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Miscellaneous - 97 LOST POND LANE 4/30/2018
7 r .s ^N� �� r �.i :' �.�'� . �Y � a ! ..n� XL � i,•,�, �... �'�M'l�'. i w � �. •,� . A ivjtt MAP #LOT#�`f,�*'i PARCEL # STREET QONSTRUCTION A.PPDYES HAS PLAN REVIEW FEE BEEN PAID? NU PLAN APPROVAL= DATE C5 ZcSlI �� BY�c DESIGNER: PLAN DATE. CONDITIONS Z00Af-5 Z) /3D D FDIV oepAl WATER SUPPLY: TOWN WELL WELL PERMIT WELL TESTS: .. COMMENTS: DRILLER__. BACTERIA RILLER_.,,_•- CHEMICAL BACTERIA I BACTERIA II DA1 E APPROVED._ DA 1 E (IPPRUVED DATE APPROVED FORM U APPROVAL: APPROVAL TO ISSUE YE5 NU DATE ISSUED /% 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 NO FINAL BOARD OF HEALTH APPROVAL: DATE:.FI-NI DY: i d ngnynangCn System Owner Daubresse Louise & Gary 97 Lost Pond Lane North Andover, MA, 01845 (617) -947--6904 x Type: Emerger Cesspool: No Date of Pumping: (a System Pumped By: Contents Transferred to I Contents Disposed at: Commonwealth of Massachusetts Massachusetts System Pumping Record Routine Yes Wind River Environmental, LLC `f Date: 5— I Condition of System/Other Comments Pumper Signature: nainamnlA - Form 4 -- System Pumping Record, RECEIVED 'UN ' 2015 System Location I UWN ,- P %'�R FN A HUUH b'EPARTMENT Primary Home 97 Lost Pond Lane North Andover., MA, 01845 (617)-947-6904 x Daubresse Louise & Gary -yaverhill WWTP 40 q P dQI St 01835 10 ® Noted on recycled paper Dep Approved Form - 12/07/95 Septic Tank: No = Yes Quantity Pumped: Gallons Permit #: W S A 7 i Important: When filling out forms on the . computer, use only the tab key to move your cursor • do not use the return key. i, sr . yi,v ytr r Commonwealth of Massachusetts City. Q n.'of:.. RTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. ' be submitted to the local Board of Health or other approving au A. Facility Information 1. System Location: Address he System Pumpirig' Record mu; hority, OCT I � Zpp H Ai- ')OVER I Clty/Town — State -- --- ~— Zip Code — �, 2. System Owner: rPse,f _ Name � Address (if different from cation) City/Town -- Zip Code Telephone Number b. Pumping Record 4. 1. Date of Pumping 3. Type of system: ❑ ❑ other (describe): Date 2, Quantity Pumped: 1— �Q---- -- Gallons Cesspool(s) 46eptic Tank ❑ Tight Tank 4, Effluent Tee Filter present? ❑ Yes APlo ► r 5. Condition of System: If yes, was it cleaned? ❑ Yes No 6. Asyern Pumped By: ____.......... ...... . - Vehicle License Number. Company , / _- 7. Location where contents were disposed: 01 Si ature of Hay Date http:l/www,masg;gov/dep/water/ proyals/t5forms.htm#inspect t5form4.doc- 06/03 System Pumping Record • Paget of HP Fax K 1220xi Last Transaction Date Time Twe Mar 18 12:47pm Fax Sent Log for NORTH ANDOVER 9786889542 Mar 18 2004 12:49pm Identification 819786649886 Duration Pages Result 1:31 1 OK 0 n i DATE: Q. i SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) PATE OF PUMPING: 4.3 G QUANTITY PUMPED U�4 d6.6 GALLONS T ~CESSPOOL:. NO .. YES SEPTIC TANK: NO ;,,_ YES u __. ' NATURE OF SERVICE: ROUTINE = EMERGENCY a OBSERVATIONS: GOOD CONDITION FULL TO COVER, HEAVY GREASE BAFFLES IN PLACE _ ROOTS LEACHFIELD RUNBACK _ EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) aSYSTEM PUMPED BY:.. — i+,kt'�fith, iY fF s a' ;K 1 4 i. J. ' ,COMMENTS: , T SK 4599 PG 211 Exhibit A That certain parcel of Ind with the bulldings dM=tt m NOM Andover, Essex County, Cammonwttdth of Muuehtteems 11ha d on the wesmdy die ofLm pond Lme ind shown u Lot 8 on a p1m eaddtdPl , mned Raddmtid Dsvdoprmat "Loot Pond" Fllmlook Ineo:poae W, Ttttnttn 6. Neva Amadatee, Ino.. whkh aid plan is "=:a, with the Fawn Notch Dhnria Regimy of Dsrds u Pim•No.12610 cad said Lot 8 is macs ad particularly bottaded and dexxibed as follovn: EASTERLY by a curve 04 the cu149-sae at.the end ofLost Pond Lane as Shown of said Alen ooe huadued and 01/100 (10e.oi) feet; NORMASTERLY by Lot 9 Is shown on said plan two hmdrad eighty eight and 76/100 (288.76) feet; WESTERLY by Lot 7 u shown on said pini ono htmdmd seventy nine and 57/t00 (17937) fes; SOIMMRLY by said Lot 7 u shown on avid piss two hundred thiny-nWc and 241100 (219.24) feet. Said Lot 8 contoiaiag 31,574 square feet of lend, according to "Id plan. For my ddt see deed deed September 25,1996 frmn Flintlock Inc. to ]mice L. Boyle recoMad bemwith. u�iau�a api I .V,O*A Pee Xoh A(atiyy e IAO ' •' . �d / Via►. • DO" Spas+ Jrw t / • Alan p • � t 7 � • - +�'ht•r��en Rayh ' . i. a tAomes It i )INS ri • � � � � . K•Nrytl k .bAra •. 7 a .• C3 l BIt 4 +1'A1am 1 _ a 14 �,�rrl C. �;,Oit � 0 tl � A^n Bareogolb w . r � ¢ ��• Adel,.. ! + Cdr p. ! • • a .. a RA.f W Q . SK 4549 PG 203 Marshy r.a•rv1j to the Grantor the tee in Loot fond Lsa a. sbovn on said plan, but hmby ALM to the a ntru the right to esa Loot wow Lan• In cumman with gtbwo in title floret- for all curposes for which stmets and mye an US" in the Tom of Nott 1M1 going a portion of the preriee• to the Orantor by ed Des et a•rthe Love recorded vlth 0e14 "istsy at geode, gook 4 277 a•9• 70. gee also Dead OL SaModsS Sack lPagel35. t0 ens br•�or recorded with said hssas gook •ala, raga 7s. rs wrixads warms the said plintlool¢t tea. baa -awed Its o atr waw to 6 berets affixed ctrl tM" pnrestf to be Itsft -evident sad delivered in ice aur eM bNalt gy its ersalreat ant tseaerns Mnto duly wtborieed, toys loth dsy of eepterber in the pear one tbexaam nam htladl¢sa and nln.ty- In, .. Sem �xh;aJ'�' nrffrtaas, :mc. ui c byf rr e. aa. cm entwtx or xuuomarms auox est septsdbrr 70, 1996 Men personally appeared the above -rased David A. xindred, or••Sdast end Treasurer or flue sa¢f, t. alfa aothevlydged no toregting insuvamt to bs h of dost befess ss xY C se3etlen apiresi a)27107 nm,.tnvan p6E1- kfc ¢'J fs'wf eGatM aA.'iY.JH6 06 CBIS.)- CWX 1S4S.k/ k699p1¢4 431lh EtCltf tpt Heftr sd BGUW Hates sud "" BK 4599 PG 202 y®—� colmaiustow oNaD �,Mq e.7/yi 7LIPTLDrd, LNC, • M+•@scha**tt* sdrperatlon duly orr�qani•ed by }� lar and having its msuel plop of busimapp at 40 Norblesidga C1 mead, North Andewer, niNt County, dageee@sith of Massasbus•tto T f0A ON pS06ftA't1ON PAID, In In full Consideration of Three N O~ Hundred ?hirtIMno Thousand (6739,000.00) bolter* OmAm "I JAMS L. DOYLN. or 1.7 Atiantle Avenue, Marblehead, Massachusetts irsTR CvrrcuLM dovaAwrp 5EP46'96w1:35 Teat cerasin reseal at land wtah the bu1101ngs thereon In Norm Andover, Neoax County, Coaohvselth at )lupaohuestte situated on the wosterl sidle of Let Pond Lane and shown as Lot A on e plan entitled Moaned Residential bsraldpaant Rost vena•, rilatleea, Inoorporat•d•, Theses N. Mews Associates, Inc., ' which sold plan 1s rose M4 with the Neoax worth Dlstrlet Reglatry o! Deeds u Plan Me. i7•t0 and No Lot • is fore pertiea arly bounded and deoorihed sa tollowas LMTNSLY by a aur" On the 14101.40-000 at the •ed off tort Pond Lane of shown of said plan one 8 hundred and 01/200 (100,01) Nott MORTN"TARLY pbyy Lot 9 a* shown @s amid plan two hundred •1fplty-*lght and 761109 (6!4.76), wr6TMY by Lot 7 as shown •n sold plan one hundred N seventy-nlna and 67/100 (179.67) taeti MUMMY by Bald Let 7 pa wn Sbaon said plan two hundred thirty-nine and 34/100 (1391.74) feet. Said tot 6 containing 33,674 square feet CL land, &Ccerding to paid plan. said tot 6 is convoyed a�iiot to the Condition that the Grantees, their heir* a traters, @sedeesora and "signs, scall 0069tru*t ho bu(Idintqaas *r accessory baildlnpeN•• at any kind y within the so toot mo fbnstsa0Visa Nona u dellneAt•d oa so d Wvtan and 0414 lot is also Conveyed aubisdt to the Condition . the olid gleneeas, their basis, inistrator• saeoe*sor■ -arid &@sign• *ball hot rat trees within Us as teat 6e Cwt Sone as delineated on maid plan) provided, howver, that this "striation obeli not prevent the removal of Goad or fallen uses from said area. Said lot Is also psrphveyd sub sot to the condition that the sold gYant@ss, their Mizs, enlatratoa, eneeapaosa and u6/tmgn1us ah•11 csMlreet no bulShcr,ge er edaeeosry ►uildiega at e�sno •seddilirteilie • ;t ;neo within the ea fast bgffor roetrie!!an shall not ► ) pewida novver that this tr*as troll laid ane. piewat the removal at Ned er talion Thais prosise* are come spa set to the d4Conditioan then eothat to dwall*h tling Am entainlocated or Iwo to a threeMbe ft fit$ so ad�dlt�.l1an AnilAmes ) he sada to the antling to lndn•ee the tafbor of Oedtomp in viol4tLm of these reotrlot(ons, afe ill!) so req is the d"6111m 6ball be Conwsted to a bedraef !n violation of this* reser! leas. in the *vsfb that rhe Town of Norm Andover Should eftend the ppuoblio ■aver *Mae wav"b Leat pond tont, pa this s04tien she11 terminate upon the eoneection at'tbe buildings loostsd OR $414 lot to the laid public waver *ytas by the grant*", their *ucwasors or eeelgits. 7Ae pptt@slpa• herein conveyed do not constitute all or ae C:11•lly all at the assets of the grantor 1009ted within the Colmalw@slth of Ms@sachasetts. f NORTq F w 9 •"s S�1CHU Eta Town of North Andover, Massachusetts BOARD OF HEALTH DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Form No. 2 g qJ Applicant &,A(%" Test No. Site Location Wr IR Reference Plans and Specs— ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee _ CMURNIAN, BOARD OF HEALTH Site System Permit No.1q3_ Form No. 4 Town of North Andover, Massachusetts BOARD OF HEALTH Sept. 24, 1 96 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (X ) or repaired ( ) by Peter Breen INSTALLER at (Lot 8) 97 Lost Pond Lane SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 793 dated 5/28/96 19 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH • HoRTH 1ti0 p< Sao ; e • 3 0 A icant Appl — NAMi Site Location Form No. 3 k, Town of North Andover, Massachusetts BOARD OF HEALTH DISPOSAL WORKS CONSTRUCTION PERMIT E AD ranted to Construct ✓�or Repair ( ) an Individual Soil Absorption Permission is hereby S g Approval S.S. No. Sewage Disposal System as shown on the Design App Feed=1 MAN, BOARD OF HEALTH D.W.C. No. �' " v CO) C O CO) Cl) Cl)CD Z CO3 CD O 'C r C") 03 C O. �• CO) D� O 0 v `° O CDC Cr CD CD o CD _ cl) CD Q v CO) O ca CD S o y O 1 Z CD Cl) O CD 0 CD 5 im 0 CD 0 co O C qlp��y � O CD C nO /� O (�.JI �I O CD 0. 0 v'1:2 i r+� Q C ��o ED -- CA o a H ao<_W acn o o C7 H ca n m CD CD o' T CCD a?W m N =CD CD = �co o CD Q zt.osCD: W O 'O CA � O a O to O. „� ,.► W O m H O CD CL CD ..► N Di y ±� CL �. C C W a ^. cCD CA O NO CD O _ H O CD �C', o O . CD 0 CD moo: V= ED CD Co r o, m cl -< o �A0 OCD: t� C�7 7:11 wL Cn Crt tz In 7J w aGc ':7 VJ °= S ter] 7� - r `ri n �J rJ (/� 'r1 O zOilr� o rt C x n : It x 0 c 0 O� 0 ti O,oen S,oace Area � O Cb (b � Ct II C.,,, • II � � �P � o 64 CZ i rn)� 1 Pfa ip C" xa i� Im � O � I� Ilr-11oo ° k � � � � � � � t,� •\�I� �� o p �p � � 1 2_4.,3. _ _ .` O k, AN NCN No v (� 9) v ^V p (z -"J oo �cNyr I'� 75, �? lb1) II II II II II II o° co Ileo (b N) 44N). c�i�o Nocno y `O` ko co W rocn`° O �r-11�y �QJ(bC)� O tz Cb cD jp J (' O Q Cb Cb ri o a dao y ��oa �(b m �aQo �o� Q Do oo � Cb ()o� rn �( Open Spa Ce Area 1 iv Fd9e`` ��'� • � � O We flan ds , 50' No Cons truc do a ti I uaj}oPunOj alaJOu00 �,� j 6uilsrx gam, � I .� y �•�QO ti� 1 Il coo G�� cb i• Ip Q �o ap io? �� <<,tp'OOl» ; .0 ' 00��.7 \ ; I 00 ►/ aQ`� o d Q�. Z O m �� ET �s rn 60 j��13 Qu r4 Q 5 i� �o�� p 4 cod m `�� Zooms`�� �• o c "ko 4 O (J) cn I ►� ; x „' ��a s O Q O, O cp m O j cOp s O Q • 4p.p j Op cD Q �� �• �C j 0 D O C� O �4 a n• Al Q a o' X1-1 (n rn o �o o�oQ- rn O. rn O --1 Z 00 Q �C i a 83s/23/i3136 03 9 t- Jo-0858Ot � U-� CE C COLLOPY ENGINEERING CONSULTANTS 65 AYER STREET FRANCIS H. COLLOPY REJ3. 1AAWISSrONAI ENGINEER Board of Health Town of North Andover North Andover, MA 01845 To Whom It May Concern; METHUEN, MA 01844 RWAU.$IN August 30, 1996 Mald' sea. (508) 885.7989- 0mac (608j 655$069 F�xs n n I am writing in regards to the Lost Pond development in North Andover, MA. In particular, I am writing relative to the Reinforced Concrete Barrier Wall on Lot 8. The location of this Nall is shown on Drawing No. 9-1276-8, titled "S,initary Disposal Sys; .: 08f 23f 1996 09:.9 5.98-5858069 COLLOPY ENG7f EEP,IhJu PAGE 03 made the footing sine wider and deeper. This extra weight- of' the concrete in the footing- provides a similar resistance= to•motion- from the soil pressure as was offered by the shear key which we eliminated, This was necessitated by the presence of rocky terrain below the bottom'of the basic footing. I have enclosed herein Sheets D-1, D-2 and D-2 Revised for the records. If you have any questions concerning this matter, please do not hesitate to call, this office. Sincerely, COLLOPY ENGINEERING CONSULTANTS _.. Francis H. Collopy, F.E.- Structural Engineer Qrrwc N.it �v r 0e'. _a. 1395 09: -9 309-S8510069 UJLLUF1 Gi"it]>^IEc lh'Ia ' ;Vt b 3 L V s -r ro Nll C ENGINEERING �� t�P15ULTA'�TS 9HEEf"�0. PY D^r Z 7 f9` 65 Ayer Street CALCUUTc0 6Y fH o o.TF METHUEN, MASSACHUSETTS 01844 TEL/FAX ;508? 685.8069 CHECKED BY a►rE 9;;ALE l�= zoZ.l N C VA JASSat `HAY ` Pi- #0 7/111 W'. l !/� tl�' f /F04tND ORAIrI l�Aq J �y`_y ' _ , (mss ( e f VITA _ ' y F.a p o ��Lti'�iG► X25 le; QOo p • �0, - - • Srr TIC d'3 .TP► K Hand,Bf zone ! .0 3' -� P9 13 L _ 100.01' R 0.00' 1 94- IJA See 5Oir I A. "" ' • � i2E4NFOKCEp � I ♦ � BREAKOUT `� r BATT. fit,.. •• I . /r , !' 1 �TrLt.iCTUSZAt r r it 1 1 Ge „ PRM* yw'" **):Ol Imo. ®.YL,La1w,On Otgt. hOiM11tli1CLLN18 !�160H�D s I i r 1 � alp 1 1 - �,� ost Pond Lane (FrIvvte v 50' Wide) N - M 08/23/1996 03:13 508-n-858069 COLLOPY ENGINEERING CONSULTANTS 65 Ayer Street METHUEN, MASSACHUSETTS 01844 TEL/FAX (508) 685.8069 COLLOPI' E4SINEERD15 PAGE 05 Joe La57- a -D , Lu r- cs SHEET NC. Q —71 OF ^ �6 CALCJLr'ED 9Y 6yc DATE CNECKW By nl T - S . DATE 10v �. _................ ::.. r ..... _ .... . tel. : f , i . 1 7 i MWmj-iSSW.aeMjM oaW.edaa.Mwt$4".t.adwRWaonEi+*aie 08/23/1996 09:19 508-6853063 COLLOR)' E1,113--NEEPING p A 86 COLLOPY ENGINEERING CONSULTANTS 65 Ayer Street METHUEN, MASSACHUSETTS 01844 TEVFAX (508) 685-8069 Joe ; -a ,1V ej v op j: W-71�7 CALCULATIO wo CHECKID DY DATE - &O -Al a . .. Aja r, 5. Fa,�z cs 'D '—T ol CP Ar lCt .... ..... .. Foo 0. 1: z r 3,poo ps;k, V 4 ATT R Ar N.J 20 2 1 cob I r—o 0 F-7 OA I I> t --T - ----- -- -- - fy X. - Xoi. fa - . .......... .. f--__ Y .41 ^ _._ �'�j /� I � 1` -1• .._ ;_,` .t ins.. �� tO ..... .......• 6- awow,"wtso►w�w�•�.r�.�wr��o�nee+�►a�+duWrt�mmor R&J'Vt Z, t -v- JW7% >ttg. .rte L v s 7- PoNU c o r--:- COLLOPY ENGINEERING CONSULTANTS , 65 Aver Street CALCULATED BY fl�� OATE /� // METHUEN, MASSACHUSETTS 02844 TEL/PAX (508) 685.8069 CHEOMDBY DATE SCALE ft 'raw `HAY B� r V1 11 F01.1NA DRAIN P TO 5B T4 `0 TA K Z• ._ loQ' W, dond�aW. oiif Zone, r LEACH T;ZF—wc 1373 i fn 14' . CP .a- R 60.00' QI ~ 94-13A See sus ` 'A' I , �•���� RLINFpRGED ZAc 1 �•� P94-14 y�cT,o►v .A. �1 Q er STitt..1GTUQ�IL �x , I 1 1a ost" Pond 1 ca ' Lane I 1 (Privote- 50' Wide) 1 M Pao00 2%11%*MuW10}1jW0®4AL*WMR41411.700*M'!10U1414►2*m APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 7hlqA CURRENT INSTALLER'S LICENSE# LOCATION: (o - � La LICENSED INSTALLER: Pe- (c -C 6 �;M SIGNATURE: V _i k4, TELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: k-,/ IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? (Yes I No Foundation As -Built? t Yes Y No Approval r Date: /tf/L/Z4� _",.ft .16' v 0 N 11 /'VO/7,- :�/' FWAJW'eCreC�10 / FCS'`-`8�'m� �- MAW 4 " Maw �-� Lr) 2. 4 t, Top Df 00 �� d po" Foundation <<v Ele vcrtion I J5.66' C. b Lr) 2. 4 t, Top Df 00 �� d po" Foundation <<v Ele vcrtion I J5.66' " FORDS U - LOT PELFFASE FORM INSTRUCTIONS: This form is usedto verify thatall necessary approvals/permits from Boards and Departments having jurisdiction have been.obtained. This does not relieve the applicant and/or landowner from compliance with,any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: APPLICANT : �l N I I .� N C Phone ' /AeT� 1Z iS� 2rI7S LOCATION: Assessor's Map Number Z� Parcel �� Subdivision Z 6 5 TPO,u ,6 Lot (s) S Street b57- S7- fa D 14 'IV C St. Number _ al Use Use Only --k****** RECOMMENDATI S TO GENTS: �1 Date Anoroved b %14 Conservation Adm' istrator Date Rejected._ Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector -Health Date Rejected ��f Date Approved Septic Inspector -Health Date Rejected Comments G1A9� Public Works - sewer/water connections -I�TL�) /0 - driv ay p ermi Fire Department Received by Building Inspector Date .h P.O. Box 531 North Andover, MA 01845 (508)688-6558 Fax(508)683-4430 ---"nu OF HEALTH v r 1996 0E -vim -1935 tB� _^�',i =i -7f^ PHILIP R. SHEA JAMES T. OANOORA. ER. STEPHEN A. NELSON HATHLEEN M. PATENACDE. JAMES T. DANOORA. JR ALSO ADMITTED IN NEW HAMPSHIRE -3 S11EA & DAINGORA ATTORNEYS AT LAW 566 BOSTON ROAD F.O. BOX :509 BIT I RICA. MASSACHUSETTS 01891 15360EZ4430 P.02 June 3, 1996 (809k667-271-57 (5 081 6874758 PAX ,3061 6703709 Flintlock, Inc. P. Q. Box 531 North Andover, MA 01845 Re: Sale of Lot 8, Lost Pond Lane, North Andover Dear. Dave: Enclosed herewith please find a Sample Deed pertaining to Lot'8, Lost Pond Lane. If, after reviewing the Deed, the North Andover Board of Health is not satisfied with the restriction, please notify me accordingly and I will make whatever reasonable modifications they feel are appropriate. very trdiy yours, Philip R. Shea, Esq. PRS/:jkm Enclosure 06-04-i990 ip 56,4'` rFOf 77 15026==,1430 ?.03 SAMPLE DEED FLINTLOCK, INC., a Massachusetts corporation duly organized by law and having its usual place of business at 40 Marbleridge Road, North Andover, Essex County, Commonwealth of Massachusetts FOR CONSIDERATION PAID, in in full consideration of One ($1.00) Dollars GRANTS TO: JOHN DQE and JANE DOE, husband and wife, as tenants by the entirety, of Main Street, North Andover, Massachusetts 01845 WITH QUITCLAIM COVENANTS That certain parcel of land with the buildings thereon in North Andover, Essex County, Commonwealth of Massachusetts situated on the westerly side of Lost Pond Lane and shown as Lot 8 on a plan entitled "Planned Residential Development "Lest Pond", Flintlock, Incorporated", Thomas E. Neve Associates, Inc., which said plan is recorded with the Essex North District Registry of Deeds as Plan No. 12610 and said. Lot s is more particularly bounded and described as follows: EASTERLY by a curve on the cul-de-sac at the end of Lost Pond Lane as shown of said plan one hundred and 01/100 (100.01) feet; NORTHEASTERLY by Lot 9 as shown on said plan two hundred eighty-eight and 76/100 (288.76); WESTERLY by Lot 7 as shown on said plan one hundred seventy-nine and 57/100 (179.57) feet; SOUTHERLY by said Lot 7 as shown on said plan two hundred thirty-nine and 24/100 (239.24) feet. Said Lot 8 containing 31,574 square feet of land, according to said plan. Said Lot 8 is conveyed subject to the condition that the Grantees, their heirs, administrators, successors and assigns, shall construct no buildings or accessory buildings of any kind within the 50 foot No Construction Zone as delineated on said plan and said lot is also conveyed subject to the condition that the said grantees, their heirs, administrators, successors and assigns shall not cut trees within the 25 foot No Cut Zone as delineated on said plan; provided, however, that this restriction shall not prevent the removal of dead or fallen trees from said area. said lot is also conveyed subject to the condition that the said grantees, their heirs, administrators, successor:: and assigns shall construct no buildings or accessory bui;dings of any kind nor shall they cut trees within the 50 foot buffer zone as delineated on said plan; provided however that this restriction shall not prevent the removal of dead or fallen trees from said area. These premises are conveyed subject to the condition that no dwelling now located or hereinafter located on the premises (i). shall contain more than three bedrooms, (ii) no addition shall be made to the dwelling to increase the number of bedrooms in violation of these restrictions, and (iii) no room in the dwelling shall be converted to a bedroom in violation of these restrictions. The premises herein conveyed do not constitute all or substantially all of the assets of the grantor located within the Commonwealth of Massachusetts. Hereby reserving to the Grantor the fee in Lost Pond Lane as shown on said plan, but hereby granting to the Grantees the v, 06-0�-� ?^t i50Eoc�44�0 F.�4 i right to use Lost Pond Lane in common with others in title thereto for all purposes for which streets and ways are used in the Town of North Andover. Being a portion of the premises conveyed to the Grantor by Deeds of Martha Love recorded with said Registry of Deeds, Book 4.272, Page 30. See also Deed of North Andover Associates to the Grantor recorded with said Deeds Book 4272, Page 28. IN WITNESS WHEREOF, the said Flintlock, Inc. has caused its corporate seal to be hereto affixed and these presents to be signed, acknowledged and delivered in its name and behalf by its President and Treasurer hereto duly authorized, this day of in the year one thousand nine hundred and _ ninety-six. FLINTLOCK, INC. By: David A. K n e , Pres./Treas. COMMONWEALTH OF MASSACHUSETTS Essex ss: 1946 Then personally appeared the above-named David A. Kindred, President and Treasurer of Flintlock, Inc. and acknowledged the foregoing instrument to be his free act and deed before me 'Notary Public My commission Expires: FLSMKE.DED/DMT TOTAL ?.04 PLAN REVIEW CHECKLIST ADDRESS �, �'�T ��� L� ENGINEER /11,5✓,6r GENERAL 3 COPIES �� STAMP LOCUS `""' NORTH ARROW L� SCALE C ---- CONTOURS PROFILE Cl--*" SECTION L/ BENCHMARK A SOIL & PERC INFO �ELEVATIONS WETS. DISCLAIMER WELLS & WETLANDS L::,"' WATERSHED?1V0 DRIVEWAY �(Elev) WATER LINE e� FDN DRAIN SCH40�e::,-- TESTS CURRENT? (� SEPTIC -TANK / MIN 150OGt/ .17 INVERT DROP L,-"" GARB. GRINDER(+200% EDF) 25' TO CELLAR i% MANHOLE TO GRADE ELEV GW D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT INLET1 D, - OUTLET/30,5 = • W (2 " OR .17 FT) TEE REQ' D?A LEACHING MIN 660 GPD?X RESERVE AREAV' 4' FROM PRIMARY? L-"" 2% SLOPE�� 100' TO WETLANDS !/ 100' TO WELLS 4' TO S.H.GW� 35' TO FND & INTRCPTR DRAINS L--"""325' TO SURFACE H2O SUPPy� 4' PERM. SOIL BELOW FACILITY f- MIN 12" COVER V- FILL? j5' if above natural elev; 10' if below) BREAKOUT MET? C� U-) ALL TRENCHES / MIN 660 gpd SLOPE (min .005 or 6"/100') V >31COVER?-VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61) IS RESERVE BETWEEN TRENCHES? V IN FILL? MUST BE 10MIN. 4" PEA STONE? ty BOT �� 9 X LDNG + SIDE 79 X LD ' = TOTy (L x W x-#) (G/ft2) (DxLx2x#) (G/ft2) Po , 3 ,5��,2ooMs V�Copyright 0 1993 by S.L. Starr DATE-- jv Sheet of BOARD OF HEALTH ►WN OF NORTH ANDOVER CE DISPOSAL DESIGN REVIEW TIT # M DATE RECEIVED ADDRESS PLAN DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED ASSESSOR'S MAP PARCEL # LOT # STREET x--667- Zo' " 6 Z REVISION DATE M / N U rC.S, IV 19 � /N 6 ---e TLS M v s 7- .0 '�7-- DATE /c3 �q Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEEPERMIT # 79,3 DATE RECEIVED APPLICANT AVE fJ D,e&D ASSESSOR'S MAP ADDRESS PARCEL # LOT # ENGINEER A)ey6 STREET ADDRESS PLAN DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED REVISION DATE 7Zou,ub4,-)-6 /3-r� @ � �o7--�� N 61 LA .7U D '03 tfl I r4 :N N !'Z / � I , I . . . �------------------' - ----------�---------� Town of North Andover f NORT1 14 OFFICE OF 3a o �'"° °0 COMMUNITY DEVELOPMENT AND SERVICES p 146 Main Street KENNETH R MAHONY North Andover, Massachusetts 01845 9SSACHuS�� Director (508) 688-9533 November 16, 1995 Mr. Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot #8 Lost Pond Lane Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Last 3 inches of perc 94-13 perked in 31 minutes, making rate 11 minutes/inch. Design rate must be 15 minutes/inch. 2) No benchmark within system area. 3) No wetlands disclaimer. 4) Groundwater at 123.06, so system not 4 feet from groundwater. NO FURTHER REVIEW Sincerely, Sandra Starr, R.S. Health Administrator SS/cj p BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D. Robert Nicetta Michael Howard Sandra Stan: Kathleen Bradley Colwell D R A F T November 16, 1995 Mr. Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot #8 Lost Pond Lane Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Last 3 inches of perc 94-13 perked in 31 minutes, making rate 11 minutes/inch. Design rate must be 15 minutes/inch. 2) No benchmark within.system area. 3) No wetlands disclaimer. 4) Groundwater at 123.06, so system not 4 feet from groundwater. NO FURTHER REVIEW Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp .:,a�t',r1itr�sr�.l i^ I . ^ S•i 71 dS_y� i4J l' 4 '.�. 4 '-� c .1-j, Svi AJ, ' i.4a11't i Vii) t �� 1 ltY k/� 4, V'4ai F r S 5 �t -y t• t jr r I i ;"S Icx i`t -I t / r I ♦� N f s t h e Irrj,. i 1 [_ � 1 V Ir ! y �4 t I � ,� t yr lad rr i r 3 k �l Y r 'A' jn.. u' >r. r I I C I CAL -11c; I j n Ir; fEl �v CA I 1 i I Ilii II i �II� IN it I� . i i i i ! I- -- ! ! I N I I I � it --- - P Op i F. Ul m a IM Rw P.A mm m mm mm mmm =�— M.MNIM WE Op i 4i ! ! z4 ti.. • { r } 1 ' A r �� ;1 4 •'1:q 1�• f. v S �'''1 I 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRO �,AL AFFAIRS DEPARTMENT OF E"NVI SIAL `ROTECTION }FILE COPY l o k TITLE 5 OFFICIAL INSPECTION FORM — NOTT-011 VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1 t LpE2&-D ,/VO• l- 1rc vIDo0l✓ Owner's Name: /'C ATH L 'C 1✓N I LAJ! L H E Gm Owner's Address: c'% 1-05 7-1 rC'�✓'b RD Date of Inspection: 3-- ) `( – 0 Name of Inspector: please print) tJtjR"RCN R I(�A�2c1L mit Company Name: ru- L Mailing Address: Ic to /yo, TZ E, I1Dtu9 m), 0181"1 Telephone Number: S -X Go 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: V Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Si nature: /t P � Date: — b Inspe S 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 z 7. ****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. Title 5 Inspection Form 6/15/2000 page I iA Page 2 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART A CERTIFICATION (continued) Property Address: CD L O 5 T Po"b Iz 1 ONO /)hrbOV r�VZ Owner: W I L 14 iv L 01 Date of Inspection: 3-1 ` d q Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D T A. System Passes: `Ihave 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. ' I 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): 0 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):), - ND explain: broken pipe(s) are replaced obstruction is removed 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: / � L05—T f o Nb Imo • AN Dovt�'dL Owner: (,'q t L 1) r L1g 1 Date of Inspection: 3-1'9 - a q 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 envirorunent. 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 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 "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: " 7 LO c I o Iv J '.D. ". NDO u E IrL Owner: bir(, H Et,M Date of Inspection: 3—Ij- OV 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 _IL" Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool — _✓Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow "Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ _✓ Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. _✓' Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for 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.] O (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,wrface 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 I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: T7 L O, tt (2c/vTj Ra. IVO AN JC,U L A - Owner: �0 C L N I✓ clm Date of Inspection: pq Check if the following have been done. You must indicate "yes" or "no" as to each of the following: i Yes o Pumping information was provided by the owner, occupant, or Board of Health IzWere any of the system components pumped out in the previous two weeks ? AZ -Has the system received normal flows in the previous two week period ? Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined? (If they were not available note as N/A) L,,"'_ Was the facility or dwelling inspected for signs of sewage back up ? Was the site inspected for signs of break out ? Were all system components, excluding the'SAS, located on site ? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: 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)j a 5 Page 6 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: � % L O c' I 'F©/O) 2� NO, AIV DO lJ &1� __ Owner: W I LH Iz,(.m Date of Inspection: -- _ _ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): Z) DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 3 3 C7 Number of current residents: O Does residence have a garbage grinder (yes or no): Is laundry on a separate sewage system (yes or no): [if yes separate inspection required] Laundry system inspected (yes or no): ; _g C7 A U0,t, Seasonal use: (yes or no): &--O Water meter readings, if available (last 2 years usage (gpd)): P �0 ! .3 13 C)� �� la L Sump pump (yes or no): �V 'b U Last date of occupancy: 010 �( COM MERCIA L/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,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: /VU n_ S Was system pumped as part of the inspection (yes or no): _L/ If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM �ptic tank, distribution box, soil absorption system _ Single cesspool _ Overflow cesspool Privy N 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: 1 C3 9 (. A_5 B v I LT' E �y%.5 0 L1) Were sewage odors detected when arriving at the site (yes or no): No Page 7 of I 1 `y1 ' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 ] L05 1 oNb RD hLo s N bo u iz- vZ Owner: Lk-9iL /4 r, (,M Date of Inspection:— BUILDING SEWER SEWER (locate on site plan) Depth below grade: 30 p Materials of construction: _cast iron V"4�0 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: z (locate on site plan) Depth below grade: 'concrete Material of construction: ' _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: Sludge depth:'' 33�� Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: n Distance from top of scum to top of outlet tee or baffle: 61 Distance from bottom of scum to bottom of outlet tee or baffle: III N How were dimensions determined: `j—P P - /" jz. AS u Q E - Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): SPL'lf✓ .N 6if)C' Ll,-,L'ta L. ,u&(- 1S dk- 't�3 N Jl I G I" 00 )D S M PN 11 & GREASE TRAP: 1(locate on site plan) Depth below grade: J_ 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 I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 97 Lo -7 IYbAlyDnoEsu Owner: RCUPA Date of Inspection: 19- 0 � TIGHT or HOLDING TANK:/0)(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:(if present must be opened)(locate on site plan) d i� �✓ 1v Lo 1 J Depth of liquid level above outlet invert: _ Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 15 C,0 --L 15 9t,A No Solt pf D at)* LS l►v ©c7b 3l4ArIL No Sr�N PUMP CHAMBER: 1�(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.): N 8 Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: qj C' o5 1 1 DIVA lzb' ryQ- /-) N b0 Q E Owner: (,) 1 L M E UM Date of Inspection: 3 —1 `1 - 0 SOIL ABSORPTION SYSTEM (SAS): AzIlocate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: aching galleries, number: ? O T - "YL rz j cc ti r'5 PC rt l� S J� L-71 leaching trenches, number, length: 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.): /VGA SvrtincA- N 131I'^ 5 /Vp cjr�/t1 C, K- CESSPOOLS: cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: Depth - top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: locate on site plan) Materials f 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: q7 to -71- O"D Rb pyc -NDaU e►1 Owner: L 11. i L✓n Date of Inspection: 3 —1'I— !ay 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. N Page I I of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: M i~ 65 11 P"—b in No NboV F-vL Owner: (,J / L l i &G Date of Inspection: S :—:719 -- C) SITE EXAM Slope bo to r- Ole/ I'D 1i,' Surface water f4T R E P( o f f ric�)Pf h T-/ Check cellar n hl _ /vo F -m P Shallow wells No tl E Estimated depth to ground water _q__ 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: I R 2 bserved site (abutting property/observation hole within. 150 feet of AS) Checked with local Board of Health -explain: J1 ES (> 16 (AJ '�( Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: -r 5� N o L, F_ 1) WT �N t= ht, rte- 'b Vg «-fry ? 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