HomeMy WebLinkAboutMiscellaneous - 891 GREAT POND ROAD 4/30/2018Town of North .Andover
D.S.A. — Zoning Compliance Form
978-688-9545
This form must be reviewed with the Inspector of Buildings.
Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday.
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Address of Business: M I 60& i o yl1 W Zoning District : rz, A-
W W
10'
Lot 0 Q '�l
PonGi ODmpry
Phone: 8100 Email Vv (fir) h � com
Nature of Business: N o r on N yu-/ Qm wnj Sm7M c'caL6 mos l q h rl�
Do you own this property? Yes No
If no, written permission is required from your landlord.
Will you have clients coming to this property? Yes No v
Will you have any employees? Yes No
Will you have any major deliveries? Yes No
Description of Business Activity (Must be Completed)
SPgAR
p l d Ee 1 I (P-oCV-V- - -0t M E,
cmot►I (Ccecss R, I -,b av7d
Signature of Applicant
VV4 N�
�J
For Signage Refer to North Ando r Zoning Byla-vv Section 6
The proposed use is e e m this zoning district.
Issued By Date �(�%
Address of property
TIGER ENVIRONMENTAL
ENGINEERING
969 WASHINGTON STREET
BRAINTREE, MA 02184
617-849-0088
Town AAouer \�
Owner's Name
Date of Inspection Aoc, 1
PART A
CHECKLIST
Check if the following have.been done:
\� Pumping information was requested of the owner, occupant, and Board of
,Health.
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. •harge'volumes'of water have not been introduced into'the
system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not
available with N/A.
The facility.or dwelling was inspected for signs of sewage back-up.
The site was inspected for signs of breakout.
All system components, exc1 dinthe $AS, have been_,jocated on,the
site. 0 �0N GfC$SS� l�v1C h CC�I'tiCY' i►�C �i�S
The septic tank manholes were uncovered, opened, and the interior of
the septic tank was inspected for condition of baffles or tees,
material of construction, dimensions, depth of liquid, depth of
sludge, depth of scum.
The size and location of the SAS on the site has been determined based
on existing information or approximated by non -intrusive methods.
The facility"owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
TIGER ENVIRONMENTAL
ENGINEERING
969 WASHINGTON STREET
BRAINTREE, MA 02184
617-849-0088
FLOW CONDITIONS
If residential
number of bedrooms
number of current residents
garbage grinder, yes or no
U{,�laundry connected to system, yes or no
Ea seasonal use, yes or no
If nonresidential, calculated flow:
Water meter readings, if available: -5QQ A' C�Q
Q�UYYC' i� Last date of occupancy
GENERAL INFORMATION
Pumping r ords a d source of information•
Ho Yna ( P 1.1 A CA,
Ci() ( ) � Ci q 0- Loy).
00 System pumped as part of
if yes, volume pumped
Reason for pumping:
inspection, yes or no
Typ of system
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes,- attach previous inspection
records, if any)
Other (explain)
Approximate age of all components. Date installed, if known. Source of
information: A i I
`qe � �'� r a�%o � e r cin L -A -o I
1-4 V N! • ->±:t toU'<1f I
-LI—E) Sewage odors detected when arriving at the site, yes or no
e
TIGER ENVIRONMENTAL
13
SEPTIC TANK:4
(locate on site plan)
depth below grade:
ENGINEERING
969 WASHINGTON STREET
BRAINTREE, MA 02184
617-849-0088
PART B cost.
material of construction: ,concrete metal FRP other(explain)
r3rl
9
dimensions: 5 �� I Ci I Vl —i F-Ppi I Ui LO
I'
sludge depth
distance from top of sludge tc bottom of outlet tee or baffle
�J 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,
ev(�d -fie of leakage/. recommeipdat' ons flQr ,re`n�airs/ etc.)
4
d^�Z �.i... -!E� r /-. A l'4 :.�"v � I I^ elx%n!1 � O. ! If, ► !1 r--. I 1'-\1 _ %F .+i
DISTRIBUTION BOX:
(locate on site plan)
W)— depth of liquid level above outlet invert
Comments:
(note if level and distribution is equal, evidence of solids carryover,
evidence of leakage into or out of box, recommendation for repairs, etc.)
PUMP CHAMBER: _A
(locate on site plan)
pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,
recommendations for maintenance or repairs,etc.)
approximated by
TIGER ENVIRONMENTAL
ENGINEERING 4
969 WASHINGTON STREET
BRAINTREE, MA 02184
617-849-0088 PART B cont.
SYSTEM (SAS):
plan, if possible; excavation not required, but may be
non -intrusive methods)
If,not determined to be present, explain:
Type
leaching pits and number
leaching chambers and number
leaching galleries and number
leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool, number
f
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegq acttion, recommendaions fort ma�intenancel-or repairs,etc.)
CESSPOOLS (locate on site plan): Q6
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, recommendations for maintenance or repairs,etc.)
PRIVY:
(locate on site plan)
materials of construction
dimensions
depth of solids
Comments:
(note condition of soil,
condition of vegetation,
signs of hydraulic failure, level of ponding,
recommendations for maintenance or repairs,etc.)
TIGER ENVIRONMENTAL
{{
ENGINEERING 6
969 WASHINGTON STREET
BRAINTREE, MA 02184
fy ` 617-849-0088
,d
PART C
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of
determination in all instances. If "not determined", explain why not)
_LLOBackup of sewage into facility?
Discharge or ponding of effluent to the surface of the ground or
surface waters? "
l Static liquid level in the distributio b x abov outlet invert?
-fix �c N C �YY\ZVTtVI , syncs �sK G V10 pz, 0
Liquid depth in cesspool <6" below invert or available volume< 1/2 day
flow? --
Required pumping 4 times or more in the last year?
number of times pumped I_
Septic tank is metal? cracked? structurally unsound? substantial
infiltration? substantial exfiltration? tank failure imminent?
+� Is any portion of the SAS, cesspool or privy:
,V below the high groundwater elevation?
v within 50 feet of a surface water?
within 100 feet of a surface water supplyr tributary to a surface
water supply? ?Sf-0014. CY\ QYCJ�*-11\ ,
`y
within"a Zone I of a public well?
.within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, not the SAS)?
within 50 feet of a private water supply well?
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 acceptable, attach copy of well water analysis
for coliform bacteria, volatile organic compounds, ammonia nitrogen
and nitrate nitrogen.
y>r�.xr. . s�'117-'r.. r a.ry. rr� ,f ii eery.. �T•.,.r • w.drv..,-. o�.gr.,�rr•r. .x..,ti t:.,..3. ne .. »..�,.a a a. .. •r � <. . . .'i,.>, . ., . `. .. �.-_•.. <. ... .. ..
t
Property Inspected
Street
Town
TIGER ENVIRONMENTAL
ENGINEERING
969 WASHINGTON STREET
BRAINTREE, MA 02184
617-849-0088
PART D
Assessors Map, Block and Parcel #l.1 I , +�
Owner's Name { }�
Certification Statement
certify that I have personally inspected the sewage disposal system at this address and that
the information reported is true, accurate and complete as of the time of inspection. The
inspection was performed and any recommendations regarding upgrade, maintenance and
repair are consistent with my training and experience in the proper function and maintenance
of on-site sewage disposal systems.
C eck one: ' 44 ecr lie r( .
have not found any information which indicates that the system fails to adequately protect
public health or the environment as defined in 310 CMR 15.303. Any failure criteria not
evaluated are as stated in the FAILURE CRITERIA section of this form.
❑ I have determined that the system fails to protect public health and the environment as
defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE
CRITERIA section of this form.
Inspector's Signature
Date A Iq k4 �_-
have attempted to locate the following information ❑AS BUILT and ❑ WATER USAGE
FOR TWO YEARS. This information was NOT available.
Signature
The intent of 310 CMR 15.302 is to provide reasonable guidelines for the inspection of existing systems in as non -
intrusive a manner as is possible to avoid damage to the system and any unnecessary disturbance of the surrounding
soil area which is related to the treatment process. The inspection is not designed to provide information to demonstrate
that the system will adequately serve the use to be placed upon it by the new owner. The inspection criteria are intended
to allow for timely inspection to avoid undue delay in the transfer of property.
This Report Does Not Constitute A Guaranty Or Warranty Of Future Operation.
-- TIGER ENVIRONMENTAL
ENGINEERING
969 WASHINGTON STREET
BRAINTREE, MA 021844
617-849-0088
Addre:
a�
.Town
Owner
Date o
Check
�.,." *PART A
CHECKLIST
if the following have --been done:
ping information w,a's requested.of the owner, occupant, and Board of
lth.
d \V-
e of the system components have been pumped for at least two weeks
the system has been receiving normal flow rates during that
lod. Large volumes of water have not been introduced.into the
'em recently or as part of this inspection.
As:built plans have been obtained and examined. Note if they are not
available with N/A.
N The facility or dwelling was inspected.for signs of sewage back-up.
The site was inspected for signs of breakout.
All system components, exclud'nit
the AS, have b en ocated on the
4
site. x %i 0 N G(�C-2 �i�1CY'Q CMZ. �>O k e s
The septic tank manholes were uncovered, opened, and the interior of
the septic tank was inspected for condition of baffles or tees,
material of construction, dimensions, depth of liquid, depth of
sludge, depth of scum.
The size and location of the.SAS on the site has been determined based
on existing information or approximated by non -intrusive methods.
The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
V`A'47"
.A.
TIGER E URONMENTAL
ENGINEERING
96,19 WASH I N&DN�STREET
BRAINTREE,MA 02184
617784:9,;;0088
PART 8
FLOW CONDITIONS
If residential
number of bedrooms
number of current residents
garbage grinder, yes or,,, no
I �au'-d- connected to 'system, 'es or no
n dry` conh d Y,
seasonal use, yes or no
If nonresidential, calculated.flow:
Water meter readings, if available: -az A41r--�c4g
Last date of occupancy
GENERAL INFORMATION
Pumping r�ords a�pd source of informatiqpA,,,:1
—0-0 System pumped as part of inspection, yes or no
if yes, volume pumped
Reason for pumping:
V)
Typ of system
,., —A, eptic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool'
Privy
Shared system (yes or no) (ifyes
attach previous inspection
records,..if any)
Other (explain)
Approximate',age of all components. Datein'stalled, if'knoWn. Zource of
information:
mew AXEM1-Y.�L61[V-%qkrA 1 A
-U)IDSewage odors detected when arriving at the site, yes or no
0
i .--
` M,Fi'. W4 ryi, ...fix r • k. ;�, r i`�� � fi� kid iP;tY wwi: a wl s -ys ^,' rN uiy"� r
TIGER ENVIRONMENTAT L
�
ENGINEERING 3 ��
l
969 WASHINGTON STREET
n BRAINTREE,; MA 02184
617-849-0088
PART B ,,;
SEPTIC TANK:
(locate on site plan)
depth below grade:"
material of construction: concrete metal FRP other (explain)
5/3 r I I f
dimensions: /
i
/sludge depth
distance froi`
ao $ b f sludge to"abbttom hof'outlet =tor .baffleee
7Tscum thickness
t
distance from top of scum to top of outlet tee or baffle
h
distance from bottom of scum to bottom of outlet tee or baffle
Comments: ¢�
;I
(recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in relation to outlet invert, structural integrity,
ev'd a of leakage,^ recomme�dat'ons f r,re airs etc.)
p C1fLJCt
Alls hp- e
DISTRIBUTION BOX:
(locate on site plan)
depth of liquid level above outlet invert
Comments:
(note if level and distribution is equal, evidence of solids carryover,
;;evidence_.:.ofleakage;.into•.or out of box, recommendation for repairs, etc.)
a 4 m�-
PUMP CHAMBER:_'
(locate on site plan)
pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition of pumps,and appurtenances,
recommendations for maintenance or repairs, etc.)
i
t ^mac`
TIGER EIVVI.ROIVMENTAL
EPOINEERMG a
969MASHINGTON STREET
IT ;r, ' BRAINTREE; MA 02184
fy 617-849.0088 PART B cont.
SOIL ABSORPTION SYSTEM j.(SAS)
(locate',on site plan, if poss b e; excavation no.t required, but, may be
approximated by non -intrusive methods)
If.not.determined to be present, explain:
Type
leaching pits and number
;,aea_ching. chambers, and 'rumbe�r `,
.:
leaching galleries and number'
leaching trenches, number, length 3 I 1
leaching fields, number, dimensions
overflow cesspool, number
Comments:
(note condition of soil, signs of hydraulic
failure, level
of ponding,
a
condition of v g tion, recommenjations for
Mln�enance r
repairs,etc.)
CESSPOOLS .(locate on site plan) : , A
'
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 inspection777
a.
Comments:.
(note condition of soil, signs of hydraulic
failure, level
of ponding,`
°condition of vegetation, recommendations for
maintenance or
repairs,etc.)
PRIVY:.,
(locate -,on site plan)
,r
x .
'materials of construction
:.
dimensions'.:,u
'
depth of solids
Comments:
f
(note condition of soil, signs of hydraulic
failure, level
of ponding,
condition of vegetation, recommendations for
maintenance or
repairs,etc.)
' .yy.'r..ro�,gr y'r1~•1n Y iw r .� '° fi ,',tr .ksn•.i '+�.r"; y' r "^•ilY.lh •; i -Y iv;Ft ty;.:y'r iw.F N.fn r w qq
TIGER ENVIRONMENTAL
6 '
�f ENGINEERING
969 WASHINGTON STREET
" BRAINTREE, MA 02184
fyd 617-849-0088 Y
PART C ;
Indicate yes, no, or°`not determined (Y, N,' or ND). Describe basis of
i
determination in all instances. If "not determined", explain why not)
-A�nBackup of sewage into facility?
Discharge or ponding of effluent to the surface of the ground or
surface waters?
"Stati°c li id lev'1 in< tie di tribution - 6x abo r out' et: invert?
�/� , f
% ~ x Vr� C PVVVJA 7"CV� �,v - �'V S (X3.11 fJ ,
N Liquid depth in cesspool <611 below invert or available volume< 1/2 day {
flow?
Required pumping 4 times or more in the last year?
'gp number of times pumped
Septic tank is metal? cracked? structurally unsound'),xsubstantial "
infiltration? substantial exfiltration?tank failure,Umminent?
1 Is any portion of the SAS cesspool or privy: i
below the high groundwater elevation?:
within 50 feet of a surface water?
I• +Y
�, urface water supply r tributary to a surface
withnsu001 eet ofc�:>a s,. ��' _..�� �:... ,;�.,;� ..,. • ,
water pp Ly • 4Se� fL �1~. CYC
within a Zone I of a public well?
within 50 feet of a bordering vegetated'wetland or salt marsh JV
(cesspools and privies only, not the SAS)?
i, within 50 feet of a private water supply well?
1,
less than 100 feet but greater than 50 feet from aprivate water
supply well with no acceptable water quality analysis? If the well
1
has been analyzed to be acceptable, attach copy of well water analysis,
for coliform bacteria, volatile organic compounds, ammonia nitrogen
and nitrate nitrogen.
.4.
TIGER ENVIRONMENTAL
ENGINEERING
9.69 WASHINGTON STREET
t, BRAINTREE, IVIA 02184
617-849 0088
f
PART D:
Street Address
Town L�i�,.'fi Ain
� we r 1 l
Assessors Map, Block and Parcel # G e
Owner'' .Name . 1 � � ry ,U A
Certification Statement
certify that I have personally inspected the sewage disposal system at this address and that
the information reported is true, accurate and complete as of the time of inspection. The
,inspection was performed and any: recommendations regarding upgrade, maintenance and'.
repair are consistent with my training and experience in the proper function and maintenance
Of on-site: sewage disposal systems.
C eck one tel ') vJ -'. °. IV,
have not found any information which indicates" that the system fails to,adequately protect
' public health 'or the environment as defined in 31 o CMR 15:303. Any failure criteria not
evaluated are as stated in.rL theL FAILURE CRITERIA section of this form.
Dw . I have determined that the system fails to protect public health and the environment as
defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE
CRITERIA section of this form.
;fir Inspector'srSignature
Date 11 �vl
have attempted to locate the following information EAS BUILT and ❑ WATER USAGE
FOR TWO YEAR This information was NOT available.
Signature
The intent of .310 CMR 15.302 is to provide reasonable guidelines for the inspection of existing systems in as non -
intrusive a manner as is possible to avoid damage to the system. and any unnecessary disturbance of the surrounding
soil area which, is related to the: treatment process. The inspection .is.:not designed to provide information to'demonstrate
that the system will adequately serve the use to be placed upon it.by the new owner. The inspection criteria are intended
to allow for timely inspection to avoid undue delay in the transfer of property.
This Report Does Not Constitute A Guaranty Or Warranty Of Future Operation.
'
�
. �
�
'
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SMUUB04A/CS/VO4/L015 TOWN OF NORTH ANDOVER
TERMINAL NO: 052 CONSUMER METER F/M
DATE: 08/11/�
TIME: 16:11:�
Acct: 01-3356000-0.DAVIS, WILLIAM 891 GREAT POND RD
Meter No: 1 Rev Mtr/#: N Book: 13 Page: 33560.00000 Meter Flg� 0 [1
Connector: ] Digits: 33 Dim Cd: A] Multiplier: ] Arb #:
Manf Cd: ] Units: Pipe Size: ] Len: ] Type.-
Req:
ype:Req: Inst: Cnct: Disc: Cd: 6
Wrk Cd: ] Mt Code: ] `Met Loc: 3 In/Out:
Notes: 5/8 TRI ] Serial #: 0�1642757"
:1
Bgn: Cur: 337 C Prev: 311 E 2nd Prev: 275 C 12--
From:
2�From: 04/20/95 To: 07/11/95Cur2: Prev2:
Next: Cns Cr: Mth Bill: 03 User: ]
-------------------------- Consumption Information ----------------------------
--- First 12 Billing Months ------[3] |------ Last 12 Billing Months ------- [4�
09/95 C 03/94 42 E 109/92 51 A
06�95 36 E 12/93 58 C 106/92 48 A �
03/95 37 C 09/9362 E 103/92 20 A
12/94 27 C 06/93 ' 11 A |
09/94 6 C 03/93 30 A |
06/94 44 E 12/92 52 A |
First 12 Total: 431 1 Last 12 Total: 119
<ESC> to Enter New Meter Number
(M}odify, (D>elete or <Nyext
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