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HomeMy WebLinkAboutMiscellaneous - 724 SHARPNERS POND ROAD 4/30/2018j . 9 114 ell I'li <<jC V 1 O c > v� Z o mm OD W N 00 I 0 v 0 00 g z 0 a sz North Andover Health Department (ommunity 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. Thank,you, S an Sa er, /REHS Health Director Notary Public DOr r �., PUMJC r ❑r 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 SUBDIVISION PLAN OF LAND IN NORTH ANDOVER � O� Scott L. Giles, Surveyor June 2, 1998 If - Subdivision Subdivision of Lot 5 Shown on Plan 40967-8 sh. 2 Filed with Cert. of Title No. 11905 North Registry District of Essex County Separate certificates of title may be issued for land Abutters are shown as shown hereon as ots 11 and 12 on original decree plan. By the Court. ,( 1 " Copy of part of pion — filed ,n — W.� co Uwo REGISr2mnON OFRCE SEPT. 11, 1998 SEPT. 11, 1998 Seats of this plan 100 feet to an Inch ABH-02YJ Louls A. Moore, Enghecr for Court -7 .?ecl as //. /.5 11., i Doc --?8 s.535 ..Db. -19-20.09 12255 QUYTCL,AIMMEM.th.Land Court wistrx We, Hans 6 Ruecker and Elise Tai Ruecker of North Andover, County of Essex, Massachusetts in consideration of one dollar ($1.00) paid grant to Peter E. Ruecker as Trustee of 724 SHARPNERS POND ROAD REALTY TRUST of North Andover, County of Essex, Massachusetts with quitclaim covenants (Description and encumbrances, if any) The land in North Andover, Massachusetts, being shown as Lot Nos. i 1 & 12 on plan hereinafter mentioned. All of said boundaries are determined by the Land Court to be located as shown on plan drawn by David W. Preston, Registered Land Surveyor, of Development Service Company, dated January 31, 1994, filed in Land Registration Office as Plan No. 40967-B. Said Lots 11 and 12 contains approximately 2.0 acres, more or less, according to said plan. The adjoining land of the Commonwealth of Massachusetts also known as Sharpners Pond Road is subject to the provisions of a deed from the United States of America. dated March 12, 1973, and duly recorded in Book 1219, Page 58. For Grantor's Title, see Book 117, Page 233, Certificate of Title no 131 k1 of the Essex North County Registry of Deeds dated September 3, 1996. Witness our hand and seal this day odojv , 2009 —7'a AR - Hans G. Ruecker Elise Tai R ker The Commonwealth of Massachusetts Essex, ss jjjl.P q , 2009 Then personally appeared the above named Hans G. Ruecker and Elise Tai Ruecker and acknowledged the foregoing instrument to be their free a deed, before Me, o - Public mmission expires: PREPARED BY: DALTON & DALTON, UP P.O. B" 608 CHARLES F. DALTON, JR. Andover, MA 01810 Notary Public (978)470-I320 Cmmwew of mw2ftsft Ut My Commiwlon Explrn Novea # 19, 2015 fA N .t (A to MAP # PARCEL # I LOT # Qt STREE V HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE APP. BY --- DESIGNER: Pee 4 PLAN DATE:- �- CONDITIONS WATER SUPPLY: TOWN WELL PERMIT- 0 WELL TESTS: CHEMICAL COMMENTS: a 4 DRILLER 7-d - OG b& --A) . ... . . ... .............. . . .... ......... . ... ... ... BACTERIA I BACTERIA II DA I E APPRUVED�v'v�/�f_s DAIE (IPPRUVEDO/ovk DATE APPRUVED�/e-4� J/ 9�:C FORM U APPROVAL: APPROVAL TO ISSUE YE5 NO DATE ISSUED -9 BY CONDITIONS: FINAL APPROVAL:. ALL PERMITS PAID NO WELL CONSTRUCTION APPROVAL YES NO YES SEPTIC SYSTEM CONSTRUCTION APPROVAL', t yE NU OTHER NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE:64f/ Dy.-...-�/j i v `, a �E I r SZUQ ".Js 'THEINSTALLER LICENSED? ` YES _NO f .TYPE OF.- CONSTRUCTION: " NEW REPAIR ♦;', NCW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YE NO CONDITIONS OF:. APPROVAL • YES NO 1 (FROM FORM U) r,ISSUANCE OF DWC PERMIT _ ES NO I DWC PERMIT .NO. � `. INSTALLER: BEGIN INSPECTION YES 0:' ' -EXCAVATION, INSPECTION: :NEEDED: PASSED CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: %'FINAL. GRADING APPROVAL: DATE �e— BY DATE:' S FINAL CONSTRUCTION APPROVAL: -BY 41 ,. '7 Z y '70 13 t 3 Z , �, ,; � : � s, V ? 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'_c:.•.. ;. i,.r•,`�.� .,'.d..._ _ ,.. ..,. ^.:•...,.t ....,.:r_ ... .'_'D:>k:xr_.t.ai. 's2A'i'c 2' �r��( NC-1,.�� ._ '1s's±� A`O° LOCATION: H/O NAME CONTRACT 7038 Type of Permit or License: (Check box) OE MORT :,y . O 0 Animal $ • Town of North Andover �'•�,; ;o �: HEALTH DEPARTMENT ,SSACNU`+�S CHECK #: DATE: 16 r. LOCATION: H/O NAME CONTRACT 7038 Type of Permit or License: (Check box) 0 Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector Title 5 Report $ $ ❑ Other. (Indicate) $ X A Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Of NORTH ,� � ,«✓ 10- • Town of North Andover ,SSACMUSR4 r CHECK #: LOCATION: H/O NAME: CONTRACT( 70 Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ 4 ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ 'Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5Inspector $ Title 5 Report $M ❑ Other. (Indicate) $ Health Agent Initials 9 White - Applicant Yellow - Health Pink - Treasurer PEARCE CONSTRUCTION Town of North Andover Title V filing fee 10/24/2014 7421 . CITIZENS BANK Title V filing fee 50.00 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. ISI Commonwealth of Massachusetts f I., Title 5 Official Inspection Form FiLL5 � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Stinson Owner's Name North Andover Cityrrown MA 01845 State Zip Code Inspection results must be submitted on this form. Inspection forms way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Warren Pearce Jr Name of Inspector Pearce Construction Company Name 196 Park Street Company Address North Reading Cityfrown 978-664-5264 Telephone Number B. Certification MA State SI1959 License Number 10-14-2014 Date of Inspection not be altered in any RECEIVE OCT 28 2014 TOWN u1- NUR I H ANDOVER HEALTH DEPARTMENT 01864 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority W Q!!�-)C)— Inspector'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 - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 1 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 724 Sharpners Pond Road Property Address Brian Stinson Uwner'S Name North Andover MA 01845 10-14-2014 CitylTown 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: ® 1 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: Leach area is located on the adjoining property. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Stinson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ 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. t5ins • 3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Stinson Owner's Name North Andover MA 01845 10-14-2014 City(rown 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 ❑ M Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow Title 5 Official Inspection Forth: Subsurface Sewage Disposal System . Page 4 of 17 ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. l 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 - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Stinson Owner information is Owners Name required for North Andover MA 01845 10-14-2014 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No F� ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. l 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 - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ti 724 Sharpners Pond Road Owner information is required for every page. Property Address Brian Stinson Owner's Name North Andover MA 01845 10-14-2014 Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ❑ ® Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ❑ ® Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information_ For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): t5ins • 3113 Title 6 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 JCC Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Stinson Owners name North Andover City/Town D. System Information Description: RAA 01845 10-14-2014 Zip Code Date of Inspection Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): N/A Detail: Well water in use. There is no meter. Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ 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 724 Sharpners Pond Road Property Address Brian Stinson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. City/Town D. System Information (cont.) Last date of occupancy/use: Other (describe below): State Zip Code General Information Date Date of Inspection Pumping Records: Source of information: pumped 3 years ago per owner. Service Pumping Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Stinson Uwners Name North Andover MA 01845 10-14-2014 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1994 plan System is 20 years 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): 2.5' feet Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): All appears in good shape inside the house. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal If tank is metal, list age: 39" Risers to grade feet ❑ fiberglass ❑ polyethylene ❑ other (explain) years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'6" by 5'8" by 5" deep Sludge depth: 3" 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 724 Sharpners Pond Road Property Address Brian Stinson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness <1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 16" 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.): Tees are in place and in good shape. Liquid is at the proper level. Tank appears in good shape. No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 'R a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5.1 724 Sharpners Pond Road Owner information is required for every page. Property Address Brian Stinson Owner's Name North Andover MA 01845 10-14-2014 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons ❑ polyethylene ❑ other (explain): 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 • 3113 Tide 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 M 724 Sharpners Pond Road Property Address Brian Stinson Owner Owners Name information is required for North Andover every page. CitylTown D. System Information (cont.) MA 01845 State Zip Code Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 10-14-2014 Date of Inspection 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.): Distribution box is clean and level. Distribution is equal with 2 pipes out. Minimal solids in d -box. Disribution box is 4' below grade, risers have been added to within 12" to 15" of surface (site slopes down in this area.) Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 O 1 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Stinson Owner Owner's Name information is North Andover required for MA 01845 10-14-2014 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 60' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No surface sign of problems and no indication of backup in distribution box. End of both trenches have been located and marked with a grade stake orange top Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Stinson Owner's Name North Andover MA 01845 10-14-2014 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3/13 Title 5 Official Inspection Forth: 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 724 Sharpners Pond Road Property Address Brian StSinson Owner's Name North Andover MA 01845 10-14-2014 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately I a x Iy ToO L� Y Caq, •� s Ll �c I(moo• � t 1J;V p W T �O li- �6 �. Ttb EJ F `r/LpiNLt� 15ins • 3/13 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 724 Sharpners Pond Road Property Address Brian Stinson owners Name North Andover MA 01845 10-14-2014 Ctty/TownState 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: 7' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked date of design plan reviewed - Final revision date 6-6-1994 ' Date ® Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: Review Files El Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test hole data from design plan dated 6-6-1994 (final revision). Site slopes down in the rear to a wet area well below the bottom of the leach trenches. Before filing this Inspection Report, please see Report Completeness Checklist on next page. (Sins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 " Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Stinson Owner .. information is required for every page. t5ins - 3/13 North Andover MA City/Town State E. Report Completeness Checklist 01845 10-14-2014 Zip Code Date of Inspection ® 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 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 ME DEPARTMENTAL. REFERPAL, FORM Director, Public Works Assistant Director of Engineering Fire Chief Conservation Administrator Building Inspector Health Agent Police Chief FRONT : Town Planner and/or Clerk, Planning Office RE. Preliminary Plan _ Definitive Subdivision Special Permit Site Plan Review DATE -f A Public Hearing has been scheduled for ? p.m. on to discuss the plans checked above (preliminary plans dono er quire public hearing). Ifyotrrrevfe5v eer�rffenis suggestions -an or recomm�n lyes plans-hav— e cFiTH-Te-t—since ttie Technical Review Committee meeting of ,' ` i r" ; \ � L-A , 19cl Li at -which -these plIansw=- discussed, may-we-pi-ease-lraveyuur icNised comrirents-NO-LATER-THA-N----------- - - ---- Thank you. 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 keyy. a9un ��ECEib'�D Commonwealthof Massachusetts OCT 212014 ��Title®Official�'�� Inspection F® FNUtNUKIfiANDOVER Subsurface Sewage Disposal System Form - Not for Voluntary A DEPARTMENT 724 Sharpners Pond Road Property Address Brian Steinson Owner's Name North Andover Cityrrown MA 01845 10-14-2014 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. A. General information 1. inspector: Warren Pearce Jr Name of Inspector Pearce Construction Company Name 196 Park Street Company Address North Reading City/rown 978-664-5264 Telephone Number 5. Certification MA State SI1959 License Number 01864 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. l 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 220-)� VIv Inspectors 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 • 3I13 Title 5 Official inspection Form: Subsurface Sewage Disposal System • Page i of 17 Commonwealth of Massachusetts Title 5 Official Inspect)®n Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name information is North Andover required for MA 01845 10-14-2014 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E 1 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: Leach area is located on the adjoining property. 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):. Mns - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name information is North Andover MA 01845 10-14-2014 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y [] N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning In a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins - 3113 Title 5 Official inspection Form: Subsurface Sewage Disposal System •Pape 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 724 Sharpners Pond Road Property Address Brian Steinson Owner's Name North Andover MA 01845 10-14-2014 CityfTown 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 aseptic 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 El ® 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 15im • 3113 Tide 5 official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name Information is required for North Andover MA 01845 10-14-2014, every page. cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Anyportion 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 Iis within 50 feet of a private water supply well. ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes If the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes" to any question in Section E the system Is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 151ns • 3/13 Tide 5 OPodal Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as NIA) ❑ ® 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)1 D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): 440 15ins • 3H 3 Title 6 Official inspection Form. Subsurface Sewage Disposal System • Page 6 or 17 Commonwealth of Massachusetts Title 5 Official Inspecti®n For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): N/A Detail: Well water in use. There is no meter. Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non -sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins • 3113 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 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. Cityrown 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: Type of System: Date pumped 3 years ago per owner. Service Pumping gallons ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ 0 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): . 15ins • 3113 Title 6 official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Z Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1994 plan System is 20 years 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: 2.5' feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): All appears in good shape inside the house. Septic Tank (locate on site plan): Depth below, grade: Material of construction: ® concrete ❑ metal If tank is metal, list age: 39" Risers to grade feet ❑ fiberglass ❑ polyethylene ❑ other (explain) years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'6" by 5'8" by 5" deep Sludge depth: t5lns • 3113 3" Titre 6 Ofiidal Inspection Form: Subsurfaoe Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness `1 Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 16" 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.): Tees are in place and in good shape. Liquid is at the proper level. Tank appears in good shape. No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: feet ❑ polyethylene ❑ other (explain): Date 151ns. 3113 Me 0 WWI MspecUon Form: Subsurface Sewage 015posal System • Pape 10 of 17. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner Owners Name Information is required for North Andover MA 01845 10-14-2014 every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Capacity: Design Flow: Alarm present: El fiberglass ❑ polyethylene ❑ other (explain): gallons gallons per day El Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments. (condition of alarm and float switches, etc,): " Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No ISIns+3/13 Title 5 official Inspection Forth: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. Cityfrown state Zip Code Date of Inspection D. System Information (cont.) Distribution i3ox (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.): Distribution box is clean and level. Distribution is equal with 2 pipes out. Minimal solids in d -box. Disribution box is 4' below grade, risers have been added to within 12" to 15" of surface (site slopes down in this area.) 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: (Sins - 310 Tide 5 Oflidal Inspection Porn. 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 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: El leaching galleries number. ® leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 2 60' Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No surface sign of problems and no indication of backup in distribution box. End of both trenches have been located and marked with a grade stake orange top. 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 1Sins • 3113 Tide 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts t Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner owner's Name information Is North Andover required for MA 01845 10-14-2014 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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 TWO 5 Offldal Inspection Forth: Subsul face Sewage Disposal System - Page U of 17 I' , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian StlAson Owner Owner's Name information is required for North Andover MA 01845 10-14-2014 every page. City/town . 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 To i? -.Ab bo 7s i✓ WD bF I-AfiNcti �tj-;TLIN- le .1-3. a = to t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 115 of 17 4,. Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson owners Name North Andover MA 01845 10-14-2014 Cityrrown 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: ?'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Final revision date 6-6-1994 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Review Files ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test hole data from design plan dated 6-6-1994 (final revision). Site slopes down in the rear to a wet area well below the bottom of the leach trenches. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3113 We 5 Official tnspeclion fon». Subsurface Sewage Disposal System - page 118 of 17 ' f4 Commonwealth of Massachusetts WW— -Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpners Pond Road Property Address Brian Steinson Owner Owner's Name . information equired for is North Andover required for MA 01845 70-14-2014 every page. Citylrown 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 15ins • 3113 Title 5 official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 I 5009 o w A Town of North Andover HEALTH DEPARTMENT ,SSACHUSEt i CHECK #: M� DATE: r D LOCATION H/O NAME: CONTRACTOR NAME:ZJ. 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) $ �T,.*tlednspector $�'') Report s60-0119 - ❑ Other: (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpner's Pond Road Property Address Peter Ruecker w Owner Owner's Name information is required for every North Andover MA 01845 04/14/10 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor - do not John Soucy/Shawn Brazel use the return Name of Inspector key. Soucy's Sewer Service Company Name 78 North Broadway Company Address Salem NH 03079 City/Town State Zip Code 603-898-9339 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's SOrrature 04/14/2010 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 1 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 724 Sharpner's Pond Road' Property Address Pater Ruecker Owner information is required for every page. Owner's Name North Andover MA 01845 04/14/10 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 � -e. 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Commonwealth of Massachusetts N W Title 5 official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 724 Sharpner's Pond Road Property Address Peter Ruecker Owner Owner's Name information is required for every North Andover MA 01845 04/14/10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 1"0 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 • 09/08 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 724 Sharpner's Pond Road Property Address PPtor Rttarkar Owner's Name North Andover MA 01845 04/14/10 City/Town 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 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 El El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool El El due or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El El or 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 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 - 09/08 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 724 Sharpner's Pond Road Property Address Peter Ruecker Owner information is Owner's Name North Andover MA 01845 04/14/10 required for 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 o+ the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ ® 10,000gpd. The system fails. I have determined that one or more of the above failure ® criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered yes in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 724 Sharpner's Pond Road Property Address Peter Ruecker Owner Owner's Name information is required for every North Andover page. City/Town C. Checklist MA 01845 04/14/10 State Zip Code Date of Inspection 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? El ® 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? ® El the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? information The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins • 09108 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 "p 724 Sharpner's Pond Road Property Address Peter Ruecker Owner Owner's Name information is required for every North Andover MA 01845 04/14/10 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: well 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.): N/A Gallons per day (gpd) ❑ Yes ® No 03/31/2010 Date Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non -sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cwM 724 Sharpner's Pond Road Property Address Pi -ter Ruecker Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: MA 01845 04/14/10 State Zip Code Date of Inspection 03/31/2010 Date General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: Owner 1500 gallons gauge on truck Inspectioin ® Yes ❑ No ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 724 Sharpner's Pond Road Property Address Peter Ruecker _ Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) MA 01845 State Zip Code 04/14/10 Date of Inspection Approximate age of all components, date installed (if known) and source of information: 06/1994 Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): 2.5' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line100': feet Comments (on condition of joints, venting, evidence of leakage, etc.): ❑ Yes ® No Septic Tank (locate on site plan): T Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years is age confirmed by a Certificate of Compliance? (attach a copy of certificate) 6'X 10.5' Dimensions: 3" Sludge depth: ❑ Yes ❑ No t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposai System • Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpner's Pond Road Property Address PPtAr Ri1PCkPr _ Owner Owners Name information is North Andover required for every page. City/Town Q. System Information (cont.) MA 01845 04/14/10 State Zip Code Date of Inspection Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 37" 9 Scum thickness Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 14" Tape and sludge tool How were dimensions determined? a Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins • 09/08 feet El'polyethylene ❑ other (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 wM 724 Sharpner's Pond Road Property Address Peter Ruecker Owner Owner's Name information is North Andover required for every page. City/Town MA 01845 State Zip Code 04/14/10 Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: — Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 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 724 Sharpner's Pond Road Property Address Peter Ruecker Owner's Name North Andover MA 01845 04/14/10 City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 101 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Flow checked ok; no solids carry over. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 t5ins 09/08 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 724 Sharpner's Pond Road Property Address Peter Ruecker Owner Owner's Name information is required for every North Andover page. City/Town D. System Information (cont.) Type: State 01845 04/14/10 Zip Code Date of Inspection ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2: 60'x 3'x 2' ❑ 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.): 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts H - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 724 Sharpner's Pond Road MA 01845 State Zip Code 04/14/10 Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No siqn of hydraulic failure 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 - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 Property Address Peter Ruecker Owner Owner's Name information is North Andover required for every page. Cityfrown MA 01845 State Zip Code 04/14/10 Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No siqn of hydraulic failure 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 - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 724 Sharpner's Pond Road Property Address Peter Ruecker Owrie'r Owner's Name information is North Andover MA 01845 04/14/10 ' required for every page. City/Town 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 El drawing attached separately T61 VNgFNORTNwila 1� 'A' Dot f a` L0CS/cS. FraP 'PR6ADSkD fk(�,R+RYRtE SEP'/Rd' .BisPo5R:1 SYSt9�1" :7 � .Z.O A, 0.6U•.L -G�T'F .µ'Vi -,Pi?�'° m \� 7J 6 +.%' fP�J.-'+.+� a��4'�dACaMbYkc / R•S`.� ;.g � a F o�,, may.+�,s•Qtr/�s' 1��' '��, . +,`...�?, 10 N K2 ( G,f t5ins • 09/08 K, r > ' srz=� i g jl, } �gr�j n Pins s#�q�,S2eg a lgj sal System •Page 15 of 17 -,Pi?�'° m \� 7J 6 e d y r/ n its}, F`� IT •se. `^ � .,r_r� '. A. L \. • r,.,, J• F .11 J. �p i 'Y. fit' r / 4v1•,m'\.•+L` a/ '�. vt �' a 1 r % A y+�' ! '•`: r "' .. . % . 1 i :y R;G .j�����a��iH.A . s.:%i •,�h A'.r "r +'�• •;k: �'-.,;,:�.,h,.,•.,R.,• +.s'r_'-.'ka,'ra�. ;pry '•''s:�r.'r""• 4`rF .>.'Fa.. ..:' .. _ r ��fi 3,�"u•q xYP yrs `• � 'i'o REu k�N l�il �lA�r}` * '.'..'' 4'�,:�, •. •h 4 rr �Sar�'`•" f t�a.�..: tea+ gg,� d. -r , ° :i':'. �''� 1: N K2 ( G,f t5ins • 09/08 K, r > ' srz=� i g jl, } �gr�j n Pins s#�q�,S2eg a lgj sal System •Page 15 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 724 Sharpner's Pond Road D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells MA 01845 State Zip Code 04/14/10 Date of Inspection 7' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 5/24/1993 If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Duq hole with backhoe in low drop off area. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 t5ins - 00/08 Property Address Peter Ruecker Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells MA 01845 State Zip Code 04/14/10 Date of Inspection 7' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 5/24/1993 If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Duq hole with backhoe in low drop off area. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 t5ins - 00/08 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °^M 724 Sharpner's Pond Road Property Address Peter Ruecker Owner Owner's Name information is North Andover required for every page. City/Town MA 01845 State Zip Code 04/14/10 Date of Inspection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked 2/Inspection Summary D (System Failure Criteria Applicable to All Systems) completed stem Information — Estimated depth to high groundwater ketch of Sewage Disposal System either drawn on page 15 or attached in separate file Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 t5ins • 09/08 vq 'lw gg —AMP Z., p zip Ul cc 361 C:o CL RAI Am <i 0404 . .... < iza Co 144 la tic. Act 04 Commonwealth,of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 724 Shar2ner's Pond Road Property Address Peter RueCker Owner Owner's Name Information is North AndoverMA 01845 04/14/10 required for every -Et-ty/Town 7State Zip Code Date of inspection page. - D. System Information"(conf) 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 Wilding. Check one of the boxes below: hand -sketch in the area below drawing attached separately '?R0610 SUe9_jftj1,41C,0 50"0, e'A Lf 7-P 44 A)W % - - 2e,1211511 -i -I 4. . . . . . . . . . . gal System •Page 16 Of t5ins - 09108 04 N. 6 41.7 4. . . . . . . . . . . gal System •Page 16 Of t5ins - 09108 s' Commonwealth of Massachusetts TVA itle 5 Official Inspection. Form - a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 724 Shar ner's Pond Road # 7 4 I Property Address Peter Ruecker i OwrWr Owner's Name MA 01845 04/14/10 ' information is North Andover required for every City own State Zip Code Date of Inspection page. 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. 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'�"C�; •, 4;kt'+t:�;.•,�- � ' _•��• ',�- .tr- ,fijY. ti( ��=''z..t ,sszi'.:}i�3:. t~J.•'t. :3••i zl!�_� 1 t ' >., ����• e't-� • T r •�•' `r � iti `•'' ! al System •Page 15 of !Sins • 09/08 lir+a�«rsp'F$ki.:•...:Y, .s:u su :'. , _, z :,•m.:'s.r.t:4 ..7. ':a,4> :rrZ1�iu�<ee:�:.3t' b+....ra.:Y.:rHl+q+a�li+,..ro?Tw•.•,..:, .,... rtic_=:•.. -r.-->;_-..._ ._._ __ - _.- D 0:107.203 12-20--2012 2:15 Caro z 16855 Essex Borth Land Cawt Resistrs When Recorded Retum To. Indecomm Global Services 2925 Country Ddve St. Paul, MN 55117 QUITCLAIM DEED 5:�05,:f$eg, t Gs6w— KNOW -ALL MEN BY THESE PRESENTS THAT: ?kbF � i 7 (10 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: A 712 Sharpness Pond Road, North Andover, MA 01845 4 P'°i ,O* ajdrdkj 5 Witness my hand and seal this _9 day of 11bW--*y 2012. COMMONWEALTH OF MASSACHUSETTS ESSEX; ss On this � day of &m6/ , 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 Pudic u dclr,l t•r o,hj S� j/ My commission expires L-13 -t7 SANOYWIWAMS NOTARY PUBLIC CnmmOnweahh oFMassechUSM �%� My Commisslon Ezplms on Janum 13,2017 .U03242144* 1632 11/27/2812 79189976/4 hj ,y SUBDIVISION PLAN OF LAND IN NORTH ANDOVER J'�j (� 0 Scott L. Giles, Surveyor V .7 / June 2, 1998 Subdivision of Lot 6 Shown on Plan 40967—B Sh, 2 Filed with Cert of Title No. 11.905 North Registry District of Essex County Separate certificotes of tftle may be issued for land shown hereon as Lots M and 14 By the Court.. 1 + Copy of pod of ct�an X0967—C Ilk. ' . • .1 • . . . LAND REGISTRATION .OFFICE SERs 11, 1998 e or r sEPT. 11, 1998+ W-0368 Scold of thlg pkntoo het to an h Loute AMaae, Engbeer for Co� ® 'r 4. O N N ' m O pmmm mm�y7�7� �wm X m ;;;*0O n w7N,^j Owns� O z 3mq s 7NN0 CR1�*0 a rt =0 n �A..A?moo$ 4 V1 = ,Z7 -D m n..mo a w aoi 3 -C- 03i Z W=NO rn N ' Ns G33 05 a� m ;;;*0O n w7N,^j Owns� O z 3mq (D (D W 9) (D r,,nn � E+ 1U 0.2- �A..A?moo$ 4 V1 fl.Dw Oz �_�� ,Z7 -D cn� '_ "0> c')=- w aoi ��n �w�1n'Ny'N RDI �v O0F W W O �a z 0 0 �m C� m r co W N = 4� w a m D n O Z q 0QLZ prs c: Z n A mas�vm O gl� n O@ w 4' Oma; M-0 N -n n � " R OOO 71 0 00 Oe � ?I� T� = O C Z w a3o. Woo �D3D� �v F! -c Dm D w to a 06 0 �~ w00 w nZ 0 00 �„ �X rn of O °D 0 � Gi.Gis, N ,> Z C G> N N < L'iIn t a 0 0 a- rn N ' >>Own .w mmw> CLCL� GD O O --i C ;;;*0O n w7N,^j Owns� O z 3mq (D (D W 9) (D r,,nn � E+ 1U 0.2- CR" . 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O0F (n iTJ iC C`Ji C`T NIV -{...a ON� b7 Opo o� o> N 0 Q Ul00 i 00 00 i t mas�vm (1) Cl) D M 71 0 o <-�p.0 ,c:mmm o�� D 0 0 m N o O N O � N N a X IV Z Q.oX0 '(D Nay0 ' wo N Om �T' a0 W oo °071 0 r�rao O Z uooao p 00000 p j 0 0 0 N W ,q 1 e4 1 -4 Iq 1�4 �� A of NoRIUD) m COPY �SSACHus�� North Andover Health Department (ommunity 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 -in regards to the properties'bnsite 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 y 15.010. " (2) Prior to dividing a facility all existing systems shall be inspected in accordance with 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 1.5.305. 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 he 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 Susa S wy�a" er, S S C/ Pub is Healt irec 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 Blackburn, Lisa From: Sent: To: Sawyer, Susan Thursday, October 02, 2014 11:48 AM Blackburn, Lisa Subject: FW: Sharpners Pond Road, North Andover Email for mitchell From: Mitchell E. Weisman[ma i Ito: mweisman (ab massfirm.com] Sent: Tuesday, September 30, 2014 4:00 PM To: Sawyer, Susan Subject: Sharpners Pond Road, North Andover Hi Susan - I spoke to Matt Egge. We have no issues with the Planning Department. I will wait to hear from you regarding resolution of the potential Health Department issue. Thanks for your help. Mitchell Mitchell E. Weisman, Esquire Kajko, Weisman, Colasanti & Stein, LLP 430 Bedford Street, Suite 190 Lexington, MA 02420 (P) 781-860-9500 (F) 781-861-1833 www.massfirm.com CONFIDENTIALITY NOTICE KAtK0,WEISMAN,C0tASAN"n&SM1N, Axa, The pages and attachments of this e-mail contain CONFIDENTIAL INFORMATION from Kajko, Weisman, Colasanti & Stein, LLP. This information is intended solely for the use of the individual or entity named as the recipient hereof. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of the contents of this e-mail is prohibited. If you have received this e-mail in error, please delete it and notify us by telephone at 781-860-9500 or by return e-mail. Your cooperation is greatly appreciated. Applicable U.S. Treasury Regulations require that we inform you that any federal tax advice contained in this communication (including any attachments) is not intended or written to be used, and cannot be used, for the purpose of (i) avoiding penalties under the Internal Revenue Code or (ii) promoting, marketing, or recommending to another party any transaction or matter addressed herein. Please consider the environment before printing this email E , n _ t.\ 2 LLk Ln / t / A S Q g @ LA / \ \ ƒ 00 m ? ~ \ u -C / 04 \ FD \ \ J � » .\ ® u f m m % = 2 § \ ¥ / mLn l f \®f \ /UJ U X� e a o— u E§ >2 LL LL 3 u /\/\\0 \/ / < � ®2oL @ 2 / §�*5Ln 0 @ # ® 0 c z2 LL/ 0 g / { 2 0 . $ / s 3 \ q / \ / / ) / E ® 9 / Q o 04 E un m g d / 0 7 / . S u •- - J l Ln a c 3 / E .L'I / / \ < R w oranftt, otatt Main office' Laboratory 22 Manchester Rd. - Rt. 28 Derry, NH 03038 (603)432.3004 . Trrttifiratr of ;knalgsis SENT TO:I Andrew & Maurice Bldrs. DATE & TIME SAMPLED: 06,/15/95 At: f ramway Marketplace 'Route 16 & 2$ West Ossipee, NH 03890 ? -800»699-"20 for Prinkin'S 3Vatrr PARAMETER RESULT" (PPM) PH UNITS HARDNESS CHLORIDE NITRATE NITRITE SODIUM IRON MANGANESE COLIFORM ABSENCE /100 ML OTHER BACTERIA /100 ML COPPER ARSENIC LEAD CHROMIUM CALCIUM FLUORIDE COLOR CPU ODOR TON TURBIDITY' NTU HYDROGEN SULFIDE TEST NO.: 18964 SAMPLE' LOCATION: Lest 5 Sharpners Pd "24 SharpDers Pond No. Andover, MA EPA RECOM i-,NDED ,KAX.LEVEL(PPM) 6.5 — 8.5 UNITS 150 250 10.0 1.0 250 0.3 0.05 ABSENCE /100 ML 200 -/100 ML 1.3 0.05 0,015 0.1 NONE SET 2.0 15 CPU 3 TON 5 NTU ;SONE SET (XXX) THE TESTED PARAMETERS MEET CURRENT EPA STANDARDS FOR DRINKING WATER. ( ) THE TESTED PARAMETERS MEET CURRENT EPA PRIMARY STANDARDS FOR DRINKING WATER, BUT SOME SECONDARY PARAMETERS EXCEED STANDARDS. ( ) THE TESTED PARAMETERS FAIL CURRENT EPA STANDARDS FOR DRINKING WATER DUE TO PRIMARY STANDARDS OUTSIDE OF LIMIT$. -------------------------------------------------------------------------------------------- COMMENTS < LESS THAN OUR LOWEST CALIBRATION POINT GREATER THAN OUR HIGHEST CALIBRATION POINT TNTC TOO NUMEROUS TO COUNT 1 FLAGS PARAMETERS THAT EXCEED PRIMARY STANDARDS; CAUSES TEST FAILURE. 2 FLAGS PARAMETERS THAT EXCEED SECONDARY STANDARDS: DOES NOT F'AI'L TEST NOTE: SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY VF{ AuU�orized ley GG OTTLEM., Min ww.pOkG, f.v5 01bat _ (906? b92,8 4S FAX (508) 692 002) 1.9()0.649�TE'T Report Number: C -i° 009 cliont,a ThOMAN Qgd�{ra 17 0&thelgw4d Tew$ccbo�� , 'MA 61AU Report bates rlarah 201 1095 Sam la Taktn Aire L10%;' I - Mla prmr o rand Rd M w1hudovtaai Hems. Ump3 a Tnk4n icy a 69da4n staff 601 Maroh i7 a 1905 d�1t'�1�`YC�t�� f�P A1+YAYrY.fi�ZB� TEST PAkAM*.rizn e Total Cal Matin (P) calgium �:OpOp6r (a) Iron (a) 3iagnesa4um t�nr►gat�4ers C� ) sodium �btAi� Ea Z1YlYt � $ ) Alkalinity jo) AMb.n i e, Chl6elds { } chiarina (t6tal ) calor (a) ; conduutiv"y liardness Nitratea ( air ts) t F ) S�iCrl.tss(s.j� h) PH (d) odor (s) 0ul.phate s ka) Turbidity 89dimont EPA Mkk A291VLTV U 42Ta 0 0 Per i 0010 NO Limit 25.4 mgt/L 1.$ <0.01 Mq M ti . 3 3. 7, mq /L NO Limit 1..6 mg/11 0.05 mg/L No Limit 0.1 Mg/r, Na Limit We M9 /K' No %i+tir9 t 0.i10 mg /L 250 .5.5 mg/L m6t QV40, ed,OS MgrL IS CPU No Limit. 164 umhoa/can No Limit 70 mq/L 10 0.01 ung/L 1 -CO. Oa 091 IL 6.5+9I5 6.6 su 3 1 TON 150 5 , 2 mag /I/ 5 5 NTU poo/neq pas HT -Not Too *dr #-Value Zrcaede 1WA M, %7NTC+TQQ NUMOrqus "anldc xvirQu d sa vuvrja Not*dr ,,*ArA Advisory Limit '-3:0sado� M Advisory Limit (P}-1Prieaaar r am 04andard, (d)-0000 adary EPA oti 41adAL4 (Amy aaethetica; 0f driAiwi way.<61: 4.0. LA41tef 00103:1 etc*) This wader' samplo, as t-#*t#dr is cc-n►idored MAVE t,:� drink to EPA quiktelinsa. "C7w vor, r one or amore bf the parameters XPA ovoQndary standards as indicated by the (4) sJ,g:r,. Masdaachuse'tts state Certified Testings L4oratory OMA040 to count at to maac.rMn$ 6xceeda 21r4aa F. Carlson, for Thoratensen L aboz:ataxy Xi • BOA -RD OF lire LTH AN DoVETZ, Jlxss 14oRTH Permit A permit. is r )_ squact-Qd tn. ei ......... . C -Lof"1. �") A/A/..9t 4- LOCATION LV rd1't`' Owne Add. Well Contrctjq L e Tel j4d'd f Pump Contn­t ****** SMELT �e'llo be col"Plete.d At P. Tj se - L . Type of size Diameter Depth of Depth casing No Date of Seal been t wa t;a r Depth, P 14 'For. Depth tO t P_ r Del Or S- (bo w . . . e '.?� P 4 ) TO —bours M Drawdowl). coat after' Date of Completion, SI PUMPS tl be tame & 'Size of j')"IMP kzy/ G P 111� 1pump, delivers PI. a Cast i r 0 n C pj_pe used Sleeve used to protecl- Yes L___ PuTV.P Date," Health :ted Bcard of Cr analysis Date wat . ......... I . ......... DelleChiaie, Pamela Subject: Sandy-APPT. Location: 27 Charles St. - Counter Start: Tue 5/13/2003 9:00 AM End: Tue 5/13/2003 9:15 AM Show Time As: Tentative Recurrence: (none) Meeting Status: Not yet responded Required Attendees: DelleChiaie, Pamela; Starr, Sandy Hans Ruecker of 724 Sharpeners Rd. came in this morning. His leach field is on his neighbor's property. He would like to discuss this with you, and options of what he should do. He is concerned that if he or neighbor try to sell their property, that it would become a concern. If you need to reach him, his number is: 978-989-9905. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: PhoneIt 1c1�1 3S 7( LOCATION: Assessor's Map Number 1015 ) Parcel C4f Subdivisionr �2��1 .' Lots) a Street S h A�oa�u,e �i< ��,,.�� 1ZA St . Number 7 Z `% ************************Official Use Only************************ RECOMMENDATI NS OF TO AGENTS: A&,& Conserves ion Administrator Comments Town Planner Comments Food Inspector -Health j Septic Inspector -Health Comments Date Approved Date Rejected �� +D )bwte Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections r1 e, -L-) / _ 1,5'- �� - driveway permit T Fire Department Received by Building Inspector Date DATE_ � 1 ex - Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE PERMIT # DATE RECEIVED / APPLICANT 7-0 6Y -Z/- ' 7"0-067- ADDRESS "0-06?ADDRESS ENGINEER J . ADDRESS ASSESSOR'S MAP PARCEL # LOT # P.o�✓ioc� 3 STREET PLAN DATE 0%glW- REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED .lC 61 ,0,219-7 X19 /A%b/Gl,97 b 7,0 �G • /z�� m ', iDG G./�5� Sr.�D u� � �itJ/3G �` /c'�3/jJ.�L> �' ee 7---7 /j C4 :�oJm ' z +r O ` O AS y o a� Q=om �omt� N :oa :oo g gym= .>3 t • y ... Q m y �! c m a y A o fA m _ .o 0 cm 4, C: aca C:y®m oc L O Cp C O Q=� m m O � ca y o TT c�•�Z o cm Q _ c ca �.. o a . Q m �/ /�. 2 o= C2 = mV':m�o N a f" y m o O c/� cv t m W c�"' �� w F- y at�5 Z Qcm _+r �• Q V m C2 m C J �A a m� off_ Z eyv yo O Sa.... m Z wO ., U WE- E W C6 OW CD 0 CD 0 0 G CA y CLL t C 0 CD Q m CO) O .CL CO) C C d H r�mb� L CO -� a - COD C CD tm z o o cm C, w m m z 0s o CD 0 EL Om Q CIO J � Z cv CO2 �l C A O U O� U� � u \IN ruc, 4,PQ is(n [ L ""`/ U) wo rx w w V) C/) C4 :�oJm ' z +r O ` O AS y o a� Q=om �omt� N :oa :oo g gym= .>3 t • y ... Q m y �! c m a y A o fA m _ .o 0 cm 4, C: aca C:y®m oc L O Cp C O Q=� m m O � ca y o TT c�•�Z o cm Q _ c ca �.. o a . Q m �/ /�. 2 o= C2 = mV':m�o N a f" y m o O c/� cv t m W c�"' �� w F- y at�5 Z Qcm _+r �• Q V m C2 m C J �A a m� off_ Z eyv yo O Sa.... m Z wO ., U WE- E W C6 OW CD 0 CD 0 0 G CA y CLL t C 0 CD Q m CO) O .CL CO) C C d H r�mb� L CO -� a - COD C CD tm z o o cm C, w m m z 0s o CD 0 EL Om Q CIO J � Z cv CO2 �l C A 1 R M.. • . � \ � 44 `'` � l 1t t't.F G `,- ''.. tib. t .* t• I Town of North Andover, Massachusetts Form No. 3 MORTN BOARD OF HEALTH f F �''�•,,,o,�"� DISPOSAL WORKS CONSTRUCTION PERMIT 1SSACMUS�� 0 Applicant_'• NAME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. Fee r CHAIRMAN, BOARD OF HEALTH D.W.C. No. a2 PLAN REVIEW CHECKLIST OZ,6 Gvr j ADDRESS Qr,15' �1�A,eP�u�,e� ENGINEER GENERAL 3 COPIES STAMP LX LOCUS NORTH ARROW SCALE CONTOURS PROFILE (/ SECTION Z/ BENCHMARK 6/'. SOIL & PERC INFO c/ ELEVATIONS WETS. DISCLAIMER WELLS & WETLANDS WATERSHED?/U0 DRIVEWAY' f(Elev) WATER LINE FDN DRAIN C� SCH40 TESTS CURRENT?—/99,-3 SEPTIC TANK MIN 150OG L� .17 INVERT DROP 41 GARB. GRINDER/I%O (+200% EDF) 25' TO CELLAR �� MANHOLE TO GRADE � ELEV GW Y D -BOX SIZE # LINES^ FIRST 2' LEVEL STATEMENT INLET - OUTLET/&,p-F3= - %? (2" OR .17 FT) TEE REQ'D?_ LEACHING MIN 660 GPD? RESERVE AREA %'41 FROM PRIMARY? X2% SLOPE 100' TO WETLANDS �00' TO WELLS ✓ 4' TO S.H.GW 1-- 35' 35' TO FND & INTRCPTR DRAINS 325' TO SURFACE H2O SUPP Lam' 4' PERM. SOIL BELOW FACILITY MIN 12" COVER � FILL? Pa (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 6') IS RESERVE BETWEEN TRENCHES? 1✓� IN FILL? - MUST BE 10' MIN.----- 4" PEA STONE?In�-x BOT _�60 X LDNG + SIDE .4049 X LDNG _ = TOT (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) O'S0" �1IJ &,s 0r- s � �Copyright O 1993 by S.L. Starr >&: N E TO (5�)l�E d S P mac, a 064, n 217-0,/45'° �� c. r4 ��-e&It-.T Un/ �PO� 51s6 R WELL DATABASE ADDRESS: ip J I -- AGE OF WELL: tA.4 WELL DRILLER: WELL PERMIT m: L -f 16 WELL LOCATION: 1, 0 _. WELL PERMIT DATE: Z / --:Y `%"/ DEPTH OF WELL: TYPE OF WELL: DRILLED b. DUG TYPE. OF WATER BEARING ROCK - WATER ANALYSIS DATE: c. TiNKNOWN HIGH MANGANESE: Y �N HIGH IRON: Y UV OTHER CONTAMINANTS: WELL DATABASE Y N ADDRESS: �✓��� 5 AGE OF WELL: v"_ WELL DRILLER: WELL PERMIT 4: WELL LOCATION: WELL PERMIT DATE:. - Gj 5 DEPTH OF WELL: TYPE OF WELL: a.. DRILLED b. DUG c. UNKNOWN TYPE OF WATER BEARING ROCK: WATER ANALYSIS DATE: 6 S HIGH MANGANESE: Y HIGH IRON: Y 0 OTHER CONTAMINAINTS: Y N NUMBER FEE �{3G THE COMMONWEALTH OF MASSACHUSETTS TQhT11I..__ of ......... NQRTH..ANI?QVER...---...---•.----..._. _ This is to Certify that'FY,I. Qgde-n----ComP&r+y--------------------------------------------------------- NAME 17 Catherwood Road, Tewksbury, MA 01876 ADDRESS IS HEREBY GRANTED A LICENSE For[�l_..I2x.j.l. i gig._ P..xm.t...-.... L4t...# 5...S.a�er'.s_..Pond-_Road ------•---------•----------•-----••---•-•------•--•---•------------------------ ........................................ This license is granted in conformity with the Statutes and ordinances relating th reto, and expires ...... Qeeebe 31 X995 Unless s r�earle01 revoked. -- ... •..... f�-------------------------------------- Mar c-1? ---7 19--- _.-..-- - _ ------am/ Tr .................•---•---- 9.5 �-�-i--•--i, „ •-7-T.:-�/��:���"w Lam; - ..._. FORM 433 HOBBS & WARREN. INC. r�-ate.--------------- TOWN OF NORTH ANDOVER NOR7N Office of COMMUNITY DEVELOPMENT AND SERVICES °•4,`.. ,. +ti°ot HEALTH DEPARTMENT ' 400 OSGOOD STREET t NORTH ANDOVER, MASSACHUSETTS 01845 ;'ss�cMug``� 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.9542 FAX Public Health Director E-MAIL: healthdeptntownofnorthandover.com WEBSITE: http://www.townofiiorthandover.com April 11, 2005 To all Sharpeners Pond Road Residents: Please note that it has come to the attention of the Health Department that many residents are leaving their trash barrels and trash bags out at the curbside for days, or weeks at a time. Empty trash barrels blowing about in the road are a safety hazard, and trash and debris along the roadway is a health hazard. Please be mindful of this, as the Health Department will conduct periodic inspections of the area to determine who is in violation, and fines will be issued if protocol is not followed. The Board of Health follows the State Sanitary Code regarding Human Habitation, 105.CMR410, Section 1: 410.600 (A): Garbage or mixed garbage and rubbish shall be stored in watertight receptacles with tight- fitting covers. Said receptacles and covers shall be of metal or other durable, rodent -proof material. Rubbish shall be stored in receptacles of metal or other durable, rodent -proof material. Garbage and rubbish shall be put out for collection no earlier than the day of collection. (B): Plastic bags shall be used to store garbage or mixed rubbish and garbage only if used as a liner in watertight receptacles with tight -fitting covers as required in 105 CMR 410.600(A), provided that the plastic bags may be put out for collection except in those places where such practice is prohibited by local rule or ordinance or except in those cases where the Department of Public Health determines that such practice constitutes a health problem. For purposes of the preceding sentence in making its determination the Department shall consider, among other things, evidence of strewn garbage, torn garbage bags, or evidence of rodents. 410.602 (A) Land. The owner of any parcel of land, vacant or otherwise, shall be responsible for maintaining such parcel of land in a clean and sanitary condition and free from garbage, rubbish or other refuse. The owner of such parcel of land shall correct any condition caused by or on such parcel or its appurtenance which affects the health or safety, and well-being of the occupants of any dwelling or of the general public. (D) Common Areas. The owner of any dwelling abutting a private passageway or right-of-way owned or used in common with other dwellings or which the owner or occupants under his control have the right to use or are in fact using shall be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth or causes of sickness that part of the passageway or right-of-way which abuts his property and which he or the occupants under his control have the right to use, or are in fact using, or which he owns. Residents should know the following: • The Town has a mandatory paper and cardboard recycling ordinance that requires residents to separate these items from their household trash. Paper and cardboard are collected every other week on the same day as the household's normal trash. Residents can call the DPW at 978.685.0950 to get their recycling schedule. • Residents are responsible for picking up loose trash left at the curb after collection. Banned Items and Recycling Requirements: Please refer to the DPW website for a complete list of all the recycling requirements: http://www.northandoverrecycles.com. Please contact the Health Department if you have any additional questions. Thank you. Sincere L /64445- L an Y. Sawyer, REHS/RS Public Health Director File Town of North Andover, Massachusetts Form No. s f 10R7M BOARD OF HEALTH A s0.40 �1y0 "I � w ' s • „ • •-;---• DESIGN APPROVAL FOR asACNU SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant _ _�� I 1_ 1 LLQ . Test No Site Location '� . _ _ 1 ...�.� �•. �. ®1/Lim_ ��. Reference Plans and S ®NGINEER U DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CITAIR AN, BOARD OF HEALTH 6V Fee bol Site System Permit No. Wow z- LtOt 1 Li Delete: :e EXISTi CA (Held) –9XIST. CIO. (ei�d) 41iq- :ft 8,040.12191, — 204.04' proposed Lot Line Lot 1 LOT 61 106,286.5E Owner: Fernando S; 712 Sharpnf North Ando, 315SO—t Driveway Easement for lot 6 (13) on lot DOCUM6nt No.#60577 Cert. 12104 Parcel::194 Lot 12 It to be joined with Lot 11(5A) Lot 14 is to be joined with Lot 13 ($A) ,,.ASSESSORS R1 Map 90A Parcels 182(l !� Received by Town Clerk I REOEM-'O JOYCE BRAD HAW TOWN CLERK NORTH ANDOVER G 06 AM 'N Notice to APPLICAX-/TOWPI CLERK of action of Planning Board on !� accompanying plan: 1. The North Andover Planning Board has determined that said plan does not require approval under the Subdivision Control Law, and the appropriate endorsement has been made upon the same.. 2. The No Ando/en a Board has de ermi ed that id Ian sho a subdivefined by G c. 4? s. 8--L, and m st th reforem'tted to 't for appro al under the ubdivision Co Very truly yours, NORTH ANDOVEP PLANNING BOARD 1 L ^ yu B y :[ Date �1 l I q, w M.. BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext23 ilw May 27, 1994 Mr. Joe Barbargallo 1 Westward Circle North Reading, MA Re: Lot #5 (previous Lot #3) Sharpner's Pond Road Dear Joe: This is to inform you that the proposed plans for site referenced above have been disapproved for the following reasons: 1) Reserve area is not 4 feet from primary. 2) Perc test done over 2 feet above bottom of system. It should be done lower. 3) A manhole to grade for tank must be specified. 4) Need observation pits on southeast and northwest corners of leach area. 5) Excavation for leach area fill removal should specify at least 6 inches into parent material. 6) Please specify double - washed stone. 7) Final grade over leach area on profile indicated to be above elevation 128; site plan indicates both above and below elevation 128. Please show final grading on site plan. 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 cc: Karen Nelson, Director, Planning & Comm. Dev. Torey Realty Trust File WELL DATABASE ADDRESS: LfDiu ��t-C� I �n AGE OF WELL: WELL DRILLER: WELL PER lyfIT.r-: L -'S 0 WELL LOCATION: __WELL PERNflT DATE: q_5' DEPTH OF WELL: 0 TYPE OF WELL: Da.. DRILLED b. DUG c. UNI N OWN TYPE. OF WATER BEARING ROCK- 5_ze(l 7 - WATER ANALYSIS DATE: 1-HGHiNLkNGANESE: HIGH IRON: y OT= CONTAMINANTS: y Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 1 19L APPLICATION FOR SITE TESTING/INSPECTION -� Applicant Y`��-��� n NAME ADDRESS TELEPHONE Site Location i Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee ' ") �' CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. 7Z�;Dc)6IX410Ay 0 lu r ! 1y -1-14E L o a ,c c fS 63 74XL` 'S'LtR V C Yo R CLg iMs 7 ;4,- 74o )5,o , f S iI�D E/V flCi� fv /4 Ls a o J c AL Z�� vAJ P / f s j e4 1a Town of North Andover, Massachusetts BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 19 Applicant '�'`r' 1` -.I _t%�'A.A-'�-�) NAME ADDRESS TELEPHONE Site Location K''u�h�::'�- Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION AERATED PPp\��y Form No. 1 19! Applicant '''"l%"l�tJ�.. •r�� _ �,(,�-�.t_� _ NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee I Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. ae &: ved by Town. C.1 a roc : FORM A ' t #f SAW APPLICATION FOR ENDORSEMENT OF PLAN BELIEVED NOT TO REQUIRE APPROVAL � TH A06� i 04 AN IS8 AUGUST 27 , 19 98 To the P1 annina Board of the Town of :`lcrth Andover: The undersigned wishes to record the accempanyina plan and requests a determination by said Board thac approval by it under the Subdivision Control Law is not required. The undersigned believes that such approval is not required for the following reasons: 1. The division of land shown on the accompanying plan is not a sub - di v;sion because every lot shown thereon has the amount of frontage required by the ?sort, Andover �onli ng By Law and i s on a public way. nameiy, Sharpner's Pond Road or a private way, namely, being 'and bounded as follows: Bounded on the Northeast by lot 3 Williamson #705 Sharpners Pond Rd., bounded Northerly by lot land of Smart #1055 Forest, on the Northwest parcel 180 land of Pease #1041 Forest St. bounded southerly by Lot 7 land of Donovan #700 Forest St. 2. The division of land.showr. on the accompanying plar_ is not a sub- division for the following reasons: The existing lots have the; required frontage on a public way and meet all the requirements. A lot line change is being performed by this plan and shall not create any new subdivision lines The new line shall not alter or affect the conformity of the lots. 3. '7417.1e reference North Essex Deeds, Book Page or Certificate of Title No. 409678 Registration Book 90 Pane 25 . y _`cant's=gnature: arie.ReV_ (Print Name) Applicant's Address: 712 Sharpnees Pond Road North Andover, MA 11_21. NC.- (978) 794-1837 Owner's siana;.ure and address i f not the applicant, Commonwealth of Massachusetts North Andover, Massachusetts System Pumpinz Record System Owner & Address: Brian Stinson 724 Sharpeners Pond Road North Andover, MA 01845 Location of system: Left side yard, rear Date of Pumping: November 02,.2012 Type of system: Septic Tank Gallons Pumped: 1500 gallons System pumped by: Service Pumping & Drain Co., Inc. S Hallberg Park North Reading, Ma License #: BHP -2011-0413,0412,0411,0410,0409,0408 Contents transferred to: Greater Lawrence Sanitary District RECEIVED NOV 12 2012 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT I/ Date: November 02, 2012 Pumping Technician: D© This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes