 2009 Form 4 _s TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other forms TENT information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to- the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: Left front, left rear, left side of hous Right fron , right rear, right side of house. forms the ( 0 computeto 0 r, use �� to� only the tab key Address to move your A � cursor-do not City/Town State Zip Code use the return key. 2. System Owner: Name Address(if different from location) City/Town State Zip Code TTelephone �mber B. Pumping Record 1. Date of Pumping t o o 1 2. Quantity Pumped: Date Gallons 3. Type of system: 0 Cesspool(s) Septic Tank Tight Tank El Other(describe): 4. Effluent Tee Filter present? Yes �No If yes, was it cleaned? El Yes L] No 5. Condition of System: A)0( 0�d ItNet ( M �&Ok 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: L`-S10 Lowell Waste Water igna ure of H u r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 SEPTIC SYSTEM AS- BUILT CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE.1 =50 DATE:9/14/95 REV. 11/4/95 Scott L. Giles R.P.L.S. 50 Deer Meadow Road n OP�v North Andover, Mass. �v LOT #2 4 5 0) + R► LOT #12 �► a 40,244 S.F. CD x. TABLE OF ELEVATIONS O INV.OUT HSE:157.13 / ? IN TANK=156.36 OUT TANK=156.13 IN D.BOX=155.77 o OUTD.BOX=155.59/1-5 Q R=30.00 END TRENCH 1=155.01 L=27.40 �3s "-2=154.99 " 3=155.04 n " 4=155.02 � " 5=155.05 101,11, 180.91' LOT #13 I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE Of THE OFFSETS � OF THE BUILDING INSPECTOR ONLY 3 SHOWN COMPLY AND SUCH USE IS FOR THE H WITH THE ZONING 3172 e DETERMINATION OF ZONING- BY LAWS OFSR NORTH ANDOVER CONFORMITY OR NON-CONFORMITY L LAO WHEN BUILT WHEN CONSTRUCTED. Commonwealth of Massachusetts m City/Town of a System Pumping Record MAY 25 2010 WM SV.y�v Form 4 TOWN OP NOAI1�I,gNDOVER DEP has provided this form for use by local Boards of Heal . T but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of hous Right fro of house Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address City/Town State Zip Code 2. System Owner: Name Address(if different from location) City/Town State„ r�! r ZOqo5e�� Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes [.]'No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: Nc---.� r\M�a �' A —4z"-� ,-4 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: zo-L;TD) Lowell Waste Water 0 g to a of Haul r Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 e. a