Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 67 SHERWOOD DRIVE 4/30/2018 (2)
67 SHERWOOD DRIVE e 2101105.C-0073-0000.0 i I L Form No. 4 -- — Town of North Andover, Massachusetts BOARD OF HEALTH Auaust 12 , 19 97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (g ) or repaired ( ) by Bob Innis INSTALLER at Lot #16 Sherwood Drive, North Andover, MA 01845 A vION has been installed in accordance with Board fCHealth Regulations as described in the Design Approval Site System Permit No. 834 dated 4/2 19 96 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH Town of North Andover, Massachusetts Form No.3 NORTOI BOARD OF HEALTH of '�ti p 19 y,SE�h DISPOSAL WORKS CONSTRUCTION PERMIT SACMUS Applicant NAME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. R60F HEALTH Fee _ D.W.C. No. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: LfZ- 1 A 7 CURRENT INSTALLER'S LICENSE# LOCATION: / LICENSED INSTALLER: gob b T h n I's SIGNATURE:LSC , U„ � TELEPHONE# "0 8 - e'2 - C CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As-Built? Yes No Approval /�/G//�/�' Date: 1 E Town of North Andover 01 40RTN 14 OFFICE OF 3a <<"" ",�° COMMUNITY DEVELOPMENT AND SERVICES A 146 Main Street � � • North Andover, Massachusetts 01845 WILLIAM J.SCOTT Ss emu Director November 12, 1996 Tom Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot 16 Sherwood Drive Dear Tom: This is to inform you that the proposed plans for the site referenced above have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, d, Sandra Starr, R.S., Health Administrator SS/cjp cc: File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 `Town of North Andover f koRTH OFFICE OF 3?o c, COMMUNITY DEVELOPMENT AND SERVICES °-.' 146 Main Street " North Andover, Massachusetts 01845 WU,LIAM J. SCOTT 4SSACHU S i Director September 11, 1996, Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot # 7,12, 14; 16 Sherwood Drive Dear Tom: This is to inform you that the proposed plans for the sites referenced above have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely; Sandra Starr, R.S:, Health Administrator SS/cjp cc: Bob Janusz BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 THOMAS E. NEVE ASSOCIATES, INC. Engineers * Land Surveyors • Land Use Planners 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 (508) 887-8586 DATE i V �, I^, JOB NO. � L/�� /� (FA{.X (05008) 888873�4r�800 �/j G.� ATTENTION C/I�Lv� / y/�rj�✓���p��.�/) (�� TO / L-3I� ;E e RE: ` �j� VrWVI.�✓ Vt+. oPr1Zlp ©r- -tl4 TOaNN IVORTF►��;TE-i`�� i �-s.066,, Rfa WE ARE SENDING YOU Attached ❑ Under separate cover via L—_1_11-31 ol o ing items: > ❑ Shop drawings Prints ❑ Plans ❑LSa_mples__-----M"Specif" i'coati ns ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 9112 VMIP� -2�_I�M Ler'( LO Pi�IrC_PK,60 THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return correctedP rints For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS JX, '_�'bbCA- C U''ir1" 4- '�k3 0 �S 'L-. fi{2 Qf -raa t C-C—y tl-2W Vb-2 fief, N c f- ^'Ty,"Of R ROS 7 Nt,6 M I Q&- -2 _f -10 `"�W Pr� 'ice 06ifz ry', c 1 fz_leVtcU15�7 'FCA43", �-e P�cgo 9I t� 1� -fes N kst_� PW�KSL-r Av)12 �`2W-Uc- V- Ux�c ry . `AAA !�7kLIV 046— A-W -e COPY TO VbO RECYCLED PAPER: g�Contents:40%Pre-Consumer-10%Post-Consumer SIGNE If enclosures are not as noted,kindly n yus at once. ` THOMAS E. NEVE ASSOCIATES, INC. [UR44M W Engineers • Land Surveyors • Land Use Planners 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 DATE _t JOB NO. A '� (508) 887-8586 ATTENTION G� v FAX (508) 887-34480 TO kf\3 t '��a' RE: t�0 V___nNl�Gam - 16 ���T� PS1.1�by�►2- , l ����o���� ` _.. n WE ARE SENDING YOU 'Attached ❑ Under separate cover viae followin s: > 1 ❑ Shop drawings. Prints El Plans [ISamplesSpecifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION r�.`�_I SA�i-c�r+2��t t�151 s-�s- G�s►G terr ttp t�scs� THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted Resubmit 3? copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS . G>_f - FC.-E��(5F S� CSP l� CV ��f_ 1 v t 5 i A-pr-_ PSV,4� --Vb G6-y�A w I-rte �o UL(, ��652 •�C�1,`�- yI.'fUAft01-� W 1TA- Y 0 0 1 t� -3kt-AVf'se_� o V SCD P 'GV),E- ?0) COPY TO RECYCLED PAPER: aP'Contents:40%Pre-Consumer•10%Post-Consumer SIGNED: If enclosures are not as noted,kindly noti at once. Town of North AndoverNORTH Of 1ti OFFICE OF �? a °0 COMMUNITY DEVELOPMENT AND SERVICES A 146 Main Street North Andover, Massachusetts 01845 SSACHUSO June 11,19996 Mr. Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot#16 Sherwood Drive Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. No wetlands disclaimer. 2. No foundation drain. 3. No perc elevations. . 4. Tank not 25 feet to foundation; no manhole to grade. 5. Trenches not 35 feet to foundation. Size not based on 110 GPD w/660 GPD minimum. 6. Leach area not 100 feet from street drain(N.A. 4.18). 7. Only 1 soil test in system. 8. No map & parcel. If you have any questions, please do not hesitate to.call the Health Office. i Sincerely, Sandra Starr, R.S., Health Administrator SS/cjp cc: Bob Janusz f BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 DATE /qG Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER / SUBSURFACE DISPOSAL DESIGN REVIEW FEE 1p PERMIT # DATE RECEIVED �L/a�96 APPLICANT O 1-3 J A AIUS Z, ASSESSOR'S MAP ADDRESS PARCEL # LOT # /lo ENGINEER �EU STREET S��•eLc10Q b 7��2. ADDRESS PLAN DATE �5��16 REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED X p�c2 /Vo /ti pl-v - /UCS N6,�C 7-0 7 C 1� E C. -AA), iU0 7- TO SDN A-)0 a T�OU C/Y-ES A-)O T j3 �r TD D/v " OA-) 10 T2 /00 7 ��,7! O��y IA-) 5 ,V-57&- M , g34 j PLAN REVIEW CHECKLIST ADDRESS ENGINEER GENERAL / 3 COPIES STAMP � LOCUS NORTH ARROWy SCALE CONTOURS �� PROFILELI SECTION BENCHMARKSOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS f- WATERSHED?-.1-6 DRIVEWAY �Elev) WATER LINE 1--' FDN DRAIN SCH40 L----' TESTS CURRENT? �� SOIL EVAL '�3 • T) 1 2 56 SEPTIC TANK / MIN 150OG V . 17 INVERT DROP l/ GARB. GRINDER(+200% EDF) 25 ' TO CELLAR MANHOLE ELEV GW # COMPS. D-BOX SIZE # LINES FIRST 2 ' LEVEL STATEMENT INLET 147. 3. - OUTLET 14716 (2" OR . 17 FT) TEE REQ'D? Wr) LEACHING t-D kA-"U MIN 660 GPD?z RESERVE AREA I/ 4 ' FROM PRIMARY? v 2% SLOPE 100TO WETLANDS 100 ' TO WELLS (/ 4 ' TO S. H.GW 5 '>./IN) 35 ' TO FND & INTRCPTR DRAINS 325 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER ,�FILL? (15 ' if above natural elev; 101if below) BREAKOUT MET? �- TRENCHES MIN 660 gpdZ SLOPE (min . 005 or 6"/1001 ) SIDEWALL DIST. 3X EFF. W OR D (MIN 6 ' ) RESERVE BETWEEN TRENCHES? 4---*' IN FILL?_"- � MUST BE 10 ' MIN. 4" PEA STONE?4--' VENT? �� (>3 ' COVER; LINES >501 ) BOT 3 64- + SIDE 364- X LDNG 7¢'= TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright 0 1995 by S.L. Starr Town of North Andover NORTH OFFICE OF of ``�to °,�0L ..COMMUNITY DEVELOPMENT AND SERVICES A . - 146 Main Street • t � �` North Andover, Massachusetts 01845 9SSACHUS�S i April 17, 1996 i Mr. Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lots 3,4,5,7,14,15,16,12,&19 Sherwood Drive The above named lots at Sherwood Drive have been incompletely submitted. The submission of new designs after January 1, 1996 requires the inclusion of soil evaluation forms. Until these forms have been received, the above mentioned plans will not be considered submitted. Should you have any questions, please call me at the number below. Sincerely, Sandra Starr, R.S. Health Administrator S S/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 C 'l / FORM U - .VERIFICATION 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: ?I)0bee.► Phone pv 8- 3?3_ 7&3 LOCATION: Assessor' s Map Number \U(A Parcel L4-IrS 3Aze 1V Subdivision �y Lot(s) Street St. Number 7 ************************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- alth Date Rejected �/t) Date Approved -Septic Inspector-Health Date Rejected Comments V/ Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date MAP AND PARCEL ADDRESS 7�� OWNERtir,L�i 1i1� SIZE OF LOT IN SQUARE FEET C7 1 6 F #BEDROOMS SEPTIC SYSTEM LOCATION f 4'AO—AA Va-A% ' (For example,FRONT YARD SOUTHEAST C R) FINAL GRADING DATE Z— 7 AS BUILT PLAN IN FILE? � INSTALLER �� ^v DWC PERMIT DATE� "6� `j -e--' 7 CERTIFICATE OF COMPLIANCE DATE ENGINEER �- rt h, Uwn or iNO.J . Andover No. L "I"0 h Andover Mass. ' 9 PE BOARD OF HEALTH Food/Kitchen RMIT 0 BUIL Septic System THIS CERTIFIES THAT................................... ...... BUILDING INSPECTOR ................................................................... Foundation has permission to erect.................... 0 �4�:: buildiin s on .....f :...�/...... ':�.; at o nr ! ........... ..... to be occupied as................................ , provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Chimney this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. VIOLATION of the Zoning or Building Regulations Voids this Permit. PLUMBING INSPECTOR ',�; Final ELECTRICAL INSPECTOR Rough .................................................... ....... Service BUILDING INSPECTOR Final l GAS R_— Display in a Conspicuous Place on the Premises — Do Not RemoveRough No Lathing or DrV Wall To Be Done Final FIRE DEPARTMENT 3urner --et No. 'ce Det. TOW'U OF}VC;RTH A�JDO+,SER! 1JG I SEPTIC PLAN SUBMITTALS "" i 1 LOCATION: 'fAhaed NEW PLANS: YES $60.00/Plan REVISED PLANS: YES $25.00/Plan DATE: DESIGN ENGINEER: �ln When the submission is all in place, route to the Health Secretary a Town of North Andover, Massachusetts Form No.s BOARD OF HEALTH �r •_w. • p 4 o w 19 -"-"--��•* DESIGN APPROVAL FOR Ss"C"j5`` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM 3 t ApplicantTest No. Site Location Reference Plans and Specs._ lw-,/\ ENGINEER DESIGN DATE + F Permission is granted for an individual soil absorption sewage disposal system to be installed. I in accordance with regulations of Board of Health. F• _ J 6 ' CHAIRMAN,BOARD OF HEALTH i 1 Fee �9V Site System Permit No. g 3 z' � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Sherwood Dr Property Address William & Ronna Duffy Owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not John DiVincenzo use the return Name of Inspector key. J and S Development Corp dba Stewart's Septic Service, Andover Septic Company Name 58 South Kimball st Company Address rear Bradford Ma 01835 Cityrrown State Zip Code 978-372-7471 s113386 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 16.340 of Title 5(310 CMR 15.000).The system: RE**3* V E D ® Passes ❑ Conditionally Passes © FailtP 0 9 2013 ❑ Nees urth r E uation b e Local Approving Authority TOWN 0F NORTH ANDOVER HEALTH DEPARTMENT 1 8-15-13 Inspis signature Date Th/ 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 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Sherwood Dr Property Address William & Ronna Duffy Owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 page. Citylrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ one or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 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 �e 67 Sherwood Dr Property Address William & Ronna Duffy - Owner Owner's Name information is Ma 01845 8-15-2013 required for every No Andover page. Cityfrown 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 Y day flow t5ins•3/13 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 J�< 67 Sherwood Dr Property Address William & Ronna Duffy Owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 page. Cityfrown 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. ❑ [D 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 El 11 Area 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "f 67 Sherwood Dr Property Address William & Ronna Duffy Owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 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? ® E] Were P 9 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? ® El information the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 67 Sherwood Dr Property Address William & Ronna Duffy Owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 page. Cityfrown 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 years usage d 56 GPD Detail: Water meter readings Sump pump? ❑ Yes ® No Last date of occupancy: O�ecupied 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 .' 67 Sherwood Dr Property Address William & Ronna Duffy Owner Owner's Name information isNo Andover Ma 01845 8-15-2013 required for every page. CitylTown 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: Stewarts Septic Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Site guage on truck Reason for pumping: Inspect tank 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 UA 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 67 Sherwood Dr Property Address William & Ronna Duffy Owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 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: 17 Years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 26"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.): Septic Tank(locate on site plan): Depth below grade: 14"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: Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments 67 Sherwood Dr Property Address William & Ronna Duffy - Owner Owner's Name information is Ma 01845 8-15-2013 No Andover required for every ty page. Ci /Town 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 26" .5 Scum thickness Distance from top of scum to top of outlet tee or baffle 5.5 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape measure sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both baffles in good shape, No leakage , Liquid levels good. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 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 67 Sherwood Dr Property Address William &Ronna Duffy owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 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): 9 Depth below rade: P 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 UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Sherwood Dr Property Address William & Ronna Duffy Owner owner's Name information is required for every No Andover Ma 01845 8-15-2013 page. City/Town 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.): Dist box level, no solids carry over, No leakage 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•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Toile 5 Official Inspection Form Subsurface Sewage Disposal System Farm-Not for Voluntary Assessments 67 Sherwood Dr Property Address William &Ronna Duffy Owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 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: 2-32"x 34' ❑ 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.): No hydraulic failure , No ponding , No damp soils. Cameraed lines of both trenches. No ponding in trenches both lines dry. 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 Inspecti®n Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Sherwood Dr Property Address William & Ronna Duffy Owner Owner's Name information is No Andover Ma 01845 8-15-2013 required for every page. Cityfrown 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.): i 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 Forth: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 67 Sherwood Dr Property Address William & Ronna Duffy Owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Cornmonw r alth of Massachuseft °q'itle 5 Official Inspection Form Subsurface Sewage Msposal System Form-Not for Voluntary Assessments 67 Sherwood Dr Property Address William & Ronna Duffy Owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 page. City/Town State Zip Code Date of Inspection D. System Information (Cont.) Site Exam: 0 Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells TO= 112" &TP2=108" Estimated depth to high ground water: 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: Date 96 Date E Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Pulled file on property Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Taken from plans drawn by Thomas E Neve Asso. No water @ 108"elevation 139.8 bottom of trenches @ Elevation 144.80 system raised 5 above water table Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 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 67 Sherwood Dr Property Address William & Ronna Duffy owner Owner's Name information is required for every No Andover Ma 01845 8-15-2013 page. Cltyrrown State Zip Code Date of Inspection E. Report Completeness Checklist • Inspection Summary: A, S, 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•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 FOR 111 - SOIL EVALUATOR FORA Page 1 of 3 No. � _ �LP Date: A-hlzu 9Ca Commonwealth of Massachusetts �6 _1�4 wvNE2 , Massachusetts Soil�SuitabilitY Assessment �for �On-site=Sewage Disposal S. .. . �l U2Sa1-1,93 Performed By: .. Da Witnessed By: � C > .. T 0-ner's Name. —T N\V6L LPrvz ��1�� � INC- L•orauon Address or - La0 !tom K.IJ�►a��. w•i" Telephone I ��pC��16CL- MAS o�8�o New construction 2 Repair ❑ ��DB E-4`'15— 115 Office Review Published Soil Survey Available: No ❑ Yes r� 1 1 1?7ZO� Soil Ma Unit 1�-��_�Hll-� �`�J Year Published �� Publication Scale .. P El-Cj96 ivy..t �� uC-xtS� (�cit�r'��. f�2s4u-%% ......... Soil Limitations _.............. ......... Drainage Class �,/' Surficial Geologic Report Available: No Ll�!" Yes ' ❑ Year Published Publication Scale GeologicMaterial (Map Unit) ......................................................................:...........................:............................-_. ............._-...._ :...................— Landform _. Flood Insurance Rate Map: Above 500 year flood boundary No Yes r , Within 500 year flood boundary-No IDY/es ❑ ` Within 100 year flood boundary No es ❑ - i Wetland Area: National Wetland Inventory Map (map unit) ......................................................... Wetlands Conservancy Program Map'(map unit) ....................................................... CL'rferit,Water ResourceConditions (USGS): Month F Range :Above Normal ❑Normal ❑Belay Norma l,f_0� Other References Reviewed: DEP APPROVED FORM•12/07/95 - FOR 111 - SOIL EVALUATOR FORM _ Paaye of 3 Location Address or-Lot ,4o. LP ✓�1'�G2u16Ls� 1U'� On-site Review Deep Hole Number93 3 5I I lme: Weather . Date:. � 9�j w F� Location (identify on site plan)_ - � +.stT '-� t7t54�bsgt.: Eiti� S%''�St�� Land Use Slope M Surface Stones - Vegetation Landform ..�SY.E�✓l_- Position on landscape (sketch on the back) Distances from: Open Water Body "Z-� feet' Drainage way Vbt—SLS feet / o-r S t V*—rs . "Possible�Wet Area "Z-oo — feet* Property Line rjp" -feet Drinking Water Well �Q�� '`feet Other ` DEEP OBSERVATION HOLE LOG* , , /, .. Depth from Sod Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA): (Munsell) Mottling (Structtire,�Stones,,Boulders, Consistency, % ,..Gravel,) t► None -s'c�so� t ►t� 3to►' —I b8" U *�sc - y } TEVERY PROPOSED Parent Material (geologic) 4XA_TW PC54� DepthtoSedrock: Depth to Groundwater: Standing Water in the Hole: 19bvx__� Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM- 12/07/95 i t - 03-21-1996 14:36 517 932 7615 DEP NORTHEAST REGICN-L P.02 FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS , Massachusetts Percolation.Test" ; Date: Time: Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" I � I Time at 9" Time at 6" Time (9"-B") Rate Min./inch Minimum of 1 percolation test must be performed in both the primary area AND reserve area- Site Passed ❑ Site Failed ❑ Performed By: - - Witnessed By:`. �— Comments: _... _... DYT AMOY=TDRM-u/V/nf FORM 11 - SOIL LVALliATOR FORM Page 3 of 3 Location Address or Lot No. j �CD Sl�'�rltiTat� 1�J� Determination for Seasonal, High-' WaterE-Table- Method Used: No V-eyk�) ❑ Depth observed standing in observation hole............ .... inches ❑ Depth weeping from side of observation hole .......... .... inches ❑ Depth to soil mottles inches ❑ Ground water adjustment .................. feet Index Well Number ........ ....... Reading Date .......... . . Index well level Adjustment factor ................. Adjusted ground water level ...... ............... ...... ....... .. Deoth of Naturally Occurrina Pervious Material Does at least four feet of naturally occurring pervious material exist in ay areas observed throughout the area proposed for the soil absorption system? ES If not, what is the depth of naturally occurring pervious material? Certification I certify that on ..-'11/94 (date) I have passed the soil evaluator examination j approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date 5/1/96 I DEP APPROVED FORM. 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot iso. CP �✓ 2 �� � On-site Review Deep Hole Number Date:.-4tS\,95 Time: PM Weather VPglTZ— Location (identify on site plan)G_=AGsc_-- Land Use Siope (°so) Surface Stones Vegetation \tjQCYpC-q Landform Position on landscape (sketch on the back) '' Distances from: Open Water Body ZCC�'V--'feet Drainage way "D5ts6 feet Possible Wet Area ZZbl feet Property Line feet Drinking Water Well *.�UjvK- feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) ( I (USDA) (Munsell) ( Mottling (Structure,Stones, Boulders, Consistency, Gravel) Nom C>11 co s s i A7-Tj0A-rtrAi:s0 -mss CYF:-- c�Ai� crmsE � HOLES I EVERY PROPOSED * , Parent Material (geologic) =W � // Oepthtol3edrock: ty Death to Groundwater: Standing Water in the Hole: N UN's Weeping from Pit Face: Estimated Seasonal High Ground Water: �-T WS DEP APPROVED FOILNt-12107!95 i l FORA111 SOIL EV.-kLU ATOR FOR.%1 Page 1 of 3 No. A4' — Ido Date: 4�2e� 9Co Commonwealth of Massachusetts �6�-� �,.►�E2. , ,.Massachusetts Soil Suitability Assessment for On-site Sewage 'Disposal ZI Performed By- G���� -�,. �'1 Lt2Sa �_ t . ., ......... . .. . Date: - °`VIqX' Witnessed By: yfL Ulu") �� '�C L=uan Addrms Or S .{ddICSS.i(f0 _T � l.Y ✓ r f�--✓//W 13.J1Y Y1(�,V Tele.norc / ^_t��✓�,IV�\�' t-A^ o% ewconstruction ReQair ! 5 Office Review Published Soil Survey Available: No Yes Soil Mao Unit Year Published �. Publication Scale 1�P1a�►-�E�A.......... Soil Limitations Drainage Class ...................................... .................. Surficial Geologic Report.Available: No Lam' ' Yes f ❑ ,� Year Published Publication Scale GeologicMaterial^(Map Unit) ..............................................................................................................................__. .............__.._- Landform 1 _ Flood Insurance Rate Map: Above 500 year flood boundary No Yes ❑ Within,500 year flood bouriddry No Wifhin-100-year,flood-boundary Na. _, es ❑ Wetland Area .A National Wetland Inventory Map'(map unit) ............................................................................. .... . f . .................................................................... Wetlands Conservancy Program Map (map unit) ............................... l ft Current Water Resource Conditions (USGS): Month - Range :Above Normal []Normal ❑Bela•/ Normal ❑ Other References Reviewed: DEP APPROVED FOFLM.1:/07/95 03-21-!996 14:36 517 932 7615 CE? NORTHEAST REGiCNGL r.02 FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS ,i Massachusetts Percolation Test' Date: g ,9�j Time: Observation Hole K C3;5 _ 5 Depth of Perc �bN Start Pre-soak is C 46 � ' End Pre-soak Time at 12" y I Time at 9" ` Time at 6" Time (9"-6") Rate Min./Inch L Z • Minimum of 1 percolation test must be performed in both the primary ,area AND reserve area Site Passed tom! Site Failed ❑ ....... ....... _..................................... Performed BY: �'``� Witnessed t3y:�_ Comments: Ot?A MOYIM MRM-u197nf FOR1•t 11 - SOIL LVALliATOR FORM Page 3 of 3 Location address or Lot No. 1V� Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ....... . inches U epth weeping from side of observation hole inche's !'1 Depth to soil mottles 80 inches Ground water adjustment .................. feet Index Well Number Reading Date ...... Index well level Adjustment factor ... . ...... ' ''' ` Adjusted,ground water level ......... Deoth of Naturally Occurrina Pervious Material Does at least four feet of naturally occurring pervious material exist in, ail areas observed throughout the area proposed for the soil absorption system? E� If not, what is the depth of naturally occurring pervious material? Certification I certify that on 11/94 (date) I have passed the soil evaluator examination j approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date 5/1/96 DEP APPROVED FORM- 12/07/95 FOR 111 - SOIL EVALUATOR FORA Page '_ of 3 Location .-kddress or Lot A. �(4 V4—: On-site Review Deep Hole Number Date:. 4lZ',\9%3 Time: f't A Weather FA12 Location (identify on site plan)� ��tT�`4 flvS� �:✓ Land Use Slope (%) Surface Stones Vegetation Landform Position on landscape (sketch on the back) ' Distances from: Open Water Body Zoe- feet Drainage way vztZ6 feet Possible Wet Area Zoz ;H- feet Property Line '31j /—feet (tFiRAtA LF--T k-tr-1 Ut<• ) Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG i Depth from Soil Horizon Sod Te:aure Soil Color Soil Other Surface IInchesI I I (USDA) (Munsell) I Mottling (Structure, Stones, Boulders, Consistency, % Gravel) t N6hJ r::,r (�o ---3Z ) i �.ocarn�t SAw-s� css�wt-� HULES REQUIRFL)T—ItVERYc Parent Material (geologic) arPW PC54A DepthtoBedrock: �6 ' Deoth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM-12/07/95 i i FORAI 11 - SOIL EVALUATOR FOR:1l Page 1 of 3 Date: 412t_o 9Co l.o -� Commonwealth of Massachusetts N6C-C�A p1N,PN6 . , M.assachusetts Soil Suitability Assessment for On-site Sewage Disposal Perrormed By: !]'���1C Date: _ _....._.._ .. Witnessed By: __. L-1=Andras« Owrxr's Vane. '�1 .A V�-+L L ir`�'Y ?'u /»U V✓' 1N L i 1 U ^ ✓ rZ1 WW V 1�v1 V Tele:om ! � 7� —/ ew construction i✓ Repalr '! I Office Review Publisned Soil Survey Available: No Yes 8� �� �N....... � Year Published Publication Scale -'............. Soil flap Unit Drainage Class t�eAu.�E .......... Soil Limitations Surficial Geologic, Report Available: No Lam" ,Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) ..........................._. .....__......__...._ Landform Fj ICS_...... .. .................... Flood Insurance Rate Map: Above 500 year flood boundary No Yes ❑ Within 500 year flood boundary No Ewes ❑ Within 100 year flood boundary No es ❑ 1 Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range :Above Normal []Normal ❑Bela•/ Normal ❑ Other References Reviewed: OFF APPROVED FORM-12/07/95 03-21-.996 14:36 517 932 7615 QE? NORTHE;.'37. REGICNaL C2 FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test- Date: g ` $ IC,�rq Time: Observation Hole K 9 V5_ � Depth of Perc Star Pre-soak tiJOV�� �( I6L� �61Pr(L End Pre-soak Time at 12" I Time at 9" Time at 6" 1 Time (9"-6") I Rate Min./inch • Minimum of 1 percolation test must be performed in both the primary area AND reserve area Site Passed Site Failed ❑ Performed By: Witnessed BY:�_ .l TACC Comments: OQ ArrxOvm CORM•uio7n! FORM 11 - SOIL LVALliATOR FORM t Page 3 of 3 Location Address or Lot No. kj'-- Determination for Seasonal High Water Table Method Used: ❑_ Depth observed standing in observation hole ........... inches U Depth weeping from side of observation hole�� inches ❑ Depth to soil mottles inches ❑ Ground water adjustment .................. feet r Index Well Number .- . ........ Reading Date ......... Index well level . Adjustment factor ... Adjusted gound wate;level _ .. ........ Deoth of Naturallv Occurrina Pervious Material Does at least four feet of naturally occurring pervious material exist in,a� areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on 11/94 (date) I have passed the soil evaluator examination j approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date 5/1/96 DEP APPROVED FORM- 12/07/95 Plan Of L and InY.. North Andover, Mass. tj 2 �N showing g "As—Built " Sanitary Disposal Syste Lot 16 - Sherwood Drive Prepared For Timberland Builders, Inc Scale: 1" = 20' Date: May 31, 1997 Leach Trench System: Zoning District: R— 1 2 Trenches: 38' Long, Residence 1 District 4' Wide, 2Deep (Planned Residential District) 40.00 D—Box j G P9S-3to Note: Property line data token from o Definitive Subdivision Plan Of "Jercd Place — Phase IV" B) �.. ' Thomas E. Neve Associates, Inc., doted Septembi ti 1, 1995 and revised to March 12, 1996. I V' ~'• l hereby certify that l have inspected the construction o 93-3 '�nt p this disposal-system and that the construction and final P 95-35 (b grading has been in accordance with the designer's inten and that the materials used conform to the plan t _ specifications and 310 CMR 15.0. �93-4 This plan has been prepared for the purpose of showing the "As—Built" conditions of the sanitary disposal systen installed on thepremises A# work was done in substanfi+ conformance with the design plans as prepared. A# work 85.00' done within the construction /imitations expected for a jc of this type. Design Engineer P.E. 7 Dote t+�OF AM NIA. MOI NN 8 AN. Thomas E. Neve Associates, Inc. Engineers — Surveyors — Land Use Planners 447 Old Boston Road — U.S. Route 1 Topsfield, Massachusetts 01983 887-8586 1449-16-58'1 Lot 17 A9 \ 524 O9' a\ ` 1500 Gallon ...... Septic Tank co � Top Of Foundation A 10 Elevation = 153.79 co �- Lot 16 � Existing Dwelling 62,,336 S.F. 1 c 1.43 Ac. ^O CRA = 29,317 S.F. .o ► z �I � o 261.42' I Lot 15 Schedule of Inverts Schedule of Tie Distances Invert @ Foundation = 150.44' CE = 13.2' BG = 52.8' Al = 41.8' Septic Tank In = 149.60' DE = 18.3' DG = 41.4' Cl = 54.9' Septic Tank Out = 149.30' D—Box In = 14Z71' CF = 22.3' AH = 27.8' D—Box Out = 147.51' DF = 25. 1' CH = 44.7' Trench In = 14 7.50', 147.41' Trench End = 147.31', 147. 18'