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Miscellaneous - 660 SHARPNERS POND ROAD 4/30/2018
660 SHARPNSRS POND ROAD id Road _ 21011055 0000.0 _ I 4 I i MAP # j LOT,# 4 PARCEL # '+ STREET �ON$TRUCTIO.N_APPROVAL ; HAS PLAN REVIEW FEE .BEEN PAID? ' . ,.YES NO PLAN APPROVAL: DATE Z� C� APP. BY_ __.__ ___ DESIGNER: `��R$v���Lc�, PLAN DACE; S/93 A7 4 CONDITIONS WATER SUPPLY: TOWN /'WELL., WELL PERMIT " DRILLER.-.I - _..��CG l WELL TESTS: CHEMICAL DA I E APPRUVED.__)117/�S BACTERIA I DALE OPPROVLD . tJ/415 BACTERIA II DATE APPRUVEDSZ, S COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES DATE ISSUED r _BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAIDNO WELL CONSTRUCTION APPROVAL _ NU SEPTIC SYSTEM CONSTRUCTION APPROVAL S NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL.: DATE: 12-AgS _BY: a SES G SY&I�L"t_�NSIfl�L,HT 4N �AI IS4THE INSTALLER LICENSED? NO f TYPE OF- CONSTRUCTION: - ' NEW REPAIR , tt ,NEW CONSTRUCTION: , CERTIFIED PLOT PLAN REVIEW �., NO 1st r CONDITIONS OF..APPROVAL ES NO (FROM FORM U) r ISSUANCE OF DWC PERMIT � r ` ' YES NO : DWC PERMIT N0. � 1~ INSTALLER: �., � Ah LiBEG IN_ INSPECTION s \. t • EXCAVATION ,INSPECTION: : NEEDED: ilt ; - t - + 'S. ilu 1 aStr •[• `.,;-.�,tt - .. PASSED M.-,h BY =`. CONSTRUCTION INSPECTION: NEEDED: it _ � .. �. � .,+ V •.. .. �, ,1. - AS BUILT PLAN SATISFACTORY: ,ES -- .; .:APPROVAL. TO. BACKFILL: DATE. By FINAL. GRADING APPROVALS DATE ��+ 9 BY FINAL CONSTRUCTION APPROVAL: DATE: S/��4� BYtib 6986 NOFTN 1 of ,..o;y0y� F?o-Z. 0 Town of North Andover HEALTH DEPARTMENT S�CMUSf r� CHECK#: DATE: LOCATION: 4 ri , %/M1 H/O NAME: CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Title 5 Report $ ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer NORT1� L 6 g . of ;� Town of North Andover HEALTH DEPARTMENT $ACNUSE CHECK#: DATE: v ' 6Mwnj LOCATION: H/O NAME: So Ora CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Title 5 Report $ ❑ Other:(Indicate) $ VA?2 Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When felting out A. General Information forms p the p �ECEIVED computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not use the return Name of Inspector AUU Z Z014 key. Bateson Enterprises Inc. TOWnt Oc".0,� rrrvuO�ER Company Name L,yEALTH DEPARTl�'E/yT � III 111 Argilla Road �--..e Company Address Andover MA 01810 Cityrrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ eedsrFurther Evaluation by the Local Approving Authority 8/19/2014 Insp ctor's ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ***"This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .'� 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I i i t5ins•3113 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •�''r 660 Sharpners Pond Property Address Michael Simeone Owner Owners Name information is required for North Andover MA 01845 8/19/2014 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 ,Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *'This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to.or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ''� 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sawage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d On well water 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2012, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpners Pond Property.Address Michael Simeone Owner Owners Name information is required for North Andover MA 01845 8/19/2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 20 years ,old, 5/19/1994, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.4 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4" PVC through wall, 3" PVC in house, no leaks visible. Septic Tank(locate on site plan): Depth below grade: .4 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 4' Sludge depth: 311 � t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage.Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Outlet tee corroded on top. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: II ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpness Pond I. Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 level &distnb equahNo vidence of leakage. Evidence of carryover, pumped d-box to clean. D-box cover roken, replaced it. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump,chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments V•y�� 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 55' long ❑ 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 ok. Vegetation ok. No sign of ponding to surface. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpners Pond Property Address Michael Simeone Owner Owners Name information is required for North Andover MA 01845 8/19/2014 every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately C W 2kx A �� Z' i t a J2 su t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �r 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sha ners Pond � I Property Address � Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2/1/1994 ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Boar f d o Health - explain. Design plan ❑ Checked with local excavators, installers- (attach documentation) Accessed USGS database-explain: p You must describe how you established the high ground water elevation: As per design plan test pit data Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 660 Sharpners Pond Property Address Michael Simeone Owner Owner's Name information is required for North Andover MA 01845 8/19/2014 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 %-#ummonweann oT massacnusens City/Town of . System Pimping Record Folron 4 I DEP has provided this form for us6�by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine'the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/Right front of hourg lea f hou . , Left/right side of house, Left/ Right side of building, Left/Right front of Siding , Left/Right rear of building, Under deck � I Address Cityrrown State Trp Code 2. System Owner. Name' Address(if different from location) City/Town ' . Telephone Number S. Pumping Record 1. Date of Pumping gate 2. Quantity Pumped: Gallons ,. 3. Type-of system', cesspool(s) Y. ❑ eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filterresent? P ❑ Yes if yes, was it cleaned? ❑ Yes ❑ No, ' 5. Condition of System: 6. System Pumped By. Nell.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company nc Company 7. Location contents were disposed: � Lowell Waste Water Sig a Haul If. t5fomr4.doc-06/03 System Pumping Record•Page 1 of 1 Cx COMMONWEALT OF MASSACHUSETTS m EXECUTIVE OFF E OF ENVIRONMENTAL AFFAIRS A d DEPARTMENT ENVIRONMENTAL PROTECTION v ' gY TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 660 Sharpners Pond Road- -North Andover Owner's Name:_Glen Murchie Owner's Address:_660 Sharpners Pond Road_ RECEIVED North Andover,MA 01845_ Date of Inspection 5/18/2005_ MAY 2 5 2005 Name of Inspector: Neil J Bateson_ Company Name: Bateson Enterprises Inc._ TOWN LT NORTH ANDOVER p Y rp i HEALTH DEPARTMENT Mailing Address:_111 Argilla Road_ _Andover,Ma.01810 Telephone Number:_(978)475.4786_ 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 ails Inspector's Signature: Date: _5/18/2005_ 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. i Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_660 Sharpners Pond Road- - North Andover— Owner:_Murchie Date of Inspection:_5/18/2005 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 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_660 Sharpners Pond Road_ _North Andover_ Owner:_Murchie Date of Inspection:_5/18/2005_ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance_ "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_660 Sharpners Pond Road_ _North Andover— Owner: Murchie Date of Inspection: 5/18/2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: _ No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ' flow. r available volume is/2 da _ _No Liquid depth in cesspool is less than 6 below invert o ava a y in more than 4 times in the last year NOT due to clogged or obstructed i e(s). _No Required pumping y � P P Number of times pumped No Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No 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 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 I1 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 accordancewith 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_660 Sharpners Pond Road_ North Andover_ Owner:_Murchie Date of Inspection:_5/18/2005 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes _ Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes_ _ Were as built plans of the system obtained and examined? Yes — Was the facility or dwelling inspected for signs of sewage back up? Yes _ Was the site inspected for signs of break out? Yes _ Were all system components,excluding the SAS,located on site? _Yes_ _ 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? _Yes_ _ 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 _Yes_ — Existing information. _Yes_ _ 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)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_660 Sharpners Pond Road_ _North Andover – Owner:_Murchie_ Date of Inspection: 5/18/2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_3_ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_660_ Number of current residents:_2 Does residence have a garbage grinder(yes or no): No_ Is laundry on a separate sewage system(yes or no):_No_ Laundry system inspected(yes or no): Seasonal use:(yes or no):_No_ Water meter reading:_On well water_ Sump pump(yes or no):_NO_ Last date of occupancy: — Current-COMMERCIAL/INDUSTRIAL Type of establishment:__ Design flow(based on 310 CMR 15.203):`gpd 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:— OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 2 years ago,owner_ Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank_ Reason for pumping: _Inspect tank&tees_ 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/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) `Tight tank _Attach a copy of the DEI'approval Other(describe): _ Approximate age of all components,date installed(if known)and source of information:-20 Years old,5/19/1985, as built plan_ 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:_660 Sharpners Pond Road_ _North Andover_ Owner: Murchie Date of Inspection: 5/18/2005 BUILDING SEWER X (locate on site plan) Depth below grade: 24 Materials of construction: __cast iron _X 40 PVC_other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) 4"PVC thru wall, 3"PVC in house_ SEPTIC TANKS:_X_ Depth below grade:_12"_ Material of construction: X concrete_.__metal_fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: 10'x 5'x 4' Sludge depth 211 _ Distance from top of sludge to bottom of outlet tee or baffle: 25"_ Scum thickness:_2"_ Distance from top of scum to top of outlet tee or baffle:_8"_ Distance from bottom of scum to bottom of outlet tee or baffle:_19"_ How were dimensions determined:_Tape measure_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.)_Pumped septic tank.Inlet tee ok.Outlet tee ok.Depth of liquid at outlet invert.No evidence 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 battle: 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_660 Sharpners Pond Road_ _North Andover— Owner:_Murchie Date of Inspection: 5/18/2005 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 working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:—X — 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 level&distribution equal.No evidence of leakage.Evidence of carryover.Pumped d-box to clan. — PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):_ Alarm in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_660 Sharpners Pond Road_ _North Andover_ Owner:_Murchie Date of Inspection:_5/18/2005_ 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:_2 trenches 55'long_ _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 oL Vegetation oL No sign of ponding to surface. _ 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 sludge 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.): Page 10 of 11 I UBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 660 Sharpners Pond Road_ _North Andover— Owner:_Murchie_ Date of Inspection: 5/18/2005 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. Driveway Well Garage head A To Well —� House B Ato1=56' Ato2=52' A to D-Box=60'3" B to 1=35'2" B to 2=32'5" Septic Tank B to D-Box=41' 2 1 D- Box Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_660 Sharpners Pond Road_ North Andover Owner:_Murchie — — Date of Inspection: 5/18/2005_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater _4'_ 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:_2/1/1984_ 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:_As per design plan_ Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 660 Sharpners Pond Road, North Andover Owner: Murchie Date of Inspection: 5/18/2005 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. NeiqBat n Bateson Enterprises, Inc. If O 'dia , Al z aJar` f 13 o�c o -Le CAll) C) l r aG sg TOWNOF NO OARTH ANDOVER/ BRD OF HEALTH �- MAY 13 D` M C3 ���N of Massa SE y: ARBAG,1i 10 v' C' a No. 3, �SSION,I SP 5 � 5H19RPA4cAs Pc/) A//D 2 � � 4� .p 3 F i TiIIS PLAN IS NOT FOR ' RECORDING PURPOSES Q OFFSETS ARE NOT TO BF USED. FOR THE REPRODUCTION OF PROPERTY LINES � SPECIAL . "LOOD HAZARD AREA (FIA) IS NOT AP LE ` QOYER/ t . TQ1Al � � 1 ---_`� MAR ,3 0 199 `r CO, i i I �. LoT- I j i I � IM r � � 1 �r\ i 1 1 ti " FOUNDATION CERTIFICATION " "I certify that the foundation shown hereon is in compliance PLOT PLAN with the applicable Zoning Bylaws of the Town of x0trNA��, OF LAND with respect to horizontal dinal requirements." IN DAMASS. PQio�13 M SCALE: 1" _ 'n ' FEET DATE:F���; .j, D S C DEVELOPMENT SERVICE COMPANY -- �` 30 WOODLAND ROAD P.L.S. DATE ASHLAND, MA 01721 (508) 881-8776 /0 C_,g a T Cd �o /.V sTAc c s s d S �s ► Ila O �by�i 7 IIS Alp,0 411 ki kaa V' y � 8 � d v c-j £g ,t h Ns Ick -44 Vlr Q i FOR- DAT TIME M P.M. OF PHONE PHONED ' AREA CODE R.TURNEO MESSAGE NUMBER YOUR CALL EXTENSION PLEASE CALL WILL CALL AGAIN CAME TO SEE YOU SIGNED WANTS TO SEE YOU TOPS FORM 4003 I PLAN REVIEW CHECKLIST - ADDRESS,, ip ENGINEER J GENERAL 3 COPIES t..,-' STAMP LOCUS L/ NORTH ARROWy SCALE CONTOURSi✓' PROFILE SECTION BENCHMARK SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER WELLS & WETLANDS r/ WATERSHED?,O) DRIVEWAY (Eley) WATER LINE FDN DRAIN ,/ SCH40 (, TESTS CURRENT? �99J SEPTIC TANK / MIN 1500G_�,/ . 17 INVERT DROPy GARB. GRINDER/VO (+200% EDF) 25 ' TO CELLAR L-� MANHOLE TO GRADE �^ ELEV GW D-BOX SIZE # LINES vZ FIRST 2 ' LEVEL STATEMENT INLET ��>,y j� - OUTLET/'1�5,Jq = Z_ (2 11 OR . 17 FT) TEE REQD? LEACHING D MIN 660 GPD?.)(/ RESERVE AREA./ 4 ' FROM PRIMARY?z 2% SLOPE 100 ' TO WETLANDS f 100 ' TO WELLS L,- ' 4 ' TO S.H.GW 35 ' TO FND & INTRCPTR DRAINS t,--' 325' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY c% MIN 12" COVER FILL? (25 ' if above natural elevr 101if billow) BREAKOUT MET? TRENCHES 0 MIN 660 gpd ' SLOPE (min .005 or 611/100 ' ) >3 'COVER?-VENTA SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) 4,-' IS RESERVE BETWEEN / TRENCHES?L,--" IN FILL? MUST BE 10 ' MIN. 1/ 4" / PEA STONE? l BOT �gC? X LDNG_ + SIDE &"�ao X LDNG �7� = TOT_ (L x W x #) (G/ft2) (DxLx2x#) (G/�jftt2) Copyright® 1993 by S.L.Starr Ale's A/7 5 f CZ, ALI f N 'A 1 l•♦ y t S \ R 1 i,.�i`i,�tl+u1at1\i �,li ! ��'i3'4'7:�..'�tia ti 'C�s� tir, 4yy x,�:tial\� ,�,�NnCki ui.,��...}7. ;►�Ga Ni �} � ,..,� i.� i.• � �...i... - ,.i•.� T � ,`r y .t �1 � �! �� e}Y``r � r+ C�' ��4�, t a'V ,e... ;.j,�! i '.. .. � ; _ } 4 �, i ,�\e�i �� t'r�c�,`-. ,� a..r r ` i yl i �).;`.r1-��,• �i� S!_,<1 ' �� .. � �.n - 'e e. a /; >et ��� _ � r' 1 �� .1 �, •' t ' � � � .. � .. � ; 'r 11 ,r ,;tri iV r �` > � � \�1r � i �s},•r I tl:S /lam ' STONES TU 2y r 94 136)i? Z& y� , f I NORTN 0 Z. BOARD OF HEALTH 120 MAIN ��. � NORTH ANDOVER, MASS. TEL. 682-6483 SS. 01845 7SSACHUS Ext 23 May 9, 1994 Mr. Joe Barbargallo 1 Westward Circle North Reading, MA Re: 10 Sharpner's Pond Road Dear Joe: This is to inform you that the proposed plans for site referenced above have been disapproved for the following reasons: 1) Soil tests not current - show all tests done. 2) No water line. 3) Reserve not 4 feet from primary. 4) Show final grading. 5) Insufficient leaching (482 .9) . If you have any questions, please do not hesitate to call the Board of Health Office at the number above. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp DATE / CI Sheet of I i BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE ��® � PERMIT # SATE RECEIVED APPLICANT _7o-,&7f i L7-Y, ASSESSOR'S MAP ADDRESS PARCEL # LOT # f� STREET :��fia.F'6Ve— ,S 7 ENGINEER J , ��8/�G��� ADDRESS ��STLJ/�,�� �lpc�G� /u � "flDi/r/G PLAN DATE c3 /fv�/9¢- REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED .A-O-d4 D/A-16 V�j - I Town of North Andover, Massachusetts Form No.2 f MORTh BOARD OF HEALTH 41 ,;;,,.«� DESIGN APPROVAL FOR ss4CN°5SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Vlrl�/J Test No. I© - - - - - - - — — - Site Location �-� ------ ¢: Reference Plans and Specs. Ajo v A� la—— 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,BOARDZF HEALTH !' Fee �O' Site System Permit No. `I. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: &MIlle/Ct 22da/ttet rives Phone LOCATION: Assessor' s Map Number for, Parcel C++ � Subdivision Fes" A Lo-y s Lot (s) �U Street (%aD _c\ . St. Number {c(CG *******************+****Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected fl 1; _Q -!. �,+ Date Approved / f 1 7!`/�_... Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector _ Date ,,:'Cts 'P::i;�,?s. ;4k`� 34. f t •wsy ;rr L.e' •oma r� ,yZti 1i . a�. -,.F kEnti t, r� v ti 34 Y'.> #�• _7��. `.y'�.. i. tY'. � Y •v :Slv ,1• y �*�., p ,rr a: a���.11'ay T`,. tb��►b�,��{`';k�:+ �ct` +�y,�i�.,, ��� \-�,���, 1V���«��'X,��; r I. ,a -� - - , �'1 x `-•: �' a's \ a�, - �Z .� .,tet t,,_� 1�. *' i r ..i� 4 e�Y � ` t � - ;�1�=. 1Y Lam& \-- J{�:`i`v} ♦ �, sl L � 5 � s. r Y� - e E E E 7 y `21 7 LL Y4�� \l. 1 `�` a, c t L +Y• + f ty.. h \�.T r iy.•y �++•�� C� 4 i - C� �• +1 i C 1 �.`t Y ♦ �. 5 i � 1 7f + tl�y „ it{ya v�C \ s�., 1 1' b !0I, t' \ ,\ _ , Vit••, Town of North Andover, Massachusetts Form No.3 NpRTF, BOARD OF HEALTH o 19 P �,'°�•.ro0*'l DISPOSAL WORKS CONSTRUCTION PERMIT SSACHUSE� Applicant_ No-kr-A NAME I ADDRESS ^ TELEPHONE Site Location Permission is hereby granted to Constructor Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No—93 ,1 y TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) S p DATE OF PUMPING:f()"(n'y,X-QUANTITY PUMPED GALLONS CESSPOOL: NO YES SE ,TIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: Gi✓� COMMENTS: CONTENTS TRANSFERRED TO: S ' TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES o:°b'?�.o'�'°�°O� HEALTH DEPARTMENT Y ; • +M 400 OSGOOD STREET • �, ...�::.. �� I NORTH ANDOVER, MASSACHUSETTS 01845 I 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.9542—FAX Public Health Director E-MAIL: healthdept@townofnorthandover.com WEBSITE:hqp://www.townofnorthandover.com April 11, 2005 To all Sharpeners Pond Road Residents: Please note that it has come to the attention of the Health Department that many residents are leaving their trash barrels and trash bags out at the curbside for days, or weeks at a time. Empty trash barrels blowing about in the road are a safety hazard, and trash and debris along the roadway is a health hazard. Please be mindful of this, as the Health Department will conduct periodic inspections of the area to determine who is in violation, and fines will be issued if protocol is not followed. The Board of Health follows the State Sanitary Code regarding Human Habitation, 105.CMR.410, Section 1: 410.600 (A): Garbage or mixed garbage and rubbish shall be stored in watertight receptacles with tight- fitting covers. Said receptacles and covers shall be of metal or other durable, rodent-proof material. Rubbish shall be stored in receptacles of metal or other durable, rodent-proof material. Garbage and rubbish shall be put out for collection no earlier than the day of collection. (B): Plastic bags shall be used to store garbage or mixed rubbish and garbage only if used as a liner in watertight receptacles with tight-fitting covers as required in 105 CMR 410.600(A), provided that the plastic bags may be put out for collection except in those places where such practice is prohibited by local rule or ordinance or except in those cases where the Department of Public Health determines that such practice constitutes a health problem. For purposes of the preceding sentence in making its determination the Department shall consider, among other things, evidence of strewn garbage,torn garbage bags, or evidence of rodents. 410.602 (A) Land. The owner of any parcel of land, vacant or otherwise, shall be responsible for maintaining such parcel of land in a clean and sanitary condition and free from garbage,rubbish or other refuse. The owner of such parcel of land shall correct any condition caused by or on such parcel or its appurtenance which affects the health or safety, and well-being of the occupants of any dwelling or of the general public. (D) Common Areas. The owner of any dwelling abutting a private passageway or right-of-way owned or used in common with other dwellings or which the owner or occupants under his control have the right to use or are in fact using shall be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth or causes of sickness that part of the passageway or right-of-way which abuts his property and which he or the occupants under his control have the right to use, or are in fact using, or which he owns. ,. Residents should know the following: • The Town has a mandatory paper and cardboard recycling ordinance that requires residents to separate these items from their household trash. Paper and cardboard are collected every other week on the same day as the household's normal trash. Residents can call the DPW at 978.685.0950 to get their recycling schedule. M • Residents are responsible for picking up loose trash left at the curb after collection. Banned Items and Recycling Requirements: Please refer to the DPW website for a complete list of all the recycling requirements: http://www.northandoverrecycles.com. Please contact the Health Department if you have any additional questions. Thank you. Sincere an Y. Sawyer, REHS/RS Public Health Director File I 4� TOWN OF SYSTEM PUMP RECORD RECE ' ` L MAY 2 5 2005 DATE: TOWN OF NORI t! 'J'4L 0 ER HEALTH DEPAf MENT SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of house) te DATE OF PUMPING: QUANTITY PUMPED: GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: coNTENTS TRANSFERRED To: G.L.S.D Lowell Waste 1� .: . ill :�s�chusetts ANDOVER MASSACHUSETTS a9?fir ♦, , W=,System'Pu � TPing Record ryi! JC i�f'Ti« £ f�tyl i]JijE . fitJ 14„ , v Fo�� v , 6\EC �� DEP.has provided this form for use by local Boards of Health. Th! System Pumping Recor must be submitted to the local Board of Health or other approving auth rity, SEP 7 2007 A Facility Information TOWN OF NORTH ANDOVER ��-Uwrtant. H HL. DEPARTMENT s,,,yYhen filling out 1 :: System location foitna on the computer,use` only the tab key Address n / to move your ./VU. cursor do not Ci use the retum tyState Zip Code key 4 ,, 2` System Owner t Name Address(if different from Location) City/Town State Q •p Crq Telephone Number Pumping Record �. ' Date of PumpingPumped: 1. 2 • Quantity an 1 t III Date tYGallons 3 TYpe ofool system ❑ Cess s P � ) eptic Tank ❑ Tight Tank 'Other tdescrlba);` ' I ! 4 ffluent Tea Filter present?:❑ Yes.�No If yes, was if cleaned? ElYeNo • Condition of S st m ;r I Y 4 YI VJ 1 .•1 i y rV /' 6 Sy esn,Pumped By. • ,. ,G I . !Jame Vehicle Ucen$e Number t ••sxvti. hs,r•f. .t�,f�>�4twt� cid �'�4 t �•�'�' n„r „„^• Company,., 1 h.Hirttlhaai�w t t_,!4 1yt= 7 locatign.where contents yvere dit3po`sed; d ,,', s l :Slpnatury of Hauler;=1 Date httpW/0w*mass.gWdOtwafe�A rgvals/t5forms,htm#inspect t5fomv4 docs 08!03 System Pumping Record Page 1 of 1 . . .. ti f• -� :1 1-ASSACH-U-S-E- 8 S t I' .m '.Record .- • ��`•`'` 1 j �1lI)�I �e 1.,1ic �1,��,1.� �V��C^��1 •.'Yr\`IL�•.�'. D he# proVldad lhli form for c'eo ,y ;o^el 6oarce or HoaC;T , 2��$ bml{{od Io the local BOOrc cr ;,oa to Or clhvr �-, 'r ,'1; o Sy3cem P P0/ , : ,. ...vvinOrl HEA_rEi fY•%CT A. Faclllty Inforrta� lon ` T SYV.gM locauon: 7.4 '.,4lee ' �"�•00f1Q1 {,��,`' Y•Ct.;'��, ,�"•1' i,.'.,La;'1�,;�,., '/, �.•.� , � SIM 1_"_------- ,. Y v Tc!opnOnf K,m01r 6 Pu. ml p n ord 1e' - .•• R , g � . .f: Pum'.In S 7y a pl a a!e D m;` Y Ce99p001(9) $9 OC Tan,, } P a , .,... ' lont Ter,, - 1 F ❑ O he (describe: Ef YOV Tea FIllo('Pr.mnr? r' Yo9 ❑ Noit ' �1r r Ye9. ria9 i; Clean !1 r I. sY p�'mped ay. G .� �r.... Y,�1%'J .t .•k �I d �; �• ..'C rcoo VON + ,'7, oca on.whare f;;lt�,;..,:�,•. . �:,� .L.;.�,,,�, •.,,.,,;,,r,'. pprllenls',yrere d►sposeo: ail t;" IN i, ,;:�;�,''•;::./•f�,,� ,SInitwr �I1 �.8ov/deF.�waler/apprpvaJsJlb/orms.n�m�1�9�eC! Towrr.00f over C) :0 No.D2 i o_`Nort , ' dover, Mass., ��� 19 qr 15Coc"i "r _CM It ,`°RATED PP�,�� BOARD OF HEALTH LD h ;-1 � Food/Kitchen Septic Systerk!, 2 ,qPERMIT TO o � BUILDING INSPECTOR THIS CERTIFIES THAT . ... I�I JI�. .... `�4 .. ............................................... ... ounda io � 3�'q�_(3S) �,0 has permission to erect. ..... n1f�.. buildings on .��nQ.....Sl-�r� tl�. ..!x- ........... ... dm��n Q� t I� t0 be occupied as..&146L& �l .4 �`... ......tN . .... .�.... �t �0 Cey CA provided that the person accepting this permit shall in every espect 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. PERMIT FOR FOUNDATION ONLY PLUMBING INSP CTO REGULATED BY PARA. 114.8-S. B.C. �(y�3�9 -'` VIOLATION of the Zoning or Building Regulations Voids this Permit. oU PERMIT EXPIRE 6 MONVkTq I FEE PAID A/, ELECTRIC INSPECTOR UNLESS CONS' U I NT Rough PERMIT FOR FRAMUBUILDING BUILDING INSP OR Fin DATE: EE PAID:._._._.._.. Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FIRE DEP RTME T II-1� � ► � PLANNING 2INAL CONSERVATION M FI L street N°. �IZ Qf{L{ �, -4 Smoke Det. 6 --SEWER-/WATER `SAF NAL DRIVEWAY ENTRY PERMIT l ` Fr-cirn T il-r!.wtf: =LL FI_irF -J'I• PHONE do. c_ ��-; 351 9tc_,Ia Ta.r-I. i.�a 191;5 1i•1.72 w' F0i aif3 tt LVN')K -t;�,4�s ++1L$xF'l7liC Nfn VaEt�b i$08) S92.639b FAX (NM) 6532x04?3 1-$p(),�iQ§�-TA T R POt'tt M-Ifnbb l` i C- 14474 ReVQru ZaLv ; j as1ud1 v ' , 1995 T erint& Ogde p x�zsc I.,Qt 10- Ohapnere Mond ?gid , fi gam pla Taken Ay : Ogden St.&ff C"R3 TIS ?ICA'i A OF A�JALYSJS T `AT PAP-W21'E : BPA Max RESUILVSLAN I 1��' ' ' Co )Psi: ( 3 1 , T(Mq/L lyin • rl@s`L-tic" NO L'.^,.-t- i. 2 niq/T) t'7�a �a Bit-, S _ um Po ABVIUM (81 No 114mit 0 .43 titQ/Z� Ai alin'it y (5) NO TRIM" L 25 , t,? ^�� /L Am tori a NO Lit'st 0 , ^3 M '/L C%h o�.`ide s;) 250 6'. C' tri mg f T.J Ch tea:ik,. +,'t,.ts� ) N 0 t S} c, . '0102 Q01 ductivity No Limit 6;n carttl)01;/c.M HSLI dneco No Limit 24 MU/L ( 7Gir u ( 5G 7 , 4 L Tut 17idit'y 5 1, • 5 IdR"T s m�zs� pC, Riff' Isar ` ibPted, #-Vali:lc L":��Ceeed€t E�'A STD, T ,TTC-�'�a( N%Mt cur, to Count - tt� •r sort emit a,n..darr!t; C,;hCtl�.t'r! TINA t Y1dA. c� (m8y :9 t�'rt a0ri thatics of water e , ta8t s �^r,a Q. 9 t c r ! Th.:. wAtar sample, a.�, mow—ed, is t.:-nf; .derew.1 SAF ' to Crink according t: PA gt.idelinep , Howevovv, one oirf sore Ql t.;rie pa)-ameters excearjsa EPN Recondary st-andard.q as indic-4:t-asci by the (#; sign, ,etas ac.?tuset,t.s State. Ce.-.tif.ied M.j Iwo`. t.a�1"scjil, `f_ur �! ( G):,1�Er+)Cut,71 (+1\ry1t7tU11E13t:1t�lti)rJ2�@ttlCril/DI','(41{)di:)f%`hater Resources , '�..wa...a....�..aw.eran�.�„w..msi.YMm.n,. ... .,w.•wrw«�s• WELL LOCATION 0E04,11iAP3 IC VE3CHWIION p.;'l Ci I o SS�--•-1�-�+�--�-__.-__I�,._.--_.__.__-------- r .,,..,,.. rexrr,trr.+tnr�e�ew '-• - ..,...�...,..,.....�......,.,.�------ a v76'r� r� - Weil cwaf,cr,__/��, d cf4_.�__`'�_.. s��•L'• . S if ni i rt✓)) (LIrCfR) Board of?ieait!r parr,;t omaa,necl yes , no [7j /ro=dl 4trl;f t IME 4VLf.L O ATA y (� Dortirstir M 'initis I-] Ir;clkloC:;i (,•f l ]tr.i wcll dclaiit., later boariny ro ;/iinCe,r?& 1tUat+?d tl1 ii91t l: �T ::;7 Ltescrtptrc t---" pf �- 4"•fJ jlr f-•p hi,nfr 7tt rlu[: CMING TO r ]l {t O 1T\ - yth into Lod:,c)•-- (-—___.,f1. Jl i� -�,-yy,rN�yw,.•._.-_. �f Utrte.f)v Y: WF.tI ortryl; tylhl,t.� Ulfler•?��,`� i'k�lr :j'i.-il"_----icngt,?„ .._---fion'�_._�ta,�,_,,.,_., .•....�..... _ �� ..arr,�,......,....w...,.��.arwn+ow.w.r«.,.r..e,rsrn 51 A I IC;VVATFFi LEvEL fall wells) Stalls wratur levot bclo;a land sui fare .___6____. h. Late WELL TEST(production we',$) _ shc�r titcfriplilg- "f._.lit _-.-P,;- {)lin. Qt_�'t__t,p{n liow rneasurvtf�4.��1"��-•---f�eaft<'e)y__�._-._1i, alta)._”"- f,r _.._�n31n. h •'ate rrw�owa, areiu�.aw»�w+wr�w.rcu i LOG of FDRMAVONIS cON",MC,N t S AArte;r�,l �..." How ,« ...,.w w�.w-..Aar.•.a.es+r.+1.'+w.�n�.ju.,.w...,...W ,�, _ . .. — � PJarwr,nntrrmlY DRILLER C0PY t►ORTM F — 9 BOARD OF HEALTH MAY 7 1995 °..•.s ,SSACMUSE� NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT Permit -� 5� Date A permit is requested to: drill a well_; install a pump_ LO I ON: �L ./!_L� S -got AT Owner`)L;�Lc Tel well Contrctr�/�. �-� & LI) Add.��° S _ Tel L)7 - �1�-� Pump Contrctr yU — Add. Tel WELLS (To be completed at time of pump test. ) Type of well Use F SSC C Diameter of well (11 // Size of. casing (o ,L Depth of bed rock Depth casing into bedrock Seal been tested? Yes (_) No (_) Date of test Depth of well Water-bearing rock Depth to water Delivers GPM for (how long?) Drawdown `� feet after pumping hours at GPM Date of completion_ ' Signature of well contractor PUMPS (To be filled in before installation. ) Name & size of pump Type Size of tank Pump delivers GPM Galvanized Plastic ( ) Pipe d in well: Cast iron ) (_) — PiP use (_ Sleeve used to protect pipe? Yes (_) No (_) Type well seal Date Signature of pump installer Dat water analysis report submittedto B and of Health P 'umbing inspector W' Ing inspector V r Board .of Health j Department of Environmental Management/Division of Water Resources a WELL COMPLETION R T WELL LOCATION GE R ION Address 7�)U N S W of �1,409 P ,e) O��� �� r--- (Icer/ (circle) City/TowSh;,9urucT Well owner 444110f la 014-0//S O (road) —� Address _ NOS E W of (m!.in tenths) (circle) ,--,/ intersect. w/ 1 Board of Health permit obtained: yes Lg' no El (road) WELL USE WELL DATA Domestic vublic❑ Industrial ❑ Total well depth —ft. Monitoring❑ Other Depth to I C� —ft. ?A ater-bearing to /unconsolidated material: Method drilled Date drilled Description 7 QF C i g, o Water-bearing zones: CASING 1) From L'5 To S Type 19 1!:) _ZYCP'L- 2) From To Length-Zd_)_ft. Dia(,I.D.)_J,,,;,-in. 3) From To Length into bedrock f h ft. Gravel pack well: dia. Protective well seal: Screen: dia. Grout_❑ Other :%212Aje S kh-1- Slot# length from_to STATIC WATER LEVEL(all wells) �• Static water level below land surface—6 It. Date A "21 WELL TEST(production wells) Drewdown -9�- 57 ft. after pumping-4-hr. 0 min.at How measured910LJ Recoveryft. after=hr. 2 min. 0 LOG of FORMATIONS COMMENTS g c k Materials From To 0 1, n c POL O 0 Driller l - - dP✓1 1���_ Firm Address A 'o �ow City/Town Supervising Driller Reg.>x _— Sr nature of supEYvr41h re istered well driller Please print firmly ` I BOARD OF HEALTH COPY J - I MAY-23-95 TUE 09 :20 AM GRAN I TE. =TATE. ANAL'r'T I C 603 434 4837 P. 01 FM*ln nit Office/Laboratory At: Tramway Marketplace At: Daniels Artesian Wells 22 Manchester Ptd.!Fit. 28 Route 16& 25 Route 3 Derry, NH 03038 West Ossipee, NH 03890 Sahbornton. NH 03269(603) 432-3044 1.800.699.9920 1.600.699-9924 i ITerfif irate jaf 11-Analgelis for P rinhing Water a SENT TO: � Andrew & Maurice Builders TEST NO. : x:69 Nferrsiac S t. R,P't�tt2err, 11.11 0184,14 `PMFtLV T,0"AlION; Lot, I 660 SharpnerS Pond 1 DATE & TIME SA21PLED: 05;18/95 11 ;45 AM No, Andover, MA EPA PARA-MIRT,ER RESIJLT RECOIMMEN3DED } i T?AROT>rES5 j'r'p "PLOPTH 2`0 NITRATE. 10.0 NITRITE 1 .0 S0D1U114 250 i I P 0 N . I COLIFORM ABSENCE /1.00 11L WENCE /100 ML OTHER BAC TERTA /100 ML 200 110Q ML COPPER 1 � ARSENIC' LEAD ij G i CTiRf;:fIU14 CALL T i1R•T }acNE SET PLUORIDE 2.0 COLOR CPU )5 C.pl; f E ODOR ION 3 i C)1i TURPTOITY NTU 5 NTL HYDROGEL SULFTIOE NONE ^Ei' XXX1 l , THE 'BESTED PARAMETERS NEET CURRENT EPA STANDARDS FOR DR.INi(A WATER. THE TESTE1.) PARAIMFT�RS RIFET CURRENT EPA PPIFTARY STANDAPPS FOR DRINKING WATER, BUT SO ME SECONDARY PARAMETERS "h'CEEL STANDARD$, } 141 '.HE TESTED PARAMz&TERS T±A.x(_, CURRENT EPA STANDARDS FOR DRINKING WATER i ___ ----_._ . -- --_- L'LiF TO PEIMAR7 STANDAR!'S OUTSIDE OF .IHIi TS, I LESS THAN OUR LOWEST l,'z,LIt3.4ATI..014 PONiT GREA'T'ER THAN rOUP.. HIGHEST CALIBRATION POTNT TNTC TOO HUMOROUS TO COL11 T I CLADS PARPITIETERS THAT EXCEED PRIMARY STANDARDS; CAUSES TEST FAILURE. � 2 FLAGS PARAMETERS THAT EXCEED SECONDARY STANDARDS; DOPNOT FAIL TEST. NOTE,: SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE KAY V1lR Authorized by Authorized byy ,FcO kJ,b 6L"-, —P/ Ui'Y/ ili�1 G i�SSC -Gi�.�c5 (508)851-9051 ~ Residential ` 1-800-339-9051 IndustKILI T.J. Ogden.Co- wells,Pumps,filters Repairs&24 hr.Emergency Service } Tracey Davis q tier,"� 17 Catherwood Road I. _ Tewksbury,MA ol876 3� •�,• '' OCL ` .....• BOARD OF HEALTH �SS„"USEt NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT Permit # 5� Date A it is requested to: drill a well_; install a pump • 1 LO ATION: �L. /LC a S . -� of # / L% Owner`)L.i.�..CL Tel Well Contrctr�� ��c�. &- �z� Add.f C� -� STel Pump Contrctr Add. Tel WELLS (To be completed at time of pump test. ) Type of well /t'.S /6Z-A- Use Diameter of well 6; Size of casing Depth of bed rock Depth casing into bedrock Seal been tested? Yes (_) No (_) Date of test Depth of well Water-bearing rock Depth to water Delivers GPM for (how long?) Drawdown feet after pumping_ hours at aJ`� GPM Date of completion_ Signature of well contractor PUMPS (To be filled in before installation. ) Name & size of pump Type Size of tank Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_) Sleeve used to protect pipe? Yes (_) No (_) Type well seal Date Signature of pump installer ********************************************************************** Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS ...Tawn....... of ..........Rox.tb—Ariclo-var.............................. This is to Certify that ---T.t...j-t----QgAgja...ca�........................................................................... NAME 17 Catherwood Rd. , Tewksbury, MA 01876 ........................................................................................................................................................................... ADDRESS IS HEREBY GRANTED A LICENSE For ---------Kell...dri I I Ing...at—Lot...10LA-Shar-parie-r.1z---Parid—Rd-------------------------- ............................................................................................................................................................................ ............................................................................................................................................................................ ............... ......................:'k........................................................................................................................ Fhis liccuseois- anted,% conformity with the Statutes and ordinances relating thereto, and 4;1 1� -- cem 1995 expi es_____ unless 800)2�x ided k :d�� ------------------ ---------------------------- suspgn or,,r(!vo e . ..... ......... .... ................................... --------- ............. Jcnu J Ayr- .................... .... ........ ........... ............. FORM ass HOBBS & WARREN. INC. .7 AN- 4 FORM 4-SYSTEM PUMPING RECORD SEPTIC,& DRAIN_SERVICE 107 FOREST STREET;MIDDLETON MA 01949 _ z 978 774-2772 , ! x r r 'COMMONWEALTH OF MASSACHUSETTS `AJ Ml pove,2. MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER; .:'; SYSTEM LOCATION: X35-6 DATE OF PUMPING: QUANTITY PUMPEp.• -GALLONS , Y CESSPOOL: NO YES SEPTIC TANK: NO a YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: 40 h DATE: ry . INSPECTOR: C,f.. Y 6 1 WELL DATABASE ADDRESS: P 0 - 4tV ? J y�� ✓�;� �C.� � D AGE OF WELL: WELL DRILLER: WELL PER1tiffT.T: 5 WELL LOCATION: t WELI.PERNET DATE. - `Z DEPTH OF WELL: -- TYPE OF WELL: a DRIL b. DUG c. UNKNOWN TYPE OF WATER BEARING ROCK: '7f rf WATER ANALYSIS DATE: 5 S HIGH MANGANESE:. Y FHIGHIRON: Y OTHER CONTAMINANTS: Y N Commonwealth of Massachusetts "� - FHEALTH hiVED City/Town of NO. ANDOVER a System Pumping Record ' ` ' ��� Form 4 OF NORTH ANDOVER DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use 660 SHARPNERS POND DR. only the tab key Address to move your NO. ANDOVER MA 01845 cursor-do not City/Town State Zip Code use the return key_ 2. System Owner: CMICHAEL SIMEONE Name Address(if different from location) s City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 9/23/10 2- uantity Pumped: 1500 Gallons 3. Type of system: ❑ Cesspool(s) E Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ YesNo If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: James H. Currier H79 406 Name Vehicle License Number J's Septic& Drain Company 7. Location where contents were disposed: GLSD 9/23/10 Signature of Hauler Date t5form4.doc•06/03' System Pumping Record•Page 1 of 1 �L\ Commonwealth of Massachusetts W City/Town of NO. ANDOVER System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use 660 SHARPNERS POND RD. only the tab key Address to move your NO. ANDOVER MA 01$45 cursor-do not use the return C4/Town State Zip Code key. 2. System Owner: rQ MICHAEL SIMEONE Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 9/11/12 2. Quantity Pumped: 1500 Date Gallons 3. Type of system: F1 Cesspool(s) ® SePtic Tank El Tight Tank El Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ® No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: GOOD 6. System Pumped By: JAMES H. CURRIER H79 406 Name Vehicle License Number J's SEPTIC & DRAIN Company 7. Location where contents were disposed: GLSD 9111/12 Signage of Hauler Date Signature of Receiving Facility Date t5form4.doc-03/06 System Pumping Record-Page 1 of 1