Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 712 SHARPNERS POND ROAD 4/30/2018 (2)
Ir ItT MAPLOT.r Ci PARCEL # STREET CON$_lRUCjIPN Ap6-k-) pl-p-D....Y. (4. HAS PLAN REVIEW FEEDEEN PAID? YES NO PLAN APPROVAL: DATE APP. BY DESIGNER: PLAN DATE:_ 25L CONDITIONS WATER SUPPLY: TOWN WELL PERMIT DRILLER ZC' N. . . . ....... . . WELL TESTS: CHEMICAL DAIS BACTERIA I DALE (lPPRUVED//`/"`h BACTERIA II DAT -E APPRUVED_/,/Z&/ COMMENTS: FORM U APPROVAL: APPROVAL 1*0 IS'7'UE (aS�.Nu DATE ISSUED BY 7j� .... . ..... CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO NSI�L.L.BU 4N �.. . `� 1(r' '.;i i.'.,..J .tit:•?>. -` .,' .,. a •- r-t•a*'. µ 'lti 1� i. t'�£n T i __ - .., +2:IS THE ' INSTALLER LICENSED? . '" r YES NO + 1. .,' , , -:' `o s .tom J t• ; TYPE . OF CONSTRUCTION : ? - NEW `h REPAIR - - .;", NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF..APPROVAL NO (FROM .FORM U' '.,ISSUANCE OF DWC PERMIT YES NO DWC PERMIT N0. f� �: INSTALLER:, BEGIN INSPECTIONNO: EXCAVATION. INSPECTION: :NEEDED: ._ .. ... _ i •.mow ._. , PASSED PY4 CONSTRUCTION INSPECTION: NEEDED: ..M. , -. - . .. • _. ... .. .. 1. - - . AS BUILT PLAN SATISFACTORY: YES:� L APPROVAL. TO BACKFILL: DATE: BY APPROVAL: DATE tl�fBY FINAL.GRADING 1 6/�� DATE:Y FINAL CONSTRUCTION APPROVAL: North Andover Health Department Community Development Division Notice of Decision December 9, 2014 Brian and Melanie Stinson 724 Sharpners Pond Road North Andover, MA 01845 In conformance with MA DEP 310 CMR 15.211(1) [5], a variance has been granted at a regularly scheduled meeting of the Board of Health, held on November 20, 2014 for "Locating a system component or any part thereof beyond a property line of the facility, whether pursuant to an easement or otherwise, requires a variance issued in accordance with 310 CMR 15.410". The general purpose of this variance is to provide the homeowner access to service or repair an existing subsurface disposal system that services 724 Sharpners Pond Road, but currently lies within the boundaries of abutting property at 712 Sharpners Pond Road. Motion was as follows; Motion made by Dr. McMillan for a variance to allow an existing subsurface disposal system to be located outside of the property it services with the condition that the variance be recorded with the Register of Deeds and with the stipulation that any repair or replacement must comply with the laws and regulation at that time of that repair or replacement. This variance applies to the property located at 724 Sharpners Pond Rd. and its easement with 712 Sharpners Pond Rd. Motion seconded by Mr. Pease. All were in favor. TInkou, a er, /REHS Health Director Notary Public _.=QVIWV24 '"MUM r rJ =s 016r I -VEL? Expires Page 1 of 1 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 O, NORTH 1M . O Town of North Andover `'•�;, :o �:,' HEALTH DEPARTMENT ,SSACM15tt Q `� j CHECK _ . DATE: LOCATION: H/O NAME: CONTRACTOR NAME: 7018 Type of Permit or License: (Check box) ❑ Septic - Soil Testing ❑ 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 $ SEPTICSystems : ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector r"P�'Title $ 5 Report $� ❑ Other: (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Of NORTp 1� '; 7018 ° j°.. O ♦ •s Town of North Andover tHEALTH DEPARTMENT SACMUSt � V' CHECK #: D5 �0-- DATE: LOCATION: H/O NAME: UZZO CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ Title 5 Report $Uv ❑ Other. (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key 'Q ILEI Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 712 Sharpners Pond Road Property Address Michael Luzzo Owner's Name North Andover MA 01845 Cityrrown State Zip Code Inspection results must be submitted on this form. Inspection f way. Please see completeness checklist at the end of the form. RECEIVED � SEP 3 0 2014 TOWN OF NORTH ANDOVER" HEALTH DEPARTMENT 9/22/2014 Date of Inspection f not be altered in any RECEIVE A. General Information ` 4; g' 1014 1. Inspector: TOWN ur NUK I H ANDOVER Neil J. Bateson - HEALTH DEPARTMENT Name of Inspector Bateson Enterprises Inc. Company Name 111 Arailla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 S115 Telephone Number B. Certification License Number 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 ❑ Needs Further Evaluation by the Local Approving Authority 9/22/2014 Insecto Signat 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 1 -Title 5 VmClal Inspection Form: Subsurface Sewage Disposal System • Page 1 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 712 Shafpners Pond Road Property Address Michael Luzzo Owner's Name North Andover MA 01845 9/22/2014 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 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 712 Sharpners Pond Road Property Address Michael Luzzo Owners Name North Andover MA 01845 9/22/2014 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 712 Sharpners Pond Road Property Address Michael Luzzo Owners Name North Andover MA 01845 9/22/2014 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than'/ day flow t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts Q glo Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 712 Sharpners Pond Road Property Address Michael Luzzo Owner Owner's Name information is required for North Andover MA 01845 9/22/2014 every page. Cityrrown 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- 1 0,000g pd. ❑ ® 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 712 Sharpners Pond Road Property Address Michael Luzzo Owner's Name North Andover MA 01845 9/22/2014 City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 660 t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts a . I U Q2 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 712 Sharpners Pond Road Property Address Michael Luzzo Owner information is required for every page. Owner's Name North Andover Cityrrown D. System Information Description: State 01845 Zip Code 9/22/2014 Date of Inspection Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): 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: Gallons per day (gpd) ❑ Yes ® No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No On Well Water ❑ Yes ® No Current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 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 712 Sharpners Pond Road Property Address Michael Luzzo Owners Name North Andover MA 01845 9/22/2014 Citylrown State Zip Code Date of Inspection 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 last year, owner 1500 gallons Measured tank/ Inspect tank & baffles Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy /.1 E • ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3113 Title 5 official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 712 Sharpners Pond Road Property Address Michael Luzzo Owner Owners Name information is required for North Andover MA 01845 9/22/2014 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 19 years old, 6/19/1995, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4"PVc through floor, 3" PVc in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 3 feet ❑ 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'x 5' x 4' Sludge depth: 3" ❑ Yes ❑ No t5ins - 3113 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 712 Sharpners Pond Road Property Address Michael Luzzo Owner Owner's Name information is required for North Andover MA 01845 9/22/2014 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 baffle ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Center cover has riser 8" deep. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins • 3/13 Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 712 Sharpners Pond Road 9/22/2014 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: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 of 17 Property Address Michael Luzzo Owner Owner's Name information is required for North Andover MA 01845 every page. CityrFown State Zip Code 9/22/2014 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: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 712 Sharpners Pond Road Property Address Michael Luzzo Owner Owner's Name information is North Andover MA 01845 9/22/2014 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -box level & 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 712 Sharpners Pond Road Property Address Michael Luzzo Owner Owner's Name information is required for North Andover MA 01845 9/22/2014 every page. C4rFown State Zip Code D. System Information (cont.) Type: Date of Inspection ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 65' long ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 712 Sharpners Pond Road Property Address Michael Luzzo Owner information is required for every page. Owner's Name North Andover MA 01845 9/22/2014 CityrFown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,p 712 Sharpners Pond Road Property Address Michael Luzzo Owner Owners Name information is required for North Andover MA 01845 9/22/2014 every page. Citylrown 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 A' G t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 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 712 Sharpners Pond Road Property Address Michael Luzzo Owner's Name North Andover MA 01845 9/22/2014 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >4feet 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: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test pit data on design plan 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 712 Sharpners Pond Road Property Address Michael Luzzo Owners Name North Andover MA 01845 9/22/2014 Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 ti . Uommonwealth of Massachusetts OMMEMM City/Town of . System Pumping Record Form 4 DEP has provided this form for us&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 /6 Wig hous. ,Left /right side of house, LeftRight side of building, Left / Right front of building, Leftear of building, Under deck Address Cityrrown state Trp Code 2. System Owner. Name' Address (if d'dferent from location) citylrown ' r Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons ,. 3. Type of system: ❑ Cesspool(s) &Zeptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Y" a'No If, yes, was it cleaned? ❑ Yes ❑ No 'S. ConditiofSYstem: 6. System Pumped By: 7. Neil. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany contents were disposed: t5fomi4.doc 06/03 System Pumping Record • Page 1 of 1 of tAoRTTECOPY l� �SSACHl75�� North Andover Health Department Community Development Division October 2, 2014 Mitchell E. Weisman, Esquire Kajko, Weisman, Colasanti & Stein, LLP 430 Bedford Street, Suite 190 Lexington, MA 02420 Dear Attorney Weisman, - This correspondence is iri regard"s'to the properties onsite subsurface disposal systems located at 712 and 724 Sharpners Pond Road. As you are aware, the N. Andover Health Department was recently contacted by your client, Michael Luzzo, who is the owner of 712 Sharpners Pond Road. Subsequently to a conversation, a number of questions arose regarding these two properties, past changes of property ownerships and an easement for access to a septic system. This office appreciates the research you have conducted to clearly identify the outstanding issues that I will outline below, along with the anticipated action by the owners. Fact: As found on plan 40967-C "subdivision plan of land in North Andover, - 712 Sharpners Pond Road is comprised of 2 parcels; # 13 and #12. - 724 Sharpners Pond Road is comprised of 2 parcels; #11 and #14. - Parcel #12 contains the disposal system leaching area for # 724 according to health records. There exists a legal easement for the owner of 724 to maintain his subsurface disposal system as found on the quick claim deed recorded on 12-20-2012 at the Essex North Land Court Registry. Fact: The NA Health Department official files have information from the initial approval and installation of the 2 disposal systems. The files indicate only 2 parcels of land existed, and each dwelling's disposal system is shown on their parcel. The Health Department having reviewed this information, and consulted with the MA DEP wastewater division staff, has determined that the land swap transaction is invalid under MA DEP regulation as there -exists an inherited the lack of inspection(s). In addition, the Board of Health did not approve this easement or any other request regarding this condition. Violation Code reference; 310 CMR 15.211(1)[5] states the following: "Locating a system component or any part thereof beyond a property line of the facility, whether pursuant to an easement or otherwise, requires a variance issued in accordance with 310 CMR 15.410,...." Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 15.010. " (2) Prior to dividing a facility all existing systems shall be inspected in accordance with f 310 CMR 15.301(8). The division of a facility shall not be approved unless the Approving Authority has determined that the division will not put existing systems in noncompliance with the Title 5 and the applicant has demonstrated to the satisfaction .of the Approving Authority that the division of property will not prevent the upgrade of existing systems in accordance with Title 5. Failed systems shall be upgraded in accordance with 310 CMR 15.305. Existing systems shall be altered as required by the Approving Authority for each new facility divided out of the original facility. Prior to the division of a facility, any shared systems to be created as a result of the division shall comply with 310 CMR 15.290, and the owner(s) or operator(s) shall obtain a shared system approval if the system will serve more than one facility after division of the facility." Proposed Resolution: A variance request shall be submitted by the owner(s) of 724 Sharpners Pond Road and 712 Sharpners Pond Road, or their representative(s) on their behalf, requesting to be placed on the agenda of the next available Board of Health meeting. This shall be in writing, shall detail the situation that exists and request the relief from the code sections noted above. Please provide any and all pertinent documentation that is necessary for the board members to understand the situation, whether or not it has already been provided to, this_ office... You will be notified .of the. time and date _of .the meeting. A current Title V . . inspection, for each septic system, shall be part of the request package. The Title V inspection for 724 Sharpners Pond Road must include verification of the location of the field area. This criterion is specifically added, due to concerns over anecdotal discrepancies verbally given to the Health Director, regarding the Title V date 2010. It is not a regular criterion of the state inspection; therefore the Septic Inspector will have to be given specific directions. If the inspector has any questions, please contact the Health Department. Please feel free to contact the Health Department with any comments or questions. This situation must be addressed within 30 days or an Order Letter shall be issued by this office. Thank you for your cooperation in this important matter of public health. Sincerely r us Sawyer, S S 6' Public Health ecc Cc: Owner of 712 Sharpners Pond Road Owner of 724 Sharpners Pond Road Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 a. h U) CO W 0 0 Q J W U it . a i ' N Q �} O _o '(O .m .a J i M O O Y U U J m Z N LU OZ. Q N 00 NIM• 0 �C N Cl) Ca r e O O 00000 0--000 Zl0 �N o N Za o0 o 0-0 N.r- a p CN o ami i� 0 m °� `ui ov n 5 o ZZ OC v � \� mtLU t tYU50 O `� m ZvsQ `° u.c ZO a o O0 000 c p 0=tn �m v (� �} MN 20 Zorn oCL - •-aa.¢� F -IL pZ0 Cw F--ov N Z WN mm ? ® LU hiii o :, g �¢ =N aIL Z mTio� �^c a� foo w 0. 2 S? 0) C 'a iF (D o o o. W •- - o Q _ cn cn cn cn cD m mm� w H � •-� C� g �� N tll p N O a C ,- m o (� rnrn 0 o UH D as aH O � F- Z m D- ~O o �00 •-F-NN aN�oaN10 m �i�nX�-tA m� ZU1 04 IL a id id 0) d m m iu ul o 0 o <,a N C C U iTL -j CV m a)�= ¢ Cl) M a �zF-F- E raj 7 r (V N ¢ M "a .. ¢ y- -J'cvm 5 !-. QmLLM m'EfAUQQ N cooN 0)b V N V� Z --08 - a. o ro LL o m rn co co ¢ ¢ N '3 = C ad 0 LL c mm v o oo c Z 0 F- W LL ji y o avc o w �° 0 S�? lw= o v LL v �0 Z ^2�¢OF- OcLlo LL N LL 0) ? 0 N LL S i Q¢ W N U. Zi 0LO V Z m Z 0,Z 0. Ll, fA tli L LL M M•. U� LL E .,..z 7� co mU y W0W0 U 0wa NN W O LY ommmap C7o `m C7 c N V LY ? p N 7 /0 !C � t. jj F-mLLxumScu 2 0— N a w p a`�m¢ a n, 4�a Z �w ¢ N=m U t¢i0�> ¢UN Z _ N rn F'- O N L�U zm M LM Z u w e 2 m y o c a� F- � H W O¢¢ U) °o m m ai � aoi o Y co co 2 L xu.LLU c N F, 67 411A)lt.x) �...� 1•t/_.� tet' � C-� / ? / O 7 !2 •57 SUBDIVISION PLAN OF LAND IN NORTH ANDOVER Scott L. Giles, Surveyor 40.967' June 2, 1998 Subdivision of Lot 6 Shown on Plan 40967-8 Sh. 2 Filed with Cert. of Title No. 11905 North Registry District of Essex County Separate certificates of t/tle may be issued for land shown hereon as Lots 13 and 14 BY the Court . Il�} ��} ...... . . SEPT 11, 19,98 �1. ABH -0368 cuPy of Pod of Pim, 40967-c filed In — LAND R£6ISTR47I0N Off/CE SEPT. it, 1998 — Scale of th Pleol00 feet to W Louie A, me, Engtheer for�Gour� SUBDIVISION PLAN OF LAND IN NORTH ANDOVER Scott L. Giles, Surveyor 4 09 6 7 C June 2, 1998 z Subdivision of Lot 5 Shown on Plan 40967—B sh. 2 Filed with Cert. of Title No. 11905 North Registry District of Essex County Separate certificates of title may be issued for land shown hereon as ots 11 and 12 By the Court. ' 1 SEPT. 11, 1998 CO MH-02YJ Abutters are shown as on original decree Plan. Copy of of plan MNO REGISM77ON OMM SEPT. 11, 1998 �• Scale of this plop app feat to an fa Lola A core, of g&iear for Cor --I ) 6'"!" -7 Je G % N 0 w N N w i� Blackburn, Lisa From: Sawyer, Susan Sent: Thursday, October 02, 2014 11:49 AM To: Blackburn, Lisa Subject: FW: 712 & 724 Sharpeners Pond Road septic systems Attachments: 201409261219.pdf And Luzzo owner of 712 From: Luzzo, Michael A. [mailto:Michael.A.Luzzo(a)fmr.com] Sent: Tuesday, September 30, 2014 8:00 AM To: Sawyer, Susan Cc: 'merri624@hotmail.com' Subject: RE: 712 & 724 Sharpeners Pond Road septic systems Thanks for the update Susan. I do want to bring another related issue up to you so we can bring accurate closure to this matter. I am certain that the Title V documents that you forwarded me (I have attached) for the 724 Sharpners property sale in 2010 are incorrect. The D -Box that is depicted in the copy as being on my property is not located there. I know this because the septic company did not dig in my yard when they did the certification. I confirmed with my neighbor that the D -Box is located to the right of the risers that are shown on the sketch. In addition, the next page showing the "as -built" for lot 6 is actually my property and my "as -built". Obviously the company that did the certification did not accurately sketch the proper locations which leads me to believe that the leaching trenches are not entirely on my property. How do we correct this? We can discuss further when you hear back from the DEP today but in reality I have no idea where the leaching trenches are because the documents are incorrect. Can your office pull the proper documents for review (as -built, design plan, Title V) as they relate to the 724 Sharpners so we can resolve this properly? Either my wife or I can stop by the town hall on Thursday morning to review if that works. Talk to you soon. Michael From: Sawyer, Susan [mailto:ssawyer(a@townofnorthandover.com] Sent: Monday, September 29, 2014 4:56 PM. To: Luzzo, Michael A. Cc: Sharon Coskren (sharonc@andoverhomesales.com) Subject: 712 & 724 Sharpeners Pond Road septic systems Good evening, This message is a follow up to a conversation I just had with Michael, but rather than repeat myself, I am copying Sharon as well. Clearly, the legal portion of the easement, which you provided me, is in order and both parties understood the details of the land swap; unfortunately, one item was not considered. The section of the MA DEP Environmental Code requires that approval be sought in this case. (see below in red) I hope to receive guidance from MA DEP tomorrow, which will indicate whether the N. Andover Board of Health would be the approving authority in this case. If so, this could eliminate an application to the state. As soon as I have confirmation I will be able to give you more details. Basically the neighbor's property is not compliant with the DEP subsurface disposal regulations at this point. Once I clarify, I will put in writing to both addresses what is expected. 310 CMR 15.211(1)[5] states the following: "Locating a system component or any part thereof beyond a property line of the facility, whether pursuant to an easement or otherwise, requires a variance issued in accordance with 310 CMR 15.410, except that the placement of fill or grading material beyond the property line of the facility, pursuant to an easement or otherwise, shall not require a variance under 310 CMR 15.410." Thank you, Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com A- c Al /9 19 czwlft:.a �Nk ZA1 X30 • �7 �`�iyk au f - i3o �3z Q p X / N l 2�• 9.�.._� iia( r�c!f l.�CY B1 �N /1,r lz 9•fen, ' Doc:107.203 12-20--2012 2915 ctro z 16855 Essex Iioeth Land Court Resistrs When Recorded Return To. lndecomm GMW Seruloes 2026 CoS Patti, MSN 55117 QUITCLAIM DEED KNOW-ALL MEN BY E PRESENTS THAT: Michael Anthony Luzzo and Meredyth Ann Luzzo, husband and wife, as joint tenants, of North Andover, Essex County, MA ; for consideration paid of One and xx/100 ($1.00) Dollars, GRANT to Michael Anthony Luzzo and Meredyth Ann Luzzo, as Trustees of the Michael Anthony Luzzo and Meredyth Ann Luzzo Joint Living Trust, dated December 19, 2008 of 712 Sharpners Pond Road North Andover, MA 01845 With QUITCLAIM COVENANTS, the land in North Andover, Essex County, Massachusetts, being more particularly described as follows: Tax Id Number(s): 210/105.D-0183-0000.0 Land Situated in the City of North Andover in the County of Essex in the State of MA LOT 12 AND 13 ON LAND COURT PLAN NO. 409670, A COPY OF A PORTION OF WHICH PLAN 18 FILED WITH CERTIFIED OF TITLE NO. 11905. Certificate No. 16688 Being the same property conveyed to Michael. Anthony Luzzo and Meredyth Ann Luzzo, husband and wife, as joint tenants, by deed dated of record in Deed Instrument/Case No. in the County Clerk's Office. Commonly known as: x 712 Sharpness Pond Road, North Andover, MA 01845 Witness my hand and seal this 0 day of Aomlaw 2012. COMMONWEALTH OF MASSACHUSETTS ESSEX, ss On this P4 day of 4amlmi , 2012, before me, the undersigned notary public, personally appeared Michael Anthony Lu;Lzo and Meredyth Ann Luzzo, proved to me through satisfactory evidence of identification, which were driver's licenses, to be the persons whose names are signed on the preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated purpose. s�9irircQr. A Notary Pull Ic "04,j My commission expires 1-13-17 SANDYWILUAN NOTARY PUBLIC commonweehh oPMassachus m My Commission Expires on January 13, 2011 *u032421440 1632 11/27/2012 78189976/4 r w Dvc:107 v 243 12-20-2012 2 = 13 Ct r * x 16855 `" Essex Borth Land Court Registry Whets Recorded Return To. Indeoomm QWW SerWon 2WA Co3 PAW, MN 55117 QUITCLAIM DEED KNOW ALL MEN BY E PRESENTS THAT: 74_1'9 y �� Michael Anthony Luzzo and Meredyth Ann Luzzo, husband and wife, as joint tenants, of North Andover, Essex County, MA ;, for consideration- paid of One and XX/100 '($1.00) Dollars, GRANT to Michael Anthony Luzzo and Meredyth Ann Luzzo, as Trustees of the Michael Anthony Luzzo and Meredyth Ann Luzzo Joint Living Trust, dated December 19, 2008 of 712 Sharpners Pond Road. North Andover, MA 01845 With QUITCLAIM COVENANTS, the land in North Andover, Essex County, Massachusetts, bcing more particularly dcscribcd as follows: Tax Id Number(s): 210/105.D-0183-0000.0 Land Situated in the City of North Andover in the County of Essex in the State of MA LOT 12 AND 13 ON LAND COURT PLAN NO. 409670, A COPY OF A PORTION OF WHICH PLAN 18 FILED WITH CERTIFIED OF TITLE NO. 11905, Certificate No. 16688 Being the same property conveyed to Michael Anthony Luzzo and Meredyth Ann Luzzo, husband and wife, as joint tenants, by deed dated of record in .Deed Instrument/Case No. , in the County Clerk's Office. Commonly known as:,, 712 Sharpness Pond Road, North Andover, MA 01845 V Witness my hand and seal this 84 day of Aba-Mbv 2012. COMMONWEALTH OF MASSACHUSETTS ESSEX; ss On this ,10 day of A&m6z ; 2012, before me, the undersigned notary public, personally appeared Michael Anthony Luzzo and Meredyth Ann Luzzo, proved to me through satisfactory evidence of identification, which were. driver's licenses; to be the persons whose names are signed on the. preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated purpose. Notary Pu licr>/�r j s� � My commission expires /--/3 •uO3242144* 1632 11/2712912 78189976/4 SANOYWILLIAMS VARY PUILIC Comm Omveahh OFMNUChUKtts My COmmib7fOn EXPIM on Janubly 13, 2017 N w tll 4/ �l SUBDIVISION PLAN OF LAND IN NORTH ANDOVER Scott L. Giles, Surveyor 409674? June 2, 1998 Subdivision of Lot 6 Shown on Plan 40967-B Sh. 2 Filed with Cert, of Title No. 11905 North Registry District of Essex County Separate certificates of title may be issued for land shown hereon as �Lots 13 and 14 By the Court. � Imo: •'• .,/�.�.. SEPT 11, 1998 a or r ABN -0368 aV P,1 4o9s� c MND RECIMMON OnWE SEPT. 11, 1998��+ $ode of th/9phml �t aan_.Ndr ioeM A Mose 6bW( A O M 0 O CO) N'COZ o WO KMX. w no U ' M:3 =o �z v =n..m a� Z 3 w Cil .moi. 00 ooy< r a�W> NWZ Ta — WZ 0 0 O r � aa� V N 00 00 N _N 4 N OD W O O 00 Z WMM Nr NB063 � �0=EFF � m tnw m S r- ?�43 i3 y m .i `o o vn0m -fc>c� Z o � a 9@ A a 3 av v -i �. o ORCL- :$ _13 CL -3 O Q M 3 0 W W 3 D 3>= = a 2r@ D (D mw' w.0 m .n m w w 0 o Z m ccr h N'COZ 3O MM v L Z "v � m o -' m 00 a tJl �D N = D (A b N rn w v_ To n 0' v CL Z C O Z WC c)- w .000 o ci c S� ig am Z J i >v0 CA 11 z �X y N ZZ rr 0 po ..� CL O CA 'UZ N w� °'z O IDM y 0 N n 01 N m n? ? u D MM M L Z P Q N0D >i fp N o m� ZZ� N o Xm� b 0M c - ZOO Zvo w o vim _ n b0 Dp�r O o v�Nz o .Q cn Z b r O 0 O FOM95 --1 W cow 0 a CD Q 3 >> m n i v � (D 0 too c �p Opo `D A) N Cj O i 00 �OD N[ D m -4 ;a �wwwm 0) N pi _ ._, — F (p n CL 3 fD N M M 0 o <p� M Q � — X3 r 006 aM D 3 0 0 9'U r> -v M c Q 13 _o y N � N a M oao(DXmm Z ' o aC3""a0 m cn pp� o Z 000006 p 000006 Q 0 0 0 V 0 W N N O rr �O 0 0 A Commonwealth of Massachusetts r City/Town of ' w System Pumping Record SEP_ 2 3 2013 Form 4 I TOWS! OF NORTH MOOVER � L -HEALTH DEPART;o::�!T DEP has provided this form for us&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 / ig t 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 Cityrrown 2. System Owner. Name Address (if different from location) state Lu-2'�>—p Zip Code City/Town Stat , rde "� E7 Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date 2. Quantity Pumped: Gallons Cesspool(s) eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No: 5. Condition of.System�� \ V fpt�` j1� j_ A 6. System Pumped By. Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Lo ere contents were disposed: Lowell Waste Water t5form4.doc• 06/03 Date System Pumping Record • Page 1 of 1 Sawyer, Susan From: Sawyer, Susan Sent: Wednesday, April 03, 2013 9:44 AM To: Kevin Murphy Subject: 712 Sharpners Road Hi Kevin, I am out in the field a lot today, but in answer to your question. We need the proposed construction on a scaled plan. So either it can go on the as -built to scale or on the scaled drawing for construction. Showing the distances to the components. Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Bldg, 20, Unit 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawverCa)townofnorthandover.com Web www.TownofNorthAndover.com FORM U - LOT RELEASE FORM RUCTIONS: This form is used to verify that all necessary approvals/permits from [rds and Departments having jurisdiction have been obtained. This does not relieve applicant and/or landowner from compliance with any applicable or requirements. �************APPLICANT FILLS OUT THIS SECTION APPLICANTS hne,� .1 1 PHONE LOCATION: Assessor's Map Number. SUBDIVISION IL �-,� \ STREET ���Y.iCS-�'�--- PARCEL LOT (S) ST. NUMBER I D *************OFFICIAL USE ONLY*********************************** RECOM DATIONS OF TOWN AGENTS: /I -A CONSERVATION ADMIN!§TRATdR DATE APPROVED 5� DATE REJECTED-—T–T— COMMENTS TOWN PLANNER DATE 4PPROVED DATE REJECTED COMMENTS R -HEALTH DATE APPROVED DATE REJECTED ,91�PTIC INSPECTOR -HEALTH DATE APPROVED _S/A/g"' T DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Commonwealth of Massachusetts REC191VED City/Town of .° System Pumping Record APR ?4. NQ Form 4 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 ht rear 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 City/Town State Zip Code 2. System Owner: L Name Address (if different from location) City/Town Stati Code a Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date 2. Quantity Pumped Cesspool(s) Q Sep ict Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes D-90- If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of ystem: O - " 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company t'O�A � V'\ 4c;(�"� 7. Location 7erecontents were disposed: Lowell Waste Water F5821 Vehicle License Number Date ('6 - t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 TRAHSMISSION 'VERIFICATION REPORT TIME 011'291'2008 08:37 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE. TIME 01129 08:.36 FA".'NO.!H44E 89784755451 DURATION 00: 00: 22 PAGE(S) 0'2 RESULT O4 MODE STANDARD ECM North Andover Niealth Department 1600 Osgood Street Building 20, Suite 236 North Andover, NIA 41845 978.688.9540 - Phone 978.688.8476 — Faux heaithdetowno•Fncktkitundover.EokI - E-mail www.tawnofnorthandoverfrom - Website TO: a COMPANY: Phone: Fax: Letter of Transmittal of TE: 1/69 FROM: RE: 0 We are sendiog yore: C7 Copy of L ver O glans L7 Other lfill 6n below) These are transmitted as checked below: VqLs- f6 V QO 0 �' p T F y y Y Health Dopartment Assistant ON 0*pvved �, Qrbr4a and C%hn6* W*kr � i- �farwr�mrem�r�t � ;�' CJAsIu�i�aP Gl�arYo�rUs % IJ,Sirt a►forn�st. North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — fax healthdept(&-townofnorthandover.com - E-mail www.townofnorthandover.com - Website Letter of Transmittal Page--/ of 4 NORTH °� O4 COCMICMIWNM y1' �.A A�R�1TE D PPp i•�y/ T0: „ ` (-+J DATE: COMPANY: FROM: Pamela DelleChiaie, Health Department Assistant Phone: • �C7 (/" �� RE: Fax: COPY TO: We are sending you: O Copy of Letter O Plans O Other tfill in below) These are transmitted as checked below: ➢ O,Qotaovad ➢ Raul ➢ a,&R*&W ➢ OFor, Amwd ➢ O%rRe4%y BdLq/I vff ➢ Oforrowaa ➢ L7&svbn* mpiesfor ➢ asuAnrt q*sfar&t. REMARKS: COPY TO: COPY TO: SIGNED: COPY TO: TOWN OF .-v• �4do �'Cc SYSTEM PUMPING RECORD DATE: S' L , "L3 SYSTEM OWNER & ADDRESS V'JQ C5 �C)vlj - s6f vi -C SYSTEM LOCATION (example: left front of house) �t#- �3 a� 0 ko us -c— ; 06/;19/1995 11:59 508-7943571-123 Maln Office 1 Laboratory 22 Manchester Fid. / Rt. 28 Derry, NH 03058 (603) 432.5044 ANDREI)J MAURIC.E BL)rRS PAGE 03 &tAtt i At: Tramway Marketplace Route 18 4 2S Wast Oeslpee, NH 03890 11.600.899.9920 Certtifirat.e of Anal"sxs SENT TO; Andrew & Maurice Bldrs, i far Prlhtki4 TEST N�.; SAMPLE''! LOCAT16N: Water 18985 Lot 6 Sharpners Pd 712 Sharpners .Pnnd DATE & TIME SAMPLED; 06/15/95 1 No. Andover, MA r" EPA ! PARAMETER RESULT RECOMMENDED (PPM) MAX.LEWEL(PPM) --------- PH ------------i------- UNITS 6.5 - 0.5 UNITS HARDNESS 150 CHLORIDE 250 NITRATE 10.0 NITRITE 1.0 SODIUM 250 IRON 0.3 MANGANESE 0.05 COLIFORM ABSENCE /100 ML ABSENCE /100 ML OTHER BACTERIA /100 ML 200 /100 ML COPPER 1.3 ARSENIC 0.05 LEAD 0.015 CHROMIUM 0.1 CALCIUM NONE SET FLUORIDE 2.0 COLOR CPU 15 GPU' ODOR TON 3 TON TURBIDITY NTU 5 NTU HYDROGEN SULFIDE DONE SET (XXX) THE TESTED PARAMETERS MEET CURRENT EPA STANDARDS FOR DRINKING WATER. ( ) ----------- THE TESTED PARAMETERS MEET CURRENT EPA PFIMARY STANDARDS FOR DRINKING WATER, BUT SOME SECONDARY PARAMEiTERS EXCEED STANDARDS. ---------- ( ) THE TESTED PARAMETERS FAIL CURRENT EPA STANDARDS FOR DRINKING WATER DUE TO PRIMARY STANDARDS OUTSIDE OF LIMITS. --- --- -------------------------------------------------------J--------------------------- COMMENTS; --------------------------------------------------------------- ------------------- ----- t LESS THAN OUR LOWEST CALIBRATION POINT > GREATER THAN OUR HIGHEST CALIBRATION POI9T TNTC TOO NUMEROUS TO COUNT 1 FLAGS PARAMETERS THAT EXCEED PRIMARY STANDARDS; CAUSES TEST FAILURE. 2 FLAGS PARAMETERS THAT EXCEED SECONDARY glIANDARDS; DOES NOT FAIL TEST NOTE; SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAy rainy Authorized t r" System Owner Commonwealth of Massachusetts ` Massachusetts System Pumping Record System Location SoN.I� `Iia �^�ners Date of Pumping: ��—a 1— 98 Cesspool: No LYes Ll Quantity Pumped: �� gallons Septic Tank: No LJ Yes 14 ' System Pumped by: Farejea 514MA ma License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: TOWN OF NORTH ANDOVERNORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845SACMUgt� 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.9542 — FAX Public Health Director E-MAIL: healthdeptotownofnorthandover.com WEBSITE: hq://www.townofiiorthandover.com April 11, 2005 To all Shameners Pond Road Residents: Please note that it has come to the attention of the Health Department that many residents are leaving their trash barrels and trash bags out at the curbside for days, or weeks at a time. Empty trash barrels blowing about in the road are a safety hazard, and trash and debris along the roadway is a health hazard. Please be mindful of this, as the Health Department will conduct periodic inspections of the area to determine who is in violation, and fines will be issued if protocol is not followed. The Board of Health follows the State Sanitary Code regarding Human Habitation, 105.CMR.410, Section 1: 410.600 (A): Garbage or mixed garbage and rubbish shall be stored in watertight receptacles with tight- fitting covers. Said receptacles and covers shall be of metal or other durable, rodent -proof material. Rubbish shall be stored in receptacles of metal or other durable, rodent -proof material. Garbage and rubbish shall be put out for collection no earlier than the day of collection. (B): Plastic bags shall be used to store garbage or mixed rubbish and garbage only if used as a liner in watertight receptacles with tight -fitting covers as required in 105 CMR 410.600(A), provided that the plastic bags may be put out for collection except in those places where such practice is prohibited by local rule or ordinance or except in those cases where the Department of Public Health determines that such practice constitutes a health problem. For purposes of the preceding sentence in making its determination the Department shall consider, among other things, evidence of strewn garbage, torn garbage bags, or evidence of rodents. 410.602 (A) Land. The owner of any parcel of land, vacant or otherwise, shall be responsible for maintaining such parcel of land in a clean and sanitary condition and free from garbage, rubbish or other refuse. The owner of such parcel of land shall correct any condition caused by or on such parcel or its appurtenance which affects the health or safety, and well-being of the occupants of any dwelling or of the general public. (D) Common Areas. The owner of any dwelling abutting a private passageway or right-of-way owned or used in common with other dwellings or which the owner or occupants under his control have the right to use or are in fact using shall be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth or causes of sickness that part of the passageway or right-of-way which abuts his property and which he or the occupants under his control have the right to use, or are in fact using, or which he owns. j Residents should know the following: The Town has a mandatory paper and cardboard recycling ordinance that requires residents to separate these items from their household trash. Paper and cardboard are collected every other week on the same day as the household's normal trash. Residents can call the DPW at 978.685.0950 to get their recycling schedule. • 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. Sincerev an Y. Sawyer, REHS/RS Public Health Director File ,C'\ Commonwealth of Massachusetts = City/Town of\j System Pumping Record Form 4 M 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: Le i 44A Right side of house, Left front of house, Right front of house, Left rear of hou , i�t rear of eft rear of building. Right rear of building. Address City/Town (- State Zip Code 2. System Owner: Lu Name Address (if different from location) City/Town State a a ,, ! l ^"zip Code D Telephone Number B. Pumping Record `3 1. Date of Pumping . Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition �y t 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locateshere contents were disposed: DJ i � Lowell Waste Water of Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 _C_\ Commonwealth of Massachusetts - - ro City/Town .of NECEIVED System Pumping Record Form 4 SIR , 6 2091 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other form T 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 front of house, right front of house, left side of house, right side of house, Left rear of house, right rear of house, left side of building, right rear of building, under deck. k �- Ski e ASS Qck pj\,I*A, City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Sta1r 51&__GC Zip ode Telephone Number 4 ( Date 2. Quantity Pumped: Cesspool(s) -�3Sep Ict Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes No J If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of1Sysau w_� � V �-- 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. Locatbawhere contents were disposed: L. S. D. of F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record •Page 1 of 1 .tiw:_ ♦. Tr �.I,�i�c�,�� tiff' .�. 41e...,. .? ti,._a.��� �.. A, �... `l ,�' ,. ' GL I lit I ' i i I / I ��``% t� Gam- I C✓� i' j i i i I:s��' Vi i' i c I �d icv lig l j l l l i Il % i I I j I✓ � i i iZ i ^�' i / i I I i I''jl lj jMH H, �I , �j/� � I II i II �jl Ijl ; II .tiw:_ ♦. Tr �.I,�i�c�,�� tiff' .�. 41e...,. .? ti,._a.��� �.. A, �... `l ,�' ,. ' 11 N. lJO C U1.)06-0 7119lq-3 —5 ii -19t PIV&,P- s ?b k � 13 /-? 6 4 C, C- 3 /Q o P 'o-'3 40 1-;2 ZeD PITS MIN 660 LEACHING MIN 1 (131x16') PIT C-,� MANHOLE/PIT t/ GW MIN 4' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 601) MIN 13' X 16' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS MIN 660 GPD 900 ft2 BED PERC RATE FASTER THAN 20M/IN GW MIN 4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 4" PEA STONE? DIST LINE SLOPE .005? >3'COVER-VENT SCH 40 MIN 12" COVER RATE LDG X 660 = = TOTAL ft2/G REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY gpm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME gpm MANHOLES TO GRADE inlet) HWL OP. SWITCH Copyright m 1993 by S.L. Start ALARM SEP. CIRC. GW (Min. 1' below LWL CHECK VALVE BLEEDER HOLE MANUAL #- �h PLAN REVIEW CHECKLIST ADDRESS-/ �j �`�. �� ENGINEER. GENERAL 3 COPIES �� STAMP LOCUS o� NORTH ARROW SCALE CONTOURS PROFILE �l SECTION °' BENCHMARK ` SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER -4 WELLS & WETLANDS WATERSHED?,4/0 DRIVEWAY)jL(Elev) WATER LINE FDN DRAIN SCH40 TESTS CURRENT? /q 9J SEPTIC TANK MIN 1500G t-"'� .17 INVERT DROP GARB. GRINDER NC) (+200% EDF) 25' TO CELLAR �,. MANHOLE TO GRADE — ELEV GW D -BOX SIZE # LINES 5 FIRST 2' LEVEL STATEMENT INLET 133.67 -'OUTLET 1,53._ 17 ( 2" OR .17 FT) TEE REQ' D? NO LEACHING 1 MIN 660 GPD? RESERVE AREA 4' FROM PRIMARY? 2% SLOPE 100' TO WETLANDS,/ 100' TO WELLS t"'�4' TO S.H.GW 35' TO FND & INTRCPTR DRAINSy 325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER 41FILL? (25' if above natural elev; 101if below) BREAKOUT MET. TRENCHES MIN 660 gpd SLOPE (min .005 or 611/1001) >31COVER?-VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61) IS RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? BOT X LDNG + SIDE X LDNG = TOT (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) Copyright © 1993 by S.L. Starr PITS MIN 660 LEACHING MIN 1 (131x16') PIT MANHOLE/PIT GW MIN 4' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 601) MIN 13' X 16' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS MIN 660 GPD 900 ft2 BED PERC RATE FASTER THAN 20M/IN GW MIN 4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 4" PEA STONE? DIST LINE SLOPE .005? >31COVER-VENT SCH 40 MIN 12" COVER RATE LDG X 660 = = TOTAL ft2/G REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = L W D Vol. DISCHARGE SIZE DISCHARGE RATE MANHOLES TO GRADE inlet) HWL OP. SWITCH Copyright © 1993 by S.L. Start ALARM SEP. CIRC. LWL CHECK VALVE PUMP CAPACITY gpm G1= DISCHARGE TIME GW (Min. 1' below BLEEDER HOLE MANUAL M r-♦ s: -OT -6 >7 y O J m O co :�/ .3.► O � Z OO y LOQ cs A��� .CCyO.,� m ro— �maW� r4 .. c a. W ci o OR !� E s o r:�rm NCO $ cm N :mc c.:.. E l m m Ali O N N H mm3 Cl O N a - m ' N O O E " � m omc r t o a► c .p v c :oa N _ ' C' C m m C t' V H O Cl•�Z O F- C a � fymc N = O m C * O H O F— o y .. c LOS Cr `� 5 Z OCLU O 'r m .y O C.3 •o m C y C W.- 0:5 H s «c. `Ci. rm (D 0 w m 0 c W W LL W Q 0 O O crO Z 0 v H H co L co s O CD V _m W N O V .CL y C 0 cc .0 cc H O OO 0 U x v �L� / �G )OR, ° U ►� �'a ° w° cid i -OT -6 >7 y O J m O co :�/ .3.► O � Z OO y LOQ cs A��� .CCyO.,� m ro— �maW� r4 .. c a. W ci o OR !� E s o r:�rm NCO $ cm N :mc c.:.. E l m m Ali O N N H mm3 Cl O N a - m ' N O O E " � m omc r t o a► c .p v c :oa N _ ' C' C m m C t' V H O Cl•�Z O F- C a � fymc N = O m C * O H O F— o y .. c LOS Cr `� 5 Z OCLU O 'r m .y O C.3 •o m C y C W.- 0:5 H s «c. `Ci. rm (D 0 w m 0 c W W LL W Q 0 O O crO Z 0 v H H co L co s O CD V _m W N O V .CL y C 0 cc .0 cc H 1 1-07-1:14 i=?' 46,PM i ` 71 #1 66 LIr7LET oN ROAp17 WESTFORp, MA 018$5 (5'?8; 692 8395 FAX (508) 692.0023 1.800-649•tEST y Report Number: C-13869 Cli+ont: Rgport este; NOVG Gr 4, 1994 00ple Taken At r S.M. Young Artasittn 'dell 36 Pelham Rd. Morris & Caruso Salem Na 03079 Lot 6 Sharponers pond Rd. N. Andover,Mess. Samgl" raker. ayr Young 5taeff n 4n: NOVet bOr 31 1994 r 4 CERTIrICATE ve 1iNAZ,YSTB _ Q rSe^^. PAR&%MTSK t ETR. Max RESULTS UNITS Total Coliform () Calcium � 0 0 Per i00m1 COPPor (8) No Limit 39 Iron (a) 1.3 0.03 mq ala v.3 mg/L i Magno@item X0.01 ng/y Mangano&@ (B) No Limit 3.5 f 0.05 <0.01 mq%L Sodiummq/L Poteesium (S) 20 8.3 i Alkalinity (a) No Limit 2.4 �tg/L � 1�:nmor:fa No Limit Y 45 t O Limit Mg/,L.1, Chloride (s) <0.03 rig /L Chlorine (total atilt S 250 46 mg/L Calor 8 FeC. r0.02 ( ) 15 mg/L conductivity 0 CPU Ha►rdnesa tae Limit 265 umhoo/cm j Nitravea(aa ,�) ( ) No Limit } 1p 0.57 mg�L rritrites(ae N) mg/L PH (a) <0.01 mg/L # odor (s) 6.5w8 . S 6.8 9,r Sulphates (S) 3 0 TON Turbidity 250 11.1 Sediment 5 0.17 mglL � pcss /nay c:eq NTu NT -Nat Tested #•.d7aluea XxoGods EPA STD, TNTC -Too Numerous t **Background 8acteri.s Noted r o Count '�EXC®edo EPA Advisory Limit } FPA Advisory Littsit (P)&primary EPA standard aesth®tics of drinkingw r @. tastea. tajtx EpA Star:dard (play affect atez +., color, etc!) x f I This wator sample, as tested ' MeetH Or eXcesds EPA health for the parameters listed above. standards �'he duelisi+ of this water is t accepted AS PpTABLE according to EPA Standards. f Massachusotts state Certified TOsting Laboratory M ahael P. Carlson, for y y MAo48 Thorstansen Labor4tory Inc. r 4 y NUMBER FEE 415 THE COMMONWEALTH OF MASSACHUSETTS $25.00 TownNorth Andover --------------------- of............................................................... I ............. This is to Certify that ... E E. M Young Artesian Well Co. .................................................. NAME ........... 3.6___ Pe lham Road, Salem,N ". ADDRESS IS HEREBY GRANTED A LICENSE For ...---.to drill a well at Lot _6 Sharpner' s Pond Road ........-------------•••------------------- ------ North__Andover MA ..........1................................................................................................................... .................................•---•.---.._...--.................._..._......_......._......__........._...................._..--_............_..........._.__.--.__...-_. ............................................................................................................................................................................ This license is granted in conformity with the Statutes and ordinances relating thereto, and December 31, 1994 expires ---•---- unless sooner sup de or revok a- /.--- - .---•--- ....... �.! --- --------- /- � [ . .... -----• November 2, 914 / A-11 -------------------------------------------------------- 19 .--.... ... ........... ................. - ... ._. .. _. .. .. .. ........... .... ......................... . ... ... ........ ..................... FORM 433 HOBBS & WARREN. INC. t NORTH r°. 40 oz. F 9 ,SSACHUSE Applicant Site Locat Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 3 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted to Construct ("I or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. Fee C� t 121LA� CHAIRMAN, BOARD OF HEALTH D.W.C. No. /1)./ -� r' r. ..{. :k\:, 1. r<�• JS'Ci7"'�.qti`�//qtr , y�yjlwt \�'F�t.yt� 'i ti'a `ati`V S. \'.-•'� ��tn ', ..—'�, 4�Z�f }•hl ����SY2��ti r\4'� 4i �Z,1 ��,22 r�- 6 11 Z'% � . -�. �. 1 ,t '� :� .'V.� '.^LU a Z !? a ��\ d a. � T ar � .� , r� t. �.k1 t .. � - �,!.,ak*' ♦ Vr r� t V t =a � `', v- \ .r..`��all}.4 :f,L� r�.'r:i :.a2a,Rt Z ..Y 1�`yl..l:.. .y\�•r�Rpa` ?a.t 4+ac., n# -T. i+.} •f" �-t a !, '. , - t �•i'ti �ilt'"`r. ' t\ 'e'�vk� t• �;T.Vj !� a.�����', *:'tty,� 1. ,.-tomtit 1r�ti�- -. C' tk a �- f .; i a� y � � t � r � �•i,• <�'�A� ii Z'Ta]i. ` y � Y.. ..1: 4 T w .�i�♦1 . � �0_?�� L� a:' (,� r b i 1, C '- `•� `� � � t fii, � -t � \ c ya 1 a., �. sYa1�� le,��.,llti �. 51 ;• ! '2 Zi,.IL .!['�.` Y.` 4r.. �a ..JL4 {., t t L ti3t - iC `TtN.k ,.`c f a`E , a 4 . �- i. rKs.,�lci7. ii2'cd�i�'.:41A �alaa4_. jV8 wit ate?^��1X•�a V.LKii `�!Lvt.Lat. rT �o \ .-,4..1..lce.+ �1�:`.;.eiY..�sti�4�! tn�ii �'1. �k�;: T4: a. �.l�v�. �E.\ . ; \rael . t=SS°...P ., , . •t j..',; 1 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 landowner from compliance with any applicable .local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: ANDRE✓ ;� MpvnIC_E Phone 794/-35'1 LOCATION: Assessor's Map Number Parcel Subdivision Foam A LoT-, Lots) t1l, Street St. Number 7/2 - ************************Official Use only************************ RECOMMENDATIONS OF TOWN AGENTS: P. r. . Conservation Administrator Comments I<g_�►.r�o Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments i Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections - driveway permit Fire Department, /.�%'— liter- Received by Building Inspectdr Date PLAN REVIEW CHECKLI'ST' 6060 ¢) ADDRESSLpT �, 5{�ARPNS %� ENGINEER GENERAL i 3 COPIES / STAMP / LOCUS CONTOURS Li'PROFILE �'� SECTIOl PERC INFO ELEVATIONS W} WETLANDS 1/' WATERSHED?,66t- DRIVI111% FDN DRAIN f SCH4 0 TESTS SEPTIC TANK MIN 1500G t/ . 17 INVERT DROP t/ Y 1 25' TO CELLAR ✓ MANHOLE TO GRAD "w C D-BOX , �O NO (� SIZE # LINES 5Hkl f _ INLET a - OUTLET = / LEACHING MIN 660 GPD? RESERVE AREA L1�4' 100' TO WETLANDS �00' TO WELLS 35' TO FND & INTRCPTR DRAINS 325 4' PERM. SOIL BELOW FACILITY MI if above natural el ; 10'if belo ) BREAKOUT MET? TRENCHES MIN 660 gpd - SLOPE (min .005 or 6"/1001) 1,�3'COVER?-VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 6') �% IS RESERVE BETWEEN TRENCHES? t/ IN FILL?_tZ""' MUST BE 10' MIN.tf 4" PEA STONE? BOT Of 2) X LDNGj�J4 + SIDE k3�-o X LDNG Z6= TOT _ /,3,� (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) Copyright 1993 by S.L. Starr / Town of ?north Andover,ilass. P e r Ti i t r- -- Da t o �) -. 9 APPLICATION FOR 1 -?ELL & PUMP PERMIT Application is hereby made for permit to drill a well (J. Application -s made to install ( ) a pump system. Location: Address P,,z_Z -i��'. C .C.��� a��'Lot _/;dc;ress - --e/ /-3-;:7 [?ell Contractor �4 • � — Address -?4 /1'e - Tel Pump Contractor Address Tel: -.-- l' EU CON'1RACTOR (To be completed at time of pump test) Type of !•?ell Well used for Diameter of VIell �, Size of Casing i Depth of Bed Rock.---------------- -- —Depth casing into Ped Rock Iti'as Seal Tested? Yes (-) No (_) Date of Testing Depth of t,�ell _ _ -_ - _ - _V?ell Ended in What Material Depth to 1?ager _- --Delivers - -Gals . Per Min. for 4 h _urs Drawdown -feet after pumping hours at GPM Date of Completion Si �nai-e — X11 Contractor HJIMP INSTALLER (To be filled-i.n )(,fore i.nstallation)- Size & ;'ame Pump _--- Pump Type Used !•'ater Pump Delivers. GPM Size of Tank Pipe !•',rit-(-rial. Used in !,'ell: C:isr iron(-) ani.<;cd ( ) plastic ( ) l'el.l Pit (_) or Pi Hess Adapter. ( ) !%'as sleeve used to protect pipe? .Yes (-) NO(_-) Type or ;t'a,ne ,•;ell Seal 7jat-e J? l jl 11 5.t?1.�.�-r Date 1•?ater analysis report sulhmitted to Board of health Date rel ease given to owner of rr'cord & BI c1g. Tnsp llealth Inspector - --- r+ - NORTq ,ssACHUS Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 19 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Reference Plans and Si NE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee CHAIRMAN, BOARD OF HEALTH Site System Permit No. & 4 , a� 1 iiI�X�tt\t �b. Stitt �,� Y� \._�`�4 � , t ..� ,- •\ t .\.: ,'1 t � _ �.. � • _� Ml _ U 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext23 May 12, 1994 Joe Barbagallo 1 Westward Circle North Reading, MA Re: Lot #6 Sharpner's Road Dear Joe: This is to inform you that the proposed plans for site referenced above have been disapproved for the following reasons: 1) Elevations on profile incorrect. 2) No final grading shown. 3) No wetlands disclaimer. 4) Perc done at 127.02 - this is bottom of system. 5) North arrow missing. 6) Insufficient leaching area. If you have any questions, please do not hesitate to call the Board of Health Office at the number above. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp DATE _ I JAV 6 Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEED ao / PERMIT # lt1 � DATE RECEIVED APPLICANT 7f ASSESSOR'S MAP ADDRESS ENGINEER J. ADDRESS PARCEL # LOT # STREET 51419kPVM `s Pb P..N PLAN DATE REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED 111 D % TO Po . 5,C, 1Q.1 /MI6 k 7-A l M /5511L)6 mak/ v&cJr� y 7- A-1 No?" Town of North Andover, Massachusetts NORTH • BOARD OF HEALTH ?QED ib 6,YO Applicant Site Location APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 19G Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time S Fee CHAIRMAN, BOARD OF HEALTH �. Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. DATE Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER c�// SUBSURFACE DISPOSAL DESIGN REVIEW FEE PERMIT # DATE RECEIVED APPLICANT 2 02C-y�e12Lr'1 7;?- ASSESSOR'S MAP ADDRESS ENGINEER ADDRESS PLAN DATE CONDITIONS OF APPROVAL: APPROVED PARCEL t_ LOT # _L� 4 ) STREET 51-IPRpNC,eS -'D R REVISION DATE DISAPPROVED / , CGS V/9 T/ON,S O N }�iPQ % /��" /NG O/Z •� G� 2_ NO FIA W I- 6 h P D I V G �3, No Wer6191vps .4, -pE,eC aoAv&- 6 �:, /l�02T .92.2ocJ M1s61N6.