Loading...
HomeMy WebLinkAboutMiscellaneous - 117 BROOKVIEW DRIVE 4/30/2018 J� n 117 BROOKVIEW DRIVE ive I / 2101090.A-0066-0000.0 � 1 e� North Andover Board of Assessors Public Access Page 1 of 1 N0RT/1 North Andover Board of Assessors Ot t•�•o*a 7ti0 f y 9 CHUS� 4- property Record Card Click Seal To Return Parcel ID :210/090.A-0066-0000.0 FY:2011 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels 6 Search for Sales Summary Residence Detached Structure Condo 117 BROOKVIEW DRIVE Commercial Location: 117 BROOKVIEW DRIVE Owner Name: NIKOLOPOULOS,NICHOLAS T&JOANN K Owner Address: 117 BROOKVIEW DRIVE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:9-9 Land Area: 0.93 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3180 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 644,900 672,500 Building Value: 411,300 438,900 Land Value: 233,600 233,600 Market Land Value: 233,600 Chapter Land Value: LATEST SALE Sale Price: 677,500 Sale Date: 09/24/2002 Arms Length Sale Code: Y-YES-VALID Grantor: MAUGER,MICHAEL D Cert Doc: Book: 07116 Page: 0018 http://csc-ma.us/PROPAPP/display.do?linkId=1705646&town=NandoverPubAcc 7/19/2011 Residential Property Record Card PARCEL ID:210/090.A-0066-0000.0 MAP:090.A BLOCK:0066 LOT:0000.0 PARCEL ADDRESS:117 BROOKVIEW DRIVE FY:2011 PARCEL INFORMATION Use-Code: 101 Sale Price: 677,500 Book: 07116 Road Type: T Inspect Date: 08/08/2003 Tax Class: T Sale Date: 09/24/02 Page: 0018 Rd Condition: P Meas Date: 08/08/2003 Owner: Tot Fin Area: 3180 Sale Type: P Cert/Doc: Traffic: M Entrance: X NIKOLOPOULOS,NICHOLAS T&JOANN K Tot Land Area: 0.93 Sale Valid: Y Water: Collect Id: RB Address: - ' Grantor: MAUGER,MICHAEL D Sewer: Inspect Reas: S 117 BROOKVIEW DRIVE NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 9 Main Fn Area: 1622 Attic: N NBHD CODE: 9 NBHD CLASS: 9 ZONE: R1 Story Height: 2.00 Bedrooms: 4 Up Fn Area: 1558 Bsmt Area: 942 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: H Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 40651 0.930 233,570 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: G VALUATION INFORMATION Masonry Trim: Ext Bath Fix: 3 Tot Fin Area: 3180 Current Total: 644,900 Bldg: 411,300 Land: 233,600 MktLnd: 233,600 Foundation: CN Bath Qual: M RCNLD: 411319 Prior Total: 672,500 Bldg: 438,900 Land: 233,600 MktLnd: 233,600 Kitch Qual: M Eff Yr Built: 1998 Mkt Adj: Heat Type: FA Ext Kitch: Year Built: 1998 Sound Value: Fuel Type: G Grade: V Cost Bldg: 411,300 Fireplace: 2 Bsmt Gar Cap: Condition: V Aft Str Val 1: Central AC: Y Bsmt Gar SF: 616 Pct Complete: Att Str Val2: Aft Gar SF: %Good P/F/E/R: ///96 Porch Type Porch Area Porch Grade Factor E 352 P 64 W 96 SKETCH PHOTO 22 E . W 16 352 Sq.R 16 ; 186 Sq 02 "► 1 FU/FM/B I/FU/FM t 942 Sq.R 616 Sq.Ft 28 28 26 3 3 117 BROOKVIEW DRIVE Parcel ID:210/090.A-0066-0000.0 as of 7/19/11 Page 1 of 1 MAP # LOT # PARCEL # STREET CONSTRUCTION APPRO HAS PLAN REVIEW FEE BEEN PAID? / YES NO PLAN APPROVAL: DATE �Z/q APP. BY -� DESIGNER: Z6077 PLAN DATE CONDITIONS WAFER SUPPLY: TOWN WELL WELL PERMIT DRILLER Ff WELL TESTS: ' CHEMICAL DATE APPROVED BACTERI DATE APPROVED Y BACTERIA II TE APPROVED PLUMBING SIGNOFF a WIRING SIGNOFF COMMENTS: 1 FORM U APPROVAL: APPROVAL TO SSUE YE NO DATE ISSUED BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: L SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? NO TYPE OF CONSTRUCTION: REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT �ES NO DWC PERMIT PAID? YES NO DWC PERMIT NO.- %,,4r- INSTALLER- Pe/2?Z- 32� v BEGIN INSPECTION YES O: EXCAVATION INSPECTION: NEEDED: PASSED L�/ 97 BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: (YES:/ APPROVAL �O BACKFILL: DATE: lelBY Ah FINAL GRADING APPROVAL: DATE BY FINAL CONSTRUCTION APPROVAL: DATE: BY ,/ • - • North Andover Health Department (ommunity and Economic Development Division 06/27/2017 Address: 117 Brookview Drive All North Andover Residents with Septic Systems and Garbage Disposals Please note that due to a recent review of a Title 5 Report, your property has been identified as maintaining a working garbage disposal that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage disposals are never recommended where septic systems are used, but if they are installed, the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this disposal could quickly cause a pre-mature failure of your septic system, resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdept&northandoverma.gov. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. Sincere y, Tian LaGrasse, CEHT Director of Public Health 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov , t i i 0) 611 I, 409651 S. F. �-� 0- 93 A c. i EXISTING EX. 150 FO , 0 GAL. <� FOOTING SEPTIC TANK 19b EX. D- BOX O� 23 ' "'v 621 EX. VENT // / / EX. 3' X 75' TRENCHES /\ CHES (TO LOT LINE) i Q I 23 , Q0 00 Mn + no m N 6 ►��� � 2� o ST �- ELEVATIONS TAKEN AT TOP OF PIPE TOP OF FOUNDATION: SWING PIPE @ DWELLI;NG: -- " TIES COMPONENT TANK IN: � —'— -- SEPTIC TANK TANK OUT: ---•-- COR A COR g 139.63 D—BOX (CENTER) D—BOX IN: END PIPE: C (CENTER) D-BOX. OUT: 139.35 I END PIPE — A: 139.17 (ALL) END PIPE: D END PIPE _ B: 138.63 u END PIPE: E END PIPE 138.61 f) I I I AS-BUILT SEWAGE DI ` SPOSAL SYSTEM PLAN MARCHIONDA ___ _ - & ASSOC. , L. P. _ ENGINEERING AND PLANNING CONSULTANTS LOT g - � BROOKVIEW DRIVE I NORTH ANDOVER, MASS6. STONEHAM, MA. 02180 2 MONTVALE AVE., SUITE i I � PREPARED FOR BROOKVIEW (617) 438-6121 COUNTRY HOMES P.O. BOX 531 SCALE: 1=20' DATE: 11/11/97 NORTH ANDOVER MASSACHUSETTS I M & A FILE No.: 51 3 — 9 22 f �n �I 1 � 1 I i I -� Commonwealth of Massachusetts 6a . Title 5 Official Inspection Form �,� a Subsurface Sewage Disposal System Form Not for Voluntary Assessmen 5 117 Brookview Drive Property Address Bruce Eggers ?W1 � Owner Owner's Name information is required for every North Andover MA 01845 6-1-2017 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be akered in any way. Please see completeness checklist at the end of the form. X V:C., Important:When A. General Information 3 2� filling out forms on the computer,use on key to move your the tab 1. Inspector: �CO�N�PP�M+GNT cursor-do not Neil James Bateson �� use the return Name of Inspector key.Y Bateson Enterprises Inc. I� Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 SI-15 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Need Further Evaluation by the Local Approving Authority t 6-1-2017 Ins pec i ignatu 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 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page t of 17 � ' !� 1 I Commonwealth of Massachusetts w - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 117 Brookview Drive Property Address Bruce Eggers Owner Owners Name information is North Andover MA 01845 6-1-2017 required for every page. 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is required for every North Andover MA 01845 6-1-2017 page. Cityrrown 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 publichealth, 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 117 Brookview Drive Property Address Bruce.Eggers Owner Owner's Name information is required for every North Andover MA 01845 6-1-2017 page. 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 arivate water supply well ** P PP Y 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.doc•rev.6/16 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 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is required for every North Andover MA 01845 6-1-2017 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.] ❑ ® 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts mom Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is North Andover MA 01845 6-1-2017 required for every page. Cityrrown 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? I ® ❑ Were all system components, excluding the SAS, located on site? Z ❑ 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is North Andover MA 01845 6-1-2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is required for every North Andover MA 01845 6-1-2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped last year, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank. Reason for pumping: Inspect tank, tees&clean outlet filter Type of 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) ❑ 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is required for every North Andover MA 01845 6-1-2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 20 years old, 11-11-1997, as built plan. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below rade: 1.8 p g 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.): 4" PVC through wall, 4" PVC to septic tank. 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: 0.8 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 4' Sludge depth: 3 11 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Bruce Eggers Owner Owners Name information is required for every North Andover MA 01845 6-1-2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 3 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 12" 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 clogged, clean same. Outlet filter clogged, clean same. Outlet tee ok. Depth of liquid at outlet invert after cleaning filter. No evidence of leakage. Pumped septic tank. Grease Trap (locate on site plan): Depth below grade: feet 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: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,•''� 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is North Andover MA 01845 6-1-2017 required for every page. Cityrrown State Zip Code 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): j 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.doc•rev.6/16 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 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is North Andover MA 01845 6-1-2017 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. Evidence of light carryover, pumped d-box to clean. No evidence of leakage. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is required for every North Andover MA 01845 6-1-2017 page. City/Town 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 75' 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 117 Brookview Drive Property Address Bruce Eggers Owner Owners Name information is North Andover MA 01845 6-1-2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Priv locate on site plan): Y ( p ) Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Brookview Drive Proert Address P Y Bruce Eggers Owner Owner's Name information is required for every North Andover MA 01845 6-1-2017 page. City(rown 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 WC4� n , P �o< a 1✓� � V ���,11 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is required for every North Andover MA 01845 6-1-2017 page. Cityrrown 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: 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: As per test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Bruce Eggers Owner Owner's Name information is North Andover MA 01845 6-1-2017 required for every page. Cityfrown 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 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 • Summary Record Card generated on 5/30/2017 2:53:26 PM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-090.A-0066-0000.0 Parcel Id 14646 117 BROOKVIEW DRIVE BRUCE & GONNY EGGERS 117 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 2017 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until BRUCE&GONNY EGGERS Owner 117 BROOKVIEW DRIVE NORTH ANDOVER MA 01845 NIKOLOPOULOS, NICK&JOANNE Previous Customer Inactive 4/4/2012 117 BROOKVIEW DRIVE NORTH ANDOVER,MA 01845 RAJ DUDANI Previous Customer Inactive 10/26/2012 117 BROOKVIEW DRIVE NORTH ANDOVER MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive i Bldg Id. 17716.0-117 BROOKVIEW DRIVE Last Billing Date 4/6/2017 3170380 03 Cycle 03 Active UB Services Maint. Account No. 3170380 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 26.60 /1 UB Meter Maintenance Account No.3170380 Serial No Status Location Brand Type Size YTD Cons 36207112 a Active ERT HH b Badger w Water 0.63 0.63 1676 Date ReadingCode Consumption Posted Date Variance 3/9/2017 1681 a Actual 7 4/12/2017 -86% 12/8/2016 1674 aActual 52 1/23/2017 -47% 9/7/2016 1622 a Actual 91 10/24/2016 131% 6/13/2016 1531 a Actual 43 8/2/2016 321% 3/11/2016 1488 aActual 10 4/22/2016 -74% 12/10/2015 1478 aActual 38 1/20/2016 -66% 9/9/2015 1440 a Actual 109 10/16/2015 315% 6/10/2015 1331 a Actual 26 7/24/2015 117% 3/12/2015 1305 a Actual 12 4/28/2015 -59% 12/12/2014 1293 aActual 30 1/15/2015 -66% 9/11/2014 1263 a Actual 88 10/15/2014 190% 6/10/2014 1175 a Actual 30 7/16/2014 164% 3/10/2014 1145 aActual 11 4/11/2014 -73% 12/11/2013 1134 aActual 41 1/17/2014 -46% 9/12/2013 1093 a Actual 70 10/15/2013 154% 6/12/2013 1023 a Actual 27 7/24/2013 207% 3/14/2013 996 a Actual 9 4/22/2013 -64% 12/12/2012 987 aActual 13 1/9/2013 -80% 10/25/2012 974 f Final Bill 57 10/25/2012 4% 9/13/2012 917 a Actual 121 10/15/2012 176% 6/12/2012 796 a Actual 33 7/16/2012 -100% 4/3/2012 763 f Final Bill 0 4/5/2012 -100% i • Commonwealth wealth 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 withY our 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 I. System Location: Left/Right front of douse, Left/Right rear of house, Left./right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address CityFrown State Zip Code 2. System Owner. Name Address(if different from location) CiVrown ' Sta Zip Cod Telephone Number i B. Pumping Kecord 1. Date of Pumping Date 2. Quantity Pumped: Gallons Y 3. Type-of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ® rso�YNoIf yes,was it cleaned? ,�'YesN Y/ L� a ' 5. Condition of stem: no r z At 6. System Pumped By. `�- Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company 7. Location wbere contents-were disposed: �LS- Lowell Waste Water Sign a qt Ha-uleru Date 0orm4.doC 06/03 System Pumping Record•Page 1 of 1 : Commonwealth of Massachusetts RECEIVED City/Town of JUN i 3 2017 ° Stem Pumping.Record TOWN OF NORTH ANDOVER ys Form YS 4 HEALTH DEPARTMENT SV 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 withY our 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 douse, Left/Right rear of house, Left/right side of house, Left Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address I 1__`7 City/Town State Zip Code 2. System Owner. Name Address(if different from location) Cityrrown g� / � Zp Cod Telephone Number .B. Pumping JRpcord 1. Date of Pumping Date 2. Quantity Pumped: Gallons �` 3. Type-of s ❑ Cesspooltic Tank YP stem:Y. (s) � a p E] Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? a16,s ❑ No If yes,was it cleaned? es ❑ No ' 5. Condition of stem: ( �' no f 6. System Pumped By: Neil.Bateson ' F5821 Name Vehicle License Number Bateson Enterprises Inc' Company 7. Location wbere contents-were disposed: G L S: Lowell Waste Water Sign a 9t Haul Date t5form4.doa 06/03 System Pumping Record•Page 1 of 1 i r Cf,NORT:,y 7968 00" = 9 Town of North Andover HEALTH DEPARTMENT �ss�eHusts CHECK#: 3� DATE: 6 -13-A01"7 LOCATION: //-) ro 0 tViLW H/O NAME: CONTRACTOR NA E: 25n.T Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ xTitle 5 Report /1111L 55 $ 50 — ❑ Other:(Indicate) $ Heat&Agent Initials White-Applicant Yellow-Health Pink-Treasurer 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/Right rear of house , ng Aer of hou Left/ ' Right side of building, Left/Right front of building, Left/Right rear of ing, Un Address City/Town State Zip Code 2. System Owner. RECEIVED Name' TOWN OF Address(ddifferent f om location) HEALTH DEpANT,M v R ENT City/Town stat�ny � ip Code f Telephone Number —< a i i B. Pumping Record ol+e3 1. Date of Pumping gate 2. Quantity Pumped: Gallons ptic Ta 3. Type of system: ❑ Cesspool(s) Senk ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? Yes ❑ No If yes,was it cleaned? [ es C3 No " 5. Condition of\Sy'st� 6. System Pumped By. Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Loca' re contents were disposed: CSL S: Lowell Waste Water I Sign agtHauiezUDate f t5form4.doc 06/03 System Pumping Record•Page 1 of 1 i Commonwealth of Massachusetts RECEIVED City/Town of • UN1 System Pumping Record 4 Form 4 DEP has provided this form for useby 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/Right rear of hous. L g sid of us , eft/ Right side of building, Left/Right front of building, Left/Right rear of bu Under eck Address C"dyfrown State Zp Code 2. System Owner. Name Address(if different from location) citylrown ' State de Telephone Number B. Pumping Record 1. Date of Pumping 2. Qtity Pumped: DateGallons 3. Type of system: ❑ Cesspool(s) ;--SepfiucaTank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? 0 Y�soo If yes, was it cleaned? es ❑ No; ' 5. Condition of System: v` AQP 6. System Pumped By.- Nell. y:Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Loere contents were disposed: GaL S'. Lowell Waste Water Sig Haul Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts R ECEIVED City/Town of tip 4 2013 System Pumping Record Form 4 TH ANDOVER PARTMENT 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/Right rear of hous , e ng side�of hous , Left/ Right side of building, Left/Right front of building, Left/Right rear of uilding, Under eck Address Cry Cityrrown State Zip Code 2. System Owner. r I Name Address(if different from location) Citylrown Stat 2ip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Qu ntity Pumped: Gallons 3. Type of system: ElCesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? Yes ❑ No If yes, was it cleaned? Yes ❑ No. S. Condition�f System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: S. Lowell Waste Water SignAtufe Hauletj Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 ` I 5571 Of,HORT�1h F •- - 9 i Town of North Andover `ti'•,,,,,�: HEALTH DEPARTMENT is CHECK#: � / DATE: LOCATION: / / H/O NAME: CONTRA R E: l� Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Titl Inspector $ ZTitle 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts Title 5 Official Inspection Form ,-- Subsurface Sewage Disposal System Form-Not for Voluntary Assessm is 117 Brookview Drive JUL 29 201 Property Address TOWN OF NORTH ANDOVER Joann Nikolopoulos HEALTH DEP Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 `t every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Neil James Bateson cursor-do not use the return Name of Inspector key. Bateson Enterprises Inc. Company Name � 111 Argilla Road Company Address Andover MA 01810 Cityrrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete.as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ e Further Evaluation by the Local Approving Authority a 7/19/2011 Inspectors Signature Date The system inspector shall-submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts a W Title 5 Official Inspection Form y Subsurface Sewage Disposal System Form-Not for Voluntary Assessments l M 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. 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: ® 1 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 Q N ❑ ND (Explain below): t5ins•11/10 Tdle 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water } supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owners Name information is required for North Andover MA 01845 7/19/2011 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. El ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For 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 El Elthe 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. Cityrrown 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 i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. CityrFown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped last year, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool 9 ❑ Overflow cesspool ❑ Privy ❑ .Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 E Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ..'' 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 14 years old, 11/11/1997, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.8 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.): 4" PVC thru wall to tank, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: .8 feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x5'x 4' Sludge depth: 3" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Inspection Form official ■ Voluntary Assessments 1 -Title 5 �f f stem Form-Not for ' Subsurface Sewage Disposal Sy 0 117 Brookview Drive " Property Address 01-- 7119 2011 Joann Nitrol° oulos ection MA Code Date of Insp owner owner's Name State Zip information is North Andover required for Citylrown (cont.) every page. D. System Information Septic Tank(cont.) 24" Distance from top of sludge to bOttOm°f outlet tee or baffle 6„ Scum thickness I 61 Distance from top of scum to top of outlet tee or baffle 15" ' to bottom Of outlet tee or baffle Ta a Measure Distance from bottom of scum How were dimensions determined? and outlet tee or baffle condition,structural integrity, um +ng recommendations, in le of leakage,etc.): ,clean same. Comments(on p P` evidence Outlet tee ok. Outlet filter clogged Inlet tee clogged,clean same. cleaned, level back to normal.No evidence of liquid levels as tank-Inll outlet invert, d outlet filter,Pumped septic Depth of liquid above invert from clogged leaks e.1 Grease Trap(locate on site plan): feet Depth below grade: 0 other(explain): '0 fiberglass Material of construction: 0 polyethylene p concrete 0 metal I Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Di Distance from bottom of scum to bottom of outlet tee or baffle Dist Date Date of last pumping= ion Form:Subsurface Sewage Disposal System•Page��°t VTitle 5 off pal Inspep� t5ins•11110 I Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. Cityfrown State Zip Code 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-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Disposal System Form Not for Voluntary Assessments Subsurface Sewage isp y ry 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. City/Town 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 i Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. City/Town 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 75' 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. Citylrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. Citylrown 1. 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 Beet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I w D-'Qct Porth � . 0i� il � Z {prof rt t5ins•11/10 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is required for North Andover MA 01845 7/19/2011 every page. City/Town 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: As per test pit data on design plan. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 117 Brookview Drive Property Address Joann Nikolopoulos Owner Owner's Name information is � required for North Andover MA 01845 7/19/2011 every page. City/Town 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts City/Town of System Pumping Record y` 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 front of house, right front of house,dl ft side of house right side of house, Left rear of house, right rear of house, left side of building, right rear of building, under deck. G '`7 T-0 a 00-C4� Cityrrown State Zip Code 2. System Owner: �JN dodv los Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date l 2. Quantity Pumped: canons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? es ❑ No If yes,was it cleaned? es ❑ No 5. Condition of System: 6. System Pumped By: Neil J. Bates®n F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Location where contents were disposed: ow ll Was Wpker Signature ule Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 Summery Record Card generated on 7/19/2011 1:55:47 PM by Karen Hanlon Town of North Andover Tax Map # 210-090.A-0066-0000.0 Parcel Id 14646 117 BROOKVIEW DRIVE NIKOLOPOULOS, NICK &JOANNE 117 BROOKVIEW DRIVE NORTH ANDOVER, MA 01845 Class 101 Single Family ! Property Type 1 Resid, Size Total 0.93 Acres FY 2011- UB 011UB Mailing Index Name/Address Type Loan Number Active/inact. From NIKOLOPOULOS,NICK&JOANNE Payor 117 BROOKVIEW DRIVE NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id.,.;771.0-117 BROOKVIEW DRIVE Last Billing Date 7/13/2011 3170380 03 Cycle 03 Active UB Services Mal nt. Account No.3170380 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 303.17 /1 UB Meter Maintenance Account No.3170380 Serial No Status Location Brand Type Size YTD c 36207112 a Active ERT HH b Badger w Water 0.63 0.63 Date Reading Code Consumption Posted Date Vari 6/7/2011 678 a Actual 61 7/20/2011 3/7/2011 617 a Actual 54 4/13/2011 12/8/2010 563 a Actual 137 1/12/2011 9/9/2010 426 a Actual 216 10/15/2010 6/8/2010 210 a Actual 143 7/15/2010 3/9/2010 67 a Actual 67 4/14/2010 -1 1/30/2010 0 n New Meter 0. 4/14/2010 -1 1/30/2010 2865 r Replacement 62. 4/14/2010 12/8/2009 2803 a Actual 105 1/12/2010 9/4/2009 2698 a Actual 164 10/15/2009 2 6/8/2009 2534 a Actual 49 7/20/2009 3/16/2009 2485 a Actual 83 4/29/2009 12/9/2008 2402 a Actual 110 1/20/2009 9/10/2008 2292 a Actual 200 10/10/2008 6/6/2008 2092 a Actual 111 7/16/2008 3 3/7/2008 1981 a Actual 26 4/11/2008 - 12/11/2007 1955 a Actual 52 1/22/2008 9/5/2007 1903 a Actual 216 10/12/2007 6 6/19/2007 1687 a Actual 36 7/20/2007 3/15/2007 1651 m Manual estimate 30 4/16/2007 - 12/12/2006 1621 a Actual 32 1/19/2007 9/18/2006 1589 a Actual 149 10/20/2006 2 Trouble Code:03 6/19/2006 1440 a Actual 44 7/10/2006 3/8/2006 1396 a Actual 33 4/17/2006 - Trouble Code:03 r t � 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, July 19, 2011 10:52 AM To: 'nbateson@comcast.net' Subject: Septic- 117 Brookview Drive-As Built and Plan Information with test pit and water table info. Attachments: 20110719093903431 Importance: High p 9 Follow Up Flag: Follow up Flag Status: Flagged To: Neil Bateson 978-815-2708 Re: 117 Brookview Drive-Septic-117 Brookview Drive-As Built and Plan Information with test pit and water table info. Hi Neil, Here is the information you need to conduct a Title 5 Inspection. Call if you have any questions. Have a great day!--O &4t Rgag4, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 R Fax-978-688-8476 El Email-ndellechiaie@townofnorthandover.com '16 Website httl2://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous If you are happy with the customer service you have received from town departments,please let us know...feel free to complete the general Comment Form (link below): http://www.townofnorthandover.com/Pages/NAndoverMA WebDocs/contact 2 I IL EXISTING / FOOTING EX. 1500 GAL. <� SEPTIC TANK EX. D- BOX 23 o, / EX. 3 X 75 TRENCHES d� EX. VENT / T LINE) Q0 23 —� OF VIL 2 y O !ST TIONS. TAKEN AT TOP OF 'PPE ` SWING TIES COMPONENT COR A COR B FOUNDATION: SEPTIC TANK (CE DWELLING: _ .__ D-BOX (CE N: --- END PIPE: C DUT: 139.63 END PIPE: D IN: 139.35 END PIPE: E OUT: 139.17 (ALL) PE A: 138.63 PE - B: 138.61 _= IJy• �4 BOTTOM OF. Pil LLEV. _128.1 / 127.67 1ZO. /O Q 138.8609S. WATER TABLE 128.17 NONE NONE NONE JT = 138.69 DESIGN MATER TABLE 132.83 133.30 132.17 132.50 Date 4CHES = 138.54 A HORIZON 9" 5" 6" 3" Signature CHES = 138.30 30" 5„ 26". �". - 24' 3' - 27" i00YR 5/6 10YR 4/6 10YR'4/6 10YR 4/6 4CHES = 137,30 B HORIZON FINE SANDY FINE SANDY FINE SANDY FINE SANDY LOAM LOAM LOAM LOAM FRIABLE. GRANULAR v 36" - 50" 26" -- 112' 24" - 91" 27" - 93" 1.OYR 5/6 1GYR 6 10� 5/6 :?.5YR 4/4 GRAVELLY 1 08BLY GRAVELLY O$HLY .GRAVELLY' 088L'Y SAhID'Y L��AAA SAA1[ � LOAM SANDY LOAM s�AidaY LO41v1 Cl H'OR'IZON FIRM, MASSIVE MASSIVE MASSIVE MASSWE. SOME STONES VERY FIRMA VtRY Fi& VERY FI1ZM TO '12" pEF..0 91" REF 0 93" 10YR5/8 2.5Y6/3 10YIf 5/8 2.5Y6/3 10YR5/8 2.5Y6/3 MOTTLES 0 36". MOTTLES ® 40" MOTTLES. 6 .48 6JLENZES OF 10YR 3/2 r 5Cr" - 1 d6" COARSE SAND 2.5Y 5/6 SANDY LOAM 1r % VER'f FIRM. MASSIVE •.-•� �! / C2 HORIZON 5t)% STOKES 7.5YR5/8 5Y6/2 MOTTLES 0 50" { %0 C3 HOF;I ON � ; * CJNDUCTE£� 8'( CHRiSTIANSEN � SERGI INC, _---------.___._ WITNESSED BX: S. STARF. -' N0. ANDOVER 80AR.D �I HEALTH MAI�CHIr?NDA, 3 ASSOCIATES, L.P. - MICHAEL. J. ROSATI, SOIL EVALUATOR CONDUCTED BY: _- _ PERCOLATION .TEST A9 36A DATE7/25,/96 9/19/95 l ' SATURATION _ 15 MIN. _ 15 MIN. 6» j g MIN. -- .. .7-AIIt' D; RATE 1� MIN /IN 3 MIN/IN $O`T0 BOTTOM 78-TO BOTTOM * CON DUCTED BY: ... ._. 3'.:: C V ;Ttfl#�1 137.0 136.2 Cf4ktSTIANSEN �t SERGI INC. _ �—— 300' TNI`5' I D :BY;.: „' S. STARK NO. ANDOVER . BOARD OF HEALTH C41 DUCT ..8 :: '( A CHICI�IC�A c ASSOCIATE,......—L.F. — MICHAEL J. .ROSATI:Z. SOIL EVALUATOR 12" COVERS (SEE NOTE #2) -- PLAN' VIEW 3 4„ — 1 1 2" DOUBLE 6.. .QIA: 4„ 36,. . ...4., WALLS OP�iNG WASHE STONE 6 !A. 4PEhdNING 12" L MEN N.T.S. 15' FINiSH GRADE 138.97 48" PROP. (OUTLET �} 13 LIQUID TEE WI TH ?EQ. TITLE v GRaE 3 _ 2 3 138.97 n BEVEL GAS EAPEL.E t. INV = 138.30(TYP) 137.30 TION VIEW O _ o �( JAW ET , S+#VtlT - i333D '�fi N.T.& 1. TANK BY SHEA CONCRETE PRODUCTS. WILMiNG•TON, IIIA . OR APPROVED EQUAL.. 2. ACCESS COVER OVER OUTLET TEES, SHALL BE RAISED TO WITHIN W'. OF FtNf SH:GRADE BY RISER SECTIONS OF 24" Wk. DIAMETER. 3. WHEN UNDER PAVEMNT ALL COYERS TO BE RAISED TO FINISH GRADE BY RISER SECTIONS OF 24" MIN. DIAMET LEGE —8 EXISTtNG GRADE_ C 15' MtN PROPOSED GRADE 'H 40 PVC )05'/' PERCOLATION TES PROP. 4" P.V.C. VENT INV.=138.30 W/ SCREENED OPENING PROP. GRADE ENDS CAPPED DEEP HOLE TEST SIGNED FROM ACCEPTABLE BOTTOM OF TRENCH 137.30 STATE & LOCAL REGULATIONS. ;-EVITY OF THE DISPOSAL SYSTEM INV END TRENCH 138.30 A TOPOGRAPHIC SURVEY CONDUCTED INV BGN TRENCH 138.541 ELARK TOP OF HUB FINISH GRADE OVER TRENCH 140.5 MIN:. Not- M EXISTING PLANS OF RECORD kTELY SHOULD FIELD CONDITIONS FROM THIS DESIGN SHALL BE BY THE DESIGN 1<NGINEER. r THE DESIGNER IS REQUIRED, THEN ;OIL SPECIFIED IN CONSTRUCTION 4t DESIGN ENGINEER PRIOR TO dT MATERIAL. ` f rEA DRAIN, FLOOR DRAIN OR ANY r-- �E ,CONNECTED TO THIS DISPOSAL 00 ."BUILT PLAN BY THE. DESIGNER v. LI N+i:G'`C}F, [-EAGHING FACILITY. A 1' THE'.:DESI:GCV�R rj E oO*'- T000fo,OVER THE RESERVE 40, TED. 101 FT. OF THE PROPC,15 a..LEACHING `4 40. J ;R SUPPLIES ARE PRESS N T*": :TH1#f' '1.'Q0..FT. OFJ TED IN THE. FLOOD ZOITE OR TI .E.'II1F1 .Zt?N. NO TES ANY IMPERVIOUS LAYERS, . THE LEACHING FACILITY. REMOVAL SHALL Y .AAII� RF F�FP1..A F1 WITHRFPI Ar-FM1"hIT. . DOUBLE WASHED GRAVEL STONE. JD AND PERFORATED, SHALL BE POLYVINYL fl 40, UNLESS OTHERWISE SPECIFIED. BE USED ON ALL PIPE' JOINTS. CONNECTIONS <v BE MADE WITH HYDRAULIC CEMENT AND MORTAR R 4R SHALL NOT BE USED. LEACHING FACILITY SHALL BE LEVEL. OQ Std ' ALCt LATiONS ED-ROOMS rZ:0 110 GAL'./DAYPROPOSED _ k FLOW: __ _ 440 G.P.D. 10 - RATE: MIN/IN RATE 0.60 GPD/S.F. S.F. NT LOADING RATc 3 / � . rtAN . 1 71 � 20' NG AREA REQUIRED P.D. / O.GO G.P.D./S.F. 734 S.F. L=10 FT TRENCHES — 3 FT. WIDE X 75 FT. LONG X 12" EFF. DEPTH 4" CIP 0 NG AREA PROVIDED S.F. SIDEWALL + 450 S.F. BOTTOM AREA 750 _ S.F. T.F.=142.0 ,141.0 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: r - QUANTITY PUMPED_! r Shy GALLONS CESSPOOL. • NO ZYES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) a SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: L �Commonwealth of Massachusetts Massachusetts System Pumping Record S System Owner stem Location Y Y LA e-tsj C� Date of Pumping: `CJ q.—C Quantity Pumped:/�llons Cesspool: No H--' Yes (] Septic Hank: No (] Yes fl, System Pumped by: Vute~ s License# Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: :f t DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, July 19, 2011 10:53 AM To: 'nbateson@comcast.net' Subject: Septic- 117 Brookview Drive-Additional information - Pumping Records Attachments: 20110719094147541 Importance: High Follow Up Flag: Follow up Flag Status: Flagged Septic-117 Brookview Drive-Additional information-Pumping Records rat R1464, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 2 Office-978-688-9540 Fax-978-688-8476 0 Email-pdellechiaie(@townofnorthandover.com `6 Website http://www.townoftiorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous If you are happy with the customer service you have received from town departments,please let us know...feel free to complete the general Comment Form (link below): http://www.townofnorthandover.com/Pages/NAndoverMA WebDocs/contact 1 1 Commonwealth of Massachusetts City/Town of R System Pumping Record MAY 28 2010 Form 4 'rOWNOFNORT, n DEP has provided this form for use by local Boards of Health.Ot A r the information must be substantially the same as that provided here. Before using , eck 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 LocatioLeft side of 'Right side of house, Left front of house, Right front of house, Left rear of house, Rig rear of house. Left rear of building. Right rear of building. Address r 1 � . Cityrrown ` state Zip Code 2. System Owner: 1`� ,.cv Name Address(if different from location) Cltylrown State��r Zip Code Telephone Number ---�.� B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) optic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? es ❑ No If yes,was it cleaned? es No S. Condifon of Syst 6. System Pumped By: Neil Bateson �.J F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location wbw contents were disposed: s Lowell Waste Water g t of Haul r Date t5form4.doc•06/03 System Pumping Record•Page 1 of I j Commonwealth of Massachusetts F E.w City/Town of System Pumping Record FEB 2 7 2008 Form 4 TOV%1i4 OF NORTH ANDOVER 11"ALTH DEPARTNIE NT form DEP has provided this for use by local Boards of Health.-Off--#rf8l`tvr8-ii IJUU d, 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 Important: When fillingout 1• 6s m l0 on: faoth me on the computer,use only the tab key Address to move your �L„V cursor-do not y�oWn State Zip Code use the return key. 2. System Owner: VQ C-1 rMSAName es► Address(if different from[Dation) Cityfrown 3tafej !^ •- f r"11 Telephone Number `'f B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) epffc Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? es ❑ No If yes,was it cleaned? es ❑ No 5. Con di�Tofyst9v�� 6. Systegn P mp�d By: Name Vehlde Lkens e Number Company 7. location ere contents wer isposed: 4 �-7 � � Signatare I Date t5form4.doc 06103 System Pumping Record•Page 1 of 1 QN Commonwealth of Massachusetts Ci /Town of Y IVED System Pumping Record Form 4 JUL 0 3 2007 DEP hasrovided this form for use by local Boards of Health.Ot be used, but he Information must be substantially the sane as that provided here B� ! f Imb k with your local Board of Health to determine the form they use.The System Pumtnp g ftecofi� t submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. Syste Locatb ' forms on the �l computer,use only the tab key Address t ( 1-7 1 �W f to move your f cursor-do notsyn state Zip Code use the return key. 2. System Owner: Nemo Address(d different from location) CRY/Town State �� � �Zip cue Telephone Number B. Pumping Record C. 1. Date of PumpingDate 2. Quantity Pumped. Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filterp resent? es ❑ No If yes,was it cleaned? s ❑eNo 5. Condiof Sy tem: 6. 5yste P ped By: Name Vehicle License Number Company 7. Locatloqrepontensnc$re osed: Yx-'a'V Signets 96ut Date tbfam4.dw 08103 System Pumping Record Page 1 of 1 Co mmonweaith.of'Massachusetts > -- --- :. City/Town oft System Pumping Record AUG 2 4 2006 Form 4 IV TOWN OF M0F TH AJN0OVtR DEP has provided this form for use by local Boards-of Health..T h";SA em�fjitm2 ging y p gec rd must :be submitted to the local Board of Health or other approving authority. X Facility-Information .important: When filling out ....1. Sys em L 0� forms on the computer,use only the tab Key Address to move your dursor-do not Gif/Town / lyse theretum .y State Zip Code key. 2. System OWner: Name Andress(it different frau location) LA cityfrown State Zip Cade Telephone Namber S. Pumping Record •1.' .Date.of Pumping Date 2. Quantity Pumped: canons 3. Type of system: cesspool(s) eptic Tank- ❑ Tight Tank [J Other(describe): . 4. Effluent Tee Filter present? es ❑ No* If yet,was it cleaned? es [] No 5.'-Condi'on of System: 6. System Pumped-By t -.F - c- c Name Vehicle j.icen§e Number company, .7. I;oca' n where cop. pts" re disposed: . S . j2a. - Sime re Ha er Taw http://www mass:gov/dep/water/approvalt/t5forms.htm#inspect t5form4.doc•06103 System .gmpinq Record•Page 1 of 1 • i TOWN OF NORTH ANDOVE RECEIVED SYSTEM PUMPING RECOR NOV d 9 2005 DATE: LfHEAOL N F NORTH ANDOVER TH DEPARTMENT SYSTEM OWNER&ADDRESS SYSTEM LOCATION C Q 6 (example: left front of house) DATE OF PUMPING: Q ANTITY PUMPED ._GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) -IZ7 SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: ✓ f ' %7 TOWN OF -,K,, SYSTEM PUMPING RECORD 01. (';) DATE: SYSTEM OWNER&ADDRESS SYSTEM LOCATION (example:left front of house) c� 6T(1 tk-I 9(00V\JCV3 DATE OF PUMPING: ^ TITY PUMPED: v C> GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: s Commonwealth of Massachusetts City/Town of RaZis , a w° System Pumping Record MAY Form 4 TOWN OF � DEP has provided this form for use by local Boards of Health. Ot he information must be substantially the same as that provided here. Before usick 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 LocationLeft side of ?Right side of house, Left front of house, Right front of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address -7 J ljoAq�:� qaV,8�,)� City/Town State Zip Code 2. System Owner: Name Address(if different from location) Citfrown Stat Zi Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? es ❑ No If yes, was it cleaned? es ❑ No 5. Condition of S —f �/60(tf' L/Y 6. System Pumped By: V � Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location wbam contents were disposed: Lowell Waste Water g toe of Haul r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RIE-CEIVE® City/Town of System Pumping Record FEB 2 7 2008 g` Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. her fords may-bused, 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 Important: When filling out 1. Syst m L ion, forms on the v computer,use only the tab key Address ,�j / n ,r to move your C C t ��� /r ", cursor-do not cityfrown p use the return State Zi Code key. 2 System Owner: f Name Address(ff different from location) Cityrrown State. p ode _,_,rf Telephone Number B. Pumping Record ,� -C 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): � � 4. Effluent Tee Filter present?�,,Yes L_.I No If yes,was it cleaned? es ❑ No 5. Condit' of System: o �- �C t 6. SysteWn P mpecd By: Name .- - Vehicle License Number Company 7. Location ere contents wer isposed: ,L _�, //.///Ic �--—� 3--7 �� Signature I Date t5form4.doc^06/03 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: fo—5'D SYSTEM OWNER &ADDRESS SYSTEM LOCATION �au (example: left front of house) q� Us � a uS� _ . 0�. DATE OF PUMPING: (n—S-C-)a QUANTITY PUMPED ' ` GALLONS CESSPOOL: NO ZYES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: o o✓l�c7 COMMENTS: CONTENTS TRANSFERRED TO: /(Commonwealth of Massachusetts f " • Massachusetts System Pumping Record System Owner System Location mac- LAe-U) Date of Pumping: ��-� ��� Quantity Pumped:k5�llons Cesspool: No Yes [] Septic Tank: No [] Yes System Pumped by: Ta&44w License# Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: Tc. , 127 Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record Form 4 JUL 0 3 2001 DEP has provided this form for use by local Boards of Health. aFrpay be used, but e information must be substantially the same as that provided here Be �� Fd with your local Board of Health to determine the form they use. The System Pumpl Re`eor - submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. Syste Locati forms on the computer,use only the tab key Address to move your �7 �... cursor-do not City/Town §iae Zip Code use the return key- 2. System Owner: �j Name 1�1 Address(if different from location) City/Town State — l � �"I� `ZipCode� Telephone Number a B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): �� 4. Effluent Tee Filter present? es ❑ No If yes,was it cleaned? D—Yes LJ No 5. Condi ' of iyte s. Systerp P mid By: � F5&4, C Name Vehicle License Number Company 7. Locatiore ontenre osed: Signatu ul Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth.of Massachusetts RECEIVED City/Town of System Pumping Record AUG 2 4 2006 Form 4 TOWN OF NORTH ANDOVER EAi_TH D_FP,RT,"JE DEP has provided this form for use by local Boards of Health. The ystemumptng ec rd must be submitted to the local Board of Health or other approving authority. . A Facility Information Important: When filling out 1. Sys em Location: forms the computer,use only the tab key Address to move your cursor-do not Ci /Town use the return tY State Zip Code key. 2.. System Owner: U C) y �GS Name ntin . Address(if different from locationy City/Town State�� Rap Code Telephone Number B. Pumping Record A. Date of Pumping Date. Quantity:Pumped: Gallons 3. Type of system: ❑ cesspool(s) eptic Tank ❑ Tight.Tank ❑ Other(describe)' 4. Effluent Tee Filter present? es ❑ No If yes, was it cleaned? es ❑ No 5. Condi 'on of System: c Cage 6. System/Pumped BY-'' Name Vehicle License Number G Company 7. Loca ' where contents Nre disposed: Signature 6f HaLher Date http://www.mass.gov/dep/water/pOprovalt/t5forms.htm#inspect t5form4.doc•06103 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVE SYSTEM PUMPING RECORI RECEIVED DATE: NOV - 9 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: ��—�" Q ANTITY PUMPED l'SeGALLONS CESSPOOL: NO —JZ/YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: V �'� TOWN OF SYSTEM PUMPING RECORD DATE: SYSTEM OWNER& ADDRESS SYSTEM LOCATION 1 (example: left front of house) Fpov\j" �,J DATE OF PUMPING: QUANTITY PUMPED : Ob GALLONS CESSPOOL: NO n/ YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE L EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACIHULD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: i I Town of North Andover, Massachusetts Form No.2 • f NORM BOARD OF HEALTH^,., y O't,� o��•Lp 4 !1 (� �?ten, � ..• p O 15 . F w DESIGN APPROVAL FOR ss''C"�5`t SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant�_T(J�U�-Q.- " Test No. : Site Location Reference Plans and Specs. 7 ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CRA MAN,BOARD OF HEALTH Fee Site System Permit No. 7 � 9 FORM U - LOT RELEASE FORM r , 4' 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. *****************************AIPPLICANT FILLS OUT THIS SECTIO ***************** * * * /1 I- f e�w , MuoPk`� coN�r•A�-�Or APPLICANT V �1�e-Yl,,e,l `--ll-6 A U.q e PHONE (v 89� LOCATION: Assessors Map Number O PARCEL Co 4 SUBDIVISION LOT (S) STREET 3 nP0/�-�/U!f-'e­� • ST. NUMBER 11 USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: gxka glpf-u DLCy-. -+- J G ->e Su�v rabw• CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS �EC� / _ - PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm FORM U - L I OT RELEASE FORM INSTRUCTIONS his form is used to verify that all necessary ds and Departments having jurisdiction applicant and/or landowner from diimpl ahCv havebeenobtained This does from This does not relieve *****APF with any applicable or requirements. LICA,NT FILLS OUT THIS q menu. APPLICANT SECTIO ********* � ***** *** LOCATION: Assessor s Ma PHONE ` �-3 b y Map Number �' _ SUBDIVISION PARCEL STREET LOT `— �; ******* ***** ST. NUMBER_�� OFFICIAL USE ONLY*********** RECOMMENDATNS OF QTOWN AGENTS: NSERVATION ADMINISTRATOR DATE APPROVED � {j COMMENTS DATE REJECTED U�.�j� C �0' TOWN PLANNER DATE APPROVED DATE COMMENTS REJECTED FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED COMMENTS 5 G,e,��.-� DATE REJECTED / PUBLIC WORKS -SEWERIWAT E R CONNECTIONS E CT10 NS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED By BUILDING iNSPECTOR Revised 9197jm DATE ME WE ■■■ === ■■■ = o . oNEWS MI m m= ��� =_= NMI =Z' == INN �■■ -. it I II loom I ENE! ME H owl in wo" M m 111111111M on owl son! =M- ME 'no I jig rmrrorro _r1rmill 9' 3'-4'X 3'-5" I i -LIDING cc II j I j in � CH I � I KITL �-4 I , — N � I 5 ° - - - - - - - j — I r - - - --- - - - - i I 2-2'-0" i I LO I I I 11 4 I' I N I I I O II I iv I I II I I � DINING ROGM II � II I IYING- ROO!"' I I i i `ol I I I h l � I I It I I I II I -- 1 ' j I 2-1-X5 " I z'_D" I i L 2. 5" i i i 4 �4' I 1 ,,,,J// 'I-A1 G.1/111 1 j i 4,_,J„ -" - - - - - - - - - - - - - - I 2'-6" ,Y rLo of � `\\✓ j If p �, ;r,i - - - - - - -- - - - - - - of CV i - - - - - - - -- - - -I 3'-0" -0" 3'-811/4"= / �I -0"SLIDING � - i� I I 5'�0"SLDING 7'-0" Tf� _ 8E✓R � 5-0)"SLIDING i 5'-0"SLIDING _ I of GPS i ! 6'-113/4" N, I I I SLOW �I - - - - - - - I f ( 2'-'0 Y 4 9" 2'-10" 4'-9" HANDRAIL N2r io, 2\ I 3'-9" h-9" i 3'-6"10 12_0„ I p r) CR F) l A I _ar• 1 OV- 12—S7 WED 16 : 22 �_•_,•,•,,,.„ P . 02 �. rl ;•I y., i 40,651 S.F. 0", 0.93 Ac.413 10 EXISTING ff EX. 1500 GAL. FOOTING SEPTIC TANK EX. D-BOX -31 v s / / 8 EX. 3' X 75' TRENCHES ~ _ EX. VENT y t' cD T� (TO LOT UNE) ! Lo 23' 00 -1 C ''�'r •��� SOµ• FAQ 4 U ;. o.. ' -� ELEVATIONS TAKEN AT TOP OF PIPE -••---• - , '• SWING TIES •OM�ONENTCOR A COR 8 4 41 TOP OF FOUNDATION: SEPTIC TANK (CENTER) C. PIPE O DWELLING: 4TANK IN: _ �.�-' — --- (CENTER) NO PIPE: TANK OUT: 139,63 D-BOX IN: 139.35 I '` 0-BOX Out: END 439.47 (ALL) PIPE_ - •-- END PIPE - A: 135.63 ENO PIPE - B: 136.81 END PIPE - >.: AS-BUILT SEWAGE DISPOSAL MARCHIONDA & ASSOC., L P- ENGINEERING AND PLANNING CONSULTANTS SYSTEM PLAN 62 MONTVALC AVE.. SUITE I LOT 9 BROOKVIEW DRIVE l ,:TONENAM, MA. 02180 NORTH ANDOVER, MASS. (647) 436-6421 PREPARED FOR 3G ;. BROOKVIEW COUNTRY HOMES SCALE: 7 DATE: 44/11/97 '(,I P.O..BOX 531 NORTH ANDOVER. MASSACHUSETTS Mel A FILE No.: 351 — 22 y•, S { a N O V - 1 2 - 9 7 WED 16 : 29 P . 01 I ' FAX TRANSMTTAL COVER SHEET Date: l—/2- 9;7 TO: Fax #• ���� 9 FROM: wYY�arJ c4> ` Marchionda &'Associates, L.P. 62-1 Montvale Avenue Stoneham, MA 02180 Tel (617) 438-6121 Fax (617) 438-9654 s MESSAGE: 1 f Total number of pages, including this cover letter If you do not receive all of the pages please call at(617) 438-6121. 4arcin nda �C��'C G°3 OGS 4G°3Qa� i]0�UL� s: � 3.En-ineeri igand - - , �,"a Planning Consultants D ATE JOB No. �,• EVA�. a 11 p, (617)-1381121 Fax(617)438-965.1 N - �� RE. ,�oILZ To WE ARE SENDING YOU Attached D Under separate cover via the following items: D Shop drawingsints D Plans D Samples D Specifications ❑ Copy of letter ❑ Change order DESCRIPTION COPIES DATE .I NO. I- I THESE ARE TRANSMITTED as checked below: ❑ For approval O Approved as;submitted ❑ Resubmit copies for approval For your use D Approved as noted D Submit copies for distribution O As requested ❑ Returned for corrections ❑ Return - corrected prints ❑ For review and comment O ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS 13 • X COPY 70 SIGNED:� Mws ' It enclosures aro not as noted,kindly notity us it once. .nom.._. - -.•-.,. —"•-.-�---- -- _- _. - _._ ...... ., . Town of North Andover, Massachusetts Form No.3 t goRrM BOARD OF HEALTH 7 a. O tt�ao ,aa ti0 � 7 F ".JL e r +►;'f 4`0"` DISPOSAL WORKS CONSTRUCTION PERMIT SSACHUSEt -r.d Applicant �}�TE,e � Gs•� NAME ADDRESS TELEPHONE Site Location IZ407 Permission is hereby granted to Construct (C-or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAT KMAN, BOARD OF HEALTH {' = Fee 7c5 D.W.C. No. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 2 CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER:— PC7-(f-r SIGNATURE: C'.Q� TELEPHONE# 2 2 Y CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee-Attached? Yes �,�_ No Foundation ? o As-built? Yes No i/ Ps � ✓ Floor plans on file? Yes No Approval Date: ���7 FORM U — IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section*****************p APPLICANT: Phone v r LOCATION: As:e_==_or' s Map 3 Number 9oAf�!/ � Parcel 9 Subdiv is on �D�UrP'J F 74 Lot (s) Street ,��04 F- UT�W DC/(�� St. Number Use Only*******************x**** RECO TDATIONS OF TOWN AGENTS: Date ADcrcved :.Isar',at_or. A�c�- Date Re;ectad Cc;.�erts �V l/v W�lyL�� 11 R. 1 0 0 1 V Date Approved IO LCA Town Planner Date Re j ec..ad Co=erz_s Date Ancroved Foo:: Date Rej ect�.. Date Apprc•.red C i e;�- . ,_ e�_t Date Re j ec=__ Co-...__.t_ Wcr�:s - se,er 'water ccnnect_ons - driveway er-iit �I F_re Decarzme.^.t �G�,�l� -f 97 3-165"`u Reca i•red by Buil ding Ins:.ector Daze Town of North Andover a H�RTN OFFICE OF �a o•`" h°oL COMMUNITY DEVELOPMENT AND SERVICES p 30 School Street North Andover,Massachusetts 01845 �,9`°^^=•o�.P��y WILLIAM J. SCOTT S$AcwUS Director August 8, 1997 Mike Rosati Marchionda & Associates 62 Montvale Ave., Suite 1 Stoneham, MA 02180 RE: Brookview Circle Dear Mike: This letter is to inform you that the proposed septic plans for Lot 9 Brookview Circle has 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 CONSP VATTON f.88-9530 HEALTH 688-9540 PI.ANNTNG 688-9535 Town of North Andover a 4oRTH OFFICE OF 3�°�' 6. °c COMMUNITY DEVELOPMENT AND SERVICES ° F- p t X 30 School Street North Andover,Massachusetts 01845 WILLIAM J. SCOTT SSACHUS Director June 18, 1997 Mike Rosati Marchionda & Associates 62 Montvale Ave., Suite 1 Stoneham, MA 02180 RE: Brookview Circle Dear Mike: This letter is to inform you that the proposed septic plans for Lots 2, 4, 5, 6, 7, 8, and 10 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 M. Wm. Scott, Dir. CD&S File Dave Kindred rowEFVA770W 688-9t'%Q FIF.Ai-1-4 698-9540 PIANINTN 63.8-95-10., . May 30, 1997 Marchionda Associates 62 Montvale Ave. Suite#1 Stoneham, MA 02180 Re: Lot #9 Brookview Circle To Whom it May Concern: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: If new plans satisfactorily addressing all the following issues are submitted to the Health Department by 0 /Z then approval for the plans should be given by Only 2 copies of plans submitted. (N.A. 6.01) V2' Elevations of perc tests missing. (N.A. 6.02j) Vent on lines missing. (310 CMR 15.251) koo' Benchmark not within 75 feet of system. (310 CMR 15.2208) No foundation drain. (N.A. 6.02V) L,,C` Reserve not 4 feet from primary. (N.A. 2.23) U, Additional deep hole needed at SSW side of SAS. 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 S S/cjp cc: David Kindred NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT DATE FEE:_� PERMIT #_L DATE RECEIVED APPLICANT MAP PARCEL ADDRESS LOT #�_ STREET # ENG. sT� STREE �GYaCV�E[c� �ieCG� ENGINEER' S ADD. PLAN DATE REV. DATE CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: sUaE3M/ TTC� ( /v � vl9 T/d'v S (lv,4 4. E,uc� �t�4� evo i 6j1�tiJ 7S-' o sy S��'`'l (113C Af � ,j7� bAJ - 01,q )U p 7 , 19�D ' T/a,v�� ��EP acE luccb6b L s5* e<j S /DE 6 S ,0S PLAN REVIEW CHECKLIST ADDRESS 9 IJh/ �yl ENGINEER GENERAL 3 COPIESSTAMPc� LOCUS `� NORTH ARROW SCALE CONTOURSPROFILE/ (Sc) SECTION BENCHMARK PERCS ELEVATIONS- WETS . DISCLAIMER t- � WELLS & WETS WATERSHED? J1Y0 DRIVEWAY 4--' WATER LINE C---- FDN DRAIN M&P SCH40 TESTS CURRENT? !/ SOIL EVAL /V -;eG 5AT1 SEPTIC TANK �/ MIN 150OG L� . 17 INVERT DROP `' GARB. GRINDER WQ( 2 comps +200 ) 10 ' TO FDN ,. ------ MANHOLE ELEV .� GW v # COMPS . GBL/ D-BOX SIZE # LINES c FIRST 2 ' LEVEL STATEMENT INLET / - OUTLET = r / 7 (2" OR . 17 FT) TEE REQ'D? A/0 LEACHING / MIN 440 GPD? L RESERVE AREA 4"'� 4 ' FROM PRIMARY'? 20 SLOPE 100 ' TO WETLANDS '- 100 ' TO WELLS-LZ' 4 ' TO S .H.GW L--' ( 5 ' >2M/IN) N 20 ' TO FND & INTRCPTR DRAINS ✓ 400 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY i-- MIN 12" COVER I/- FILL? x'( 15 ' ) BREAKOUT MET? L,--- TRENCHES /TRENCHES MIN 440 gpd SLOPE (min . 005 or 6"/1001 ) SIDEWALL DIST. 3X EFF. W OR D (MIN 6 ' ) � RESERVE BETWEEN TRENCHES? l/'IN FI LL?t`- MUST BE 10 ' MIN. Ll 4" PEA STONE?✓ VENT?-=�— ( >3 ' COVER; LINES >50 ' ) BOT + SIDE C33 1 X LDNG = TOT �So7 9 ( L x W x #) (DxLx2x#) (G/ft2) Copyright © 1996 by S.L. Starr Town of North Andover f °RTS OFFICE OF �?O`I, e o do COMMUNITY DEVELOPMENT AND SERVICES ° 30 School Street �9 North Andover,Massachusetts 01845 g......�<5 WILLIAM J. SCOTT CH Director May 30, 1997 Marchionda Associates 62 Montvale Ave. Suite 91 Stoneham, MA 02180 Re: Lot #9 Brookview Circle To Whom it May Concern: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: If new plans satisfactorily addressing all the following issues are submitted to the Health Department by June 12, 1997, then approval for the plans should be given by June 19, 1997. 1. Only 2 copies of plans submitted. (N.A. 6.01) 2. Elevations of perc tests missing. (N.A. 6.02j) 3. Vent on lines missing. (3 10 CMR 15.251) 4. Benchmark not within 75 feet of system. (310 CMR 15.2208) 5. No foundation drain. (N.A. 6.02V) 6. Reserve not 4 feet from primary. (N.A. 2.23) 7. Additional deep hole needed at SSW side of SAS. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp cc: David Kindred CONSERVATION 688-9530 I-TF.AT.TTT 688-9540 PI.."NTNr 688-9535 SEPTIC PLAN SUBMITTALS LOCATION: .�DD.��/� � NEW PLANS: YES $60.00/Plan REVISED PLANS YES $25.00/Plan C--� DATE: V l` DESIGN ENGINEER: When the submission is all in place, route to the Health Secretary SEPTIC PLAN SUBMITTALS LOCATION: NEW PLANS: YES $60.00/Plan REVISED PLANS: YES $25.00/Plan DATE: Is--) C, DESIGN ENGINEER: When the submission is all in place, route to the Health Secretary S COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a d DEPARTMENT OF ENVIRONMENTAL PROTECTION A r� ' Y TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_117 Brookview Drive_ North Andover_ Owner's Name:_Michael Mauger Owner's Address:_117 Brookview Drive_ _North Andover,Ma.01845_ Date of Inspection 6/5/2002_ Name of Inspector: Neil J.Bateson Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,Ma.01810_ Telephone Number:_(978)4754786_ 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 ils Inspector's Signature: e Date: 6/5/2002 P g _ _ 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 I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_117 Brookview Drive_ _North Andover— Owner: Manger Date of Inspection: 6/5/2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_117 Brookview Drive_ _North Andover— Owner: Manger Date of Inspection: 6/5/2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_117 Brookview Drive_ _North Andover— Owner: Manger Date of Inspection:_6/5/2002_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: Yes No —No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _No_ Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 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 (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone R of a public water supply well If you have answered yes to any question in Sectio n 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:_117 Brookview Drive_ _North Andover_ Owner: Manger Date of Inspection: 6/5/2002_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: i r 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?(If they were not available note as N/A) 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? �I The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _Yes_ _ Existing information.For example,a plan at the Board of Health. _No_ 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)(6)] i Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_117 Brookview Drive_ _North Andover– Owner: Mauger Date of Inspection:_6/5/2002_ 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):_440 Number of current residents:_4 Does residence have a garbage grind_er(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:_Jan.00 to Jan.02=20,100 Ft3 x 7.5=150,750 Gals./730 Days=207 GalsJDay_ Sump pump(yes or no): No_ Last date of occupancy:— Current-COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped two years ago,owner Was system pumped as part of the inspection(yes or no): Yes If yes,volume pumped:—1500_gallons--How was quantity pumped determined?_Measured tank._ Reason for pumping:—Inspect tank&tees._ TYPE OF SYSTEM _X Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank —Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: 4 years old. 5/11/1998 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:_117 Brookview Drive_ _North Andover— Owner: Mauger Date of Inspection: 6/5/2002 BUILDING SEWER(locate on site plan)X Depth below grade: 22" 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.): 4"PVC thru wall to septic tank.3"PVC in house.No leaks. SEPTIC TANK: X locate on site plan) Depth below grade:_10" 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 2" Distance from top of sludge to bottom of outlet tee or baffle: 25" Scum thickness: 2" 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:_19" How were dimensions determined:_Subtract scum&sludge depth to tee length._ 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,has gas baffle.Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP: locate on site plan) —( P ) 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.): ' � � yI� 1 I Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_117 Brookview Drive_ _North Andover- Owner: Manger Date of Inspection: 6/5/2002 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 level. Distribution equal.No evidence of leakage.Evidence of slight solid carryover._ 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 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_117 Brookview Drive_ _North Andover— Owner: Mauger Date of Inspection: 6/5/2002 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 75'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 inspectionxlocate 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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:_117 Brookview Drive_ _North Andover_ Owner: Manger Date of Inspection:_6/5/2002_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Lute all wells within 100 feet.Locate where public water supply enters the building. � 75' Porch D- Septic Boz Tank %A House Driveway B Water Meter A to Tank=18'3" A to D-Boz=25'7" B to Tank=2313" B to D-Boz=3313" a Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_117 Brookview Drive_ _North Andover— Owner: Manger Date of Inspection: 6/5/2002_ 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:_9/19/1995_ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per design plan_ I Tel: (978) 475-4786 Fax: (978) 475-5451 4 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems &Pumping Service 111 Argilla Road Andover,Mass. 01810 Title 5 Inspection Report Property Address: 117 Brookview Drive, North Andover Owner: Manger Date of Inspection: 6/5/2002 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations,and I hereby disclaim any further operation of your current septic system. c r Neil J. Bateson Bateson Enterprises,Inc. �I