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HomeMy WebLinkAboutMiscellaneous - 75 SHERWOOD DRIVE 4/30/2018 (3)75 I. a C co o 0 v 0 ;! 00 0 A � o< I MAP # PARCEL # f �� STREETS QONSTRUCTIQ.N APPDES HASPLAN REVIEW FEE.©EEN PAID? �1)gk NO / PLAN APROUAL:DATE APP. BY_��G�" PLAN Dn-rE.�::&k5� CONDITIONS Fib WA`T R SUPPLY. WELL PERM WELL TESTS: COMMENTS: TOWN CHEMICAL WELL DRILLER.`__._._ IA I BACTERIA II DA I E APPROVED._.____ DA I E (1PPRUVED DATE APPROVED FORM U APPROVAL: APPROVAL TO ISSUE YES NO P DATE ISSUED% BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID CONST SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YE NO YES NU YES NO YES NU YES NU DATE �L_.po BY: i • A ,:'ria: wrt r, ::. tij % .. ,' "••i •1. .� _`•�t.: ?'":' .'.1 ... .•r•_.•r. .'i t'a w,. FC_ .1'"' J.-^ `:y,� + x IS THE INSTALLER LICENSED? :: + YE5 NO ,'. E . — `TYPE OF CONSTRUCTION: ? NEW REPAIR '• NEW CONSTRUCTION: CERTIFIED CERTIFIED PLOT PLAN REVIEW YES NO •� " e _ t ` CONDITIONS OF.. APPROVAL S NO • . (FROM .FORM U) �� , r ` YES NO `4ISSUANCEOF DWC PERMIT •1 211.': ... ...:'..r,.. 4 � t' , i .:. .. DWC PERMIT N0. r INSTALLER: r . ,... BEGIN INSPECTION YES N0 _; , INSPECTION: ;NEEDED: ....EXCAVATION . \ -i` .:IV j ` - ,l.t.,. `=moi .� • .. .. ... - ' �. •I�'•� . '` .• • SSED.' `.�? BY ' It COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 75 Sherwood Drive North Andover,Ma.U1845 Owner's Name: Ahmad Zahed i Owner's Address: SAME Date of Inspection: 1 Name of Inspector: (please print) Brian S . Murphy Company Name: B&D Septic Inspections Mailing Address: P . 0 . Box 47 1 Ma.02045 Telephone Number: 781 290-99:1-2 RECEIVED JAN 18 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper fimction and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X pies Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: / i Z/a % 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. Notes and Continents ****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 a different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 75 Sherwood Dr. N.Andover,Ma. Owner. Ahmad Zahedi Date of Inspection: 1/ 10 / 0 7 Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old; or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORIM PART A CERTIFICATION (continued) Property Address: 75 Sherwood Dr. N.An over,Ma. Owner: Ahmad Zahedi Date of Inspection: 1/10/07 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 153030)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: — Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I 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 :semis system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 75 Sherwood Dr. N-Andover,Ma. Owner: Ahmad Zahedi Date of Inspection: 171076T -- D. 10 07D. System Failure Criteria applicable to all systems: You must indicate "yes" or `bo" to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or X clogged SAS or cesspool — Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or X cesspool _ _ Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number X of times pumped . Any portion of the SAS, cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface X water supply. _ Any portion of a cesspool or privy is within a Zone 1 of a public well. x Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 certitted laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No) The system fai 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. barge Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gP� You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — _ the system is within 400 feet of a surface drinking water supply — _ the system is within 200 feet of a tributary to a surface drinking water supply _ — the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — I WPA) 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 } es" 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 CbIR 15.304. The system owner should contact the appropriate regional office of the Department_ Page S of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddress: 75 Sherwood Dr. .An over, a. Owner. Ahmad Zahedi Date of Inspection• 1/10/07 Check if the following have been done. You must indicate `yes" or "no" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health X Were any of the system componentsum p ped out in the previous two weeks X_ Has the system received normal flows in the previous two week period X Have large volumes of water been introduced to the system recently or as part of this inspection X_ Were as built plans of the system obtained and examined? (If they were not available note as N/A) X — Was the facility or dwelling inspected for signs of sewage back up X — _ Was the site inspected for signs of break out X Were all system components, excluding the SAS, located on site X Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum X _ 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: Yes no X _ Existing information. For example, a plan at the Board of Health. _ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 75 Sherwood Dr. N.Andover, a_. Owner. Ahmad Zahedi Date of Inspection: 1/10/07 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): 4 4 0 Number of current residents: 4 Does residence have a garbage grinder (yes or no): n o Is laundry on a separate sewage system (yes or no): no [if yes separate inspection required] Laundry system inspected (yes or no): — Seasonal use: (yes or no): no Water meter readings, if available (last 2 years usage (gpd)): apex. 300 gpd. Sump pump (yes or no): no Last date of occupancy: p r e s e n t CONUKERCUL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): end Basis of design flow (seats/persons/sgtetc.): Grease trap present (yes or no): — Industrial waste holding tank present (yes or no): _ Non -sanitary waste discharged to the Title 5 system (yes or no): — Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: system last pumped 2/05 (homeowner) Was system pumped as part of the inspection (yes or no): n o If yes, volume pumped: __gallons — How was quantity pumped determined? Reason for pumping: — TYPE OF SYSTEM X Septic tank, distribution box, soil absorption system Single cesspool _ Overflow cesspool _ Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank _ Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information. 6+ yrs. system installed 4/00 local BOH records. Were sewage odors detected when arriving at the site (yes or no): no Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 75 Sherwood Dr. N.Andover,Ma. Owner. Ahmad Zahedi Date of Inspection: 1/10/07 BUILDING SEWER (locate on site plan) Depth below grade: 2 0 " Materials of construction: _cast iron X 40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: 14 " Material of construction: X concrete _metal fiberglass _polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: 10'x5,x5, 1 0 0 gal. Sludge depth: 1 " Distance from top of sludge to bottom of outlet tee or baffle: 31 " Scum thickness: 1 " Distance from top of scum to top of outlet tee or baffle: 51, Distance from bottom of scum to bottom of outlet tee or baffle: 18 " How were dimensions determined: IN FIELD Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank and tee's in good condition,outlet tee has gas baffle in place, liquid level with outlet,tank appears sound no signs ot leak-a—ge. GREASE TRAP: _(locate on site plan) Depth below grade: _ Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 75 Sherwood Dr. .an over, a. Owner. Ahmad Zahedi Date of Inspection: 1/10/07 TIGHT or HOLDING TANK: (tank must be pumped at time of inspectionxlocate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 " Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D—box in good condition,liquid level distribution equal, no signs of carryover or leakage PUMP CHAMBER: (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 1 l OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 75 Sherwood Dr. . n over, a. Owner: Ahmad Z a e i Date of Inspection• 1 10 0 7 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number leaching chambers, number. leaching galleries, number �— leaching trenches, number, length: 2 @ 2 ' x4 ' x3 8 ' leaching fields, number, dimensions: overflow cesspool, number. innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil conditions normal,no signs of hydraulic failure,vegetation normal. 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 constriction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of i l OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAddress: 75 Sherwood Dr. . n over, a. Owner: Ahmad Zahedi Date of Inspection: 1/10/07_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Page I 1 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 75 Sherwood Dr. N.Andover,Ma. Owner: Ahmad Zahedi Date of Inspection: 1 / 10 / 0 7 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 12 +feet Please indicate (check) all methods used to determine the high ground water elevation: X Obtained from system design plans on record - If checked, date of design plan reviewed: 11 2 9 9 _ 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 youestablished the high ground Water elevation: Groundwater determined from design plan on record at local BOH, no water encountered on perk test. Summary Record Card generated on 1/10/2007 12:57:18 PM by Elaine Barclay Town of North Andover Tax Map # 210-105.C-0072-0000.0 75 SHERWOOD DRIVE ZAHEDI, AHMAD 75 SHERWOOD DR NORTH ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Size Total 1.04 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until ZAHEDI, AHMAD Payor 75 SHERWOOD DR NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17875.0 - 75 SHERWOOD DRIVE Last Billing Date 10/16/2006 3170540 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 1 1 9.18 1/ WTR WATER 01 ALL METER SIZE 212.64 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 32154226 a Active ERT HH b Badger w Water 1 1 Date Reading Code Consumption Posted Date Variance 12/12/2006 113 a Actual 20 -58% 9/18/2006 93 a Actual 51 10/20/2006 37% 6/19/2006 42 a Actual 42 7/10/2006 -62% 3/8/2006 0 a Actual 30 4/17/2006 0% 2/8/2006 0 in New Meter 0 4/17/2006 0% 12/22/2005 750 m Manual estimate 30 1/17/2006 -60% MSG 9/21/2005 720 a Actual 70 10/14/2005 262% 6/27/2005 650 a Actual 20 7/15/2005 -22% 3/30/2005 630 a Actual 30 4/5/2005 -20% 12/16/2004 600 a Actual 30 1/14/2005 -37% 9/24/2004 570 a Actual 60 10/8/2004 7% 6/11/2004 510 a Actual 30 7/30/2004 93% 4/16/2004 480 c Correction 33 5/17/2004 0% NEW ENGLAND ENGIIc EERING June 14, 2005 North Andover Board of Health 400 Osgood Street North Andover, MA 01845 SERVICES RECEIVED JUN 2 0 2005 TOW,4 wC.�`TH ANDOVER HEALI H DEPARTMENT RE: TITLE V REPORT: RE: 75 Sherwood Drive North Andover, MA Dear Sir or Madam: Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely, r� C Benjamm C. Osgoo , Jr. Certified Title 5 Inspector 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 IXofII COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM I PART A CERTIFICATION Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fariba Zahedi Owner's Address: 75 Sherwood Dr. North Andover, MA 01845 Date of Inspection: June 13, 2005 Name of Inspector: (please print) Benjamin C. Osgood, Jr. Certified Title 5 Inspector Company Name: New England Engineering Services Inc. Mailing Address: 60 Beechwood Drive North Andover, MA 01845 Telephone Number: 978-686-1768 0 JUN 2 0 2005 TOWN OF NORTH ANDOVER HEALTH DEPART_ M_ EENT CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of the on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5 (3 10 CMR 15.000). The system: Inspector's Signature: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails C /1�a The system inspection shall submit a copy of this inspection report to the Approving Authority ( Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use.. 2 °of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fariba Zahedi Date of Inspection: 06/13/05 Inspection Summary: Check A, B, C, D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: A)D One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined' please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): Broken pipe(s) are replaced Obstruction is removed Distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): Broken pipe(s) are replaced Obstruction is removed ND explain; 3 °of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fariba Zahedi Date of Inspection: 06/15/05 C. Further Evaluation is Required by the Board of Health: V0Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment, Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health ( and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: The system has a septic tank and (SAS) Soil Absorption System and the (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance * * This system passes of the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organize compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 4 °of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fariba Zahedi Date of Inspection: 06/13/05 D. System 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 overload or clogged SAS or cesspool. j Static liquid level in the distribution box above outlet invert due to an overload or clogged SAS or cesspool 1 / Liquid depth in cesspool is less than 6" below invert or available volume is less than %z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times ✓ pumped Any Portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply 1/ Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. ( this system passes if the well water analysis, performed at a DEP certified laboratory for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrogen is equal to or less than 5ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either `eyes" or "no" to each of the following: (The following 'teria apply to large systems in addition to the criteria above) , Yes No The system is v%i* 400 feet of a surface g water supply The system is within 2bgee o a tributary to a surface drinking water supply The system . ated in a nitro7the nsitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a c water supply well If you answered "yes" to any question in Sectionsystem ' considereda significant threat, or answered `yes" in Section D above the large system has failed. The owner or operaty large sy m considered a significant threat under Section E or failed under Section D shall upgrade the system in accordanc310 CMR 15. The system owner should contact the appropriate regional office of the Department. 5'of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fariba Zahedi Date of Inspection: 06/13/05 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes / No r Pumping information was provided by the owner, occupant, or Board of Health `Were any of the system components pumped out in the previous two weeks_? Has the system received normal flows in the previous two week period ? Have large volumes of water been introduced to the system recently or as part of an inspection ? Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up ? Was the site inspected for sign of break out? V Were all system components, excluding the SAS, located on site? Were all the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? V Was the facility owner ( and occupants if difference from owner) provided with information on the proper maintenance of the subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes No /Existing information For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fanba Zahedi Date of Inspection: 06/13/05 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design)Number of bedrooms (actual)___y__ . DESIGN flow based in 310 CMR 15.203 ( for example: 110 gpd x # of bedrooms): y `/y Number of current residents: Does residence have a garbage grinder (yes or no): AtO Is laundry on a separate sewage system (yes or no): N Q [if yes separate inspection required] Laundry system inspected ( yes or no): Seasonal use: (yes or no): — Water meter readings, if available (last 2 years usage (gpd): -row Aj Sump Pump (yes or no): A� 0. Last date of occupancy r- v r r e �Y COMMERCIALANDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgk etc Grease trap present (yes or no): Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no) Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: 31 t0, O q Pe- k 0,, -j 1-j E 2 Was system pumped as part of the inspection (yes or no): Al 0 H 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) Tight tank Attached a copy of the DEP approval Other (describe): I Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected wen arriving at the site (yes or no): /V 0 . Tof 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fariba Zahedi Date of Inspection: 06/13/05 BUILDING SEWER (locate on site plan) Depth below grade: 3 0 Materials of construction: cast hon. ✓140 PVC other (explain) Distance from private water supply well or suction line: N� Comments (on condition of joints, venting, evidence of leakage, etc.): I FYI L oUKS ✓lliw 1 lLl F3f1S�M �tJ (( SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: ✓ concrete metal fiberglass polyethylene Other (explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance (yes or no): (attach a copy of certificate) Dimensions: L"b Av S Sludge depth: z Distance from top of sludge to bottom of outlet tee or baffle: -X;?Scum thickness: 2 ' Distance from top of scum to top of outlet tee or baffle: (0 Distance from bottom of scum to bottom of outlet tee or baffle /V " T- How were dimensions determined: M-6 H 5 � a E s'n C k Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANJC J.v 6-a0i> Comp -flon, rt", ,v 1,-00C) CO .J n / D0 A GREASE TRAP:_L (locate on site plan) Depth below grade: Materials of construction: concrete metal fiberglass polyethylene other (explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from botton of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc. 8"of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fariba Zahedi Date of Inspection: 06/13/05 TIGHT OR HOLDING TANK- (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Materials of construction:_„ concrete metal fiberglass polyethylene other (explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_2 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.): FoX e"'p rl FQVA-L. /!lJ WDc.�CI� PUMP CHAMBER N 0 (locate on sire plan) Pumps in working order (yes or no) Alarms in working order (yes or no) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 9"of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fariba Zahedi Date of Inspection: 06/13/05 SOIL ABSORPTION SYSTEM (SAS): (locate on site elan, excavation not required If SAS not located explain why TYPE leaching pits number leaching chambers, number Teaching galleries number leaching trenches, number in length �9 j r te, ti s leaching fields, number, dimensions: overflow cesspool, number. innovativetalternative system Typetname of technology: Comments ( note condition of soil, signs of hydraulic failure. Level of ponding, damp soil, condition of vegetation, etc) QEKi CST .5,1 stem N a am4t,. /1!Z� f Dr Dflti1P Tai L v,- 0tu-1 AG ✓FGA i7, -it CESSPOOLS: N &ool must be pumped as part of inspection) (locate on sire pian) Number and configuration: Depth — top of liquid to inlet invert Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of Construction Indication of groundwater inflow (yes or no) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY:,. IV 0 (locate on site plan) Material of construction: Dimensions: Depth of solids Comments (note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation, etc. 16 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fariba Zahedi Date of Inspection: 06/13/05 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 11 of 11 OFFICIAL INSPECTION FORM -- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 75 Sherwood Dr. North Andover, MA 01845 Owner's Name: Fariba Zahedi Date of Inspection: 06/13/05 SITE EXAM Slope Surface water Check cellar r,1 5 rm P Shallow wells �vv/I Estimated depth to ground water — feet Please indicate (check) all methods used to determine the high ground water elevation: _ Obtained from system design plans on record – If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health – explain: Checked with local excavator, installers – (attach documentation) Accessed USGS database-cxplain: You must describe how you established the high ground water elevation: HS'reM Des ;u ntcY !:� ff ?0o F. G�(LaVN17 w�1F� bascmtn7 1s pR�j_ FwoR 3eLauf C�2ifl� f'� NEW ENGLAND ENGINEERING SERVICES Vr INC TOWNOF NOts i n N�vU%J �„ 80ARD OF HEALTH MAR 7 2002 February 11, 2002 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 75 Sherwood Drive, North Andover, MA Dear Sirs: Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely f�;' G"d-� Benjamin C. Osgod, Jr. 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 COMMONWEALTH OF MASSACHUSETTS If igj EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 75 SHC Rwoo-p DIZtUe, 10_o9-TH A&) i> co - 2 M � Owner's Name: _ t:;, wa2e ice. -Mo ; 1 M v K Owner's Address: -7,s- Ss E Rw oo D tv \D 2TH AN nooE e 61 Date of Inspection: 31 zI o 2 Name of Inspector: (please print) F> C N 4AAW C 0&C -60D J CompanyName: �-3 L wMailingAddress: G � 9,ECC.q LA/yo.7 1>>Zt yr �Vc> ►2TK a�D RC2 �v9 proms Telephone Number: -77,2- 6 8 6- 1 7l 8 ;CERTIFICATION STATEMENT L.Jzerfify that I have personally.inspected the sewage disposatsystem at -:this address and that the information reported Wow,is true, accurate and complete -as of the time of the. inspection jhe inspection was performed based on my training and egxperience 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: �L Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 1� � Date: <3 ),;K%° 2 - The 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or di&rent conditions of use. Page 2 of 11 J, OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: — 75 SHERWOOD DRIVE Owner: — NORTH ANDOVER, MA DARELL AND TRACEY.TRORMUK Date of Inspection: 3/2/02 - Inspection Summary: Check AB,CD 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: System Conditionally Passes: . 1 - e or more system components -as: described in the "Conditional Pass" section need to replaced or, ems upoiicompletibWthe'replacement or repair, as approved by the Bo a4of Health,: Answer yes, no or n ermined (YN,,ND) in the for the following stat ts. If "not determined" please explain. o ermined m the for the following wing stat ism 0 ver (whether m en ti The septic tank %istrietaLan '20 old* or the septic er metal or not), is structurally :f. yer, ,years fil tj i It I t1: I "M 20<y rati r fail is unsound, exhibits substantial,'"...intifiditra 'Drioxfiltration or tank fail is imminent. System will pass :mspectio . n lif e 7-th- c tic t pproy existing tank is replaced with a compl tic tank as appro by the Board of Health. 'i t 11 d , t Ic . g s ru4 *A metal septic tank will pass inspectioh�if i U structurally d, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old vailab ND explain: Observation of sewage backup orA5out or high static�ter level in the distribution box due to broken or obstructed pipe(s) or due to a broken, ed or uneven distributionem will pass inspection if (with approval of Board of Health): "S broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: Th "yst!T required pumping more than 4 times a year due to broken or obstructed pipe(s)�I�ystemwill pass in 'on if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _ 75 SHERWOOD DRIVE Owner: — NORTH ANDOVER, MA DARELL AND TRACEY TROFIMUK Date of Inspection: _ 3/2/02 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 fail' n o protect public health, safety or the environment. I. System 11 pass unless Board of Health determines in accordance with 310 1&303(l)(b) that the system is n functioning in a manner which will protect public health, s ety and the environment: _ Cesspool or ivy is within 50 feet of a surface water _ Cesspool or pn is within 50 feet of a bordering vegetated w d or a salt marsh 2. Systcm.:will fail unless the Board of:=He th (and blic Water Supplier,: if any) determines thaC the system is functioning in a manner that protec th ublic health, safety and environment: The system has a septic tank and soil a rp ' system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a ce water ply. Th6,,system has a septic tankSAS and the SAS is 'thin a Zone I of a public water supply. The system has a septic and SAS: and the SAS is wi 0 feet of a private water supply well. The system has a tic tank and SAS>and the SAS is less than 1 feet but 50 feet or more from a private water supply ell**. Method used to determine distance **This system if the well water analysis, performed at a DEP certified la ratory, for coliform bacteria an olatile organic compounds indicates that the well is free from poll utt from that facility and the pres ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, ovided that no other: fail criteria are triggered A copy of the analysis must be attached to this form. 3. Other: 4'w " k R h Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSM SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A CERTIFICATION (continued) Property Address: _ 75 SHERWOOD DRIVE Owner: - NORTH ANDOVER, MA DARELL AND TRACEY TROFIMUK Date of Inspection: _ 3/2/02 D. System Failure Criteria applicable to all systems: You must indicate "yes" or `no" to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓' Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ✓' Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓, Any portion of the SAS, cesspool or privy is below high ground water elevation.: _= ✓ Anyportion of cesspool or privy is within 100 feet of a surface water supplyor.tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public.well. E ► 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 supplywell with no acceptable water quality, analysis. [This system passesif :the well water analysis, . performed at a DEP .certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the•presence of ammonia nits'.ogee>and nitrate;ultrogen 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.] (Yes/No):The system fails. I have determined that one or more of the above failure: criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 You indicate either `yes" or -no" to each of the following: (The followm eria apply to large systems in addition to the criteria at yes no _ the system is within 400 feet o ce tersupply _ the system is within 200 feet of a tri to a s drinking water supply the system is located in ogen sensitive area (Interim Wellh ection Area - IWPA) or a mapped Zone H of a public ter supply well If you have answ "yes" to any question in Section E the system is considered a significant threat or answered "ye.s" in: D above the large system has failed. The owner or operator:ofan large system considered a y g sigtufi t threat.under:Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15304. The system owner should contact the appropriate regional office of the:Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _ 75 SHERWOOD DRIVE NORTH ANDOVER, MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 Check if the following have been done. You must indicate `des" 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 builtvlans.of the system obtained and examined? (If they were not available -note as N/A) Was the facilityor 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 ? _Voe'_ Wme:.the. septic, tank manholes uncovered,opened, :and, the interior of the tank inspected for the condition of the baffles br tees, material ;of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? Was the Iacility;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: Yes no Existing information. For example, a plan at the Board of Health. _ Determined in the field (if any of the failure criteria related to'Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSME] SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _ 75 SHERWOOD DRIVE NORTH ANDOVER, MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): L�_ Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: 9 _ Does residence have a garbage grinder (yes or no): -&W Is laundry on a separate sewage system (yes or no): jVQ [if yes separate inspection required] Laundry system inspected (yes or no): — Seasonal use: (yes or no): _No Water meter readings, if available (last 2 years usage (gpd)): Sump pump (yes or no): _!J Last date of occupancy: C o 22ENY COMI IERCIALMiDUSTRIAL „ . Type of establishment: . � Design flow (based on 310 CMR 15.203): and Basis of design flow (seats/pmsons/sgft,etd.): Grease trap present (yes or no): Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use OTHER (describe): GENERAL INFORMATION .Pumping Records Source of information: - V E-vc(L TF -P- OL'U"JOY2- Was system pumped as part of the inspection (yes or no): _ If yes, volume pumped: gallons — How was quantity pumped determined? Reason for pumping: T'Y�E OF SYSTEM v Septic tank, distribution box, soil absorption system _ Single cesspool Overflow cesspool — ivy — Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank _ Attach a copy of the DEP approval _ Other (describe): - Approximate age of all components, date installed (if known) and source of information: 0 Y 2-yrtt-s ilL p w rti ��/Z Were sewage odors detected when arriving at the site (yes or no): AJOi Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSME; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _ 75 SHERWOOD DRIVE NORTH ANDOVER, MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 BUBLDING SEWER (locate on site plan) Depth below grade: 24u � Materials of construction: cast iron v/40 PVC _other (explain): Distance from private water supply well or suction line: --- Comments (on condition of joints, venting, evidence of leakage, etc.): Pt?E "o Kr, NEw ln1 0RSc--0 F PT SEPTIC TANK: _ (locate on site plan) Depth below grade: 12,E Material of construction: ,"concrete _metal _fiberglass _polyethylene other(explain) If tank is metal list age: _ Is age confirmed by a Certificate.of:Compliance (yes or no): _ (attach a copy of certificate) Dimensions: 65'00 &-6I-L O N 5 - Sludge Sludge depth: z" 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 baffler l/•• How were dimensions determined: _ rn EHsL. rz E s n c K Comnzei}ts (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): _T19,V IN (rpJ� lon 1i1c7�. SLK Lto Roc Z LN 6-0L)o eOADt70n9. /ZCCCliUEND INSiI9LLy-T)0IL/ C> 2isc-i s 7-v Ot= "Cl NI-Sh G0A0E 0 t ALt. ©PEA91,VtrS GREASE TRAP: N 4(locate on site plan) Depth below grade: _ Material of construction: concrete metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural ual integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of i 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS X v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM { PART C x SYSTEM INFORMATION (continued) Property Address: ^ 75 SHERWOOD DRIVE fi NORTH ANDOVER, MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: _ 3/2/02 TIGHT or HOLDING TANK: A14 (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: Qallons Design Flow: Qallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DLSTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: b `< Comments,(gote if box is level and distribution tooutlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): I o1C —i et u:7 t.Jn011oKj} n15T2tau-lDnN E-(zoA1- /t/o FO) DCAM- r c�F so 1-1 n s , At244Y �e 2 v t2 i -e0 M.R6-C j/v o 2 PUMP CHAMBER: MA (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 va } OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTSr�zj SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _ 75 SHERWOOD DRIVE NORTH ANDOVER, MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why. Type leaching pits, number: _ leaching chambers, number: -leaching galleries, number: :21eaching trenches, number, length: a H a ` i.o n LT T(LEN C! (r S leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Typetname of technology: Comments (note condition of soil, signs of hydraulic failure; level of ponding; damp soil, condition of vegetation, etc.): CESSPOOLS: IV 6 (cesspool must be pumped as part of inspectionXlocate on site plan) Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: /M -(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.): Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _ 75 SHERWOOD DRIVE _ NORTH ANDOVER MA Owner:' DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 11 M dodo ��o so l a r Structural Group Jon P. Ward, SE, PE Structural Engineering Manager ion.wardCa- vivin tsolar. com October 26, 2016 Mr. Dan Rock, Project Manager Vivint Solar 24 Normac Road Woburn, MA 01801 �J 1800 W Ashto Lehi, Ulf\ Clint C. Karren, PE Structural Engineering Manager clint.karren0vivintsolar.com Re: Post Structural Certification Gilbert Residence 75 Sherwood Dr, North Andover, MA S-5196052; 10.865 kW; 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 August 17, 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 fof1 wnwanl solar Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _ 75 SHERWOOD DRIVE .— NORTH ANDOVER, MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 SITE EXAM Slope z Surface water V%o „ e Check cellar r.D s ,� Shallow wells in Estimated depth to ground water 1� feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: 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: j f 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 15 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 \I td M 0 z ui am ° w ¢� m c � A G x v Eco z u w �1 as C/)-00 v w w z c° V)w° a°' cr; co cn cn M 0 z ui am E � N C) ca o �N C r.1 o cm O C: Of c m P-4 `o CIO S 'C N :r Q ) z O t= W G. W a L Ls. C2 T moMen uj o , ' v a Q cm 0 �C c 0 •LA EW W 03 0 CD CD QCD > 0 Q cc 0 CZ L M C Q ca Q O CL. Q � ca Q C Q V Na O C cm �C C h is ui C U) ui Irw W w U) m c � C a c CO m c ` m =o ` Q A m C 4.,is * O p. �..' N �M m� d a:� N 16 ca co m = t C N m z aL.3 N O m co¢ N cs O: a0. a�yZ QCL N C = H mm t 03 CL w co W N m :s CD .y R � C •vi W v .E v pCD 0 y a N = A .0 ` =,a*m E � N C) ca o �N C r.1 o cm O C: Of c m P-4 `o CIO S 'C N :r Q ) z O t= W G. W a L Ls. C2 T moMen uj o , ' v a Q cm 0 �C c 0 •LA EW W 03 0 CD CD QCD > 0 Q cc 0 CZ L M C Q ca Q O CL. Q � ca Q C Q V Na O C cm �C C h is ui C U) ui Irw W w U) 05/05/00 18.34 5067748149 TFiE ERASER COMPANY .PAGE 01 'I'UVYIY OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION Fhe uadttsignad hereby certify that the Sewage Disposal System repaired. V1 constructed; t ) --&V— located at was installed in cordomsance with the North Andover Board of Health approved plan, System Design Permit #.,UL dated 0 -----_._..... , with an approved design f]ary oi_! ff gAous per day. The materials used were in caniormance with those spe.�:10 ou the approv ed glary; the system was installed in accordance with the provisions of 31 G C1 15. C�IiC, 'Title 5 and lova! regulations, and the 4rtai grading agrees subsWitially with the approved plan. All work is accurately represented o*t the As -built which has berm submitted to the Board of Health. Bed inspection date: Engineer RepreJentative Final inspection date Engineer Representatii e uu►taller: Lic.#; _ Late: ---/4F-- -_ Design Engineer; ftu-"` Date: 7'"e"6 AS -BUILT CIIECKI.,IST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATION & DEMENSIONS OF SYSTEM, / INCLUDING RESERVE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK / b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM ✓ TOP OF FDN ELEVATION STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW FINAL CONTOURS LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN 4�a 0944. 1W LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW FINAL CONTOURS LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN 4�a 0944. 1W M V LU z z 0 E 2 o a a U. O O � w ro c r C O LL r O Z .� Q 3 o 0 Ln -C Z cn U _O Vro1 T -- L Ln "; \ \ i ~ ro V ro ro 2 J a > V L w > LLJ a O fn O LL Z Q O O b=0 Q 0 U — N C,� Y L Q O O z \ L U N w m 3 o O l U O J � 0 0 a � c � � ro ro a`o E a� LA Q � � z L V) W 'A \OO H Ln r•u o,; z ter„ �xo U O ^ a� a U rt Q (n U U a Ln APPLICATION FOR DISPOSAL WORKS CONSTRtiCTION PE` AUT DATE: 311r, /DO CURRENT L'VSTALLER'S LICENSEm LOCATION: LoT /5 SgE L)W D .IDP/UE LICENSED INSTALLER: SIGNATURE: CHECK ONE: TELEPHONE? 978-8.52- 2001 `C9Z1- .) NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. 575.00 Fee Attached? Foundation As -Built? Yes No Floor Plans? Yes ;,4— Approval Administrative Use Only Yes `''f IN Date: Q5 A,�wo INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property 49 yMo�,l� ?• %>'f�SG21 at L07- /5 5herw,�cd Dpi g e relative to the application of , fF,rl . % r� J dated 311C An for plans by "04' A%0 C and dated 1 27 V with revisions dated I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I' understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed — generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to BOH, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installe Date: 3Z/6�OC� •_ J MAR 16 ; ,1 THOMAS E. NEVE ASSOCIATES, INC. Engineers • Land Surveyors * Land Use Planners 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 (508) 887-8586 FAX (508) 887-3480 TO SA r4r>y S TAR $cQ<a- o'F HP -061+1-1 l­Ze>rt.A-, AndaJer _ MA WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings ❑ Copy of letter Prints ❑ Change order ❑ Plans ❑■ DATE 1 1 � Z 9fv DATE JOB NO. •� ... �� 1 ATTENTION Jared. Sty,<r RE: SAn:+ow Di 1 ' L.0-} IS -• 51�cr+.so ❑ Approved as noted 5i�e<wood. Dr; v T1 nWN CF P,OP.T4 : _" d�! ❑ Returned for corrections ❑ Return corrected prints 1, r, 4 »�5 the,followEilng items: ❑ Samples O Specifications COPIES DATE NO. DESCRIPTION X For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted 5i�e<wood. Dr; v ❑ As requested ❑ Returned for corrections ❑ Return corrected prints l�wCl i �"�s►S been tv.a+ucd t0 (rn-,y) ❑ For review and comment ❑ o�oorox G1eva�-ion eS +I e ❑ FORBIDS DUE see.l:C_e 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS FFye.3 K..e of kes:'ht 4 y,o THESE ARE TRANSMITTED as checked below: sandy PIC-as.e Find e_n c -le seek X For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints l�wCl i �"�s►S been tv.a+ucd t0 (rn-,y) ❑ For review and comment ❑ o�oorox G1eva�-ion eS +I e ❑ FORBIDS DUE see.l:C_e 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS FFye.3 K..e Cie C% C- sandy PIC-as.e Find e_n c -le seek 3 o r -k^ of !)!.R tba re rt-Perp-,c.ed lo+ per o.>t Ci+ene ol:sc�ss.o., 't�►e t^c �Pa+�n ,Q Sophie.. 'i-tr+l! �9 l�wCl i �"�s►S been tv.a+ucd t0 (rn-,y) Jr" Va+er SePyttR -rile o�oorox G1eva�-ion eS +I e 'V'4e'r see.l:C_e G.oew4ng t"4o 4}-e ot�el9ne :� 1 44 S FFye.3 K..e of kes:'ht 4 y,o COPY TO RECYCLED PAPER: C•"7�TJ/YJ// / ����r.� gP" Contents: 40% Pre -Consumer •10% Post -Consumer SIGNED: if enclosures are not as noted, kindly notify us at once. THOMAS E. NEVE ASSOCIATES,C1OA� O� EA0, Engineers a Land Surveyors 9 Land Use Rlann rs� _ .. 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 1 + ail '" 1996 (508) 887-8586 FAX ((55�0/8�) 887-3480TO n N �;N& f;D PIN K/ cgs WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter n rL ' U D ° H�L!'LJu UCTU LL DATE � /�� JOB NO. DESCRIPTION A�ION' W fn e�isi �. ' - Attached ❑Under separate cover via _ �hefollowii7g items! Prints ❑ Plans ❑ Samples ❑ Speci ications ❑ Change order ❑ THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ 0 FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS - �J C�Pt PL ts� r—1 v s c> C-Q C4_ VL'P r-� I'D --A7 N6VJ VWVMW COPYTO RECYCLED PAPER: 49 Contents: 40% Pre -Consumer -10% Post -Consumer SIGNED: if enclosures are not as noted, kindly not t once. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ 0 FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS - �J C�Pt PL ts� r—1 v s c> C-Q C4_ VL'P r-� I'D --A7 N6VJ VWVMW COPYTO RECYCLED PAPER: 49 Contents: 40% Pre -Consumer -10% Post -Consumer SIGNED: if enclosures are not as noted, kindly not t once. DATE�/�6 Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER ADDRESS ENGINEER /1/G1lr� ADDRESS PARCEL # LOT # !� STREET 517�lewoo A )-e. PLAN DATE 4-/5Z9A� REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED l No zA-)e-r� .¢ xv O S �pX, KZ, 7-A V4 A)0 7 a S ` ro T-' DA N p A4 14 NI/D `f � io G•�f9DC_ 6 / 6A-) �Go cAJ A./0 7- u/9 5 4b D .V 110 6 .d 64 cy �•��� 3s TQ TSN S l�SitJ L�/j / ry a / k) lq G -5 e -C7-16 SCJ . 6 x c/411.EriD,v -/-- D� s 0/3561 c- � L E/qS. 7 46r 4* /x,) 7-6 ,U /9ri.e/4 c &,e wo asCp. 1q. ?, Iqj SUBSURFACE DISPOSAL DESIGN REVIEW FEE >° to PERMIT # (F3 3 DATE RECEIVED APPLICANT —BO6 -14A)Q 5 Z ASSESSOR'S MAP ADDRESS ENGINEER /1/G1lr� ADDRESS PARCEL # LOT # !� STREET 517�lewoo A )-e. PLAN DATE 4-/5Z9A� REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED l No zA-)e-r� .¢ xv O S �pX, KZ, 7-A V4 A)0 7 a S ` ro T-' DA N p A4 14 NI/D `f � io G•�f9DC_ 6 / 6A-) �Go cAJ A./0 7- u/9 5 4b D .V 110 6 .d 64 cy �•��� 3s TQ TSN S l�SitJ L�/j / ry a / k) lq G -5 e -C7-16 SCJ . 6 x c/411.EriD,v -/-- D� s 0/3561 c- � L E/qS. 7 46r 4* /x,) 7-6 ,U /9ri.e/4 c &,e wo asCp. 1q. ?, Iqj 0 THOMAS E. NEVE ASSOCIATES, INC. Engineers • Land Surveyors * Land Use Planners .447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 (508) 887-8586 FAX (508) 887-3480 TOG�.<,Aej� OUR UA 0\B45- WE vB45- WE ARE SENDING YOU �6ttached ❑ Under separate cover via ❑ Shop drawings Prints ❑ Copy of letter ❑ Change order ❑ Plans 0 DATE ffj � I,..� j JOB NO. ATTENTION RE: c HE� cwt c1� MOBIF I F9- rCnA�`Z i � �/LuTT '+✓tJ �J/c/�'✓, I - tl5e following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION Tl-'Ttr V3 I F9- rCnA�`Z i � �/LuTT '+✓tJ �J/c/�'✓, t {/�ryTr�vt / ,�/��a�F-Am � 1540Q PV -TC :&, 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 copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS x\1f--- --Tr VE PoeQu6: k7 -C `(Ojy2 re'115QU e - CP PAS7 t _SZ�T Qb YOU uj i"_�tA �N ''c ckfc— ec-Qyir-s" r A M)66171111sZr 51r_� Tl-'Ttr k=d� A W A-[ Ue � PL"=S� COPY TO RECYCLED PAPER: aP Contents: 40% Pre -Consumer - 10% Post -Consumer SIGNE If enclosures are not as noted, kindly no us at once. Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 June 11, 1996 Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot #15 Sherwood Drive Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. No wetlands disclaimer. 2. Tank not 25 feet to foundation; No manhole to grade. 3. Design flow not based on 110 GPD with 660 GPD minimum. 4. Leach area not 35 feet to foundation. 5. Map & parcel missing. 6. Leach area less than 100 feet from drain (N.A. 4.18). 7. Perc elevations missing. 8. Note discrepancy of trench length on longitudinal section. 9. See Lot #14 letter, note 7. 10. Note: Excavation & top & subsoil shall extend at least 6 inches into natural �;crvlotls material CN.A 2.19.). If you have any questions, please do not hesitate to call the Health Office. Sincerely, Sandra Starr, S., Health Administrator SS/cjp cc: Bob Janusz BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 PLAN REVIEW CHECKLIST ADDRESS /,S 0116 -le ),00b Z,e ENGINEER GENERAL 3 COPIES L-' STAMP C---' LOCUS NORTH ARROW c� SCALE CONTOURS PROFILE &--' SECTION 1,� BENCHMARK v� SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS � WATERSHED?4 DRIVEWAY __�(Elev) WATER LINE &�--_ FDN DRAIN SCH40 f TESTS CURRENT? SOIL EVAL SEPTIC TANK MIN 1500G L-"""_ .17 INVERT DROP f GARB. GRINDER/ -10(+200% EDF) 25' TO CELLAR MANHOLE ELEV GW # COMPS. D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT INLET OUTLET I93 - _ 2� ( 2" OR .17 FT) TEE REQ' D? //40 LEACHINGO TO MIN 660 GPD?x RESERVE AREA4`� 4' FROM PRIMARY? V11" 2% SLOPE _. 100' TO WETLANDS'/ 100' TO WELLS �� 4' TO S.H.GW !/ 5'>2M/IN) 35' TO FND .& INTRCPTR DRAINS 325' TO SURFACE H2O SUPP Cis 4' PERM. SOIL BELOW FACILITY ✓ MIN 12" COVERy FILL? x(15' if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd E SLOPE (min .005 or 6"/1001) c" SIDEWALL DIST. 3X EFF. W OR D (MIN 6')1/� RESERVE BETWEEN TRENCHES? (ice IN FILL? MUST BE 10' MIN. "1--- 4" PEA STONE?GWENT? (>3' COVER; LINES >501) BOT 96� + SIDE 9 D �' X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft,2) Copyright O 1995 by S.L. Start A- 10-21-1999 10:17AH FROM TO: S4,,` Phone Fax Phone ')O--:�; 4Z - Com' .. .' z Date /Z>/Z/g [Number Of pages inciudi cover sheet FROM. • William Barrett Homes Div. of C. V. D.C. 1049 Turnpike Street North Andover, MA 01845 Phone 978-682-2320 Fax Phone 978-682-2397 REMARKS: ❑ Urgent 0 For your review ❑ Reply ASAP ❑ Please Comment J(�14s- c IJ 1;_1. C' �T 2 11999 10-21-1999 10 = 17AM FROM P.2 10-21-1999 10:17AM FROM P.3 9-10-1999 11:01AM FROM P.2 aoowa�5 0. T. -.:77 7---77 10-1 0. 9-10-1999 11:01AM FROM P.3 NVUZOIA 6NO).:F -1 -1 IAA 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 p•tt oto ,e •ryO 3? a° •a pG o ;• p :2 9 i O4Ar— •PP y'(� �9SSACHUS�� BOARD OF APPEALS 688-9541 BUR DING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 - - FORM U: - VERIFICATION FORM INSTRUCTIONS This form is: -,used to verify that all necessary approvals/permits-,from Boards and.Departments.having jurisdiction have been obtained. This does notrelieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this s�ection****************** APPLICANT: �n 2✓ wo �►� �2-!/ fOm2.�f LLC Phone 6d Z ';U LOCATION: Assessor's. Map Number= -Parcel Subdivision _, � re -k L - Lot (s) /3' Street -^--7i�490^CcJDDl'— �(� 1 �� - - St. Number ************************Official Use RECOMKF'"DATIONS OF -TOWN AGENTS: - Date Approved (0 v� ---- Corts•eration :Administrator Date Rejected S 1. Comments Date Approved Town Planner Date Rejected Comments OYVI2/ �\ .� �_� ^� V vY Date..Approved . Food Inspector -Health: Date Rejected Date.Approved `f Septic Inspector -Health Date Rejected Comments g �M5 -AZ F4Q4-JMVh Public Works - sewer/water connections 7-1 `9 - driveway p it Fire Department ©�c- . L'/5' Received by Building Inspector Date SEPTIC PLAN SUBMITTALS LOCATION: Lo T- 15 �� n NEW PLANS: YES $.60.00/Plan REVISED PLANS: DYES $25.00 DATE: r Gi DESIGN ENGINEER: f When the submission is all in place, route to the Health Secretary � NORTM O'�tJo . • ��O O � F • ' 9 • o, ;C r �ss�cHusE� h Applicant a Site Location //w f L -A - Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Test No. Reference Plans and Specs Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD OF HEALTH Fee 60 Site System Permit No.,_ -3 03-c'_-iS96 _C: 35 si7 932 7615 CEP NGRTY. %ST RE61CV:L P.02 FORA 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS ,Massachusetts Percolation Test" Date; gjl� 1�5 Time: G�-;2e�► Obsarvation Hole R �3 Depth of Perc Go� Start Pre-soak 4'.-z U PM I i cnd Pre-soak I �OVI.'Q �� I �pt� �i0�►L Tune at 12" 1 Time at Time at 6" 1 Time (9"-6") Rate ./Inch • Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ -_.......... ....... ................... . ............... Performed By: Witnessed By'. Gj Comments: ....... ... _.- ov ►MOYM rowA . w0717f FOR 111 - SOIL LVALUATOR FORM Pale 3 of 3 Location .-address or Lot No. P� 'J?AfAf�wwo V'-)21Vr= Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole........... inches b❑ pth wee ping,,fromside of observation hole-..-.-. `in•ches /'Depth to soil mottles j b& inches ❑ Ground water adjustment .................. feet Index Well Number ............... Reading Date ..... \Index well level .. Adjustment factor Adjusted ground water level Deoth of Naturallv Occurrino 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 (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. 1 Signature Date 5/1/96 DEP APPROVED FORM - 12/07195 FORA 11 - SOIL EVALUATOR FOWNI Page 2 of 3 Location .=address or Lot ivo.j� ��� '%•��� On-site Review Deep Hole Number Z-0--1 Date:. -4\Z% `lli95 Time: A111J1 Weather Location (identify on site plan) �-� .rR�+-�`rTPsc`� i��spcs�r� Sys-T6�1 >=—Q=StC�ry Land Use Siope (%) Surface Stones Vegetation Landform _ Position on landscape (sketch on the back) Distances from: Open Water 8ody1t00+/ feet Drainage way t,\iQ1.TE feet Possible Wet Area 1caD+/ feet Property Line 1JSY feet (VOOY•-1 (-F-T LpT L-tv­sE) Drinking Water Well Q'ht-� feet Other DEEP OBSERVATION HOLE LOG* Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Calor (Munselq I Soil Mottling Other (Structure, Stones, Boulders, Consistency, Oro Gravel) sPV+Ao-t Mann iF %t-s'E ��� �2,► OVA V309 t.oativt,. 2"..-- `bb r G i ✓ �i���4/�}- eW0Y-t@ G.itA"�1 F l EAG SP�+�l`G� AP s� �Jtl►�C�l-+c lob" 1:1 c9e�l1E'L GP�'t►•-i LOOSE' kDC7,t". 1'iC1' G2 � �L Z•5Y5I3 IV �NG C-.�1vr��{�s•�.L►-1 G%�Q� Wn��•l NO C -V W "vwPYtC-t2. 1 1 IVIIIVIIVIUIVI Vr c nv•.�+ • ••-�`+•• •"' -' - - - - - - Parent Material (geologic) G�_TWPfSA DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: 'V, b`NG Weeping from Pit Face: Estimated Seasonal High Ground Water: N kiUEP,.PPROVED FOtOt - 1:/07195 -4o. 144S3 — IS it Performed By: Witnessed By: FOR�Nl 11 - SOIL EVALUATOR FORM Page I of 3 Commonwealth of 'Massachusetts Massachusetts hilltv Assessment for On-site Sewage Date: iSDOSal Date: 412N \9'5 L=uan Address or rdc-r� 2 P fVC/W GW t�,V— I V T (c-- A&,NMj6(L, W Pf C*�-k S to New Construczicn R(ReQair 4715— 15 Off -ice Review Published Soil Survey Available: No ❑ Yes Year Published Publication Scale ........... Sol, map Unit ...... Drainage Class .... I ........ Soil Limitations C .................................... ....... ............ . . ................ . .. ......... Surficial'Ge'ofogic ke'p-olri'Avdilable: No. 2Iyes,.71 Year Published Publication Scale Geologic Materal'(Ma'p Unit). ........... ................................. ............. . .............. Landform .................... ............................................................................ . ............... .............. ....... . ......... Flood Insurance Rate Map: Above 500 year flood- boundary No "Exes', '4 �Yes❑ Within 500 year flood boundary No Within 100 year flood boundary No 19Yes F7 Wetland Area: - j i National Wetland Inventory,Map (map unit) . ..... .......................... ........................................ ............................. . . ..... Wetlands Conservancy Program Map (map unit).. .. ................ Current Water Resource Conditions (USGS): Month r-�Normal F-1 Belc,.-/ Range :Above,Norma'i Normal ❑ Other References Reviewed: WDEF APPROVED FOP -M - 12107195 03-c1-1996 1�=36 Si? 932 7615 DEP NORTHEAST REGICNAL Location Address or Lot No. P.02 FORM 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS Massachusetts • Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed ❑ Site Failed ❑ Performed By: Witnessed By:_ Comments: ..._ _... Da xprxpvm MRM - U197171 FOR,N1 11 - SOIL LVALliATOR FORINJ Page 3 of 3 Location Address or Lot No. T'-)01Vr= Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ........... ... inches ❑ epth weeping from side of observation hole ?.�-+' ::j inches LJ Depth to soil mottles i08. inches ❑ Ground water adjustment .:................ feet Index Well Number ................ Reading Date ................. Index well level Adjustment factor .................. Adjusted ground water level .. . Deoth of Naturallv Occurrina 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 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. Signature a Date 5/1/96 .r.�. , DEP APPROVED FORN - 12/07/95 F0R:'ti1 11 - SOIL EVALUATOR FORM Page '_ of 3 Location .address or Lot iJo. On-site Review Deep Hole Number ?-0-2-- Date:. x\S% 9%5 Time: Weather Location (identify on site plan) . 5P+--rTP-x_'•e ��spt�5 ` S�IS"T '� LAS IC�ty Land Use Slope (%) Surface Stones Vegetation Landform _G./l_ S�DSq�' S1-t�stE►-t pESt Cv� Position on landscape (sketch on the back)—'r'Tfiii Distances from: Open Water Body 16'CX feet Drainage way J,&aoS feet Possible Wet Area �t/— feet Property Line �jcj r�-4est �� �� L � Drinking Water Well 1Jbk-� feet Other DEEP OBSERVATION HOLE LOG' Depth from Surface (Inches) Soil Horizon Sod Texture (USDA) I Soil Color (Munselq I Soil Mottling Other (Structure, Stones, Bould)rs. Consistency, % Gravel � s J � iNo►� ��� S�� �M LD,� Cd' — 3LO" '0, , 16w, -OP*" �jLa'--1 U� v S 1cN►Z414 rxvgx @ 4i z•5`I`_13 No�.rE. • �t�,v�L.L-t San�t�t c olaM ►.�p�ss�vE / 110 C72ov ��7t�'P►rI� — -` MINIMUM OF L HULtJ rttuumty A' tvcn r• ^-^••-• • Parent Material (geologic) cx�—CWA•SrrA Oepthto8edrock: k) mJ6 Death to Groundwater: Standing Water in the Hole: , `1"Q' Weeping from Pit Face: Estimated Seasonal High Ground Water: 1"000 DEF APPROVED FOR.%t - U-107195 FORM 11 - SOIL EVALUATOR FORM Page I of 3 .No. 144E5 —15 Date: -4 �Z(v le5cp Commonwealth of Massachusetts j40V--Ik �)qbVtVL— , Massachusetts Soil . Suitability Assessment for On-site Sewage Disposal TI! --- \ I C:: J. v1 "V—S-0 Dace: Performed By: -.. .1 .......... P*,� CVA —Tpeee— . ..... ... ............ Witnessed By. -- ............ . ........... .. ........ ........... . L=1,0ft A=US X .Address. ana rdc-.rwc I r2 New Construction dRepair Office Review Published Sol, Survey Available: No F-1 yes T1 Soil Nfao unit Year Published Publication Scale .. . ...... Ye, IEYCr ... ........................................................ ... ..... ......... . ....... . .. ...... . ............. Drainage Class ... .... .. S0*1 Limitations Surficial Geologic Report Available: No '2"**Yes'-f ❑ Year Published Publication Scale Geologic Material'(Maip Unit) ........................ ; .................................................................................................... .. - Landform ...... .......................................................................................................................... .... . .......... .... .... ............. ... . ........... Flood Insurance: Rate Map - Above 500 year flood boundary No es Within 500 year flood boundary No Yes ❑ Within 100 year flood boundary'No, FYes Wetland Area: National Wetland Inventory Map (map unit) ............................... ...................................................................... . Wetlands Co'nservancy Progarri Maip (map unit)- I ........ ............ ........................... Current Water Resource Conditions (USGS): Month Range :Ab&ve,Norrnai ONormal F-113elcw Normal ❑ Other References Reviewed: WDEP APPROVED FORM - 12/07195 03-2i-isSo 14:26 Si7 932 7615 DEP NCRTH_)=ST REGICN•=L R.02 FORM 12 - PERCOLATION TEST I Location Address or Lot No. �+Afjjw�(Ge-\vr-- COMMONWEALTH OF MASSACHUSETTS 4N,0C>Vf::AZ— , Massachusetts • Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑_ ............................... _.............. Performed By. Witnessed By Comments: :....... ...._ _._ _.. 0U A moYm MR.M . U1071ff FOR 111 SOIL LVALUATOR FORM Pale 3 of 3 Location .-address or Lot No. (;� Determination for Seasonal IHigh Water Table Method Used: l� Depth observed standing in observation hole .... 6� inches ❑ Depth weeping -from sidle of observation hole inches ❑ Depth to soil mot -ties inches ❑ Ground water adjustment .................. feet Index Well Number-- ....... Readina 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 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. Signature , Date 5/1/96 DEP APPROVED FOR.N1 . 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Loeztion-Address or Lot No.C2: On-site Review .v, n Deep Hole Number I Date:..15. Y? 9Z Time: AM Weather Location. (identify on site plan).--+j`� b�spaS_S-r t»� tv�v. Land Use Slope (%) Surface Stones Vegetation , (f-6-AvC4:4S15. Landform Position on landscape (sketch on the back) Distances from: Open Water Body 1.�� feet ' ` Drainage way feet Possible Wer Area. \!�, = feet'; Property Line feet l(LwA (Z-71 l.Ctf `uric-) Drinking Water `Well.: Lodi-� feet. Other " DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface Ilnches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) O11_� �► _ tsli�s•�S•' ToRSn� � !BONN • (yfLRv art., G�(C,r�t,ti.1 c:>W�T4ti @ 8�1" Ivillmlivauivi Ur Z. M��U� Parent Material (geologic) eti�—TWPtGkA DepthtoSedrock: 1wN� Depth to Groundwater: Standing Water in the y� Hole: 81� ��� ` l34 Weeping from Pit Face: Estimated Seasonal High Ground Water: IV" DEP APPROVED FORM - 1:107195 i FOR NI 11 - SOIL EVALUATOR FORM Page I of 3 Commonwealth of Massachusetts k4D , Massachusetts nif Suitabilitv AOn-site Sem Performed By: Witnieskd'By. . .. . .......... ........._i........_ L=twn Address Of iew construction dRepair Date: S Date: *1-3 112192 Address. ir,4 A Telephom I q-0 e7Q0-!7f.—r 1r,0LV,"PP til pr owLt) Off -ice Review Available: No ❑ Yes Published Soil Survey Year PublishedPublication Scale ... ...... Sol, Map Unit ,cESSiv. A16; . ..................... . ...................... Drainage Class ........ Soil Limitations ........................................ Surficial Geologic Report Available: No 2 -"*Yes ❑ Year Published Publication Scale GeologicMaterial (Map Unit) ....................... i .................................................................................................... ... .............................................................................................................................. .................... Landform.................................................... Flood Insurance Rate Map: Above 500 year flood boundary;No, [9�es 0 Within 500 year flood boundary No lyes* ❑ I - Within 100 year flood boundary No Yes Wetland Area:. National Wetland Inventory Map (map unit) ............................... ........................................................................ . . ..... ..................... Wetlands Conservancy Program Map (map unit) ............. I .... ....................................................... Current Water Resource Conditions (USGS): Month Range :Above Normal El Normal El Belc�v Normal Other References Reviewed: iiDFP APPROVED FORINI - 12107195