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Miscellaneous - 700 SHARPNERS POND ROAD 4/30/2018 (2)
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O o � c m��A� D yam° C c N Cp ;U CD & m wO n� o CD r CD CO)w o 0 o 3 CD0)o ca o m 3 Z o m o W n v co N O �CCDON cn o A = D X T Z CD X 0 o CL 0 * CA ID 00 a 00 :3 O a'o s' .. Z v c �T -1 n O 5 OM95 v cn O CD Co m v Cv -o 7 CD CD v Cn CD cn ==0 o� v �aoR C0 Co CD o CD 0 CD y;uxczCD o rA North Andover Board of Assessors, Public Access Page 1 of 1 Parcel ID: 210/105.D-0184-0000.0 Community: North Andover SKETCH Click on Sketch to Enlarge PHOTO Location: 700 SHARPNERS POND ROAD Owner Name: SULLIVAN, JOHN F. SULLIVAN, BERNADETTE C. Owner Address: 700 SHARPNERS POND ROAD City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6 - 6 Land Area: 2 acres Use Code: 101- SNGL-FAM-RES Total Finished Area: 2128 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 481,600 508,900 Building Value: 282,600 319,300 Land Value: 199,000 189,600 Market Land Value: 199,000 Chapter Land Value: LATEST SALE Sale Price: 496,000 Sale Date: 04/23/2003 Arms Length Sale Code: Y -YES -VALID Grantor: JEWETT, STEPHEN K. Cert Doc: 82104 Book: 112 Page: 209 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=467362 7/22/2005 y MAP # LOT PARCEL # STREET /J t'_.._.......�. CONSTRUCTION APPR L HAS PLAN REVIEW FEE .BEEN PAID? / YES NO l0 PLAN APPROVAL: DATE Z,/ l q -- APP. BY_ DESIGNER: - ( P` AA 6A ez-o PLAN DATE: �/A� 1�0--- CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMIT ��3 DRILLER,_...___.: Uit� WELL TESTS: CHEMICAL DA1 E APPROVED._��/,7 BACTERIA I DATE (1PPRUVED 11.7 ... . BACTERIA II DATE APP ROVED 7 COMMENTS:. FORM U APPROVAL: APPROVAL 1*0 ISSUE YE DATE ISSUED BY A CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL.: YES NO DATE :14`�%�5., BY :,(-d_ _ ' J ;. sSEPT��.SY&ZEM�.NSS8.41,.8�t� Q�! ... •. _ t IS "THE' INSTALLER LICENSED? NO + .� ' a .:}1•J h ` -w. .,r .`. .fir J. ,.t _ `� TYPE. OF- CONSTRUCTIOEPAIR'NEW tN. CONSTRUCTION: ,.. CERTIFIED PLOT PLAN REVIEWNO - r CONDITIONS OF..APPROVAL YES NO �tt (FROM FORM U) { ISSUANCE OF DWC PERMIT YE NO ?' DWC' PERMIT N0.�—� INSTALLER:�,`���1Vi���.l BEGIN• INSPECTION YE N0: EXCAVATION. INSPECTION: :NEEDED: PASSED y` BY ' <'%CONSTRUCTION INSPECTION: NEEDEDs AS BUILT PLAN SATISFACTORY:--- YES: APPROVAL TO BACKFILL: DATE: BY FINAL. GRADING APPROVAL: DATE BY APPROVAL: DATE. /��BY—� FINAL CONSTRUCTION HUSETTS .. , ;t•r:?,c:.`@},._ �wq«•, �•; �' i�?a��y''',t.:r•1'r'�• iR�ys..�!r�\'i���:,.::. ':: - ... �sr ;. DE as provided this form for use by local Boards of Health. The be submitted to the.local'Board of Health or other approving authorl A Facility lnforr>�ation s Wt Ming out 1.. System l.ocatlon; T( -:ti: forty►:: on tt►e.' �.. .. � , L9 only the tab keyr Addres to move your cursor.- do not `use the return 'i'. City/Town State m Owner, Name ` ""' r Address (If different from location) S tem Pumping Re {„•L - .-. 0 4 Cityfrown•; state' Telephone Number G umping Record: r' �•!J: •i• ;'.'.�;4D.313.;;.1;'�;'.}:�.yJ/,ij,ar:.;,yiC} iYC;j,i. •!''•a .. .,• -Dat Pumping•'' Date 2, Quantity Pumped: Z�� Gallons .• yp,9 Of system. , ❑ Cesspool(s) (etic Tank P ❑ Tight Tank - ',Other (descrlbej; 1 1 '!�;:%I; kv's' Efflue nt Tee Filter present? ❑ Yes%No If . yes, was if cleane ❑Yes ❑No ':'i., •' .. 3 1 .lyh;,'. " Sy pppyyr//y., Pumped By' •.l^'. ':• \.. •':: 1.:.: .. Loor :: -:� '':`•'%" 4�, � .�.,.;r:�'I;��F.0 ' �,;5', '•'''`� �.v�. �•iso;::.i�:;:;.',,:;��;,,.,Xr,�T�:�:,s,r Y�` Vehicle Uce /1 � umber :.. - .a%t: Jnfti•.l� �: •. �6�tt�.,•I�:i�•.' it:�t tk` .lJJyyy � vl yr :S.r� ..; ;.,_ .7:;i11••':iu,:• ,.,1• t'• sF. ,r;�il::.,,... . .'• fig+ ,f"i'•' i-`•f'ry • ��C !.'', !1•ti i.t1W �:, i:,., :.i•,. .. .✓�`t/1,4`.....W:l . �.;•�,;;;, ':.-:, 7;''; LocatJoI' where Contents yuere':disposed; .:. ', S nature of Hauler;; Date :Y'.: httpJhvww.mn ass.GoWep/wafer/approvalslt5forms•htm#Inspect .. ... ... Y; •v,. ., , . .. - tStonM.doa'08103 ,� " . ' System Pumping Record Page 1 of i MORTH ot of Permit or License: (Check box) ❑ « Town of North Andover `'•�;, ,SSACMU`+Et HEALTH DEPARTMENT CHEn �A DATE: �]Q LOCATION: H/O NAME CONTRACT 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) $ U� Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer OE PO eTh �h w of Permit or License: (Check box) ti p Town of North Andover s4emu HEALTH DEPARTMENT CHECK #: (/ 1, K DATR- AU LOCATION: H/O NAME CONTRACT 6966 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 $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $- I,] ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ Title 5 Report $ V ❑ Other. (Indicate) $ 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 700 Sharpners Pond Road Property Address Marlene Mitchell Owner Owner's Name information is required for North Andover every page. City/Town Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ILEI MA 01845 State Zip Code RECEIVED AUG 0 4 2014 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 7/30/2014 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. 0 A. General Information 1. Inspector: Neil J. Bateson Name of Inspector Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State 978-475-4786 S115 Telephone Number B. Certification License Number Zip Code 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 ❑ aNeedurther Evaluation by the Local Approving Authority 7/30/2014 Inspatur 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 Rt Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 700 Sharpners Pond Road Property Address Marlene Mitchell Owner's Name North Andover MA 01845 7/30/2014 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): l5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 700 Sharpners Pond Road Property Address Marlene Mitchell Owner's Name North Andover MA 01845 7/30/2014 Citylrown 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 obstruction is removed distribution box is leveled or replaced ❑ Y ❑ Y ❑ Y ❑ N ❑ N ❑ N ❑ ❑ ❑ ND (Explain below): ND (Explain below): 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 • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 700 Sharpners Pond Road Property Address Marlene Mitchell Owner's Name North Andover Cityrrown B. Certification (cont.) MA 01845 State Zip Code 7/30/2014 Date of Inspection 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 - 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System - Page 4 of 17 ❑ ® 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 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 700 Sharpners Pond Road Property Address Marlene Mitchell Owner Owners Name information is required for North Andover MA 01845 7/30/2014 every page. CityrFown 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 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts ti Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ..�'" 700 Sharpners Pond Road Property Address Marlene Mitchell Owner Owner's Name information is required for North Andover MA 01845 7/30/2014 every page. Cityrrown 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 - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 700 Sharpners Pond Road Property Address Marlene Mitchell Owners Name North Andover Citylrown D. System Information Description: Number of current residents: MA 01845 7/30/2014 Date of Inspection 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? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: ❑ Yes ® No Current Date Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Forth: 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 , 700 Sharpners Pond Road Property Address Marlene Mitchell Owner information is required for every page. Owner's Name North Andover Cityrrown D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date Pumped 2013, owner 1500 gallons Measured tank. Inspect tank & tees. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy 7/30/2014 Date of Inspection ® Yes ❑ No ❑ 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 700 Sharpners Pond Road Property Address Marlene Mitchell Owner's Name North Andover Cityrrown MA 01845 7/30/2014 State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 29 years old, 2/27/1995, info at 13.0.1-1. Were sewage odors detected when arriving at the site? 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 throuoh wall. 3" PVC in house. no leaks visible. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal A feet ❑ Yes ® No ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10'x5'x4' Sludge depth: 3"3" ❑ Yes ❑ No 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 "r 700 Sharpners Pond Road Property Address Marlene Mitchell Owner Owner's Name information is required for North Andover MA 01845 7/30/2014 every page. City/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 30" Scum thickness 3 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 12" 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. Water constantly coming into tank from leaking toilet. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass 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: feet ❑ polyethylene ❑ other (explain): Date t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 10 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 700 Sharpners Pond Road Property Address Marlene Mitchell Owner's Name North Andover MA 01845 7/30/2014 Cityrrown 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: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3113 Title 5 Official Inspection Forth: 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 700 Sharpners Pond Road Property Address Marlene Mitchell Owner Owner's Name information is required for North Andover MA 01845 7/30/2014 every 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 E 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 clean. 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 Owner information is required for every page. t5ins • 3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 700 Sharpners Pond Road Property Address Marlene Mitchell Owner's Name North Andover Cityrrown D. System Information (cont.) Type: State 01845 Zip Code 7/30/2014 Date of Inspection ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 4 trenches 42' 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 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Owner information is required for every page. 15ins • 3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 700 Sharpners Pond Road Property Address Marlene Mitchell Owner's Name North Andover MA 01845 7/30/2014 Cityrrown 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.): Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 700 Sharpners Pond Road Property Address Marlene Mitchell Owner's Name North Andover Citylrown MA 01845 7/30/2014 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 -Vo W� � VV�_ [4Oc (2, Oiecv 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 700 Sharpners Pond Road D. System Information (cont.) Site Exam: ® Property Address ® Marlene Mitchell Owner Owner's Name information is required for North Andover MA 01845 every page. Cityrrown State Zip Code D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated de th to hi In round water• >4 7/30/2014 Date of Inspection F g g 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: 5/24/1993 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Desian Dlan ❑ 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 test pit data no water found 4' deep. 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 700 Sharpners Pond Road Property Address Marlene Mitchell Owners Name North Andover MA 01845 7/30/2014 City/Town 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 • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 . Commonwealth of Massachusetts = City/Town of . 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. A. Facility Information 1. System Location: Left / Right front of house, Le ht rear of hous.- Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Rig rear of building, Under deck Address r-7 c 5 6 _ Cityrrown ( �— State Zip Code 2. System Owner. Name Address (if different from location) tAA �e�l.( CihrlTown . Telephone Number B. Pumping Record V1 "3y ` LY 1. Date of Pumping oats 2. Quantity Pumped: r Gallons 3. Type of system. ❑ Cesspool(s) Septic Tank El Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yep No If yes, was It cleaned? ❑ Yes ❑ No: 5. Condition of Sy tem: 6.. System Pumped By: Neil. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Loca U=Where contents -were disposed: aL JD Lowell Waste Water SignItufe Hau Date t5fom4.doc- 06/03 System Pumping Record • Page 1 of 1 • ��.0 � � �M� >x•. ; l mom^ �s a ... {- �•'"k`tik,..e� �.��?,JJ� �� x j y.0 ''� _ IY i W�} �i -� 4 J • J.•F .w.T 'H y rr.�... ,,�. t" h- i • A- 9 le r 1 �FrY� r �� �Yi•• ry N. • > 1 - 1 :; .r (asn04 9M SWO? Alddns ja1eM :)llgnd aja4M atmol) .00I W41! slla^^ lieI ro se Lpuaq jo sVewpuel sa�uajalaa )uaueuuad OAq seal Ql salla l�ul s � T, ��Ii1SA5 1�SOd 37V JO WWAS i :U01padi41 10 i)f 00 11'S94vo pvws 3;wonson5 � t Commonwealth of Massachusetts _ City/Town of System Pumping Record Form 4 s RECEIVED OCT E3 `013 TOWN OF NORTH ANDOVER HEALTH 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 1. System Location: Left / Right front of house, Left 0 i rear of hou , Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address I �d Cityrrown 2. System Owner. Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe)• State Zip Code �k I A-z�-eg i State , Telephone Number t" 2. Quantity Pumped: - Date Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yep No If yes, was it cleaned? ❑ Yes ❑ No. '5. Conditin f System: MK% 1� 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio re contents were disposed: G.. S. Lowell Waste Wc, .. —.1 _ Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Phone: 978-342-2660 JAMES A. TRUDEAU Fax: 978-342-2699 Adjustment Service Inc. P. O. Box 942 Fitchburg, MA 01420 claims(iVtrudeauadi.com Notice of Casualty Loss of Building Under Massachusetts General Laws, Chapter 139, Section 313 March 13, 2013 Building Inspector 120 Main Street North Andover,, MA 01845 JBoard of Health 120 Main Street North Andover, MA 01845 Fire Department MAR 2 0 2013 Dept. of Records LIW NORTH 124 Main Street DEFAR ANDOVER North Andover, MA 01845 Insured: Marlene Mitchell Loss Location: 700 Sharpners Pond Road, North Andover, MA 01845 Insurance Company: Preferred Mutual Insurance Co. Policy No.: PHOO100744192 Date of Loss: February 8, 2013 File Number: 13-11471 Claim Number: 13002868 Type of Loss: Property Damage Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000.00 or cause "Mass. Gen. Laws, Chapter 143, Section 6" to be applicable. If any notice under "Mass. Gen. Laws, Chapter 1.39, Section 313" is appropriate, please direct it to the writer and include a reference to the captioned insured, location, policy number, date of loss, and file or claim number. On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first class mail. Sincerely, Nicole 'Percuoco Claims Adjuster GQ \�TlD r%1' PUBLIC HEALTH DEPARTMENT Community Development Division CYF127I�FICArrE Off' CO_14(PGIAX(�E As of: Septemderl8, 2007 This is to cert that the individuaCsubsurface disposaCsystem received a SATISTAC7oRT INST ECY OX of the: 12epCacement of OutCet lee By. Todd Bateson At: 700 Sharpness (Pond Road ,flap 105.1; (Parcel184 North Andover, WA 01845 Tie Issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfpgctorily. Susdn T Sawyer (Public gfealth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 7 * ! � �_ COCNI[NtwK� . 1' PUBLIC HEALTH DEPARTMENT Community Development Division C'rE127IIFICA7E OAF CO9JI(PGIANCYE As of: September 18, 2007 This is to certify that the individual su6surface disposal system received a SATISTAC ORTINYPEMONof the: 12epCacement of OutCet lee By: Todd(Bateson At: 700 Sharpners Pond Wpad Wap 105.1D; Parcel184 North Andover, W,A 01845 The Issuance of this cert�6cate shall not 6e construed as a guarantee that the system will function satisf,qctorily. Susdn T Sawyer blic Yfealth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com t f NORTti Commonwealth of Massachusetts Map -Block -Lot a n Board of Health PermittNo84 O _ I BHP -2007-0264 North Andover ----------------------- r� . a P.I. FEE issRcwust� F.I. $125.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Todd -B -ate - -on ------------------------------------------------------------------------------------------------- to (Replace Outlet Tee) an Individual Sewage Disposal System. at No 700 SHARPNERS POND ROAD as shown on the application for Disposal Works Construction Permit No. BHP -2007-026 Dated September 10, 2007 ------------------------------------------ Issued On: Sep -10-2007 Board of Health a0RTM Map -Block -Lot of�,,., .,�ti Commonwealth of Massachusetts p - or ,• 105.D- 0184 - Board of Health ----------------------- • North Andover �J3„C,;U;t<� Certificate of Compliance THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Replace Outlet Tee) by Todd Bateson Installer at No 700 SHARPNERS POND ROAD ------------------------------------------------------------------------------------------------------------------------------------------------ has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2007-026 Dated September _I 0, 2007 ---------------------------------------------------------- Printed On: Sep -10-2007 Board of Health O� 40 RTH 1, ' i i w ti _ p Town of North Andover s.,,,• HEALTH DEPARTMENT SACIIUSf CHECK #: - c ' 3 %� DATE: 910 Ai LOCATION: `170 H/0 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 $ ❑ Sep/tic'- Design Approval 7. -Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ 2585 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer ..,..... ............so-. v.. "-'—.+1+—.. ,....w, w...v.... Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ICI ITI Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal ❑ Repair or replace an existing system component A. Facility Information 0 k Address or Lot # TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component __ 1 em*RECEIV. L,-, SEP 10 2007 TOWN OF NORTH p, xiGOVER VI Clty/TOWn — 2.- *TYPE OF SEPTIC SYSTEM'`: E]Pump cavity (choose one) P 1`� 0 ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Name Address (if different from above) Citylfovm State Zip Code IV- & Telephone Number 3. Installer Information j BATESON viii 7 [:------ Name Name of Compan glia Cali /// 4"7 • /114 Andover, MA 01810 Address City/Town State Zip Code Telephone Number (Cell Phone # if possible please) a. Desianer I Name Name of Company Address City/Town — ----- .---------- — State --- -- Zip Code------._._.._--. _ Telephone Number (Best # to Reach) Page 1 of 2 Application for Disposal System Construction Permit Page PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: esidential Dwelling or ❑Commercial B. Agreement TODAY'S DATE $ 250.00 - Full Repair $125.00 - Component The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been Jspdq-�f by this Board of Health. Na Date Appli ion Approv7B.Board of Health Representative) Date Application Disapproved for the following reasons: r Office Use Only: L Fee Attacbed? Yes_ No Z Project Manager Obligation Form Attacbed? Yes No 3. Pump System? If so, Attacb copy _of karical Permit Yes o_ 4. Foundation As -Built? (new construction ronly): (Same scale as approwd plan) S. Floor Plans? (new construction only): r` Yes_ No Yes_ No ' S'EPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 7049 Sk4fjpA,��J-5 (address of septic system) For p: Relative to the application of �O� A / Sd,'./ (Installer's name) And t Dated r0 Io ae s ate— With I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requestingg an inspection without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company; a. Bottom of Bed — Generally, this is the first (1'� inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdept a,toxvnofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used c. Final inspection by Board ofHealth staff or consultant d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved 121ans No instructions by the homeowner general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Name —Print) (Today's Date) t 1 e — Signe �oR*� Commonwealth of Massachusetts p Board of Health North Andover P.I. `s,.rwus�< F.I. Disposal Works Construction Permit Permission is hereby granted -Todd-Bateson to (Replace Outlet Tee) an Individual Sewage Disposal System. at No 700 SHARPNERS POND ROAD Map -Block -Lot 105.D- 0184 - ---------------------- Permit No BHP -2007-0264 ----------------------- FEE $125.00 ----------------------- as shown on the application for Disposal Works Construction Permit No. BHP -2007-026 Dated September -10,200-7 ----------------------------------------------------------- I ssued On: Sep -10-2007 Board of Health t "°"", Commonwealth of Massachusetts Map -Block -Lot ?4 •"`° '+`•y°o 105.D- 0184 - Board of Health ----------------------- North Andover �•••���`� Certificate of Compliance THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Replace Outlet Tee) by Todd Bateson- ------------------------ - --------------------- - Installer at No 700 SHARPNERS POND ROAD has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2007-026 Dated _ September 10, 2007 ------------------------------------------------- Printed On: Sep -18-2007 Board of Health Commonwealth of Massachusetts Map -Block -Lot 4' oot 105.D- 0184 - A Board of Health Permit No North Andover BHP -2007-0264 FEE r�Ss�,cNustt� $125.00 ---------------------- Disposal Works Construction Permit Permission is hereby granted Todd Bateson to (Replace Outlet Tee) an Individual Sewage Disposal System. at No 700 SHARPNERS POND ROAD as shown on the application for Disposal Works Construction Permit No. BHP -20077026 Dated September 10, 2007 Issued On: Sep-10-2007 ------------------------------------------------------------- ------------------------------------ Board of Health I of 11 Lam, t ... "t, 9 Y4X 15C A: COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFF DEPARTMENT OF ENVIRONMENTAL, PROTECT TITLE 5 REdE VSD JUL 2 1 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 700 Sharpners Pond Road North Andover, MA Owner's Name: Burnadette Sullivan Owner's Address: 700 Sharpners Pond Road North Andover, MA Date of Inspection: July 9, 2005 Name of Inspector: (please print) Benjamin C. Osgood, Jr. Certified Title 5 Inspector Company Name: New England Engineering Services Inc. Mailing Address: 60 Beechwood Drive North Andover, MA 01845 Telephone Number: 978-686-1768 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 the on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5 (3 10 CMR 15.000). The system: Inspector's Signature: _(_Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fads 7 The system inspection 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. 2of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 700 Sharpners Pond Road North Andover, MA Owner's Name: Burnadette Sullivan Date of Inspection: July 9, 2005 Inspection Summary: Check A, B, C, D or EIALWAYS 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: R System. Conditionally Passes: N 0 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_ 3 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 700 Sharpners Pond Road North Andover, MA Owner's Name: Burnadette Sullivan Date of Ynspection: July 9, 2005 C. Further Evaluation is Required by the Board of Health: Ili 0 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 (SAS) Soil Absorption System and the (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 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 organize 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 5ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 4of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 700 Sharpners Pond Road North Andover, MA Owner's Name: Burnadette Sullivan Date of Inspection: July 9, 2005 D. System Criteria applicable to all systems: You must indicate "yes or No" to each of the following for all inspectionsi Yes No _j_ 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 overload or clogged SAS or cesspool. x Static liquid level in the distribution box above outlet invert due to an overload or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow _j_ 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. Y, Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or pmry 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 nitrogen is equal to or less than 5ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) A)y _ (Yes/No) The system fails. 1 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 b onsidered a large system the system must serve a facility with a design flow of 10,000 gpd to You must m ' e either "yes" or "no" to each of the following: (The following crit ly to large systems in addition to the criteria above) Yes No The system is within 400 feet of a ater supply The system is within 200 feet o i utary to a sures. r eking water supply The system is l9catd&in a nitrogen sensitive area (Interim of a pub ' ater supply well Area — IWPA) or a mapped Zone 11 If you answe es" to any question in Section E the system is considered a significant threat, or answer ` es" in Section D above the larg 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. 5of11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address: 700 Sharpners Pond Road North Andover, MA Owner's Name: Burnadette Sullivan Date of Inspection: July 9, 2005 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 an inspection ? y" 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 sign of break out? Were all system components, excluding the SAS, located on site? ✓ Were all 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 difference from owner) provided with information on the proper maintenance of the subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes No Existing information. For example, a plan at the Board of Health. ✓ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] 6of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 700 Sharpness Pond Road North Andover, MA Owner's Name: Burnadette Sullivan Date of Inspection: July 9, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design) H Number of bedrooms (actual): DESIGN flow based in 310 CMR 15.203 ( for example: 110 gpd x # of bedrooms): — Number of current residents:_ Does residence have a garbage grinder (yes or u6):!6e,5 Is laundry on a separate sewage system (yes or no):y _ [if yes separate inspection required] Laundry system inspected ( yes or no): Seasonal use: (yes or no): A10 . Water meter readings, if available (last 2 years usage (gpd): w 91 -1 - Sump Pump (yes or no): N 0 . Last date of occupancy c., r r e . yr COMMERCIALANDUSTRLU 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 nod: 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: Z -4F-6Q'5; pert 0""./ .v& I; Was system pumped as part of the inspection (yes or no): W 0 If yes, volume pumped: --gallons - How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _7 Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank Attached a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information: VAC.'se- t3vkc.l 191.-14 pert r9S 16L1 Were sewage odors detected wen arriving at the site (yes or no): N� . 7of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 700 Sbarpners Pond Road Porth Andover, MA Owner's Name: Burnadette Sullivan Date of Inspection: July 9, 2005 BUII.DING SEWER (locate on site plan) Depth below grade: Materials of construction: cast iron+�40 PVC other (explain) Distance from private water supply well or suction line: 25 ' Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK (locate on site plan) Depth below grade: I. Material of construction: y, metal fiberglass volyethylene 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: t Sludge depth: < z Distance from top of sludge to bottom of outlet tee or baffle: ttr# Scum thickness: L 2 Distance from top of scum to top of outlet tee or bale: Distance from bottom of scum to bottom of outlet tee or baffie *- How were dimensions determined: A4E#4&.)aF- Enc V. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 0.r"T- TnE r l'sxfev rE,vr0 rroDe7)oif �� AGK Lf_ -y PVC - GREASE TRAP:_ _(locate on site plan) Depth below grade: Materials 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 sludge to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc. 8of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 700 Sharpners Pond Road North Andover, MA Owner's Name: Burnadette Sullivan Date of Inspection: July 9, 2005 TIGHT OR HOLDING TANK:AjIiI (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Materials of construction: concrete metal fiberglass polyethylene other (explain) Dimensions: Capacity:_ Design Flow. gallons gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 8 Comments ( note if box is level and distribution to outlets equal, any evidneace of solids carryover, any evidence of leakage into or out of box, etc.): Q i2 0.7r PUMP CHAMBER N JA- (locate on sire plan) Pumps in working order (yes or no) Alarms in working order (yes or no) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 9of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 700 Sharpners Pond Road North Andover, MA Owner's Name: Burnadette Sullivan Date of Inspection: July 9, 2005 SOIL ABSORPTION SYSTEM (SAS): flocate on site plan, excavation not required If SAS not located explain why TYPE leaching pits number leaching chambers, number leaching galleries number leaching trenches, number in length q — ys` 1.0 A) G- 144 CN.c at leaching fields, number, dimensions: overflow cesspool, number innovativetalteinative system Typetname of technology: Comments ( note condition of soil, signs of hydraulic failure. Level of ponding, damp soil, condition of vegetation, etc) fiR�R OF �.hS iEM i-0oKS NJ2.Ksft- PoNA•NA- d2 .., Lj--y. C -y �,/cl4rrs LS Cj-t:AN .?.vp Pay CESSPOOLS: A.w (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth — top of liquid to inlet invert Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of Construction Indication of groundwater inflow (yes or no) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: &:,* (locate on site plan) Material of construction: Dimensions: Depth of solids Comments (note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation, etc. 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 700 Sharpners Pond Road North Andover, MA Owner's Name: Burnadette Sullivan Date of Inspection: July 9, 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. P� 'to T W iE L — SUi3AWAtE 5MAd 046SAL 5Y§ffM.1N3PEC1`iC")RI"�tJ�t ` ,% PAP C :f SYSTEM 1Nf0@MAtlON kotitih(red) FeAddress: �' Go ,Iter. ate of Inspection: -�.�C �' , 0Alt�� �y ;ETCH OF AGF POSA! SYSTEM: F a incl a ties to least two permanent references Undtnarks dr binchrharks I all wells ithin 100' (locate where public water supply conies into house) ' ! .J wry' J . i?- A? - 4P Y 4 a 4q� D�n_t 5Ao , ` Dt..,t S Ir � 1 D-au>t = t„{q' Ill► wird 01/35/97) • ate}}' �' :f 1<r - F a • ate}}' �' d 4 4 � .. � i 'SY: `11LL i 4'�°"• fie.. ,�. !1 44, ` t A*s�a�E� #amu 7�/91a3 5 i 119t PAI,Q25 t�r1 �i�R Rl9GAL�G 5 _ �57~/9X)C /q 0 f'""-3 - 46 L 9y /6 f. Vo.EA ?�ZAZ67_/i1-�9 ANk Lsi- -mak ou +,! ox l e. v int 1 /C7./7 • ri A •FWWW.Wl �� C-� x �r 7 SH/�R/�/I/ER S j�0%l1� kOAD N 1 Grant, Michele From: Bernadette Sullivan [bernie526@mac.com] Sent: Friday, July 22, 2005 2:09 PM To: - -iMark.Silverstein@state.ma.us Cc: John Sullivan; Grant, Michele Subject: Unethical septic inspector Hello, 7Jv We recently had our septic system inspected because we are selling our house in North Andover. The system supposedly failed, but for a number of reasons, we were suspicious. I found out that the person who did the inspection is not certified. His name is Jim Cheney and his number is 978-265-7030. I then called an engineering company and had the system inspected by a certified engineer. Not only did he say the system passed, but he also said it "looks great." (The system is only 10 years old.) We have received his Title V cert in the mail. I called the Town of North Andover Board of Health and reported my experience. I talked to Michelle Grant at 978-688-9540. She suggested I get in touch with the MA Dept. of Environmental Protection. I found your email address on the website. North Andover has no report from Cheney, because he gave us a choice: Either he would file a failure report and we would pay him $325. Or, for $200 he would not file a report, and if we got him to install the system, he would take the $200 off the price. Conflict of interest! He said it would cost us between $10,000 and $30,000. When I expressed surprise that a 10 -year-old system would fail, he told me that he had already failed another one that day, and that systems in North Andover fail all the time. He said it had something to do with the environmental conditions (my words) in North Andover. I called Jim Cheney today to ask him why we hadn't received anything in writing. He said we opted not to, so we could assess the situation. I asked him how we could do that if we had nothing in writing. Then he said, "You already got the Title V cert." I asked how he knew that, and he replied, "That's none of your business." He accused ME of being unethical: "You went behind my back." I then told Cheney that I had gotten a certified engineer who passed the system and who said he would stand by his report, because the system in no way could fail. He said, "What do you think I am, stupid? He's trying to scam you." Then he hung up on me. Hmmm, some scam. The engineer made $425 for his inspection, but Cheney stood to make thousands by putting in a new system that we don't need. I know we'll never see that $200, but this guy needs to be stopped. I nearly fainted when he told us the cost involved, and I'm sure he's doing this to other people. I just searched on Google and found him: James C. Cheney, C&K Trucking, 16 Linda Road, Andover, MA 01810 Apparently he has a 2005 Drain Layers License, #HC05-0067. Sorry for the length, but I wanted to include everything. Sincerely, Bernadette Sullivan 978-689-4034 1 NEW ENGLAND ENGINEERING SERVICES lk INC July 19, 2005 North Andover Board of Health 400 Osgood Street North Andover, MA 01845 RECEIVED JUL 2 12005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT RE: TITLE V REPORT: RE: 700 Sharpners Pond Road North Andover, MA Dear Sir or Madam: Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely, � c a� Benj?min C. Osgood, Jr. Certified Title 5 Inspector 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 FORM U - LOT RELEASE FORM: INSTRUCTIONS: This form is used to verify that all- necessary approvals/permits from Boards and Departments having.jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ************** APPLICANT FILLS OUT THIS SECTION APPLICANT S��dP �We f PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION / - LOT (S) STREET �l //'/ Ow ST. NUMBER 7UU *****************************************OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: -- CONSERVATION ADMINISTRATOR DATE -APPROVED DATE REJECTED COMMENTS J V- a W'o`t�445 TOWN PLANNER COMMENTS FOOD I TH PECTOR-HEALTH COMMENTS A A DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING 1NSPECTO Revised 9197 jm �P 09 2 !i l ,BUILDING DEPART AENTd 3 C ki S4.ti % txe.le. l;OA-v t 14 N(de: P,r. er. VeA+ nu}dwdr v-,1a.4e-r �e..,w�t alb l>-a.Fhc (�g�wit Iy X 12 'Tl-,ree Sar,Sc,n . Roo nn, T�cS�e: cl ear Ar -e. J 1 31' %ti. (✓�e„� -Fay `, � 15r FLoop, G ROOM $ A rkm5 SF-PTic- t5ao � o� OAR C Property !►ddrtSs: co owner! �TF vi S 1T Date of lrtspettiom SKI TCH Ir AGE POSAi SYSTEM: lAhdtnarks tft bOIChMA& incl ties to int t•+vo perr"nient references 1tlE?' (Locate 4*fe public water gWtY- barim iris l 6iw a i all wells ithin Wo-, V . Cx 4ag _ G"I l (rrviiad 01/25/07) ` �►� � � St; ��`� �'- ��.�r{rte ���,^ �,: in MM is .mob t q,3 -TA Q 3 Q JA T Y 3A -Tlz 7 77�( All(f) 07 TY TlL,l wz V. v �,.A Town of North Andover, Massachusetts Form No. 2 NOR,h BOARD OF HEALTH a tee 19�_ w s ' DESIGN APPROVAL FOR as "C""5SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant ,r&4, p , o 1Zt 1 Aa,,t Test No. I Site Location- Reference Plans and 1,7 A 'C""- la -A Permission.is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD OF HEALTH Fee Site System Permit No. AMN flffl TOWN OF NORTH ANDOVER MASSACHUSETTS n�•���--9l he filed Any wit' ; : _.-. ,/s after the date ,f film'_; t-tf this Notice in ¢i =e Cf --� e of the Town Clerk. NOTICE OF DECISION JUN ti 2 24 Date. June, 21, 1994 April' Date of Hearing May 17. 1994, June 7, 199' Petition of . Torey. Realty. Trust ..................................................... Premises affected Lots .6 .& .7 .Sharpness .Pond .Road ....... , ; .. ,1 . , .... . Referring to the above petition for a special permit from the requirements of the . ,North ANdover, Zoning Bylaw . Section 2.30. 1 Common Driveway • • • .. . so as to permit ,the ,construction of .a .common .driveway .to .be ,used .by .Lots .6 .& •7 of Assessors Map 105-D #4 .............................................................................. After a public hearing given on the above date, the Planning Board voted CONDITIONALLY to ... AP........the - PROVE SPECIAL PERMIT ..... WE cc: Director of Public Works Building Inspector Conservation Administrator Health Sanitarian Assessors Police Chief Fire Chief Applciant Engineer File Interested Parties based upon the following conditions: Signed Ae,& ,,�_ Q • 7&wwC. Richard A. Nardella, Chairman ................................ Joseph Mahoney, Vice Chairman ................................ Richard Rowen, Clerk ................................ John DAghlian ................................ John Simons ... ' ..planning ' Board ........ A Mr. Daniel Long, Town Clerk Town Building 120 Main Street North Andover, MA 01845 Dear Mr. Long: June 21, 1994 120 Main Street, 01845 (508)682-6483 Re: Special Permit - Common Driveway - Lots 6 & 7; Lots 8 & 9 Sharpners Pond Road The North Andover Planning Board held a public hearing on April 19, 1994, in the Library Conference Room in the Town Building, on the application of Torey Realty Trust, 369 Merrimack Street, Methuen, MA, requesting Special Permits for common driveways under Section 2.30.1 of the North Andover Zoning Bylaw. The legal notices were properly advertised in the Lawrence Eagle Tribune on April 4 and April 11, 1994 and all parties of interest were duly notified. The following members were present: Joseph Mahoney, Vice Chairman, Richard Rowen, Clerk, John Daghlian and John Simons. Richard Nardella was absent. The petitioner was requesting two Special Permits for common driveways for Lots 6 and 7 and Lots 8 and 9 Sharpners Pond Road. Mr. Rowen read the legal notice to open the public hearing. Mr. Chris White was present representing Torey Realty Trust. An eight lot ANR plan was signed in February. Owners have agreed to put a conservation restriction on the back acres. The first proposal had two common driveways next to each other. The second proposal separates the driveways. This would reduce grading and tree cutting. The Conservation Commission has walked the site and supports the second plan. It's a better layout, less easements. Driveway is 14 ft. for common part, added a graded turnout are on both driveways. Guard rails will be put along steep slopes. °pOwiry 1y KAREN H.P. NELSON Director a�?' °° Town of '9 NORTH ANDOVER BUILDING ;,' =•:::o • ss"°"p5`t CONSERVATION DIVISION OF PLANNING PLANNING & COMMUNITY DEVELOPMENT Mr. Daniel Long, Town Clerk Town Building 120 Main Street North Andover, MA 01845 Dear Mr. Long: June 21, 1994 120 Main Street, 01845 (508)682-6483 Re: Special Permit - Common Driveway - Lots 6 & 7; Lots 8 & 9 Sharpners Pond Road The North Andover Planning Board held a public hearing on April 19, 1994, in the Library Conference Room in the Town Building, on the application of Torey Realty Trust, 369 Merrimack Street, Methuen, MA, requesting Special Permits for common driveways under Section 2.30.1 of the North Andover Zoning Bylaw. The legal notices were properly advertised in the Lawrence Eagle Tribune on April 4 and April 11, 1994 and all parties of interest were duly notified. The following members were present: Joseph Mahoney, Vice Chairman, Richard Rowen, Clerk, John Daghlian and John Simons. Richard Nardella was absent. The petitioner was requesting two Special Permits for common driveways for Lots 6 and 7 and Lots 8 and 9 Sharpners Pond Road. Mr. Rowen read the legal notice to open the public hearing. Mr. Chris White was present representing Torey Realty Trust. An eight lot ANR plan was signed in February. Owners have agreed to put a conservation restriction on the back acres. The first proposal had two common driveways next to each other. The second proposal separates the driveways. This would reduce grading and tree cutting. The Conservation Commission has walked the site and supports the second plan. It's a better layout, less easements. Driveway is 14 ft. for common part, added a graded turnout are on both driveways. Guard rails will be put along steep slopes. Page 2: Lots 6&7; Lots 8&9 Sharpners Pond Road The developer will be minimizing disturbance within retaining walls and 2 to 1 slopes. Mr. Simons questioned how house locations were chosen. Mr. Joseph LaGrasse told the Board that they would be staying on top of knolls on each lot, siting houses to look toward the street, staying within 100 ft. buffer lines of wetland areas. Mr. Simons questioned if the sites perked and do they minimize the most cutting. Mr. Simons asked the applicant if he has look at a subdivision or a PRD. Ms. Colwell stated that staff and the Board did look at this earlier, and decided that a subdivision would disturb a larger area and would create more lots. Mr. White stated that he did look at putting a short road in and it would create more lots, but a road would have greater impacts with wetland and topography. Mr. LaGrasse told the Board that boxes are shown on the plan for information only, house designs will be site specific. Mr. Simons asked if there was an issue with Lot 3 with Conservation Commission. Mr. White replied, "no" because they were still 50 ft. away. Mr. White told the Board that the Health Department was reviewing the tests. The Board scheduled a site walk for May 14, 1994, after the North Andover Estates visit. On a motion by Mr. Simons, seconded by Mr. Daghlian, the Board voted unanimously to continue the public hearing to May 17, 1994. On May 17, 1994 the Planning Board held a regular meeting. The following members were present: Richard Nardella, Chairman, Richard Rowen, Clerk, John Daghlian and John Simons. Joseph Mahoney was absent. Mr. Chris White reminded the Board that this was a continuation of the public hearing on the common driveways for Sharpners Pond Road. The driveways will. be 14 ft wide, paved. The proposal minimizes impacts to the wetlands. Page 3: Lots 6&7; Lots 8&9 Sharpners Pond Road The driveways will be 14 ft wide, paved. The proposal minimizes impacts to the wetlands. Lot 9 will have a conservation restriction on back 20 acres. There will be graded turnouts. Houses will be built to fit the topography. On a motion by Mr. Rowen, seconded by Mr. Simons, the Board voted to close the public hearing and directed staff to draft a decision. On June 7, 1994 the Planning Board held a regular meeting. The following members were present: Richard Nardella, Chairman, Joseph Mahoney, Vice Chairman, Richard Rowen, Clerk, John Daghlian and John Simons. The Board reviewed the draft decision on Lot 6 & 7. Discussed $2,000 bond. On a motion by Mr. Simons. seconded by Mr. Rowen, the Board voted to approve the Special Permit for Lot 6 & 7 as discussed. Mr. Nardella also voted. The Board reviewed draft decision for Lot 8 & 9. Discussed $2,000 bond. Wooden guard rail detail and conservation restriction to be placed on Lot 9. On a motion by Mr. Simons, seconded by Mr. Rowen, the Board voted to approve the Special Permit for Lot 8 & 9 as discussed. Mr. Nardella also voted. Attached are the conditions the Board placed on the Special Permits. Sincerely, North /fAndover Planning aBoarJdd a • 7aAd- / Richard A. Nardella, Chairman attachment cc: Director of Public Works Building Inspector Conservation Administrator Health Sanitarian Assessors Police Chief Fire Chief Page 4: Lots 6&7; Lots 8&9 Sharpners Pond Road Applicant Engineer File Lots 8 & 9 Sharpners Pond Road Special Permit Approval - Common Driveway The Planning Board makes the following findings regarding the application of Torey Realty Trust, 369 Merrimack Street, Methuen, requesting a Special Permit under Section 2.30.1 of the North Andover Zoning Bylaw for the construction of a common driveway to access lots 8 and 9 on Sharpners Pond Road. The premises affected are in an R-2 Zoning District. FINDINGS OF FACT: 1. The application adheres to the bylaw restriction that no more than two (2) lots be serviced by this common drive. 2. The specific location of the common driveway is appropriate due the location of wetlands and vernal pools along the edge of Sharpners Pond Road. 3. The design and location will not adversely affect the neighborhood as Sharpners Pond Road will benefit by minimizing the number of curb cuts. 4. There will be no nuisance or serious hazard to vehicles or pedestrians as Sharpners Pond Road will benefit by minimizing the number of curb cuts. 5. Adequate standards have been placed on the design which will meet public health and safety concerns. 6. The purpose and intent of the regulations contained in the Zoning Bylaw are met with the Special Permit Application before us. Upon reaching the above findings, the Planning Board approves this Special Permit based upon the following conditions: SPECIAL CONDITIONS: 1. Prior to any site disturbance: a. the location of the field and reviewed by must be placed so that of trees possible on cutting and filling. existing contour lines driveway must be marked in the the Town Planner. The driveway it preserves the greatest number site and minimizes the amount of The driveways must follow the to the maximum extent feasible. b. the applicant must post security in the amount of two thousand ($2,000) dollars to assure the construction is completed in compliance with this decision. The security will be in the form a check made out to the Town of North Andover to be placed in an interest- bearing escrow account held by the Town. 2. Prior to FORM U verification (Building Permit issuance) being for the proposed dwellings, a. This site shall have received all necessary permits and approvals from the North Andover Board of Health, Conservation Commission, and the Department of Public Works. 3. Prior to a Certificate of Occupancy being issued for either dwelling, a. A wooden guard rail must be installed on both sides of the driveway from the edge of pavement on Sharpners Pond Road to the front property line. The guard rail must be constructed according to the specifications shown on the following detail: Project: Wood Guard Rail Sharpners Pond Road, North Andover Sheet Title: Wood Guard Rail Lot No. 8 Prepared For: Andrew & Maurice Builders Inc. Prepared By: Joseph D. LaGrasse & Associates 1 Elm Square Andover, MA 01810 Date: 6/7/94 b. A conservation restriction must be placed on approximately 19 acres of the rear section of Lot 9. C. Easements pertaining to the rights of access for driveways between the lots involved and a maintenance agreement running in perpetuity with the land shall be recorded with the Registry of Deeds Office. d. The Applicant shall place a stone bollard at the entry to the.common drive off of Sharpners Pond Road. This stone bollard shall have the street numbers of all houses engraved on all four sides of the stone. The dimensions of the stone shall be as follows: 8" x 8" x 72". The stone shall have 48" exposed and 24" buried, and all numbering on the stone shall be 4" in height. This condition is placed upon the applicant for the purpose of public safety. e. The proposed dwellings shall have a residential fire sprinkler system installed in accordance with the provisions of North Andover Fire Department. 4. Prior to release of the security: a. As -built plans of the driveways must be submitted for review. b. The site shall have received all necessary permits and approvals from the North Andover Board of Health, Conservation Commission, and the Department of Public Works. 5. The pavement width of the shared driveway will be fourteen (14) feet. The pavement width of the individual driveway will be twelve (12) feet. 6. Graded turnouts will be provided as shown on the plan. 7. The contractor shall contact Dig Safe at least 72 hours prior to commencing any excavation. 8. Gas, Telephone, Cable and Electric utilities shall be installed as specified by the respective utility companies. 9. All catch basins shall be protected and maintained with hay bales to prevent siltation into the drain lines during construction. 10. No open burning shall be done except as is permitted during burning season under the Fire Department regulations. 11. No underground fuel storage shall be installed except as may be allowed by Town Regulations. 12. The provisions of this conditional approval shall apply to and be binding upon the applicant, it's employees and all successors and assigns in interest or control. 13. This permit shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced. Therefore the permit will lapse on June 21, 1996. 14. The following information shall be deemed a part of this decision: Plans Entitled: Proposed Site Plan Sharpners Pond Road & Forest Street North Andover, MA Scale: 1" = 50' Date: March 23, 1994; rev. 4/18/94, 4/27/94 Drawing: 13393.02 Prepared For: Torey Realty Trust 369 Merrimac Street Methuen, Massachusetts Prepared By: CWA - Christopher White Associates, Inc. Post Office Box 487 Lincoln, MA 01773-0005 cc: Director of Public Works Building Inspector Health Agent Assessor Conservation Administrator Police Chief Fire Chief Applicant Engineer File Sharpner.drive2 Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 1 9� y` 0 — 19 3/ m APPLICATION FOR SITE TESTING/INSPECTION Applicant NAME ADDRESS TELEPHONE Site Location WT Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time T—> CHAIRMAN, BOARD OF HEALTH Fee 1,5J _ Test No. "4:� 1-f - S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 ORTH n4;% BOARD OF HEALTH 4E7 / "l I. o1-19 APPLICATION FOR SITE TESTING/INSPECTION Applicant —\. Y4^L 1 %� �� ILLS -'a-( ) NAME ADDRESS TELEPHONE Site Location , ir( Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee ► Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. t lime a Derr 66 LITTLETON ROAD WES"FORD, MA 1� :68e Z2 1!-07-94 02: 47PM [' +71 #2 (578; �y2 8395 FAx (5o6) 692.00?3 1-8M649 rESt RepDrt NUMber•. C- l3B90 Cxietnts xspert their NOvQM ar 4, 1994 Sample Taken At, Yflunc� aarteBian well 36 P01ham fid. Morris C Caruso saiem NM 03079 Lot T Sharpeners pond Ad. N. sndover,MargB* 3=pler Taken by: Young Statf °n= nOVOMber 3, 1494 NxyNot Tested, #.Valle xCeede F; "Background Secteria doted PA STD, 'NTC;Top NuIrterous to Count ',Exceeds EPA Advisor r EFA Advisory Zi,n3t (�') •Prl.mar Y Limit, deatheticsyofFdrinkj, gr water i.e. t;pA sta-�dard (maty of fQGt. taste, color, etc.) This water eanpiti, As tooted, mOete or exCeede EPA health atandsr for the parameters liOt.ed above. fihes queli of aocepted as PQ'TABi,E aceordin, de 9 to EPA Standards, this Wear is Massachusetts Mate Certified TewCin T,fth^rwtor AmAnnA Y C del P. CArlsont for CZRT?TM'rCATr OF ANALyUja TEST i -MRAMETER t UFA Max RZat3LTS Total coliform UNITS(p) Calcium Capper (g) 0 No Limit 0 39.4 per 100m1 iron (S) 1.3 0.03 mg/z, Nagnasiuz 4.3mQ/L Q.O1 htangart�►a0 (s) NO LiMAt 3.6 Mg/L Sodium 0.05 0.01 iRCf/Y, Pdtaas o i (�) 20 0.6 mg /L Alkalinity (s) NO Lirit 't .5 mg/L Nmnonia No LiZit 66 mg/L Chlorides (6) No Limit <0.03 m5f C:hlorine4250 (tattal) 47 mg/L Color (a) Not spec. [0.02 mg/L conductivity 15 p mq/L dardneRa Na Limit 265M.4 N.itratesa (,xe N) (p) No Li'mi't C NitritaQ(as N) 10 Q. 56 mg/LOs/cagy PH (S) ' i 10.56 01 Rlg/L Odor (0) 6.5-8.5 6.8 m9/L sulphates (s) 3 0 8U Turbidity 250 11.3 TON Sediment 5n;g/L Over Poo /nag NTLI 4 NxyNot Tested, #.Valle xCeede F; "Background Secteria doted PA STD, 'NTC;Top NuIrterous to Count ',Exceeds EPA Advisor r EFA Advisory Zi,n3t (�') •Prl.mar Y Limit, deatheticsyofFdrinkj, gr water i.e. t;pA sta-�dard (maty of fQGt. taste, color, etc.) This water eanpiti, As tooted, mOete or exCeede EPA health atandsr for the parameters liOt.ed above. fihes queli of aocepted as PQ'TABi,E aceordin, de 9 to EPA Standards, this Wear is Massachusetts Mate Certified TewCin T,fth^rwtor AmAnnA Y C del P. CArlsont for FEE -24-95 FRI 02:17 PM GRANITE. ~TATE. ANALYTIC 603 434 4837 P. 1 oranittto Analpticatip 21110 22 Mortchoater Road - Rte. 28 9 Derry, NH 03038 a (603) 432-3044 0 (800) 699-9820 9 FAX # 60.3 434--4837 RE: FROM.: TOTAL NUMBER O�1F,• PAGES INCLUDING THIS PAGE: FAX OPERATOR V IF YOU DO NOT RECEIVE THE TOTAL NUMBER OF PAGES 'LISTED ABOVE, PLEASE CALL GRANITE STATE .ANALYTICAL AT THE PHONE 0 LISTED ABOVE. THANK YOU I 1 ' FEE -24-95 FR I 02:18 F'r'1 GRANITE. STATE . AHAL'-r T r'_ 603 4L4 4':',7 ipOreutfte &la;n Officef Laboratory 22 Manchester Rd. !Rt, 26 Derry, NH 03038 (603) 432.3044 btatt am Ipt t4d L 3n(# At: Tramway Marketplace At: Daniels Artesian Wells Route 16 & 25 Route 3 West ©sslpee, NH 03890 Senbornton, Nei 03269 1.800.599.9920 1. 00.699-9920 SENT TO: Andrew & Maurice Bil4 iders 369 Merrir,�,ac St. Methuen, NTA 01849 DATE: February 22, 1905 Drinking Water TEST NO,: 17485 TEST LOQ A'I`ION: 700 Sharpner-'s Pond Rd. Lot 7 No. Andover, MA LOWER DETECTION LIMIT (PP14 ) 4 0,1 0.5 0,05 0.1 0.03 0.01 0 0 COPPER fXXK) F, PA PARAMF'TER RF$IJLT RECOMMENDED 0.05 MAX.LEVEL (PPM) PH UNITS 5.5 PARDNE5S 150 CHLORIDE 250 NITRATE 10.0 NITRITE 1.0 SODIUM 50 IRON p 3 14ANGAN E S E; 0,05 COLIFOPM ABSENCE ,/100 ML ABSENCE OTHER BACTERIA /100 ML 200 Drinking Water TEST NO,: 17485 TEST LOQ A'I`ION: 700 Sharpner-'s Pond Rd. Lot 7 No. Andover, MA LOWER DETECTION LIMIT (PP14 ) 4 0,1 0.5 0,05 0.1 0.03 0.01 0 0 COPPER fXXK) 1,3 0.02 ARSENIC 0.05 0.001 I.E'AD 0.01.5 0.001 CHROMIUM 0.1 0.05 CALCIUM N014E SET 0,l FLUORTDE 210 0,25 COLOR CPU 1.5 1 ODOR TON 3 0 TURBIDITY NTU 5 0,5 HYDROGEN SULFIDE NONE SET () THE TESTEO PARA119TERS MEET CURRENT EPA STANDARDS FOR DRINKIrNG WATER. } THE TESTED PARAMETERS MEET CURRENT EPA PRIMARY STANDARDS FOR DRINKING WATER, BUT SOME 88CONDARY PARAMETERS EXCEED STANDARD,, THE TE,`=I'ED PAiMIETERS FAIL CURRENT EPA STANDARDS FOR DRINKING WATER, DUc 0 PRIMARY STANDARDS OUTSIDE OF F I.MITS. -------'--------------------- ---------------------------------------------- C 0i'Ih ------------------ I ----------_----------- ---_.....---------SSSS..--------------_-- TNTC DENOTES TOO NUMEROUS TO COUNT. 1 DENOTES PARAMETERS THAT EXCEED PRIMARY STANDARDS; CAUSES TEST FAILt1RE, 2 DEMO E0 PARAMETERS THAT EXCEED SECONDARY STANDARDS; DOES NOT FIJIL TEST. NOTE: SUBSEQUENT SAMPLES FROM THE SAME WAT%t�SOroijRC� MAY VARY. � rue<i ,y WELL DATABASE ADDRESS: '7 L AGE OF WELL: JA4 WELL DRILLER. WELL PERMIT r: L -t! 3 WELL LOCATION: / o WELL PERMIT DATE:Ca- TYPE OF WELL: _DRILLiD TYPE OF WATER BEARING ROCK: DEPTH OF WELL: b. DUG c. UNKNOWN WATER ANALYSIS DATE: (- L�- Cr Lt HIGH MANGANESE: Y HIGH IRON: Y(�N) OTHER CONTAMINANTS: Z' N NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS- �f 1���.:___!✓oU ------------------------------ This is to Certify that ____ :_/.!._:._YbIJ - PTS � /... ii%-- NAME ADDRESS IS HEREBY GRANTED A LICENSE For ._ ! _l /1/6...\. ...... oe�4G..---�-'---•-_..COT....7._.....................!E'p..... .k ...--...---- .._---------.....ON �_'-�!----------------------------------------------------------------------------------....................................... .--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating thereto, and expires___-_rMfi3t___ 3_jJ__-_�_c_�____unless eoonernr rev d. /------------------------19-!NL FORM 9GN- FORM 433 HOBBS @ WARREN, INC. x�,, 1 ltY ♦ �i� his < i 4�` 4 1 t-i� tl�� i,�: t\ �'�" 'y tet. r ( '''`;yam;, .+ t ' ^, t .• - tit`• •4 � �� 4 `, >e 1\ � ti . !•'ell Contractor �' _ __Address 3� ��.e.. � l.WO'' S.c = -- - Pump Contractor - --Address_------------ _--Tel:----- - WELL CONTRACTOR (To be completed at time of pump test) Type of Well Well used for Diameter of Well �p _—_Si.z_e of Casing- i Depth of Bed Rock _ Depth casing into Bed Rock V.1as Seal Testcd? Yes ( ) No ( ) Date of Testing___ Depth of Nell -__--- _ _-_--IJell Ended in What 1•11aterial Depth to Water _ _ - Delivers- - -Gal S . Per Min. for 4 h _urs Drawdown -feet after pump:;ng_- -_hours at - --_GPM Date of Coinpleti.on-_ _____ (I'LL "Z Sign tureX-11 Contractor •-._J..•-.r__-.•..L.LJ. !.;-J. J. J-il .^.. - _1.-n"-• iL"-n nen n iii.-i��_� _ i-n��-ni.-i.i:i.i:'i: '�`. .i.-�iL iLn�-.L.ri.:�.. i.. PU11P INSTALLER (To be filled-in before- installation)-- Size & ;'arne i u��p - - -.- Pump Type Used 1,'ater Pump Del ivers_ —_--GPM Size of Tank-_--- -_- Pipe Mlaterial Used in !':ell: Cast Iron (-) Cal.vanized (-) Plastic (_) Pit ( ) or Pitl.cs.s Adapter ( ) !''as sleeve used to protect pipe? Yes (_) NO(_) Type or Name '','ell Seal Date C', l7� C' Pi TPP T7l�t.r�].�.t%}^ ., .� .....r ., ., .• SS'ii ., ;i ',• .• n �'t Si 'i: '�i ll'Yi '.: S'i :; S..i 5.:�i `ii'.; Y7 „ .. „ ,. „ n n .. S'i .... 5. tir .... ,............. 5li Date !.later analysis report sub*Tii tted to Board of Health Date re] case given tD oxaner of record & Bldg. Tnsp ------ --_-- -_ _-._...-_. Health Inspector Town of North Andover,Mass. ti Permit rj APPLICATION FOR WELL & PUMP PERMIT Application is hereby made for permit to drill a well (_). Application _s made to install (_) a pump system-. d d Location: A r e sS%ia"J►�'r�.'• Owner d4 - —Address '��' P_e •fic • _77 ``{Tel.----- ---- !•'ell Contractor �' _ __Address 3� ��.e.. � l.WO'' S.c = -- - Pump Contractor - --Address_------------ _--Tel:----- - WELL CONTRACTOR (To be completed at time of pump test) Type of Well Well used for Diameter of Well �p _—_Si.z_e of Casing- i Depth of Bed Rock _ Depth casing into Bed Rock V.1as Seal Testcd? Yes ( ) No ( ) Date of Testing___ Depth of Nell -__--- _ _-_--IJell Ended in What 1•11aterial Depth to Water _ _ - Delivers- - -Gal S . Per Min. for 4 h _urs Drawdown -feet after pump:;ng_- -_hours at - --_GPM Date of Coinpleti.on-_ _____ (I'LL "Z Sign tureX-11 Contractor •-._J..•-.r__-.•..L.LJ. !.;-J. J. J-il .^.. - _1.-n"-• iL"-n nen n iii.-i��_� _ i-n��-ni.-i.i:i.i:'i: '�`. .i.-�iL iLn�-.L.ri.:�.. i.. PU11P INSTALLER (To be filled-in before- installation)-- Size & ;'arne i u��p - - -.- Pump Type Used 1,'ater Pump Del ivers_ —_--GPM Size of Tank-_--- -_- Pipe Mlaterial Used in !':ell: Cast Iron (-) Cal.vanized (-) Plastic (_) Pit ( ) or Pitl.cs.s Adapter ( ) !''as sleeve used to protect pipe? Yes (_) NO(_) Type or Name '','ell Seal Date C', l7� C' Pi TPP T7l�t.r�].�.t%}^ ., .� .....r ., ., .• SS'ii ., ;i ',• .• n �'t Si 'i: '�i ll'Yi '.: S'i :; S..i 5.:�i `ii'.; Y7 „ .. „ ,. „ n n .. S'i .... 5. tir .... ,............. 5li Date !.later analysis report sub*Tii tted to Board of Health Date re] case given tD oxaner of record & Bldg. Tnsp ------ --_-- -_ _-._...-_. Health Inspector MORTH o O 9 SSACHUSEt Applicant Town of North Andover, Massachusetts Form No. 3 BOARD OF HEALTH DISPOSAL WORKS CONSTRUCTION PERMIT tSS Site Location a /4 Permission is hereby granted to Construct (-/(or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. /1:1 C) i 7z HAIRMAN, BOARD OF HEALTH Cly Fee - D. W.C. No. % / 3 v 1 r \ �\ �'� l lL r't F'.tii tY ' - tiY !.-� c�4:ix r7 4 t ' + ' , y .q :. c t \ 3, '� •' , z 4k1yi 3. 5 ;j �y a . Y • a�\ ,^� a: 3\� i i,t. !, � 3�.'��y� ttl � � +�..x 2!�' 4� ttx � a R++---•. : T �'` 'v ti -.ti :3- .F .�. i .7 � _ � F c d �� t ` a i),7 :e:. kt ! _>-� t 4 ar- 2 . k�"• - +tt , �- r , e a � °,. '\.. r �; �- i?• , 6 `x at 4 1`% is ` 1.. � . it -1. ,� ra 'tjt � ` 1 � � s � . � v e t ` �.ty(.���ri. 'f, -, q`\(i��. �. F�.:��' av �l��!`''���-�� tY yt R.<.��tti<�`\_f fk,. tT ice.-.= t •7 .. A� ! a•`�1, ��: �. +x iF\�\\ .,a., i! �^ a x�," ��.e1Y. - t t� .1\ti,L� r.., ��F � `! �lk5i� Ci+ r„r* � a„ya • :y '� �+ Fc 7��:'k. sr t e - y .� . � � .,Y a (� . t � `+ a,. . y ��'� t1...v k�'w,: fir, 4-aa't,he 'ti?o. y4'2`h1,t�4:�:'L't`.},�,-'j.; !Y Y ��.\�.�.{� ya _.'s.: < i,, h r..`•.-�-FE\$i�`� �S{YtW, �S url�; �0.�1� (Y � SA 4 e.-. ti� � k i' -t cr; a t L i. F - � �l^ � .. � 4 t��i�l,'.'Gc., k} .�.�t 'k'L�} i i13���1►'�s� �+xc��..Yk 1o.�Ya; Ma. 1'. w�i � t i 1�� rte. \;Y , .���}§:: ''11v.�°'�C ! �'it1�...i. � xe k-x-T.s: t'-.. �� i �h.. yl "?` ti 'v�x�tr#�a� � t �Z .1 �c � f.. �. '!\� � i �ti �t c � ai f � U iK� ;•.r-.`, � i� •�^.tir�„`ty Z :i� '} �'"��) ,41i1,' r � ,��'"y�',���,�jh+ :�iitt����'�f;�id `�:�?aii.$.�' cn Z m z z CO) G7 m C � N — � ,m N — � r TA go CSD 0z y T r CD o .0- 5CL r c � � y 0 0 c p CD CD Q� cr CD n•F — 0 n CCD O CCD z M CD CL CD y D -G o z o CD < 3 -Ca o Z C• N o -_� CCD CD 1 li �G h a \ J 0 z cn C 0 z^ V I Wl y C') m m Ngo cj gel/ "G m z O H 0 9 r v Cn CR q7^n d o O w ( O�z n C �.y O< ca m N 0 CL -� •' 0 CD CD z c ol o Z N =O CD� =r 0 m N O O O�« !09 1 O N' n W Nc m CD �oCD c CL cc, .d+• N N Q N p• d c < N _ C CD N N O; CA O C �C : �� 3 c: � CD CO ... O 0 o: a3� CD. O CO) 'O O CD .� Crm?' o: C �? � ra�nH CD rri 00 �: C Di ate= ao– Z C-3 d CS 00 0 y C') m m Ngo cj gel/ "G m z O H 0 9 r v Cn CR q7^n d o O w ( O�z n GOR (`c ° rCA O a C x x cn -� •' d 7d z \� o co Cr tz THIS PLAN IS NOT FOR RECORDING PURPOSES OFFSETS ARE NOT TO BE USED FOR THE REPRODUCTION OF PROPERTY LINES SPECIAL FLOOD HAZARD AREA (FIA) IS NOT APPLICABLE L/�nlLi caul?-! "1 certify that the foundation shown hereon is in compliance with the applicable Zoning Bylaws of the Town ofui++ PAARxA5Z with respect to horizontal dimensional requirements." 0 P?61a. To "FOUNDATION CERTIFICATION" PLOT PLAN OF LAND IN IUae7�1 9XVZ�6yC,� MASS. SCALE: 1" = 60' FEET I DATE: z4 1994- S C c DEVELOPMENT SERVICE COMPANY 30 WOODLAND ROAD P.L.S. DATE ASHLAND, MA 01721 (508) 881-8776 tq-/31ra, 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: AU_n2F4,J XIAMICE %�UIUVX-S _ M' C, Phone 79y -3S7/ 11 LOCATION: Assessor's Map Number Parcel Subdivisionf=og AV Lo s Lots) 7 Street-5WARR�S • St. Number 700 ************************Official Use only************************ RECO. NDATIONS OF TOWN AGENTS: Date Approved Co,Aservat'on Administrator Date Rejected Comments J��) CLQ m2_0 Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Date Approved Q Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections - driveway permit - L% (. 7 Z1, Fire Department Lceived by °Building Inspector Date �N I � '-% - t , -,Iais 541* "OvIt } ` ba• hr _�k -ZZZq1q--3 (7- 5 1"-.Agt pfv,-P- 5 /Z ! 40 re 30 I 4:L IT 71 �N I � '-% - t , -,Iais 541* "OvIt } ` ba• hr _�k -ZZZq1q--3 (7- 5 1"-.Agt pfv,-P- 5 /Z ! 40 re 30 I 4:L 1 b FORM U - LOT RELEASE FOR,IM IiN1STRUC T IONS: This form is used to verify that all necessary aporov-ls/permits from. Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applic:.ble or requirements. ` �� *AFFI iCA,\aT FILLS OUT TH1S SECTION*, .......<�r�t,ttt � sl,E�l%1i ArPLICniJI ��/�i • LOCATION: AS_eS_&S I\,Iao Number D,D PHCNC -Ir732) 5� PARCEL SUEDIVISION LOT (S) ^-� 0 STRE=T S`J�ejON-e?s t�d� �( ��' ST. NUMEEFR /yv OFFICIAL USE ONLY'', RECOMMENDATIONS OF TOWN AGENTS: Z (>-Z -i-, )a s C CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPRCVED DATE REJECTED COMMENTS FOOD 1 S ECTOR- EALTH DATE APPROVED DATE REJECTED �. SYTi INSPECTOR -HEALTH DATE APPROVED DATE REJECTED T�7 y /per COMMENTS Py,. PUELIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERPAIT FIRE DEPAR T IMENT RE+C`iVE, E'( EUILDiNG iiNSPECTCR GAT- Revised g;c' im CL 31 QtJt',*Out 4c �Lf e 14f IS Iz Tinv,c. sooc.rw ROO A'N COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION } TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 700 Sharpner Pond Road North Andover, MA 01845 Owner's Name: Steve Jewett Owner's Address: Same Date of Inspection: February 10, 2003 Name of Inspector: (please print) John Soucy Company Name: Soucy Sewer Service, Inc. Mailing Address: 830 Livingston Street Tewksbury, MA 01876 Telephone Number: 978-851-8839 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shal�,s' ubmit a co f y of this inspe 'on report to the Approving Aufhority (Board of Health or DEP) within 30 days ogcrompleting this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. .Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 700 Sharpner Pond Road North Andover, MA 01845 Owner: Steve Jewett Date of Inspection: February 10, 2003 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: 700 Sharoner Pond Road _North Andover, MA 01845 Owner: Steve Jewett Date of Inspection: February 10, 2003 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: 700 Sharpner Pond Road North Andover, MA 01845 Owner: Steve Jewett Date of Inspection: February 10, 2003 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No X X X X X X X 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 '/z day flow 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 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 11 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 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 700 Sharpner Pond Road North Andover, MA 01845 Owner: Steve Jewett Date of Inspection: February 10, 2003 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No x _ Pumping information was provided by the owner, occupant, or Board of Health x Were any of the system components pumped out in the previous two weeks ? x _ Has the system received normal flows in the previous two week period ? x Have large volumes of water been introduced to the system recently or as part of this inspection ? x _ Were as built plans of the system obtained and examined? (If they were not available note as N/A) x _ Was the facility or dwelling inspected for signs of sewage back up ? x _ Was the site inspected for signs of break out ? x _ Were all system components, excluding the SAS, located on site ? x_ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? xWas the facility owner (and occupants if different from owner) provided with information on the proper mainten_ance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no x _ Existing information. For example, a plan at the Board of Health. x Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] .Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 700 Sharuner Pond Road North Andover, MA 01845 Owner: Steve Jewett Date of Inspection: February 10, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 450 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 [if yes separate inspection required] Laundry system inspected (yes or no): no Seasonal use: (yes or no): no Water meter readings, if available (last 2 years usage (gpd)): well water Sump pump (yes or no): no Last date of occupancy: current COMMERCIAL/INDUSTRIAL N/A 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: Home Owner Was system pumped as part of the inspection (yes or no): yes` If yes, volume pumped: 1500 gallons -- How was quantity pumped determined? Gauge on truck. Reason for pumping: Maintenance and inspection of tank interior. TYPE OF SYSTEM X Septic tank, distribution box, soil absorption system _ Single cesspool Overflow cesspool Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank _ Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information: 7 Years Old .Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 700 Sharaner Pond Road North Andover, MA 01845 Owner: Steve Jewett Date of Inspection: February 10, 2003 BUILDING SEWER (locate on site plan) Depth below grade: 14" Materials of construction: _ _cast iron _X_40 PVC _other (explain): Distance from private water supply well or suction line: N/A Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: x (locate on site plan) Depth below grade: 6" 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: 6'x 12' Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 37" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: Tape & Sludge Tool Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): GREASE TRAP: _(locate on site plan) N/A Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): .Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 700 Sharpner Pond Road North Andover, MA 01845 Owner: Steve Jewett Date of Inspection: February 10, 2003 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) N/A 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 (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.): Flow Checked Okay PUMP CHAMBER: (locate on site plan) N/A Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): .Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 700 Sharpner Pond Road North Andover, MA 01845 Owner: Steve Jewett Date of Inspection: February 10, 2003 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: 4 leaching trenches, number, length: Approximately 3' x 45' trenches 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 Sign of Hydraulic Failure. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) N/A Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) N/A 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 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 700 Sharaner Pond Road North Andover, MA 01845 Owner: Steve Jewett Date of Inspection: February 10, 2003 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. Well cy,�,Jo J A ,Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 700 Sharoner Pond Road _North Andover, MA 01845 Owner: Steve Jewett Date of Inspection: February 10, 2003 SITE EXAM Slope Surface water Check cellar x Shallow wells Estimated depth to ground water 7+ feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: X 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: Dua hole with auger in low drop off area. No water present at 4' Note: 3 foot elevation difference from s.a.s. Area. TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES a HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 ' s;C,p,s Susan Y. Sawyer, REHS/RS Public Health Director April 11, 2005 To all Sharpeners Pond Road Residents: 978.688.9540 — Phone 978.688.9542 — FAX E-MAIL: healthdept a,townofnortliandover.com WEBSITE: hqp://www.townofiiorthandover.com 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: J� • The Town has a mandatory paper and cardboard recycling ordinance that requires residents to separate these items from their household trash. Paper and cardboard are collected every other week on the same day as the household's normal trash. Residents can call the DPW at 978.685.0950 to get their recycling schedule. • Residents are responsible for picking up loose trash left at the curb after collection. Banned Items and Recycling Requirements: Please refer to the DPW website for a complete list of all the recycling requirements: 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 . c.a a a•a ...,, u ,i,., -_ v .wa,,• P J��.Y" �� l ', ��5� .1 � n 40 ��il� . �, fL ��e fie► ;� �„ � tib. i o �b Y �J�r►^'°�r• . , Quo � � � �� � '�► �` � . df a d. - to ,�°�� - �� •-� .� � � i .. �yw °fie � . ' � ' �',\• � \ `` � /1 �' , fid\ Ate. :W� a, � `''�► \` _ � 10 OP k.. :S. 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Seplic "I'mik: No Yeq System I'ungred by: Wde'edeft 45Nreo toed Liceiise # Ctmiews irttrrsiettted Itt : Vol Id - Dale:._._ 1 it -tN- Commonwealth of Massachusetts RECEIVED City/Town of SEP 2 7 2007 System Pumping Record TOWN OF NORTH AfJDOV Form 4 1 HEALTH 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 C V computer, use only the tab key Address!J., to move your t7 0` cursor - do not City/ToHm State Zip Code use the return key. 2. System Owner: dL rab Name Address (if different from location) Citylrown State Zip Code 00 Telephone Number B. Pumping Record 52� 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condit} o of System: 6. System Pumped By:N a>�' ( Ac--� Name _�� / Vehicle License Number Company 7. Locatio where contents w disposed: ��: 7 t5form4.doc• 06/03 Date LA - System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts IMI 11 City/Town of QCT R9�� System Purn.ping Record Form 4 TOWNOFER HEALTH DEPARTMENT wM 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 tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health or ottter approving authority. A. Facility Information 1. System Location: Left sid e, Right side of house, Left front of house, Right front of house, Left rear of ho fight rear of hou . Left rear of building. Right rear of building. K Address Citylrown State System Owner: K 47�� Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Zip Code Sn <a-') ` C C �p Code Telephone Number c� Date 2. Quantity Pumped: Gallons Cesspool(s)eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition o Lxe � � �-k 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Loca � contents were disposed: G.L.S. Sig F5821 Vehicle License Number Date t5form4.doc- 06/03 System Pumping Recons • Page 1 of 1 Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record OCT 3 0 2009 Form 4 TOWN -T NOP, ANDOVER DEP has provided this form for use by local Boards of Health. MENT O e%fta� MENT rmay-b ut the information must be, substantially the same as that provided here. Before using this form, check with your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health orotWr approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of house, Right front of house, r o ou , Right rear of house. Left rear of building. Right rear of building. Address 1-7 ©(D ��— , ,J _ Cityfrown State Zip Code 2. System Owner: eA Name u Address (if different from location) City/Town State/—r.-) ip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Q-No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: Vic U� L� 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatior ere contents were disposed: Signature of Hauler t5form4.doc• 06/03 Lowell Waste Water F5821 Vehicle License Number Date System Pumping Record • Page 1 of 1 -CN Commonwealth of Massachusetts City/Town of a w� System Pumping Record RECE �i Vic, Form 4 / DEP has provided this form for use by local Boards of Health. Other orms ble5,14A! but th information must be substantially the same as that provided here. B gTgjsjp chec with your local Board of Health to determine the form they use. The System P m 'IagLReO-A mitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, LeftRi litrear of hous , Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address `7 00 St",� �� Pel�� f City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/rown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Stat Zip Code Telephone Number Date ` 2. Quantity Pumped: Gains Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condi 'on of 1SSystem: M.�� 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: G.LjS.� Lowell Waste Water F5821 Vehicle License Number Date Cy -3t—c( t5form4.doc• 06/03 System Pumping Record • Page 1 of 1