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HomeMy WebLinkAboutMiscellaneous - 74 SHERWOOD DRIVE 4/30/2018 (2)n O M North Andover Board of Assessors Public Access Page 1 of 1 f Y J. W.ORTM North Andover Board ®f Assessors e..:. • L �x.r ,,,�. -�'� �-Wit;-°.r+� ...K�"",`"4,� �- .� . y, pe S� • SSgCN1`�� roperty Record Card Parcel 1D :210/105.C-0062-0000.0 FY:2012 Community: North Andover Click on Sketch to Enlarge Location: 74 SHERWOOD DRIVE Owner Name: POLINO, JAMES SUZANNE JOAKIM Owner Address: _ 74 SHERWOOD DRIVE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 9 - 9 Land Area: 0.77 acres Use Code: 101-SNGL-FAM-RES Tota] Finished Area: '3861 sqft 0 Total Value: 620,200 _ 620,200 Building Value: 504,700 504,700 Land Value: 115,500 115,500 Market Land Value: 115,500 Chapter Land Value: i Sale Price: , 634,900 , Sale Date:,06/27/2000 _ Arms Length Sale Code: Y -YES -VALID Grantor: _ SHERWOOD DEVELOPMENT Cert Doc: .Book: 05788 e Page: 0110 http://csc-ma.us/PROPAPP/display.do?linkld=1895141 &town=NandoverPubAcc 5/7/2012 4yAP LOT + # I, t PARCEL # * . . • • STREET CONSTRUCTI O.N—APPROVAL, HAS PLAN REVIEW FEE.BEEN PAID?r YES PLAN APPROVAL: DATE APP. DESIGNER: ,/l/ (� VCSPLAN DAME. — q� CONDITIONS s WATER SUPPLY: OWN WELL 0 WELL PERMIT DRILLER. WELL TESTS: CHEMICAL DATE APPROVED -- —•--- BA • ERIA I DAIS (IPPRUVEU BACTERI I DATE APPROVED COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUEES NO DATE ISSUED -;zBY CONDITIONS: FINAL APPROVAL:. ALL PERMITS PAID _YES— NO WELL CONSTRUCTION APPROVAL— SEPTIC SYSTEM CONSTRUCTION APPROVAL (TES NO OTHER �YE-S' NU ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO DATE • f J. . � tr NO DESIGNER: ,/l/ (� VCSPLAN DAME. — q� CONDITIONS s WATER SUPPLY: OWN WELL 0 WELL PERMIT DRILLER. WELL TESTS: CHEMICAL DATE APPROVED -- —•--- BA • ERIA I DAIS (IPPRUVEU BACTERI I DATE APPROVED COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUEES NO DATE ISSUED -;zBY CONDITIONS: FINAL APPROVAL:. ALL PERMITS PAID _YES— NO WELL CONSTRUCTION APPROVAL— SEPTIC SYSTEM CONSTRUCTION APPROVAL (TES NO OTHER �YE-S' NU ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO DATE • f J. . � tr Commonwealth of Massachusetts IVE_ Gx Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Ass ssmet ' P 2 10 74 Sherwood Drive TOWN OF NORTHANDO _ Property Address TMENT James & Suzanne Polino ner'sNam_ Owner Owe information is required for North Andover MA 01845 September 3, 2010 ____ every 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 filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. tab iernm A. General Information 1. Insrector: _Ve Name of Inspector i Compa e Company Address t lit City/Town P j q77 -66`4` 141 Telephone Number B. Certification Kil� 0i 6 State Zip Code !�'1 4L,� License Number I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: 14 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's ignature 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 - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 r• J Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Sherwood Drive Property Address James & Suzanne Polino Owner Owner's Name nformrequired is North Andover MA 01845 Se to required for p every page. City frown State Zip Code Date of B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D t5ins - 09108 A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 i mber 3, 2010 Inspection t5ins - 09108 A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 0 Commonwealth of Massachusetts N = - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a� 74 Sherwood Drive _ Property Address James & Suzanne Polino Owner Owner's Name information is North Andover MA 01845 September 3, 2010 required for p every 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 ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Sherwood Drive Property Address James & Suzanne Polino Owner Owner's Name information is North Andover MA 01845 September 3, 2010 required for P every page. 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 11 © 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 ❑ d Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ d Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Owner information is required for every page. t5ins • 09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Sherwood Drive Property Address James & Suzanne Polino Owner's Name North Andover CityrFown B. Certification (cont.) Yes No MA 01845 September 3, 2010 _ State Zip Code Date of Inspection ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: —Q-- _.Any Anyportion of the SAS, cesspool or privy is below high ground water elevation. ❑ LJ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 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 74 Sherwood Drive Property Address James & Suzanne Polino Owner Owner's Name information is required for North Andover MA 01845 September 3, 2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ EA 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) L!1 ❑ Was the facility or dwelling inspected for signs of sewage back up? d❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? IJ ❑ 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? ❑ LSI 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): Number of bedrooms (actual): ' DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): C) 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 ,. -- 74 Sherwood Drive Owner information is required for every page. Property Address James & Suzanne Polino Owner's Name North Andover MA 01845 September 3, 2010 CitylTown State Zip Code Date of Inspection D. System Information Description: 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 [d No Seasonaluse? ❑ Yes d No Water meter readings, if available (last 2 years usage (gpd)): Detail: '7 cL cztte ove.,y VV_ . Cs. Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes Fq No &L)Y y elix _$ Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Sins - 09108 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 74 Sherwood Drive Property Address James & Suzanne Polino Owner Owner's Name -- information is North Andover MA 01845 September 3, 2010 required for p every page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): Date General Information Pumping Records: Source of information: 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: `d 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 ce Commonwealth of Massachusetts --- u Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .,, 74 Sherwood Drive Property Address James & Suzanne Polino Owner Owner's Name information is North Andover MA 01845 September 3, 2010 required for p 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: Iey�Y — Qs. —bvt(f dated iI�z�o k ci 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: feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: Material of construction: concrete ❑ metal 1 1�500 aa(11 &-It & If tank is metal, list age: ❑ Yes d No it ❑ fiberglass ❑ polyethylene ❑ other (explain) years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No f < a Dimensions: 'du J- 7, t e) _' t O , !; x 5.-7 Sludge depth: 111) 1; 15 t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17 IN Owner information is required for every page. t5ins • 09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Sherwood Drive Property Address James & Suzanne Polino Owner's Name North Andover City/Town D. System Information (cont.) Septic Tank (cont.) MA 01845 State Zip Code Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? September 3, 2010 Date of Inspection � �—t -Ct— X— V Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Ga e� t 0-0j C -D -v- A t t7-.-� � i � ,� t OL e , f -D �} . t✓Y O il e I d— ci e-AlIe. IVk Grease Trap (locate on site plan): Depth below grade. - Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): 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 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 74 Sherwood Drive Property Address James & Suzanne Polino Owner Owner's Name information is North Andover MA 01845 September 3, 2010 required for p 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.): N (4*r 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 Commonwealth of Massachusetts --- 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Sherwood Drive Property Address James & Suzanne Polino Owner Owner's Name information is North Andover MA 01845 September 3, 2010 required for p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): ;E?rV ~� 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: 15ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Commonwealth of Massachusetts --- - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Sherwood Drive Property Address James & Suzanne Polino Owner information is required for every page. Owner's Name North Andover Cityrrown D. System Information (cont.) Type: ❑ leaching pits number: September 3, 2010 Date of Inspection ❑ leaching chambers number: ❑ leaching galleries number: 4w leaching trenches number, length: 1 X :2– leaching 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.): %p,/ IgA 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Sherwood Drive Property Address James & Suzanne Polino Uwner's Name North Andover MA 01845 September 3, 2010 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.): `y ( p 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Sherwood Drive Property Address James & Suzanne Polino Owner Owner's Name information is North Andover MA 01845 September 3, 2010 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: ❑J hand -sketch in the area below drawina attached separately t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Sherwood Drive Property Address James & Suzanne Polino Owner Owner's Name information is North Andover MA 01845 September 3, 2010 required for P every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: dCheck Slope [� Surface water Check cellar [I� Shallow wells v �6 40�e Vj / P, - Estimated depth to high ground water: L C) -Et. feet Please indicate all methods used to determine the high ground water elevation: (� Obtained from system design plans on record If checked date of Ansi n Ian reviewed V,'3,t9fV,&V-,!�,A 11x$1 --I g p 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 tddescribe �h�yjow you established theJ high ground �jwater elevation: g { o -le -19V Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Sherwood Drive Property Address James & Suzanne Polino _ Owner Owner's Name information is required for Northover p AndMA 01845 September 3, 2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist [�] Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed [� System Information — Estimated depth to high groundwater (>� Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 . T15, 02/05/2007 08:15 19786889573 PAGE 01/01 Surrr�tar/ R(rtord Cera genr'rwgj on 913!201010 C -P!30 AM by Karen Hanlon Town of With Andover �T)v ,, Pool . Tax Meip # 210-105.0-0062-0000.0 y Parcei Id 16978 ) 74 SHERWOOD DRIVE POLING, JAMES 74 SHERWOOD DRIVE NORTH ANDOVER, MA 01845 Class 101 Single Farrily ... Property Type — —� Size Total 0.7? Acres Residential FY 2011 U-8 Mailina Index Name/Address POLINO, JAMES 74 SHERWOOD DRIVE NORTH ANDOVER, MA 01845 UB Account Maim Account No Cycle Bldg Id. 17870.0 - 74 SHERwOOD DRIVE 3170535 03 Cycle 03 US Services Maint Account No, 3170535 Service Code MCFEE ADMIN FEE WTR WATER US (Meter Maintenance Account No. 3170535 Type Loan Number ActivellnaFt, From Payor Occupant Name Active/inactive Last Billing Date 7/7/2010 Active Rate Charge Multiplier/Users 1 1 9.18 1! 01 ALL METER SIZE 187.00 /1 Serial No Status Location Brand Type 4$029745 a Active ENC FR.L NEPTUNE NEPTUNE w Water Data 6/8/2010 Reading 2066 Code Consumption Posted 'Date 3/912010 2026 a Actual a Actual 40 37 7/15/2010 12/8/2009 1989 a Actual 44 4l14i2010 4/1212010 9/812009 51812009 1945 1901 a Actual a Actual 44 10/15/2009 3113/2009 1860 a Actual .% 41 `% 43 7/20/2009 4/29/2009 12/9/2008 9110/2008 1817 1764 a Actual a Actual fid- 53 1/20/2009 6/8/2008 1713 a Actual 51 45 10/10/2008 7/1612008 3/71200131713 a Actua! 41 4/1112008 12/11/2007 1627 aActual 44 1/2212008 9/5/2007 6/1912007 1583 1526 a Actual a Actual 57 1011212007 3/1512007 1469 n1 Manual estimate 57 35 712012007 4!1612007 12/12/2006 1434 a Actual 41 1/19/2007 9/1812006 1393 a Actua, 44 1012012006 Trouble Code:03 6/1912006 3/8/2006 1349 1299 a Actual 50 7/10/2006 Trouble Code:03 a Actual 38 4/1712006 12"2212005 1263 a Actual 64 1/17/2006 Trouble Code:03 912112005 1209 a Actual 113 10114/2005 trouble Code:03 6127/2005 3/3012005 1096 1039 a Actual a Actual 57 7/15/2005 43 4/5/2005 Size 11 Until YTD Cons 398 variance 8% 1% 1% 3% •22% 11% 7% 5% 4% •a8°,b 2-1% se % -22rA 09a� 2% -19% •fS`i% 10ti'$ 55".' 4% 0 wa oniso1arr Structural Group Jon P. Ward, SE, PE Structural Engineering Manager ion. wardC vivintsolar.com December 14, 2016 Mr. Dan Rock, Project Manager Vivint Solar 24 Normac Road Woburn, MA 01801 1800 W Ashton Blvd. Lehi, UT 84043 Clint C. Karren, PE Structural Engineering Manager clint.karrenga vivintsolar.com Re: Post Structural Certification Mcsween Residence 74 Sherwood Dr, North Andover, MA S-5195229; MA -01 Dear Mr. Rock: Pursuant to your request, a representative from our company conducted a post installation site visit under my supervision and provided post installation photos for the above referenced solar panel installation. As you are aware, this office initially prepared a structural assessment of the proposed solar panel installation, the adequacy of the connections for this system and identified maximum spacing of the connections. The photographs show panel support locations and spacing which conform to our structural assessment. Acceptable minor changes to the layout include panel position, support spacing less than or equal to 64", and/or additions or deletions of panels at roof locations. Based upon the post installation site visit, our office certifies the solar panel installation for this roof and that it was in conformance to our structural assessment report dated September 14, 2016, Ecolibrium Solar product installation criteria,, and the layout plan as specified in our report. This letter pertains only to the panel support attachments to the roof framing and not the engineered photovoltaic panel products, components, panel positioning, or electrical related installations/connections. This certification is based on the 8th Edition Residential Code (2009 International Residential Code with Massachusetts Amendments), professional engineering assessment and judgment and covers this dwellings assessment for solar panel connections and support only. Should you have any questions regarding the above or if you require additional information do not hesitate to contact me. Regards, Jon P. Ward, SE MA License No. 52584 Page 1 of 1 Avehl so l a r TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 5/12/00 This is to certify that the individual subsurface disposal system constructed (X ) or repaired ( ) by Ray Fraser at Lot 5 Sherwood Drive has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector 03/09/00 10.59 5067748146 THE ERASER COMPANY PAGE 01 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed; ( ) repaired: by— �%s4c Y �12-s+�t rte. 1111141M located at 1"~ 5 t1'i2wc.c�J�12iy ( Y) was installed in conformancevin h the North Andover Board of Health approved plan, System Design Permit #dated '/ z f with an approved design flow ofqL> gallons per day. The materials died were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer: 0, Uc.#: Date: 3/8/42 Date: Design Engineer: t/�.y-� North Andover Health Department • 27 Charles Street North Andover, MA 01845 • (978)688-9540 To: Bill Dufresne, Merri From: Susan Ford, N. Fax: 475-1448 Health Dept. Date: 03/15/00 Re: Lot 5 Sherwood as -built Pages: 1 CC: ❑ Urgent X For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle Regarding the as -built check list for Lot 5 Sherwood and future submissions. Sandy has amended the requirements for the as-builts. 1) The locus plan and the final contours have been eliminated from the list. 2) The locations of the deep holes and peres will be continued to be on the as -built as required by the North Andover Septic Regulations, Section 8.05. 3) Final as-builts should show the impervious areas. Other as-builts should be considered interim. For lot 5 Sherwood 1) The as -built does not show the bench mark as indicated. Please add. 2) The engineer's stamp is a copy. As -built submissions must have an original stamp when submitted to the BOH 3) The locations of the peres and deep holes must be added ..................... To: Merrimack Engineering Fax: 475-1448 From: Susan Ford, Health Insp. Date: 05/08/00 Re: Lot 15 Sherwood Drive Pages: 2 CC: ❑ Urgent X For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle f - Please see the attached as -built checklist in regards to Lot 15 Sherwood Drive, North Andover. You had the,old,list It was updated this spring. You do not need the contours orthe locus plan. However, you must have.the reserve location and impervious areas if complete. In addition, the stamp and signature must be original, not copied. Thanks ,� s {{ r r . . . . . . . . vi Vf J N W UJ a O Zp0 LL. Q mo c p O -C ceN U : - Z cn ° •. .. - C t �uj Y y , QiC N 1 ,yam V1 \lir •** C rn ° vER - _n cz � •� �,.. i i q Q d c:. ., MOy fir• Q (n7 d N LJ_ - ' E APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: G� CURRENT INSTALLER'S LICENSE# LOCATION: GoT 5 21 EITIO Z) DRJ UE LICENSED INSTALLER: SIGNATURE: CHECK ONE: TELEPHONE# �r8 1'7'V-6'149 NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes `' No Foundation As -Built? Yes No Floor Plans? Yes No Approval r Date:aARQ OF FaRALTS9 Y 219979 ' r jjj Nn - to, A 0 FORM U - VERIFICATION FORM =A A9- a10 i INSTRUCTIONS: This form is used to verify that all' necessary j approvals/permits from Boards and Departments having jurisdiction- k 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: ��f(teta�� �2(/�`y�0irr2.�� /-�C� Phone (9 'v?� LOCATION: Assessor's Map Number /c Parcel Subdivision Ilk- I 1z Lot(s) Street bySt. Number r% ************************Official Use Only************************ NDATI NS 0 WN GENTS: Date Approved 9 cnserva ion Admini trator n Date Rejected Comments e I <<liU - I A)Ak (0) \JA'A-W_,, AAP-C�a_,,J Date Approved o Pan r_c�Ic� I l� Date Rejected Comments) ; Food Ins ctor-Health . p c Inspector -Health Comments 411146 5<5D.5 Date Approved Date Rejected Date Approved Date Rej ected� Public Works - sewer/water connections L �( - driveway oermit Fire Department 3 Received by Building Inspector Date SEPTIC PLAN SUBMITTALS LOCATION: NEW PLANS: YES REVISED PLANS- YES DATE: U DESIGN ENGINEER: 23 � $60.00/Plan $25.00/P1an _()X&k— When the submission is all in place, route to the Health Secretary SEPTIC PLAN SUBMITTAL FORM/ LOCATION NEW PLANS: REVISED PLANS: YES, YES SITE EVALUATION FORMS INCLUDED: $125.00/Plan $ 60.00/Plan YES NO DATE: DESIGN ENGINEER: DATE TO CONSULTANT: *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port _ SEP 2 81999 Engineering. When the submission is all in place, route to the Health Secretary. I M - Town of North Andover, Massachusetts Form No. 2 pORTh BOARD OF HEALTH , A F M DESIGN APPROVAL FOR fsAcNl1SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location (Err- Reference ETReference Plans and Specs. ' ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee CHAIRMAN, BOARD OF HEALTH Site System Permit No. g ,_.r _ .... _._...._.__ _. _.._— _- — FORM II - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary ,_..,µ 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 �s/ection***************** APPLICANT.: �2fL�to� VII/�yfOme�� LL Phone LOCATION: Assessor's Map Number __/0 /c Parcel Subdivision �i�, I� Lot (s) Street 6h0/^ 6LJ o n e'L V r W, St. Number ************************Official Use Only************************ NDATI NS O WN GENTS: Date Approved onserva ion Admini trator Date Rejected Comments '� u lA��f 10V�-G� h4, I/Jr4L 1 10% Planner Comments Date Approved 7' P) Date Rejected Date Approved Food Ins ctor-Health Date Rejected Date Approved` p c Inspector -Health Date Rejected Comments Public Works - sewer/water connectionsw - - drivewaypermit Fire Department Received by Building Inspector Date FORAM 11 - SOIL EVALUATOR FOR. -NI Page I of 3 Date: .14AZL0\9CP No. o. Commonwealth of Massachusetts AQI?b\ir--e Mas'sai,-husetts e . ni or On e Disposal Soil Su On-site i te S .8w ac' Performed By. ..... ............ .... .......... .... ... Witnessed By: . .... L=auon Address (xAddrns. ird LCK 0 MIC> IC" Tek9hom 1 C> '! LA Npw . Construction [_?'Repair ZL7 Office Review No ❑ Yes F—V"' Published Soil Survey Available: %A£ r—> Publication Scale Soil Map Unit .. .......... Year Published ....... ............................................ ........ Drainage Class %;00PAb-%GWP .... ... Soil Limitations Surficial Geologic.Report Available: No VYes ❑ Publication -Scale Year Published Geologic Material (Map Unit) ................................................................ . ..................... . ............ ................................... Landform ........ I Flood Insurance Rate Map:, Above 500 year flood boundary No LJ Yes ❑ , 1 : t .? - - j I '. ) D�es Within 500 year flood boundary No ❑ Within 100 year flood boundary Nol 1�es WetlandArea: nit) ............................... .............................................................. ........ National Wetland Inventory Map (map u .............................. Wetlands Conservancy Program Map (map unit) Current Water Resourc6,Conditions (U[SGS): Month Range :Above'No6al ONormal ElBelcw Normal, Other References Reviewed: WDEP APPROVED FORIM - 12107195 FORM 11 - SOIL EVALUATOR FORM Page ? of 3 Location Address or Lot No. Fj - 'JN►F.f�-U�31`� 1�121�IE On-site Review ' Deep Hole Number Date:. 5�.I2'92 Time: - Weather Ff�u2 Location (identify on site plan) Land Use Slope (%) Surface Stones Vegetation .WOoL�EIp i-�Ap�p W do f) ,cs zp 5-:, 1A e&Ji15 Landform I.,5`Y-se _...; Position on landscape (sketch on the back)'DES\ b� Distances from: Open Water -Body, 23,{;feet,r _1 . Drainage way 1.300E feet Possible Wet Area feet. r Property Line._ .'c2 -O'./ -feet (f o%.k kf--( LV -T L4t`tiE) Drinking Water Well feet, Other DEEP OBSERVATION HOLELOG* J `-'6epthrffom' +'Soil Horizon Soil Te. ture,. ( Soil'Color Soil Other Surface (Inches) (USDA) (MuKsell) Mottling (Structure, -Stones, Boulders, Consistency, % +' -Gravel)' y CD it _.. �d I.S2S1.sfE+ SV � SOt L. Ar.sb S i L,'riC �' �S-c�¢a�T�G��o 'moo �o►.� �,.p k0 C�5v1.t1p W^F-YTOlI_. N D 75G-�SA-L- = MINIMUM OF 2 HOLES REQUIRED AT EVERY HHUPUStD OISPUSALAHEA Parent Material (geologic)'T1J'#� DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole:��d Weeping from Pit Face: Mwe iv Estimated Seasonal High Ground Water: y*+a DEP APPROVED FORM - 12107195 03-21-1996 14:36 617 932 7615 DEP NORTHEAST REGICN4L P.02 01� FORM 12 - PERCOLATION TEST Location Address or Lot No.� C2� COMMONWEALTH OF MASSACHUSETTS N�j(k NtQQU%W-3e, , Massachusetts Percolation, Test" Date: v 1?>1c> Time: Observation Hole n p.Jri� Depth of Perc 9� A Start Pre-soak 2 •. ar2�PM End Pre-soak Time at 12" Time at 9" Time at 6" Time t9"-6") -17 Rate Min./inch Z, Z • Minimum of 1 percolation test must be performed in bath the primary area AND reserve area. Site Passed I'Site Failed ❑ Performed By: G EVA J • Witnessed BY: . � L A Comments: DLT AMOvm rORM - U/97/f! f FOR,NI 11 - SOIL LVALLATOR FORINJ Page 3 of 3 Location Address or Lot No. 2%j — 5l-%�2V�SCSO� �121VE Determination for Seasonal High Water Table' Method Used: (Nb GizuNowAlfue- I eJtVe1.1C-C- ❑. Depth observed standing, in observation hole..... ... inches ❑ Depth weeping from side of observation hole .*...... inches ❑ Depth to soil mottles ... ... inches ❑ Ground water adjustment .................. feet Index Well Number ................ Reading Date ...... ....... Index well level ......... .... Adjustment factor ................. Adjusted ground water level ..................................... Deoth of Naturally Occurring Pervious Material - Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the .area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on --11/94 (date) I have passed the soil evaluator examination approved by the Dpartment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature f Date 5/1/96 DEP APPROVED FORM - 12/07/95 7 03-21—?996 14:36 517 932 7615 CE? NORTHEAST REGICN.^.L. P.02 FORM 12 - PERCOLATION TEST 01 Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS Psi- Qb\K�& , Massachusetts Percolation .,Test' , Date: 81319 Time: 3 : Cao PM . Observation Hole I 95 —10 Depth of Perc Start Pre-soak End Pre-soak { 0 I Time at 12" I I Time at 91° I � Time at 6" I , Time (9"-6") Rats Min./Inch G 2 " Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed 12'Sits Failed ❑ Performed By: Gj�EVC—tJ J • �u e`er Witnessed By:. Comments: aQ AYMOrm MRM - UM/11 FORA 11 - SOIL LVALUATOR FOR11 Page 3 of 3 Location Address or Lot No. Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole .......... ... inches ❑ Depth weeping frrom side•of observation hole........ inches ❑ Depth to soil mottles inches ❑ Ground water adjustment .................. feet . Reading Date - Index well level Index Well Number ....... Adjustment factor Adjusted ground water level ...... ........ Deoth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposedt. for the soil absorption system? SES If not, what is the depth of naturally occurring pervious material? Certification I certify that on - 11/94 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 9 Signature S 9 1/ 4"Date 5/1/96 iiDEP APPROVED FORUM - 1:/07/95 jj� FOR 111 - SOIL EVALUATOR FORN1 Paae '_ of 3 Location ,address or Lot ,Jo. v° – S4f1C vjtCC> pews On-site Review Deep Hole Number C–Z Date:. Time: PM Weather FAV2- Location (identify on site plan) SSE. SA�tTAtZ"f .L7iS STE1..� LSsC-�� Land Use Slope (°%) Surface Stones Vegetation WCc�flE�p Landform 1S.:5)C-11 . Position on landscape (sketch on the back) —. S�TAfL�-f DtSpusAt_ S-t�srL�1 DE St �i� Distances from: (Lc�C�S MIA3>� Ooen Water Body. "ZZ01--feet Drainage way MbMC– feet Possible Wet Area ZZdt/– feet Property Line 1:50+/– feet (fzCtYMT L_F-C L trT l,tt�se) Drinking Water Well LS61-5C feet Other DEEP OBSERVATION HOLE 'OG* Death from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) I (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) Olt_ 5►1 1sa C>er� t►s�p t.-�osC �occ�. 11-011444,M A sst tri Fie t P—r*–lam X10 C�t(LgvNrrF.2� Parent Material (geologic) (=>LXT V-AR–k, OepthtoBedrock: Oeoth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: m6m Estimated Seasonal High Ground Water: NbfS� I DEP APPROVED FOR,M - 1./07195 I FOR -NI 11 - SOIL EV.aLUATOR FORM Page 1 of 3 Date: �-��`�P tio. 144�'_-S Commonwealth of Massachusetts Nue-rA AQpovvs;�. Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Date: Performed By: -r�V�►�s J. D'ueso �.... POs .. ........... . Witnessed By: L=uon Address or Address. Ud 11{ refe.m /-atJSE'C Q.ot.1,[_ New Constructionpair ❑ 1�08��-15' 115 Office Review _ Available: No Yes I Published Soil Survey C Year Published 1�.... Publication Scale _- �'�13ZA Soil Map Unit �jGG E�S►V E�►~t E e� (, 5 L .o � ....... G Soil Limitations ..-........ ................................ ... Drainage Class �7ewr.��L'�... Surficial Geologic Report Available: No L1Q Yes" ❑ ` Publication Scale Year Published . ,- �: ,_ Geologic Material (Map Unit) ........ ........ ....... ..... .......... ......... .......................................................................................__... Landform. ............................................................................................ Flood Insurance Rate Map: Above 50o year flood boundary No LJ Yes ❑ Within -500 year flood boundary No, D`(es ❑ Within 100 yeaf flood boundary No f es ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range :Above Normai []Normal ❑Bela•/ Normal ❑ Other References Reviewed: DEP AFpROVED FOR,tit . 12/07/95 �J� FOP -N1 11 - SOIL EVALUATOR FORM Parc ? of 3 Location .-address or Lot ;Jo. A5 - '!54f'Ck& C> 0121 On-site Review Deep Hole Number Date:. f>jMj92 Time: Weather motif: Location (identify on site plan) 5��. SP,�i-rq�-T ,pYSVlc A< Land Use Slope (%) Surface Stones Vegetation WMC)Et> ("AepwmC> Landform J_Z_-!51GX-=2 Position on landscape (sketch on the back) 5F %TA2,? DtSP�s.A.�_ S-tsrL�i vES� �J Distances from: Open Water Sody.-EZO'�-feet Drainage way A40KC feet Possible Wet Area ?jzt,4/- feet Property Line 956t/ feet (MviA t,..pT Ltrr UNE, Drinking Water Well ^jp1 jX-5: feet Other DEEP OBSERVATION HOLE =0G' Depth from Soil Horizon Soil Texture Soil Color Soil other Surface (Inches) (USDA) (Munsell) I Mottling (Structure, Stones, Boulders, Consistency, % Gravel) CSL U" Norte -Tbp S'uSSc'Iii,.- 651>eAv I- V-10 v tisr�wArtC2 Parent Material (geologic) "151-M Deoth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: DEP APPROVED FORM - 12107195 MW DepthtoBedrock: 1 i1 wt' " Weeping from Pit Face: FORM 11 - SOIL E``.�LL ATOR FORM Page 1 d 3 Date: -,;o. 1449' — S Commonwealth of Massachusetts due -tib AQDov M as saci� u s ett s Soil Suitability Assessment or On-site Sewage Moo al V+E1� Date: ....................... . Performed By. TIA .............. Witnessed By Qurnei �i ViffY, � Lxauon -AOGtess nor I '' .``f�� fj, 1 / ,�pdsus.:•�a ew construction pair ❑ Office Review Published Soil Survey Available: No 71 Yes year Published \�\. Publication Scale 13?-� Soil Ntap Unit �►��--� e� C s� ..........._ ... .......... Limitations ---�-��� Drainage Class VOa��p- Soil ........'. , , ❑J. Surficial Geologic Report Available: No Yes Publication Scale Year Published ..._..._ F. Geologic Material (Map Unit).......................................................................................................... Y ............................ —._. Landform............................................................................ .......................... Flood Insurance Rate Map: Y ❑. �,. -' �f - Above 500 year 'flood boundaryNo� es _ �(es Within 500 year flood boundary No ^� 0 year floodondary N Within 10o-..buL�'Y es ❑ Wetland Area: ............................................................................... National Wetland Inventory Map (map unit) ...................... Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (U SGS): Month -P ' Range :Above Normal ❑Normal ❑Belcw Normal -- Other References Reviewed: pep APPROVED FOWM . 12/07195 PLAN REVIEW CHECKLIST ADDRESS ���j �/�CGC�40%� ��', ENGINEER�//� GENERAL / / / 3 COPIES �� STAMP �/ LOCUS' V NORTH ARROW v SCALE CONTOURS( PROFILE ¢/ SECTION BENCHMARK 4,`� SOIL & PERCS ELEVATIONS4 WETS. DISCLAIMERz WELLS & WETS L---"� WATERSHED?j DRIVEWAY L---'(Elev) WATER LINE t-� FDN DRAIN(% 3 SCH40_Z- . TESTS CURRENT? 6,--' SOIL EVAL SEPTIC TANK / MIN 150OG ✓ .17 INVERT DROP v GARB. GRINDER(+200% EDF) 25' TO CELLAR MANHOLE A-' ELEV GW # COMPS. D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT INLET - OUTLET W, -56 = (2" OR .17 FT) TEE REQ 'D? VO LEACHING MIN 660 GPD?� RESERVE AREA 1-� 4' FROM PRIMARY?L/ 2% SLOPE 100' TO WETLANDS 100' TO WELLS 4' TO S.H.GW L�,(5-_'>2M/INN 35' TO FND & INTRCPTR DRAINS X 325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY e/ MIN 12" COVER � FILL?1 (25' if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/100') SIDEWALL DIST. 3X EFF. W OR D (MIN 61) RESERVE BETWEEN TRENCHES? 1/ IN FILL? --r MUST BE 10' MIN. 4" PEA STONE? 1/ VENT? (>3' COVER; LINES >501) BOT JVD + SIDE 13 U4 X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft,2) Copyright m 1995 by S.L. Starr Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 June 10, 1996 Thomas Neve Neve Associates 447 Old Boston Road Topsfield, NIA01983 Re: Lot #5 Sherwood Drive This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: .Design flow less than 660 GPD & 165 GPD per bedroom. .Only one perc in system (N.A. 4.09). .Wetlands disclaimer missing (N.A. 6.02 0). .Tank not 25 feet from foundation and no manhole. .Leach area not 35 feet from foundation. .No perc elevations. .Gas baffle needed on outlet of tank. .No map & parcel. .Vent. If you have any questions, please do not hesitate to call the office. Sincerely, ,.J� Sandra Starr, R ., Health Administrator SS/cjp cc: Bob Janusz BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 • ���45� 3 �-S--e�.e-�''1� }AIMi�ua� m (�cce `� 13 �i FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used`tb verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT '(ASSES SORS MAP NUMBER �V 5CAfLOT NUMBER �� a SUBDNISION� Z,LOT NUMBER STREET ` P (N P v 0 _�> le - 14 c �� REET NUMBER .......................................... .in .............. ......... OFFICIAL USE ONLY .......■..■.■.■..■......■..■..■..■■...........■....i RECOMMENDATIONS OF TOWN AGENTS sn DATE APP C ONSERRVATION ADMINISTRATOR DATE REJI COMMENTS TOWN PLANNER (U CY � 111-1(/,'t�iA T�0 C LO I( Y CO Cit c•/e. f �' DATE APP rr DATE REJF f T 1. i3. cf 12c�o w d S hA S 4,,v 0(C.Cc2 vp4-acr\ DATEAPP1__ .-_-. . FOOD INSPECTOR BE.s�A''-L��TH DATE REJECTED DATE APPROVED AI SEPTIC INSPECTOR - HEALTH DATE CON DENTS L 16 ja/,e,5/9 y? 1'dr' CQ X �rr�u� a 1l e) _ ©2�22 a -C >A P I-aacf5 , - OAC fir- L g.& PUBLIC WORKS — SEWER 1 WATER CONNECTIONS DRIVEWAY PERMIT d DATE APPROVED FIRE DEPARTMENT DATE -REJECTED CONIIviENTS RECEIVED BY BUILDING INSPECTOR DATE 8. Structural Engineering Structural Peer Review Yes ❑ No ❑ SECTION I0a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Hereby authorize. My behalf, in all gna of Owner Owner of the subject property Z relative two work authorized by this building permit application 1 —7v�� Date to act on New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory. Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: -,e;1 G a USE GROUP Check as a livable CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ A4 ❑ A-5 ❑ 1 1 B 0 0 B Business ❑ 2A 2B 2C 0 0 0 C Educational 0 F Factory 0 T-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B 0 0 IInstitutional 0 I-1 ❑ I-2 0 I-3 0 M Mercantile ❑ 4 0 R residential R-1 0 R-2 0 R-3 0 5A 0 0 S Storage 0 S-1 0 S-2 0 U Utility ❑ Specify M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: �$ g YIf-hi Kq-M VMS, BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft Structural Engineering Structural Peer Review Yes ❑ No ❑ SECTION I0a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Hereby authorize. My behalf, in all gna of Owner Owner of the subject property Z relative two work authorized by this building permit application 1 —7v�� Date to act on LIC #054201 REG 0 12 nay �t (761)246-2328 11 HAWrHoRNE STREET, WAKEFIELD, MA 01680 FAX(781)246-2326 r �..� - - -. THOMAS E. NEVE ASSOCIATES, INC. ��44�� W �, p e ����44 e�� Engineers • Land Surveyors • Land Use Planners 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 T®�N aF r10RT14 Atai?avtrr�/ "V o'LTW �a�gn o (508) 887-8586 FAX (508) 887-3480 AUS TO ' N O iz k t.1 UoV�2 *AR- CD t 13 4-s- WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints Plans ❑ Copy of letter ❑ Change order ❑ rDATE -,,, � JOB NO. 144!S y + S ✓ 1���N R Ptzt V'F-- 1 Q�V 15lEV Co (o �y sf FNZz D rfi�SEi 1-�pr1Z ( S S'iEryt �C1�/L� t _r'-1-4_'e_W=-G> >t:;Ipat Vf F4=!x2E,0 -ti4o \,evU the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 1 Q�V 15lEV Co (o �y sf FNZz D rfi�SEi 1-�pr1Z ( S S'iEryt �C1�/L� t _r'-1-4_'e_W=-G> >t:;Ipat Vf F4=!x2E,0 -ti4o \,evU 5 4.Ou I­X� lr�� E • fv �� tags sou f'rT�S THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ For review and comment ❑ Resubmit 1 ❑ Submit ❑ Return copies for approval copies for distribution corrected prints ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS ' S A �� - `�C- '� t v�ls� tc_— S C -e_. t C -Z) P`i Ar 'c-c_'-v1Se-- � s�� COPY TO RECYCLED PAPER: l �� - C Contents: 40% Pre -Consumer -10% Post -Consumer SIGN if enclosures are not as noted, kindly notify us at once. Ps -!5- --r4T- c clef. \,evU 5 4.Ou I­X� lr�� s�� COPY TO RECYCLED PAPER: l �� - C Contents: 40% Pre -Consumer -10% Post -Consumer SIGN if enclosures are not as noted, kindly notify us at once. XDATE/Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW +, FEE PERMIT # gad DATE RECEIVED1046 APPLICANT ��J,41vysa ASSESSOR'S MAP ADDRESS PARCEL # LOT # v�-- �/ STREET 51-Je"2OG0 D D 4 ENGINEER /V eve ADDRESS PLAN DATE CONDITIONS OF APPROVAL: REVISION DATE APPROVED DISAPPROVED 1, 7� E5/G (A/ A b c G�4 i�&Z w! 5 5 �.U6' /I/. /� fJ U ti� .......... 2 ol Si 5MOXINW - L - a 1 r MIA% vy, Flr,5f FLOOr\ PLAN f.6.H. Y�'CD, 0' -CD wlO alb Si 5MOXINW - L - a 1 r MIA% vy, Flr,5f FLOOr\ PLAN f.6.H. ro T 111 IAM I � P rn I I -- — Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 April 17, 1996 Mr. Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lots 3,4,5,7,14,15,16,12,&19 Sherwood Drive The above named lots at Sherwood Drive have been incompletely submitted. The submission of new designs after January 1, 1996 requires the inclusion of soil evaluation forms. Until these forms have been received, the above mentioned plans will not be considered submitted. Should you have any questions, please call me at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp 'FG , BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535