HomeMy WebLinkAboutMiscellaneous - 93 BROOKVIEW DRIVE 4/30/2018A l x { lk MAP # LOT # PARCEL # STREET U • CONSTRUCTION APPROVAL HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATEl7le APP. BY DESIGNER:PLAN DATE CONDITIONS t, WADER SUPPLY: TOWN WELL WELL PERMIT DRILLER F� WELL TESTS:- CHEMICAL DATE APPROVED BA IA I DATE APPROVED BACTERIA I DATE APPROVED PLUMBING SIGNOFF A WIRING NOFF COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE ES NO DATE li ISSUED 71Z BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: >' w SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED?ES NO TYPE OF CONSTRUCTION: > REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEWYESJ NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT PAID? �%ES NO DWC PERMIT NO. / W3 INSTALLER: BEGIN INSPECTION , ES NO: EXCAVATION INSPECTION: NEEDED: PASSED CONSTRUCTION INSPECTION: NEEDtD: AS BUILT PLAN SATISFACTORY: APPROVAL TO BACKFILL: DATE: ` BY FINAL GRADING APPROVAL: DATE R FINAL CONSTRUCTION APPROVAL: DATE: BY Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 93 Brookview Drive, North Andover Owner: Goodnow Date of Inspection: 1/3/2001 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: November 3, 1998 This is to certify that the individual subsurface disposal system constructed ( x ) or repaired ( ) by North Andover Licensed Installer Peter Breen at Lot #6 Brookview Circle, North Andover, MA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # 922 dated November 13, 1997. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 93 Brookview Drive_ North Andover_ Owner's Name: _Tim Goodnow_ Owner's Address: 93 Brookview Drive_ North Andover, Ma. 01845_ Date of Inspection: _1/3/2001_ Name of Inspector: Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, Ma. 01810_ Telephone Number: _( 978 ) 475.4786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: _X Passes Conditionally Passes Nee4 Further Evaluation by the Local Approving Authority Fail -"Inspector's Signature: ate: _1/3/2001_ The system inspector shall submit a copy of t is 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. v�rJ, Page 2 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 93 Brookview Drive- - North rive__North Andover— Owner: Goodnow Date of Inspection: _1/3/2001_ Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: _X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 93 Brookview Drive_ _North Andover— Owner: Goodnow Date of Inspection: _1/3/2001_ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 93 Brookview Drive North Andover— Owner: Goodnow Date of Inspection: _1/3/2001_ D. System Failure Criteria applicable to all systems: You must indicate "yes" or `no" to each of the following for all inspections: Yes No _No— Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ____ _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _No_ Liquid depth in cesspool is less than 6" below invert or available volume is less than ''/Z day flow _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ No_ Any portion of the SAS, cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 1 i OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _93 Brookview Drive_ North Andover — Owner: Goodnow Date of Inspection: _1/3/2001_ Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Yes — Pumping information was provided by the owner, occupant, or Board of Health No_ Were any of the system components pumped out in the previous two weeks ? Yes_ _ Has the system received normal flows in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection ? Yes _ Were as built plans of the system obtained and examined? (If they were not available note as N/A) _Yes_ _ Was the facility or dwelling inspected for signs of sewage back up ? Yes_ _ Was the site inspected for signs of break out ? Yes _ Were all system components, excluding the SAS, located on site ? _Yes_ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _Yes_ _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no Yes _ Existing information. For example, a plan at the Board of Health. _No_ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _93 Brookview Drive_ North Andover_ Owner: Goodnow Date of Inspection: _1/3/2001_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4_ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CMR 15.203 (for example: i 10 gpd x # of bedrooms): _440 Number of current residents: _4 Does residence have a garbage grinder (yes or no): Yes_ Is laundry on a separate sewage system (yes or no): No_ [if yes separate inspection required] Laundry system inspected (yes or no): _ Seasonal use: (yes or no): _No_ Water meter readings _Oct 98 to Jan00 = 44,060 Ft s x 7.5 = 330,450 Gals. / 791 Days = 417 Gals./ Day Sump pump (yes or no): No Last date of occupancy: — Current-C OMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): _ Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped, owner_ Was system pumped as part of the inspection (yes or no): Yes_ If yes, volume pumped: _1500_gallons -- How was quantity pumped determined? Measured tank _ Reason for pumping: _Never pumped, inspect tank & tees._ TYPE OF SYSTEM X Septic tank, distribution box, soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) _ Tight tank _ Attach a copy of the DEP approval — Other (describe): Approximate age of all components, date installed (if known) and source of information: 2 Years old. 10/29/98 As built plan. Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Brookview Drive- - North rive__North Andover— Owner: Goodnow Date of Inspection: _1/3/2001_ BUILDING SEWER (locate on site plan) X Depth below grade: _24" Materials of construction: _X cast iron _X_40 PVC other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): _ house. No leaks. SEPTIC TANK: X locate on site plan) 4" Cast iron thru floor. 3" PVC in Depth below grade: _12" Material of construction: —X—concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: 10' x 5' x 4' Sludge depth 2" Distance from top of sludge to bottom of outlet tee or baffle: 25" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: _8" Distance from bottom of scum to bottom of outlet tee or baffle: _15" How were dimensions determined: Subtract scum & sludge depth to tee length. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet & outlet tees ok. Depth of liquid at outlet invert. No evidence of leakage. 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.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Brookview Drive- - North rive__North Andover— Owner: Goodnow Date of Inspection: _1t312001r TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _0_ Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): _D -box level & distribution equal. No evidence of leakage. Evidence of carryover, pumped d -box to clean_ PUMP CHAMBER: (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Brookview Drive- - North rive__North Andover— Owner: Goodnow Date of Inspection: _1/3/2001 SOIL ABSORPTION SYSTEM (SAS): _X (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: X leaching trenches, number, length: 3 Trenches 54' 6"_ leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): —Soil ok, Vegetation ok. No sign of ponding to surface._ CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of ll OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Brookview Drive- - North rive__North Andover— Owner: Goodnow Date of Inspection: _1/3/2001_ 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. A to Tank = 40'4" A to D -Boz = 63'1" B to Tank = 367" B to D -box = 35' Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Brookview Drive- - North rive__North Andover— Owner: Goodnow Date of Inspection: _1/3/2001_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4 feet Please indicate (check) all methods used to determine the high ground water elevation: _X_ Obtained from system design plans on record - If checked, date of design plan reviewed: _4/30/1996 _ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: As per design plan. _ I 1 CD J / J OO AUG 2 7 I 6 53, 820 S. F. 1.24 Ac. 75.4' 47.7' ' BROOKVIEW r STEPHEN M. j 3 MELESCIUC N THIS PLAN IS INTENDED FOR ZONING A No. 39019 PURPOSES ONLY. IT WAS PREPARED FROM EXISTING PLANS AND RECORDSe OFES`;``) b4 WITH THE STRUCTURES SHOWN LOCATED a►�q/Vp ftv1A BY AN INSTRUMENT SURVEY. THIS PLAN / ►�� SHOULD NOT BE USED FOR PROPERTY LINE DETERMINATION. CERTIFIED PLOT LOT 6 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS EXISTING FOUNDATION Top Fn d. EL. =136.84 42.9' 25.3' L12LT41 SO4°11 '22"W 2 DRIVEE WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THAT ALL APPARENT EASEMENTS AND ENCROACHMENTS ARE LOCATED AS SHOWN. THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OF THE MUNICIPALITY . WHEN CONSTRUCTED. ALSO, ACCORDING TO THE F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, COMMUNITY PANNEL NO. 250098 0009 C DATED 6/2/93 , THE STRUCTURE IS NOT LOCATED IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. PLAN MARCHIONDA & ASSOC,, ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: I"=20' DATE: 8/25/98 u fl.. (D O El z v n o 3 0 v 0 c � 3 o m Cu a p D o (D go co 0 n� a 0 =1 avv rp (D 3 3 j+ O A) L L Q u fl.. (D O El TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: November 3, 1998 This is to certify that the individual subsurface disposal system constructed ( x ) or repaired ( ) by North Andover Licensed Installer Peter Breen at Lot #6 Brookview Circle, North Andover, MA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # 922 dated November 13, 1997. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector O z 0 C CO) CD M'. Z . D :Z a� .O .0 O CIO dc CD CLQ d s CD O c CDD " av ca CD z r m cn cn n O VJ 9 O 5M IJ o' O 0 2 O b CL cr O. 0 a "0 y 92 � d CD N C! o m Z s,o 01a H N -� T � .+ 7 + .= O m o m a CD N s O -40 O .r"o O = o f �� a O to O -• o y. n 0 O C Sr ="a: � a m CL �c o ?IC CO N CD 1 C m c n y N Q. Q V C _ CA O N to COD O O O O =co Nt' CD �. N m C3 m os o CL -9 C-1) 0 0 IJ o' 0 :f G C O b CL 3t?� nM cn x Q to 0 c G C O b CL 3t?� nM cn x Q to ro s 0 c TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) �j2aW' 0-,Z- Nus -e- T DATE OF PUMPING: ( r � > QUANTITY PUMPED (bof/GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: is<� COMMENTS: CONTENTS TRANSFERRED TO: JAN - T w, 14ORTh 4L 4-n. ACH Town of North Andover, Massachusetts BOARD OF HEALTH Form No.2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location Reference Pla Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee16'1 CHAIRMAN—,BOARD OF HEALTH Site System Permit No. qd-,)-- OO EX. VENT COR C 41.8' COR D \\ -7L \ \ \\ �—s \ \ d- I 1 1 53, 820 S.F. 1.24 Ac. EX. D—BOX 21.9' 1 12' BROOKVIEW THIS PLAN IS INTENDED FOR ZONING PURPOSES ONLY, IT WAS PREPARED FROM EXISTING PLANS AND RECORDS WITH THE STRUCTURES SHOWN LOCATED BY AN INSTRUMENT SURVEY. THIS PLAN SHOULD NOT BE USED FOR PROPERTY LINE DETERMINATION. 76.5' EX. 1500 GAL. SEPTIC TANK EXISTING FOUNDATION Top Fnd. EL. =136.84 29' --� —, COR A 127.41' S04011)22"W [DRIVEE 2 WE HEREBY CERTIFY THAT WE HAVE EXAMINED . THE PREMISES AND THAT ALL APPARENT EASEMENTS AND ENCROACHMENTS ARE LOCATED AS SHOWN. THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OF THE MUNICIPALITY WHEN CONSTRUCTED. ALSO, ACCORDING TO THE F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, COMMUNITY PANNEL NO. 250098 0009 C DATED 6/2/93 , THE STRUCTURE IS NOT LOCATED IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. CERTIFIED PLOT PLAN LOT 6 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR .BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MARCHIONDA & ASSOC., L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: 1"=20' DATE: 8/25/98 d „o—le I'll ,o—,s 11111111111111111 ilii IIII 1111111111111111mmm�n OM IC 1111111111111111nnnnnn IMMMMMMII IS IIS s � II cfl Lool K'll CV I I I I I in I x I s d- I I � I � I I I I C, I — I C C) I ol (� „0-,9z „0-,L 1) u � 0 I N ifl I iU-) I Lo x � 0 I fi0 N I in CIDI C) I a O I rn s C) I CD tD I I c v 00 I i� 0 I Qo oa I Ln CV e �t- I x Q I Lo O I r c cp I CV Lr; I 4 e I Lr „9 -,ll ". 119-,Z u0-,Vl TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (X constructed; ( ) repaired; by located at 1 9r° 4 d6o ez was installed in conformance with the North Andover Board of Health approved plan, System Design Permit #yZ Z , dated / 7 7 with an approved design flow of t gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Boar of Health Bed inspection date: Inspecto Final inspection date: %b/z Inspector Installer: 6 Lic. #: Date: Design Engineer: , Date: p Z,Co Ma,m rw wo h 1 o n d a & Associates, L.P. Engineering and Planning Consultants TO: NORTH ANDOVER BOARD OF HEALTH WE ARE SENDING YOU ® ATTACHED ❑ UNDER SEPARATE VIA THE FOLLOWING ITEMS: ❑ SHOP DRAWINGS ❑ PRINTS ❑ PLANS ❑ SAMPLES ❑ SPECIFICATIONS ❑ COPY OF LETTER ❑ CHANGE ORDER ❑ COPIES DATE NO. 1 8/25/98 1 1 8/25/98 1 FOUNDATION AS -BUILT (LOT 6) 1"=20' FOUNDATION AS -BUILT (LOT 6) 1"=40' THESE ARE TRASMITTED AS CHECKED BELOW: DESCRIPTION ❑ 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 ❑ ❑ PRINTS RETURNED AFTER LOAN TO US ❑ FORBIDS DUE REMARKS: IF YOU.HAVE ANYQUESTIONS PLEASE CAUL COPY TO: Flintlock Inc. Marchionda and Associates, L.P. Tel: (781) 438-6121 62 Montvale Avenue, Suite I Fax:(781) 438-9654 Stoneham, Massachusetts 02180 email: engineers@marchionda.com SIGNED: 64" 004 www. march ionda.com 141.30' `b DRAINAGE EASEMENT ��`"" ► 22.06' i AUG 2 7 LOT 7 DRAINAGE EASEMENT 6 53,820 S.F. 1.24 Ac. 75.4' EXISTING FOUNDATION Top Fnd. EL.=136.84 r 47.7' 42.9' 127.41' I VIEW - � ♦ ?����w OF Mgss�cy�' U STEPHEN M. 4 MELESCIUC N No. 39049 11 l9OFES SO4°11'22"W DRIVE N/F LOT 5 T N 55.9' E 39.0' L 116.45' 243.86' WE HEREBY CERTIFY THAT WE HAVE EXAMINED glZS/� EASEMENT16 THE SAPPARENT S AND ENCROACHMENTS S AND THAT ALL ARE LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED. ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LOCATED F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, BY AN INSTRUMENT SURVEY. THIS PLAN COMMUNITY PANEL NO. 250098 0009 C SHOULD NOT BE USED FOR PROPERTY DATED 6/2/93, THE STRUCTURE IS NOT LOCATED LINE DETERMINATION. IN AN ESTABLISHED 100 YR. FLOOD HAZARD ZONE. I CERTIFIED PLOT PLAN I LOT 6 BROOKVIEW DRIVE MARCHIONDA & ASSOC.,L.P. NORTH ANDOVER, MA ENGINEERING AND PLANNING CONSULTANTS PREPARED FOR 62 MONTVALE AVE. SUITE I BROOKVIEW COUNTRY HOMES STONEHAM, MA. 02180 P.O. BOX 531 (617) 438-6121 NORTH ANDOVER, MASS. SCALE:1"=40' DATE: 8/25/98 . 2�1 k- 1_I I!: T — :2 N —II _ _ r 1_J F'� 1 0 ...... � 2 EXISTING .� COR A 36.2' D—BOX FOUNDATION Top Fnd. 136,.84 34.5' ENf7M. -77 11 8 .9 END PIPE: D f 21.7' 71,5' LOT 7 aP-,AI, GE EASEMENT 20 C 127,41 S 0 SR06KVI15WSO4'11'22"W �.. 1INO v` a' N04'11'22 E 3. ' 24 A fi Is la,3 1 - TOP OF FOUNDATION: SEE PLANOF SWING TIES EX. VENT •• COR c 6 • \\ :•:. ti� �\ 53,820 S.F. h 133.7 \\ EK. 0-60X ~• �B.s' EX, \�NT 2 3' C01111.8 EX. 1500 GAL. SEPTIC TANK�J: -�- �� ,' d 7 12' E:K, 3' X 63' TRC PIFE V DWELLING: 127,76 ' TAIJK IN: 127,35 TANK OUT: 128,92 D—SOX IN: 126.58 D—BOX OUT: 126.43 (ALL) END PIPE — A 125 8,-7 COMPONENT r COR A CORE SEPTIC TA ' EXISTING .� COR A 36.2' D—BOX FOUNDATION Top Fnd. 136,.84 34.5' ENf7M. -77 11 8 .9 END PIPE: D f 21.7' 71,5' 20 C 127,41 S 0 SR06KVI15WSO4'11'22"W " DRIVEi 24,3.86' v` a' N04'11'22 E 3. ' 24 A fi ELEVATIONS TAKEN AT TOP OF PIPE la,3 1 - TOP OF FOUNDATION: SEE PLANOF SWING TIES PIFE V DWELLING: 127,76 ' TAIJK IN: 127,35 TANK OUT: 128,92 D—SOX IN: 126.58 D—BOX OUT: 126.43 (ALL) END PIPE — A 125 8,-7 COMPONENT r COR A CORE SEPTIC TA ' 40,2 36.2' D—BOX 62,8 34.5' ENf7M. -77 11 8 .9 END PIPE: D f 21.7' 71,5' (CENTER) (CENTER) /I/NAL d END PIPE - 8: 1s5.96 ��'►��°� END PIPE - C: 125,96 AS—BUILT SWAGE DISPOSAL' MARCHIONDA & ASSOC, L,P. SYSTEM PLAN ENGINEERING AND PLANNING CONSULTANTS LOT G BROOKVIEW C)F'IVE 62 MONTVALE AVE., SUITE STONCHAM, MA. 02180 NC)fiTH AN[ 0W.7R, : MA Sw (781) 438-612, PREPARED FOR �;if.�(,)%)KVIF.INGC)1,1N`II"iY II MES: SCA! -E: 1= it DATE: 10/10/98 I to EX. VENT COR C COR 1 D \\ 21.9' 6 53,820 S. F. 1.24 Ac, 76.5' EX. 1500 GAL. SEPTIC TANK -- 2 9' -,1 COR A 127.41f S 0 4 °11 ' 22 "W INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Hoards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section**************%***** APPLICANT: geoo(i�,c� dutul e 0Mo S Phone 0 V + f� S5 LOCATION: Asse=s=sor's Map Number /d'� '� /��'� Parcel 3 f Subdivision W"il'ewLot (s v Scree} �oo6U11e� �e��C St. Nu: er Use Only*******************x**** RE. NDATION 0 TO AGENTS: vv�v Date Antroved Censer: a -ion 3d- _-listratcr Date Rejected C =. e? ft - i wO sd Date Approved Town Planner Date Rejected cc=er-s Dare Ancroved Fccd Date Re j ec-ed Date Annrcved inS-Cec-.,_-iea_t^ Date Rejec_e� F _re De=ar -.-,e.^. se::e-- '-';a-er connections �-�l� � — f n driveway perm.-41-- F er:zit Rec==ved by Building Ins:.ector Date 41.8' EX. VENT COR C cc) (,C) \� cof) j �� 21.9P. COR Bi Approx. Location of Prop. /'Driveway 6 53,820 S.F. 1.24 Ac. EX. D—BOX 76.5' EX. 1500 GAL. SEPTIC TANK 12' COR A EXISTING FOUNDATION Top Fnd. EL. =136.84 I �-i BENCHMARK b�> I Top Fnd. Sly olu EL.=136.84 �+�� �3'g , Q_e Of U, ¢�< 1 10 7.41 BRDo--,,.�� .®.� A,�.. GAS- ----- KVIE►-..�... W DRIV --a, W� ELEVATIONS TAKEN AT TOP OF PIPE SWING TIES TOP OF FOUNDATION: SEE PLAN COMPONENT COR A COR B 9 e PIPE @ DWELLING: 127.76 SEPTIC TANK 40.2' 36.2' (CENTER) TANK IN: 127.33 D—BOX 62.8' 34.5' (CENTER) 14 TANK OUT: 126.92 END PIPE: C 116.6' 82.9' s D—BOX IN: 126.58 END PIPE: D 121.7' 71.5' LOCUS iS 4 s D—BOX OUT: 126.43 (ALL) NOTE: THERE ARE NO WELLS OR N.T.S. END PIPE — A: 125.97 WATERCOURSES WITHIN 150' OF END PIPE — B: 125.96 THE SEPTIC SYSTEM END PIPE — C: 125.96 ASSESSORS MAP 090A LOT 0063 AS—BUILT SEWAGE DISPOSAL SYSTEM PLAN LOT 6 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MARCHIONDA & ASSOC., L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: 1"=20' DATE: 8/25/98 REV. 10/29/98 AS—BUILT SEWAGE DISPOSAL SYSTEM PLAN LOT 6 BROOKVIEW DRIVE NORTH ANDOVER, MASS. PREPARED FOR BROOKVIEW COUNTRY HOMES P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MARCHIONDA & ASSOC., L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: 1"=20' DATE: 8/25/98 REV. 10/29/98 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE://0 CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER: A Arif L� SIGNATURE: �' , ;l G TELEPHONE# � 7 �z CHECK ONE: 1930,11M NEW CONSTRUCTION: ' IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes v No Foundation As -built? Yes �� No Floor plans on file? Yes No_ Approval v P, f eL a &q _-t- Date: 1Z/ l:: LOCATION: NEW PLANS: YES SEPTIC PLAN SUBMITTALS 1-725�'&o14L-vxt�7-� REVISED PLANS: YDS- DATE: DESIGN ENGINEER: 5A -T/ $60.00/Plan $25.00/Plan Z --- When the submission is all in place, route to the Health Secretary WILLIAM J. SCOTT Director Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES • 30 School Street North Andover, Massachusetts 01845 June 18, 1997 Mike Rosati Marchionda & Associates 62 Montvale Ave., Suite 1 Stoneham, MA 02180 RE: Brookview Circle Dear Mike: This letter is to inform you that the proposed septic plans for Lots 2, 4, 5, 6, 7, 8, and 10 Brookview Circle have been approved. If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator CC' Wm. Scott, Dir. CD&S File Dave Kindred CONSF.RVA70N 6RR-9530 HFAI..TH 688-9540 PLANNJNG 0;8R-9535 D Town of North Andover 0 t NORTN OFFICE OF 3� `1 t o tiQOL COMMUNITY DEVELOPMENT AND SERVICES0 to 30 School Street North Andover, Massachusetts 01845 9c t Oq�ifD fiP,y (/ WILLIAM J. SCOTT Director May 30, 1997 Marchionda Associates 62 Montvale Ave. Suite #1 Stoneham, MA 02180 Re: Lot #6 Brookview Circle To Whom it May Concern: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: If new plans satisfactorily addressing all the following issues are submitted to the Health Department by June 12, 1997, then approval for the plans should be given by June 19, 1997. - 1. Only 2 copies of plans submitted. (N.A. 6.01) 2. Need manhole to within 6 inches of grade. (3 10 CMR 15.228(2)) 3. Elevations of perc tests missing. (N.A. 6.02j) 4. Reserve not 4 feet from primary. (N.A. 2.23) 5. Vent on lines missing. (3 10 CMR 15.251) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp cc: David Kindred CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 May 30, 1997 Marchionda Associates 62 Montvale Ave. Suite #1 Stoneham, MA 02180 Re: Lot #6 Brookview Circle To Whom it May Concern: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: If new plans satisfactorily addressing all the following issues are submitted to the Health Department by l Z , then approval for the plans should be given by Only 2 copies of plans submitted. (N. A. 6.01) _,2-' Need manhole to within 6 inches of grade. (3 10 CMR 15.228(2)) tj�Elevations of perc tests missing. (N.A. 6.02j) 4,4: Reserve not 4 feet from primary. (N.A. 2.23) L.. ! ent on lines missing. (310 CMR 15.251) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp cc: David Kindred NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT DATE CIT FEE: PERMIT ## DATE RECEIVED 7 APPLICANT jC/k) DeC-f MAP PARCEL ADDRESS LOT # O�D STREET ## ENG. 'TD 5/37-% STREET" eCO)eUI&W (f/ eC11G- ENGINEER'S ADD. PLAN DATE 3 ZI ICT 7 REV. DATE. CONDITIONS OF APPROVA APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: j a CDP/,5 5 U em eLEV14 V66U7- NI7ss//�6, d V O 7 r it oa PLAN REVIEW CHECKLIST ADDRESS �o,�Q�,�/CL� ENGINEER GENERAL 3 COPIES STAMP LOCUS NORTH ARROW tl� SCALE CONTOURS PROFILE tZ (Sc) SECTION Ll ---- BENCHMARK SOIL & PERCS ✓ ELEVATIONS>( WETS. DISCLAIMER c---' WELLS & WETS WATERSHED?4/0 DRIVEWAY WATER LINE LI -1, FDN DRAIN4-' M&P SCH40 � TESTS CURRENT? ��' SOIL EVAL M "--ZO S 147-% SEPTIC TANK MIN 150OG ✓ .17 INVERT DROP` GARB. GRINDERA(2 comps +200) 10' TO FDN ✓ MANHOLEX ELEV L"" GW C # COMPS. GB D -SOX SIZE # LINES 3 FIRST 2' LEVEL STATEMENT INLET` JL7 - OUTLET = `1 7 (2" OR .17 FT) TEE REQ'D?,&,� LEACHING MIN 440 GPD?" RESERVE AREA L 4' FROM PRIMARY? 20 SLOPE 100' TO WETLANDS` 100' TO WELLSi/� 4' TO S.H.GW L'' (5'>2M/IN) 20' TO FND & INTRCPTR DRAINSl- 400' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER V 'FILL?y-(15') BREAKOUT MET? TRENCHES MIN 440 gpd ✓ SLOPE (min .005 or 6"/100') --�SIDEWALL DIST. 3X EFF. W OR D (MIN 6' )_L, --RESERVE BETWEEN TRENCHES? L -----IN FILL? L-�fMUST BE 10' MIN. L,----4" PEA STONE?_LZ'VENT?� (>3' COVER; LINES >501) BOT 477+ SIDE 7c 7q,J X LDNG �J` = TOT 7 `� (L x W x ##) (DxLx2x#) (G/ft2) Copyright 9 1996 by S.L. Starr Cl No so Ems MEN MEN son Ems mom NONE ■■■ ■ soon I no no on • I::I:: 111 �IIIIIIIIIIIIIIIIillllilll�t 'IIII I� ■■ ■■ Illt. IIIII �� ■■ on III III I — II ... IIIIIIII (II II�111111111111111 II ' ' 111111111111111111 111 -- - IIIIIIIIIIIIIIIII ■■SMmEoMmO ■■■■ ■■■■■■ ■■ MEMO �...... :::: 1`,,I OW ■■■■■■I IIIIIIIIIIIIII ', IIIIIIIIIIIIIIIII `, MENNEN I ---- soon IIIIIIIIIIIIII .............. ��ll I I11 ::... 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