HomeMy WebLinkAboutMiscellaneous - 1 BRECKENRIDGE ROAD 4/30/2018Lot & Street Map/Parcel
CONSTRUCTION APPROVAL
Has plan review fee been paid: (�g:s) NO Permit# l�
Plan Approval: Date: Approved by:
Designer: /2T.� P Plan Date:
Conditions:
Water Supply: To-wn . _ .. -._-- _ Well
Well Permit: _.Driller-.
Well Tests: Chemical Date Approved
Bacteria I Da Approved
Bacteria H Date Approved
Plumbing Sign -Off: -Wiring Sign -Off:'-"
Comments:,
Form "U" Approval: Approval to -Issue: YES NO
Date Issued By:
Conditions:
r mai Approvai:
..All Permits Paid? "'YES ----"NO
Well Construction Approval?YES NO�
Septic System Construction Approval? `YES- NO
Certification? NO
Other CS NO
Any Variance Needed? YES ,. NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:_
APPROVED BY.
'4
f �ne
r'
W
SEPTIC SYSTEM INSTALLATION
Is the installer licensed?
G
NO
Type of Construction:
THEW
REP AJ
New Construction- _ _.-.Certified Plot Plan Review
YES
NO
—Floor Plan Review
YES
NO
- _— Conditions of Approval from Form U
YES
NO
_Issuance of DWC permit: —
S
NO
_DWC Permit Paid?
YES
NO .
---DWC=Permit # �_= Installer:
�y'/
Dr-1�
.-BegTh_Inspection:_ � --
YES
NO
.Excavation Inspection:
Needed.
Passed: By: -�
Construction Inspection:
Needed:
As,�ui1tP anland Satisfactory:
Y'E S` .
Approval of Backfill: Date/i By:
---Final Grading Approval: Date: By:
t
Final Construction Approval: Date: By-
Certificate of Compliance: Approval: Date: /t?
t
Important: When
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key.
tab
Commonwealth of Massachusetts
City/Town of North Andover
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 forr
local Board of Health to determine the form they use. The System Pumping Record mu e•
the local Board of Health or other approving authority within 14 days from the pumping dat i`r�
accordance with 310 CMR 15.351. IN 15 2015
A. Facility Information I UVVN
HEALTH�DEFttRTMENTE�
1. System Location:
Address
North Andover
City/Town State Zip Code
2. System Owner:
t
Name
Address (if different from location)
------------------------- ---- ----- ---
City/Town State Zip Code
Telephone Number
B. Pumping Record
4500
1. Date of PumpingD 2. Quantity Pumped: gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other (describe): -- - -- ---- — -- — -- --
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System: —
6. Syste
s Septic Service
Company ---------..----------
Vehicle License Number
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Signature of Hauler
Signature of Receiving Facility
Date
Date
t5form4.doc• 03/06 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
W City/Town of NORTH ANDOVER
a
w° System Pumping Record
Form 4
RECEIVED
SEP .i 2 [313
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
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 within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
Important: When
filling out forms 1. System Location:
on the computer,
use only the tab 3-2wtu6e_ N r 1( Ent)
key to move your Address
cursor - do not NORTH ANDOVER M
use the return
key. City/Town State Zip Code
2. System Owner:
yb /.I �r
Name
Bnan
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date Z3 2. Quantity Pumped
3. Type of system: ❑ Cesspool(s)
❑ Other (describe):
Septic Tank ❑ Tight Tank
/ as �
Gallons
❑ Grease Trap
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
Name Vehicle License Number
Stewart's Septic Service
Company
7. Locati n where contents were disposed:
s -treatment Plant, 20 So. Mill Bradford, Ma 01835
Sig ture uler Date
Signature of Receiving Facility Date
t5form4.doc• 03/06 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.
VC]
nwa
}
Commonwealth of Massachusetts
Cityjown of No Andover
System Pumping Record
Form 4
MWN OF NORTH ANDOVER
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 within 14 days from the pumping date in
accordance with 310 CMR 15.351,
A. Facility Information
1. System Location:
. I / Brec?��q R
Address
No andover
Cityfrown
2. System Owner:
A ) ) er
Name
Address (if different from location)
Cityfrown
Ma
State
State
Telephone -Number
Zip Code
Zip Code
B. Pumping Record 5A A 21
1. Date of Pumping pate 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. 1 Astern Pumped By:
Name
Stewart's Septic Service
Company
7. Location where contents were disposed:
Vehicle License Number
Stew rt's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Si ure of Haul Date
ature of Receiving Facility Date
t5form4.doc• 03/06 System Pumping Record • Page 1 of 1
6069
oq�
Town of North Andover
HEALTH DEPARTMENT
CHECK #: DAXE:
LOCATION:
1-1/0 NAME:
CONTRACTOR NAME:
Type of Permit or License: (Check box)
0
Animal
$
0
Body Art Establishment
$
0
Body Art Practitioner
$
0
Dumpster
$
0
Food Service - Type.
$
0
Funeral Directors
$
0
Massage Establishment
$
0
Massage Practice
$
0
Offal (Septic) Hauler
$
0
Recreational Camp
$
0
Sun tanning
$
0
Swimming Pool
$
0
Tobacco
$
0
TrashlSolid Waste Hauler
$-
0
Well Construction
$
SEP77C Systems:
13 Septic - Soil Testing
0 Septic - Design Approval
0 Septic Disposal Works Construction (DWC)
0 Septic Disposal Works Installers (DW)
0 Title spector
't'e'�
;;T'i-tle 5 Report
0 Other (Indicate) $
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
Nj
I
�v�
L/
M M, Me mull
RECEI
APR. ?012
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
VAT
Dean 0. Luscomb Il & Sons
P.O. Box 13�
Middleton, MA 01949
978-774-4065
Lk=sed Plumber #20295
SUBSURFACE SEWAGE DISPOSAL SYSTEM DUKSBCrMN FORM
PROPERTY .OWNERS NA)a V4,11
PROPS= ADDRESS 1_
IL
N
ADDRESS OF 0WNERCifdxff=2*
DATF-oinwwnm A.Drt--1 Qq aQIQ
Lctsr-n bob,
NAME OF INSPECM.R. 0, r)
QUALM IS NUMER. ONE TO US.
ti
Owner
information is
required for
every page.
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
_Q
ISI
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form r'
Subsurface Sewage Disposal System Foran - Not for Voluntary Assessments
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
'ZL4��111 0
lnsp6ctors Signature
April 24, 2012 _
Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins • 11/10 Title 5 Official Inspection Foran: Subsurface Sewage Disposal System • Page 1 of 17
1 Breckenridge Road
Property Address
Williams
Owner's Name
North Andover MA
April 24, 2012
City/Town State Zip Code
Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
A. General Information
1. Inspector:
Dean G. Luscomb II
Name of Inspector
Dean G. Luscomb II & Sons
Company Name
P.O. Box 135
Company Address
Middleton MA
01949
City/Town State
Zip Code
978-774-4065 S1848
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
'ZL4��111 0
lnsp6ctors Signature
April 24, 2012 _
Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins • 11/10 Title 5 Official Inspection Foran: Subsurface Sewage Disposal System • Page 1 of 17
Commonwealth of Massachusetts
4 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 Breckenridge Road
Property Address
Williams
Owner Owner's Name
information is North Andover MA Aril 24 2012
required for p
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Checlo,C,D or E / always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not
/ determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins - 11/10 rrtle 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17
Owner
information is
required for
every page.
1�
t5ins -11110
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 Breckenridge Road
Property Address
Williams
Owner's Name
North Andover MA April 24, 2012
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if (with approval of Board of Health):
❑
❑
❑
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
❑ Y
❑ Y
❑ Y
❑ N
❑ N
❑ N
❑
❑
❑
ND (Explain below):
ND (Explain below):
ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if (with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 Breckenridge Road
Property Address
Williams
Owner Owner's Name
information is
required for North Andover MA April 24, 2012
every page. CityrFown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
0/1
'* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes
No
❑
®
Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑
®
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑
®
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑
®
Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins • 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 Breckenridge Road
Property Address
Williams
Owner Owner's Name
information is
required for North Andover MA April 24, 2012
every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑
®
Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑
®
Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑
®
Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑
®
Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For IaMe systems, you must indicate either "yes" or "no" to each of the following, in additio to the
questions' Section D.
Q Yes No
❑ ❑ the sys ro, is within 400 feet of a surfacgAfinking water supply
❑ ❑ the system �Iwithi-KQOfeet tributary to a surface drinking water supply
El Elthe system is locate ' a rtrtogen sensitive area (Interim Wellhead Protection
Area - IWPA) mapped Zonal of a public water supply well
If you have answered "yes" any question in Section E the sy is considered a significant threat,
or answered "yes"' S Ion D above the large system has failed. T ner or operator of any large
system consider e significant threat under Section E or failed under See -tion D shall upgrade the
system in ac dance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins • 11/10 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 1 Breckenridge Road
Property Address
Williams
Owner Owner's Name
information is
required for North Andover MA April 24, 2012
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
® ❑
Pumping information was provided by the owner, occupant, or Board of Health
❑ ®
Were any of the system components pumped out in the previous two weeks?
® ❑
Has the system received normal flows in the previous two week period?
❑ ®
Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑
Were as built plans of the system obtained and examined? (If they were not
available note as.N/A)
® ❑
Was the facility or dwelling inspected for signs of sewage back up?
® ❑
Was the site inspected for signs of break out?
® ❑
Were all system components, excluding the SAS, located on site?
® ❑
Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑
Was the facility owner (and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑
Existing information. For example, a plan at the Board of Health.
® ❑
Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 gpd
t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17
e
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 Breckenridge Road
Property Address
Williams
Owner
Owner's Name
information is
required for
North Andover MA April 24, 2012
every page.
City/Town State Zip Code Date of Inspection
D. System Information
Description:
Owner and town
2
Number of current residents:
Does residence have a garbage grinder?
® Yes
❑ No
Is laundry on a separate sewage system? [if yes separate inspection required]
❑ Yes
® No
Laundry system inspected?
❑ Yes
® No
Seasonal use?
❑ Yes
® No
Water meter readings, if available (last 2 years usage (gpd)):
town water
Detail:
Sump pump?
❑ Yes
® No
Current
Last date of occupancy:
Date
CommerciaUlndustrial Flow Conditions:
Type of Establishment -
Design flow (based on 310 CMR 1 . 3):
Basis of design flow (seats/persons/sq.ft., etc.
Grease trap present?
Industrial waste holding tank
Non -sanitary wa�ste'discl�ed to the Title 5 system?
Water meter ead ings, if available:
Gallons per day
❑ Yes ❑ No
❑ Yes ❑ No
S Yes ❑ No
t5ins -11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17
.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
, 1 Breckenridge Road
Owner
information is
required for
every page.
Property Address
Williams
Owner's Name
North Andover MA April 24, 2012
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of
Other (describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection?
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
Date
Last pumped 1 1/2 - 2 yrs ago - owner
0
gallons
No need at this time
❑ Yes ® No
Type of System:
® Septic tank, distribution box, soil absorption system Pump S!6'0 h
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other (describe):
t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17
a,
Commonwealth of Massachusetts
• Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 Breckenridge Road
Property Address
Williams
Owner Owners Name
information is
required for North Andover MA April 24, 2012
every page. City/Town state Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
System was installed in 1999 - 13 years old
Were sewage odors detected when arriving at the site?
p� Building Sewer (locate on site plan):
Depth below grade:
Material of construction:
® cast iron ❑ 40 PVC ❑ other (explain):
Distance from private water supply well or suction line:
16"
feet
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
4" cast iron in good condition. Nd spins VP � prob 14MS
❑ Yes ® No
Septic Tank (locate on site plan):
8..
4 Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain)
Precast rectangular concrete 1500 gallons
If
Dimensions:
Sludge depth:
by a Certificate of Compliance? (attach a copy of certificate)
5'Dx5'Wx10'L
1"
❑ No
t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17
Owner
information is
required for
every page.
. f,
t5ins • 11/10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 Breckenridge Road
Property Address
Williams
Owner's Name
North Andover MA April 24, 2012
City/town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
34"
1"
6"
15"
sticks and 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.):
The septic tank and baffles are in very good condition. The solids in the tank are very light. The liquid
in the tank is running at it's correct working heigth. The tank does not require pumping at this time.
Trap (locate on site plan):
Depth belt
Material of
❑ concrete ❑ metal �`°. y ❑ fiberglass
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from, bottom of scum to bottom of outlet tee or baffle
Date -of last pumping:
feet
❑ polyethylene _ , er (explain):
Date
Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M ,••''y 1 Breckenridge Road
Property Address
Williams
Owner
information is
required for
every page.
Owner's Name
North Andover MA April 24, 2012
Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Co nts (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels ed to outlet invert, evidence of leakage, etc.):
a�
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
u Depth low grade:
Material of c truction:
❑ concrete metal ❑ fiberglass ❑ polyethylene other (explain):
Dimensions:
Capacity:
gallons
Design Flow: Ilons per day
Alarm present: Yes El No
Alarm level: — Alar ' working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition ofrm and float switches, etc.):
* Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
t5ins -11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 Breckenridge Road
Property Address
Williams
Owner Owner's Name
information is North Andover MA April 24, 2012
required for
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
Zero "
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.):
The d -box is 11" below grade and is 16" x 16" square. it is structually sound and level. The liquid in
the d -box is running at it's correct working heigth. The soil in this area is clean and dry with no signs
of any problems. This area is covered with well maintained green grass.
Pump Chamber (locate on site plan):
7 Pumps in working order: ® Yes ❑ No
Alarms in working order: ® Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
The pump chamber is 5'x5'x8' -1000 gallons. The pump chamber and pump and alarms are in good
working condition with no signs of any problems.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
�j If SAS not located, explain why:
S.A.S. was located by d -box and level area of yard and asbuilt drawings. _
t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
, 1 Breckenridge Road
Property Address
Williams
Owner
information is
required for
every page.
t5ins • 11/10
Owner's Name
North Andover
Citylrown
D. System Information (cont.)
Type:
State Zip Code
❑
leaching pits
❑
leaching chambers
❑
leaching galleries
❑
leaching trenches
®
leaching fields
❑
overflow cesspool
April 24, 2012
Date of Inspection
number:
number:
number:
number, length:
number, dimensions: 1 - 30' x30'
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.):
The S.A.S. is in very good condition with no signs of any problems. The soil in this area is clean with
no signs of ponding or breakout.
S
(cesspool must be pumped as part of inspection) (locate on site plan):
Number an nfiguration
Depth — top of liquid to invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construct'
Indication o , oundwater inflow ❑ Yes ❑
Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 Breckenridge Road
Property Address
Williams
Owner Owner's Name
information is
required for North Andover MA April 24, 2012
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
(locate on site plan):
u Materials of
Dimensions
Depth of solids
Comments (note condition of soil, signs of
etc.):
of ponding, condition of vegetation,
t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17
• ' Commonwealth of Massachusetts
Title 5' Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
t5ins • 11/10//
1/10Cul/� � � \
t 0 6 Title 5 Official Inspection Fo .Subsurface Sewage Disposal System • Page 15 of 17
l
1 Breckenridge Road
Property Address
Williams
Owner
information is
required for
Owner's Name
North Andover
_
MA
Aril 24, 2012
every page.
City/Town
State Zip Code
Date of Inspection
D. System Information (cont:)
°rem,,
Sketch Of Sewage Disposal System: Provide a view of the
wa a di
posa
syluding ties to
at least two permanent reference landmarks or benchmarks
Lo to a
well
wfeet. Locate
where public water supply enters the building. Check one of
he t coxe
belo
:
® hand -sketch in the area below
`
W)
❑ drawing attached separately
66T- 3�0°
At x � '� P
D-•Qax
&tD
I
Al
j ktl
"
�iD _ r- 5
a'� To-Akt
n
A
ju .
t5ins • 11/10//
1/10Cul/� � � \
t 0 6 Title 5 Official Inspection Fo .Subsurface Sewage Disposal System • Page 15 of 17
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
.�' 1 Breckenridge Road
Property Address
Williams
Owner Owner's Name
information is North Andover MA April 24, 2012
required for
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water Qofs-v-',,
® Check cellar Prq�' �c�p Pyr
® Shallow wells
Estimated depth to high ground water:
20" below grade
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed. 5-11-99
Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health - explain:
Proposed, asbuilt and permit on file.
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
Deep hole test done 5-11-99 showed ESHGW at 20" below grade by Richard Tangard. Because of
this this sytem was raised to maintained a 4' ground water separation.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins • 11110 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 Breckenridge Road
Property Address
Williams
Owner owner's Name
information is
required for North Andover MA
every page. Cityfrown State Zip Code
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
April 24, 2012
Date of Inspection
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information — Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins - 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17
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TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
10/20/99
This is to certify that
the individual subsurface disposal system
constructed ( ) or repaired (X )
by
John Soucy
at
1 Breckenridge Road
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 Site System Permit # 1085 dated 8/27/99.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
t
••.:i �-"Yr '�,. �'.x :�+'=�l'f'-`•; ;,:`:�� � '-::ire n'`: �* .�..: °`; -.:y,•y,,�;},..,•�. .r`.7� :4,•_ .��
1 � .
cv 1 .� 51999
TOWN OF NORTH ANDOVER SEWAGE DISPOSAI: SYSTEM
I- STALLA"TION CERTIFICATION
The uncersivned here -;v cerci v that the Sewage Dispcsal System. i ) co::Sur_ic,.;;s
f �O re^aired: V
b '_�.1�aJ _ C, u --
located at r2 t eILE V -------
was installed in confc.rmance with the North Andover Board of Heaith acprove plan.
System Design Pe,"Mat dated��, with an aperoved design
flow of (� 4ailorts per day The materals uses were in con ormar.c- wir` those
specirea ort the approved plan; the system was installed in accordance the -revisions
op 310 Ovff: l 5.000, Title 5 and local re—gulations, and the anal Rrading agrees
substantially with the approved plan. Affil work is accurateiv reoresenred or, the As -built
which has been submitted to the Board of Health.
Bee inspection date: /o V-19
Final insoect:on tate 10
Installer:
DeslLm EnQ er: '' . C v'`
ff y�
'RICHARD
g C.
0
TANGARD
A FG/STElkEp.
FSS��NAL E�C
---Z- �� -
1=.n�ineer R;�reszr,tative
EzCtr.eer RepreserIzat_re
Date: %
Date: ---- —
�v
C!d/L
V
NEW ENGLAND ENGINEERING SERVICES
lk INC
October 9, 1999
Venna and Benson Ho
2 Breckenridge Road
North Andover, MA 01845
Re: 1 Breckenridge Road septic system installation
Dear Mr. and Mrs. Ho:
This letter is being written as a response to your letter dated October 6, 1999 and several
telephone conversations we have had regarding the septic system installation at 1
Breckenridge Road in North Andover.
As mentioned:in the conversation at l Breckenridge;Road on October;6,.1.999 thisr.office,
has worked with Mr..John S6ucy to insure .that surface water flowing_from the.property at
1 Breckenridge Road will not flow -on to your. property at 2 Breckenridge road. As was,
agreed to at the site on October 6, 1999, a swale was installed at the base of the slope
from the new septic system that will direct the water towards the road. I personally
visited the site and used a transit to insure that the swale that was installed on the 1
Breckenridge Road property was in fact lower than your property and would direct water
towards the street and not towards your house.
Concerning the sprinkler pipe that was damaged by the installation of the Swale. I stated
on the phone that it is my opinion that when your sprinkler pipe is not on your property
and it is damaged by work done on the property you do not own, it is not up to the
property owner or the contractor that damaged the pipe to fix that pipe. In my opinion
you should have the pipe fixed and relocated in such a manner that it is not on your
neighbors property. However, as I stated on the phone, I will mention to Mr. Soucy that
you would like him to fix the broken sprinkler pipe. Please note that my mentioning this
to him is not a guarantee that he will fix the pipe.
Please note that my role in the process of repairing the failing septic system at 1
Breckenridge:Road is -to supply a design that meets the regulations of the state and local
bylaws that governs the design of such systems:. The regulations. were developed�to t�, F A,D04 .
protect all involved=in the.process including the abutters. I believe that, the; designCr-__eated'`- A H
by this office meets or exceeds the requirements of the regulations and will not have an
1999
33 WALKER ROAD - SUITE 23 - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
adverse affect on your property. I do not have anything to do with installing the system
except to insure that 'it has been installed per the plans.
I will be happy to listen to and try to address all of your concerns, however you must
understand that I may disagree with some of your views. If you would like to meet at the
site I would be happy to meet you any day during working hours or in the late afternoon
or early evening as long as my schedule permits.
Sincerely,
Benjain C. Osgood, Jr., EIT
President
Cc: North Andover Board of Health
Soucy's Sewer Service
Elaine and John Lunde
(P..H.0.KE..V W
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—7177
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FOR 0 T TIM P. M.
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RETURNED
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YOUR CALL
AREA CODE NUMB ER Ex-rENSION
PLEASE CALL
MESSAGE I
WILL CALL
AGAIN
11 .818191
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CAMETO
SEE YOU
WANTS TO
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UIGNED FORM 4003,J
WILL CALL
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—7177
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SEE YOU
WANTS TO
SEE YOU
UIGNED FORM 4003,J
r -'s
NOTE
NOTES
Mr. Ben Osgood Jr.
New England Engineering
60 Beechwood Drive
North Andover, MA 01845
Venna & Benson Ho
2 Breckenridge Road
North Andover, MA 01845
rcWn:
October 6; 1999, f
OCT — 81999
This is to record the conversation taken place at 1 Breckenridge Road, North
Andover, Massachusetts, on October 6t'' 1999.
The following parties were present:
Mr. Ben Osgood Jr. of New England Engineering, the designer of
septic system currently under construction at 1 Breckenridge Road, North
Andover, Massachusetts.
Ms. Sandy Starr from the North Andover Board of Health.
Soucy's Sewer Service, builder of the septic system at the above said
address.
Venna Ho, owner and tenant of 2 Breckenridge Road, North Andover,
Massachusetts.
The following issues were discussed:
Venna Ho presented the fact that the new septic system being built at 1
Breckenridge Road had raised the original landscape a few feet off the
ground, and would cause water to run on to her property, thereby causing
drainage problems and property damage. Mr. Osgood and Ms. Starr, both
experts in this issue, agreed that the solution would be to create a "swirl" or
ditch of some sort so that the water would run to the street than draining
towards 2 Breckenridge Road. In addition, it was agreed that the top of the
septic area would be graded away from the property at 2 Breckenridge to
drain the water away from Venna Ho's property. It was also agreed that if
the drainage problem is not resolved, additional action would be taken at a
later date.
Mr. Osgood further assured Venna Ho the septic system being built on 1
Breckenridge Road would not cause any water drainage problems on her
property.
The second issue brought up by Venna Ho was the placement of the white
ventilation tube. It was placed in the corner of the area that it was directly in
her line of sight from her window. As it was aesthetically unpleasant, she
requested that it be moved to the other side. The Soucy's Sewer Service
representative said since that was part of the design, it would cost him
money to move it, and he would not be willing to do that. Ms. Starr agreed
with him. It was agreed that the white ventilation tube would be painted
green so as to make it less conspicuous.
Cc: North Andover Board of Health
Soucy's Sewer Service
Elaine and John Lunde
Town of North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
WILLIAM I SCOTT
Director
(978)688-9531
October 6, 1999
Venna Ho
2 Breckenridge Road
North Andover, MA 01845
Dear Mrs. Ho:
27 Charles Street
North Andover, Massachusetts 01845
Fax(978)688-9542
This letter comes as a follow-up to our discussion earlier today concerning your
complaint about the height of the septic system being repaired at 1 Breckenridge Road
and possible runoff onto your property. As I explained to you, there should not be any
significant increase in runoff water since the area of the leach field will absorb rain just as
it does now. In addition, the design engineer has assured me that he will work with the
septic installer to create a small swale to direct any potential new water from the septic
system area away from your house.
As far as your view of the vent pipe goes, I again suggest you try to work with
your new neighbors to landscape the area and hide the vent. They may find the view of
the pipe as unpleasant as you. do and will be more than willing to plant a bush or two. I
hope everything works out for you.
Sincerely,
Sandra Starr, R.S.
Health Administrator
Cc: File
W S 4-
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Town of North Andover, Massachusetts Form No.2
,t0ftTh BOARD OF HEALTH
0 -19
DESIGN APPROVAL FOR
CHU SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant Test No
Site Location
Reference Plans and Spec
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
Fee- /
—CHAIRMAN, BOARD OF HEALTH
Site System Permit No. /6SK-'-
0
Applicant
Site Location
Town of North Andover, Massachusetts
D fN A Q r*% n E7 U E: I Ll
t-% I
�5/x--*6-19 9� 7
Form No. 1
APPLICATION FOR SITE TESTING/INSPECTION
�) /) d 0-
/ e --k -e n'r-1 d
Engineer --3-f'--2 01360(16
NAME ADDRESS TELEPHONE
Test/inspection Date and Time— A)w
CHAIRMAN, BOARD OF HEALTH
Fee Test No. ?;Zc?
S.S. Permit No. /e&5�DXC. No.!/�9/ C.C. Date—Plbg. Permit No.
Town of North Andover, Massachusetts
I R T BOARD OF HEALTH
APPLICATION FOR SITE TESTING/INSPECTION
Form No. 1
19 fl/
Applicant
NAME ADDRESS TELEPHONE
Site Location—/
Engineer ) "�"� )
NAME ADDRESS TELEPHONE
Test/inspection Date and Time
Fee __ P
CHAIRMAN, BOARD OF HEALI H
Test No.
S.S. Permit No. D.W.C. No. C . C. Date—Plbg. Permit No
BOARD OF HEALTH
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE: 9 , zo
LOCATION Or SOL TESTS: t
Assessor's map & parcel number: 1-07P //6
(IjC 3 /4 0
M9
TEL. 688-9540
TOWN O NORTH ORTH A�;DOVER/�
BOARD OF HEALTH
v
APR 2 01999
1 I
OWNER: 1^ �a(v�e l.�nr�e� TEL. NO.: q 78 -- 6 e-7- [ 8 (a
ADDRESS:
Nem, x -a" Fl!�;:.ee.%
ENGINEER: -xxc� TEL. NO.: 6178-&8CI-17C S
CERTIFIED SOIL EVALUATOR: fx�,cr C O70a0 /L drjX
Intended use of land: residential subdivision, single family home, commercial
Repair testing `ZC Undeveloped lot testing
N. A. Conservation Commission Approval:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of $75.00 per lot for
repairs or upgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic
plans.
3. At least two deep holes and two percolation tests are required for each septic system
disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the
discretion of the BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1°-100') shall be submitted to
the Board of Health showing the location of all tests (including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
NEW ENGLAND ENGINEERING SERVICES
INC
August 13, 1999
Sandra Starr, Administrator
North Andover Health Department
Town Hall Annex
27 Charles Street
North Andover, MA 01845
Re: 1 Breckenridge Road, North Andover, Septic system design
Dear Sandra:
Please accept this letter as a request to have the above referenced plan considered for
approval at the Board of Health meeting on August 26, 1999. Specifically, the board
needs to approve the following.
LOCAL UPGRADE APPROVAL:
1. Allow the reduction in the offset distance between the bottom of the leach bed and the
water table from the 4 feet required by Title 5 section 15.212 to 3 feet.
If you have any questions or need additional information please do not hesitate to contact
this office.
Sincerely,
c 0a aBenjamin C. Osgood, Jr., EIT
President
-e 1) RTH�
[`_u..F?1,cAE;TH
AUG 1 101 F 31999
33 WALKER ROAD - SUITE 23 - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
FORM 11 - SOIL EVALUATOR FORM
Page I of 3
No. Date:
Commonwealth of Massachusetts
Az),z'/� , Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
0 Date: -�7111A?f
............ ..... ........
Performed By: . . ....... ............ ..................... ........ C. . ..... I
WitnessedBy: ... ....... ;7�� . ..... ..... ......... ..... .......... ........ .. . ..... ...... ........... ..
Owner's Narne.
Location A6drcss or Aftess, and
Lot
Tckphomt
New Construction El Repair
Office Review
Published Soil Survey Available: No El Yes
Year Published ............. Publication Scale ................... Soil Map Unit
Drainage Class .... ...... . Soil Limitations ... .... ......
Surficial Geologic Report Available: No E Yes ❑
Year Published Publication Scale
GeologicMaterial (Map Unit) ............................................... I ........... .......... I ............................................ ..... .. ...... . ....... . ...
Landform, ..... I ................. ... ................... ............................................................... .........................
Flood Insurance Rate Map:
Above 500 year flood boundary No E]Yes R3
Within 500 year flood boundary No 0Yes El
Within 100 year flood boundary No []Yes El
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS): Monthj�//—
Range :Above Normal ONormal nBelcw Normal 91
Other References Reviewed:
13
DEP APPROVED FORM - 12107/9S
FORM 11 - SOIL EVALUATOR FOIZN1
Page 2 of 3
Zv/
Location Address or Lot No. /
On. -site Review
r.'e'o Weather'75�ell-1-7—.601
Deep Hole Number Date: Time:/
_4
Location (identify on site plan)
Land Use Slope (%) Surface Stones
Vegetation
Landform
Position on landscape (sketch on the back)
Distances from: '� feel
Open Water BocljFed�e Drainage way feet
Possible Wet Area feet Property Line feet
Drinking Water Well -7. feet Other
DEEP OBSERVATION HOLE LOG*
Depth from
Surface (inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, %
Gravel)
,2
x�
7
Z_
7;
v
MINIMUM Ur Z MULL0 nCuuinrLj mi vvcni rnwrwaLLi Ljiovwor%
Parent Material (geologic) DepthtoBedrock:
Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face:
Estimated Seasonal High Ground Water:
DEP APPROVED FORA) - 12107/95
FORM 11 ' SOIL EVALUATOR FORNI
. Page 2 of 3
Location Address or Lot No. / � /M7.
On-site Review
*p
Deep Hnio Number -/ _ Date:. ~�'�/ ' / Ti 147
'���, VVaethe��r'� _
(identifyLocation i plan) ��-�����--`�`��-^���-�-----'---' —~------' `_' -
Land Use Slope (�6) --�--� Surface Stones
Vegetation
Landform
Position onlandscape (sketch onthe back)
Distances from:
Open Water Body ��wpo"~' fao\ Drainage way ^���~� feet
Possible Wet Area feet Property Line feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE LOG*
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, %
-47
1viiixiiviuivi °,4""LCO"C""."C"°. =F". ,"",""='°.","=~^°"=~ ~
Parent Material (nomvoic) 000mmavuu
Dgpthto Groundwater: Standing Water iothe Hole: --' Weeping from Pit Face: -- _
Estimated Seasonal High Ground Water:
-----' ocnAPPROVED FOP -NJ 'umns
J.i
FORM I I -,SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. /='`���y���
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole ................. inches
❑ Depth weeping from side a . observation hole ............. inches
® Depth to soil mottles inches
❑ Ground water adjustment .................. feet
Index Well Number .................. Reading Date .................. Index well level ..................
Adjustment factor ................. Adjusted ground water level ..............................
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in a 1 areas
observed throughout the area proposed for the soil absorption system? 5
If not, what is the depth of naturally occurring pervious material? -"
Certification
I certify that on Wl�qlo!5_ (date) I havepassed the soil evaluator examination
approved by the Department of Environmental Protection and that the above analysis
was performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature 4`— Date `�/����
DEP APPROVED FORM . 12/07/45
9A - APPLICATION FOR LOCAL UPGRADE APPROVAL
Commonwealth of Massachusetts
No 12 f4 k1joam , Massachusetts
Application for Local Upgrade Approval
Title 5, 310 CN1R 15.000
DEP approved form required by 310 CMR 15.403(1)
To be submitted to Local Approving Authority/Board of Health: For the upgrade of a
failed or non -conforming system with a design flow of <10,000 gpd, where full
compliance, as defined in 310 -CMR 15.404(1), is not feasible.
To be submitted to DEP: For the upgrade of a failed or non -conforming system with a
design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility,
where full compliance, as defined in 310 CMF 15.404(1), is not feasible.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that
includes the addition of new design flow to a cesspool or _privy or the addition of new
design flow above the existing approved capacity of a system constructed in accordance
with either the 1978 Code or 310 CMR 15/000.
1) Facility/System Owner:
Name: /—v4c
Address: ! gre, 4 PrMiL)Gt-.�-
A•v oma. e /Na
Phone#: 978.- 6G-7- 63f 6
Address of facility:
2) Applicant (if different from above)
Name:*
Address: 54 wke
Phone #:
3) Type of Facility:
_Residential Commercial School Institutional
(Specify) '—,i'.Ic 1�-eatnd. ory,c
DATE: �
�—
LOCATION'. t
ENGINEER:_.—
BOH, WITNESS:
t
F�� 0LAT10N TE -ST �� .0
BO i i O(vi DEPTH OF PERC TEST:
0 �-'0 ` • (At Ie -s 1 � .minutes 1cnc)
TIME OF SOAK: _ .�
TIME AT 2" l o < �'
TIME ATS"
TIMEAT5`:1��-f O
CV'= .NIGHT SOAK
TliviE STAF. T ED _
NEXT D.L"Y SOAK:
-;MEAT 12°
TME A.T
TIME AT
L.,.t e� 1 - ,Minutes)
a►sarn�,
Z� I a
L 5S� 7511 4
Z�
✓ ,G l
-77/
�S
41
a►sarn�,
SEPTIC PLAN SUBMITTAL FORM
LOCATION:
NEW PLANS: �T S125-00/Tian
REVISED PLAINS: YFS 60.00/Plan
SITE EVUUATION FORMS FN�CLUTIDED: NO
DATE:
DESIGN ENGINFER:
DA'rE TO CONSULTANT:
*If you want your plans expedited, please submit three plans and included a
stamped envelope with the correct amount of postage to mail plans to Port
Engineering.
When the submission is all in place, route to the Health Secretary.
WILLIAM F. WELD
Govemo:
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA
DEPARTMENT OF ENVIRONMENTAL PROTEi
ONE WINTER STREET. BOSTON, MA 0.108 617-292-5j00
+'� , 31999
TRUDY COXE
. Secretary
ARGEO PAUL CELLUCCI DAVID B. STRUHS
Lt. Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Uk9� f .�� c.E' t4 tic �5' --">/
%�s /�%//fjQ c,l--�' �'
Property Address: / P Address of Owner:
Date of Inspection: '%'r"#^ -e • (If different)
Name of Inspector: �coc ( US's
I am a DEP appy ved system inspector pursuant to SecVon 15.340 of Title 5.(310 CMR 15.000)
Company Name: a �i✓ e &.- ",- e 7-1 C,Mailing Address: c><'i *I i-fLr fro
Telephone Number: �^} L - i yi
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
_ Passes
_ Conditionally Passes
Needs Fu rt , r,
By the Local Approving. Authority
Fails
Inspector's Signature: Date:
v
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTIONSUMMARY: Check A, B, C, or D:
A] SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria.as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
BI SYSTEM CONDITIONALLY PASSES: p1 rL
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.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health. .
(raviaad 04/25/97) Page 1 of 10
DEP on the World Wide Web http:/twww.magnet.state,ma.us/dep
0 Pnnted on Recycled Paper
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM'
PART A
CERTIFICATION continued)dt
Property Address:
Date of Inspection: , r
Bj SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four 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....
Cl 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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE .
ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS) and the.SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the Well i 4ree from-pollution-=ftorn that facility and the presence -of -ammonia nitrogen: and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
i
(revised 04/25/97) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner: IkI 'Al G
Date of, Inspection:.
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
Pumping information was provided by the ownr, occupant, or Board of Health.
_ None of the system compone�t��have bebnflpumped for at least two weeks and the system has been receiving normal
flow rates during Mi i period. arge volumes of water have not been introduced into the system recently or
as part of this i s�'ectio j
_G'I As builtplans have been obtained and examined. Note if they are not lavaiiable with -N/A' - =
The facility or dwelling was inspected for signs of sewage back-up. _
The system does not receive non -sanitary or industrial waste flow.
The site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub -Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b)]
1
(revised 04/2S/97) Page 4 of 10
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (cont'' ued)
Property Address:/ /
Owner: a
Date of Inspection: _//r
DJ SYSTEM FAILS:
.You must indicate either "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an 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.
Ei Static liquid level in the distribution box above outlet invert due to an overlloaded or clogged SAS.or.cesspool.. ,f
Liquid depth in cesspool is less than 6” below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
_ Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to.
public health and safety;,and the environment- because one or more of��Mhe following- conditions exist: .
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97)
Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
fi Y r cfle e u v,
Owner: V "A4 D
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow: t:.p.d./bedroom for S.A.S.
Number of bedrooms:
Number of current residents:
Garbage grir:der (yes or no):_
Laundry connected to system (yes or no):_
Seasonal use (yes or no):_
Water meter readings, if available (last two (2) year usage (gpd):
Sump Pump (yes or no):
Last date of occupancy: —&6b
COMMERCI.AUINDUSTRIAL: %
Type of -establishment: /
Design flow:_gallons/day
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:
OTHER: (Describe)
Last date of occupancy.
GENERAL INFORMATION
PUMPING RECORDS and source of information: /'��-r Ye
System pumped as part of ins ction: (yes or no)
If yes, volume pumped: of
f
Reason for pumping rtx a.lcc-
TYPE OPSYSTEM
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)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no)'21-4
(revised 04/25/97)
Page 5 of 10
A d:..e, *
Property Address:
Owner:
Date of Inspection:
BUILDING SEWER:
(Locate.on site plan) .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
AA1 40
fj
Depth below grader
Material of construction: _.cast iron _'-40 PVC _ other (explain)
Distance from private water supply well or suction hrc
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
if
SEPTIC TANK: P -
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _ (Yes/No)
Dimensions:
Sludge depth: i.
Distance from top of udge to bottom of outlet tee or baffle:,
Scum thickness: tom -
Distance from top of scum to top of outlet tee or baffle: .
Distance from bottom of scum to bottom of outlet tee or baffle: %t
How dimensions were determined: ('4r S' / % 'e
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid. level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
GREASE TRAP:
(locate on site plan) fJ�,
.SFr. *
Depth below grade: F-
73
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:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity; evidence of leakage, etc.)
r
(revimed 04/15/97) page 6 of 10
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: t-v�t "C►
Date of Inspection:
TIGHT OR HOLDING TANK:=(Tank must be pumped prior to, or 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/dav
Alarm level: Alarm in working order _ Yes; No ' 4
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: �P5
T
(locate on site plan)
Depth of liquid level above outlet invert: (i
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order: (Yes or`No)
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of,pumps and appurtenances, etc.)
)
(revised 04/2S/97)
Page 7 of 10
Property Address:
Owner:
. -. .. ". � . +. ='CF9' . -...—rte. •S"s. .« .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Date of Inspection: I,.VN C
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excdeo�'
n not required, but may be approximated by non -intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:_
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number,°`dimensions: 1 V3 A? d ,(i
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
41,e-1 G 'cy c C Ur clem
CESSPOOLS:
(locate on site plan) 1hI
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 (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY: 4
(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.)
f
(revised 04/25/97) Paye ! of 10 4''".
. � • . • ..,fir -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:. f /� r P C I`C
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
(revised 0{/25/97)
Page 9 of 10
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
it
Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
,/Observation of Site (Abutting property, observation hole, basement sump etc.)
`�' Determine it from local conditions
i.
Check with local Board of health f,
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. Must be completed)
(�Lt/
Or
4
1
(revind 04/2S/97) Page 16 of 10
r HANCOCK SURVEY ASSOCIATES, INC.
2 Electronics Ave. Danvers Industrial Park
DANVERS, MASSACHUSETTS 01923
(508) 777-3050
JOB ENI V OOI J
SHEET NO. OF
CALCULATED BY �C. DATE
CHECKED BY DATE_
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HANCOCK SURVEY ASSOCIATES, INC. n
2 Electronics Ave. Danvers Industrial Park SHEET NO. l of Z
DANVERS, MASSACHUSETTS 01923 CALCULATED BY DATE i 1� i89
(508) 777-3050 vv
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r
Notice to APPLIcurr/TONN cLEU and Certification of 1�ct o .of Planning Board i
.on Definitive Subdivision Plan entitled:
Breckenridge Homes'`''
_ dated July 21 19 87
By: Richard F xaminc;l { w _ _ .�
The North Andover Planning Board has voted to APPROVE said plant subject to the
following conditions: `
1. That the record owners of the subject
ci-rrise land
rforthwith
ovide securitexecute
foratherecord
a "covenant running with the land", or p y
struction of ways and the installation of municipal services within said sub-
divisiont all as provided by G.L. c. 41, S. 81-U.
2. That all such construction and installations shall in all respects
conform to the governing rules and regulations of this Board.
3. That, as required by the North Andover Board of Health in its report to.
this Board, no building or' other structure shall be built or placed upon Lots.
No. as shown on said Plan without the prior
`
consent of said Boarof Health.d
4. Other conditions:
The following Plans shall be deemed approved:
Prepared by: Richard F. Kaminski & Associates
Entitled: Definitive Subdivision, Site Regrading Plan,
Sheet 2-3 and,
Plan & Profile Details Sheet
and. Sheet 3 of 3
Breckenridge Homes - Dated: July 23, 1987 and revised August 26, 1987
September 28, 1987 and October 26, 1987
See Attached
In tha event that no appeal shall have been taken from said approval Within
twenty days from this date, the North Andover Planning Board Willi forthwith
thereafter endorse its formal approval upon said plan.
The ]North Andover Planning Board has DISAPPRUVED said plan, for the following
reasohs:
NORTH A)IDUVER PLANhIIIG BOARD
n.+,a November 23, 1987 BY: -T)-.0-r Heda-t-rem, effetirma r
Breckenridge Homes
Conditional Approval
A. All Planning Board Order of Conditions are t�gg �b,e pIG�d
on the recorded Definitive Plan, (cover sheef� prior to
endorsement and filing with the Registry of Deeds.
B. Prior to signing the Definitive Plans, all executed deeds
of easements and parcels shall be submitted to the Planning
Board and held in escrow until completion. At the time of
completion and prior to final security release, the developer
shall record said documents for the Town.
C. A certified document from a Professional Engineer and/or
Land Surveyor shall be submitted to the Planning Board after
the completion of each phase verifying that all utilities
(including electric, telephone, sewer and cable) have been
installed in accordance with the plans prior to binder coat
of application. Installation shall be in accordance with
plans and profile prior to the release of any lots.
1. The Order of Condition issued by the NACC for Lot H
Breckenridge Homes shall be followed.
2. A bond in the amount of $8,000 for the As -Built Plans
shall not be released until approved by the
Planning Board.
3. No Certificate of Occupancy shall be issued for any
structure built in this subdivision prior to the
binder coat of bituminous pavement being placed
to the satisfaction of the Department of Public
Works.
4. All septic system designs must be approved by the
Board of Health.
5. All homes in this suvdivision shall install residential
sprinklers as recommended by Fire CHief's letter
dated August 12, 1987.
6. Existing trees listed to remain on the subdivision
plan shall not be removed on the site.
7. All areas indicated on the plan to remain with tree
cover shall be maintained. No tree cutting shall be
allowed in these areas. A bond in the amount of
$10,000 shall be posted with the Planning Board to
insure replanting if builders or developer does
remove any trees. Also any cutting in the public
way shall conform to MGL Chapter 81.
cc: Director of Public Works Police Chief
Highway Surveyor Fire Chief
Board of Public Works Applicant
Tree Warden File
Conservation Commission Engineer
Building Inspector Interested Parties
Board of Health
Assessors
'tz:51
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HANCOCK SURVEY ASSOCIATES, INC.
2 ELECTRONICS AVENUE DANVERS. MA 01923 (508) 777-3050 / 283-2200 / (617) 662-9659
DANVERS INDUSTRIAL PARK FAX: (508) 774-7816
139 BEACH ROAD SALISBURY, MA 01950 (Ase 00, ( (508) 462-3036 / 352-7590
#3675 FAX: (508) 462-5547
June 15, 1989
Board of Health
Town Hall
120 Main Street
No. Andover, MA 01845
ATIN: Mr. Michael Graf
Re: Subsurface Sewage Disposal System
Lot 1, Breckenridge Road
Dear Mr. Graf:
I hereby certify that the subject system was installed as shown on the
enclosed as -built sketch.
An existing coupling on the pipe leading from the septic tank to the
distribution box is causing the pipe to sag. The contractor, Ken DiRaffael
was instructed by an HSA'engineer to install a sturdier coupling shall be in
order to maintain a uniform pipe slope between the septic tank and
distribution box.
Field changes made by you and Ken DiRaffael on May 22, 1989 include:
1. Bottom of leach trenches being constructed at elevation 209.5 (0.83
feet lower than the original design bottom elevation). '\ K)dy
2. 10 feet of top & subsoil removed and replaced with gravel instead
of 25 feet.
Please call if you have any questions.
VVT/bc
Enclosure
NC.
cc: Mr. Ken DiRaffael
Kenwood Development Corp.
4 School Hill Lane
North Reading, MA 01864
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Date
10/6/99 Complaint
Complaint#
83
Complaintant
Venna Ho
Addresss
Phone#
2 Breckenridge Road
No. Andover
686.9380
Action
Owner of Property I
Owner's Address 11 Breckenridge Rd.
Installing a septic at 1 Breckenridge and
there is a large hill now, use to be flat &
forest, dug out trees. Worried that when it
rains water will flood her property, house.
What can she do, she doen't want to get
flooded.
Phone#
OL Sent ❑