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HomeMy WebLinkAboutMiscellaneous - 139 ROCKY BROOK ROAD 4/30/2018 139`Rock- yper_Br_-o-ok R-o--a.da:f • i �,� .r, ��4 f`-i S1„� _��� s.*t[ /' , � t f�'*•� a�...`LR�,.iw, '� y° .. ' `' � Y My�/, � . 01,"�,,, 3 • ' T MAP m' LOT ,# # r _ " PARCEL # STREET �ONSTRUCTI_QN—AP . , 1 HAS PLAN REVIEW FEE .SEEN rAID 7j YES NO�/Q��� �--�-. PLAN APPROVAL: DATE APP. BY_ �� DESIGNER: A 26--ye PLAN DATE.. CONDITIONS 77 WATER SUPPLY OWN WELL ' o `� WELL PERMIT DRILLER.___ ------__- - --- - .., . WELL TESTS: `HEMICAL DAZE APPROVED.-.---.__- BACTE 1.0 I DAIE OPPRUVEU BACTERIA II DA1-E APPROVED— COMMENTS: PPROVED!COMMENTS: FORM U AP5_ ROVAL': APPROVAL 1'0 ISSUE .SCE_ NU DATE ISSUED ���/�� BY !` — CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO -OTHER YES NU ANY VARIANCE NEEDED YES NO DATE:lz l7, FINAL BOARD OF HEALTH APPROVAL: _.. . _ SEPTI C`}SY�CM�.•: t1L.L—IMA ' y'(r - �i i \ f.'• _. :•fir. may-:.a . .9� :' .;r•:• ;, ".,...r � '�� - rt. 1 fes • ! _ t IS,THE INSTALLER LICENSED? 4, c NO TYPE. OF- CONSTRUCTION.: �' 1NEW' REPAIR •. ' .NEW CONSTRUCTION: CERTIFIED PLOT 'PLAN REVIEW YES NO e CONDITIONS OF..APPROVAL. YES NO (FROM .FORM U) YES NO `.,ISSUANCE,OF DWC PERMIT _ •, . ; ..::'::��," _ =_`• -' � ••f ~ ;IWC PERMIT NO. r'• � INSTALLER:. ...,BEG ININSPECTION ; NEEDED:EXCAVATION . INSPECTION: PASSED ' (p , By 'CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY .. .YES: t - 1A APPROVAL TO BACKFILL: DATE: BY .... . FINAL'.GRADING APPROVAL: DATE tw LOL(­ BYZ6�4� ' r FINAL CONSTRUCTION APPROVAL: DATE: BY y,F ` a a* n" ON �r S k7, 5 -� ski W p'>_°t +k • i.�lar- i� " f� ;: �,�1 x.�. —� 'g_,}i��t'. �" " t s�- °�� y ` °'"a7+ n "•. • a a- �.. _. k Mr "i i �r. t`" x h 5 ,��.- y- � -.� �a�.t;' ; �"`-�' ' s^+yy,. �.., &�,,��i ,�,. ., x. MAP # 3 ,� �. _far , , � k ! LOT • s, a PARCEL # TRE T ONSTRUCTI.ON APPROVAL, HAS PLAN REVIEW FEE .BEEN PAID' YES NO PLAN APPROVAL: DATE APP. BY DESIGNER: EJVGaa1, U PLAN DATE. CONDITIONS %�, 7`"-�S j er r. WATER SURLY: TOWN WELL WELL PERMIT DRILLER WELL TESTS: CHEMICAL DAIS APPROVED BAC IA I UA I E (IP RUVLU ... ....., BACTERIA II DAI'E APPROVED-. COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NU DATE ISSUED BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: DY: t, r _. IS THE INSTALLER LICENSED? '�� � � YE 5 NO , r TYPE OF- CONSTRUCTIO'l NEW REPAIR NEW CONSTRUCTION: , CERTIFIED PLOT PLAN REVIEW YES NO % CONDITIONS OF APPROVAL YES NO f (FROM FORM U) i.;•f:. - ,� ..i4 �.`•1 '..: �f'L ;,•... .:�_... ;, S yam. . . . r ' ISSUANCE •OF DWC PERMIT 'ry ' YES NO DWC PERMIT N0. INSTALLER: BEGIN INSPECTION YES N0: .` EXCAVATION .INSPECTION: : NEEDED: • f, .+ t � •1 t 4n5 _ is .`. .t\' Y, X� • • .''.r / � - - , � ; ,r..\ r > a• �a f r 1. .-. - - - `r 'i ,. ` ., •l ,. PASSED aw `` BY . < .:'CONSTRUCTION INSPECTIONS NEEDED: S AS BUILT PLAN }SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: BY FINAL. GRADING APPROVAL: DATE By DATE. BY • FINAL CONSTRUCTION APPROVAL: • - : Town of North Andover, Massachusetts Form No,a NORTh BOARD OF HEALTH Qi - o•4,"D I•,hO ��C // F w p ' t • ' «ir DESIGN APPROVAL FOR • ;�s�cMus t� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant ill �Cy�b; �2- ''G.'�LTY T2 Test No. T : Site Location 7- � . t� lk-j/ Reference Plans and Specs. y w CNGG�wbiVG 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. CHAIRMAN,BOARD OF HEALTH Fee �`�D ' Site System Permit No. Town of North Andover, Massachusetts Form No.3 BOARD OF HEALTH &ORTH 19 m DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACHUSEt Applicant - NAME ADDRESS TELEPHONE Site Location LI)T- °l pee) : Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. n/CHAIRMA OT-HE-AtTFI 0 Fee D.W.C. No. �-- APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: `{j % 7 LICENSED INSTALLER: �C're'r SIGNATURE: 9'�% �- `/ Ilt,, TELEPHONE# �7 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation_ As-Built? Yes No v Approval Date: �d PP �'. NORTH Town of 0 No. 652 1! �O - i: A� E O dower, Mass., I I ZY 19 T COCMICMEWICK ORATED P? 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........................... ... . N.om.oi..5............................................. Foundation has permission to erect........................................ buildings on ..........(%3..l...........to.C.'K. .......O rK.. ...0 ... Rough tobe occupied as.................................................. ./...r40.�e. .. ........ I ll... .......4.yy............................................ Chimney provided that the person accepting this permit shall in every respect conform to the term4 the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAR Rough ... ... . ....... .. ....... ........................ Service - BUIL SPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR. Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. 7 Smoke Det. a TOWN OF JV SYSTEM PUMPING RECORD DATE:_ oZ C 5 SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) v-6 ws-c-- tm G(4 DATE OF PUMPING: O c—�) QUANTITY PUMPED : 1 Q 0 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES L NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTBER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: t CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste r NEW ENGLAND ENGINEERING SERVICES INC March 9, 2000 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 139 Rocky Brook Road,North Andover Dear Sirs: Enclosed is a copy of the Title V report for the above referenced property. The systemap ssed our inspection. If there are any questions please call me at my office, 686-1768. Sincerely )?;-? r Benjamin C. Osgood r., E.I.T. President j 4 r {4 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 C6MMONWEALTH OF MASSACHUSETTS ..;,.i EXECUTIVE'OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02108 (617)292-6600 • 'rRUDY CO. ARGEO PAUL CELLUCCI DAVID A. �Govemor C SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM - PART A i CERTIFICATION Property Address: Roc 2D Name of Owner 6 HC" ' JA04 iV o,2T-r A va L)Er2. 444 Address of Owner: /?­y/,,V 42100014 /Zp, Vo1?7;V• /-Wvaek Date of Inspection: /�l� b0 Name of Inspectors(tubas Print) Beni amin C. Oagood,Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310-CMR 15.0001 Company Name: New England •Engineering Services Inc. MaiingAddress: 60 Beechwood Drive, North Andover, MA Telephone Numbe : 978-686-1768 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information.reported below is true,accurate and complete as of the'time of inspection. The inspection was performed based on my training and experience In the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Falls Inspector's Signature: Date: t� The System Inspector shall submit a cop of this inspection report to the Approving Authority(Board of Health or DEP)wlthin thirty(30)-days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department vKhvironmental Protection. The original should bo sent toVw system owner•and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS ' i revised 9/2/98 Page Iofli •Printed ttn ee o—l.,l Pe,.e, ! ,URkURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTA Property Address: 139 Rocky Brook Rd. CERTiFICATiON(continued) ` North Andover,MA ' W. Owner:Shell Kochanski : �,. , Date of Inspection:3/8/00 INSPECTION SUMMARY: Check A, •B, or D: Aj ' SYSTEM PASSES: 1 1 y 1 have not found any Information which Indicates that any of the failure conditions described in 310 CMR 15:303 exist. Any failure,,';'. criteria not evalgated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY.PASSES: One or more systemcomponents as described in the"Conditional Pass"section need to be'replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y.N.or ND). Describe basis of determination in all Instances. If"not determined',explain why not: _ The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspectloh;or the septic tank,whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.. The system will pass inspection if the existing septic tank Is replaced with a complying septic tank as approved by the Board of Health. i _ Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed pipe($) or due to a broken,settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced _ - The system required pumping-more thaniourtfines n yeardue to broken or obstructed pipe(s). The system%Vktpa$s" Inspection If(with approval of the Board of-Health): - broken p(pe(s)are replaced obstruction is removed revised 9/2/98 IPete:ortt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ? •'.•' PART A Tr• Property Address: 139 Rocky Brook Rd. CERTIFICATION(continued) North Andover;MA Owner:Shelly Kochanski Date of Inspection:3/8/00 , C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: : • j ' Coriditiohs exist which require further evaluation by the Board of Health in order to determine if the system is flailing to protect the.' ' public health,safety and the environment. 11 SYSTEM WiLL PASS UNLESS BOARD OF HEALTH DET1RMifkS IN ACCORDANCE WITH 310 CMR 15.303(1)(b)-THAT THE SYSTEIJ IS NOT FUNCTIONING INA MANNER WH•ICI-LY LLPRQTfCT,THE PUBLIC UEALTKAND SAFETY ANQ THE ENMIRONMENI. Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or , tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well: The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic.tank and soil absorption system and the SAS is leas than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not vefid). 3) OTHER revised 9/2/98 Pop 3of11 o n v5 SUBSURF�CE SEWAGE DISPOSAL SYSTEM iNSPECi16N FORM i PART A CERTIFICATION(continued) Property Address: 139 Rocky Brook Rd. North Andover,MA Owner:Shelly Kochanski Date of Inspection:3/8/00 ' } 'f,jx.: D. SYSTEM FAILS: You must Indicate either-yes"or"No" to each of the following; � 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. The basis for tws> determination Is identified below. The Bpard of Health should be contacted to determine what will be necessary to correct tha;fallure. Yes No Backup'of iewageietoiacility-or-ortemcomponent•due qoanovertoededorcbggedSAS•or:ceespool.' _ — 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 1/2 day flow. !Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s). Number of.tirnes pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. — — Any portion of a cesspool or privy Is within 100 fdet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy Is-within a Zone I of a public well. — Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for -coliform bacteria,volatile organic-compounds.ammonia nitrogen-and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No" to each of the following: The following criteria apply to large systems in addition to the criteria above: .. The system serves a facility with a design flow-of 1:0,000 gpd or greater(Large System)and the system is a significant throat to public health and''safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system•ie-within 200 feet ary�ee�urfaoedrinkPNy.water-suKlY•.. —.. _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further Information. revised 9/2/98 Pege4ertt `V �' � .IE .. ... :,.•ate 2 ' J SUBSURFACE SEWAGE DIItPOSAL SYSTEM'INSPECTIQN FORM =' PART 0 CHECKLIST Property Address: 139 Rocky Brook Rd. � { North Andover,MA " Owner:Shelly Kochanski Date of Inspection:3/8/00 = Check If the following have been dodo:You must Indicate either"Yes"or"No' as to each of the following: a`' Yes _ No � Pu ping information was provided by the owner,occupant,or Board of Health. V _ :Noneofthesystemcompoasnu.kawab"npna►padL(or-atlaasttwo•avaa"arid•the•systemhasAwoawcslaiagrw—sitiow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this Inspection. _ As built plans have been obtained and examined. Note If they are not available with NIA. -The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or Industrial waste flow. "The site.was inspected for signs of breakout. _✓ Absorption System,_ IAII system components,excluding the Soil have been located on the site. The septic tank manholes were uncovered,opened, and the interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: _ Existing information. For example,Plan at B.O.H. ` i _✓ Determined in the field(if any of the failure criteria related to Part C Is at issue,approximation of distance Is unacceptable) / (15.302(31(b)l _ The facility owner(and.octupaats.Jf different from ovunar),ruat&pwsddad,with lnfnrmatioo.an f SubSurface Disposal Systems. i 8 revised 9/2/9 Page serlt • SUBSURFACE SEWAGE DISPOSA PART i SYSTEM INSPECTION FORM "� *rz i SYSTEMf INFORMATION Property Address: 139 Rocky Brook Rd. North Andover,MA Owner:Shelly Kochanski ,. Date of Inspection:3/8/00 FLOW CONDITIONS RESIDENTIAL, Design flow:2�Lg.p.d.lbedroom. Number of bedrooms4design):, Number of Bedrooms(actual).—Y Total DESIGN flow 60[00 NYtuber of current residents: Al G6rbage grinder(yes or no)4-19 Laundry(separate system) (yes or no);L. If yes,separateJnspection.required • Laundry system Inspected ( es or no) , Seasonal use(yes or no): � Water meter readings,if evailgble(last two year's usage(gpd): Sump Pump(yes or no):,/" 1l Lest date of occupancy: ea, eev COM M ERCIAL/INDUSTR IAL: Type of establishment: Design flow: apd (Based on 15.2031 Basis of design flow 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)_ Wpter meter readings,if available: Last date of occupancy: OTHER:(Describe). Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of informatiop: System pumped as part of inspection:(yes or no) O If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM _ Septic tank/distribution boxisoil absorption system Single cesspool Overflowcesspool :. Privy Shaved system(yes or no) Of yes,attach previous Inspection records,If any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date Installe"fknown)-and sourceof4waimation: -• �_.._� /L. ..Wis V/CT- Sewage odors detected when-arriving at the site:(yes or no) (' I I revised 9/2/98 Page 6ofit • suttSPRFACE SEWAGE DISPOSAL SYSTEM WSPECTiON FORM • '=?h PART C Property Address: 139 Rocky Brook Rd. SYSTEn INFORMATION(continued) ' !North Andover,MA Owner:Shelly Kochanski ; Date of Inspection:318100 . - ,�. v, mfr;• BUiLDWG SEWER: (Locate on site plan) Depth below prude: PA Material of construction:—cast iron�0 PVC_other(explain) S. Distance from private.water supply well or su tion line4 Diameter Comments:(condition of joints,veriting,evidence of fsakage,-etc.) - /�i/'r /A/ A1XJvV low/n/i�0.t/ I"V oto 54�r�tE.yi SEPTIC TANK (locate on site plan) Depth below grade: Material of construction:_concrete_metal_Fiberglass _Polyethylene—other(explain) If tank is(netal,list age_ 1s.age•conflrmed by Certificate of Compliance_(Yes/No) Dimensions: /vim CTrALK7AV-S Sludge depth: Distance from top of sludge to bottom of outlet tee orfraffie:1-3-Z - -- Scum thickness: '3/f Distance from top of scum to top of outlet tee or baffle:,_ Distance from bottom of scum to bottom of outlet tee or baffle: /Cl How dimensions were determined:A4tW QF -%:-7I4K Comments: (recommendation for pumping,condition of inlet and outlet tees or-baffles,depth of liquid level In relation to outlet invert,•structur". tegrity, . evidence of leakage,etc.) T!"A)A /N %ODD 4f0AJp/770it/ 5CH s/O PUC 70�-5 /4J 6.660 6vN I->177 D Al. ivy &I/n eA.1 CC- rA A&CZ: vIZ_ OCJn .PEc 0-44E-lO /�STi/LL I u G 2l S fLs 7'1> Qj=- afeA D G /1 N GREASETRAP• (locate on site plan) j 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 oudet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of fiquid.level in relation to outlet Invert,structural integtfty, evidence of leakage.etc.) I revised 9/2;/98 Pate 7ofit SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO(#M PART C SYSTEM INFORMATION(continued) ` Property Address: 09 Rocky Brook Rd. ? North Andover,MA Owner:Shelly Kochanski Date of Inspection:3/8/00 TIGHT OR HOLDING TANK:AW(Tank must b¢pumped prior to,or at time of.Inspection) (locafa on site plan)" I ; Depth below grader_ `_T Material of construction: metal -Fiberglass_Polyethylene_other(explain) _cPncrete ;'a •Dimensions: Capacity: gallons Design flow: gallons/day Alarm present E. Alarm level: Alarm in working order:Yes_ No_ Data of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:• (locate on she plan) Depth of liquid level above outlet invert: ' Comments: (note if level and distribution is equal,evidenoo of solids carryover,evidence of leakage into or out of box,etc.) — - —— ,60X i,v ; 67220P ev,IJo770 AJ. A) COO 91- '4/o Epi . ce J-F-AAL% /icJ c7iZ ds PUMP CHAMBER 41- on site plan) ) ( pl 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,ate.) revised 9/2/98 Page a of 11 iY • .r SUBSURFACE SEWAGE DISPOSALYSTEM INSPECTiON FORM ;,;',r�.• ' • Pro PART Property Address: 139 Rocky Brook Rd. SYSTEM INFORMATION(continued) _ , North Andover,MA Owner:Shelly K ` ochanski Date Of Inspection:318/00 SOIL ABSORPTION SYSTEM(SAW: lar if ossible•excavation not required,location may be approximated by nomintrusivs methods) (locate on site p qu , If not located,explain; Ty e. leeching pits;number:_ leeching chambers,number:_ leaching galleries,number:_ _ leaching trenches,number,length: &6 leeching fields,number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) Ae'6A ear fiCLD L'00AS /!/y2vi i41_ AAD P-9 A.0 V Cr OAL410 sa I Z o /9NL�dAL ' �IGG-ETA?1�,t1 -- CESSPOOLS: (locate on site plan) Number and configuration, Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensioha of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil',signs of hydraulic failura,4evel of ponding,condition of-vegetation,etc.) PRiVY: (locate on site plan) Matedels of construction: Dimensions: Depth of solids: Comments: (note condtion of soil,,signs of hydraulic failure,level of ponding,condition of vegetation;etc.) revised 9/2/98 Paee9of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART C SYSTEM INFORMATION(continued) Property Address: 139 Rocky Brook Rd: North Andover,MA 'Owner:Shelly Koehanski Date of Inspection:3/8/00 , ,SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least tJvo permanent reference landmarks or benchmarks I locate all wells within 100'(Locate where public water supply comes Into house) i F1 00c, vJ SCPTt THnJK i VENT a revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM i I = 1 PART C Property Address: 139 Rocky Brook Rd. SYSTEM wFORMATiON(corrtirxied) uL, r North Andover,MA Owner:Shelly Kochanski Date of Inspection:3/8/00 NRCS. Report name nth SyQ ess& x CojA)a 1-1A014—> itl72TH&R.y ►t�Al2�[' Soil Type^ C N A-i2 Lro A) I Typical depth to groundwater y(o•U' I USGS Date website visited Observation Well checked i Groundwater depth: Shallow Moderate Deep SITE EXAM Slope �v Surface water /vow C Check Cellar yp Song A Shallow wells nDAJC Estimated Depth to Groundwater f1:51 Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site(Abutting property,observation hole.basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) �� Sol t, MAPS t w»e c jq j-F w IfT If Dii-777 a� PL►4Us WftTER f- OC•��..•%C I revised 9/2/98 Page 11 of 11 Plan Of Land North Andover, Mass. showing "As—Built " Foundation Location Lot 9 — Rocky Brook Road Prepared For Ogunquit Homes, Inc. Scale: 1" _ 40' Date: November 11, 1996 Zoning District: R— I �0�' 26 Lot 9 (Residence 1 Dis tric t) (previously Approved Subdivision & 46,280 S.F.fI Under R-2 Zoning) 1.06 Acres +/— Note: Property line data taken from a Definitive Subdivision Plan Of "Rocky Brook Estates" By Thomas E. Neve Associates, Inc., Dated November 24, 1986, revised to August 30, 1988. �o �g In my opinion, the proposed Dwelling is not in a Dc0 Flood Hazard Zone as shown on the U.S.D.H.U.D. Existing ConC ��� Flood Hazard Boundary Maps, Community Panel Foundation0� No. 250098 0007 C, Revised to June 2, 1993. s l Top Of Foundation hereby certify that the foundation on this property ..•••'•• � �. Elea = 138.35' ; is located as shown on plans and complies with the zoning requirements o fkown of North Andover, r �t� Massachusetts. � ON �, O0srs, N&31 essional Land Surveyor O�� •�� � hof P���A�O,�a� \ `so, 29 56 O �J O Thomas E. Neve Associates, Inc. p Engineers — Surveyors — Land Use Planners $ C� 447 Old Boston Road — U.S. Route 1 Topsfie/d, Massachusetts 01983 887-8586 NORTIr BOARD OF HEALTH � p ♦ s 120 MAIN STREET TEL. 682-6483 C'H„ NORTH ANDOVER, MASS. 01845 Ext23 March 29, 1994 New England Engineering Services, Inc. 33 Walker Road, Suite 22 North Andover, MA 01845 Re: Lot #9 Rocky Brook Road Dear Ben: This is to inform you that the proposed plans for site referenced above have been disapproved for the following reasons: 1) Need additional soils tests in system. 2) Note that stone must be double washed. oAZ-) Perc rate cannot be interpolated. Indicate elevation of groundwater in soil logs and on profile. Please show pertinent topo on lot 10 relative to leach area. If you have any questions, please do not hesitate to call the Board of Health Office. Sincerely, - Sandra Starr, R.S. Health Sanitarian /c7P NEW ENGLAND ENGINEERING SERVICES INC April 8, 1994 t V'P-, AW j It North Andover Board of Health Main Street North Andover , MA 01845 Attention: Sandy Starr Dear Sandy: Enclosed is a copy of a revised septic system for Lot No . 9 Rocky Brook Road . Items 2 - 5 in your letter dated March 29, 1994, have been corrected on the plan. Item No . 1 has been taken care of by moving the system so it falls over two deep water tests and two percolation test sites. If you have any questions, please do not hesitate to call . Yours t/r/uA/ly, 1. l,/ en min C. �od Jr . Enclosure I I 33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768 PLAN REVIEW CHECKLIST ADDRESSZENGINEER GENERAL 3 COPIES STAMP LOCUS v NORTH ARROW t,/ SCALE CONTOURS v PROFILED SECTION BENCHMARK SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER 'L/ WELLS & WETLANDS ✓ WATERSHED?_ DRIVEWAY Elev) WATER LINEy' FDN DRAIN 1_� SCH4 0 .Z TESTS CURRENT? SEPTIC TANK r / MIN 1500G ✓ . 17 INVERT DROP GARB. GRINDER(+200% EDF) 25 ' TO CELLAR MANHOLE TO GRADE ELEV GW D-BOX SIZE # LINES FIRST 2 ' LEVEL STATEMENT ,� /V INLET./,V,/7 - OUTLET _ �7 (2 11 OR . 17 FT) TEE REQ'D?�% D LEACHING / M ERV 1/ IN 660 GPD RES E AREA 41 FROM PRIMARY./ 2% SLOPE 100 ' TO WETLANDS / 100 ' TO WELLS -' 4 ' TO S.H.GW 35 ' TO FND & INTRCPTR DRAINS L,"" 325 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY v MIN 12" COVER r/FILL? 4:-- (25 ' if above natural elev 10 ' if below) BREAKOUT MET? TRENCHES ,V MIN 660 gpd �- SLOPE (min . 005 or 611/100 ' ) >31COVER?-VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61 )_tz IS RESERVE BETWEEN TRENCHES? L""' IN FILL? MUST BE 10 ' MIN. L_ 4" PEA STONE? BOT X LDNG + SIDE ,� X LDNG� ')= TOT (L x W x #,) (G/ft2) (DxLx2x#) (G/ft2) Copyright 1993 by S.L.Starr SEPTIC PLAN SUBMITTALS LOCATION: I NEW PLANS: YES $60.00/Plan REVISED PLANS: YES $25.00/Plan DATE: DESIGN ENGINEER: When the submission is all in place, route to the Health Secretary TOWN OF NORTH AP'!C0 R/ BOARD OF HE"kLTN Fo-CT 18 1996 �YNOZ FORM U - VERIFICATION 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***************** APPLICANT: UJ/ Av'­t'�G Phone Z LOCATION: Assessor' s Map Number c� 0 Parcel % d Subdivision �fl � /C 'OA) J�Lot(s) Street St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS Date Approved Conservation Administrator .Date Rejected Comments U�St4 il� ra( 4 a CR Date Approved g l Q Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments I I �I Public Works - sewer/water connections driveway permit Fire Department Received by Building Inspector Date THOMAS 'E. NEVE ASSOCIATES, INC. Engineers• Land Surveyors • Land Use Planners ������ O� � �ROM OUEL 447 Boston Street US Route #1 TOPSFIELD, MASSACHUSETTS 01983 DATE JOB NO. (508) 887.8586 January 19 , 19961 684 FAX (508) 887-3480 ATTENTION :! v Y Sandy. Starr, NABH RE: TO Sandy Starr Lot 9 Rock Br ok Road, SSD North Andover Board of Health O��R ORTHA .� H BOARM7 f 9x > WE ARE SENDING YOU Xl Attached ❑ Under separate cover via the. o 'ng items: ❑ Shop drawings [X Prints ❑ Plans ❑ Sa pies ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 3 11/28/95 4 - 68 Lot 9 Rocky Brook Road Septic Design F ISIMIAW AS PlAffn4 A BOARD OF HEALTH ADS owl awp THESE ARE TRANSMITTED as checked below: )0 For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ .For your use ❑ Approved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: PRODUCT 240.2 Ees Imo.,Groton,Mass 01471. If enclosures are not as noted, kindly notify us at once. - 'O - '.y,r, c - - - -:�. - ...i`��� �LiJ` :to ♦ J _! ! i.,ti ). r �v! tj.i�JC w7u� ' _ ,:PFS• � �t ^...r � . � _ .t '•[•. . HTJA=H JO ORAOS 0 - .•I .-LI .. J!'�' :� it� + i� •'�. .�.�, �� 1 jr 3 a 4<.,�,� _. 3. .•ua� + 79�r`t; i �Di -r5 �L �L:.[ , v 1 �'.r iii%_. .+:a�'•;., '�.�:�F'': . .. '4 JS>.'� 4 - -•-- --— - ,i�� � ,. . - - - - - - - A9i ';r CT Y`:CQ yy PLAN REVIEW CHECKLIST ADDRESS f�-� �dG � � - ENGINEER GENERAL 3 COPIES f/' STAMP &"� LOCUS L/ NORTH ARROW ' SCALE C------" CONTOURSr-� PROFILE SECTION L/ BENCHMARK SOIL & PERCS ,I ELEVATIONS WETS. DISCLAIMER/ WELLS & WETS WATERSHED? /�/O DRIVEWAY L-----,(Elev) WATER LINE,/ FDN DRAINc_-- i SCH40 L, TESTS CURRENT? c/' SOIL EVAL- = i . SEPTIC TANK GG MIN 1500GC-� . 17 INVERT DROP v GARB. GRINDER(+200% EDF) 25 ' TO CELLAR V-"- MANHOLE ELEV GW # COMPS. D-BOX SIZE # LINES 3 FIRST 2 ' LEVEL STATEMENT INLET/3 4, 4Z - OUTLET )34,ZZ = ,ZU (2" OR . 17 FT) TEE REQ 'D?yo LEACHING MIN 660 GPD. ^'� RESERVE AREA :/� 4 ' FROM PRIMARY?4-'� 2% SLOPE 4-- 100 ' TO WETLANDS ✓''`100 ' TO WELLS 1-� 4 ' TO S .H.GW L---' (5 ' >2M/IN) 35 ' TO FND & INTRCPTR DRAINSL,---' 325 ' TO SURFACE H2O SUPP L-- 4 ' PERM. SOIL BELOW FACILITY L-�MIN 12" COVER &-- �FILL? `'� (25 ' if above natural elev; 101if below) BREAKOUT MET? TRENCHES / / MIN 660 gpd SLOPE (min . 005 or 6"/100 ' ) L" SIDEWALL DIST. 3X EFF. W OR D (MIN 6 ' ) (,/ RESERVE.BETWEEN TRENCHES? `f IN FILL? C/ MUST BE 10 ' MIN. !/ 4" PEA STONE? ✓ VENT? C--- (>3 ' COVER; LINES >501 ) BOT 7Z + SIDE 2526 X LDNG TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright 0 1995 by S.L. Starr t) _ Sheet of 7Z `! ® � y BOARD OF HEALTH U &,_ TOWN OF NORTH ANDOVER L )RFACE DISPOSAL DESIGN REVIEW PERMIT # DATE RECEIVEDa / r/ -- ASSESSOR a S MAP_ PARCEL # LOT # 9 STREET --- - REVISION DATE i %=ITU TIONS OF APPROVAL: APPROVED DISAPPROVED A J✓&e-D /� D i rra Av,4 G �6i� 5 �G`5 T;� //t) /V07-6' T/7 � STD rVG-' /�'1 UST j C �CJBG UJ/35/�' �j -pCl2 C --F_/97-2�-- Cl-/VN© 7- -- »!V7-67,e 77,!5)A) 6 i'= �' Dr��J4 1.0/ T �, —d 6�5 (9z- o 1U -7-F2a,G-1 c'-4!��-. b�✓ � �G / 5 65- 6ou>