HomeMy WebLinkAboutMiscellaneous - 323 DALE STREET 4/30/2018 323 DALE STREET
2101 000.0 _
1
TOWN OR NORTHH-ArfD VER,,
SYSTEM PUkPING "c6R S �'9•
�- ft- r32003
1,57-EM OWI4(ER & ADDRESS SYSTEM~L'OGATIOIll I
(enmple: left front or house) _
r
DA TE OF PUMPINC: QUANTITY PUMI'CD/S66C:.�LLc��,
VSSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE; ROUTINE . EMERGENCY
c,IIlr:RVATION&
GOOD COMD]ITIOM FULL TO Covrit
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK.,.
EXCESSI-VE SOLIDS FLOODED"
SOLIDS CARRYOYER iU.WHER (EXPLAJN)
i 1'a'IlEll�i PUM Pc-b BY: • �'e -, ' f
C'U:►-I'yI EATS:
O1TIWTS TRANSPERRED TO:
Address : Title of File
Page _ of
Date File Open:
Date file dosed:
Doc Document/Action Title Date of T
action 6�efer to other Purpose of DocuMent/Action and note
fWum. Document/ doeunvent/ --
Action De artment
-» -----•»moi
Board of Appeals — Board of Heal h Planniang.Board _ Cons Tommision — Bi �il.ding Departrnen;t -'
ER FORNI 4,SyS,rtM
-409
CURRI
SEPTIC & DRMN SERVICE
11949
(97S) 7/7-1-2"7_2
upIt's!AT.,-,
MASSA(A I VSF I FS
YREALPOWING ALECURP
I J,oCAl10,NC LO k
G
01 4
DA'l is 01 PI-AVIN6 01 'AN"ITIV ll[ :�
DO_
YES No )-f-s
NO SEPTICIMNK:
J
FAI) BY: (j:RR I ER SEA"I'lQ&
CONI f:N. I'S I RAlq,-)f'L R R 1,1) TO,.
;DA rT., 7- INSPECTOR:
y
FEB 3 :
y 01
DALE 5����7" •
INVERT ELEVATIONS
50.00'
r.
AT HOUSE 193.75
TANK INLET . . . /93. L
TANK OUTLET . !92.88
PUMP INLET . . _ 192.83
EAg��
1 x.37' PUMP OUTLET _ 192.7(0
�0 DIST. BOX INLET . . .. _ _ 2D 4. &4
DIST. BOX OUTLET . . .. , 204.24
END OF LINES . . . . . .. . .. .. . . _ _._.202.0&
6,
r
202. 99-
END OF LINES
END OF LINES _ 204.09 *3�
Q ��0 S��JC•`�f.. ,� .
�o ... `�" PvMP "' � AS - BUILT DRAWING
. SUBSURFACE SEWAGE DISPOSAL SYSTEM
/c
10K
Q SCALE ! 0 = 40' DATE ; At)6U!57' 9, 1984
p. 9,
OWNER-' 2ACUAkY e6pL-(v Coepc)eATIOki
gox IA LOCATION: LA-f !A OALE srCEE�
44,(b 5 S.F I A10)e N AAIDOVEe , MASS.
andover
pO \\COt1SUIt� nts 's` WILLIAM
\ ;
213 Broadway,Methuen, Mass.
Tei, 687- 3828
THIS DRAWING IS NOT TO BE CONSTRUED AS A GUARANTEE
i
THAT THE SYSTEM WILL FUNCTION PROPERLY. �
O
andover
C onsultants 213 BROADWAY
inc.
METHUEN, MASSACHUSETTS 01844
(617) 687-3828
�`a'ia� ZPy�xrineehe DATE (54
TO : NORTH ANDOVER HEALTH DEPARTMENT
TOWN HALL, 140. ANDOVER, MASS .
RE : SUBSURFACE SEVIAGE DISPOSAL SYSTEM
NO. ANDOVER, MASS .
I hereby certify that I 4ave inspected the construction of the
disposal system at ( o-r- I LE North Andover, Mass .
and that the location and elevations are shown on the As-Built
Drawing dated ALi6w.
ANDOVER C SUT1
William S . Malo
Registered San ax.1an
This certification is not to be .construed as a guarantee' of `the'"system.
I
WATERSHED RESIDENTS QUESTIONNAIRE
1. NameJ --�� — r n C;
2. Street Address `� J)C`�e_ J t
3. How many members are in your household? 3
4. What type of sewage disposal system do you have?
❑ cesspool
1,'�septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for our sewage disposal system on file with the Board of Health?
❑ yes ❑ no do not know
6. How old is your sewage disposal system? 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewaage/disposal system been rebuilt or repaired?
❑ yes LV no ❑ do not know
If yes, approximately how long ago? years. What was done?
8. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years never
�) 9. Have you had any problems with your sewage disposal system? ❑ yes 4�nno
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine dishwasher - V� garbage disposal
dehumidifier drain sump pump toilet ✓
A11roof/pavement drains shower/bathtub —A/-
11.
. Please state the brand and ty a (liquid or powder) of detergent you use for:
dishwasher C n C'r t� ��'--
clotheswasher L1_ S V_ —V (`d
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre
Ly' more than 1 acre (Specify) 1 ,— acres
13. How often do you fertilize your lawn?
No. of applications per year 4
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
C ► \f Y11 \L
. heck here if your lawn is maintained by a professional landscape contractor.
Board of Health SEPTIC SISTEH
North- And. over�Haaa.
INSTALLATICK CHECK LIST LOT"i ` A
pQ DATE DISAPPROM
EXCAVATION Ob FAIL
easonst
j
,i FAIL M
1. Distance Tot
no Wetlands
b. Drains
Co. Well
2. Water Line Location
3. No PVC Pipe
(/ 4. Septic Tank
a. _Tees _Length & To Clean Out Covers.
b. Cement Pipe .to Tank an Both Sides of Tank
5. Distribution Box
a. Covers & Box - No Cracks
b. All Lines Flowing Equal Amounts
c. No Back Flow
6. . Leach Field or Trench
no Dimensions
b. Stone Depth
c: Capped Ends
.i d. Clean Double Washed Stone
?. Leach Pits
a. Dimensions
b. Stone Depth
c. Splash Pads
j d. Tees
e. Cement Pipe to Pit - Both Sides
f. Clean Double Washed Stone
8. No Garbage Disposal
' 9. Final Grading Inspection
10. Barricading Covered System
11. As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location with Regard-to Pere Test
,{= d. Elevations
e. Water Table
4
Board of Eealth
.gcrt). :,,ndover,Mass
SUBSURFACE DISPOSAL DFMGm CHECK LIST
LOT
APPROVED DATE
DISAPPRQPED �
Provided*. Reasons:
Title V FAIL CK •.
Reg 2.5
e submitted plan must shox as a min4m„ms
the lot to be served-area,dimensions lot #,abntters
location and log deep observation hoes-distance to ties
Location and results percolation tests-distance
OS
design calculations & calculations showing required leaching area
location and dimensions of system-including reserve area
existing and proposed contours
g) location any vat arsas -Atkin 100' of sewage disposal system or
disclaimer-check wetlands mapping
h) surface and subsurface drains within 100' of sewage disposal
system or disclaimer
i) location any drainage easements ifs thin 200' of sevage disposal
system or disclai�r=r-P'►nnni ng Board files
3) know sources of water simply vi.thin 200' of savage disposal a
system or disclainer
j — — --- — k location of sny proposed-well to serve lot-100' from leaching facili
MVno
tion of -water lines on property-10' from l�ehing faeility—
rm';� tion of benchmark
eways
age disposals
VC to beused 3n constructions tic tankile of system elevations of basement, plumb, pipe, ep
stribution box inlets and outlets, distribution field piping and
tber elevations
maximum ground water elevation in area sezage dis_or other
system
er
s) plan must be prepared by a Pro es conal Engine
plans
professional authorized by law
Reg 6Tank
Se�xtic s
a) capacities-150% of flow, meter table, tees, depth of tees,
access, pumping
cleanout
' from cellar X11 or inground sing pool
d) 25' from subsurface drains
Reg 10.2Distribution Boxes
slope greater than 0.08
Reg 10.E LI b) mop
s.
Subsurface Design Check List Page 2
FAIL Cg
Leaching Pits
Leaching pits are preferred where the installation is possible
Seg 11.2 a) calculations of 1 g area-�ni 500 sq ft
11.4 b) spacing
11.10 c) surface a 2%
11.11 d) cover mat al
de) 2 f x2 1 splash pad
f) tee elbow
g) ends in pipe from d-box to pipe
Leaching Fields
teg 15.1 a) no greater th- 20 minutes/inch
b) area- 900 sq ft
15.4 c) cons on of field
15.8 d) our a drainage 2 %
3.7 e) from cellar vall or inground swimming pool
chin Tenches
teg 14.1 c c tions o leaching area-min 500 sq ft
14.3 ing-4 ft min 6 ft with reserve between
14.4 c) sions
11 .6 c truction
14.7 stone
114.10 f) surface drainage 2%
Dom_ ll Slo e
s ope y x = to be shown)
b) y/x X 150 = (to be shown) _
.eg 9.1 a) royal
9.6 b) tared-by power
of
T SUBSURFACE DIS,"OSAL DIZIS' CSE LIST
LOT # 1 VA.L<-- ST
APPROM DATE S b ,f3 DISAPPROVED DATE
L
Provided: -Reasons:
Title V FAII, Cg
Reg 2.5 a submitted plan must show as a minimum:
the lot to be served-area,dimensions lot #,abutters
location and log deep observation Mes-distance to ties
location and results percolation tests-distance to ties
design calculations & calculations showing required leaching area
e ocation and dimensions of system-including reserve area
existing and proposed contours
g location any wet areas within 100' of sewage disposal system or
disclaimer-check wetlands mapping
surface and subsurface drains within 1001 of sewage disposal
stem or disclaimer
location any drainage easements within 100' of sewage disposal
system or disclaimer-Planning Board files
3) known sources of water supply within 2001 of sewage disposal a
system or disclaimer
location of atq proposed well to serve lot-1001 from leaching facilit,
location of water lines on property-101 from leaching facility
location of benchmark
n) driveways
garbage disposals
no PVC to be used in construction
q) profile of system-elevations of basement., plumb, pipe, septic tank,
distribution box inlets and outlets, distribution field piping and
other elevations
r maximum ground water elevation in area se-,-age disposal system
s) plan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plana
Reg 6 Sevtie Tanks
a) capacities-150% of flow, water table, tees, depth of tees,
4caccess, pumping
(b) cleanout
) 101 from cellar wall or inground swimming pool
251 Brom subsurface drains
Reg 10.2 Distribution Boxes
slope greater than 0.08
Reg 10.4 b) MW
5�1� ALL* ace �1+m Ch :y List Dtge 2
FAIL OT
Leaching Pits
Leaching pits are preferred where the installation is possible
Reg 11.2 a) calculations of lea area- *� �*►� 5c}0 sq ft
11.4 b) spacing
11.10 c surface 2%
11.11 d� cover mate
e) 2'x2'x4" lash pad
f) tee at bow
g) no b ds in pipe from d-box to pipe
Leaching Fields
Reg 15.1 a) no greater than 20 minutes/inch
area-mom 900 Bq ft
15.4 construction of field
15.8 surface drainage 2 %
3.7 20' from cellar wall or inground suiumdng pool
Leachina SWenches
Reg 14.1 a) c culatIons o eaching area-min 500 sq ft
14.3 b) spacing-4 min 6 ft with reserve between
14.4 c) dim mai,
14.6 d) cons ction
14.7 e) s e
1.1;.10 f face drainage 2%
Douahill Slope
r—slope y x = to be shorn)
b) y/x X 150 = (to be shown)
-
g
Reg 9.1 a) v9.6 b) d-by power
.y Any�` ny appeal sha?t '. ..
�4 within:(20) days
T p;W N OF N O R T H ANDOVER date Of filin of this r�c ;ce
M A S S A C H U S E T T S in the Office of the Town
JA's' 31iQ 5;' ( Clerk.
f NORr 1
3 �
.. Ti °..ao.•"•`t9
,SSACHU`ES
January 30, 1984
Mr. Daniel Long, Town Clerk
Town Office Building
North Andover, Ma 01845
RE: LOT 1 DALE STREET-Designer Homes, Inc.
Special Permit in the Watershed District
Dear Mr . Long:
The North Andover Planning Board held a public hearing on
Monday evening, November 21, 1983 in the Town Office Meeting Room
upon the application of Designer Homes, Inc. . The hearing was
advertised in the North Andover Citizen -on November 3 and 10, 1983
and all abutters were notified- by mail as to -the time :.-and place of
the hearing. The following members- were present: John- J. Burke,
Erich W. Nitzsche, and John A. James; Jr . ,Clerk.
The petitioner seeks a Special -Permit under Section 4. 133 (d) of
the North Andover Zoning By Law which requires a Special - Permit
granted from the Planning Board to allow construction _ to -occur
within 100 feet horizontally from .the edge of all tributaries of
Lake Cochichewick. The proposed construction activity will be
adjacent to, but not in a wetland tributary area. The site is
known as Lot One Dale Street and is located on the south side of
Dale Street with a total area -of 43, 560 square feet, and-150 feet
of street frontage in- the Residential-2 (R-2) zoning- district.
The construction of the proposed two story, single family, wood
frame dwelling will have the following dimensions: 64 -feet front;
28 feet deep; 27 .5 feet height; including associated structures.
The application was previously approved in June 1983; however, due
to modifications on the site plan, a new petition was required by
the Planning Board.
Mr. Alexanian, representative and applicant for -Designer Homes,
Inc. , appeared before the Planning Board and provided the following
testimony regarding the proposed work shown on the site plan
entitled "Subsurface -Disposal System for Lot 1-Dale Street, North
Andover, MA" by Kaminski & Associates, Inc. , dated October 25, 1982
revised through October 20, 1983 .
LOT 1 DALE STREET-Designer Homes, Inc.
Special Permit in the Watershed District NfC�.
January 30, 1984
Page 2 Jtf Qp
!� J '.y� �li?
A.R � t 4
-The property described lies within the town' s designated Watershed
Zoning District. A previous Special Permit was granted on June 30,
1983 regarding the same lot . Subsequent modification of the site
plan requires a new application, public hearing and review.
-The modification on said plan shows the dwelling situated closer
in proximity to the Westerly property line and Dale Street away
from the wetland tributary to the East. As a result of this change
on plan, less .fill will be required on site, thereby minimizing the
increase in grade on the lot or creating undue land disturbance.
-The septic system location and design shall remain the same as
depicted on the original site plan.
-No work is proposed or will occur within the 25 foot wetland
buffer area on the East side of the property.
The following members were present and voting at the January
23, 1984 meeting when the board rendered its decision: Michael P.
Roberts, Vice Chairman, John A. James, Jr . , Clerk, Erich W.
Nitzsche, and John J. Burke.
Upon a motion made by Mr . Burke and seconded by Mr . Nitzsche,
the Board voted unanimously to grant the Special Permit requested,
subject to the following conditions:
1 . Upon- completion of-_.finial-- grading and construction,- a certified - -
' as built' plan -from -a Massachusetts - Registered- Professional.
Engineer and/or.-Registered -Land Surveyor shall be. submitted to the -
Planning Board--for- review -of compliance._with said approved- plan. .
Certification--shal-1- state that the:-' as built' grading, - construction -
and - septic system complies in all-- respect to said plan and
condit-ions set forth=-in -this decision.
2. No vegetation, including trees -or topsoil shall be disturbed
within 25 feet of the East property line delineated on the
referenced plan;- according- to Section 4.133, Par.3 (c) Watershed
District in 'the Zoning. Bylaw.
3 . Erosioncontrol measures shall be placed 25 feet from - the
easterly lot line-- for the- entire length of the property -and along
the frontage of said lot, and shall be continuously monitored and
maintained- until vegetationhasbeen stabilized.
4. Any excess water flowing from Lot 2 Dale Street . shall continue
its ' natural course -across -Lot 1 Dale Street- away from -the leach
field on Lot 2.
LOT 1 DALE STREET-Designer Homes, Inc. -"it ; ; :" t
Special Permit in the Watershed District,,,' .
y 30, 1984 ' �.
Januar ,
Page 3 t o8a
54
i
5. Any deviation from the approved plans and conditions will be
considered due cause for the rescission of this permit granted by
the Planning Board.
6 . No construction activity will be allowed until March 15, 1984,
subject to review of the Planning Board, at which time, due to
weather conditions, the March 15, 1984 date may be extended.
In granting the Special Permit, the Planning Board finds, pursuant
to Section 10.31 of the Zoning Bylaw, Conditions for Approval of
Special Permits, that the following conditions are met:
a) The specific site, Lot 1 Dale Street, is a suitable and
appropriate location for a single family residential use due to the
facts and information presented by Mr . Alexanian that no
environmental ill effects will develop in the Watershed District
from on-site development.
b) The on-site residential use is a continuation of -the permitted
uses in the R-2 zoning district and will not adversely affect the
Watershed District or any surrounding residential neighborhood.
The development is engineered and designed to minimize impacts to
the wetland tributary.
c) The ingress- and ..egress - of -the lot presents - no -nuisance- or -
serious -hazard -to vehicles- or . pedestrians.
d) - Adequate and appropriate facilities, such as public -water and
an approved septic system; will be provided -- for the proper--
operation and occupancy -of- the proposed residential use.
e) - Based .on site -visits, the public hearing process, and review
and input by appropriate- town boards and departments, the -- single
family use in the Watershed District is considered to be in harmony
with the general purpose and - intent of -the Zoning Bylaw. -
Sincerely,
FOR THE-PLANNING BOARD-
6_r)
OARD--� q
.ted
Michael-. P.- Roberts,
Vice-Chairman
jw
S � .�.�
=� I
%y>
LAW OFFICES OF
PHILLIPS, GERSTEIN, HOLBER, LAFLAMME & MIGLIORI
A PARTNERSHIP WCLUDING A MASS, PROFESSIONAL CORPORATION
HERBERT P. PHILLIPS, P.C.• 25 KENOZA AVE.
MICHAEL A. GERSTEIN' P.O. BOX 909
STUART M. HOLBER•'• HAYERHILL, MASS. 01830
GERARD R. LAFLAMME, JR.•• TEL. (617) 374.1131 / 373.4804
MICHAEL J. MIGLIORI-
KAREN L. FIORELLO•••• N.H. ADDRESS:
2 STILES RD., SUITE 212
SALEM, N.H. 63079
VINSON W. GRAD*
GARY H. LANTNER•
MAINE ADDRESS:
(OF,COUNSEL) 155 SACO AVE. - P.O. BOX W
OLD ORCHARD, MAINE 04064
' ADMM'ED IN MA. ONLY
•• ADMITTED IN MA. k N.H.
REPLY TO HAVERHILL OFFICE ONLY
••• ADMITTED IN MA.. N.H. & ME.
•••• ADMITTED IN MA. k FLA.
Town of North Andover
North Andover
Massachusetts
This is to confirm that Zachary Realty Corporation, the owner of Lot 1 and
2 Dale Street, North Andover, Massachusetts, said lots being a portion of
that conveyed to it on October 21, 1981 and recorded with Essex North
District Registry of Deeds in Book 1543, Page 35 agrees that an easement
for fill for the installation of a septic system on Lot 1 requires work
to be done on Lot 2 to effectuate such situation.
It is, therefore, agreed that a permanent easement as to Lot 2 shall
be granted to the Town of North Andover to accomplish the required
septic system on Lot 1.
Zachary Realty Corporation
A .
By
P.
t and Treas er
Michael A. Gerstein, Atty. for
Zachary Realty Corporation
COMMONWEALTH OF MASSACHUSETTS
Essex, ss /��i�. 1 1983
Then personally appeared the above named Zachary Alexanian, President and
Treasurer of Zachary Realty Corporation and Michael A. Gerstein, and
acknowledged the foregoing to be their free act and deed, before me.
H •
Notary Tiub7lic
y comm. exp. g l?
1w. '
b.
&ORTol
BOARD OR"
H:EALTH
n
Julius Kay, M.D.,Chairma
NORTH ANDOVER
R. George Caron MASSACHUSETTS
Edward J. Scanlon 01845
,SSACNus
TEL. 682-6400
March 22, 1983
Mr. Richard Kaminski Re: Drainage on Rand
Kaminski ,Gelinas and Assoc. property
451 Andover Street . 280 Dale St . ,No.Andover
North Andover, Mass .
Dear Rich:
Enclosed is a copy of the letter I sent to Buddy Cyr. Please
excuse the corrections . If you have any questions or comments
feel free to contact me.
Yours truly
Michael J. osati , R.S.
w -
i
I
I
Mr. Cvr
f1 .ghway Surveyor
Osgood St. Re: Subsurface Disposal System
No.Andover, . ;A.ss . David Rand
289 Dale St. iitf.Andovur
DeL.z 7.1r. Cyr:
I
It is any understanding gnat t(le
existing drainage on the above-listed property is to be
repaired in accordance with t-he off-site drainage of thge
Rear Hill Subdivision . it is important tilat tfte r-ollowip
conditions be met in order to reduce any adverse c6nditdt6ng
tf.i.s septic systert might have on the Lake:
1. Drai.nshould be re—loc2,26 as far as
conceivable frozet'2e sen"C ic system.
2. All joints should be sealed to minimize
ISI
effect oi any leachate in-filtration from,
om,
the septic system.
? . If at all possible d.rai_n pipe shoulc% be
above: the elevation of the septic system.
If you have any cuestions ,please call re
a.-nd I am available for any on-sire in.snections if necessary.
Very truly yours ,
Michael Rosati, R.SJ
NSnitary Iihipector
• ��- ••mow. /`/"�Z�,e=eav
DEOE File No. 211.2-l
(To be provided by DEQE)
l
Commonwealth city/Town North Andover
of Massachusetts Applicant Zachary Realty Tr
Order of Conditions
Massachusetts Wetlands Protection Act
and under the Toxm. of Norrt.Fi�An over§ByLaw, Chapter 3.5 A & B
From North Andover Conservation Coy mission
To - Zachary Realty Trust satie
(Name of Applicant) (Name of property owner)
Kin-stop road
Plaistow, New Ha7iapshire
Address Address
i
This Order is issued and delivered as follows:
❑ by hand delivery to applicant or representative on (date)
return receipt requested on .T„1�, ? . 1 P R? (date)
f� by certified mail, p q
This project is located at Lot 1 D,= i e Street
f
The property is recorded at the Registry of Iyo.L therr, Essex
Book 1010; Page 1 o G
Certificate(if registered)
The Notice of Intent for this project was filed on June 24 sp 1983 (date)
The public hearing was closed on July , 1983 (date)
Findings
The Coi�servaiioin Co::u,iss 1_ott - has reviewed the above-referenced Notice of
Intent and plans and has held a public hearing on the project. Based on the information available to the
NZACC at this time, the T"ACC has determined that
. the area on which the proposed work is to be done is significant to the following interests in accordance with
bj
the Presumptions of Significance set forth in the regulations for each Area Subject ect to Protection Under the
Act(check as appropriate): _f
t/Public water supply C^�/Storm damage prevention
❑ Private water supply L9 Prevention of pollution'
G
❑ Land containing� round water supply 9 shellfish
D Flood control 0 Fisheries
Therefore,the i\7,'1(1,C, hereby finds that the following conditions are
necessary,in accordance with the Performance Standards set forth in the regulations,to protect those inter-
ests checked above.The NACC orders that all work shall be performed
r
in accordance with said conditions and with the Notice of Intent referenced above.To the extent that the fol-.
lowing conditions modify or differ from the plans, specifications or other proposals submitted with the Notice
of Intent,the conditions shall control.
General Conditions
1. Failure to comply with all conditions stated herein,and with all related statutes and other regulatory meas-
ures,shall be deemed cause to revoke or modify this Order.
2. This Order does not grant any property rights or any exclusive privileges;it does not authorize any injury
to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying with all
other applicable federal,state or local statutes,ordinances, by-laws or regulations.
4. The work authorized hereunder shall be completed within three years from the date of this Order unless
either of the following apply:
(a) the work is a maintenance dredging project as provided for in the Act;or
(b) the time for completion has been extended to a specified date more than three years,but less than
five years,from the date of issuance and both that date and the special circumstances warranting
the extended time period are set forth in this Order.
b. This Order maybe extended by the issuing authority for one or more periods of up to three years each
upon application to the issuing authority at least 30 days prior to the expiration date of the Order.
6. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or de-
bris,including but not limited to lumber, bricks, plaster,wire, lath, paper, cardboard,pipe,tires,ashes,
refrigerators,motor vehicles or parts of any of the foregoing.
7. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or,if
such an appeal has been filed, until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the hand
Court for the district in which the land is located,within the chain of title of the affected property.In the
case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name
of the owner of the land upon which the proposed work is to be done. In the case of registered land,the
Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which
the proposed work is to be done.The recording information shall be submitted to the N.='.CC
on the form at the end of this Order prior to commencement of the work.
9.- A sign shall be displayed at the site not less than two square.feet or more than three square feet in size
bearing the words, "Massachusetts Department of Environmental Quality Engineering,
File Number. 242-198
10.Where the Department of Environmental Quality Engineering is requested to make a determination and
to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings
and hearings before the Department.
11. Upon completion of the work described herein,the applicant shall forthwith request in writing that a .
Certificate of Compliance be issued stating that the work has been satisfactorily completed..
12.The work shall conform to the following plans and special conditions:
- _2 -
ORDER OF CONDITIONS : Lot 1 Dale Street 242-198
12. a. Notice of Intent of Zachary Realty Trust dated
June 22, 1983, seven (7) pages .
b. Plan entitled "Notice of Intent for Subsurface Disposal
System Design for Lot 1 Dale Street, North Andover, 1,iA.
prepared for Zachary Realty Trust by Kaminski, Gelinas a
Associates". Dated June 23, 1983.
13. A row of stalked hay bales shall be placed between all
construction areas and i.;Tetland areas . This row ofTybales
shall remain intact until all disturbed areas have been
stabilized to prevent erosion.
14. The log diversion located in the proposed dr:i.vej-lay and
shown on the referenced plan sizall be kept in place and
cleaned behind thea as required until the drives,-ay shall
be paved. No access to the building site will be permitted
except along the drive s'_loiai on the referenced plan.
15 . All disturbed areas si-Lall be graded loa�.ed and seeded t
e o
provide restabilization of disturbed areas. After re-
'k stabilization, hay bales shall be removed and sedimentation
shall be removed fro areas of accumulation.
16 . All erosion prevention and sedimientation protection measures
found necessary during construction by the North Andover
Conservation Co�miissi on <<All be 17nple-nented at the direction
of the N."A.CC or Highway Surveyor.
17. Any chances- in the submitted plans , Notice of Intent, or
resulting from the aforementioned coedit i ons -,iniust be sub- .
mitted to the ivy^.CC for approval prior to imple-_:encat on.
If the NACC finds , by majority vote, said changes to be
significant and;or deviate frorz tlie Original plains, Notice
of intent or this Order of Conditions to such an extent that
the interests of the Wetlands Frotectioin Act cannot be protected
by this Order of Conditions and x,,Ould best be served by ti-ie
issuance of additional conditions ., then the N CC will call for
another public hearing within 21 days, at the expense of the
applicant, in order to take testi-moray from all interested
parties. : itiin 21 days of the close of said public hearing ,
tine NACC ;r7ill issue an aiiended or new Order of Conditions .
18. Any errors found in the plans or information sub.-iiitted by the
ji applicant shall be considered as changes and procedures
outlined for changes s1�all be follo�,.ed.
19. The provisions of this Order shall apply to and be binding
upon the applicant, its emplo;Tees, and all successors and
assigns in interest or control.
3 _
ORDER OF CONDITIONS : Lot I Dale Street 242-r198
2.0. Prior to the issuance of a Certificate of Compliance, the
applicant shall submit a letter to the Conservation Com:-nission
from a registered professional engineer certifying that the
work is in compliance with the plans referenced aboe and
the conditions stated above.
21. Members of the NACC shall have the right to enter upon and
inspect the premises to evaluate compliance with this Order
of Conditions .
22. Accepted engineering and construction standards and procedures
shall be followed in the completion of the project.
23. Issuance of these conditions does not in any way imply or
certify that the site or downstream areas will not be subject
to flooding, storm damage, or any other forn-i of damage due to
wetness.
4 e
242-198
o-
Issued 1i rth Ardover Conservation Commission
61
Signat '
Q
This O� a signed by a majority of the Conservation Commission.
On this Is t day of Jt?1 V 19 R' ,before me
personared
,��CC ,tome known to be the
person did in and who executed the foregoing instrument and acknowledged that he/she executed
the safer free act and deed.
Notary My commission expires
The apprctrner,any person aggrieved by this Order,any owner of land abutting the land upon which the proposed work is to
be done asidents of the city or town in which such land is located are hereby notified of their right to request the Department
of Envirorality Engineering to issue a Superseding Order,providing the request is made by certified mail or hand delivery to
the Depar 'un ten days from the date of issuance of this Order.A copy of the request shall at the same time be sent by certified
mal or harms to the Conservation Commission and the applicant.
1
t
i
Detach case and submit to the. prior to commencement of work.
TO :.Issuing Authority
Please beat the Order of Conditions for the project at
File Numbers -has been recorded at the Registry of and
has beenre chain of title of the affected_property in accordance with General Condition 8 on . 19—
If
19If recorder instrument number which identifies this transaction is
If registersSMte document number which identifies this transaction is
Signature Applicant
Any appeal shall be filed
MUM
HM
within (20) days after the
, date of filin
RtC . g of this Notice
0}i°`£�- -, TOWN O F NORTH ANDOVER in the Office of the Town
T0�'}� n �t1ErjvER
NOR1' R MASSACHUSETTS Clerk.
JUN 30
OE .�ao •.,'1O .
,SSACMUSEt .
n
NOTICE OF DECISION
June 30 , 1983
Date. . . . . . . . . . . . . . . . . . . . . .. . . . . . .
January 3
Date of Hearing . : 8 3
. . .
Petition of Za.r,h4ry. .RQ41 t-v. .QgrP.o,r ti,o,n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Premises affected . . . . . . 1 t ,1 ,.,D 41 P. At re e t ,
Referring to the above petition for a special permit from the requirements
OfJ1EX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . ..
so as to permit . .the . .c.onstrurtion. .af. a. .new..dw.el] 7n.g. .aud. .as5Ocj.atQd. . .
strut-tures.,. .inc.l.uding. .a .sub.s,urfa.ce. .dis-PQShc. ,sy5taR ,] p.Ca.te�, yri tin„
100 feet of a wetland tributary to Lake Cochichewick .
After a public hearing given on the above date, the Planning Board. voted
to .appriox.e . . . . . . .the . . . . . . . . . . . . . . . ... . . . . . .. . . . .
based upon the following conditions:
Signed'
Paul A . Nedsrom , Es.q . , Chairman
. . . - . . . . . . . . . . . . . . . . . . . . . . . . . . .
John J . James , Esq -
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Erich Nitzsche
John J . Burke ,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
'punning . Board. . . .
� AWN 8 Any appeal shall be filed
RFC,:
�v"� O w N O F NORTH ANDOVER Within (20) days after the
date of filing of this Notice
SOP,— L's;1130VER MASSACHUSETTS
in the Office of the Town
Clerk.
Jux 3p
FO �
1SSACHUSEt
June 28, 1983
Mr. Daniel Long, Town Clerk
Town Office Building
North Andover, MA 01845
RE: Lot 1 Dale Street - Z achary Realty Corporation - Special Permit - Watershed
Dear Mr. Long:
The North Andover Planning Board held a public hearing on Monday evening,
January 3, 1983 in the Town Office Meeting Room upon the application of Zachary
Realty Corporation. The hearing was advertised in the North Andover Citizen on
December 16 and 23, 1982 and all abutters werre notified by certified mail. The
following members were present: Michael P. Roberts, Vice Chairman; Walter
McDonough, Clerk; Erich W. Nitzsche; and John J. Burke.
The petitioner seeks a Special Permit under Section 4.133 (d) of the Zoning ByLaw
so as to permit the construction of a single family, wood frame =dwelling, associated
structures, including a subsurface disposal system within 100 feet of a wetland tributary
to Lake Cochichewick. The premises is located and knowh as Lot 1 - Dale Street. The
proposal construction will be adjacent to but will not extend into the wetland area.
The applicant testified, through his engineer, that:
1). The proposed construction will allow the utilization of the land in
conformance with its main land use designation with minor environ-
mental effects.
2). The subsurface disposal system design and construction will conform to both
local and state sanitary codes.
3). Haybale erosion checks will minimize erosion and siltation.
The site affected is located in the R-2 zoning district, possessing-an area of
43,560 square feet, with the required 150 feet of frontage. The proposed dwelling
will have the following dimensions: 78' front; 28' deep; height: 2 stories totalling 281.
The following members were present and voting when the Board rendered their
decision. Paul A. Hedstrom, Chairman; John J. James; Etich Nitzsche; and
John J.-Burke.
Upon a motion made by E. Nitzsche and seconded by John J. Burke , the
Board voted unanimously-to grant the Special Permit, subject to the following
conditions:
Lot 1 - Dale Street
Zachary Realty R E C E;V:J
Special Permit - Watershed D7Ak?;nL L0fi;
` 1li?eY fi ,(_L 1K
Page 2 N0R f4; r' L_!0VER
r •
JUN 30 1110 Am 183
' 1). Only the proposed work shown on plan entitled "Subsurface Disposal System for
Lot 1 - Dale Street, North Andover, Ma." by Kaminski, Gelinas, & Associates,
Inc., dated October 25, 1982, revised June 14, 1983 and June 23, 1983, is,
allowed under this Special Permit.
2). Upon completion of final grading on the lot,
a. a certified "as-built" plan from a Registered Professional Engineer
;f and/or Registered Land Surveyor shall be submitted to the Planning
Board for review of compliance with the Special Permit conditions for
approval.
b. An "as-built" septic system plan shall be submitted to the Planning
Board for review of compliance withtheseconditions.
c. Said certification will state that the "at-built" grading and construction
complies in all respect to the approved plan with noted revisions.
3). No construction shall commence until receipt of Board of Health approval.
4). An Order of Co.niitions from the Conservation Commission shall be submitted to
the Planning Board for review and approval to ascertain compliance with
Special Permit prior to any construction taking place.
5). 'The proposed dwelling shall be serviced by the public water supply from Dale Street.
6). No vegetation, including trees or topsoil, shall be disturbed outside of the work
limit as shown on the referenced plan as delineated by the proposed contours.
7). A no cut buffer zone exists 25 feet horizontally from the edge of all tributaries in
the watershed, according to Section 4.133, Par. 3(c), unless conditioned upon the
granting of a variance from the North Andover Board of Appeals.
8). The Planning Board requests a final review of compliance with conditions prior to
the issuance of an occupancy permit. Any departures from said plans and/or
conditions may be cause for recission of this permit by the Planning Board.
In granting the Special Permit, the Planning Board finds, pursuant to Section 10.31
of the Zoning ByLaw that:
a). the specific site, lot 1, Dale Street is the appropriate location for a single family
residential use;
b). the residential use as developed will not adversely affect the surrounding
residential neighborhood due to the fact that it is minimizing any impact
to the denoted wetland area and is a continuation of its allowed surrounding
uses;
c). there will be no nuisance or serious hazard to vehicles or pedestrians;
d). adequate and appropriate facilities will be provided for the proper operation
and occupancy of the proposed use; and
e). the use is in harmony with general purpose and intent of the Zoning ByLaw.
Lot 1 - Dale Street
Zachary Realty
Special Permit - Watershed R E C E I VE 0
Page 3 DANT ONG
N0RI� ,A:ix�0-
The granting of said Special Permit will in no wdUN }ogej� intent and.purpose
of the Zoning ByLaw.
Sincerely,
Paul A. Hedstrom,
Chairman
PAH
cc: Applicant
Building Inspector
Board of Health
Highway Surveyor
Board of Public Works
Conservation Commission
Parties in Interest
DEQE
KAMINSKI, GELINAS AND ASSOCIATES, INC.
ENGINEERS •ARCHITECTS •LAND PLANNERS •SURVEYORS
451 ANDOVER STREET 418 BRIDGE STREET
NORTH ANDOVER,MASS.01845 LOWELL,MASS.01850
TELEPHONE 687-1483
TELEPHONE 453-0395
March 23, 1983
Mr. Paul Hedstrom
Chairman
North Andover Planning Board
Town Hall
Main Street
North Andover, MA 01845
Re: Special Permit Request
Lot 1 Dale Street
Dear Mr. Hedstrom:
The North Andover Board of Health has required my client to
obtain additional soil data prior to their issuing a subsurface
disposal system installation permit. Because the work proposed
is directly related to the installation of the disposal system,
this office requested that the Planning Board table any action
relative to the Special Permit until this additional data had
been obtained. However, because of the unusual amount of rain,
I have been unable to do the required testing. I am, therefore,
again requesting the North Andover Planning Board continue to
hold this matter in abeyance until the required soil data has
been obtained.
If I can be of further service to you in this matter, please
do not hesitate to contact me.
Sincerely yours,
Kaminski, Gelinas and Associates, Inc.
i
Joseph B. Cushing
Environmental Biologi t
cc: Zachary Alexanian
North Andover Board of Health
JBC/jt
i .
f NORTH
BOARD OF HEALTH 3?°•'�`' "
Julius Kay,M.D., Chairman NORTH ANDOVER ° a
R. George Caron MASSACHUSETTS
Edward J. Scanlon 01845 ' ''• '
�SSACNUSEt
TEL. 682-6400
June 27 , 1983
Paul A. Hedstrom, ' Esq, Chairman
Planning Board
North Andover, MA
Dear Sir:
The plans for the subsurface disposal system on lot 1
Dale Street have been reviewed and approved by this
Board.
Very trul yours ,
- -- - -- ---- - -- -- - ----- -- Ju-lius Kay, -M..D-. Chairman -- --
i
RICHARD F. KAMINSKI AND ASSOCIATES, INC.
ENGINEERS•ARCHITECTS •LAND PLANNERS •SURVEYORS
451 ANDOVER STREET
NORTH ANDOVER,MASS.01845
TELEPHONE 687-1483
June l; 1983
Mr. Michael Rosati
Inspector
North Andover Board of Health
Town Hall
Main Street
North Andover, MA 01845
Re: Soil Testing, Lot 1 Dale Street,
North Andover, MA
Dear Mr. Rosati :
As you requested, I am enclosing a copy of the subsurface disposal
system plan for lot 1 Dale Street, which had been tentatively
approved by the North Andover Board of Health, along with a copy
of the soil log obtained as a result of the testing performed by
me and witnessed by you on May 25, 1983. As you will note from
the enclosed soil log, the spring high water table, as measured
on May 25, 1983, is 71,2- feet, i foot lower than originally estimated.
Would you please inform me, at your earliest convenience, as to
the status of :this lot relative to the Board of Health Rules and
Regulations.
Sincerely,
Richard F. Kaminski and Associates, Inc.
J seph . -Cushing
nvironmental Biologist
Enclosure
cc: Zachary Alexanian
JBC/j t
�ubcivi=ior Plan Owne ��
lnves ti gator Observer
SOIL PROFIT-ES Date:
1. Elev. ; 2. Elev. 3. Elev. A . Eley
4
2 2 2
2 �
3 3 ; 3
j
4 4 4 i 4
5 -- 5
5 � 5
6 \ 6
6 6
7 7 7 7
8 — _ _ \\ 8 8 _ g
° - 9 --— 9 9
0 -- -- 10 — 10 /-
Eench-zrk Location �C'Gv Q.rr' i�7Cc/
Elevation Datum Znz
ZI
PERCO=A ION TESTS Date:
Pit Nu,.,ber 1 2 3 4 S
Start Saturation ( i
Start Test - Time
Drop of 3" - Time I I I I
DroD of 6" TiTte
SOIL PROFILE & PERCOLATION TEST DATA
North Andover, Mass. Street No aA GGA Lot No /
Loc/Subdiv. Pland Owner Foe. /-Z.C-K
Investigator Observer .x-17-le 15-AS/83 _
SOIL PROFILE DATES
l.�lev 2.Elev 3•Elev 4.Elev
PECoyS/FiQ.y ... ..
.41,.>. '
0 0 0 0
1 1 1 1
--�-4 Ties Pits est
2 2 2 2 .
3 3 3 3
4 4 4, 4
5 � 5 5 5
6 6 6 6
7 7 7 7
8 8 8 8
9 9 9 9
10 10 10 10
Benchmark Location
Elevation Datum
PERCO;&TION TESTS
DATES
Pit Number 1 2 3 4
Start Saturation
Soak-Minutes
ar e
Drop of 3"-Time
Drop of 6"-Time
Mims-lst 3" drop
Mins.2nd " Drop
Percolation
r
BOARD OF HEALTH
DESIGN APPROVAL
Septic Tank
Lot # STREET ��CE �� -Permit .#
Proposed Construction
Approx Building Size
/Under Garage Attached None
4
Min. elevation of top of slab 1`Zq 8 0
Min elevation of top of foundation 40'7-
Height
0'7•Height of foundation
wall
Footing in filles no
Further Comments
i
AMENDMENTS TO REGULATIO.lS I
UNDER 149-E
tris lb02.04(c) (12) Delineate the site(s) dedicated to sewage dis-
posal for each lot.
Ws 1002.05(x) Show a suitable area for a replacement system.
Ws 1002.05(y) Show all areas of exposed ledge or boulder greater
than three feet in diameter within seventy-five feet of the proposed
system.
Ws 1002.055 Owner' s Signature Required. The owner shall agree
to sign the following statement on the "Application for Individual Sew-
age Disposal System" prior to Construction Approval .
"The undersigned certify that they are the present
owners of the property being applied for and that
they have seen the plans and they are in accordance
with their needs and desires. The undersigned
fully understand that should this plan be approved,
no waivers to the Construction Approval will be al-_
1 ovied. Any changes will require a new submission,
review and approval ".
Vis 1003.045 Operation Approvals. To obtain an Operation Approval ,
the disposal system, well , toundation (trailer pad, hookup, etc. ) must
be installed compatible within Regulations.
Ws 1003.055 Field Waivers. No field waivers will be granted to
accommodate non-conformance with approved plans or inaccurate inform-
ation on approved plans or for any other reason.
Revised plans and formal submission shall be required to accommo-
date any changes desired or site discrepancies found, before construc-
tion.
Ws 1003.07 Expiration of Construction Approvals.
(a) All construction approvals issued by the Commission shall
expire 4 years from the date of issue, unless an operational approval
has been granted or is imminent for subject construction.
(b) All construction approvals previously issued .by the Commis-
sion and not exercised shall continue in effect for 4 years following
the effective date of paragraph 1003.07 (a) provided, however, that
said permits in order to remain in effect shall be resubmitted for
review and updating, if necessary, to conform to current design stan-
dards.
Source '1382, eff 6-10-79
-lA-
,i
Ws 1003.03 Transfer of Construction Approvals. Construction an-
provals shall be formally transferred from one owner to another by the
Commission. Transfer will be allowed only if the new owner agrees to
i and cions the following statement:
NEW HAPIPSHiRE 'WATER SUPPLI AND POLLUTION CONTROL COMMISSION
P. 0. Box 95 Hazen Drive
Concord, NH 03301
APPLICATION FOR TRANSFER OF RSA 149-E Approval No.
"I!-LE - CATEC:ORY (S) (Subdivision) (Construction) (Operational)
the undersigned certifies that they are the present owners of the.property for,^rly
of _ and that they have read, viewed and possess
uie prior approvals. plans and any related conditions assigned thereto. lhe under-
oirned aq-ees that he will, abide by the previously issued approvals. The uc�ersi::ned
fully understands that the system must b2 constructed in strict accordance 'with thesi
plans and that no waivers to this Construction Approval will be allowed. Any rnanr.•�s
will require a new submission, review and approval prior to any construction.
Our Title Reference is Book Page Registry of Cee,. and
briefly is for certain land known as:
situated in New Hamnsnire.
To-all. etc.
Transfer in Accordance with
Regulation as 1003.07 Eff. Jan. 1. 1981 Owner(s)
! Gies to:
Town Offices — ——
Owner
'J.S. 3 P.C.C. File
' 12/17/80 Batt: —
I
Ws 1003.09 Relation to Other State Approvals. Any sewage dis-
posal construction proposal which requires State approvals or permits
i under other State statutes in order to be constructed in accordance
with the plans shall be denied unless copies of thos permits or ap-
provals are submitted with the plans.
Ws 1004. 01 Purpose. Subdivision regulations are to assure to
the greatest extent possible that each lot in a subdivision can sus-
tain on-site sewage disposal indefinitely, unless municipal sewerage
is imminent, so that the purpose of RSA 149-E and Ws 1001 .01 can be
i maintained.
Ws 1004.015 Approval From Water Supply Division. (Formerly
known as Ws 1004.01
Ws 1004.09 Test Pits and Percolation Tests for Subdivision.
The suitability of each lot for sewage disposal shall be demonstra-
ted by a test pit and a percolation test at each site dedicated to
serfage disposal .
I
I Ws 1004.10 Conversion to Condominiums. Adopted 1/14/81',
a Effective 3/15/81 .
(a) Under the provisions of t:SA 1494:5.'11. the Concnission hereby
establishes the folluwinq requirement, for subdivision approval
of all existing properties where conversion to condominium
ownership is proposed.
i
(b) Current subdivision regulations shall govern the conversion
of existing developed property to condominium ownership.
-2A-
I
(Ws 1004.10 continued)
(c) Existing subsurface sewage disposal facilities shall meet
current construction design regulations or it shall be
demonstrated that the lots can support an adequate waste-
water disposal system.
(d) Drinking water supplies from groundwater aquifers shall
be protected by restricting land use and prohibiting all
activity detrimental to water quality and quantity within
the protective radii based upon the average daily demand on
the system as follows:
(1) System Demand Protective Radius
(gallons oer day) (in feet from source df.suooly)
400 ----------------- 75
800 ----------------- 125
1200 ----------------- 150
1600 ----------------- 175
2000 ----------------- 200
(2) No sewer, sewage, or waste disposal system shall be
permitted within the protective radius.
(e) The responsibility for maintenance, operation, replacement
and protection of the water supply and see:age disposal systems
shall be clearly established by the condominium agreement. In
the event enforcement action becomes necessary the Commission
shall proceed, individually and severally against those served
by the system or such other legally recognized group as the
Commission shall determine.
Ws 1015.01 (a) Have the seasonal high water table 6 inches or
more below the round surface during all seasons of the year.
9 9 Y
(d) Be under and extend 75 feet laterally from the
proposed system.
(e) Have all of the above before a site is considered
suitable in its natural state for modification, as needed, for system
design and approval .
Ws 1024.02 Repeal Effective January 5, 1981
"Ws 1024.02 Wastewater Disposal System. If there will be
wastewater such as from sinks and showers, a small septic system shall
be provided. For private residences up to 4 bedrooms, the wastewater
disposal system shall consist of at least a 500 gallon septic tank
and 1/2 the normal required leaching area. All the standard require-
ments shall apply to the small disposal system, except that the depth
to ledge and impermeable soil may be reduced to 6 feet."
-3A-
12-
-L'i,el
xn off- SCl"a 3 U_ I
SEPTIC SYSTEM INSPECTION FORM
ADDRESS 5-2
DATE INSPECTED
-
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS : �` � 6
too
WA lER QLALtTY TESiEb REs0LTS?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECVON
5FOR; M-�rvQo�` VER/
BOARD OF Hi'LTH
PART A
CERTIFICATION Nut 141996
Property Address: 323 Dale Street, North Andover Address of Owner:
Date of Inspection: 09/27/96 (if different)
Name of Inspector: William G. Whalen
Company Name, Address and Telephone Number: D.F. Clark, Inc 508-356-5638
24A Mitchell Road, P.O. Box 265
' Ipswich, MA 01938
� CERTIFICATION STATEMENT
1 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:
X Passes
Conditionally Passes
Needs further Evaluation By the Local Approval Authority
Fails
Inspector's Signature: Date: %�/`r
The System Inspector shall submit a copy of this inspection report to the Approving Authority within
thirty (30) days of completing this inspection. If the system is a shared system or has a design flow
of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the
appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure
criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated
below.
B] SYSTEM CONDITIONALLY PASSES: N/A
One or more system components need to be replaced or repaired. The system, upon
completion of the replacement or repair, passes inspection.
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, cracked, structurally unsound, shows substantial infiltration or
exfiltration, or tank failure is imminent. The system will pass inspection if the existing
septic tank is replaced with a conforming septic tank as approved by the Board of Health.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 323 Dale Street, North Andover, MA
Owner: Steven Taney
Date of Inspection: 09/27/96
B] SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is
due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box.
The system will pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than four times a year due to broken or obstructed
pipe(s). The system will pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
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 the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2) SYSTEM WILL FAIL UNLESS BOARD OF HEALTH (AND THE PUBLIC WATER SUPPLIER,
IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER
THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a
surface water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a
public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a
private water supply well
The system has a septic tank and soil absorption system and is less than 100 feet
but 50 feet or more from a private water supply well, unless a well water analysis
for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate
nitrogen is equal to or less than 5 ppm.
3) OTHER
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 323 Dale Street, North Andover, MA
Owner: Steven Taney
Date of Inspection: 09/27/96
D] SYSTEM FAILS: N/A
I have determined that the system violates one or more of the following failure criteria as
defined in 310 CMR 15.303. The basis for this determination is identified below. The Board
of Health should be contacted to determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overloaded or clogged
SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an
overloaded or clogged SAS or cesspool.
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 N 0 T due to clogged or obstructed
pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high
groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to
a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of acesspool or privy is less than 100 feet but greater than 50 feet from a
private water supply well with no acceptable water quality analysis. If the well has been
analyzed to be iacceptable, attach copy of well water analysis for coliform bacteria, volatile
organic compounds, ammonia nitrogen and nitrate nitrogen.
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 323 Dale Street, North Andover, MA
IIS Owner: Steven Taney
Date of Inspection: 09/27/96
i
E] LARGE SYSTEM FAILS: N/A
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and
the system is a significant threat to public health and safety and the environment because
one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area
(IWPA) or a mapped Zone II of a public water supply well)
The owner or operator of such system shall bring the system and facility into full compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 323 Dale Street, North Andover, MA
Owner: Steven Taney
Date of Inspection: 09/27/96
Check if the following have been done:
X Pumping information was requested of the owner, occupant, and Board of Health.
X None of the system components have been pumped for at least two weeks and the
system has been receiving normal flow rates during that period. Large volumes of water
have not been introduced into the system recently or as part of this inspection.
X As built plans have been obtained and examined. Note if they are not
available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components, excluding the Soil Absorption System, have been located on the
site.
X 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.
X The size and location of the Soil Absorption System on the site has been determined
based on existing information or approximated by non-intrusive methods.
X The facility owner (and occupants, if different from owner) were provided with information
on the proper maintenance of Subsurface Disposal System.
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 323 Dale Street, North Andover, MA
Owner: Steven Taney
Date of Inspection: 09/27/96
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 440 gallons
Number of bedrooms: 4
Number of current residents: 2
Garbage grinder: (yes or no) No
Laundry connected to system: (yes or no) Yes
Seasonal use: (yes or no) No
Water meter readings, if available:
Last date of occupancy: Currently Occupied
COMMERCIAL/IN DUSTRIAL:
Type of establishment:
Design flow: gallons/day
Grease trap present: (yes or no)
Industrial Waste Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title 5 system: (yes or no)
Water meter reading, if available:
Late date of occupancy:
OTHER: (Describe)
Late date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped on 7/29/94 by D.F. Clark and confirmed by owner
System pumped as part of inspection: (yes or no) Yes
if yes, volume pumped: 1500 gallons
Reason for pumping: Requested by owner for maintenance purposes
TYPE OF SYSTEM:
i
X 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)
Other: (explain)
, r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 323 Dale Street, North Andover, MA
Owner: Steven Taney
Date of Inspection: 09/27/96
APPROXIMATE AGE of all components, date installed (if known) and source of information:
System installed August 9, 1984 according to as-built by Andover Consultants
Sewage odors detected when arriving at the site: (yes or no) No
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 2'6"
Material of construction: X concrete metal FRP other (explain)
Dimensions: 101 x 5'W x 4'10"D = 1500 gallons
Sludge depth: 5"
Distance from top of sludge to bottom of outlet invert: 32"
Scum thickness: 2"
Distance from top of scum to top of outlet invert: 5"
Distance from bottom of scum to bottom of outlet tee or baffle: 7"
Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in
relation to outlet invert, structural integrity, evidence of leakage, etc.) _Inlet and outlet baffles are in place,
Water level is normal. Tank is in good structural condition.
GREASE TRAP: N/A
(locate on site plan)
Depth below grade:
Material of construction: concrete metal FRP 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:
Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in
relation to outlet invert, structural integrity, evidence of leakage, etc.)
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 323 Dale Street, North Andover, MA
Owner: Steven Taney
Date of Inspection: 09/27/96
TIGHT OR HOLDING TANK: N/A
(locate on site plan)
Depth below grade:
Material of construction: concrete metal FRP other (explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments: (condition of inlet tee, condition of alarm and float switches, etc)
DISTRIBUTION BOX: X
(locate on site plan)
Depth of liquid level above outlet invert: 0"
Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out
of box, etc.)
The d-box is level and the distribution is equal. No evidence of solid carryover.
PUMP CHAMBER: X
(locate on site plan)
Pumps in working order: (yes or no) Yes
Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.)
Pump is in good working order. Alarm checks out to be in order as well.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 323 Dale Street, North Andover, MA
Owner: Steven Taney
Date of Inspection: 09/27/96
SOIL ABSORPTION SYSTEM (SAS): X
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive
methods)
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number.-
leaching
umber:leaching galleries, number:
leaching trenches, number, length:
leaching fields, number, dimensions: 61' x 20' leach field
overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
CESSPOOLS: N/A
(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 (cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)__
PRIVY: N/A
(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.)
it
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 323 Dale Street, North Andover, MA
Owner: Steven Taney
p
Date
of Inspection. 09/27/96
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references landmarks or benchmarks locate all
wells within 100'
i
A - 1 =475"
B - 1 =31'5"
A - 2 =39'9"
B - 2 =387'
A - 3 = 717'
B - 3 = 117'
Back
A B
O O #1 - Septic Tank
462 - Pump Chamber
#3 -d- box
#3 #2 #1
DEPTH TO GROUNDWATER:
Depth to groundwater: EL 199.00 4' Below trench #3
method of determination or approximation: _according to plan by Richard F. Kaminski & Associates
revised September 16 1983
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