Loading...
HomeMy WebLinkAboutMiscellaneous - 86 SHERWOOD DRIVE 4/30/2018E y r r• MAP # LOT # (P PARCEL #¢ °r J,� STREETilpr1t-Z1��. CONSTRUCTION APPROVAL, HAS PLAN REVIEW FEE BEEN PAID YES NO PLAN APPROVAL: DATE 7 LAPP. BY DESIGNER:j PLAN DATE CONDITIONS WATER SUPPLY: WELL PERMIT_ 9�. WELL TESTS:` TOWN WELL DRILLER CHEMICAL DATE APPROVED B4-CTERIA I DATE APPROVED BACTER II PLUMBING SIGNOFF.4 WI COMMENTS: DATE APPROVED SIGNOFF FORM U APPROVAL: APPROVAL TO ISSUE YES NO DATE ISSUED /zXZ % BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: I SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? TYPE OF CONSTRUCTION: NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW CONDITIONS OF APPROVAL (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO NEW REPAIR NO YES NO YES NO DWC PERMIT PAID? YES NO DWC PERMIT NO. `���� - INSTALLE -'. BEGIN INSPECTION YES NO: EXPAVATION INSPECTION: NEEDED: PASSED_ CONSTRUCTION INSPECTION: BY NEEDED: AS BUILT PLAN SATISFACTORY: C YES:) APPROVAL `O BACKFILL: DATE: FINAL GRADING APPROVAL: DATE ; FINAL CONSTRUCTION APPROVAL: DATE: BY R 00 a C Q r Z 0 V i v i a m C Y N CO O O N N oo ao 0 o o Z J J D a 0 v m Y 0 V J C C y cn N O L Ci _ G c Gyi G m Cc) O v) a c0CL O O v) 4� C U m C N a d Lu cn m y ` o a y a m¢ w c o ea J o Z 0 Z o Z a m m a y (, m Zn � z R. Y Y m m U U y O y a a m m 00 R Z Z Z w cn rn �► 0(D W No ,O p J rn H N = LL a G iri iri ch E as c a) E d o m `m ayi a ' a) m E C " N E dLO E y 3 3 a m.__ o O 0 o' o V V m y N U o LL Ll O io ` 3~ m L► aii V D D c� C7 12 cn Ot MO oTM qh 3+ .:. r� .,!• nuc Town of North Andover `ti'• .: HEALTH DEPARTMENT CH CHECK #: DATE: LOCATION: H/O NAME: CONTRACTOR NAME:,--!/ ��,e,� Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑Titl 5Inspector $ Zitle 5 Report $ 0 ❑ Other. (Indicate) $ 2 41 1 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer COMMONWEALTH OF MASSACHUSETTS P 1 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: 86 Sherwood Drive _ North Andover_ Owner's Name: _Shafik Kawar Owner's Address: _86 Sherwood Drive _ North Andover, MA 01845` Date of Inspection: _4/25/2007_ Name of Inspector: Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810 Telephone Number: _( 978 ) 475-4786_ REEF` ...' ) MAY 0 3 2007 TOWN OF NOK HEARTH DEFT 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 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 Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fa' s "V Inspector's Signature:` Date: _4/25/2007_ 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 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: _86 Sherwood Drive _ _ North Andover— Owner: _ Kawar _ Date of inspection: _4/25/2007 _ 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _86 Sherwood Drive _ _ North Andover— Owner: _Kawar _ Date of Inspection: 4/25/2007 _ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance _ "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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 5 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 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _86 Sherwood Drive _ — North Andover — Owner: _Kawar_ Date of Inspection: _4/25/2007 _ D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: _ _No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6" below invert or available volume is V2 day flow. No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped —No Any portion of the SAS, cesspool or privy is below high ground water elevation. No Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No_ 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 nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (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 `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 — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 86 Sherwood Drive _ _ North Andover _ Owner: _Kawar_ Date of Inspection: 4/25/2007 Check if the following have been done. You must indicate `yes" or "no" as to each of the following: Yes No Yes_ _ Pumping information was provided by the owner, occupant, or Board of Health No Were any of the system components pumped out in the previous two weeks ? Yes_ _ Has the system received normal flows in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection ? _Yes _ Were as built plans of the system obtained and examined? Yes _ Was the facility or dwelling inspected for signs of sewage back up ? Yes Was the site inspected for signs of break out ? Yes _ Were all system components, excluding the SAS, located on site ? _Yes_ _ 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 ? _Yes_ _ 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 _Yes_ _ Existing information. _Yes_ _ 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: 86 Sherwood Drive _ _ North Andover– Owner: _Kawar_ Date of Inspection: 4/25/2007_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _5 _ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CMR 15.203 _550 Number of current residents: _3 Does residence have a garbage grinder (yes or no): No_ Is laundry on a separate sewage system (yes or no): No _ Laundry system inspected (yes or no): Seasonal use: (yes or no): No_ Water meter reading: Yes_ Sump pump (yes or no): _No Last date of occupancy: _ Current _ CONEVIERCIALMIMUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): _gpd Basis of design flow (seats/persons/sqft,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: _Pumped May 2006,owner _ Was system pumped as part of the inspection (yes or no): Yes_ If yes, volume pumped: _1500_ gallons -- How was quantity pumped determined? _Measured tank_ Reason for pumping: _Inspect tank & tees_ 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 9 years old, 8/3/1998, As built plan _ 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: 86 Sherwood Drive_ _ North Andover _ Owner: _Kawar_ Date of Inspection: _4/25/2007 BUILDING SEWER _ X _ (locate on site plan) Depth below grade: _42"_ Materials of construction: _ cast iron _X_ 40 PVC _other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) _ 4" PVC thru wall, 3" PVC in house, No evidence of leakage._ SEPTIC TANK: X Depth below grade: _30" _ 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'x 5' x 4' Sludge depth: _5"_ Distance from top of sludge to bottom of outlet tee or baffle: 22" _ Scum thickness: _4"_ Distance from top of scum to top of outlet tee or baffle: - 8" -Distance from bottom of scum to bottom of outlet tee or baffle: 1T' How were dimensions determined: _Tape Measure _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc _Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of septic tank leaking. Center cover has extension cover 3" deep 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: 86 Sherwood Drive_ _ North Andover— Owner: _Kawar_ Date of Inspection: 4/25/2007 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/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_ ( locate on site plan ) Depth below grade _5'6"_ Depth of liquid level above outlet invert: _0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.) _D -Box level & distribution equal. Evidence of light carryover. No evidence of leakage. D -box cover broken, replaced it._ PUMP CHAMBER _ (locate on site plan) Pump in working order (yes or no): Alarm in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): _ Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 86 Sherwood Drive _ _ North Andover— Owner: _Kawar_ Date of Inspection: _4/25/2007_ 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: _ X leaching trench, number, length: —2 trenches 47' long _ _ leaching field, 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.): —Soil ok. Vegetation ok. No sign of ponding to surface. _ CESSPOOLS: Number and configuration: _ Depth — top of liquid to inlet invert: _ Depth of sludge 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: (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 Property Address: 86 Sherwood Drive _ _ North Andover— Owner: _Kawar_ Date of Inspection: 4/25/2007_ 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 A to Tank = 25.5" A to D -Box = 52'3" B to Tank = 33' B to D -Box = 54.6" Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 86 Sherwood Drive _ _ North Andover — Owner: _Kawar_ Date of Inspection: _4/25/2007 SITE EXAM Slope _ No _ Surface water _ No _ Check cellar _ Dry _ Shallow wells _ No _ Estimated depth to ground water _ 4' below trenches _ 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: _4/21/1995_ 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: _ As per design plan _ Commonwealth of Massachusetts City/Town of System Pumping Record b' Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ ren DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: n Address Cityfrown State Zip Code 2. System Owner. � Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date State Zip Code aOg- /ash Telephone Number IS -00 2. Quantity Pumped: Gallons Cesspool(s) ©'6eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 3"No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Sy em Pumped By: Name Vehicle License Number Company 7. Lo t* where contents were disposed: �- , s. o . .1 L� a S--07 Hauler t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 11 I Summary Record Card generated on 4/20/2007 12:21:10 PM by Elaine Barclay Q' Town of North Andover Tax Map # 210-105.0-0063-0000.0 86 SHERWOOD DRIVE SHAFIK, KAWAR & HELEN 86 SHERWOOD DR NORTH ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type i Kesiaenval Size Total 0.92 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until SHAFIK, KAWAR & HELEN Payor 86 SHERWOOD DR NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id. 17701.0 - 86 SHERWOOD DRIVE Last Billing Date 4/2/2007 3170372 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 62.60 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 47759796 a Active ENC F.L. NEPTUNE NEPTUNE w Water 1 1 0 Date Reading Code Consur>tiption . Posted Date Variance 3/15/2007 1431 m Manual estimate 20 :4/16/2007 -21% 12/12/2006 1411 a Actual 23 .1/19/2007 -64% 9/18/2006 1388 a Actual 69 10/20/2006 200% Trouble Code:03 6/19/2006 1319 a Actual 26 7/10/2006 20% 3/8/2006 1293 a Actual 16 :4/17/2006 -19% Trouble Code:03 12/22/2005 1277 a Actual 24 :1/17/2006 -77% 9/21/2005 1253 a Actual 99 10/14/2005 279% Trouble Code:03 6/27/2005 1154 a Actual 27 7/15/2005 31% 3/30/2005 1127 a Actual 24 4/5/2005 -51% 12/16/2004 1103 a Actual 39 1/14/2005 -41% Trouble Code:03 9/24/2004 1064 a Actual 84 10/8/2004 199% Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 86 Sherwood Drive, North Andover Owner: Kawar Date of Inspection: 4/25/2007 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. /eil #JBa!teson Bateson Enterprises, Inc. Commonwealth of Massachusetts _ City/Town of RECEIVED System Pumping. Record y, Form 4 JUN 0 1 '1015 OWN OF NORTH ANDOVER DEP has provided this form for use=by local Boards of Health. Other forms h%I the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location e / Rig fr�ronof Left / Right rear of house, Left / right side of house, LeftRight side of buil g, Left / igilding, Left / Right rear of building, Under deck Address Cityfrown 2. System Owner. Name' State A (-Q — Zip Code Address (if different from location) Cityfrown Stat Zp Code Telephone Number ; f B. Pumping 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date 2. Quantity Pumped: Gallons Cesspool(s) eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ErNo If yes, was it cleaned? ❑ Yes ❑ No, 5. Conditio 6. System Pumped By: Neil. Bateson Name Bateson Enterprises Inc - Company 7. Lo ere contents were disposed: CL.L S1 _ Lowell Waste Water F5821 Vehicle License Number Date t5form4.doa- 06/03 System Pumping Record • Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your. cursor - do not use the return key. Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 RECEIVED MAY 2 6 2009 DEP has provided this form for use by local Boards of Health. Othel' fpiD61 Ufa information must be substantially the same as that provided here. B E with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Locatio eft front, ft rear, left s' of hous Right front, right rear, right side of house. Address /o City/Town 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: El Other (describe): State Zip Code State Telephone Number —1 Quantity Pumped: Date Gallons Cesspools)eptic Tank [j Tight Tank 4. Effluent Tee Filter present? E] Yes ITo--- If yes, was it cleaned? [] Yes [j No 5. Condition of System: + j 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location—where contents were disposed: .L.S.D Lowell Waste Water JA . 5---- ( CS7—<:�9. of Hdulbr Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use, by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Locatio Left Righ �nthLeft /Right rear of house, Left /right side of house, LeftRight side of buil ng, Left / Rigilding, Left / Right rear of building, Under deck Address �( Citylrown state Zip Code 2. System Owner. Name Address (if different from location) Citylrown S r'f Telephone Number - B. Pumping Record U be �c 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes LJ" No If. yes, was it cleaned? ❑ Yes ❑ No. " 5. Conditiop of System : 6. System Pumped By: Neil Bateson Name Bateson Entemrises Inc Company 7. Locatio a contents were disposed: L S. Lowell Waste Water P/ r0i t5form4.doc• 06103 RECEIVED F5821 1 9 813 Vehicle License Number TOWN OF NORTH ANDOVER HEALTH 'DEPARTMENT IV Date System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record RECEIVED w Form 4 DEP has provided this form'for use by local BoLsof AWtl'r 88W firms ay be used, but the information must be substantially the same asi d here. Before u ing this form, check with your local Board of Health to determine the form the�,��' Record must be submitted to the local Board of Health or other approving autho A. Facility Information 1. System Location/_Rig ro t of hou"b�ildling. - i ht rear of house, Left / right side of house, LeftRight side of buil g, Left / Ig ron of Le fight rear of building, Under deck Addr ssr City/To State Zip Code System Owner: Name Address (if different from location) City/Town State/�, ;Kip Code � Telephone Number B. Pumping Record Co 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes .,No If yes, was it cleaned? ❑ Yes ❑ No 5. Conditi n qf System: I 0 f rte- 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. contents were disposed: 7 S. 7 -Lowell Waste Water Sign toe Haule Date ZJ t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 NOV � 10 DEP has provided this form for use by local Boards a be used, but the information must be substantially the same as that o Wil this form, check with your local Board of Health tq determine the form they us . m umping Record must be submitted to the local Board of Health ovother approving authority. A. Facility Information 1. System Location: Left side of house, Right side of hou e, LeZfroni:tofr?hous- Right frontof house, Left rear of house, Right rear of house. Left rear of building.ding. Address Cityrrown State Zip Code 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State d Tel one Number Date 2. Quantity Pumped-. Cesspool(s)eptic Tank (S� Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ®..W If yes, was it cleaned? ❑ Yes ❑ No 5. Conditi nof 0�9ystem \ V\— 4c:f�t� 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locati ntents were disposed: G/ L.S.D' Lowell Waste'wz Signature of F5821 Vehicle License Number Date 6 (? t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 �L\ Commonwealth of Massachusetts City/Town of ; - . -QED System Pumping Record Form 4 MAY 0 3 2007 DEP has provided this form for use by local Boards of HealthTO#her forms;may4 beau ,but the information must be substantially the same as that provided[her`e'Beforeusing thisTfonn, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. It�l 1 System Location: 8 .tj�, ya �- - 5'c� &�- V\O VSA Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): L4 -?5—otl Date Cesspool(s) State Zip Code ao�-lash Telephone Number — 2. Quantity Pumped [3-19'eptic Tank IS -00 Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes E3"'No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Sy em Pumped By: Name Company 7. Locati where contents were disposed: Sia fe Hauler Vehicle License Number Date -a -s =o°7 t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ Commonwealth of Massachusetts City/Town of NORTH ANDOVER, System Pumping Record Form 4 SACH DEP has provided this form for use by local Boards of Health. The Sy; be submitted to the local Board of Health or other approving authority. A. Facility information 1. System Location: Address City/Town 1/�,�%� State 2. System Owner: UN 7 5 2006 N ONVMTH ANDOVER Zip Code Name Address (if different from location) City/Town State 77 Zip Code Telephone Number 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): �LO Date 2. Quantity Pumped 0j Cesspool(s) xSeptic Tank Effluent Tee Filter present? ❑ 'Yes ❑ No 5. Condition of System: System Pumped By: X1 1 / ! _ n f Company /u -D n Gallons ❑ Tight Tank If yes, was it cleaned? [] Yes ❑ No Vehicle License Number 7. Location where contents were disposed: Si ature of Haul Date—T'–"----- http://www. mass. gov/dep/water/appprrovals/t5forms. htm#inspect e t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE:�-- SYSTEM OWNER & ADDRESS �aujar-, SIA-ervja of (example: left front of house) [4� 40v1j-4'- houses_ DATE OF PUMPING: L1, _ QUANTITY PUMPED 1 15 C T) GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE ZEMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE "r ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: ECLi p n. L COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFMLD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: _�� L • � - TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION Ile undersigned hereby certify that the Sewage Disposal S stem - y P<) constructed; ( ) repaired; by -r Ft ase r Con. ar,� located at L.OT. Co — S 1-{ E R woor> was installed in conformance with the North Andover Board of Health approved -- plan, system Design Permit # -C` datedZ whit as roved aPp design. flow of D _ gallons P� day. The materials used were in conformance with those specified on the plan; the system was installed in accordance with theprovisions of 310 CMR 15.000. aptie S and - — proved local regulations, and the final grading agrees substantially with the approved plan. All work is -accurately rcpreseatcd on the As -built which has been submitted to the Board of Health. Installer. J Lie. tt: 45- Dat c: S Design Engineer: a Date:1 7- CUG-03-1998 15:18 978 682 2397 95% P.©2 AS -BUILT CHECKLIST � LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER y LOT LINES & LOCATION OF DWELLINGS LOCATION & DEMENSIONS OF SYSTEM, INCLUDING RESERVE 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 U ' LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE r 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 0 LOCUSPLAN 'o ver 1Ou He It •• •• 1 1/2 " Flow Outlet • h 1 I 1 i i I ;rl I Inlet ` 1 I No-rE : ou-rLET ��►-ASS 7NALL BE LEVEL 1' N . Outlet A MINIMUM OF TIdE • FIK5-T Z•' 0I= THEIR Sonitory L�acr•rH Q) "- ' _ • Tee .�m� �F No���H A� �O!!��� 3„ 1 11211 b Inn Le& ON 4 1 Inlet & 2 Out/et(s) F -— —>zz Ind fibers. �j inforced with /•\ '\ o ��C 06 It Lo w 1 1 40, 1 `CJand x.92 ACRES •• X00' `� xo^� ' / 1 / }" ".r_ ` G.B. A. 37, p9Cv.5. Buff 1 / I FllO GRAIN . W If / ►�•� 13.0• ��� 1 / / X30` �'� .SES •. / J% � �r / O I / 1 / � r �1 —= Poo I �• o t. 01 i ♦ / // Y ./ 001 / / \ FILL R EQ IT / f . 1 l000l LEACH TRENCH 5Y5. / W/ 100%10 FUTURE• • / P� \ �3 31.so' Rs 85s � , • X1loll 18 53 /, It CB i � YY / 5. yV00d-Wide) ��� ewe n t ' _ \�,� p �" . �-s '1 �-i vQ t e C i dge j0 '0F ,�k Pavemen �'' , plari ;devvQlk �i Sca/e: 1'.:r20,, FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this )s�ection********�********** APPLICANT: �1A✓ _Pwa-os lv.2f.�elyLb/ fOmQ�� Phone LOCATION: Assessor's Map- Number 0 Parcel Subdivision ,�i�/�-� I� Lot(s) 6 Street 6he/%6LI o0 ejL �(� I �� St. Number ************************Official Use DATION OF' TO1WN AGENTS: C nservation�Administrator Comments.1��1. 11111111, 1, iiiigO MUA I 'I 1 0 cl Planner Comments Food Inspector -Health �,1 , Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved a 45 Date Rejected k-, Date Approved l Date Rejected Date Approved Date Rejected Date Approved zo Date Rejected Received by Building Inspector Date y,.011 16',0" N 41 6",211' d � _ 7s 9 I _ L- I / ' I� V�� �Q"�"" ►azo �cr Trr : 5HF W00 PI I.Dr - 6 scn �. vnn: 3/ 16 I 0 GL�BLI��I: OF FINEl NDIil1�5 feed : `'S'''HY: A �1�51" �1.00� pI.AN 1"OI�I� NOOp��: ' 13'-0" I - - -b�,- - - ---------------J _ J 0 OD I OD ZZ I i x Q I I I � I I,,O: \ / \ -- \\\ Z I / 7Z _ - - - - - - - - - - - - - - ---� O I At / \ Cl v -CC z PRO.f.Cf it1LE: SUy.E: SFEEf: VIA L - L- bol\NA 1:3. 5HM0OP PQ 1.01' - 6 5116"T" DA1i: I3�..98�f��P, OF FINF- I'OAAF-5 ..�` 5ECONP FLOR PLM w�►rt�cv: /1A- (V)1'OI2I� NOOr��I: TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the individual subsurface disposal system constructed ( X ) or repaired ( ) on 8/6/98 by North Andover Licensed Installer Ray Fraser at Lot #6 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 as described in the Design Approval Permit # 909, dated March 21, 1997. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. 0' .A�-nAa� Board of Health Inspector ►t \ O W C ;, 2 v ca a a � G o o a o G G W x W cn U)w cn w° w a 15 0 2 O co 0 c cr- ts0 Z fl. O ca o c CD cm co yO O on m �� 3� 0 CD L _cc o a o -ca 0�4 C o Cc vco J •� .ca Z s CD C.D ca C C _c d 0 f NOR7q O'�t�ao i? � r+ _.. •. of �o w p ,SSACHUSEt� Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant At -t-- Test No. Site Location 1— �o —e<Lh P 2,,A -71 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. 4'D Fee. l)— C14AIRMAN, BOARD OF HEALTH Site System Permit No. 1 (0 9 Town of North Andover, Massachusetts Form No. s of ,40RTH BOARD OF HEALTH # S 11 �� l 19_12 �•,S'„•o.E�� DISPOSAL WORKS CONSTRUCTION PERMIT SACMUS Applicant �— NAME ADDRESS TELEPHONE Site Location Z o %- Permission is hereby granted to Construct 1%A or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. `� © 151 CHAIRMAN, BOARD OF HEALTH Feel D.W.C. No. b e t'. AY MOUNT DATE 011 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# 139-8 LOCATION: LOT G SHERWOOD DRIVE LICENSED INSTALLER: 8,1YIM0A1D T F_RI3SEti r SIGNATURE:ELEPHONE# 9M 9q4 4� CHECK ONE: NEW CONSTRUCTION: " IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes_ No Foundation As -Built? Yes s/ No Floor Plans? Yes No Approval Date THE FRASER COMPANY 7-92 P.O. BOX 365 16 SHEFFIELD ROAD DANVERS, MA 01923 PH. 508-774-8148 THE ORDER OF SALEM FIVE SALEM, MASSACHUSETTS 01970 1558 110001,S32111 1: 2 1 1 3.70 S SBi: 8 i P, q n 1 IIS. .. ---- EXPLANATION AMOUNT 4532 53-7055-2113 DOLLARS CHECK AMOUNT DESCRIPTION CHECK NUMBER Lire's oz, 53Z $ 75.m eSeanry f99Nre9 � rcJW9E. D9t911s m Oack. 110001,S32111 1: 2 1 1 3.70 S SBi: 8 i P, q n 1 IIS. .. ---- APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE:/20!i CURRENT INSTALLER'S LICENSE# 13S-8 LOCATION: LOT G SHERWOOD DRIVE LICENSED INSTALLER: RAyM011 D T F)M SEh _r _2SIGNATURE: xc ul ELEPHONE# %%� r14 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes V-01 No Foundation As -Built? Yes No Floor Plans? Yes ✓ No Approval Date: `S -3 THOMAS E. NEVE ASSOCIATES, INC. Engineers • Land Surveyors • Land Use Planners 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 (508) 887-8586 1. 4:1 TO FAX l WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via 11 Shop drawings XprintECa) ❑ Plans ❑ Copy of letter ❑ Change order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION JOB NO. g / ATTENT N RE: rz the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION rz ly THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment E3 -.FOR BIDS CLUE RE El'Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit,--; __ copies for a oval ❑ kSubmit copies For_d_is_t-n5—u`tiUrf ❑ Return corrected prints COPY TO C9�' RECYCLED PAPER: Contents: 40% Pre -Consumer •10%Post-Consumer - SAL: if enclosures are not as noted, kindly notify us at once Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director June 1, 1998 Mr. Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot #6 Sherwood Drive Dear Tom: 30 School Street North Andover, Massachusetts 01845 This is to inform you that the proposed plans for the site referenced above have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp cc: File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 n 0 4 FORIYI'_1,1_-.SO1L EVALUATOR, FORiM �o Page 1 of 3 Of - No. Dates 4-h o �-1 Commonweaft-117 of Massachusetts Massachusetts Steve l7r ur5o ......... .... Date:- '4'i.z! %95 PerformedBy:...................................................................._............................. . Sar, . St.,.�.rr................................................................................................................._.... Witnessed By: ..........................y......... a, na's N„M;. Tir.bcr l an d FBI,) tdecs �lnc. [ option Addressor: res Adds. vd. s.. Lpt G. Shtcwood� T&phom,I 15 G1eM2n-j Gour'} .►e o�g3Z. Ha.�crh�ll , MA ew Construction ©Repair Q 50 37 - -7539 Office. Review Published Soil Survey Available: No Q Yes i9$ 1 Publication Scam 1 = .. ......... Soil Nlap Unit Year -Published. •.• Drainage Class Exc mss i ►. ........ Soil Limitations- ..... s1Q.?e...................... pra'.�td� Surficial Geologic Report: Available: No Q Yes Q Year.- Published w...........,_. Publication. Scale: _.,....� Geologic. Material (Map unit) ...............•.....•..............__ ►<AM E ............................ Landform............._........................._........................................... Flood. Insurance: Rate: Map:: Above- 500 year flood, boundary No QYes Q. Within 500 year flood. boundary No aYes. Q Within. 100 year flood boundary No [Eyes Q Wetland_ Area:. National. Wetland. Inventory Map (map unit)................ ............................................ Map (ma Wetlands Conservancy Program Ma unit ................... ..... I ...................... . p Current: Water Resource. Conditions (USGS): Month Range :Above Normal- ONormal Q Bela•/ Normal. Q Other References. Reviewed: DEp' MOVFA FORM- 12107195., i f FOWN1. 11 -SOIL EVALUATOR FORM Page Z of. 3 Location Address or Lot lJo. L.ot Co DEEP OBSERVATION, HOLE. ;!_OG**' On-site Review Deep Hole Number Date:..:.!tI..I tj 95 Time:..:.: M Weather Location, (identify.- on site plan) Other' Surface (Inches) Land.: Use.'t+. f *5 ► Slope ° (%1 . Z016 Surface: Stones: .... .:._:._...... Vegetation ._...w.0100SI>_..:.__ ,, (Structure. Stones, Boulders, Consistency, % Landform Position on landscape (sketch on -the back) (Se;c .Plo...>....... co --- - Distances fram: _ . Open Water -Body Nfi�. feet. Drainage way feet Possible Wer Area: Z_oo, .. feet Property Line ..ZO.......:.. feet Drinking Water Well .4/A feet Other ............ DEEP OBSERVATION, HOLE. ;!_OG**' Depth from Soil Horizon- Soil Texture Soil Color Soil Other' Surface (Inches) (USDA) (Munsell) Mottling (Structure. Stones, Boulders, Consistency, % Gravel) co i ,. " -7.4;y1Z4/16 Z. Gt.FS 3(p 13 Ms Gr.G.S. I CZ ps.s.�.. 2.sy5/3 - mimmuM Vr L. nvLaa ncuulncu r.1 cv cn1 rnv wv vwrvar��.nncr Parent -Material (geologic) ()J-f-wP,5VA Depthto8edrack: �JOn< Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: 134" ~' Estimated Seasonal High Ground" Water: —167" DEP APPROVED FORM - 12107/95 I FORM: 11. - SOIL. EVALUATOR. FORM - Page 3' of'3 Location Address or Lot No. _L0 1 (0 5 -J>r;..re Determination- for Seasonal High° Water Table Method Used: 3o„ -o,, of Hot.E : 134 Q. Depth observed standing: in observation hole ................... inches Q. Depth weeping from side: of observation hole .................. inches Q Depth to soil mottles.._..:...:::: inches Q Ground water adjustment.................... feet Index Well Number .................. Reading Date ................... Index well level Adjustment factor.. ................. Adjusted ground water level ....................... Depth 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 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and thatthe above analysis was performed by me consistentwith the required -training, expertise and experience described. in 310 CMR 15:017.. Signature<���ate. 4/10 /9-7 DEP APPROVED FORM 12107195. No- 144c) c, FORM' 1.1. -SOIL EVALUATOR FORNf- Page 1 of 3 Commonwealth of Massachusetts Date. 4/io 9-7 tJor+1-, A^ddovcr 'Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By.: ....... Stc.........p�v�s.o................................................ Date: Sar+d Witnessed. By:......... I —ion wddr= or Lath Lot Cp SI,Crw.�v� r'1 V G UvaR•: name, Tin-, bt land l3') , l eta cs (� L Address. md. .. 1 . Tdcphorar!- 1S GIcMt^-I" COJr� I{a\n% I MP 01832 wew Construction 9 Repair. Q. . � (sog) 3-7-3%s39 Office Review _ Published. Soil Survey Available: No ❑ Yes (� Year- Published I $.�......... Publication Scale 1"'- i 3 Zo�,_. Soil Map Unit HE'D Nor, I<) c Drainage: Class ........... Soil Limitations.�cce. Slo �rw .................................................... Surficial. Geologic, Report Available: No Yes ❑ Year Published.. Publication Scale Geologic.. Material (Map.Unit) LandformI< A,rl-LE. ........................................................................................................................................................................... Flood. Insurance Rate Map: Above 500 year flood boundary No ❑.Yes Q Within 500 year flood. boundary No Eyes ❑. Within 100 year -flood boundary No QYes Q Wetland. Area:. National Wetland. Inventory Map (map unit) Wetlands. Conservancy Program Map. (map unit) Current: Water Resource. Conditions (USGS): Month :.::....:.....:. Range. -.-Above Normal ®Normal ❑Belcw Normal ❑, Other- References Reviewed:. JJ7 DEP APPROVED FORM- 12/07/9S. FORM 11. - SOIL EVALUATOR FORM. Page T of 3 Location Address or Lot IJo. Lot G ~ S },,r ,-)oo dL 'Dr 1� ve- On-site Review Deep Hole Number g.' -:. - Date:....:4'.IZ(.�95 Time: ... ..tA:M Weather Location (identify on site plan) Soil Horizon Land. Use Slope. (%)_:Zo. o Surface Stones .....-,.. ...:... Vegetation Landform Gravel) Position on landscape (sketch on the back)...:1 5cc \ - Distances-from� Open Water Body N/A feet. Drainage way :N/A. feet- eetPossible. Possible.Wer Area Z-.15, feet: Property feet Drinking: Water Well :.N/A .. feet Other.:..::.:....::.. DEEP OBSERVATION HOL" E LOG.` Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure. Stones. Boulders;. Consistency, % Gravel) G�- 4Z� g,,,, 1 F.s.t�• , g�,az CrLs. . L. To. 4s" a c,o' t_D2s ' MINIMUM OF Z HULtb htUU1htU A 1 tvtMT rnuruatu uwruQAL-AnmA Parent Material (geologic) OO T w A S 1-i' DepMwSedrock: Not � Death to Groundwater: Standing Water in the Hole: rJo %4 Weeping from Pit Face: IJO t -j G v Estimated Seasonal High Ground. Water: NO IJ t✓ DEP APPROVED FORM --12107195 Location Address or Lot No. Lo + Co FORM 11- SOIL LVALUA.TOR FORM -- Page 3 of 3 51-.a�„�aod. Dr eve Determination for Seasonal HF2,h Water Table N4ethod Used: Q Depth observed standing in observation hole .................. inches - Depth weeping from side of observation hole ................. inches Q. Depth to soil mottles:inches Q Ground. water adjustment._ ................ feet. Index Well Number ................... Reading Date ................... Index well level .................. Adjustment factor Adjusted ground water level ....... Depth of Naturally Occurring Pervious Material Does at least- four feet of naturally occurring pervious material exist in all areas. observed throughoutthe area proposed for the soil absorption system? v e.s If not-, what is the depth of, naturally occurring- pervious- material? Certification I certify that. on ' ' /9`;- (date) I have passed. the: soil evaluator examination approved by the Department of Environmental Protection and.thatthe above, analysis was performed by me consistentwith the required training, expertise and. experience described= in 3.10 CMR -15.017'. Signature_ ate 4-11019-7 DEP APPROVED FORM - 12107/95 03=21-1996 14:36 617 932 7615 QEP NORTHEAST REGIONAL. P.02 . _ . Location Address or Lot No. I FORS[ 1L -PERCOLATION TEST Lot Co'�- Stitc.,.�oocL `17ri� C'O'MMONWEALTH OF MASSACHUSETTS }l.. Acdovtr , Massachusetts Minimum of 1 percolation test must be performed in both the primary area. AND reserve, area:. Site: Passed:' Situ Failed. ❑ Performed. By: S �-e %J e- T>' 1, rs o Witnessed By :\-, 5 •'ter. Foc-d Comments:- ...... .,......:::_...._ _ . _ .::........_ .. _ A, WrAtl1lG m FORM • 12MIRE Percolatiom Test` Dater 8%3% °l5 Time: 3 : ZC) Q,•-• Observation Hole: Depth of Perc --� q;' -7 Z" Start. Pre-soak 3= ZO P ^' 3- Z j P ^^ End Rf8-SQak Wo,�►d c-o�. Hotel Soak 1,Joa\d e"% jao\d goal Timm ar. T2"' Time at 9" Times ar 6" rme c9:p=s�� Rate: Mirr.11nch L Z M•^� 1„�L,. �' Z m%^�I ���, Minimum of 1 percolation test must be performed in both the primary area. AND reserve, area:. Site: Passed:' Situ Failed. ❑ Performed. By: S �-e %J e- T>' 1, rs o Witnessed By :\-, 5 •'ter. Foc-d Comments:- ...... .,......:::_...._ _ . _ .::........_ .. _ A, WrAtl1lG m FORM • 12MIRE LOCA" NEW F REVIS DATE: SEPTIC PLAN SUBMITTALS DESIGN ENGINEER: O%A_ When the submission is all in place, route to the Health Secretary 7`0 j 062- April 24, 1997 Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot #6 Sherwood Drive Dear Tom: This is to inform you that the proposed plans for the site referenced above have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp cc: Bob Janusz File PLAN REVIEW CHECKLIST ADDRESS oOT 4� 5;:f 6&k9O jj ENGINEER /1Gl/&_ GENERAL 3 COPIES STAMP LOCUS NORTH ARROW SCALE CONTOURS ✓ PROFILE t --__(Sc) SECTION 4.,-' BENCHMARK [/ SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED? -AZO— DRIVEWAY &--' WATER LINE Gl FDN DRAIN E1--*,' M&P,)( SCH40 L,-' TESTS CURRENT? SOIL EVAL_/ YDS SEPTIC TANK / MIN 1500G_ .17 INVERT DROP LGARB. GRINDERlVd(2 comps +200) 10' TO FDNB MANHOLE ELEV `'� GW �� ## COMPS . � GB D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT INLET/3P,'79 - OUTLET ��� _ to ( 2" OR .17 FT ) TEE REQ' D?/vim LEACHING MIN 440 GPD? RESERVE AREA 4' FROM PRIMARY? 20 LOPE`' 100' TO WETLANDS --' 100' TO WELLS 4""" 4' TO S.H.GW 6-�(5'1>dM/IN) 20' TO FND & INTRCPTR DRAINS-'-� 400' TO SURFACE H2O SUPP �P 4' PERM. SOIL BELOW FACILITY t•' MIN 12" COVER FILL? (15') BREAKOUT MET? L,� TRENCHES / MIN 440 gpd SLOPE (min .005 or 6"/100'), SIDEWALL DIST. 3X EFF. W OR D (MIN 61) ✓ RESERVE BETWEEN TRENCHES?b- IN FILL?L/ MUST BE 10' MIN._Z 4" PEA STONE?VENT?.(>3' COVER; LINES >501) BOT + SIDE C9� X LDNG "71' = TOT / - (L x W x ##) (DxLx2x#) (G/ft2) Copyright 0 1996 by S.L. Starr 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 SANDY STARK SOARP OF NEAL'T-H f`10RTt-� �.NDo��iZ M,A [AUTEn O[F V�e aMNULad DATE 5/z-8/'2>51449 JOB NO. -fo ATTENTION SANp STAR RE: L_ OT fo - S1�Gr w ooc�. Qr- ire: - 5 iif 1'�.�R11"� rv4 �IJoy 1449-10 DE51 G N ❑ As requested WE ARE SENDING YOU X Attached ❑ Under separate cover via the following items, ❑ Shop drawings )K Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 3 Ri,g a��g 1449-10 DE51 G N ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ o1(xr, %.s as re_v%Scd ac.c.or C&_% ❑ FORBIDS DUE r 19 ❑ PRINTS RETURNED AFTER LOAN TO US fir; tes rNc rCr rec.e.;ved an a.00ro jal Ie ier br-% tke revi'Sed Des, an THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ Resubmit copies for approval 19 For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ o1(xr, %.s as re_v%Scd ac.c.or C&_% ❑ FORBIDS DUE r 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS PEAR SaNDy Th,e s&e+;c- dLe.s%9p lar 1--ot Co St-,ec��oe�d Drlve. was re. - subr.-.-+led +o Vo�1r- or-. APr: 1 t o t'-)9-7 ►-,e o1(xr, %.s as re_v%Scd ac.c.or C&_% +v voj r re v�.e.w corruy,,,4L -5 a+ed. A tV')-7, Our fir; tes rNc rCr rec.e.;ved an a.00ro jal Ie ier br-% tke revi'Sed Des, an Our C.1;e_e%+ aSKed. us -k-0 rQ.+tSc SCP+:C_ Oh Lo+ Co +o cif-c-orr,crae,A-C a S beolrcoir+ d..,.�e.11;•.Q Tl.,e, er-,Glosedl plar-•S rc�1e.G'�' a dtS�c�r, �of Q S bedrt�or., oAWt1l�r,a� ad�d6ed 9 +o end O� Tr'�/+cti+), 1 v6.3 'r'avt C.'nx cyeSi' olow'C C-411 1, $;r,cercl COPY TO Z r q RECYCLED PAPER: Contents: 40% Pre -Consumer -10% Post -Consumer SIGNED:- 9=Z_L If enclosures are not as noted, kindly notify us at once. Town of North Andover Ot 40RTN , OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street + North Andover, Massachusetts 01845�'o_�';r;, WILLIAM J. SCOTT Director August 5, 1996 Hayes Engineering 603 Salem Street Wakefield, MA 01880 Re: Lot 16 Colonial Drive Dear Mr. Stearns: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Primary area not 4 feet from reserve (N.A. 2^23). 2. Leach area 15 feet inside 50 foot PRD buffer zone. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S., Health Administrator SS/cjp cc: Kathleen Bradley Colwell, Town Planner BOARD OF APPEALS 688-9541 RIMMING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING'* 688-9535 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 WILLIAM I SCOTT Director April 8, 1997 Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot 6 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: If new plans satisfactorily addressing all the following issues are submitted to the Health Department by April 11, 1997, then approval for the plans should be given by April 16, 1997. 1. Missing soil evaluation forms. (3 10 CMR 15.018) 2. Elevations of perc tests missing. (N.A. 6.02j) 3. No wetlands disclaimer. (N.A. 6.02 0) 4. No manhole on septic tank. (3.10 CMR 15.228 (2)) 5. Gas baffle missing. (3 10 CMR 15.224) 6. Note missing, Re: First 2 feet of pipe from D -Box to be laid level. (3 10 CMR 15.232(c)) 7. Name of soil evaluator missing. (3 10 CMR 15.2200)) 8. Map & parcel missing. (N.A. 6.02a) 9. Note stating excavation must be at least 6 inches into natural parent layer missing. (N.A. 2.18) 10. Address of record owner missing. (N.A. 6.02g) BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 -- PLANNING 688-9535 Page 2 Lot 6 Sherwood Drive April 8, 1997 If you have any questions, please do not hesitate to can the Board of Health Office at the number below. Sincerely, � - Sandra Starr, R.S. Health Administrator SS/cjp cc: Bob Janusz William Scott, Director, MCD File 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 SANay STAfZR 3C'P'Rl7 OF H�ALT1-4 NorZ-Tt-1 A�poyEQ M� dIEVVIE 3 OGS 4 D o MMOVULad DATE 411 c 19-7 JOB NO. 14495 - Q: - ATTENTION S Ae,tD S -rARK RE: Lot CO- S"Cr- wood 3 R E'v Oto )7 y I .RPR I 199f Tl.� dcSi % 1--,4s WE ARE SENDING YOU Attached ❑ Under separate cover via th fe o lowi s: ❑ Shop drawings Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 3 R E'v Oto )7 1449 - (0 5 t 5 5T EM TSE- 1 Tl.� dcSi % 1--,4s 'bCCen rcyi$eA to aololt"c < o,11 o -F VC>%jr Go�w"+en�'S. T anl� Vo 4✓ �roC �/oyC' e-��er+5 i� rGSol.��•.4 �}+e5e 1- O.� *G1� c�ann¢C, S ott- E-VAL-QAT1 o.J 1r07 -M _Eyoa 1-.a•,e -m ,y 'tom, r-}L,ar a.�25}'�S P1�5r o(c nm+ AS'*4-4 14 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 ❑ ❑ FORBIDS DUE Resubmit 3 ❑ Submit ❑ Return copies for approval copies for distribution corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS T>6 -ATP- SANDY - We 5% re- o r oL.*-caLeero✓al lei-}cr cLa4c.& Apr - l $ 19977 -tor -F1-,e a bovc c -c rrec-e nc cd l o -i Tl.� dcSi % 1--,4s 'bCCen rcyi$eA to aololt"c < o,11 o -F VC>%jr Go�w"+en�'S. T anl� Vo 4✓ �roC �/oyC' e-��er+5 i� rGSol.��•.4 �}+e5e +SSJ�S rn SJG1-, G. O.� *G1� c�ann¢C, _Eyoa 1-.a•,e -m ,y 'tom, r-}L,ar a.�25}'�S P1�5r o(c nm+ AS'*4-4 14 Strnc,tre\ COPY TO $ob Jan.�s t ..J/ 1 P r.'n+ / ��-�L► RECYCLED PAPER: aP Contents: 40% Pre -Consumer •10% Post -Consumer SIGNED: if enclosures are not as noted, kindly notify us at once. NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT DATE � g� FEE: * 6 PERMIT ## W DATE RECEIVED /tel/9 APPLICANT 6Q J8 `1 AIV 0.17- MAP PARCEL ADDRESS LOT # STREET ## ENG. //E11e'- STREET e, ENGINEER'S ADD. 447 Oct) 7Bc6r6A)Wib 7-655, PLAN DATE /D lg elcl- 6 REV. DATE CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: ole- ve3.cu,7►-io�u �o,2,Ms . /o �'8©�c�M C«U/9ria�si �.-�. /l14 0,0 SGPT/G T C -BA/Wzdg- —i - -8aX TG D G t/CL . 6,16 C'Ale 3-:2 Cc)) '0', PP 5 i AJ � . �, /9, c/o . A) a 7'C 5 i .9Ti AvG 33 -0' �e E R - R m R S 44 1�Q�l� � � mmlmnwu G o " L a I n nnw � o b0 o • ors• E; i t9 O O G 7 O lid 00 av 0 y. 0 w r o S. rt w N OD n u O 0 w n IJ - Zi C) O S1 CIQ tv T = OQ C I rD G o rD" o .b CD a o o b orD ONO O rni (D rt - 33 -0' �e E R - R m R S 44 1�Q�l� � � mmlmnwu G o " L a I n nnw � o b0 o • ors• E; i t9 O O G 7 O lid 00 av 0 y. 0 w r o S. rt w N OD n u April 3, 1997 Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot 6 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: If new plans satisfactoril addressing all the following issues are submitted to the Health Department by ZZa7 , then approval for the plans should be given by 1. Missing soil evaluation forms. (3 10 CMR 15.018) 2. Elevations of perc tests missing. (N.A. 6.02j) 3. No wetlands disclaimer. (N.A. 6.02 0) 4. No manhole on septic tank.. (3 10 CMR 15.228 (2)) 5. Gas baffle missing. (3 10 CMR 15.224) 6. Note missing, Re: First 2 feet of pipe from D -Box to be laid level. (3 10 CMR 15.232(c)) 7. Name of soil evaluator missing. (3 10 CMR 15.2200)) 8. Map & parcel missing. (N.A. 6.02a) 9. Note stating excavation must be at least 6 inches into natural parent layer missing. (N.A. 2.18) 10. Address of record owner missing. (N.A. 6.02g) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R. S. Health Administrator SS/cjp cum' 5co T t 14ORTN � A SSACHUS� Applicant NAME Site Location Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 3 v 191 '� !r F � \ DISPOSAL WORKS CONSTRUCTION PERMIT 1 Permission is hereby granted to Construct Y/ or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. `, Z> CHAIRMAN, BOARD OF HEALTH D.W.C. No. %07 L,_