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Miscellaneous - 72 PHEASANT BROOK ROAD 4/30/2018
I MAD PARCEL # STREETS _c �OIVSTRUCTIO.IV_A,PPROVAL, HAS PLAN REVIEW FEE .BEEN PAID? YES NO PLAN APPROVAL: DATE 11 A P. DESIGNER:�"gW67-1,9t15-u-J- 5 ",� / PLAN DATE. CONDITIONS WATER SUPPL WELL PERMIT WELL TESTS; COMMENTS: CHEMI.CAL BACTERIA WELL DRILLER.__ DAZE APPROVED DA I E (IPPRUVED BACTERIA II --1 DATE APPROVED FORM U APPROVAL: ©/ APPROVAL TO ISSUE YE5 NO DATE ISSUED (Q/�A=" BY 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 DATE• BY: _ " r *+ "� - - �z's9 z7►_L`•i.Z��.N_`•iIC1��� `•CLQ . X.' •moi. 1 � f. ',• 1 1 r-; J =--'��.•."i, :i �,�. } A ; `�1 \ ! ` �'- ( } }'.'.. �..' +tx. IS "THE' INSTALLER LICENSED?-:--',-': YES NO TYPE. OF- CONSTRUCTION: ? NEW REPAIR. NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW. YES NO CONDITIONS . OF..APPROVAL YES NO (FROM FORM U) l SSUANCE OF DWC PERMIT ' • - YES • - NO ..- :,: I• INSTALLER: DWC PERMIT N0. - BEGIN INSPECTION YES No: ... , �:t :.: EXCAVATION . INSPECTION: ; NEEDED: — PASSED � * - BY y - :CONSTRUCTION INSPECTION: NEEDED: ® Z,a f� G%' �- �'H t' .. AS BUILT PLAN SATISFACTG,RYa YES: '' •"; - AIV ` APPROVAL TO BACKFILL: ' DATE: tFINAL.GRADING APPROVAL: DATE BY,. .FINAL CONSTRUCTION APPROVAL: DATE: �) BY a 31 � fi y� .. 11'•.1,'••,- ;` -. U -A rt iYSTfM�I5OUs5 rowrr 0r Noy -I ►, ,,�N Lh.:,� . JYs'T m PUMPINU R cc)KI... 3POOL; NO.. Y43,. rvKl� GN KOV'rlrre '-----._ _..._.._.._..... _ i i Uts4ttA yA'nUma. 0000 COHOI'rUN VUL [Ij Cc) rx �YY OAB,•�,ga ,� �rV'Y1,83 IN Ntrn�.� Kom 6 c&98I1re SOLID�.^. �t.00m CAruY . A ONER EXPLAIN >y14rn�acJ by �� �'UmmeNr�. IVED OCT 0 7 2005 LURTHANDOVER H:Z"' (H DEPARTMENT 7 FILE #1\(A r)d 11 71 G 8 ' i V RECEIVED `..._ NOV 14 2016 Ery j {j TOWN OF NORTH ANDOVER f TITLE VV INSPECTION HEALTH DEPARTMENT vi -� Dean G. Luscomb lI & Sons "{ P.O. Box 135 M Middleton, MA 01949 978-774-4065 Licensed Plumber # 20285 F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r� PROPERTY OWNERS NAME j e Po o r - PROPERTY ADDRESS 9 a Ph 2 Q j a n -f f3r p 0 f-- kcl N, A nd ove-r DATE OF INSPECTION 1\fp V e rn b q r _--w----- -- - --`�" NAME OFy INSPECTOR D e- Q h G. L L[ 5 C -0 -no b QUALITY IS NUMBER ONE TO US Owner information is required for every page. Commonwealth of Massachusetts Title 5 official Inspection Form aI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 72 Pheasant Brook Road t-roperty Haaress Jeff Poor owner s Name North Andover CityfTown MA 01845 November 7, 2016 State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. MA State S1848 License Number 01949 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.- 0 ystem: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority v-' . November 7, 2016 Insp tor's Signature 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 A. General Information When filling When filling out forms on the computer. use 1. Inspector: only the tab key to move your Dean G. Luscomb II cursor - do not use the return Name of Inspector key. Dean G. Luscomb II & Sons Company Name 288 Maple Street IL 'ff Company Address Middleton 6 CityfTown 978-774-4065 Telephone Number B. Certification MA State S1848 License Number 01949 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.- 0 ystem: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority v-' . November 7, 2016 Insp tor's Signature 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 72 Pheasant Brook Road Owner information is required for every page. rroperry fraaress Jeff Poor uwners Name North Andover MA 01845 November 7, 2016 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Chec&,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 72 Pheasant Brook Road Property Address Jeff Poor Owner's Name North Andover MA 01845 November 7, 2016 CityrTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 72 Pheasant Brook Road Property Address Jeff Poor Owner Owner's Name information is required for North Andover MA 01845 November 7, 2016 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal YA 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 fl ❑ ® Backup of sewage into facility or system component due to overloaded or V 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 'h day flow t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 72 Pheasant Brook Road Owner information is required for every page. r-roperiy /+aaress Jeff Poor uwnerrs Name North Andover MA 01845 November 7, 2016 City1rown 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. U ❑ 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 mustintimate either "yes" or "no" to each of the fo11 wi in addition to the questions in Section D. 04 Yes No ❑ ❑ the system is within 400 fee%of a�Su-drinking water supply ❑ ❑ the system is within 200 feo,et'of a trib ry to a surface drinking water supply ❑ ❑ the system is located -in a nitrogen sensitive ea (Interim Wellhead Protection Area — IWPA) mapped Zone II of a public w r supply well If you have answered "yes" to y question in Section E the system is consi [,ed a significant threat, or answered "yes" in Sec D above the large system has failed. The owner -or- perator of any large system considered a nificant threat under Section E or failed under Section D shall upgrade the system in accord a with 310 CMR 15.304. The system owner should contact the appropriate regional office of�he Department. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 72 Pheasant Brook Road rroperty Address Jeff Poor Owner Owner's Name information is North Andover required for MA 01845 November 7, 2016 every page. CitylTown 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): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 550 gpd t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 72 Pheasant Brook Road Property Address Jeff Poor Owner information is required for every page. owner's Name Noah Andover Cityfrown D. System Information Description: owner and town Number of current residents: 01845 November 7, 2016 Zip Code Date of Inspection Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): b why Detail: Btf_26 x ?� �" - 66 6 �� -i-720 = `11��� Sump pump? Last date of occupancy: ial/Industrial Flow Conditions: Type of Establishm Design flow (based on 310 CMR 3 Basis of design flow (seats/persons/sq.ft., eta Grease trap present?„� ---"'« Industrial waste,,h ding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: (gpd) ❑ Yes ® No current Date ❑ Yes ❑ No ❑n Yes El No LI Yes . 17 No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 72 Pheasant Brook Road Property Address Jeff Poor Owner information is required for every page. Owner's Name North Andover City/Town D. System Information (cont.) Last date of occ / Other (describe below): State 01845 November 7, 2016 Zip Code Date of Inspection General Information Date Pumping Records: Source of information: Pumped July 2016. Was system pumped as part of the inspection? If yes, volume pumped: Zero gallons How was quantity pumped determined? Reason for pumping: No need at this time Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool - 0 • ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 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 °wM 72 Pheasant Brook Road Owner information is required for every page. �j t-roperry Haaress Jeff Poor uwnerS Name -- North Andover MA 01845 November 7, 2056 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System is from 1998 - 16 vrs old. Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: 3' feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): Main line and joints are in good condition. L, Septic Tank (locate on site plan): / Depth below grade: 28" / feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) Precast rectangularconcrete -1(550'0 gallons /_ '� nk is metal, list age: Is age con irme y a C Dimensions: Sludgeil8pth: a copy of certificate) 5'x 5'x 10'- 1500 1" Ilons 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 72 Pheasant Brook Road Property Address Jeff Poor Owner Owner's Name information is required for North Andover MA 01845 November 7, 2016 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 34" / 1 Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? by measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank and baffle are in very good shape. The solids are light and do not require pumping at this time. The liquid is running at it's correct working heigth. Cover built to 8" below grade. Grease Trap (locate on site plan): Depth be rade: Material of rade', ❑ concrete ❑ metal Dimensions: Scum thickness Distance from top of Distance fro rti bottom Date of last pumping: t5ins • 3113 ❑ fiberglass top of outlet tee or baffle of scum to bottom of outlet tee or baffle feet ❑ polyethylene er (explain): Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'M 72 Pheasant Brook Road Owner information is required for every page. t-ropeny Haaress Jeff Poor owner s Name North Andover MA 01845 November 7, 2016 Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) CsrQzments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid le related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan) I. Depth�b l w grade: concrete Material of c struction: ❑ `� Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumpi Comments (condi Li ❑ fiberglass ❑ pot eth ne y � ❑other (explain): gallons gallons per day •❑ Yes ❑ No Alarm`ra,,working order: ❑ Yes ❑ No Date of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3l13 Title 6 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 72 Pheasant Brook Road Owner information is required for every page. �j Property Address Jeff Poor Owner's Name North Andover nne Cityrrown State D. System Information (cont.) 01845 November 7, 2016 Zip Code Date of Inspection Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Zero 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.): The d -box is 16" x 16" and is 33" below grade. The d -box is in very good shape Chamber (locate on site plan): Pumps in work) der: El Yes ❑ No* V Alarms in working order: No* Comments (note condition of pum�cham`ber, diumps 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): �j If SAS not located, explain why: SAS was located by asbuilt drawings. _ t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 72 Pheasant Brook Road Property Address Jeff Poor Owner Owner's Name information is required for every page. City/Town MA 01845 November 7, 2016 State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields 1 -30'x40' 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.): The SAS is in good condition. There are no signs of ponding or breakout. �j t5ins • 3f13 C sspools (cesspool must be pumped as part of inspection) (locate on site plan Number and c uration Depth — top of liquid to inlet inv Depth of solids layer Depth of scum layer Dimensions of cesspool p Materials of co. uction Indication of groundwater inflow ❑ Yes ❑ No " Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 72 Pheasant Brook Road Owner information is required for every page. rroperty Haaress Jeff Poor UwnerS Name North Andover MA 01845 November 7, 2016 City/Town State Zip Code Date of Inspection D. System Information (cont.) Cmmonote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.). (locate on site plan): UMaterials o Dimensions Depth of solids Comments (note condition of soil, signs of etc.): level of ponding, condition of vegetation, t5ins - 3/13 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 72 Pheasant Brook Road Nroperty Address Jeff Poor Owner's Name North Andover MA 01845 November 7, 2016 CityrTown State Zip Code Date of Inspection D. System Information (cont.) � Broolt I2at, 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 eh inrP nublic water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawinq attached separately t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System + Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 'o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 72 Pheasant Brook Road D. System Information (cont.) Site Exam: E Check Slope N Surface water • Checkcellar Drj �),p �'qmp pL4r-ip • Shallow wells /JOYI-C Estimated depth to high ground water: 7' +/- feet November 7, 2016 Date of Inspection 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: 08/17/1998 Date z Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health - explain: Proposed and asbuilt on file. El Checked with local excavators, installers - (attach documentation) El Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test hole #1 showed ground water at 36" or 3'. Test hole #2 showed ground water at 60" or 5'. Test hole #3 showed ground water at 42" or 3.6'. Test hole #4 showed ground water at 36" or 3'. The basement is 7' below qrade with no sumD oumn. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 Property Address Jeff Poor Owner Owner's Name information is required for North Andover MA 01845 every page. City/Town State Zip Code D. System Information (cont.) Site Exam: E Check Slope N Surface water • Checkcellar Drj �),p �'qmp pL4r-ip • Shallow wells /JOYI-C Estimated depth to high ground water: 7' +/- feet November 7, 2016 Date of Inspection 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: 08/17/1998 Date z Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health - explain: Proposed and asbuilt on file. El Checked with local excavators, installers - (attach documentation) El Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test hole #1 showed ground water at 36" or 3'. Test hole #2 showed ground water at 60" or 5'. Test hole #3 showed ground water at 42" or 3.6'. Test hole #4 showed ground water at 36" or 3'. The basement is 7' below qrade with no sumD oumn. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 v Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 72 Pheasant Brook Road Hroperty address Jeff Poor Owner Owner's Name information is required for North Andover MA 01845 November 7, 2016 every page. 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 • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD µ UA I 1': 2 2003 ------------------- 1'EM OWNER & ADDRESS SYSTEM LOCATION (example; Icf( frontf ho se) DAY' ©f�. U.\'I'C OF PUMPINC: `��� �,3 QUANTITY PUMPCD,/0,1LL���� :. S1'00L: NO YES SEPTIC TANK: NO YES MATURE OF SERVICE: ROUTINE EMERGENCY ()H1 pRYATI0INS: GOOD CONDITION_ PULL TO COVER HFAVY CREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK.. CXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER Oj�HFR (EXPLAIN) PUMPCD BY: i � U 1.1 .'yI PNTS. � UN i l:'NTS l')tANSFCIZRED TO: TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: This is to certify that the individual subsurface disposal system constructed ( x ) or repaired ( ) by North Andover Licensed Installer Benjamin C. Osgood, Jr. at Lot 3 (#72) Pheasant Brook Road, Evergreen Estates, North Andover, MA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit #1045 dated September 21, 1998. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: This is to certify that the individual subsurface disposal system constructed ( x ) or repaired ( ) by North Andover Licensed Installer Benjamin C. Osgood, Jr. at Lot 3 (#72) Pheasant Brook Road, Evergreen Estates, North Andover, MA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit #1045 dated September 21, 1998. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. � Board of Health Inspector r TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System �) constructed; ( ) repaired; n byc�i4w��� J located at h=it 3 `� �h �,,-� ��oyK�� �a�. >r r f'!1 A was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # /P 5-, datedb;zt 4p,, with an approved design flow ofd gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 3 I0 C M 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which ha — --- Bed inspi Final insF Installer. - Design F From: Susan Ford, Health Insprector Date: IV2M, 1998 Re: Lot 3 A Evergreen Estates Pages: 2 CC: ❑ Urgent X For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle Jeffery Poore just dropped off the final as -built for Lot 3A. I compared it to the ",.><ri ' `'': > <> remain h ere some outstanding missing components. I have attached a copy of the eh ifif.1r our convenience. y Thank You ? Have a wonderful Thanksgiving * AS -BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER ✓ LOT LINES & LOCATION OF DWELLINGS LOCATION & DfMENSIONS OF SYSTEM; INCLUDING RESERVE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM v TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WAN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX STAMP & SIGNATURE IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW FINAL CONTOURS LOCATION & ELEVATION OF BENCHMARK USED �c LOCUS PLAN b/9 LOCATION: SEPTIC PLAN SUBMITTALS EV NEW PLANS: YES REVISED PLANS: (!ES) SITE EVALUATION FORMS INCLUDED DATE: SI -1 ��l DESIGN ENGINEER: DATE TO CONSULTANT: E5764eS $125.00/Plan $ 45.00/Plan� YES NO � 0 When the submission is all in place, route to the Health Secretary Sandy Starr Health Inspector Town of North Andover Dear Ms. Starr: WI \7 MN rim iia Uva 0. e - B ` AUG August 7, 1998 Enclosed is the redesign on the septic systemfor Lot 3 in Evergreen Estates. We expanded the design from 440 Gallons/Day to 550 Gallons/Day by expanding the leach field. This was done to accommodate a possible future expansion of the walk up attic. While we have no plans to finish the space now, we felt this redesign was the correct choice to allow us that flexibility in the future. I have also enclosed a copy of the current house plans for your convenience. While I do understand and appreciate the fact that you are extremely busy and that you are currently operating out of a temporary office, I ask that you review the plans at your earliest convenience as we hope to complete construction by late this fall. If you have any questions or recommendations on how to proceed with the installation of the system, please don't hesitate to call Ben Osgood at New England Engineering (686-1768) or myself at 975-3100x103. Thank you in advance for your help in resolving this matter. Sincerely, �7 ?efftoor 51 Barman Drive North Andover, MA 01845 CC: B. Osgood 150 Flagship Drive North Andover, MA 01845 TEL: 978.975.3100 800.733.1520 FAx:978.975.0635 www.flagshippress.com T 0 W N PRINTING, I N C. a W I L M I N G T 0 N PUBLICATIONS, I N C. a F I N P R I N T LOT 2A �• �� / 1 \ 126 1 128 \ w 90 t j 130 \ \1 130 F�IVI D. bRA/N / l�l =\,124.0 / 128 124 43, 126 I 1 1 124 SYSTEMDES - . �OFESS/OVAL INC. lGN EN EVERGREENWOTATES 2OFASSESSO RS MAP 106B LOT 41) PHILIP ?TH ANDOVER, MASS. CHRISTIANSEN N0. 28895 y A JEFFREY POOR � ISTE /0 AL � ON DRI VE NOR TH A NDO VER PHILIP EN ;h SERC' PROFFES ONAL ENGINEERS G. CHRISTIANSEN, P. E. ISURVEYORS DATE. HAVERHILL, MA 01830 TEL. 978-373-0310 DECEMBER 27, 1995 ' — REVISIONS: 5 /R /a � it �� o TOWN OF ORTH AN p'ER/ BOAPD O� E LTH } APPLICATION FOR DISPOSAL WORKS CONS;A. rCT3,ON PERMIT 1 b DATE: S L,31 CURRENT INSTALLER'S LICENSE# LOCATION: L.��- 31 &Cas�..f- Lod/, (20 LICENSED INSTALLER: 6e.,;.. SIGNATURE TELEPHONE# R'Z S— b 8 6 -17 r0 9 opt CHECK ONE: REPAIR: NEW CONSTRUCTION: X IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes `' No Foundation As -Built? Yes �--�`" No Floor Plans? Yes No Approval _.-�/ , Date: a / EX. FN T. 0. F. 136.1 LOT 3A lrap. FOUNDATION LOCATION PLAN CLIENT. JEFF POORE THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. LOCATION:LOT 3A "EVERGREEN ESTATES" NORTH ANDOVERNA. SCALE: I"=60' DATE: 7/9/98 CHRI S TIA NSEN & SERGI PRD 160 SUMMER ST. HAVERHILL.MA. 01830 TEL 308-373-010 ®T DD8 BY CHRISTIANSEN t SERGI INC. .oy F 16 's 0o� 0 I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS To THE HORIZONTAL SETBACK REQUIREMENTS OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (TMS CERTIFICATION DOES MOT CONSIDER ANY OTHER RESTRlCAONS SUGI AS COVENANTS:WETLANDS.EASEMENTS, ORDERS OF CONDITIONS.ETC.) THIS DRAWING SHALL NOT BE uSED BY THE CLIENT FOR AN" PURPOSE OTHER THAN THAT OUTLINED ABOYE.EXCEPT WITH SHE WRITTEN PERMISSION OF CHRISTIANSEN t SERGI INC FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRIST Amsim t sm /NC. AND ANY uNAUTHOR=D use 15 PROHIBITED.CHRISTIANSEN d SERGI TAKES NO RESPON981 TTY FOR THE UNAUTHORLZED USE OF THIS DRAWING OR ANY NFOR- MATTON CONTAINED HEREON. DWG.NO.: 94036076 R, v y 'O C QD � d CO) Cl) 10 0 CD Z y CD =. CL C7 C.y a� v O v CD d� r CD SD O CC CD CIO W _a C CD CA CL. C= y o co CD C? c d S O aoc m "o y CL �gmmm m O elm �, S 01 Ot CD y T o CL y _ _ CD O m y C O =r m m a O m O' O y Cl CD "L? c=rCo CL � r o W: Cn mto C7� ^ C CL n m ft Opp� y e... _ C � 1 VV+ Q_ Z y ad C o 5� f1 p _ ' ►+1 y m C ' tC ,,, f y er . S H IE C? mCD m W y O m co O O o es o j mo� o m ... 1 cn cn cnW NK �y _ a- o _ CA Q ro: _ o m N Cl cn cn z W ti '� � C d tiJ zW O r C7 W n G C a C) fD O C -� p O x O O H 0 0 c Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 (508) 688-9533 August 17, 1998 Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 RE: Lot 3A Pheasant Brook /Evergreen Estates Dear Phil: This letter is to inform you that the proposed septic plan for Lot 3A Pheasant Brook Road, dated 8/5/98, has been approved. If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. CD&S Jeffrey Poor File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 Julie Parrino D. Robert Nicetta Michael Howard Sandra Stair 0 PLANNING 688-9535 Kathleen Bradley Colwell '+ L R CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: Aooe Plan Date: O/C598 Revision Date: Name of Designer: -'BC/!) OS 666d Date of Review: Property Address:, 6r &/-9 Map: Lot: BOH Reviewer: �5 - 9 7-A P 2 Type of Plan (new or upgrade): 1t1& -4J Number of Bedrooms in Assessor' s Records: gpd) Garbage Disposal Allowed: IUCD General Information: N.A. = North Andover Septic Regulations Other numbers refer to Title 5 OK Problem N/A Street number and map/lot - 220(4)(u) r/ Maximum scale of 1 "=40' for plot plan - 220(4) cf Maximum scale of 1 "=20' for profile and component details - 220(4) Legal boundaries of the facility being served - 220(4)(a) ✓— Names of abutters from recent tax map - NA 8.02j y/ Number of bedrooms, design calcs., - NA 8.021 f/ Name & address of record owner & applicant - NA 8.02k Name & address of designer - NA 8.021 ✓ Holder and location of all easements - 220(4)(b) Date plan drawn & any revision date - NA 8.02m All dwellings and buildings, existing and proposed - 220(4)(c) Location of all existing or proposed impervious areas - 220(4)(d) All distances on site plan — NA 8.03a -c Elevation of proposed driveway - NA 8.02t Location and elevation of foundation drain - NA 8.02y 71— Location and dimensions of the system incl. reserve (new const.) - 220(4)(e) Limits of excavation of leach area on site plan - NA 8.02z Locus plan - 220(4)(t) North arrow - 220(4)(g) Existing 220(4)(g) and proposed contours - Locations and logs of deep holes - 220(4)(h) - Locations and logs of percolation tests - 220(4)(i) Date(s) of soil testing - 220(4)(h) & (i) Existing grade elevation of each deep hole - 220(4)(h), Elevation of percolation tests — N.A. 8.02rr Name of approving authority representative - 220(4)(h) & (i) Name of soil evaluator - 220(4)0) Soil logs and perc test logs match BOH records Locations of waterlines, drains, and subsurface utilities - 220(4)(m) Observed and adjusted g.w. elevation in the�vicinity of the system - 220(4)(n) Complete profile of the system to scale - 220(4)(0), NA 8.02c Cross section of leaching facility - NA 8.02w Location of benchmark(s) within 50-75 feet of facility - 220(4)(q) Note listing all variance requests with proper citations - 220(4)(p) Local upgrade approval request form submitted - 403(1) Original R. S./P.E. stamp, signature & date - 220(1) & (2) A sfc. supplies (w/in 400'), pub. wells (w/in 250'), pvt. wells (w/in 150@) - 220(4)( +/ Location of watercourses, wetlands, wells, etc. w/in 150' of system — NA 8.02r c/ Wetland disclaimer — NA 8.02s t93•-2 Land surveyor plan reference required (property line setbacks) - 220(3) f/ Plan contains designer's certification statement ;./ Use approvals / standards checked for I/A system - DEP docs., Perc rate >30 MPI - not allowed for new, LUA for upgrade - 245(1)&('3) ground water el. Perc rate > 60 MPI - must use modified tight tank or IIA technology - 245(4) Proposed system qualifies as "shared" system - 002 (definitions) 117,4 Flow is over 2,000 gpd - No R.S. allowed - 220(1) bottom of leach facility el. Design flow was set in accordance with code - 203 /a %. Existing system location and note on proper abandonment - 600.3. 1 (f), 354 Leaching facility at least 1' above Base Flood elevation — NA 9.05 thickness of acceptable soil All piping Sch 40 minimum — NA 10.01 �- Basement floor minimum I' above groundwater elevation — NA 5.04 Foundation drain present with elevation — NA 8.02y On-site Soil and Groundwater Review OK Problem N/A 41 separation to refusal Proper deep observation hole logs on plan - 220(4)(h) All deep holes and peres shown, including aborted tests — NA 8.02n Soil evaluation forms submitted within 60 days of field work - 018(2) perc rate Proper percolation test log - 220(4)(i) ✓ Ample deep observation holes in primary disposal area (minimum 2) - 102(2) Ample deep observation holes in secondary disposal area (minimum 2) - 102(2) Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4) 1� Deep hole testing conducted within two years — NA 7.05 Hole Identification Numbers: 3-1 s ground elevation el. l o`l t93•-2 acceptable soil el. --- lao. �5 Leach facilitv invert el. ground water el. refusal el. 117,4 rl CIJ bottom of leach facility el. 1,97 /a %. thickness of acceptable soil �- before & after soil R&R separation to groundwater 41 separation to refusal soil class perc rate loading rate ' �!o septic tank below g.w. table A/0 (yes or no) pump tank below g.w. table AID (yes or no) l.f in fill_ -255(l) Setback Distances (Given in feet) 15.21 1 OK/Problem N/A Is lot in the the Lake Cochiewick Watershed? NA 6.00 & 5.02 Septic Tank Leach Facility Property line 10 10 Cellar wall 10 20 Inground pool 10 20 Slab foundation 10 10 C� Deck, on footings, etc. 5 10 Waterline 10 10 V Private drinking well 75 100 Irrigation well 75 100 Wetlands 75 100 Public well 400 400 t/ Wetlands bordering surface 150 150 water Supply or trib. (in Watershed) F / " Trib. To Surface Water supply 325 325 Reservoirs 400 400 V Tributaries to reservoirs 200 200 v Drains 50 (wat. supply/trib.) 100 Drains (intercept g.w.) 25 50 1z Foundation drains 10 20 Drains (Other) 5 10 Drywells 20 25 i/ Downhill slope 15' to 3:1 slope w/o barrier 46 Buildinp, Sewer OK Problem N/A e� -,aL— v/ Septic Tank OK Problem N/A Grease trap required for certain uses (check 230 for details) Pipe diameter listed (4" minimum) - 222(1) Pipe schedule listed - 222(3) Pipe cast iron or Sch 40 PVC — NA 11.02 Watertight joints specified - 222(3) & (4) Pipe laid on compact, fin ase - 222(5) Pipe laid on continuous grade in straight line - 222(7)@ Cleanouts precede all changes in alignment and grade - 222(8) Cleanout provided every 100 feet - 222(8) Manhole at any 90 degree alignment change - 222(8) Invert elevation at building: l 30.,3-7 Invert elevation at septic tank:q /aC Length of run: 461 Slope: (minimum of 0.01 - 0.02 desired) - 222(6) 10' offset to private well or suction line - 222(2) Tank is accessible - 228(3) Tank can accommodate both primary & reserve — NA 9.04 200% of flow (required & provided given. 1500 min.) - 220(4)(f) & 223)(1)(a) 2-3" drop from inlet to outlet - 227(5) Minimum of 4' liquid depth - 223(2) 3" air space above tees/baffles (minimum) - 227(4) 9"air space above flow line (minimum) - 227(4) Tees are not to be replaced by baffles - 227(1) Tees extend 6" above flow line - 227(1) Inlet tee extends 10" below flow line (minimum) - 227(6) Outlet tee extends 14" below flow line (more for deeper tanks) - 227(6) Gas baffle installed on outlet - 227(4) Access manhole cover above center of tank & each tee (except 2 compart) 228(2) 3-20" manholes - 228(2) 1 childproof, 24" riser/manhole to final grade if <1000gpd- 228(2) Inlet and outlet tees on center line - 227(1) Soil compaction below tank specified (if soil is non-native) - 221(2) 6" of <=3/4"stone beneath tank specified - 221(2) & 22 8(1) If> 1,000 gpd AND nota single fam. dwell. must be 2 tks or 2 comp. - 223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart. tank - 223(1)(c) Buoyancy calcs. required if tank at or below water table - 221(8) Tank is watertight - 221 (1) 9" of cover over tank (minimum) - 2280) H- 10 loading (min.) - H-20 if traffic - 226(3) Top of tank <=36" below grade - 221(7) All pumping to tank (if applies) in accordance with - 229 Tank is set to keep old system in service during install if possible Tight Tank (Check here if not present: ) Distribution Box (Check here if not present: OK Problem NIA l a 4 z Inlet elevation: Outlet elevation: /,9- k 6 0.17' drop from inlet to outlet (minimum) - 232(3)(b) r 6" sump (minimum) - 232(3)(e) All outlets at same elevation - 232(3)(b) !i Outlet pipes laid level for first 2 ft. - 232(3)(c) �r Pipe Sch 40 - NA 10.0 Number of outlets: Number of laterals: _ Size of outlets: 4 ✓ Inlet baffle/tee min. V over outlet invert for all d -boxes - 232(3)(a), r/ Soil compaction below distribution box specified (if soil is non-native) - 221(2) 6" of stone beneath distribution box specified - 221(2) Box is watertight - 221 (1) sG Top of box <=36" below grade - 221(7) Buoyancy calculations required if box is at or below water table - 221(8) Pump Chamber (Check here if not present: f OK Problem N/A Volume specified: 220(4)(r) Pump on elevation- 220(4)(r) Pump off elevation: 220(4)(r) Alarm on elevation: 220(4)(r) Number of cycles per day - 220(4)(r) (also 254(1)(d) if gravity from d -box) Minimum 2" delivery line to d -box if gravity - 254(1)( c) Pressure dosed l.f if flow >= 2,000 gpd - 254(1)(a) & 254(2)(a) Cycles per day is consistent with chamber volume - 23 1 Volume calculations include flowback volume - 2') 1(2) 24 hour storage capacity above pump on elevation - 231(2) Number of pumps: 2 if system serves >2 dwelling units - 231(6) Capacity of pump(s) - gpm @ ' TDH - 220(4)(r) Pump can pass 1 1/4 "solids (minimum) - 231(7) Pump controls specified - 220(4)(r) Alarm equipment specified - 231(2) Alarm is in building and powered on separate circuit from pump - 2') 1(9) Pump sequence correct (off -lead on -lag on-alan-n on) - 231(8) Pump performance curves included - 220(4)(r) Manual operating switch - NA 12.01 Check valve, bleeder hole - NA 12.01 1 childproof, 24" riser/manhole to final grade - 2'31(5), Soil compaction beneath pump chamber specified (if soil is non-native) - 221(2) 6"of <=3/4"stone beneath chmbr. specified - 221(2) & 228(1), Buoyancy calculations if chamber is at or below water table - 221(8)@ 9" of cover over chamber (minimum) - 228(1) H- 10 loading (min.) - H-20 if traffic - 226(')), Chamber is watertight - 221 (1) Top of chamber <=36" below grade - 221(7) Leachings Facility (general - complete for all designs) OK Problem N/A ✓ 50% larger if garbage disposal - 240(4) Trenches to be used whenever possible - 240(6) ✓ No vehicle access or imperv. area above l.f. unless unavoidable - 240(7) t/ Vented if under impervious cover - 241 (1) r/ Vented through same pipes as distribution system - 241 (1)(a) L-- Vent protected from precipitation/animal entry - 241 (1)(b) Vent is placed beyond traffic or impervious area - 24 1(1)(c) All lines connected to vent if bed or trenches - 241(1)(d) 9" cover over peastone - 240(9) ✓ Reserve area provided (new construction) - 248(1) Reserve 4' from primary leach area - NA 9.04 ✓ 4' (5' if perc rate <=2 MPI) separation to g.w. - 212(a) & (b) v 4' (down to 2' with variance or I/A - upgrades only) of natural soil under Lf. GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005 - 251(9) Require 5' removal and replacement if in fill - 255(5) Top of leach facility <= 36" below grade - 221(7) Final grade over 11 minimum 0.02 ft/ft -240(10) Surface & subsurface drainage away from l.f. - 240(1 1) & 245(5) L--'- orifices specified (gravity system) - 251(8) Minimum design flow 440 gpd without deed restriction - NA 13.01 ✓ 3:1 slope where grading required - 255(2) Toe of fill slope stops 5' from property line or swale installed - 255(2) -Az," Impermeable barrier if < 3:1 slope or < 15 feet to -3:1 slope - 255(2) Lam-- Impermeable barrier/retaining wall poured concrete - NA 9.02 f- Retaining wall stamped by P.E. - 255(2)(b) Top of retaining wall >= top of peastone elevation - 255(2)(£) 10' offset from edge of leach facility to edge of ret. wall - 255(2)(g) ✓ Perc test(s) done in most restrictive layer - 104(2) ✓ Perc test 4' below leaching elevation - NA 7.06 Design flow listed and required/provided leach area given - 220(4)(f) ✓ Leach pipes SCH40 PVC - NA 10.01 Leach pipes minimum 4" diameter except for dosed system - NA 14.04 ✓ Leach lines capped, vented, or connected together - 251(9) Pressure dosing guidance followed if pressure distribution - 254(2)(c ), Pressure dosing required over 2,000 gpd or with I/A remedial use - 231(1) Leaching Trenches (Check here if not present: --- ) OK Problem N/A Number of trenches: Minimum of 2 trenches - NA 9.01(2) Depth of trenches (max eff. 2'): -247(l) Width of trenches (2' min., 4' max.): - 251 (1)(b) Length of trenches (100' max.): - 25 1 (1)(a) Trenches are vented (when > 50') - 251 (11) Trenches follow contour lines - 251(2) Trench spacing 3 times effective width or depth - 251 (1)(d) In fill or reserve between trenches, 10' min. - NA 14.01& 14.03 Available leach area given (Min. 500 s.f.) - NA 9.01(2) Bottom = L x W x # = s.f. Sidewall = L x D x# x2= s. f. Effective leach area given Loading factor: Effective area = total area s.f. x LTAR = g/day Effective area is >= design flow of facility being served 2"of 1/8"- 1/2" 2x washed peastone.- 247(2) Trench depth of 3/4" to 1 1/2" double washed stone - 247(1) Leaching Pits (Check here if not present: ) OK Problem N/A # of pits/pit systems_ (dosing chamber if>1, 231 (1)) Dimensions of each pit or system: L W D Depth of pits (max eff. 2'): --25 Available leach area given Bottom = L x W x # of systems = s.f. Sidewall = L+ W x D x 2 x# of systems = s.f. Total area = bottom + sidewall = s.f. Effective leach area given Loading factor: Effective area = total area s.f. x LTAR = g/day Effective area is >= design flow of facility being served Minimum of 2 pits at least 13'X16' — NA 9.01(3) Distribution for galleries/chmbrs. in trench config. - pipe every 20'- 253(6) Distribution for galleries/chmbrs. in bed config.-ea.pipe serves <= 40 s.f.-253(6) Spacing - 2 times the effective width or depth (the greater) - 2530)(c) 2"of 1/8"- 1 /2" 2x washed peastone.- 247(2) 3/4" to 1 1/2" double washed stone - 247(1) Each pit has at least one 20" access cover. 24" Cl to grade over 2,000 gpd -253(3) Surrounding aggregate thickness between P (min.) and 4' (max.) - 253(1)(b) Vents, if necessary, extend under covers of pit(s) - 241 (e) Leach Fields (Check here if not present: OK Problem N/A l' Number of fields: (need dosing chamber if> 1, 231 (1)) Length (100' max.): - 252 (2)(b) Width: Total area: L ?z x W s. f. Q/ Minimum 900 square feet - NA .01(1) Distribution lines connected with solid pipe — NA 15.01 i Effective leach area given i Loading factor: • c.� P i Effective area= total area Q 8gl s.f x LTAR- �3 ( _ g/dav v Effective area is >= design flow of facility being served Minimum of two distribution lines - 252(2)(a) �— 6' line separation (max.) - 252(2)(d) i/ 4' maximum separation from edge of field to line - 252(2)(e) ✓ 10' minimum separation between adjacent leach fields - 252(2)(f) ;/� Between 6" and 12" of 3/4 - 1 1/2" stone beneath field - 252(2)(g) & 247(2) y 2"of 1/8"-1/2" 2x washed peastone.- 247(2) 150 Flagship Drive FLAGSHIP North Andover, MA 01845 ::PRESS INC TEL: 978.975.3100 800.733.1520 FAX: 978.975.0635 Jeffrey N. Poor www.flagshippress.com H, 97-ff-7a5-ii4Ja i , t j r Cl ... drp Yt7 We 1 t 1 sh tx '�, sir s tQ, r 'i(.ki sir 1 tr,, � I 741—! } — — - .. ..I 1 I fi' rr t 4 Ka''S, i r � s� x'' ..1 V � .+ •. a 54 j:N ,, Yi. �,.r' 1 ° e �y., +� ''r•.', .r;i _;* ,�- '''`r.'�r "Af ':.. +t $,.i+d';� �'.f r '. 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IS d"- -� a1Y 1 - - Ilr--- --- -- ----- - - ---- ' r iAm ' - — '�► 1 ... h _�. .� of - 1 r-- 1 µl • 1 t 1 I 1 r '1 ► 1 1 1 • 1 1 • r 1 1 , 1 • ' 1 1 1 1 1 . 1 1 iia•'- .. , '------------------------------------------------------= / -- '-- 77- --------------------. - I -Ir A7 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. J*****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANTPHONE 7 j LOCATION: Assessor's Map Number��� l�c�� 7 PARCEL SUBDIVISION �VCR(�EEi�TI� S LOT (S) STREET P�i(�AS�liJ7� &ROD ST. NUMBER ************OFFICIAL USE ONLY**********�, ** * RECOMM ATIONS OF TOWN AGENTS: CONSLIAVAYION ADMINI§TRA O DATE APPROVED 7 DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH SEPTIC I COMMENTS DATE APPROVED DATE REJECTED EALTH DATE APPROVED A? DATE REJECTED �T PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT IL FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE 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. *"**APPPLICANT FILLS OUT THIS SECTION*********************** APPLICANT 6-R PHONE -1 __� LOCATION: Assessor's Map Number 06.6 LZT PARCEL SUBDIVISION LOT (S) STREET &ASekj- Y66DK ST. NUMBER ********************OFFICIAL USE ONLY***********''*********************** - - =-- RECOMMnATIONS OF TOWN AGENTS: CONStAVAfION ADMINI COMMENTS „— DATE APPROVED DATE REJECTED- - d EJECTED_-d F 6�' M (/ TOWN PLANNER DATE l PPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED % DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE LOCATION a SEPTIC PLAN SUBMITTALS L6–F 3A — E NEW PLANS: YES REVISED PLAN YES DATE: C—s ( A -TC $60.00/Plan $25.00/Plan V DESIGN ENGINEER: When the submission is all in place, route to the Health Secretary b(L � � 2 - C r FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: MeZ UI d Ot-U a TAll<,_�, Phone LOCATION: Assessor's Map Number Parcel Subdivision 2F11ie"-) Lot(s) Street �Q St Number ************************Official Use Only************************ RECOMMENDATIONS OF.TOWN AGENTS Conservation Administrator Comments Daae Approved Date Rejected Date Approved Town Planner 4=.,. Date Rejected Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date Approved Date Rejected Date Approved Date Rejected Date PLAN REVIEW CHECKLIST ADDRESS 3�.i9rfJ7 �iPCY���ENGINEER 0� GENERAL 3 COPIES �� STAMP i--� LOCUST NORTH ARROW C/ SCALE �- CONTOURSPROFILE '-� SECTION �� BENCHMARK SOIL & fli PERCS �'�8a�� ELEVATIONS WETS . DISCLAIMER L/� WELLS. & WETS WATERSHED? -p—/0 DRIVEWAY L- (E1ev) WATER LINE i/ FDN DRAIN SCH40 �� TESTS CURRENT? SOIL EVAL :s' ST9,e,'/Si, 'b UeSU SEPTIC TANK, MIN 150OG [/ .17 INVERT DROP i/ GARB. GRINDER(+200% EDF) 25' TO CELLAR MANHOLE ELEV GW # COMPS. 1 �/ SIZE # LINES Jr FIRST 2' LEVEL STATEMENT INLET &7& 47 - OUTLET la8r 30 (2" OR .17 FT) TEE REQ' D? Al v LEACHING MIN 660 GPD?RESERVE AREA, 4' FROM PRIMARY? 2% SLOPE 100' TO WETLANDS 100' TO WELLS 4' TO S.H.GW (5'>2M/IN) 35' TO FND & INTRCPTR DRAINSi-' 3225' TO SURFACE H2O SUPP �---`" 4' PERM. SOIL BELOW FACILITY MIN 12" COVER L---' FILL? �-(25' if above natural elev; 101if below) BREAKOUT MET? v TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/100') SIDEWALL DIST. 3X EFF. W OR D (MIN 6') RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? VENT? (>3' COVER; LINES >501) BOT + SIDE X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright (0 1995 by S.L. Starr PITS MIN 660 LEACHING MIN 1 (13'x16') 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) 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 GW MIN 4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? " PEA STONE? -./" DIST LINE SLOPE .005? >3' COVER -VE -Ng- I---- SCH 40 L''� MIN 12" COVER RATE /�� LDG X 660 = � w X TOTAL 0 G/ft2 REQ'D (ft2) LXW c p:� /V,:5/ -,f- ?- DOSING DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY gpm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME gpm MANHOLES TO GRADE ALARM SEP. CIRC. inlet) HWL LWL CHECK VALVE OP. SWITCH Copyright © 1995 by S.L. Starr GW (Min. 1' below BLEEDER HOLE MANUAL � NORTM 3? •�� °0 F • s ,SSACHUSEt'A Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 6-1,,?J� "7 19 9 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant 8&A2-- Test No. Site Location 1J-)1' x Reference Plans and Specs. A Z. ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee CHAIR AN, BOARD OF HEALTH Site System Permit No. 9 (Z No........ THE COMMONWEALTH OF MASSACI-IusErrsl BOARD OF HEALT BOARD OF HEALTH ........ %.of,�i............O��.....&0.9-�....�s � r �.�.......................fl 9 2 71995 , pphratioit for Bispooal Worka Tottar Application is hereby made for a Permit to Construct (t ,T or Repair ( ) an Individual Sewage Disposal System at: Location - Address or Lot No. f..............!.... --.:` ... Y!4!tJ..4+4 r � baa v r. ... W Owner Address Installer Addiess Type of Building - Size Lot.... `�-��_6!.....Sq. feet �+ Dwelling—No. of Bedrooms.............4 .....................:..Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures...........................•------......-----..........-••-.....•••-•.......:....................................._.................. Wx • g P �P n�er faYr • Total flow ................ ow.........---•-. �? Q ................. Depth.. �ga�ll.o�n- .s.r.. WSSeptiic Tank—Liquid capacityd��Q.gallons Diameter............. Disposal T-t.Width...... K ...... Total Length..... 0.........Total leaching..area.... tZ / ......sq. ft. 3 Seepage Pit No ..................... Diameter.................... Depth below inlet..:.................. Total leaching area .................. sq. ft. Z Other Distribution box ()f-) , Dosing tank ( ) � Percolation Test Results Performed by...C:K�nlST/�8.2!Sn(•-LI�•I.tiIF : Date...://.�;f�...?�1���_.... p-3_�C Test Pit No. I .....1. �`�...... minutes per inch Deptlrtof Test Pit ..... ..t.�.. Depth to ground water ...... 6.0 ...... T' 3-/ w r- b---7, Test Pit No. 2 ...... LL .... minutes per inch Depth of Test Pit ....... �.�..t.�... Depth to ground water ...... `.... F�''. ' L r4..................................•............................-••---....-•--•-..........--------......... ..:................... .................. 0 ........ x Description of Soil ..... 2_..K�� .-.1.�.....? 1�:s9vy 1�t `%..:silmC.`t--.W.111-` t.--M.-44).i.10�..l�� V......••--........--•-••••-•-••............•.............•••----.........------.......-••-•-•---•-••---•......-=--•••---•-•..: •-•••••--•---•-••-•-•----•.............•--• ••...... U Nature of Repairs or Alterations —Answer when applicable. ......................................... .................................................... ......................................................................................:................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................................................... Date Application Approved By....................................................---......------ . .................. Application Disapproved for the following reasons: ................... Date ....••.................•-........------.......-•-•--••-••...._.........-•-........................-•-.....•---•......-•-................._.............:------••-...•---..............• • •• •---•----.... •. Date PermitNo ......................................................... Issued ....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... OF Tertifiratr of Toutplitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................................. ................ _......_.................--•--•--------......------............-----...----...._._.............. i�staiier at.................................................... _... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ......................................... dated..................................... . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEMA WILL FUNCTION SATISFACTORY. DATE............:...............................................................:... Inspector .................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................................................................. No ......................... ......................................... OF ........ FP_E ........................ l9il��ro,�ttl �ox12u C�ultk�#.Yurtiuu �rruti# Permission is hereby granted ................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. Street as shown on the application for Disposal Works Construction Permit No ..................... Dated_...........__............ ......------•---------------------------•............--•-----•-----------.................... _........... DATE • Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS The (- bottom of bed; ( ) septic system located at 47 aA l' aF - , has been inspected and approved on / lqg by Board of Health personnel, and the Health Department has no objection to a construction permit being issued for this lot. Inspector 3 ill Date The undersigned hereby applies for the approval of said DEFINITIVE plan by the Board, and in furtherance thereof hereby agrees to abide by the Board's :Rules and Regulations. The undersigned hereby further covenants and agrees with the Town of North Andover, upon approval of said DEFINITIVE plan by the Board: 1. To install utilities in accordance with the rules and regulations of the Planning Board, the Public Works Department, the Highway Surveyor, the Board of Health, and all general as well as zoning by—laws of said Town, as are applicable to the installation of utilities within the limits of ways and streets; 2. To complete and construct the streets or ways and other improvements shown thereon in accordance with Sections Iv and V of the Rules and Regulations of the Planning Board and the approved DEFINITIVE plan, profiles and cross sections of the same. Said plan, profiles, cross sections and construction specifications are specifically, by. -reference, incorporated herein and made a part of this application. This application and the covenants and agree— ments herein shall be binding upon all heirs, executors, administrators, successors, grantees of the whole or part of said land, and assigns of the undersigned; and 3. To complete the aforesaid installations and construction within two (2) years fromm the date hereof. C� p V i Received by Town Clerk: \- -- -Date: Signature of Applicant Messina Development Corp., 805 Winter St. Time: North Andover, MA 01845 Signature: Address FORM C CE'ui.AD:,','N APPLICATION FOR APPROVAL OF DEFINITIVE PLQwy OL. E P, < HQRTH ARoOVER ` January 17 a; - 19 95 ]AN -i To the Planning Board of the Town of North Andover: The undersigned, being the applicant as defined under Chapter 41, Section 81—Lt for approval of a proposed subdivision shown on a plan entitled Definitive Subdivision Plan "Evergreen Estates" located in North_Andover by Christiansen & Sergi, Inc. dated December 28. 1994 being land bounded as follows: Northerly bt Com of MAL land of Steer and Fried; easterly by land of Fried, Deadder, Rough, Green, Galeassi, Yourre, Mateja, gi nzT A i Q S. ,T ani D.a.n i s., e a l effi St., a it 4 Farr, sentherly b.7 mid of Farr an d Com of MA; westerly by Com of MA.. hereby submits said plan as a DEFINITIVE plan in accordance with the Rules and Regulations of the North Andover Planning Board and makes application to -the Board for approval of said plan. 1087 314 Title Reference: North Essex Deeds, Book 2901 . Page 13 ; or Certificate of Title No. , Registration Book , page ; or Other: Said plan has(X) has not( ) evolved from a preliminary plan submitted to the Board of A uQ 24 19 94 and approved (with modifications) ( ) disapproved (X on Oct 4 1994 r ; The undersigned hereby applies for the approval of said DEFINITIVE plan by the Board, and in furtherance thereof hereby agrees to abide by the Board's :Rules and Regulations. The undersigned hereby further covenants and agrees with the Town of North Andover, upon approval of said DEFINITIVE plan by the Board: 1. To install utilities in accordance with the rules and regulations of the Planning Board, the Public Works Department, the Highway Surveyor, the Board of Health, and all general as well as zoning by—laws of said Town, as are applicable to the installation of utilities within the limits of ways and streets; 2. To complete and construct the streets or ways and other improvements shown thereon in accordance with Sections Iv and V of the Rules and Regulations of the Planning Board and the approved DEFINITIVE plan, profiles and cross sections of the same. Said plan, profiles, cross sections and construction specifications are specifically, by. -reference, incorporated herein and made a part of this application. This application and the covenants and agree— ments herein shall be binding upon all heirs, executors, administrators, successors, grantees of the whole or part of said land, and assigns of the undersigned; and 3. To complete the aforesaid installations and construction within two (2) years fromm the date hereof. C� p V i Received by Town Clerk: \- -- -Date: Signature of Applicant Messina Development Corp., 805 Winter St. Time: North Andover, MA 01845 Signature: Address Notice to APYLIUAW/'I V CLERK and Certification of A on of Ylann-i.ng Board on Definitive Subdivi`,,ion Plan entitled: Evergreen Estates By: Christiansen & Sergi dated rPtnhPr :,R , 19 94 The North Andover Planning Board has voted to APPROVE said plan, subject to the following conditions: 1. That the record owners of the subject land forthwith execute and record a "covenant running with the land", or otherwise provide security for the con— struction of ways and the installation of municipal services within said sub— division, all as provided by G.L. c. 41, S. 81—U. 2. That all such construction and installations shall in all respects conform to the governing rules and regulations of this Board. 3. That, as required by the North Andover Board of Health in its report to this Board, no building or other structure shall be built or placed upon Lots No. as shown on said Plan without the prior consent of said Board of Health. 1,.. 'Other .conditions: sr -z o See attached C> -'r -rigrnm c r -y CC-- z Lr- In the event that no appeal shall have been taken from said approval within twenty days from this date, the North Andover Planning Board will forthwith thereafter endorse its formal approval upon said plan. The North Andover Planning Board has DISAPPROVED said plan, for the following reasons: Date: AugusC 15, i995 NORTH ANDOVER PLAMWG BOARD By:WL JosepiL V. Mahoney, Chairman l �Jr 4. a. A complete set of signed plans, a copy of the Planning Board decision, and a copy. of the Conservation Commission Order of Condition must be on file at the Division of Public Works prior to issuance of permits for connections to utilities. The subdivision construction and installation shall in all respects conform to the rules and regulations and specifications of the Division of Public Works. b. All site erosion control measures required to protect off site properties from the effects of work on the lot proposed to be released must be in place. The Town Planning Staff shall determine whether the applicant has satisfied the requirements of this provision prior to each lot release and shall report to the Planning Board prior to a vote to release said lot. C. The applicant must submit a lot release FORM J to the .Planning Board for signature. d. A Performance Security (Roadway Bond) in an amount to be determined by the Planning Board, upon the recommendation of the Department of Public Works, shall be posted to ensure completion of the work in accordance with the Plans approved as part of this conditional approval. The bond must be in the form of a check made out to the Town of North Andover. This check will then be placed in an interest bearing escrow account held by the Town. Items covered by the Bond may include, but shall not be limited to: i. as -built drawings ii. sewers and utilities iii. roadway construction and maintenance iv. lot and site erosion control V. site screening and street trees Vi. drainage facilities vii. site restoration viii.final site cleanup e. Three (3) complete copies of the endorsed and recorded plans and two (2) certified copies of the recorded subdivision approval, Covenant (FORM I), Right of Way easements, and FORM M must be submitted to the Town Planner as proof of filing. Prior to a FORM U verification for an individual lot, the following information is required by the Planning Department: a. All lots must be approved by the Board of Health. The Board of Health has determined that Lots 6, 9, 12, 13, and 21 cannot be used for building sites without injury 4 to the public health without further testing. No building or structure shall be placed upon these lots without consent by the Board of Health. b. Due to the large amount of rock on the site which may interfere with the amount of parent material available for leaching, the Board of Health will require that the leaching area for each lot be completely excavated to insure that there is the requisite four feet of parent material present throughout the entire location proposed for the leaching area. C. The applicant must submit to the Town Planner proof that the FORM J referred to in Condition 3 (c) above, was filed with the Registry of Deeds office. d. A plot plan for the lot in question must be submitted, which includes all of the following: i. location of the structure, ii. location of the driveways, location of the septic systems if applicable, iv, location of all water and sewer lines, V. location of wetlands and any site improvements required under a NACC order of condition, vi. any grading called for on the lot, vii. all required zoning setbacks, viii. location of any drainage, utility and other easements. e. All appropriate erosion control measures for the lot shall be in place. Final determination of appropriate measures shall be'made by the Planning Board or Staff. f. All catch basins shall be protected and maintained with hay bales to prevent siltation into the drain lines during construction. g. The lot in question shall be staked in the field. The location of any major departures from the plan must be shown. The Town Planner shall verify this information. h. Lot numbers, visible from the roadways must be posted on all lots. 5. Prior to a Certificate of Occupancy being requested for an individual lot, the following shall be required: a. A stop sign must be placed at end of Pheasant Brook Road where it intersects with Salem Street. b. A driveway easement across Lot 22 must be granted to Ian 5 CHRIS RANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 February 20, 1996 Ms. Sandra Starr North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 3A Pheasant Brook Road (Evergreen Estates Subdivision) Dear Ms. Starr: (508)373-0310 FAX: (508) 372-3960 CBOAVAIJ ur:Z1 EB0 Thank you for your February 7, 1996 comments regarding the Septic System Design for the above referenced lot. I have the following responses to your reasons for disapproval. 1. Perc Tests 3-lA and 3-1B in the reserve area were abandoned not because they were failing but because it appeared likely that they would not meet the requirement that the first 3 inches drop in 30 minutes or less, and thus a 4 hour soak would be required. The rates of drop in the perc tests led us to believe that the area would pass the percolation test after a 4 hour soak. Since it was the morning of the first day of testing and we wanted to proceed to other lots that required testing, we decided to put off the 4 hour soak at that time. When we went back to this area the following day, Perc Test 3-1C was dug, and, after the required 4 hour soak, passed with a perc rate of 15 minutes per inch. In order to detemine whether a 15 minutes per inch perc test in this area is a fluke or is consistent with the soil conditions in the area, we reviewed the test results for the abutting lots. We found that there have been a total of 10 perc tests performed on lots 2A, 3A, and 4 within 200' of the abandoned tests. The perc rates of these 10 tests ranged from less than 2 minutes per inch to 17 minutes per inch. None of the tests had failed. It appears that the 15 minutes per inch rate is consistent with the soil conditions in the area, and no further testing is required. I would also like to point out that if the reserve area were to be constructed, there would be more than 4' of fill placed under the leaching area due to the high E.S.H.W.T. and the thick subsoil layer that would be removed. This would result in an effective 4' receiving layer of less than 5 minutes per inch material. 2. Note #2 has been changed to correspond with the latest version of 310 CMR 154.255 (3). The Assessors Map and Parcel numbers have been added to the title block. Please be aware, however, that this information does not identify this particular lot because the Assessors' office has not yet updated the maps to include the subdivision lots. Most of the lots in the subdivision area either totally of completely located within this parcel, and therefore the information was excluded from the septic system design to avoid confusion should anyone attempt to reference the lot by this designation. The designation will change when the Assessors' maps are updated. 4. The plan clearly indicates that the distribution pipes are to be joined together at the ends, both in the Longitudinal Section Detail and in the Plan view of the design. No revision is necessary. Enclosed are 3 copies of the revised Septic System Design for have any other comments regarding this design. [I Christainsen t contact me if you I CHRISTIANSEN and SERGI, INC. VENDOR ID: NA -T PAYEE: TOWN OF NORTH ANDOVER 16645 CHECK NO.: 16645 DATE: 02/21/96 MEMO: lot 3a CHECK TOTAL: ********$25.00 DATE Sheet BOARD OF HEALTH TOWN OF NORTH ANDOVER of SUBSURFACE DISPOSAL DESIGN REVIEW FEE�PERMIT # �� DATE RECEIVED /a�`Z7 /�6— APPLICANTASSESSOR'S MAP ADDRESS PARCEL # LOT # 3.4 STREET "4�A5/9.U7- -75,fc61<- fb ENGINEER e ,"15r/9A/5G/U 4- SE e6,' ADDRESS PLAN DATE 7Z /0;7 9-1 REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED /l/Ec�� i�T GE T� TD 7�7E,� i /Vp 6C,e 114) 55 /A-) G^ t) L-) NOTE 6 r Town of North Andover t NORTH OFFICE OF �r ° �t COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street North Andover, Massachusetts 01845 SSACHUS� (508) 688-9533 February 7, 1996 Christiansen & Sergi 160 Summer Street Haverhill, MA 01930 Re: Lot 3A Pheasant Brook Road Dear Phil: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Two abandoned peres in reserve. Need at least one additional passing perc to demonstrate that acceptable perc is not a fluke. 2 ) Note 2 should be changed to agree with 310 CMR 15.255(3). 3) Map & parcel number missing. 4) Add note that pipes ends in field are to be joined. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cj p BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Partin D. Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell mer JEFF POOR Date of Pumping: 7/28/08 Commonwealth of Massachusetts NOR'T'H ANDOVER , Massac us���' Lok lox1H un 72 PHEASANT BROOK ROAD Quantity Pumped: 1500 gallons Cesspool: No ® Yes . ❑ Septic Tank: No ❑ Yes RAGGS SEPTIC SERVICE, INC. System Pumped by:—d.b.a. E. A. COMEAU SEPTIC License Contents transferred to: WATER SOLUTIONS GROUP, TAUNTON. Date 7/28/08 Inspector RAGGS SEPTIC SERVICE, INC.