HomeMy WebLinkAboutMiscellaneous - 40 EQUESTRIAN DRIVE 4/30/2018 40 EQUESTRIAN DRIVE ve
210/105.D-0135-0000.0
STREET: Equestrian Drive
APPLICANT:
i
� S
4
MAP # LOT
PARCEL # STREET b,
OONSTRUCTION_APPR
HAS PLAN REVIEW FEE BEEN PAID? / l YES NO
4� PLAN APPROVAL: DATE /Wfl APP. BY
DESIGNER: PLAN DATE,_ 9¢
CONDITIONS
. I 1
WATER SUPPLY: TOWN WELL
WELL PERMIT DRILLER
WELL TESTS: CHEMICAL UA l E A{'F�RUVEU._.___,___.__
BACTERIA I UA TE (IPPRUVED
B TERIA II DATE APPROVED _
COMMENTS
FORM U APPROVAL: APPROVAL TU ISSUE Y S NO
DATE ISSUED BY
CONDITIONS:
FINAL APPROVAL: .
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DA i'E:.._... ......._..._
w , .til, �_�.: .. .... ..... .. .. . • -• , .. w
�EP � SY�ZEMNSS_94�AZT.QLt
-,�3r�`•� `t , l r - - _ ,�.d ar .1. . '/,. ., t #ti?�.1� Md'e�-',i.;1 '}. - - -
�`, IS-THEINSTA E<• LICENSED?....p
t x LL R YES NO
*
1.
f TYPE. OF CONSTRUCTION: EW REPAIR' '
4 '
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW E NO
1s CONDITIONS OF..APPROVAL YES NO
(FROM FORM U)
' ISSUANCE OF DWC PERMIT / � ' YES NO i
DWC PERMIT' N0. 1 INSTALLER: RPJA,v Ab IC6F
BEGIN INSPECTION ES 0:
- :,:,EXCAVATION INSPECTION: : NEEDED: 7707.5 L 7272-7
PASSED `" ,(� BY ' �C
CONSTRUCTION INSPECTION: NEEDED:
2 AS BUILT PLAN SATISFACTORY: YE
APPROVAL. TO BACKFILL: DATE: �' BY
FINAL . GRADING APPROVAL: DATE BY
" FINAL CONSTRUCTION APPROVAL: DATE: BY
Plan o f L an d
In
North Andover, Mass.
(2) Two Leach Trenches (O6� .5howlr)g
50' Long, 4' wide, 2' Deep ��' 'A Built Sanitary Disposal System '
A Lot I JA — Equestrian Drive
N = Prepared For
o v,
" F .� Don Johnston
40' Date: March 41 1996
"94-1 0 o Rev : March lZ 19�*
P94-1 C
`L
l hereby certify that l have inspected the
110 Vent D B Top Of Foundation construction of this disposal system and
6� G \, ! o E/evotion = 145.33' that the construction and final grading has
rA been in accordance with the designer's intent
D-Box 1.500 Gallon G�" and that the materials used conform to the
\ \\ Seo tic Tank plan specifications and 310 CMR 15.00.
\ To Equestrian Drive ¢L
x
O ►v This plan has been prepared for the purpose
of showing the "As-Built" conditions of the
sanitary o;soosa/ system installed on the
premises. All work was done within the
construction limitations expected for o job
\ of this type.
Sched ule of Tie Distances
Schedule of In verts AC = 47.8' IF = 63.3'
BC = 4 1.4' BF = 103.8' - c '`
Invert @ Fou,-�datior
Sep tic lark Irl = 139. 59' AD = 59.9' A C = 66.6'
Sep tic l only Out = 139.25' BD = 59.3' BG = 69.9' Design _'n meer, P.E.
D-Box In = 137.79'
D-Box Out = 137.64' A� = 51.4' AH = 78. 1' Thomas E. Neve Associates, Inc.
Syste, In = 137.51' BE = 57. 1' BH = 112.5' 447 Old Boston Road U.S. Route 1
5A Engi ._,
neers - urveyors — Land Usk' Planners.
y�tam Ou = 137.23 - 4
— Topsfislo� Massachuset tS01-95-T (33,-7-8585)
i�;
—TOW—NOF OF NUH CH ANOUVE
BOARD OF HFALT'H Plan /D f `1 an d
M 1 4S% #7
North Andover, Mass.
(2) Two Leach Trenches Sho wlrlq
50' Long, 4' wide, 2' Deep s—Built Sanitary Disposal System "
A Lot 1.3A — Equestrian Drive
N = Prepared For
C),
" F Don Johnston
a�
a Scale,. 1 " = 40'. Dote: March 4, 1,996
` c
Rev : March
-1�� vent D l hereby certify that l have inspected the
' B Top 0f Foundation construction of this disposal system and
6l G \, o Elevation = 145.33' that the construction and final grading has
P` been in accordance with the designer's intent
D—Box 1500 Gallon Q. and that the materials used conform to the
\ Septic Tank plan specifications and 310 CMR 15.00.
To Equestrian Drive
e'/,\ hid
G> This plan has been preocred for the Purpose
�P�� of showing the ".�.s—Bu 7t" coriditrons ci the
V s w — scnitary disoosol system installed on the
or emeses. 7,1i work was done within the
construction limitations expected for a /ob
\ of this type.
Schedule of Tie Distances �``"�"'' q�,
&t�ttQ^Sy�
Schedule of Inverts AC = 478' AF = 63.3' tA
BC = 4 1.4' BF = 103.8' eat �
u
Invert @ Fondation, = 4s
o ,�
Sep tic Tank In = 139. 59 ' AD = 59.9' AU = 66.6'
Septic Tank Out = 139.25' BD = 59:3' BG = 69.9' Design _n_ neer, P.E.
D—Box In — 137. 79'
D—Box Out = 137.64' AF = 51.4' AH = 78. 1Thomas E. Neve Associates, Inc.
System l,- = 13751' BE = 57. 1' BH = 112.5' 447 0/d Boston Road - U.S. Route 1
Sys tGr;;
nuI4 = 137.23' A - 4 ' Engineers - Sur veyors - Lc,,-,d Use Planr,ers
T o s%io/o, Mcssachusa t.S 01.:35_3
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
i
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY
DISPOSAL VOLLUN SAEASSESSMENTS
SUBSURFACE SEWAGE
R
CERTIFICATION
Property Address: ��EST f '' RECEIVED
Owner's Name: —���t'��
Owner's Address: JUN 3 2���
'� � TOWN OF NORTH ANDOVER
Date of Inspection:
HEALTH DEPARTMENT
Sd-�ti /�L'J�
Name of InspectoAlease print)Company Name: S.� �41'`�
Mailing Address: S,`
;�Prh�t , Ut�3s
Telepbone Number:
CERTIFICATION STATEMENT
1 certify that I have personally inspected the stung disposal tnspection.Thethis
inspecuonw as pethat
rformedinformation
based on reported
below is true, accurate and complete as of the
d maintenance of on site sewage disposal
Qaining and experience in the proper function ane systemems. I am a DE
approved system inspector pursuant to ection 15.340 of Title 5(310 CMR 15.000).
11---Pas ses
_ Conditionally Passes Aulhont�
_ Needs Further Evaluation by the Local Approving
Fails
Date: —i�,t—o
Inspector's Signature:
The system inspector shall submit a copy of this inspection report to the Approving Authority Board of Health or
he
m is a shared
em or
s a design
ow of
000
DEP)within 30 days of completing this inspewne shalll submit the report to thetapp appropriate regional loffice Of the
gpd or greater, the inspector and the system o buyer, if applicable, and the approving
DEP. The original should be sent to the system owner and copies sent to the buy PP
authority.
Notes and Comments
ons of use at that
—*This report only describes Address how the system wilions at the time Of isverfoom�°a he futureeu dei tthe same or different
time. This inspection does
conditions of use.
Title 5 inspection Form 6/15/2000
page 1
Page 2 of 1 1
OFFICIAL INSPECTION FORM NOAIF�SYSTEM INSPECTION ORM TS
SUBSURFACE SEWAGE DISPO
PART A
CERTIFICATION (continued)
Property Address: 'v� -7- A
e✓
Owner:
Date of Inspection:
inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes: ��S
v"l have not found an), information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes: IA-1/ .
One or more system components as described in the "Conditional Pass" section need to be replaced or
repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer ves, no or not determined (Y,N,ND) in the for the following statements. If"not determined" please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
'A metal septic tank will pass inspection if it is structurally sound, not leakine and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken p4)e(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
_broken pipe(s) are replaced
obstruction is removed
ND explain:
2
Page 3 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: Z04 0 14—:2 5 !o'er."` 4, P1 Pr
u1-/,3L,V�,,-
Owner: )gel/ Q r
Date of Inspection: L--/ y-:y s
C. Further Evaluation is Required by the Board of Health: /'i / yl
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the envirorunent.
1. System will pass unless Board of Health determines in accordance with 310 CNIR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health, safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health, safety and environment:
_ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supple well
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
A. /�,c:i rJ p ��t✓
Owner:
Date of Inspection: —/y—cis
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or"no"to each of the following for all inspections:
Yes No
_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
'Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
l 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 '/2 day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped
_ Any portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
i
water supply.
_ Any portion of a cesspool or privy is within a Zone 1 of a public well.
_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. (This system passes if the well water analvsis,
performed at a DEP certified laboratory, for coliform bacteria and volatile organic compou-nds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this forma
� (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems: /7/
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes" or"no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped
Zone Il of a public water supply well
If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any laree system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 3 10 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of I I
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 0 VeS'-1 2/41,1 J v-�
Owner:
Date of Inspection:
Check if the following have been done. You must indicate"yes"or"no" as to each of the following
Yes No
Pumping information was provided by the owner, occupant, or Board of Health
`Were any of the system components pumped out in the previous two weeks
✓ _ Has the system received normal flows in the previous two week period ?
ave large volumes of water been introduced to the system recently or as part of this inspection ?
f _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up ?
l
_ Was the site inspected for signs of break out ?
— Were all system components, excluding the SAS. located on site
— Were the septic tank manholes uncovered. opened. and the interior of the tank inspected for the condition
of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ?
Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on
Yes --rto
_✓ — Existing information. For example, a plan at the Board of Health.
Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [3 10 CMR 15.302(3)(b))
5
Page 6 of 1 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: �' 5...-tel �+� Or'
--'40 0 k'F 2
Owner: Y
Date of Inspection:
'LOW CONDITIONS
RESIDENTIAL J
Number of bedrooms(design): "i Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 pd x# of bedrooms):
Number of current residents:_3 : /
Does residence have a garbage grinder(yes or no):/'�0
Is laundry on a separate sewage system (yes or no):F-U [if yes separate inspection required]
Laundry system inspected(yes or no): _
Seasonal use: (yes or no): Ido
Water meter readings, if avai able(last 2 years usage(gpd)):
Sump pump(yes or no):_v
Last date of occupancy: UCCGVlte�
COMM ERCIAL/INDUSTRIAL /u
Type of establishment: �Y
Design flow (based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system (yes or no): _
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:S rlty>'f-
Was system pumped as part of the inspection (yes or no): -4/0
If yes, volume pumped: gallons -- How was quantity pumped determined?
Reason for pumping:
TYP F SYSTEM
eptic tank,distribution box, soil absorpticm system
_Single cesspool
_Overflow cesspool
_ Privy
_Shared system(yes or no)(if yes, attach previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
—Tight tank _Attach a copy of the DEP approval
_Other(describe):
Appro ate age of all components, date installed(if known)and source of information:
Were sewage odors detected when arriving at the site (yes or no): _
6
f:age '7 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Add7f�
Owner:
Date of Inspection: _ 4 .-/V--v-r'
BUILDING SEWER (locate on site plan)
Depth below grade: 7-4r
Materials of construction: _cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments (on condition of joints, venting, evidence of leakage, etc.):
o o
SEPTIC TANK: Y/T- locate on site plan)
Depth below grade: ))� 1'
Material of construction: concrete_metal fiberglass_polyethylene
—other(explain)
If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of
certificate)
Dimensions: /D
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: 3 C 4'
Scum thickness: d
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle/y
How were dimensions determined: 1) N z 7
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to otet invert, evidence 9f leakage, etc.):
C r' r a«t e.*( d A4s4 'ea e. Y y —.S
GREASE TRAP: _(locate on site plan)
Depth below grade: _
Material of construction: _concrete metal fiberglass_polyethylene other
(explain): — — —
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
7
Page 8 of 1 I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
TIGHT or HOLDING TANK: /(tank must be pumped at time of inspect ion)(]ocate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass__polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present (yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments (condition of alarm and float switches, etc.):
DISTRIBUTION BOX: 1165 (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: r
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):
A�CA • &V &v-/ O/ 7-1 u--/ — U 1��.4 S I=4 c•-� p G 1
PUMP CHAMBER: (locate on site plan) N/'4
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments (note condition of pump chamber, condition of pumps and appurtenances. etc.):
8
Page 9 of 1 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 440
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits, number: _
leaching chambers, number:
leaching galleries,number:
aching trenches, number, length:
leaching fields, number, dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):
No Sr!5< 74-L-21 c_ — G/�`�Ft ��`r� r 1�ta►'�(=�/
�l
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: (locate on site plan) �l
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
9
-Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE MPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: G� /F4 GiY-S"j 2l-4'1
Owner:
i
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
a72
i
5U p a
11
(1v
W �
130 - 3 gG
h
S7
�/ ' 10
Page 1 1 of 1 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection: C"yy"7J 1
SITE EXAM
Slope 0- 37,
Surface water 7 y v v
Check cellar P oz q
Shallow wells 7 .JS-'
�� Y v
Estimated depth to ground water j feet
Please indicate (check)all methods used to determine the high ground water elevation:
1` Obtained from system design plans on record - If checked, date of design plan reviewed: 3-1
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked.with local excavators, installers- (attach documentation)
Accessed USGS database-explain
You must describe how you established the high ground water elevation:
S D h 9L/1 // �•J-'T %� cc.y B U o f C a�`�i P/7-
11
o - le Aj,
l2 p ec 7--,c 4.,, .• �/L'� 2�
t
t .
H COMMONWEALTH O MASSACHUSETTS
EXECUTIVE OFFIC OF ENVIRONMENTAL AFFAIRS
DEPARTMENT O ENVIRONMENTAL PROTECTION
t
,r
� V'r
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION RECERfD
Property Address: yn ,Era L,c S/#116
tin,-V 71 A,LI;o'le,l JAN 1 9 2005
Owner's Name: Pte, In -e
Owner's Address: TOWN Orir've'(yVER
HEALTH DEPARTMENT
Date of Inspection: z./i S/0 'f
Name of Inspector: (please print) aiz„ar(J t rai2rvl��'
Company Name: JV 1/LT7(1;',IS T Iz..,u
Mailing Address: 9 cc-)115 7-y/t/ --7”
P4AIVC-A5 HA 0i7z3
Telephone Number: 972-- 76 4 - Sye-)S Cc)
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: `i'' -s G Date: i �e s
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART j�'--
CERTIFICATION (continued)
Property Address: $X0
Owner: P,4
Date of Inspection:_ /z \j
/S a
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Sy/stem Passes:
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments: /
B. System Conditionally Passes: 41114
e
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired:The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
-+ Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: S�fJ . s 7x-1 a D•- v�{�
Owner: 1041 G r}
Date of Inspection: /z. Zd y
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has aseptic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
t k
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 5/0 Fs7—,414 i! t 6
W10141-7Y fru/)a0C'�
Owner: ID,*1
Date of Inspection:
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_, /I± Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow
_j/Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
_ 4.,-' Any portion of the SAS, cesspool or privy is below high ground water elevation.
_A�7-±-- Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
N�44 Any portion of a cesspool or privy is within a Zone 1 of a public well.
_�/� Any portion of a cesspool or privy is within 50 feet of a private water supply well.
N �¢ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compomnds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
/No) e system fails. I have determined that one or more of the above failure criteria exist as
AID(Y bed in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems: /V
To be considered a large stem the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: VO /TTJi
Owner: )P4 i G
Date of Inspection:
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
Pumping information was provided by the owner, occupant, or Board of Health
Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
✓ Were all system components, excluding the SAS, located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ?
Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yo
✓/_ Existing information. For example,a plan at the Board of Health.
_✓_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [3 10 CMR 15.302(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: `t0 1
/l/c. �✓Owner: P14 P 4/G�.
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual): y
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): y
Number of current residents: Z.
Does residence have a garbage grinder(yes or no): Al
Is laundry on a separate sewage system(yes or no): A/ [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use:(yes or no):
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no): J✓
Last date of occupancy: yU IZAACA,17—
COMMERCIALANDUSTRIAL IIIA
Type of establishment:
Design flow(based on 310 CMR 15.203):_ gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: 57-4&,412-7-5
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: /Soa gallons-- How was quantity pumped determined?
Reason for pumping: .yrJ7-1 A-A,,�,f 4 / V5/��C/-I"V
TYPE OF SYSTEM
ptic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no): All
6
Page 7 of 11
f
s
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
it/�if a o
Owner: Pi,!/6�
Date of Inspection:
BUILDING SEWER(locate on site plan)
Depth below grade: -
Materials of construction:_cast iron '--�O PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
C,�o�j C o��D iT7U�
SEPTIC TANK:_(locate on site plan)
Depth below grade:
Material of construction: Lcffcrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of
certificate) f
Dimensions: G x i/.x b
Sludge depth: /2-" 41-
Distance
2-
Distance from top of, g
stud a to bottom of outlet tee or baffle: /6
�
Scum thickness: /
Distance from top of scum to top of outlet tee or baffle: 3
Distance from bottom of scum to bottom of outlet tee or baffle: '
How were dimensions determined: n'35'EAur-D
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7-/4 fiver /4 lob iivi&.2iV r9(.- /A-1 je, o c).1) Co^1,0 T70/I/
GREASE TRAP:_(locate on site plan) lvl,4
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence.of leakage,etc.):
7
Page 8 of 11
,rb
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: '//O E Q?UC—5 7—,&,A ftv
Owner:
Date of Inspection: f-2-.11 S-/a Z/
TIGHT or HOLDING TANK:N (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: - gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX:Zif present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 3/4" J9ELC( ,-j 6 1LA ArJ
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
-Z-7-/0 A/ "04 N 3 e C lJ 1!:C,
PUMP CHAMBER:A04ocate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.)-
8
Page 9 of 11
a
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: y0
Owner: Pio/F a-
Date of Inspection: /i--/ S�,/o
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not.located explain why:
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
�eaching fields,number,dimensions: z o xoverflow cesspool,cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
t9/14 L-' — C— C,4
CESSPOOLS: cesspool must be pumped as part of inspect ion)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: locate on site plan)
Materials of/construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
9
Page 10 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM'INFORMATION(continued)
Property Address: 00 AEC U&51-144-t7
,C-tl 77-1- kfU,OQLCAe-
Owner: moi¢ KIP—
Datee of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
Ln t-1 fF
I I cb (b
n Do Lt (b
1 J�
(b
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v v v v v
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II II II II II II �
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Page 1 I of 1 l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: VQ 0w_"s 7-Al V
Owner:
Date of Inspection:_�/iT
SITE EXAM
Slope e> g "
Surface water 40
Check cellar � /L",(:)— /L",(:) M R u
Shallow wells
Estimated depth to ground water G feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked.with local excavators,installers-(attach documentation)
L--<Ccessed USGS database-explain: f- /1p—
You must describe how you established the high ground water elevation:
11
THO � vE
ASS LATE INC.
October 25, 1995
Sandy Starr
Board of Health
146 Main Street
North Andover, MA 01845
Re: Lot 13A Equestrian Drive
Dear Sandy:
Please find enclosed a sketch showing the revised septic design for the above
mentioned lot. We were concerned with the grading that was being done on the
site so at the time the foundation was being located a topography of the site was
conducted. Due to the location and elevation of the stone retaining wall and the
grades,the breakout criteria could not be met for the original design.
The enclosed sketch shows the existing site conditions, the approved septic
location and the new proposed septic location. The original septic design, revised
to June 1, 1995, was for the installation of 2 trenches: 79' long, 4' wide, 12" deep.
Total system area was 948 s.f. and system capacity was 663.6 gallons.
In order to meet breakout, according to existing conditions, the septic system was
redesigned to 2 trenches: 54' long, 4' wide, 24" deep. Total system area is 864 s.f.
and system capacity is 669.6 gallons. All system design calculations and invert
information are shown on the sketch. These trenches are designed in the same
location as the original design, starting at the end of the original trench locations
and then running 54' along the same line as the original design. The system does
not require any fill requirement.
We ask that you accept this sketch as the revised septic design for this lot and we
will reflect these changes on the "as-built".
• ENGINEERS • • LAND SURVEYORS • • LAND USE PLANNERS •
447 Old Boston Road U.S. Route #1 Topsfield, MA 01983
(508) 887-8586 FAX (508) 887-3480
Sandy Starr Page 2
October 25, 1995
Thank you for your time and effort in resolving this matter.
If you have any questions or concerns please do not hesitate to call.
Very truly yours,
THOMAS E.NEVE ASSOCIATES, INC.
130' % P;&� Q-7Z�6 a
John Morin, EIT Thomas E.Neve
Civil Engineering Consultant President, CEO
Enclosure
JM/ec
#1478 Johnston.wps
� c,OT /3A — EQuES-rRIAN DR , vE
SSD REt>ESI(rt--1
i
SC-ALE : 1" z 40'
DAIS : O c.t. 7 4�
YELLOW APProvecA. SEi�T►c. c,F ��' 17 !_
Sys E
REt REv MSp SEP T►c-
SYS'T F—r i L.o(.AT►oN
r ' ' SEQTic. p
Sox ,
Ate
�A-�E � LOM►`J/►,aG`>
- $ottoM AREA= o-SS GAL/5F�t 4 5F/L-;= Z_Z
S%OS WALL, ARRA =1.00 G'L�SF,c 4 SFrILr-. ,Q
` GAL
Cocoa r Co.? _ ►o�S�F(use 'oe,
-ro?AL. SYS AREA=8b4S1
GAFAc i,Y =!0(09.0 Cay
,�iroM TtZE�lG.�-1 = i3S_30 �3it3'-�
IN OF
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CONAL EM
THOMAS E. NEVE ASSOCIATES, INC. Kff4CEn @Ijg
Engineers • Land Surveyors * Land Use Planners
447 Boston Street US #1
TOPSFIELD, MASSACHUSETTS 01983
DATE
(508) 087'8586 „ tCA JOB NO.
ATTENTION
FAX (508) 887-3480
TO 5 A�D�P�4 5rA-2� FS. RE. LfT 1�jPs EQUEST21ArtJ p1Zl�/�
SAL'P C>f= t4reAL7rE-1
BOARD OF
SOV 16
WE ARE SENDING YOU 1 Attached ❑ UnLrserate cover via the following items:
>
❑ Shop drawings Prints ❑ PlansSamples ❑ Specifications
❑ Copy of letter ❑ Change o
COPIES DATE NO. DESCRIPTION
148'1 �'�+-"-rarz-� ��� �. s.ts- vcs►c��.a -w-t i3�,��tts-retia►-� c>e.
� �' tti tis � Pe�Pw�� TNo E. tvEvE A.Sso a S
THESE ARE TRANSMITTED as checked below:
❑ 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 ❑
❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS REA+2 ; FkJSA'5E fri"D 4 e>1F -T!-W-
1ZEV 1 SES SA* i-rPW_t S>t5-:'PC>5AV- -T-}e.
Aticy E�E2Et-'C c� t_ T'N 1E � ►+-�COGS -t�T w£je�
M+A17E
Of P62 oy�oL ''CG--�-fc PEi o�E� C_ptilV f�(Z_SR�'ti cy� , A2rc "C'H's_
�o�D wti�Ca
—' ADD Swp� l I� A'CtiCr—� "Cp Ti2�c—t 4' Pt PES .
—• �'D� l..A�'lc�-L-, ICX 1S'�'l�-1Ca G-t�f�pE. EQ�-kP�t��j �lti SHE fl
G,1eADL�-
Qu�ASE
ca"L-V> 6C-1 CA= w e__CtVF�e. a ss t s o t-t res
COPY TO
RECYCLED PAPER:
4 Contents:40%Pre-Consumer-10%Post-Consumer SIGNE lit A a�cd•---�_ �-t�•
I
If enclosures are not as noted,kindly notify us at once.
PLAN REVIEW CHECKLIST
ADDRESS ��/� �qUS>,Q�A,c� ENGINEER Ale y
GENERAL
3 COPIES STAMP c/ LOCUS 4-' NORTH ARROW z�� SCALE
CONTOURS PROFILE SECTION fes' BENCHMARK USC SOIL &
PERC INFO r� ELEVATIONS WETS. DISCLAIMER WELLS &
WETLANDS l/ WATERSHED?.,� DRIVEWAY �(Elev) WATER LINEC.---�
FDN DRAIN SCH4 0 TESTS CURRENT? /9,94
SEPTIC TANK / /��
MIN 1500G . 17 INVERT DROP ✓ GARB. GRINDER,' j// 1-(+200 o EDF)
25 ' TO CELLAR�� MANHOLE TO GRADE L/ ELEV GW
D-BOX
SIZE # LINES p� FIRST 2 ' LEVEL STATEMENT
INLET - OUTLET f37.& _ 'ZU (2't OR . 17 FT) TEE REQ' D?
LEACHING
MIN 660 GPD? RESERVE AREA/ 4 ' FROM PRIMARY? �2% SLOP
100 ' TO WETLANDS l 100 ' TO WELLS 41 TO S .H.GW /�R U
GARDE
35 ' TO FND & INTRCPTR DRAINS 325 ' TO SURFACE H2O SUPP
4 ' PERM. SOIL BELOW FACILIT,. r— MIN 12" COVER Z"'I FILL? Ab (25 '
if above natural elev; 101if below) BREAKOUT MET?
4
TRENCHES
MIN 660 gpd 11-/ SLOPE (min . 005 or 6"/1001 ) /\ >31COVER?-VENT v
SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) 6-� IS RESERVE BETWEEN /
TRENCHES? �IN FILL? MUST BE 10 ' MIN. ''-�4" PEA STONE? y
BOT X LDNG 01 + SIDE �� X LDNG q3Z = TOT C9ly 7��
(L x W x #) (G/ft2) (DxLx2x#) (G/ft2)
Copyright C 1993 by S.L.Starr
THOMAS E. NEVE ASSOCIATES, INC. ��11 2 nn I� �r I� fy1 f;v;1 �r�r/� r1
Engineers - Land Surveyors - Land Use Planners ILIEUTEW O U Ull °�u� MA 0 U U U,&
447 Boston Street US Route #1
TOPSFIELD, MASSACHUSETTS 01983
DATE JOB NO.
(508) 887-8586 1-51az - V
FAX (508) 887-348O0 ATTENTION
FAX / SqJOY STARK
RE:
TO SANOy 5TARR SEPTIL Rev451o4J5 Lo-r 13A
NORTH g4aooyER B-O.H. EQJESTRIArQ C�RtvE.
> WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES DATE NO. DESCRIPTION
3 REV ll/3i/94 1382-1 5A4JI TArZy E>ttPPOSA" SYSTEM LoT I-A A
t�ESTRIA..► 1 V
THESE ARE TRANSMITTED as checked below:
)( 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 DEAR 5AaOY PLEASE. EI.JD 3 PM% JTS of -r HE
Re-VISSp SE.P-rtL DESICrINJ Fol t_0'r t3A EQyGST21Ac►J X>M1vE•
R%E-Vt5104J5 HAVE- 13ZEiJ MAGE. Ar_O2oINJ(r TO YoJ2 C.oMM NT5
o4.i YoyR oc.t_- 31 . 19Z4- 1e:++er. 10 RESPo._)SE To /o\.)re- c.o,r,enE.,,xT ' 1
T't4E pSj-z G TEST 1 :5 i3Et_o,_A -r HE f d>Tror.,\ or -r HE SYST61'"I
'r"HF. EL_eV -rtor.) of •rl+M PE1?L TEST 1S 14a.0', THE. PE1ZC-
,_jAS c-or.,tfluc-rsE> e�Z' SSLLO .s CTr2ApE WHIG-t-1 Crit/S5 yoy A^J E1_eL/AT1ow1
of 134.3`, T"15 I S I r 136L 4ot,J t3o7TOr-I of TREr/c-N EL. = 135.30 IF
yoy 9AV6 Avy FurzrHEz QOF-STIorJs 1-'::L-E:A:5 e DO —10 T'
4E51 TA-rS Ty C.At.L Si .t
COPY TO
SIGNED:
PRODUCT 240-2 n a Imo,Gmtm,Rim 01471. If enclosures are not as noted, kindly notify us at ce.
NORTI�
BOARD OF HEALTH
FO- 9
♦ 's #
' 120 MAIN STREET TEL. 682-6483
�
SS.4 D.-•'`.�y NORTH ANDOVER, MASS. 01845
"SS" SE� Ext23
October 31, 1994
Thomas E. Neve Associates, Inc.
447 Oid Boston Road
Topsfield, MA 01983
RE: Lot 13A Equestrian Drive
Dear Tom:
This is to notify you that the proposed plans for Lot 13A
Equestrian Drive, North Andover, MA, dated August 5, 1994 have
been disapproved for the following reasons:
1 - Percolation test is not at the bottom of the system.
OOLZ�- Distance from house to septic tank is missing. .
C.�P"'3 - Only 2" of pea stone is specified; must be either 4" of
--Ifeastone or 2" peastone with filter fabric.
Cya - The foundation drain is missing.
0AC5 - Please add a note that all stone is to be double-washed.
b/(f6 - Septic tank has no manhole to grade.
i
DATE Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW J/
FEE o PERMIT # DATE RECEIVED 9�
APPLICANT —�c�/V��D �oN�ySi�.� ASSESSOR'S MAP
ADDRESS PARCEL #
LOT # A.
STREET # 1,2V 2�V�
ENGINEER V&U& /9:566c-- '
ADDRESS
PLAN DATE REVISION DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED
7-o s6/°Tie�,
���,r-y-�z�v,�it�- cvf3sN�� STavC
70
ND TO
PLAN REVIEW CHECKLIST
ADDRESS �� J/=�/�%/�/� ENGINEER
GENERAL
3 COPIES L--"'- STAMP' LOCUS ' -�NORTH ARROW SCALE `J
CONTOURS L-- PROFILED' SECTION L-- BENCHMARK SOIL &
PERC INFO ELEVATIONS WETS. DISCLAIMER WELLS &
WETLANDS !/ WATERSHED? t/O DRIVEWAY (Eley) WATER LINE t--1
FDN DRAIN SCH40 TESTS CURRENT?
SEPTIC TANK
MIN 150OG L--'�" . 17 INVERT DROP GARB. GRINDERNO (+200% EDF)
25 ' TO CELLAR MANHOLE TO GRADE_ ELEV GW
D-BOX
SIZE # LINES FIRST 2 ' LEVEL STATEMENT
INLET - OUTLET (2 11 OR . 17 FT) TEE REQ'D?/UCO
LEACHING
MIN 660 GPD? RESERVE AREA t--- 4 ' FROM PRIMARY? L-- 2% SLOPE
100 ' TO WETLANDS t---- 100 ' TO WELLS °-''" 4 ' TO S.H.GW
35 ' TO FND & INTRCPTR DRAINS ? 325 ' TO SURFACE H2O SUPP
4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER L--" FILL?/Jo (25 '
if above natural elev; 101if below) BREAKOUT MET?
TRENCHES /
MIN 660 gpd v SLOPE (min . 005 or 6"/1001 ) >3 'COVER?-VENT
SIDEWALL DIST. 2X EFF. W OR D (MIN 6 ' ) �--' IS RESERVE BETWEEN
TRENCHES? '--� IN FILL?V0 MUST BE 10 ' MIN. ,-- ' 4" PEA STONE?,
BOT X LDNG, , + SIDE X LDNG3/�, = TOT &1&-3
(L x W x #) (G/ft2) (Dx x2x#) (G/ft2)
Copyright O 1993 by S.L.Starr
1
May 16, 1994
Town of North Andover
Board of Health
120 Main Street a 4
North Andover, MA 01845
Subject: Lot 13A, 40 Equestrian Drive
Request for Percolation Testing
Dear Members of the Board:
On Thursday, May 5, 1994, Thomas E. Neve Associates conducted deep
observation hole testing which was witnessed by Ms. Sandy Starr,
Health Agent. Due to scheduling time constraints, the percolation
tests could not be performed.
On May 12, 1994, we received a proposal for engineering services
from Mr. Neve which advised that percolation tests could not be
performed until July due to a scheduled vacation of the Health
Agent. Due to a pending offer from a buyer to purchase this lot,
we are unable to wait until July for percolation testing and
subsequent redesign. This offer has been made subject to
percolation test results. As you are probably aware, we are
absorbing significant additional costs to secure a new septic
system permit and, most likely, a new Order of Conditions from the
Conservation Commission.
We respectfully request an appointment as soon as possible with the
Board of Health, the Health Agent, or other representative to
witness the required percolation testing in order for us to proceed
with design and the sale of this lot.
We have requested Mr. Thomas E. Neve, P.E. , to contact you to make
the necessary arrangements.
;SWincereyrs,
William E. Goodrich and Rita Am lfitano
38 Terrace Park
Reading, MA 01867
(617) 944-8961 (H)
(617) 439-9351 (W)
cc: Mr. Thomas E. Neve
April 19, 1994
Town of North Andover
Board of Health
120 Main Street
North Andover, MA 01845
Subject : Lot 13A, 40 Equestrian Drive
Request for Percolation and
Deep Observation Hole Testing
Dear Members of the Board:
We have been the Owners of Lot 13A, Equestrian Estates, since
September, 1985 . A septic system was originally designed by the
Developer' s Engineer, Thomas E. Neve Associates, and approved by
the Board of Health on September 5, 1985, Permit No. 78 .
We are currently in the process of selling this lot to another
buyer. We requested Mr. Thomas E. Neve, P. E. , review the original
design and its compliance with current local and state
requirements . He has advised us that new testing is required for
a new design to comply with current requirements .
We request an appointment with the Board of Health or its agent to
perform and witness required percolation and deep observation hole
testing to the extent necessary.
Mr. Thomas E. Neve, P. E. , of Thomas E. Neve Associates is
authorized to act on our behalf in proceedings with the Board of
Health and its agents .
Sincerel yours,
William E. Goodrich and Rita Amalfitano
38 Terrace Park
Reading, MA 01867
(617) 944-8961 (H)
(617) 439-9351 (W)
pORTF,
3? BOARD OF HEALTH
• "s • #
120 MAIN STREET TEL. 682-6483
CHUSNORTH ANDOVER, MASS. 01845 Ext23
April 1, 1994
Thomas E. Neve Associates, Inc.
447 Old Boston Road
Topsfield, MA
Re: Lot 13A Equestrian Drive
Dear Tom:
It is possible, of course, to use old tests and still design
a new system that this department will approve. However, were
the new design to place the leaching area in the same location as
that shown on the plan dated, August 7, 1985, it would not be
approved. New soil tests would definitely be required.
If you have any questions, please do not hesitate to call me
at the number above.
Sincerely, �--
Sandra Starr, R.S.
Health Administrator
SS/cjp
THO " vE
ASS LATE INC.
March 31, 1994
Ms. Sandy Starr
Health Agent
120 Main Street
North Andover, MA 01845
Re: Lot 13a Equestrian Drive,North Andover
Dear Sandy:
Enclosed please find a copy of the Sanitary Disposal System Design for the
above-referenced lot. This plan was previously approved and has expired. Our
client has asked that we update this plan so that it can be approved by your Board.
Will you accept a new design on the lot according to new regulations using old
test pits or do you want us to do new percolation tests and deep hole observation
test pits?
Please get back to us with your decision so that we can properly advise our client.
Very truly yours,
THOMAS E. NEVE ASSOCIATES, INC.
Thomas E.Neve, PE, PLS
President
TEN/km
Enclosure #354-13a EQUESTRI.WPS
• ENGINEERS • • LAND SURVEYORS • • LAND USE PLANNERS •
447 Old Boston Road U.S. Route #1 Topsfield, MA 01983
(508) 887-8586 FAX (508) 887-3480
Town of North Andover, Massachusetts Form No.3
BOARD OF HEALTH
19
N A
• ♦ s -
�'b•,,.°.• DISPOSAL WORKS CONSTRUCTION PERMIT
• ,3 gAC14U5Et
/applicant
NAME ADDRESS TELEPHONE
Site Location
Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN,BOARD OF HEALTH
Fee O D.W.C. No. b
GRAIN SIZE DISTRIbUTION TEST REPORT
c c c m m
..• v N m m m m m TO
ly \ \
100 O m N m m # # # # # #
90
80
70
w
w
60
tL
z 50
LJ
V
w 40
IL
30
20
10
0
200 100 10. 0 1 . 0 0. 1 0. 01 0.001
GRAIN SIZE - mm
Test E/—+3 % GRAVEL % SAND % SILT /. CLAY USCS LL PI
• 19 0. 0 1 . 3 97. 0 1 . 7 SP
SIEVE PERCENT FINER SIEVE PERCENT FINER Location.
inches number
size • slze • AANGELINI PIT, GROVELAND
4 98.7
8 94.9
16 74. 6 Description :
30 50. 8 •POORLY-GRADED SAND
50 25. 4
100 2.9
GRAIN SIZE 200 1 .6
D60 0.787
D 30 :.i WI ` SACS °SE 8 6 , NC.
D10 e.>e6 1 1,E-V i=f-) Remarks :M.D.P.W. M1.04. 1
COEFFICIENTS !2,y: _L Sand Borrow for Subdrains:
C 0 78 c DOES MEET job specifications
CU 4 . 2
UTS OF MASSACHUSETTS, INC_ Project No . :
5 Richardson Lane Project : Q.C. , W. ANGELINI, GROVELAND, NA
-Stoneham, Mn 02180 Date: 01/16/96 Sample No . 4624
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
O�
11" 16
R6 �0 19
�o �0
4 °°°° -°•� APPLICATION FOR SITE TESTING/INSPECTION
�9SSACHUSE��y
Applicant
NAME ADDRESS TELEPHONE
Site Location
Engineer
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time •°.fr'� -' r �
' ' R
CHAIRMAN,BOARD OF HEALTH
' Fee Test No. (N-0
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
Town of North Andover, Massachusetts Form No.2
f MORT1BOARD OF HEALTH
1y
—19 O•t�•e ,• O V
F w
P
DESIGN APPROVAL FOR
�ssACMUS � SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant ��1``x `—��1 ff�US�d� Test No.
: Site Location G>T
Reference Plans and Specs. /r�� J� AE—
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 Site System Permit No.
Town of North Andover, Massachusetts Form No.2
Of NORTH BOARD OF HEALTH
t �•o ,•1.S.p
�? .•_�. O
o
F w
41
F
... ...
. DESIGN APPROVAL FOR
,SSACMUSEt� SOIL ABSORPTION SEWAGE DISPOSAL SYSTE
Applicant V(�JlestN .
—:
Site Location
Reference Plans and Specs. I
ENGI EER DESIGN DATE
Permission is granted for an individu .1 oil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
CHAIRMAN,BOARD OF HEALTH
Fe Site System Permit No.
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
*************{***Applicant -faills out this section*****************
/ rl
APPLICANT: J/���i�L�[/ c,s�f7i✓S%Jr/ Phone fro ")
LOCATION: Assessor' s Map Number 10,3 i" Parcel l?s
Subdivision �c,?r /�/Y Lot(s) /.3K
Street St. Number _
***************G***********Official Use Only************************
RECOMMEND ONS OF TOWN AGENTS:
C� Date Approved
onse ation Administrator Date Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
Date Approved
Food Inspector-Health Date Rejected
4i�/�� � Date Approved o2
7
Septic Inspector-Health Date Rejected
Comments
Public Works - sewer/water connections 77�_/W 2 L 212'
- drive ay permil,e_l
Fire Department
Received by Building Inspector Date
� f
NORT
ToVM Of 4 over
No. 567
o -r, ortl," dover, Mass., o\tems L Zr 19 94
COCHICHEWICK
7� ADRATED P9
H BOARD OF HEALTH
PERMIT T Food/Kitchen
Septic System
r--" BUILDING INSPECTOR
THIS CERTIFIES THAT..)�OqAz...�•... o. .stul► ......
................................................................................ Foundation
/OSI
has permission to erect..U1M..)....(.A!!N . buildings on .....AV. ....IF10 .f ..... ............
42
to be occupied as..tws-1.l .. I!etc t+u u- .�t?.b..... I...2.�.��r2.. A�?�b . ...... .. 7 5 .............. ch S y �'Z�«
provided that the person accepting this permit shall in every rbspect conform to the terms of the application on file in
P P P 9 P 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. PERMIT FOR FOUNDATION ONLY PLUMB s,sPE�cT°�
VIOLATION of the Zoningor Building Regulations Voids this Permit. REGULATED BY PARA, 114Z& &C. ug
9 9
PERMIT EXPIRE MONTtj JFEE PAID
ELE TRICAL INSPECTOR
UNLESS CON TR T sv o 5' 9 �
PERMIT FOR FRAME/BUILDING
��
........ .. .... .. ... ..... .... /
. � �q Z� BUILDING INSPECT R �iC. Fi a
DATE.. E PAID
Occupancy Permit Required to Occupy Building GAIN PSC
oh
Display in a Conspicuous Place on the Premises — Do Not Remove i�
P Y p i
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspecto 1� FIR D ARTMEC ^/
1 urner /
q
PLANNING ` ��3' AL CONSERVATION FI eet No.
�\
�
SEWER/WATERSmoke Det.'' I�l,J__ FINAL DRIVEWAY ENTRY PERMIT \ IIL..
OF HEALTH '
.Nndov?r, kmass .
SUBSURFACE DISPOSAL DESIGN CHECK LIST
LOT
APPROVED DATE DISAPPROVED DATE__
Provided: Reasons: �'
g
S 5 �
Title V FAIL CK
Reg 2.5 The submitted plan must show as a minimum:
a) the lot to be served-area,dimensions lot #,abutters
b location and log deep observation hoes-distance to ties
c location and results percolation tests-distance to ties
d design calculations & calculations showing required leaching area
(e) location and dimensions of system-including reserve area
f) existing and proposed contours
(g) location any wet areas within 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 within 100' of sewage disposal
system or disclaimer-Planning Board files
(3) known sources of water supply within 2001 of sewage disposal e
system or disclaimer
(k) location of any proposed well to serve lot-1001 from leaching facility
(1) location of water lines on property-101 from leaching facility
(m) location of benchmark
(n) driveways
(o) garbage disposals
(p) 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) maximam ground water elevation in area sewage disposal system
(s) plan must be prepared by a Professional R gineer or other
professional authorized by law to prepare such plans
Reg 6 Septic Tanks
(a) capac t es- 50�6 of flow, water table, tees, depth of tees,
access, pumping
(b) cleanout
(c) 10, from cellar wall or inground swimming pool
(d) 251 from subsurface drains
Reg 10.2 7 Distribution Boxes
(a) —slope greater 0.08 I
Reg 10.4 (b) sump
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TOWN OF NORTH ANDOVER. MASSACHUSETTS
OFFICE OF ,
- ' CONSERVATION COMMISSION
f NORTH 1
�_ • o� TELEPHONE 683-7105 -
Y p
. S^C HUSE'
Pursuant to the authority of the Wetlands Protection Act,
Massachusetts General Laws Chapter 131, Section 40, as amended,
and the Town of North Andover ' s Wetland Protection By Law, the,
1
_..—.___ .-. North Andover Conservation Commission will Lild a Public Meeting
on November 6, 1985 at 8 :00 P.M. At the Town
Building Meeting Room, 120 Main Street, North Andover, •MA on
the Wetland Determination Request of Equestrian Estates Realty Trust
land located at Lot 22A Equestrian Drive
i By: G. Vicens
Chairman, NACC
3 = _
run once in the N.A. Citizen on October 31, 1985
Copies sent to:
Planning Board y
Board of Health
Pub•l is Works J
Highway Dept.
Applicant
Engineer
DE(2E
A
°
Fort 1
_ OEGE F1s No.
(To be provided by OEQE)
eaJIM CJty/rown 02ti- 70Yya
of Massachusetts Awkant Q-'5U 7A2J 4A1/ &--5TR7-GS
/4ssouAr&-5 RCRI-7y MV57
lug
Request for a Determination of Applicability
" Massachusetts Wetlands Protection Act, G.L: c. 131, §40
1. 1,the undersigned.hereby request that the ALOZ rH AA)OOVER—
Conservation Commission make a determination as to whether the area.described below,or work to be
performed on said area,also described below,is subject to the 1!uisdkt n of the Wetlands Protection
i
Act,G.L c. 131. 140.
2. The area is described as follows.(Use maps or plana,if necessary.to provide a description and the
location of the area subject to this request.)
5Q U EsTrz,A&) Ver-4E L-O T 2 Z A
f
6
r
3. The work in said area is described below.(Use additional paper,if necessary,to describe the
P
proposed work.)
SEE SA"i TA2Y PIsPOsAL- 'SY-ST IM OES1C-�h1
EQ U E5T R I AO 'FSTAT r=S . L.OT- 4 22 A � P 21-PA2l=Fp �3�(
TROAA f4S C, �JFFVF ASSoGIA 1 e5/ lvgC. - ToPSF•l C Lpj MASS .
SCALE j 40'.
1-i
i
79
4. The owner(s)of the area,if not the person making this request,has been given written notification of this
request on (date)
The name(s)and address(es)of the owner(s):
5. 1 have filed a complete copy of this request with the appropriate regional office of the Massachusetts
Department of Environmental Quality Engineering on Ox r, Z ,A, 10)8(;7 (date)
Northeast e", A J E' Southeast
Lakeville Hospital
Woburn,MA 01801 Lakeville,MA 02346
Central Western
75 Grove street Public Health Center
Worcester,MA 01605 University of Massachusetts
Amherst,MA 01003
6. 1 understand that notification of this request will be placed in a local newspaper at my expense in accor-
dance with Section 10.05(3)(b) 1 of the regulations by the Conservation Commission and that'l will be
billed accordingly. It-I551A;S7-/Z//W -77
Signature Name
Address Tel
1-2