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HomeMy WebLinkAboutMiscellaneous - 100 BROOKVIEW DRIVE 4/30/20180 t:) r r MAP # PARCEL # ra LOT # 13 S STREET'; Yr�1CV QJWa CONSTRUCTION APP L HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE lq,7APP. BY DESIGNER: D bf��� PLAN DATE CONDITIONS WELL WELL TESTS: PLUMBING SIGNOFF COMMENTS: WELL DRILLER CAL DATE APPROVED BACTERIA I DATE APPROVED BACTERIA II DATE ROVED WIRING SIGNOFF FORM U APPROVAL: APPROVAL TOf ISSUE ES NO DATE ISSUED BY / r7 CONDITIONS:;y�,z FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: IV ) too SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? YES NO TYPE OF CONSTRUCTION: NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEWES NO CONDITIONS OF APPROVAL Y NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT PAID? YES NO DWC PERMIT NO. _ INSTALLER: BEGIN INSPECTION YES 0: EXCAVATION INSPECTION: NEEDED: PASSED BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: YES: "j j APPROVAL TO BACKFILL: DATE: Sari' BY FINAL GRADING APPROVAL: DATE ��S/ 9 BY FINAL CONSTRUCTION APPROVAL: DATE: BY Commonwealth of Massachusetts rRECEIVED City/Town of CT 2013 ° System Pumping Record TOWN OF NORTH ANDOVER Form 4 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. A. Facility Information 1. System LocatioOng., Ri ont of h , Left / Right rear of house, Left / right side of house, Left / Right side of bueft / Right front of building, Left / Right rear of building, Under deck Address City/rown State Zip Code 2. System Owner: Name Address (if different from location) Citylrown Pumping Record -1. Date of Pumping 3. Type of system- ❑ ❑ Other (describe): State, Telephone Number ✓ t Date 2. Quantity Pumped: ; Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 0' -No If yes, was it cleaned? ❑ Yes ❑ No. 5. Condi 'onf System: 6. System Pumped By.- Nell y: 7. t5form4.doc• 06/03 Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company contents were disposed: System Pumping Recons • Page 1 of 1 a i Pr: ,* � op 0 Town of North Andover HEALTH DEPARTMENT CHU`+f'� CHECK #: DATE: LOCATION:��-� E t H/O NAME: CONTRACTOR NAME:�� • G/ T_yye of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ e ❑ Body Art Practitioner $ ❑ Dumpster $ f. ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrasWSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5�Inspector $ �E7—fitle 5 Report $ ❑ Other. (Indicate) $ 2523 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer O F3 d c O � L V c c c w d L w 15 cq U O F3 d c O � L V c c c w d R w 15 cq U m w J .c O O F3 d c O � L c c w d R w 15 cq U w J a� O O F3 d c O � L c w d R z w a vl $ Q ° d c m m �cc o Coa Q c 42) IC N oa It w O a y o w O o f � w R J a o z z z n wl� O d R z z z ,n Q c N oa w m y o o f cn a o 0 3 c U G lL lL J co o v O co) (9 I°► cn ►`0i M t COMMONWEALTH OF MASSACHUSETTS J EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �( ENVIRONMENTAL PROTECTION DEPARTMENT OF E zs TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1.00 Brookview Drive North Andover.Ma.01845 Owner's Name: Dale Beaudoin Owner's Address: SAME RECEIVED Date of Inspection:. ti /1 9.10 7 Name of Inspector: (please print) Brian S . Murphy JUL 0 9 2007 Company Name: B&D Septic Inspections Mailing Address: P -0 -Box 4 7 TSH ALTt N OFFNDEPARThORTH D NTER Hull,Ma.02045 Telephone Number: ( 7 81 ) 2 9 0-9 9 4 2 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ;, „�..,w 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 o� Page 2 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 100 Brookview Dr. N.Andover,Ma. Owner: Dale Beaudoin Date of Inspection: 6/ 12 / 0 7 Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system componentsas described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced. ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): 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: 100 Brookview Dr. N.Andover,Ma. Owner: Dale Beaudoin Date of Inspection: 6/ 12 / 0 7 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more frons 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: 100 Brookview Dr. N.Andover,Ma. Owner: Dale Beaudoin Date of Inspection: 6/12 / 0 7 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6" below invert or available volume is less than''/: day flow x Required pumping more than 4.times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped x Any portion of the SAS, cesspool or privy is below high ground water elevation. x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to.a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. x Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered alarge system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply _ _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 100 Brookview Dr. N.Andover,Ma. Owner: Dale Beaudoin Date of Inspection: 6 Tl -2—/-07 Check if the following hive .-bee n done. You must indicate `yes" or "no" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period ? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined? (If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up X _ Was the site inspected for signs of break out ? X _ Were all system components, excluding the SAS, located on site ? . X _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? X _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no X _ Existing information. For example, a plan at the Board of Health. _ — Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 100 Brookview Dr. N.Andover,Ma. Owner: Dale Beaudoin Date of Inspection: 6/ 12 0 7 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 4 4 0 Number of current residents: 5 Does residence have a garbage grinder (yes or no): no Is laundry on a separate sewage system (yes or no):no [if yes separate inspection required] Laundry system inspected (yes or no): _ Seasonal use: (yes or no): no Water meter readings, if available (last 2 years usage (gpd)): appx . 315 gpd. Sump pump (yes or no): no Last date of occupancy: present COMMERCLUJINDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sqft,etc.): Grease trap present (yes or no): Industrial waste holding tank present (yes or no): _ Non -sanitary waste discharged to the Title 5 system (yes or no): _ Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: system last pumped 9/1/05 (homeowner) Was system pumped as part of the inspection (yes or no): no If yes, volume pumped: _gallons -- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank, distribution box, soil absorption system _ Single cesspool Overflow cesspool Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) _ Tight tank _ Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information: 8 yrs. system installed 5/99,local BOH records. Were sewage odors detected when arriving at the site (yes or no): no Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 Brookview Dr. N . Andover, Ma . Owner: Dale Beaudoin Date of Inspection: 6/12/07 BUILDING SEWER (locate on site plan) Depth below grade: 12 " Materials of construction: _cast iron X 40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: 8 Material of construction: X concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: 1 0' x5' x5' 1 500 gal. Sludge depth: 1 " Distance from top of sludge to bottom of outlet tee or baffle: -1 -" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 5" Distance from bottom of scum to bottom of outlet tee or baffle: 15 How were dimensions determined: MEASURED IN FIELD Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of.leakage, etc.): Tank and tee's in good condition outlet tee has aas bafflp in p ace, squid level with outlet,tank appears sound,no signs of eakage. GREASE TRAP: _(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 Brooky i ew Dr. N_AndovPr,Ma_ Owner: Dale Beaudoin Date of Inspection: 6/ 12/07 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D—box in fair condition,box shows some sians of deterioration_ liquid level distribution equal,no signs of carrvover or leakage. PUMP CHAMBER: (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 1 l OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 0 0 Brookvi ew Dr. N.Andover,Ma. Owner: Dale Beaudoin Date of Inspection: 6/ 12 / 0 7 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: X leaching trenches, number, length: 4@ 1' x 3' x 5 6' leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil condition normal no signs of hydraulic failure ve etation normaT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 Brookview Dr. N.Andover.Ma. Owner: Dale Beaudoin Date of Inspection: 6/12/07 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. PLEASE SEE ATTACHED AS—BUILT PROVIDED BY LOCAL BOH. 10 Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 Brookview Dr. N.Andover,Ma. Owner: Dale Beaudoin Date of Inspection: 6/12/07 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4 feet Please indicate (check) all methods used to determine the high ground water elevation: X Obtained from system design plans on record - If checked, date of design plan reviewed: 7 9 7 Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater determined from design plan on record at local BOH water encountered @ 2 on perk test dated 6/5/96, ESHGW @ 121.00 bottom of system @ 125.00 VEN T 12' o LA 23.5 11 CONC. D—B0; G 14.5' OF rsT TOP FND loo FT BUFFS EL=130. r1� INE \ ` ` F Ox _44.2' \ l CF\ E, SCC '--,APP RC �C. V. - k 0) 011)" �S SEDC 1500 CAL. wgrERLoc.�� SEPTIC TANK \ 3' X 56' TRENCHES ELEYi TIONS TAK N AT TOP OF PIPE TOP OF FOUNDATION: 56.9' SEE PLAN PIPE © DWELLING: 65.8' 127.99 TANK IN: 56.0' 127.60 TANK OUT: 101.6' 127.49 D -BOX IN: 127.06 D -BOX OUT: 126.88 (ALL) END PIPE - C: 126.38 END PIPE - D: 126.26 END PIPE - E: 126.31 END PIPE - F: 126.38 VEN T - I B. M. ELEV. =123.64 �� I NAIL IN TWIN 8" OAKI ljI i L-14.8', � SWING TIES / II I COMPONENT COR A COR B SEPTIC TANK 17.3 56.9' D -BOX 36.0' 65.8' END PIPE: C 78.9' 56.0' END PIPE: G 77.0' 101.6' ASSESSORS MAP 90 A LOT 0068 C! (CENTER) (CENTER) \ LOCUS N.T.S. AS—BUILT SEWAGE DISPOSAL SYSTEM PLAN Summary Record Card generated on 6%12/2007 12:28:04 PM by Elaine Barclay Town of North Andover Tax Map # 210-090.A-0013-0000.0 100 BROOKVIEW DRIVE BEAUDOIN, DALE & DENISE 100 BROOKVIEW DRIVE NORTH ANDOVER, MA 01845 Class 101 Single Family Size Total 0.77 Acres FY 2007 Property Type UB Mailing Index Name/Address Type Loan Number Active/lnact. BEAUDOIN, DALE & DENISE Payor 100 BROOKVIEW DRIVE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Bl,' Id 17856 0 - 100 BROOKVIEW DRIVE Last Billing Date 4/2/2007 g 3170521 03 Cycle 03 UB Services Maint. NEPTUNE NEPTUNE w Water Service Code Posted Date Rate MISCFEE ADMIN FEE 28 0,635/8 WTR WATER 10/20/2006 01 ALL METER SIZE UB Meter Maintenance 19 Serial No Status 28 Location 45543658 a Active 10/14/2005 ENC FR.RT. Date Reading Code 3/15/2007 1340 m Manual estimate 12/12/2006 1315 a Actual 9/18/2006 1287 a Actual 6/19/2006 1215 a Actual 3/8/2006 1 188 a Actual Trouble Code:03 12/22/2005 1 169 a Actual 9/21/2005 1 141 a Actual Trouble Code:03 6/27/2005 1062 a Actual 3/30/2005 1033 a Actual 12/16/2004 1006 a Actual Trouble Code:03 9/24/2004 982 a Actual 6/24/2004 925 a Actual Trouble Code:03 4/16/2004 897 a Actual Trouble Code:03 12/15/2003 871 n New Meter From Active/inactive Active Charge Multiplier/Users 7.82 1/ 86.05 /1 Brand Type NEPTUNE NEPTUNE w Water Consumption Posted Date 25 4/16/2007 28 1/19/2007 72 10/20/2006 27 7/10/2006 19 4/17/2006 28 1/17/2006 79 10/14/2005 29 7/15/2005 27 4/5/2005 24 1/14/2005 57 10/8/2004 28 7/30/2004 26 5/17/2004 0 12/15/2003 Size 0.63 0.63 Page 1 1 Residential Until YTD Cons 0 Variance -18% -58% 202% 5% -18% -67% 182% 26% -10% -53% 53% 92% 0% 0% 13 `- 33, 545 S. F. \ 0.77 Ac. VENT 12' G 14.5' NOF 0 0 �-�NoNSF " LOT 12 a> q ► E ELEY�TIONS TAKEN AT TOP OF PIPE TOP OF FOUNDATION: 17.3 SEE PLAN PIPE @ DWELLING: 127.99 TANK IN: 127.60 TANK OUT: 127.49 D -BOX IN: 127.06 D -BOX OUT: 126.88 (ALL) END PIPE - C: 126.38 END PIPE - D: 126.26 END PIPE - E: 126.31 END PIPE - F: 126.38 III I , o-) �.� VENT II � B. M. III I ELEV.=123.64 4 NAIL IN TWIN 8" jIOAK� L =14 � 8 SWING TIES �I I COMPONENT COR A COR B SEPTIC TANK 17.3 56.9' D -BOX 36.0' 65.8' END PIPE: C 78.9' 56.0' END PIPE: GI 77.0' 1 101.6' ASSESSORS MAP 90 A LOT 0068 (CENTER) (CENTER) 0 LOCI. N. T.' AS—BUILT SEWAGE DISPOSAL SYSTEM PLAN LOT 13 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MARCHIONDA & ASSOC., L.P. ENGINEERING AND PLANNING CONSULUfr_? NORTH OEHEALTHv 62 MONTVALE AVE. SUITE IJ _ 8 f�� STONEHAM, 'MA. 02180 (617) 438-6121 SCALE: 1"=20' -DTE-- 5716 99 VENT ` 12' C X� O ai- 'O 23.7' ¢10 ul- NO 23.5' A i� CONC. D—BO G 14.5' OF 13. 337545 0.77 S. F. Ac. APPR p 4�.2' \ op- fL . pC \ �,\ ppF pk Vt. 1500 GAL. °F w°eR�sf�� \ M SEPTIC TANK I 3' X 56' TRENCHES ` _T iil lig C a I ELEY�TIONS TAKgN AT TOP OF PIPE TOP OF FOUNDATION: 56.9' D -BOX SEE PLAN PIPE @ DWELLING: 127.99 TANK IN: 56.0' 127.60 TANK OUT: 101.6' 127.49 D -BOX IN: 127.06 D -BOX OUT: 126.88 (ALL) END PIPE - C: 126.38 END PIPE - D: 126.26 END PIPE - E: 126.31 END PIPE - F: 126.38 a VENT 9 3' B.M. �►I 1 ELEV. =123.64 NAIL IN TWIN 8" OAKI L-14.8 SWING TIES / II I COMPONENT CORA ICOR B SEPTIC TANK 17.3 56.9' D -BOX 36.0' 65.8' END PIPE: C 78.9' 56.0' END PIPE: GI 77.0' 101.6' ASSESSORS MAP 90 A LOT 0068 (CENTER) (CENTER) 3 N/F LOT 12 LOCU N. T.' AS—BUILT SEWAGE DISPOSAL SYSTEM PLAN LOT 13 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MARCHIONDA & ASSOC., L.P. ENGINEERING AND PLANNING CON SW;►sET_9:�SoRTH_A SCALE: I"=20' 62 MONTVALE AVE. SUITE 'I STONEHAM, MA. 02180 JUN - 8 Ic� (617) 438-6121 \A TOWN OF NORTH ANDOVER SYSTEM PUMPING RECO DATE: q DATE OF PUMPING: `� r CESSPOOL: NO YES NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: SEP - 7 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SYSTEM LOCATION (example: left front of house) PUMPED SEPTIC TANK: NO EMERGENCY 6� GALLONS YES FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: �` TOWN OF r L i SYSTEM PUMPING RECO"-, OF NO AiLQo �? BOARD OF HEALTH N DATE: OCT `O ZOOZ SYSTEM OWNER & ADDRESS IOo &DOkAinj SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: 0 C Off— QUANTITY PUMPED : 1 50-6 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLL4M J. SCOTT Director July 9, 1997 Mike Rosati Marchionda & Associates 62 Montvale Ave., Suite 1 Stoneham, MA 02180 RE: Brookview Circle Dear Mike: 30 School Street North Andover, Massachusetts 01845 This letter is to inform you that the proposed septic plans for Lots 1, 11, 12 and 13 Brookview Circle have been approved. If you have any questions, please do not hesitate to call the Board of -Health office at the number below. Sincerely, Sandra Starr, R. S. Health Administrator cc: Wm. Scott, Dir. CD&S File Dave Kindred CONSER�hMON 64P,-9530 HFAITH 6RR-9540 PI.ANNiN(➢ 688-9535 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: (�? I SYS (example: left front of house) 1-C44ov,+ c� 1 Musk_ DATE OF PUMPING: —tS -O ( QUANTITY PUMPED C: GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: 1)NTENTS TRANSFERRED TO: i 7j / FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills -r'out this section****************** APPLICANT: °O���C� c�Uy��, �rS Phone yd 5 LOCATION: Assessor's Map Number Parcel �� 7 Subdivision ��Gc �ryi` �s %� 5 Lot (s) / 3 e-aA C•,'; ��l'i/�� St. Number C� Use only*******************x**** REC,DM ENDATIONS 07 TOWN AGENTS: Cc ter•: at-on� d-_nistratcr Town Planner cc=er^c �/ �1 Date Approved Daze Rej ec -ad Date Approved _ Date Rej ec :ad Date Approved Date Rejec:ad Date Apprc•red Date Rejec=ed c Wcr�:s - se*.:er/water connections - dr" ve:aay pernit Fire Decar--.-,e^ Rev=ived by Building Ins=ector Date PLAN REVIEW CHECKLIST ADDRESS �1�� .�D���%l�� ENGINEER ro,54-,r- GENERAL � 0,516 3 COPIES STAMP LOCUS NORTH ARROWy/ SCALE CONTOURS(/ PROFILE ----(SC) SECTION L ---'BENCHMARK ✓ SOIL & PERCS e-` ELEVATIONS WETS. DISCLAIMER C--' WELLS & WETS WATERSHED?_A/O-.. DRIVEWAY_LZ WATER LINE FDN DRAIN L--' M&P SCH40 ✓ TESTS CURRENT? c/ SOIL EVAL M,-)EOSl4%/ SEPTIC TANK MIN 150OG ✓ .17 INVERT DROP tf� GARB. GRINDER,A&.(2 comps +200) 10' TO FDN MANHOLE 6C ELEV L/ GW ✓ ## COMPS. I GB D -BOX SIZE # LINES 4 -FIRST 2' LEVEL STATEMENT INLET OUTLET rJ = / /� ( 2" OR .17 FT) TEE REQ' D? /UCJ LEACHING MIN 440 GPD? RESERVE AREA L`�4' FROM PRIMARY? --,S--- 20 SLOPE 100' TO WETLANDS X100' TO WELLS f 4' TO S.H.GWy (51>2M/IN) 20' TO FND & INTRCPTR DRAINSI------400' TO SURFACE H2O SUPP !--- 4' PERM. SOIL BELOW FACILITY MIN 12" COVERy" FILL? C--(15') BREAKOUT MET?ice TRENCHES MIN 440 gpd SLOPE (min .005 or 611/100')1-",, SIDEWALL DIST. 3X EFF. W OR D (MIN 6') L ----RESERVE BETWEEN TRENCHES? SIN FILL? 1 MUST BE 10' MIN. L-""�4" PEA STONE?VENT? (>3' COVER; LINES >50') BOT z 72 + SIDE 4 5�-0 X LDNG ' 7` = TOT 7 �¢D Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director 30 School Street North Andover, Massachusetts 01845 June 16, 1997 Marchionda & Associates 62 Montvale Ave., Suite 1 Stoneham, MA 02180 RE: Lot 13 Brookview Circle This is to inform your that the proposed plans for the site referenced above have been disapproved for the reasons below. If new plans satisfactorily addressing all these issues are submitted to the Health Department by June 20, 1997, then approval for the plans should be given by June 27, 1997. 1. Only 2 copies submitted. (NA 6.01) 2. Plans do not show legible signature. (310 CMR 15.220(2)) 3. Perc elevations missing. (NA 6.02j) 4. Reserve not 4' from primary. (NA 2.23) 5. Vent missing. (310 CMR 15.251) If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. 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IiI I ,D I o0 I .o I IiI I — D,► I io I D'' I I' I I I ►,► I I ►�► I I oo I I I �► io D► I Ia' � _ � ICIO I I I �,►. .D I I I I I I I • a' A e r - 1 I D,► I I I I! I I I ,•a I ►'' I � I I I I I I I 1' I I I I I I '.a I ►�► c. ru I i D,► I u I L I I i V I 1,a i I ►,► I I N I I m ILI I a' I I .D I I x� I I P I 1i I I D,► I -- I l / to 1 1 /a I ►,, ------- ---- - -�If`—------- - - - - -I I i A A e 4 A A � p —1 — — — — — — — — — — — — — ►- — — a- — — — — — — — — — — — — — — — f9-16 r .9 -IV C ^ .9-,* _4" Yg „e -,o£ I (A 23.7' O O N TOP FN D loo FT BUFFER 4. EL -130.1N F SINE 23.5 a . N/F LOT 14 0 WE HEREBY CERTIFY THAT HAVE EXAMINED THE PREMISES AND THAT A APPARENT EASEMENTS AND ENCROACH ENTS ARE LOCATED AS SHOWN. THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OF THE MUNICIPALITY WHEN CONSTRUCTED. ALSO, kCCORDING TO THE F.E.M.A./H.U.D. FLOOD INSUR NCE RATE MAP, COMMUNITY PANNEL N0. 250098 0009 C DATED 6/2/93 THE STRU JURE IS NOT LOCATED IN AN ESTABLISHED 100 YR. LOOD HAZARD ZONE. THIS PLAN IS INTENDED FOR ZONING PURPOSES ONLY. IT WAS PR PARED FROM EXISTING PLANS AND ZECORDS WITH THE STRUCTURES SHOWN LOCATED BY AN INSTRUMENT SURVEY. THIS PLAN SHOULD NOT BE USED FOR ROPERTY LINE DETERMINATION. \ 60.00' 13 33) 545 S.F. N/F 0.77 Ac. 12 LO"I L=1489' OF Mgss9 •®�i o yo � s o STEPHEN M. a C-3 MELESCIUC No. 39049 O"Ess%0y0Q I N SU0, CERTIFIED PLOT PLAN LOT 13 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS M ARCH ON DA & ASSOC., L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: I"=20' DATE: 2/17/99 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 1 CURRENT INSTALLER'S LICENSEn LOCATION: fa, LICENSED INSTALLER: _ ,(,';6�- SIGNATURE: (/L� TELEPHONE# 6 �� % %% 4j" CHECK ONE: REPAIR: NEW CONSTRUCTION: l� IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. 575.00 Fee Attached? Foundation As -Built? Floor Plans? Administrative Use Only Yes ✓ No Yes No Yes �--�� No Approval 67 px,--f �--, 1/* -r' c w � 0 z E Q a `o z � *�• LL O'ER rO `9. •� �W .O o r..+ F- = •� 1 F.. J LU z h,N01 s�'� Q (n LL z O J Q � t L o uJ v r' z O Q off. N L O z Q LL 3 0 O J F•- a c w � 0 Q a z � *�• O'ER rO `9. •� �W .O o r..+ rz = •� 1 F.. J h,N01 s�'� Q (n c 0 a � •� 1 F.. J LU LL z O r' c o ro z off. Q N O Q -- c ao a� U r) L c c O U O O C -O c '^ rz bo E a� � N � N � ro In 11) • v O a LA , O p •E cC L � � CL N LL f NOR7q ,.•goo o I.-40 w 9 ,SsACHUSEI Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Ack Applicant 4 1--2 Test No. Site Location Reference Pla Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee 60 AA /=:7u CHAIRMAN, BOARD OF HEALTH Site System Permit No. �1� LOCATION: SEPTIC PLAN SUBMITTALS NEW PLANS: —�- YES REVISED PLANS: DATE: G z5 � 7 DESIGN ENGINEER: [J IA S60. 00/P1an $25.00/p(an e" When the submission is all in place, route to the Health Secretary i TOWN OF'NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System M constructed; ( ) repaired; by See (al- located at ©T tb-vcoKV` i U-7VJ was installed in conformance with the North Andover Board of Health approved plan, System Design Permit 4 dated ? y/9_:z_, with an approved design flow of 41 410 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which h4 been submitted to the Board of Health. 41671 Gi/r irYlrS e Bed inspection date: 126V � Final inspection date: Installer: Li c. 4: Design Engineer: Inspector (F,'A). G 2,dD€) Inspector Date: 61161 'F j Date: 49 `I Ijax�hionda Associates, L.P. 4�� :Engineeringand Planning Consultants (617) 438-6121 Fax (617) 438-9654 CY TO :V7 WE ARE SENDING YOU ❑ Attached J Under separate cover via. ❑ Shop drawings ❑ Prints - ❑ Plans ❑ Copy of letter ❑ Change order [L[EU EQ (MIF URRMZ OUCTRL DATEr JOB NO.. / ATTEN N RF: the following items: ❑ Samples ❑ Specifications I DESCRIPTION COPIES I DATE NO.E � � �r/�/'�/ ✓ / CJI+✓" �[r ��C�N� /..r.� "/�C7�N f�"�.�vu T iv Blew XV/ ee-CD THESE ARE TRANSMITTED as checked below: ❑ For approval O Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS i iOVtsN OFdVORTFI A*"DOt✓ER� -, a BOARD OF fra�T f JutJ - 8199 � COPY TO .�� d�1�Gl d C SIGNED: . it enclosure ale not as noted. kindly notify us at once. J AS -BUILT CHECKLIST NORTH ARROW l0 LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT (/ LINES & LOCATION OF DWELLINGS LOCATION & DEMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES & DWELLING WELLS 3. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM y TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAMS, WATERCOURSES W/IN 1 50' OF SYSTEM LOCATION OF WATE GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX R/ V STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW 1/ FINAL CONTOURS LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN M s_ ARGEO PAUL CELLUCCI Govemor COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: (� (� � ro Q � Y LRh.a, i Dr Name of Owner a c k h + � 1 '54) 4 OU i (3 k,\ � ��ri •lk ( • Address of Owner: Date of Inspection: Name of hxspectm: (Please PmrU 1 am a DEP aXwoved system inspector pursuant to Section 15.349 of Tide 5 1131 O CMR 15.000) Company Name:s y� e- r, Mailing address: Zs 3, o Telephone Number: 4t+ TRUDY COXE Secretary DAVID B. STRUHS Commissioner 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 Further Evaluation By the Local Approving Authority inspectors Signature: L Date: � 0 �'Z 4 O The System Inspector shall submit a copy of th nspection report to the Approving Authority (Board of Health or DEP)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. NOTES AND COMMENTS 12 7 revised 9/2/98 Pagel of 11 M A) SYSTEM PASSES: ° - --= =- -- -- °-=----_-- -== _ i - - ----a,,:::e co:.a,uve:s i:csti::o�w :: a : � I iinvn nve wweu airy �ouwutouvu wrowu Tiui�dca itiiic oily vF uic . ' � ` ` ' criteria not evaluated are indicated below. CCMNIENTS. B1 SYSTEM CONDITIONALLY PASSES_ One or more system components as described in the"C nditional Pass ' section need to be replaced or repaired. 1 he system, upon completion of the replacement or repair, as approvedXthe Board of Health, will pass. nn. nr nnt _..... ... �....,S.P... .mn-...y ...,, The septic tank is metal, unless the caner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating at the tank was installed within twenty (20) years prior to the date of the inspection; or c—,nh-p- iy :sror—mi i ehowc Stjnctantiai inflitratinn or g][niiratio nr tar] TaDufe !S imminent. ine sy5 m will pass inspecuuii i7 Ute exisusig Se�,iiC iaiui a :i;i,,;Bi:cv wiui a vviiiFiiri y ocjJuw iailin as approved by the Board of ealth. PART A CERTIFICATION (continued) Owner • ••,•• •.�.. Date of Inspection: _ Sewage backup or breakout or high static ater level observed in the distribution box is due to broken or obstructed pipe(s) us dile t0 8 broken. SB«,cd yr us is ribii ion bow. The S».c..... l .ass inz;pe.^.tian if (••",1: approval of tl:e i2„or„i of V~ a ry brokenVpipe(s) re replaced obsuuctio removed The system require umping more than four times a year due to broken or obstructed pipe(s). The system will pass inspertinn if 1w ntinrnv?I of the Board of Health►: obstruction is removed Conditions exist which require further evaluation by ieBard of Health in order to determine if the system is failing to protect the 1) SYSTEM WILL PASS UNLESS BOARDOF H�LTH DETERMINES IN ACCORDANCE W17M 310 CMR 15.303 (1)(b) THAT THE SYSTEM fS NOT FUIVI 'TOME:. IN A WOR .•��I'�'1'-_I_ PR',RTECT IME FA —I 11— HE 1-TH AMD'SAFE. AND TI IE ISR 111.0-MENT. Cesspool or privy is withi 0 feet of a surface water Cesspool or privy is w in 50 feet of a bordering vegetated wetland or a salt marsh. r� revised 9/2/1-98 Page ioiii 1 FUNCTIONING IN A MANNER THAT PROTECTS THE PUPUC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has aseptic tank and soi7bsorptjon ption 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 soi system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and I absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank an soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unle s a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution fr that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method use o determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: u ('QW ) f A -v v'e i, 14A. Owner. Date of Inspection: U U � u t11 D) SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that one or more of the following failure conditions exist as described 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 efflu/tc of th ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distroutlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is leinvert or available volume is less than 112 day flow. Required pumping more thanst year NOT due to clogged or obstructed pipets). 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 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. 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. EI LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in ad on to the criteria above: The system serves a facility with a design flo# of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment bec se one or more of the following conditions exist: Yes No the system i/w!Wthin eet of a surface drinking water supply the system ieet of a tributary to a surface drinking water supply the system initrogen sensitive area (interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 The size and location of the Soil Absorption System on the site has been determined based on: ILI"_ 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) 115.302(3)(b)] The facility owner (and occupants, if different from owner) wee provided with information on the proper maintenance of Sub -Surface Disposal System. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST ';ru a V VIV3 A4, -Av\ k^-�, K. Property Address: Owner:}-�t-� I o 0 Date of Impaction: U.t7 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Y� eNo .1� Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. _ 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: ILI"_ 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) 115.302(3)(b)] The facility owner (and occupants, if different from owner) wee provided with information on the proper maintenance of Sub -Surface Disposal System. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFO ATION Property Owner: A� Date of Inspection: , o ko 1 o o FLOW CONDITIONS RESIDENTIAL: Design flow:. I U g.p.d./bedroom. Number of bedrooms (design): tNumber of bedrooms (actual):_�f Total DESIGN flow�o Number of current residents: Garbage.grinder (yes or no):_ Laundry (separate system) (yes or no): �; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no) - __n 0 Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no)In Last date of occupancy: ,4',r'i'ev+ COMMERCUIUINDUSTRIAL• Type of establishment: Design flow: nod 1 Basis of design flow Grease trap present: lyes or no on 15.203) Industrial Waste Hol dingTan resent: (yes or no)_ Non -sanitary waste dischar d to the Title 5 system: (yes or no)_ Water meter readings, if a ailable: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 6-wu _o r ti k System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE 9F SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known) and source of information: U iil TVl S Sewage odors detected when arriving at the site: (yes or no) A U revised 9/2/98 Page6of11 date of occupancy:_ Tight Tank SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORM—A'TION (continued) Owner:Property dmps:li i� IS l b O e -l� 1 �e 1n7 � : ) � Date of Inspection: j U l t l( 00 BUILDING SEWER: (Locate on site plan) Depth below grade: 12 f� Material of construction: _ cast iron 40 PVC _ other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK -AZ (locate on site plan) Depth below grade._ Material of construction: Zoncrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is agge• confirmed /by(�Certificate of Compliance _ (Yes/No) Dimensions: 10 Sludge depth: 3 Distance from top of slu9ge to bottom of outlet tee or baffle: a Scum thickness:_ 1( 1, Distance from top of scum to top of outlet tee or baffle -- Distance from bottom of scum to bottom of outlet tee or baff� How dimensions were determined: M eA 51l.r Q,O� Comments: (recommendation for pumping, condition of inlet ajzd outlet tees or baffles, epth of liquid level ' relation to outlet rt inve, evidence of Ipokage, etc.) T�n D +& a Dkolt-r'LA VV -0 '1-W I I G 1A I GREASE TRAP: (locate on site plan) Depth below grade: _ Material of constructi concrete _metal _Fiberglass _Polyethylene _other(explain) Scum thickness Distance from p of scum to top of outlet tee or baffle: Distance fro ottom of scum to bottom of outlet tee or baffle: Date of last umoina: mdation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, of leakage, etc.) revised 9/2/98 . Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (con6 wed) Property Addre�i- r: Owne Date of Inspection: 10 1 1-11 ,l1 (yo TIGHT OR HOLDING TANK: (Tank (locate on site plan) Depth below grade: Material of construction: pumped prior to, or at time, of inspection) _Fiberglass _Polyethylene —other(explain) Capacity: gallolis Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert:y Comments: i � UX W fit S (nofe if level nd distributiqn is equal eviden a of solids carryov r, a denc of lepkage into or out of box, etc.) 2 '75-G Gnn PUMP CHAMBER: i� V' fi p e 5ZLA (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or Not Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/95 Page 9of11 SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addreu: Owner: Date of Inspection: 10 1 1110 L0 SOIL ABSORPTION SYSTEM (SAS) -AZ (locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number:_ ( +r9— S leaching trenches, number,length: l leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, siggs of hydraulic CESSPOOLS: (locate on site plan) level of ponding, damp spit, condition of Number and configuration:_ Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of constructio Indication of groundw er: 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- _ (locate on site plan) Materials of constructit Depth of solids: Comments: (note condition of soil/ of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9of11 Dimensions: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C (�SYSTE{�M INFORMATION (continued) n _ Property Address: u l3 ' J rbc te Z k d al .�Ji� O rJVA Pm QA Vim' 1 Owner:�{-�— Date of Inspection: lu,11100 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) I � i C 0 m iUrtP4 Li. a-%L0tA revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,Q J SYSTEM INFORMATION (continued) Property Address: 1 O Q t-� f`U tiC V 1 ��I•� Y t'. l7 I"7 I/I"V\ OLR"v ` (� I" ' Owner. Date of Inspection: n t 7 l o o NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth Shallow SITE EXAM Slope Surface water Check Cellar Shallow wells Moderate Deep Estimated Depth to Groundwater _ Feet Please indicate all the methods used to determine High Groundwater Elevation: se Y Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) The ground water determination was made as follows: 1. According to the septic system design plans, the elevation at the bottom of the trenches is 125.00 feet. The soil test data showed the water table to be at a maximum height of 119.8 feet. One test hole showed no evidence of ground water. revised 9/2/98 Page ttoftt "T LE D L E O'F--- ELEVA .INV @ DWELLING = 127.45 INV 0 TANK IN = 127.25 INV @ TANK OUT = 127.00 INV @ D—BOX IN = 1 '216.7? INV 0,D—SOX OUT — '126.55 INV @ IBECI. TRENCHES 126,27 INV @ -END TRENCHES = 126-00 80 TTOM?l"0F TRENCHES = 125.00 -OCL) S = 300' I); -:EP TEST ?A DATE 9 A S St VIE, i ..,R.OLIND ELEV. Fl. -t,4 "o BOTTOM ,-)F Pi r Ou-M ------- -- ------ DATE OBS. WATER TARLt DESAIGN WATER TABLE -,i,N oiu A HORIZON 4 ---------------- - 4 B HORIZON' M, i M. - AW""*.-` LOWIJ FIN� '4 SAND), I IT A M U LAJ� ROUND 'l: -'L.11 -W Cl HORIZON C2 HORIZON C3 HORIZON �4 5YR 5/r4 FINE -6EC LOAMY SAlf POCKETS LOOSE, I MED, SAM sa 0G&.R MASSIVE, FRI, 54 2 5 .51 LOMMY SAND j S AN"' D'f L o 005 9 A S St VIE, VERY FIPr Fl. -t,4 "o Ou-M WI VNESsED BY: S S: AE N 0. A f'i i) vc P' B; C'0 N D U Cl T E D BY, Sr Tj.-S I - PERCOLATION P 27A DATE SATURATION I -,i,N 6" M, i M. STABILIZED RAJItl '4 DEPTH IT ROUND 'l: -'L.11 -W WITNESSED Q -N P E ELEVATIONS )OF TAK�N AT TOP OF PIPE TOP FOUNDATION: SEE PLAN PIPE @ DWELLING: 127.99 TANK IN: 127.60 TANK OUT: 127-49 D -BOX IN: 127.06 D -BOX OUT: - 126.88 (ALL) END PIPE - C: 126.38 END PIPE - D: 126.26 END PIPE - E: 126.31 END PIPE - F: 126.38 1500 GAL. SEPTIC TANK 3' X 56' TRENCHES li � 11-i e.M. � ELEV.=723.64 NAIL IN TWIN 8" L=14.8' Ll ASSESSORS MAP 90 A LOT 0068 (CENTER) (CENTER) AS -BUILT SEWAGE DISPOSAL SYSTEM PLAN LOT 13 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O.- BOX 531 MARCHIONDA 8c ASS ENGINEERING AND PLANNING C0' 62 MONTVALE AVE. SUITE NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT DATE �O//q7 / A 17 FEE: 6 PERMIT # DATE RECEIVED APPLICANT -DA1/� ) L"/ lub fC-� MAP PARCEL ADDRESS LOT #/ 6 STREET # ENG. /1'�Y� ��/�/C�� Zi�%Ove 1¢ / / STREET '-BeQ5e-U1 CU-) ENGINEER'S ADD. PLAN DATE 6`bl i� REV. DATE CONDITIONS OF APPROVAL APPROVED REASONS FOR DISAPPROVAL: Z- C o P /c--5 `V a VG/, mo �L & V5' , DoT 6,�6- V e�WT Irl15s /,0G DISAPPROVED (-a / o C P-1�e -,� Sl ) Form No. 4 Town of North Andover, Massachusetts BOARD OF HEALTH % 19 -� CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( or repaired ( ) INSTALLER at tai /3��,2ooyi�y,E'ic�c= SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 95V, dated �/� �— 19 i The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. '4 GIGI/1�.� --BOAR13 OF HEALTH ENGINEER z- ka UO � � v C rt O v 0 n s� x7 � 1 D ri > O� 3 7 � � � fD 7 1 L h{ Dvv I n 3 r �* � O (0 O m � Q ir-) rt D. ka UO Marchionda �& Associates, L.P. Engineering and Planning Consultants TO: NORTH ANDOVER BOARD OF HEALTH LETTER OF TRANSMITTAL DATE: 2-17-99 JOB NO. 351-22 ATTENTION: SANDY / SUSAN RE: LOT 13 - BROOKVIEW ESTATES WE ARE SENDING YOU ® ATTACHED ❑ UNDER SEPARATE VIA ❑ SHOP DRAWINGS ❑ PRINTS ❑ PLANS ❑ COPY OF LETTER ❑ CHANGE ORDER ❑ COPIES DATE NO. 2 1/27/99 1 1 1/27/99 1 FOUNDATION AS -BUILT (LOT 13) 1"=20' FOUNDATION AS -BUILT (LOT 13) 1"=40' THESE ARE TRASMITTED AS CHECKED BELOW: THE FOLLOWING ITEMS: ❑ SAMPLES ❑ SPECIFICATIONS DESCRIPTION ❑ FOR APPROVAL ❑ APPROVED AS SUBMITTED ❑ RESUBMIT COPIES FOR APPROVAL ® FOR YOUR USE ❑ APPROVED AS NOTED ❑ SUBMIT COPIES FOR DISTRIBUTION ❑ AS REQUESTED ❑ RETURNED FOR CORRECTIONS ❑ RETURN CORRECTED PRINTS ❑ FOR REVIEW AND COMMENT ❑ ❑ PRINTS RETURNED AFTER LOAN TO US ❑ FORBIDS DUE ZEMARKS: IF YOU HAVE ANY QUESTIONS PLEASE CALL. COPY TO: Brookview Country Homes Inc. SIGNED: vCtrfilOw Marchionda and Associates, L.P. Tel: (781) 438-6121 62 Montvale Avenue, Suite Fax:(781)438-9654 WVW1/,CYIaCCIIIOIICIa.COCTI Stoneham, Massachusetts 02180 email: engineers@marchionda.com .s V (� 1 �I N �- EOGf OF CN1i rn I N WET�gND � N 23.7' 23.5' 00,61110"m Cn CA Cn v, N/F LOT 14 �0H OF Mgss � oz cyG. o STEPHEN M. MELEfiCIu No. 3�A9g N/F 0 N LOT 12 TOP FND 100 FT BUFFER EL=130 to LINE Ilk .01 13 44 2' 33,545 S.F. 0.77 Ac. L=14.89' O � 0 60.00' BROOKVIEW DRIVE THIS PLAN IS INTENDED FOR ZONING PURPOSES ONLY. IT WAS PREPARED FROM EXISTING PLANS AND RECORDS WITH THE STRUCTURES SHOWN LOCATED BY AN INSTRUMENT SURVEY. THIS PLAN SHOULD NOT BE USED FOR PROPERTY LINE DETERMINATION. CERTIFIED LOT 13 BROOKVIEW DRIVE NORTH ANDOVER, MA PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASS. R WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THAT ALL APPARENT EASEMENTS AND ENCROACHMENTS ARE LOCATED AS SHOWN. THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OF THE MUNICIPALITY WHEN CONSTRUCTED. ALSO, ACCORDING TO THE F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, COMMUNITY PANEL NO. 250098 0009 C DATED 6/2/93, THE STRUCTURE IS NOT LOCATED IN AN ESTABLISHED 100 YR. FLOOD HAZARD ZONE. PLOT PLAN MARCHIONDA & ASSOC.,L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: 1 "=40' DATE: 2/17/99 r- s N/F LOT 14 01 2 3.7' TOP FN D 00 FT .g�FFERgj EL=130 %5 N SINE 23.5 _ ., WE HEREBY CERTIFY THAT HAVE EXAMINED THE PREMISES AND THAT AL APPARENT EASEMENTS AND ENCROACH ENTS ARE LOCATED AS SHOWN. THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OFT MUNICIPALITY WHEN CONSTRUCTED. ALSO, CCORDING TO THE F.E.M.A./H.U.D. FLOOD INSUR6,NCE RATE MAP, COMMUNITY PANNEL N0. 250098 0009. C DATED 6/2/93 THE STRU TURE IS NOT LOCATED IN AN ESTABLISHED 100 YR. LOOD HAZARD ZONE. THIS PLAN IS INTENDED FOR ZONING PURPOSES ONLY. IT WAS PR PARED FROM EXISTING PLANS AND ECORDS WITH THE STRUCTURES SHOWN LOCATED BY AN INSTRUMENT SURVEY. THIS PLAN SHOULD NOT BE USED FOR ROPERTY LINE DETERMINATION. \ 60.00' 13 332545 S.F. 0.77 Ac. L=14.89' H OF iy4ss9c�®� �� Gs o STEPHEN M. C-3 MELESCIUC N No. 39049 90 P FFSgiO��QQ` ��► 9/V SUR��y Z1(-7 jq 4-1.2' N/F LOT 12 R CERTIFIED PLOT PLAN LOT 13 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS 0 OP`s IOFNd6RCH I ON D A & ASSOC., L P 10ARD OF HEAL ENGINEERING AND PLANNING CONSULTANTS LID. 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: 1 DATE: 2/17/99 6m—kn