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Home My WebLink AboutMiscellaneous - 105 BROOKVIEW DRIVE 4/30/2018e c r MAP # PARCEL # LOT # STREET 'C�1rD��CV CONSTRUCTION APPROVAL HAS PLAN REVIEW FEE BEEN PAID? 107 NO PLAN APPROVAL: DATE lh,7 APP. BY /l /tA DESIGNER: j J`% PLAN DATE CONDITIONS�Qo�Q, v WATER SUPPLY: ,. WELL PERMI WELL DRILLER WELL TESTS: CHEMICAL DATE APPROVED BACTE I DATE APPROVED �# BACTERIA II DATE APPROVED PLUMBING SIGNOFF WIRING SIGNOFF COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NO .i DATE ISSUED �D JO BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: s 16 f r SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? YS� NO • NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW Y� NO CONDITIONS OF APPROVAL YES NO (FROM FORM U)/ -I-,.- 'pla,_5 ^SLS TYPE OF CONSTRUCTION: ISSUANCE OF DWC PERMIT DWC PERMIT PAID? DWC PERMIT NO.- _4z) O. ES NO NO � INSTALLER:��f� Brea �[_��/ BEGIN INSPECTION YE NO: EXCAVATION INSPECTION: NEEDED: PASSED BY ItONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: APPROVAL `I'O BACKFILL: DATE: BY �,� �/ FINAL GRADING APPROVAL: DATE �z�—BX� l FINAL CONSTRUCTION APPROVAL: DATE BY 1 G y L N I m NORTH - 6533 Of ��. •1ti0 a r s Town of North Andover `'••,,,,• ::' HEALTH DEPARTMENT ,ssACNUSEt l � , (� l CHECK #: 'c DATE: 1 LOCATION: I us I" )riff i� U i ti H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) 0 Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrashlSolid 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 $ ?� Title 5 Report $—M— ❑ Other (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 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 s l� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owner's Name North Andover Cityrrown MA 01845 State Zip Code 6/27/2013 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 fo � 'ECEIVED A. General Information 1. Inspector: Neil J. Bateson Name of Inspector Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover City/Town 978-475-4786 Telephone Number B. Certification JUL 012013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT MA State S115 License Number 01810 Zip Code 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 6/27/2013 Inspectors Si nature 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 • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owners Name North Andover MA 01845 6/27/2013 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ 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 • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owner's Name North Andover MA 01845 6/27/2013 City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ 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 t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owner's Name North Andover MA 01845 6/27/2013 Cityrrown 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: ** 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'/ day flow t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 �. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owner Owner's Name nformationis required for North Andover MA 01845 6/27/2013 for every page. City/Town 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.] ❑ Z 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 large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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. t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 5 of 17 i ❑ Z 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 large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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. t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 5 of 17 <L. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owner Owner's Name information is required for North Andover MA 01845 6/27/2013 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 t5ins - 3173 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owners Name North Andover MA 01845 6/27/2013 Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No Yes ❑ Yes ® No Current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 3/13 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 105 Brookview drive Property Address Michelle Nadeau Owner Owner's Name information is required for North Andover MA every page. City/Town State D. System Information (cont.) Last date of occupancy/use: Other (describe below): 01845 6/27/2013 Zip Code Date of Inspection Date General Information Pumping Records: Source of information Pumped 2007, owner Was system pumped as part of the inspection? If yes volume pumped 1500 gallons How was quantity pumped determined? Measured tank Reason for um in • inspect tank & tees p P g Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Yes ❑ No ❑ 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 • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17 <f\, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owner Owner's Name information is required for North Andover MA 01845 6/27/2013 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: 15 years old, 5/6/1998, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 1.3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Unable to see piping, finished cellar. 4" PVC out to septic tank. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal .3 feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10'x 5'x 4' Sludge depth: 4" ❑ Yes ❑ No t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Owner information is required for every page. t5ins • 3113 Property Address Michelle Nadeau Owner's Name North Andover Citylrown State D. System Information (cont.) Septic Tank (cont.) 01845 Zip Code 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 2411 4" 811 17" 6/27/2013 Date of Inspection How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): 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: Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owner information is required for every page. Owner's Name North Andover Cityrrown MA 01845 State Zip Code 6/27/2013 Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3113 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 105 Brookview drive Property Address Michelle Nadeau Owner Owner's Name information is North Andover MA 01845 6/27/2013 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -box level & distribution equal. No evidence of leakage. Evidence of carryover, pumped d -box to clean Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form UVSubsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owner Owner's Name information is required for North Andover MA 01845 6/27/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 70'long ❑ 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 ok. Vegetation ok. No sign of ponding to surface. 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 ❑ No t5ins - 3/13 Title 5 Official Inspection Forth: 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 M ' 105 Brookview drive Owner information is required for every page. Property Address Michelle Nadeau Owner's Name North Andover MA 01845 6/27/2013 CityrFown 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.): 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.): t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owners Name North Andover MA 01845 6/27/2013 City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form WjSubsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owner Owner's Name information is required for North Andover MA 01845 6/27/2013 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: '4 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: 4/30/1996 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test pit data on design plan shows no waterT deep Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 Commonwealth of Massachusetts Titre 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Brookview drive Property Address Michelle Nadeau Owner information is required for every page. t5ins - 3/13 Owner's Name North Andover MA 01845 6/27/2013 CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® 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 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 ` Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use=by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Left / Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address Citylrown 2. System Owner. Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ a state Zip Code bZate� � `S-A✓ L iZip Code Telephone Number 2 Date 2. Qua tity Pumped: Cesspool(s) Septic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 21C 5. Condition of stem: i 6. System Pumped By: , -z:� Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No Neil. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: S. Lowell Waste Water t5fomt4.doc• 06/03 Date System Pumping Record • Page 1 of 1 Summary Record Card generated on 6/20/2013 2:54:00 PM by Karen Hanlon Page 1 Town of North Andover • ' Tax Map # 210-090.A-0064-0000.0 Parcel Id 14645 105 BROOKVIEW DRIVE HODLIN, STEVEN 105 BROOKVIEW DRIVE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 0.93 Acres FY 2013 UB Mailino Index Name/Address Type Loan Number Active/Inact. From Until HODLIN, STEVEN Payor 105 BROOKVIEW DRIVE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17718.0 - 105 BROOKVIEW DRIVE Last Billing Date 4/10/2013 3170382 03 Cycle 03 Active UB Services Maint. Account No. 3170382 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 72.20 /1 UB Meter Maintenance Account No. 3170382 Serial No Status Location Brand Type Size YTD Cons 36207110 a Active ERT HH b Badger w Water 0.63 0.63 599 Date Reading Code Consumption Posted Date Variance 3/14/2013 612 a Actual 19 4/22/2013 33% 12/12/2012 593 a Actual 14 1/9/2013 -76% 9/13/2012 579 a Actual 60 10/15/2012 287% 6/12/2012 519 a Actual 15 7/16/2012 -24% 3/14/2012 504 a Actual 21 4/14/2012 36% 12/9/2011 483 a Actual 14 1/17/2012 -89% 9/13/2011 469 a Actual 145 10/13/2011 224% 6/7/2011 324 a Actual 42 7/20/2011 56% 3/7/2011 282 a Actual 26 4/13/2011 5% 12/8/2010 256 a Actual 25 1/12/2011 -81% 9/9/2010 231 a Actual 139 10/15/2010 72% 6/8/2010 92 a Actual 79 7/15/2010 154% 3/9/2010 13 a Actual 13 4/14/2010 -100% 1/30/2010 0 n New Meter 0 4/14/2010 -100% 1/30/2010 2351 r Replacement 19 4/14/2010 -45% 12/8/2009 2332 a Actual 62 1/12/2010 40% 9/4/2009 2270 a Actual 41 10/15/2009 -28% 6/8/2009 2229 a Actual 54 7/20/2009 123% 3/16/2009 2175 a Actual 28 4/29/2009 13% 12/9/2008 2147 a Actual 23 1/20/2009 -74% 9/10/2008 2124 a Actual 93 10/10/2008 126% 6/6/2008 2031 a Actual 39 7/16/2008 69% 3/7/2008 1992 a Actual 22 4/11/2008 -43% 12/11/2007 1970 aActual 43 1/22/2008 -77% 9/5/2007 1927 a Actual 149 10/12/2007 290% 6/19/2007 1778 a Actual 47 7/20/2007 128% 3/15/2007 1731 m Manual estimate 20 4/16/2007 -4% 12/12/2006 1711 a Actual 19 1/19/2007 -80% 9/18/2006 1692 a Actual 101 10/20/2006 227% Commonwealth. of MassachusettsSIVE® city/Town of I - System Pumping Record JUN 2 8 2006 Form 4 TOWN Of- NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health.. The System Pumping Record must be submitted to the local Board of Health or other approving authority. . A. Facility Information Important: When fining out 1. System Location: formsthe computer, r, use only the tab key Lt�— to move your cursor - do not nD �� use the return key. City/Town r State Zip Code 2. System Owner: Name Address (if different from location) City/Town Stat J •q .-� . Zip Code Telephone Number B. Pumping Record 1. Date of Pumping �J. p g Date 2- Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) EI -Septic n.k- ❑ Tight.Tank ❑ Other(describe)` 4. Effluent Tee Filter present? ❑ Yeso LAN If yes, was it cleaned? ❑Yes❑No 5. Condition o�ys rt:. (e—PuA \(A . Sig ure H uler h.ttp://www.mass.gov/dep/`Water/approvals/t5forms.htm#inspect t5form4.doc• 06/03 1 14 A t v L V w i �0 w w Q L w z z N1 to � y ti L d JQ m m o t C O ti v L G w m �0 w w Q w z z N1 to � ayi L cn m m o t� a O ti U C N 0 0 .? 0 co m a �U C 7 a� D c0 0 0 co 0 a� C7 v L G w m �0 �l w Q z z N1 to � ayi L cn m m o t� a 3 D CO) W ? o 0 d Q. LLC\l w H y 0 R J 0 0 0 z z z i O v CO yd ID r„ o E m d � d CL H .W z U C N 0 0 .? 0 co m a �U C 7 a� D c0 0 0 co 0 a� C7 O m �0 z z z L cn 3 W ? o 0 0C LLC\l a y _ O yd ID r„ o E m y d CL O d a O 0 V co 0 U ► CO) ► w Ll lL 3 C O a ► V O c tq (9 D C7 U C N 0 0 .? 0 co m a �U C 7 a� D c0 0 0 co 0 a� C7 0 J Of NONTN F't • : Town of North Andover HEALTH DEPARTMENT SACHU/JJ//fll /�Q St 4 CHECK #: a?V LOCATION: XZ H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) $ ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ 1 770 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer i� ` v� �• OOt a... y Town of North Andover .�,s .•� HEALTH DEPARTMENT�� $�CHUSt CHECK #: W LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ 1770 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _105 Brookview Drive —North Andover_ Owner's Name: _Steven Hodlin Owner's Address: _105 Brookview Drive —North Andover, MA 01845_ Date of Inspection: 8/16/2006 Name of Inspector: Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ Andover, Ma. 01810 Telephone Number: ( 978 ) 4754786 AUG 2 4 M6 ' TOHEA� �R M'"�- 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--% < �J Inspectors Signature: Date: _8/16/2006_ The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _105 Brookview Drive_ _ North Andover_ Owner: _ Hodlin_ Date of Inspection: 8!3/2006 _ Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain . The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution 'box is lever or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the .Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _105 Brookview Drive_ _ North Andover_ Owner: Hodlin_ Date of Inspection: 811612006_ 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 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 ipublic health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. — The system has a septic tank and .SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance _ **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen .and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _105 Brookview Drive _ North Andover_ Owner: _Hodlin_ Date of Inspection: _8/16/2006 _ D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: _No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool NoLiquid depth in cesspool is less than 6" below invert or available volume is''%2 day flow. _No__ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No Any portion of the SAS, cesspool or privy is below high ground water elevation. No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. '[This system passes if the well water .analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (YestNo) 'The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either `yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — the system is within 400 feet of a surface drinking water supply — — the system is within 200 feet of a tributary to a surface drinking water supply — — the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _105 Brookview Drive _ _ North Andover _ Owner: _Hodlin_ Date of Inspection: _8/16/2006 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Yes _ Pumping information was provided by the owner, occupant, or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes_ _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes_ , Were as built plans of the system obtained and examined? Yes Was the facility or dwelling inspected for signs of sewage back up ? Yes Was the site inspected for signs of break out ? Yes_ _ Were all system components, excluding the SAS, located on site ? _Yes_ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _Yes_ _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes No _Yes_ — Existing information. _Yes_ _ Determined in the field (if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable) [3 10 CNN 15.302(3)(b)j Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _105 Brookview Drive- - North Andover_ Owner: _Hodlin_ Date of Inspection: 8/16/2006_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 4_ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CMR 15.203 440 _ Number of current residents: _4 Does residence have a garbage grinder (yes or no): No Is laundry on a separate sewage system (yes or no): No_ Laundry system inspected (yes or no): _ Seasonal use: (yes or no): No_ Water meter reading: Yes _ Sump pump (yes or no): No Last date of occupancy: Current COMIVIERCIAIA NDUSTRIAL "Type of establishment: Design flow (based on 310 CMR 15.203): _gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): _ Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: _Pumped two months ago, owner _ 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 currant 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 years old, 5/6/1998, as built plan _ Were sewage odors detected when arriving at the site (yes or no): _No Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _105 Brookview Drive_ North Andover Owner: _Hodiin_ — — Date of Inspection: _811612006_ BUILDING SEWER _ X _ (locate on site plan) Depth below grade: _18" _ Materials of construction: _ cast iron _40 PVC _other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) _'Unable to see piping finished cellar SEPTIC TANKS: X Depth below grade: _6" _ Material of construction: X concrete —metal _fiberglass —polyethylene _other(explain) If tank is metal list age: __ _ Is age confirmed by a Certificate of Compliance (,yes or no): _ (attach a copy of certificate) Dimensions: 10' x 5' x 4' Sludge depth 0"_ Distance from top of sludge to bottom of outlet tee or baffle: 27" _ Scum thickness: _011 _ Distance from top of scum to top of outlet tee or baffle: '8" Distance from bottom of scum to bottom of outlet tee or baffle: 21" How were dimensions determined: _Tape Measure _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of septic tank leaking in or out. GREASE TRAP: (locate on site plan) Depth below grade: _ Material of construction: _concrete _metal _fiberglass polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _105 Brookview Drive_ _ North Andover_ Owner: _Hodlin_ Date of Inspection: _8/1612006 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 BOXS: X_ Depth below grade _ 6"_ Depth of liquid level above outlet invert: 0"_ Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.):_ D -bog level & distribution equal. No leakage. No carryover. _ PUMP CHAMBER: _ (locate on site plan) Pump in working order (yes or no): — Alarm in working order (yes or no): , Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 +of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _105 Brookview Drive _ _ North Andover Owner: Hodlin_ Date of Inspection: _811612006_ 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: 2 trenches 70' long _ leaching field, 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 oL Vegetation oL No sign of ponding to surface._ CESSPOOLS: Number and configuration: _ Depth — top of liquid to inlet invert: — Depth of sludge layer: Depth of scum layer: _ Dimensions of cesspool: _ Materials of construction: Indication of groundwater inflow (yes or no): — Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _105 Brookview Drive _ _ North Andover— Owner: _Hodlin_ Date of inspection: _8/16/2006_ 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 D -Boz 2 Septic Tank House Water Meter A to 1= 3811" A to 2 = 40'3" A to D -Boz = 6114" B to 1 = 16'1" B to 2 = 23'9" B to D -Boz = 55'2" Driveway • Page l l of l l OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORINT PART C SYSTEM INFORMATION (continued) Property Address: _105 Brookview Drive _ North Andover – Owner: Hodl'in Date of Inspection: 8/16/206_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4' _ 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: _611, 7/1"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: _ Design plan _ Summary Record Card generated on 8/16/2006 9:16:35 AM by Elaine Barclay Town of North Andover Tax Map # 210-090.A-0064-0000.0 105 BROOKVIEW DRIVE HODLIN, STEVEN 105 BROOKVIEW DRIVE NORTH ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Size Total 0.93 Acres FY 2007 UB MailingIndex Name/Address Type Loan Number Active/lnact. From Until HODLIN, STEVEN Payor 105 BROOKVIEW DRIVE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17718.0 - 105 BROOKVIEW DRIVE Last Billing Date 7/5/2006 3170382 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 142.26 /1 UB Meter Maintenance Serial No Status Type Location 43993635 a Active Consumption ENC F.RT. Date Reading Code 6/19/2006 1591 a Actual 3/8/2006 1556 a Actual Trouble Code:03 7/15/2005 30 12/22/2005 1533 a Actual Trouble Code:03 10/8/2004 16 9/21/2005 1501 a Actual Trouble Code:03 12/15/2003 6/27/2005 1379 a Actual 3/30/2005 1357 a Actual 12/16/2004 1327 a Actual Trouble Code:03 9/27/2004 1308 a Actual 6/24/2004 1212 a Actual Trouble Code:03 4/16/2004 1196 a Actual Trouble Code:03 12/15/2003 1163 n New Meter Brand Type ? w Water Consumption Posted Date 35 7/10/2006 23 4/17/2006 32 1/17/2006 122 10/14/2005 22 7/15/2005 30 4/5/2005 19 1/14/2005 96 10/8/2004 16 7/30/2004 33 5/17/2004 0 12/15/2003 Size 0.63 0.63 YTD Cons 0 Variance 12% -13% -75% 474% -14% 21% -76% 336% -14% 0% 0% r TO!"� �J DATEI/0 ((�� TIME AM PM H O FR NO. AREACODE (j/ �77� EXT. OF E M E S I W_ E A E V / `/� SIGNED PHONED[] B CK RAL! RNED SWANTS EE YOUO AGAIN CALL WAS IN URGENT Insurance Adjustment Service, Inc. 139 Billerica Road, Unit A-1 Chelmsford, MA 01824 (978) 256-3334 Fax (978) 256-3354 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B TO: Board of Health/Building Inspector RE: Insured: Steven Hodlin & Michelle Nadeau Property Address: 105 Brookview Dr No Andover MA 01845 Date of Loss: 5/4/2007 Policy Number: H000003285 Date: May 15, 2007 MAY 2 2 2007 TOHEALLTH DEPARTMENT OF NORTH SR Type of Loss: Hidden rot to siding, sheathing and framing below back deck. File or Claim Number: 41885-tm Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 38 is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, locations, policy number, date of loss and claim or file number. Thank you for your cooperation. Very Truly yours, Tim Martino Adjuster Ext. 135 44, 1. 100 FT. WETLAND BUFFER LINE40 ' IRIAN D -BOX EX. 3' X 50' TRENCHES G 1�0 ATION p�1 o� Top Fnd. EL.=136.58 I3' d- 00 O N 7 DRAINAGE EASEMENT co 0) M \_:102.88 �.\ �4�6 2� / 36 , EXISTING FOUNDATION Top Fnd. EL.=133.75 R=125. 00' 40 BROOKVIEW DRIVE-r�,;.; ELEVATIONS TAKEN AT TOP OF PIPE i1v � Z TOP OF FOUNDATION: SEE PLAN _ PIPE ® DWELLING: 125.20 TANK IN: 124.98 TANK OUT: 124.62 D -BOX IN: 124.04 D -BOX OUT: 123.86 (ALL) END PIPE - A: 123.46 END PIPE - B: 123.41 AS—BUILT SEWAGE DISPOSAL SYSTEM PLAN LOT 7 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS a 53,820 S.F. 1.24 Ac. MARCHIONDA & ASSOC., L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE., SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: 1=30' DATE: 5/6/98 M & A FILE No:: 351 - 22 TOWN OF W 2 LdD\ftj- SYSTEM PUMPING RECORD DATE: _ 1,03 SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) f I_ �r DATE OF PUMPING: -rc)�3 QUANTITY PUMPED: �Ci ® 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: L CONTENTS TRANSFERRED TO: K- ! 1 January 7, 2003 Town of North Andover Board of Health 27 Charles Street North Andover, Massachusetts 01845 To Whom It May Concern: In December we were denied a building permit for finishing our basement at 105 Brookview Drive. Our home is a 4 %2 year old, four-bedroom home. We would like to finish the basement with a half bath and a family recreation room. The denial was due to "too many rooms for septic design as a result of finished basement (will be 10 rooms), septic designed for 4 bedrooms". We would like to appeal this decision and apply for a variance based on the Title 5 code itself. The intention of our building permit is to exclusively finish an existing basement with a recreation room and half bath. We have no intention whatsoever of adding a bedroom to our home. With this in mind, we would like to refer to the Massachusetts State Environmental Code Title 5, 310 CMR 15.002, Definitions, Bedrooms (310 -CMR - 482). We ask to keep the current design flow to our septic system, and place a deed restriction on our property that will limit our home to a 4 bedroom home. This request accurately reflects our intentions. We appeal to your reasonableness in allowing us to pursue the use of our personal home, while meeting the intention of all applicable laws. We appreciate your reconsideration of this matter. If you have any questions, please do not hesitate to call us at our home, 978-685-5891. Regards, Michelle Nadeau QSte�ven F. od/in It is the responsibility of the applicant to record. the required deed restriction per 310 CMR 15.000 Title 5. The following is a suggested format, but the final document should be approved by your attorney prior to recording. NOTICE OF VARIANCE,/DEED RESTRICTION Pursuant to 310 CMR 15.000 Title 5, and as a condition of the North Andover Board of Health Disposal Works Construction Permit # q33 dated _ notice is hereby given that real estate located at 125 r DOKy (C� wJ ye North Yuv Andover, Massachusetts, (aka Assessor's Map t 62� ), as described in' a deed fromrr"va3 dated IJ 191g'f,, and recorded in the Essex County Registry of Deeds in Book I -D ,) and Page .� and as Document is the subject of a variance from the Town of North Andover Minimum Requirements for the Subsurface Disposal of Sanitary Sewage A1.05 and C9.01(4). Said varianace limits the maximum number of bedrooms at this dwelling todwee vUi bedrooms. This variance is within the jurisdiction of the North Andover Board of Health. Signed and sealed this / j day of Property owner signatures COMMONWEALTH OF MASSACHUSETTS Essex, s.s..... _ Date: 7 6,eb k Y �l : - c11_; - Then personally appeared the above-named.Srf zj F and 101CH,14LE acknowledged the foregoing instrument to be his/her/their free act and deed, before N' e l Notary Public ESSEX NORTH RE ISTRY -OF DEM LAWRENCE, MASS. a) A TRUE C6PY:ATTEST: M 1 L ----------- - - - - - - - - - I I I I I I I 1 I I I I I I I I I L---------- ti .0-,9Z ,0-,9 ,0-16 ,9-,Z .6-b ,0-,Ol ,0-,9 ,0-,9Z ,6-,b X Al -,Z 'kn b fi b N o � M � � a s LL q � a ,9-,Ol -z M N� q a ■z � N W O Tv O m I a m s -z o � N O .6 Y •t � O N o o � I I I I L --- n I I I r --- I I I I I I I o ,0-,Ol ,0-,9 ,0-,9Z y co ooCO3 Oa� Ul `rO 61 00 — C:) c0�9 M'2 0i 0 �I Ips Em � Ci C C) Q^q j��= yea§p0 $ O artl`I b A S 84 W W JLJ QC7Q1— 0. y9 7 M V)o 2 y yU gi _ O�pj 'RE Sri s ` 9�Ka SOF o� La Ul E l� 4 O e CI cli L' O Jp �s mi C1 -0 ni V .0-,OzUl I I I II II I I •s, m N � Z 'olo l I w o ELL I I 4 h � a F SAij 1 I � ,�ti it b i� I � � N s� g -,i a I ilb I LL I IIM N :60; � � M CID o ly x I I I b I I I rn N N O � IL LLL II � II o•S-S A�-d .0-, .4-,£ ,4-,£ ,4-,£ .0-,0L .9-,Z .0-,S .9-,Z ,0-,8 .0 .0-,04-, II II I I� M I I x I I baro V` m II � I (V II I I 'ol Town of North Andover, Massachusetts Form No. 2 f 14oRTh BOARD OF HEALTH o ti w t , DESIGN APPROVAL FOR C64 SOIL SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant &A)-— 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. 4 0✓ Fee 16 _ 2? CHAIRMAN, BOARD OF HEALTH e Site System Permit No. 1'J--� > 00 N 20.0' 0 Ni r7-0, 1 17 (0 40,302 S.F. 0.93 Ac. 10 5' 3.5 ' inn, 14 0, 17.3' 41 01(0.4. 1� 0� )—Top Fn d. EL. =1 33.75 40.0' to _ l 61 ° ,3 6 � 0 V� BROOKVIEW DRIVE 6 53,820 S. 1.24 Ac. &A A4� v P�j" OF o cy G o� STEPHEN M. MELE CIUC N 4 No. 9 S C � y ®� 1l(�Y WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THAT ALL APPARENT EASEMENTS AND ENCROACHMENTS ARE LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED. ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LOCATED F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, BY AN INSTRUMENT SURVEY. THIS PLAN COMMUNITY PANNEL NO. 250098 0009 C SHOULD NOT BE USED FOR PROPERTY DATED 6/2/93 , THE STRUCTURE IS NOT LOCATED LINE DETERMINATION. IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. CERTIFIED PLOT PLAN LOT 7 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MARCHIONDA & ASSOC., L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: 1"=20' DATE: 4/14/98 Tw(0 40,302 S. F. 00 N 0.93 Ac. a � 20.0' 10.5' 3.5 14 0, 31 0, 10.0' ' o N EXISTING FOUNDATION 17.3 � 41.0 ��.A. �-To OFnd. 46. ' ' ) L. p 133.75 40.0 61 36 , 0 ' 10 R BROOKVIEW DRIVE I, 6 53,820 S.F 1.24 Ac. �XA°4&A. v a��P�ZH OF A9gss O G of STEPHEN M. J`� q Ci MELE CIUC N 4 No. 9 S y LOT 7 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MARCHIONDA & ASSOC., L.P ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 I SCALE: I"=20' DATE: 4/14/98 WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THAT ALL APPARENT EASEMENTS AND ENCROACHMENTS ARE LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS j PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY II FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED. ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LOCATED F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, I j BY AN INSTRUMENT SURVEY. THIS PLAN COMMUNITY PANNEL NO. 250098 0009 C SHOULD NOT BE USED FOR PROPERTY DATED 6/2/93 , THE STRUCTURE IS NOT LOCATED LINE DETERMINATION. IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. J i CERTIFIED PLOT PLAN LOT 7 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MARCHIONDA & ASSOC., L.P ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 I SCALE: I"=20' DATE: 4/14/98 [3 00 (N 20.0' A 7 �. 402302 S.F. 0.93 Ac. 10 5' 3.5' ') in n, 1,4 17.3' 41 0'(0.4. � 4 , )�—� Top Fnd. EL. 133.75 40.0' -i4---6 0' <�7 �Q BROOKVIEW DRIVE O 0 /(0 46. 6 53Y820 S. 1.24 Ac. p'O OF Mgss� ® o STEPHEN M. `cj'' WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THAT ALL APPARENT EASEMENTS AND ENCROACHMENTS ARE LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED. ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LOCATED F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, BY AN INSTRUMENT SURVEY. THIS PLAN COMMUNITY PANNEL NO. 250098 0009 C SHOULD NOT BE USED FOR PROPERTY DATED 6/2/93 , THE STRUCTURE IS NOT LOCATED LINE DETERMINATION. IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. CERTIFIED PLOT PLAN LOT 7 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS i MARCHIONDA & ASSOC., L.P ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: 1"=20' DATE: 4/14/98 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: I CURRENT INSTALLER'S LICENSE# LOCATION: ' % rvv LICENSED INSTALLER:�.�--�� - SIGNATURE:y — TELEPHONE# 6F 7 ,� CHECK ONE: - REPAIR: NEW CONSTRUCTION: - ^- IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUH.T. Administrative Use Only - 75 00 Attached? Y �-� } $ Fee Attac d . es N� Foundation As -Built? Yesy No Floor Plans? Yes �` No Approval �.Date: /7 cab 91 goRM U IpT B at all neCessarY tion thic is used to veli its haying 7�1 and/ or form and j}ep the applican State law STRQCTIONS- ThlfroBoards not rel�e a i This d° any aPP1ic�1e local or approvals/Perm havebeen Obtained'liance w lacomt nder from r irements' sec'.'on relations °r this �j nli.cant tills out #fne S Phone Parce - APPLICANT ' Map s i - Numb e,- o 1 �. Lot( si LOTION A= ""°.SQA S `DO(rV C tI� St • Nu:.�er �--- SubdivisiOn vte "J pLr vC ** Styap} �✓ ;al Use only * WN AGENTS: :iDATIOKS OF REC �V,r.,at-OI1 ?,d:•-;11trat..r -S on cc..� � , 1 L;;, hjjo- n P -annex - Con-ne* _s -..stet-..•.. •- - FCC - J S z: - Z' = � -0 Approve' oate Data l Date APpr-Ver Date -- Date App rwec. ate Re.ec"e' Date Ap - oats Retec= n - �r connec .=° s F _Yo Depar ` 'err 1 ding InstA�tcr Re °a; s7e , by Buy A B -6 p\=125-00' BROOKVIEW DRIVE 40,302 S.F. 8S00: -P 0.93 Ac. / flc�v // /v 'o DRAINAGE EASEMENT 6 53,820 S-1 1.24 Ac. f� FORM U LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION******"`**************** I M�cti�Cl� N��eaJ _ APPLICANT 3+- u -c �� . co (t 0 PHONE g �' � - S - cr LOCATION: Assessor's Map Number q0 PARCEL SUBDIVISION LOT (S) STREET r m o y V t �e GO Z ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS k0c-) AA(,N DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED i Z t Nl OZ �V! SC1)+ac n-1, r4 // - IO ��51. ��p'i'`�. (�7'S✓cG�- �� /( 13Pd��vpn,.5 PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm -TUU- - E+ -9a MON 1 0 : 15-6 FROM : FLINTLOCK,INC, The t Mdersig-1 by - lowcd PHONE NO. : L97668374430 ;CONN 0F'iNORTRAstiDOVLR SEWAGE DISPOSAL SYSTEM( INSTALLATION CERTIFICATION P . 0 1 Jun, 17 1999 01:39PM P1 certl:,: that the Se wags Disposal System (X) constructed, ( ) repaired; Selo ile' e tJ ,( el t`... ( LOT-, was imstgled in coxtfarmancc with the 2N'orth Andover Bomd of Health approved plan, Sy0m Desitin P=Ut 0 93 5, dat0d 4 " with art Approved design flow of gallons per day. 'Che materials used were in conformance with those speaifiCd oil the approved plgh; tate system %,as installed in accord=ce with the p ovisio% of 310 CMR 15,000, Title 5 acid 10W teg+alations, and the final grading agrees substimtially with the ; pprav'ed plan. All work is accurately ropresertttd on the As -built which has been gubmitted to rhe ow of igtalth. Bed inspection dater xtspe tax w 4'6 nnal inspection data. 51?�elor . (� ,,I Aare; l Instulter ,G �J / l�osip� Engirtaer; W tt 0 IN uj zCkm a a a O D a CO) O s C Cr.1 A ^c acis—co ° ° ° V 0 w° U)w° w°' U w w a°' 5 0 w cin cn IN uj zCkm ` j Cn -1 O O l� C � C a O D a CO) O s C Cr.1 o � c O h C v C. ACL= OR m c O co co L 00 a N E � �Em c$ 0 0 v.. t; cm ti N W CD � O N = CA 3 +. c m N C C .- S m � � _ •O N y A c O: E y a m mocn A: ymo c cp aoa acz •c m o :y O Z O w R ..- CC O cm c O n : y m c c = o m 3 N ~ •O.. H fq m m W GCD.. y0„ Z •y c +- eo c F- az — cc " Z O LU ma "os m�C- g COD = a -0 O H s O �=�CL*-Cc eN0 ` j Cn -1 O O l� Z O D a CO) O s cm CO2 O y O �O m m � H Z CL ♦.+ O cc CD � � L CL cma C O C O V J 'fl �O. O co CL C Z � V h C CL � C H J U L- G- 9 S MON 1 0: 515 FROM : FLINTLOCK,INC. The undo: by j lowed at PHONE NO. : 197S6e74430 TO�VN OF NORTH kNI DOVER SEWAGE DISPOSAL SY-MM( INSTALLATION CERTIFICATION P _ 0 1 0"S Jun. 17 1999 01:39PM P1 certi$' that the Smage Disposal Sy tem (X) conmeted; ( ) repaiied: &d eioepietJ f9Cide, ( Cr1 was insWi4od in mafonnsnca with the North Andover Bomd of Health approved plan, 5yst-sm DcsiBn Permit # y3 3. dated 4A7 7 , with as approved design flow of gallons per day. 71ta materials used were In conformance with those speoificd on the approved plan; the systm was installad in accordance with the ptovicions of 310 Ciw1R 15,00, Title 5 acid lcW tegWatiens, and the final gadjn$ agrees subst;ua Wly with the approved plan. All work is accurately reprt anted on the As -built w 1uoh has berm submitted to the oard of Health. Bed inspection date, pa tox �' Final inspection date: Sp�ciOr Tatsfiuiler; �.._„�LlL�d Li0 Aate;� zt9ian Engineer. Dato; kIl w D—BOX \\ EX. 3' X 50' TRENCHES IG ��° ATION K1 o� Top Fn d. EL. =136.58 40, 302 S. F. / 8 .00,s. 0.93 Ac. �v _ 00v�.IT 46 o DRAINAGE EASEMENT i_ I I II Iw TANK OUT: z 00 it IIS o i l o 0 Ilo 123.46 IIw N 1!" IIS' X iw EXISTING FOUNDATION 3' ip=6// °3 �9 2 8.125.00' 6 10 BROOKVIEW DRIVE ELEVATIONS TAKEN AT TOP OF PIPE TOP OF FOUNDATION: SEE PLAN PIPE @ DWELLING: 125.20 TANK IN: 124.98 TANK OUT: 124.62 D—BOX IN: 124.04 D—BOX OUT: 123.86 (ALL) END PIPE — A: 123.46 END PIPE — B: 123.41 AS—BUILT SEWAGE DISPOSAL SYSTEM PLAN LOT 7 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS Top Fnd. EL.=133.75 MM' VJ i �O 6 53,820 S.F. 1.24 Ac. MARCHIONDA & ASSOC., L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE., SUITE I I.. f STONEHAM, MA. 02180 (617) 438-6121 f; SCALE: 1=30' DATE: 5/6/98 M & A FILE No.: 351 — 22 60 Z o 1 0, 0 a C,4 (o m TA Lo "t C,4 .0-,5 ,6-4 .0-,9z ,0-, ,6-,4 x .ol-z I o � I M '6 I b fi •I � b N I n � a m i I ,9 -,OL ,9-.£ .9-.Z o-z wooN kNcjNPf9i P N � , iv I � O I z 7,,3)� W � o O m i •I � fV .� � ZV O � I N 9� N •s� •r lb o ao I Cl I a L --- I I I ILL x o b n o a 0 1 I I r --- I I I I I o I .0-,9z ,0-, ti N 0) CD 00� Iood 3 •fl tL U Ul 6� 0 W 13 co oE-0 10 [rQ(JQ md V)CD 2 b y was so$g g 6 'agSg$ yaO g ° 9 r am --•�S J sd.0 Op Q� O �9 '�°�U, v°3o3N'�G3E ,gs� a L �t�lr �� ni V ,0-,0aOL I II I II I I I •s 7n OI I E iv I m d - ,0-,L �i I I m II ryi I O Ilb tIM I N V •S b M 0 e ( Zo a N I y I �u s� I iv WO O N Q IIR II .ILLix 1 .� o 0 I I m I I � II II 11 tV ,0-, ,4-,£11,4-,£ ,0-101 ,9-Z ,0-,5 I I Ilb tIM N �, 9 •S 0 e ( Zo a I y I �u I iv O N Q IIR II 1 .� o 0 I I m I I � II II 11 tV �j6N-17-9E-- WE,D 14 :06 ,r F°RQM : FUNTLOM INC. The PHONE NO, : 19795834430 TOWN OF N''ORT11 ANDOVER SEWAGE I)X`a> 0&4,L $ySTEM INSTALLATION CERTIX+XCATEON P . 0 2 jun, 17 1998 01:40pM p4 hereby Certify that the 5awage Disposal System (k) con$truczed; ( i repaired; located at 117 p1 tie- C tor' wU installed iii c0nfatxzlaM;c) with. the North Andover board of 14talth approved plan, Sys= Design Perrtzit 0 , dated . with sr. approved design flow or40 gallons per day. The materials usid were in cvnforrujice with the sc speGigcd on tlty approved pian; the wstceo was installed in accordance with the pro,.;sions of 310 CMR 15,0100, Title I and 10041 reguIe-iotts, a -td the fmhl grading agroes sttbst,-mtially with tiie approved puri. All wcrlc is accaratdly represented Ota the As -baht which ltas been $t .Bed insp,cdoa date: Fin inspection date:. Lie, #: Date, Design Engineox: Date:.%i! 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