Loading...
HomeMy WebLinkAboutMiscellaneous - 101 FOSTER STREET 4/30/2018• 1 Commonwealth of Massachusetts _ City/Town of System Pumping Record RBCBIVL!9 Form 4 DEP has provided this form for use -by local Boards of Health. Other forms mtecjQ0%94j ek t7414 information must be substantially the same as that provided here. Before usck with yo r local Board of Health to determine the form they use. The System Pumping ° the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left / Right front of house, Left / Right rear of housOp .. ng si a of house Left/ Right side of building, Left / Right front of building, Left / Right rear of u6 ildin Under ec 9 9 9 g, Address Cityrrown v State Trp Code 2. System Owner. . Name Address (if different from location) Citylrown -de P Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank t5fbrm4.doc• 06/03 ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No; 5. Condition of stem: 6. System Pumped By. Neil. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company contents -were disposed: System Pumping Record • Page 1 of 1 IL Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 C MAY '15 'NQ ITOWN OF NORTH ANDOVERj HEALTH DEPARTMENT I DEP has provided this form'for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Left / Right rear of hous Le 'g Id of house eft / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State �, � .� Z� ode Telephone Number S� B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date 2• Quantity Pumped Cesspool(s) eptic Tank 4. Effluent Tee Filter present? ❑ Yes Q -No 5. Conditiop of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. l s� Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 'C6C�'-b F5821 Vehicle License Number Date t5form4.doc• 06103 System Pumping Record • Page 1 of 1 /Cj / � � % G � ji i - -� �� � . ...... .... w, Iz �z 3-�z0 ��. L � �!(?5 C�% fit lU;.f�r�.(iV�/ ��O�d�ter ��� �„ _,�` _ � 'QJ � � _�` � �.� 1 j R. 5 ,` ��ii�� �d� ��� i :��zln� 2� s I m Ah % -1 4' 4b 0 /� i ��� % �<< Ji NEW ENGLAND ENGINEERING SERVICES INC A1 0 6 2005 ' NORTH ANpOVE� TpWN OF pEPPRTMENT 1-IEA�TN April 30, 2005 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 101 Foster Street, North Andover, MA Dear Sir or Madam: Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. Please take note of the wording on the front page of the report. If there are any questions please call me at my office, 686-1768. Sincerely g-, C 0` Benjamin C. Osgood, r., P -E. Certified Title 5 inspector 60 BEECHWOOD DRIVE -NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECT] RE ,CE ell 1 2005 ANDOVER TITLE 5 TONE 0TN pV-PA TMEN� OFFICIAL INSPECTION FORM — NOT FOR VOLUN Y ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _ /10/ S"( .. Owner's Name: Owner's Address: v Date of Inspection: Name of Inspector. (please pant) Benjamin C. Osgood, Jr. CompanyName:New England Engineering Services Inc. Man7ingAddress:60 Beechwood Drive, North Andover, MA 01 $45 Telephone Number. 978-686-1768 CERTIFICATION STATEMENT T 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: fPasses Conditionally Passes _ Needs Further Evaluation. by the Local Approving Authority Fails Inspector's Signature:0-" Q'Z Date: p - 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 "ky5'Tr M vn,0C�2 tt N0 �(�c� w Ccs v v r i7On /1-7>i�G vT /�vS�� C �U✓[. ►'u THE wo g pt•,3 6- ,No (-0110 11A)-1W-0/Lr&s1-120"V (r '7�1c' fvZ�2� pVrtlrt-7G/i or THE Sy spm l5 Be(— G--v'ftl2e ""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 willperform in the future under the same or different conditions of use. ,Page2of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /ol fast sTlz Ity0/1-IN Ant Dy Uel - AAA Owner: ZH t-eA .ti+v,v"C Date of Inspection: Inspection Summary: Check A B Cj) or E / ALWAYS complete all of Section D A.. System Passes: C5 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: Alb One or more system components as descri-bed 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 o1d* or the septic tank (whether metal or not) is structurally unsound, exlu'bits substantial infiltration or exfiltmhon 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 pipc(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: . Pagel of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: !di `aRE /tf:0 RTH AN 7DcJ 0 Owner: L ,v 12b L Date. of Inspection: as 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(lxb) that the system is not functioning in a manner which wM protect public health, safety and the environment: — Cesspool or privy is within 50 fed 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 kdie ies that the well is free from pollution from that facility arid. 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: /o/ Fvs,2 5T2Ec ii /V--i2TY AlUyou6g.v�Fl Owner: 4 - LF ti C Date of Inspection: 3 v oS D. System Failure Criteria applicable to all systems: You mast indicate "yes" or ` nd' to each of the following for all inspections: Ye$ No ✓ZBa&-W of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓bisdiarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool — L,,7 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'/z 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 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 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.] " �(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 lid You must indicate either `yes" or "no" to each of the following: (The following apply to large systems in addition to the criteria above) yes no the system is within 4 of a surface _ — the system is within 200 feet of a tri the system is located in ogee sensitive Zone 11 of a pub ' ter supply well supply a surface drinking water supply Wellhead Protection Area – IWPA) or a mapped If you have answ red "yes" to any question in Section E the systemlsronsidered a significant threat, or answered "yes!' in Section D above the large system has failed. The owner or oper 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _ 6o/ j -`J -.5 -T19 Ce —., Lo Llf AND 0vE2 /vu9 Owner: Ty 1- '-nU/V �� t Date of Inspection: 49.&5- Check 9.& s 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 V/ 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 ? Z— Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffies or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? -I/-- 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 V Existing information. For example, a plan at the Board of Health — -ZDctermined 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 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: fo/ t::fosic2 S%2cc i /►� 2?K sFiV� ouE/L 04 Owner: LE A4UA14P C Date of Inspection: o� FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): ---- Number of bedrooms (actual): .; DESIGN flow based on 310 CMR 15.203 (for example-. 110 gpd x # of bedrooms): -- Number of current residents: Does residence have a garbage grindr (yes or no): No Is laundry on a separate sewage system (yes or no): a1 o [if yes separate inspection required] Laundry system inspected (yes or no): = Seasonal use: (yes or no): L/O Water meter readings, if available (last 2 years usage (gpd))-.N o Baa Sump pump (yes or no): ,eVo Last date of occupaac, VA -9 K No w �tf—----.-- COMIERCIALIMUSrRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sq&,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: ETHER (describe): GENERAL INFORMATION Pumping Records Source of information: u,y K yvo w n/ Was system pumped as part of the inspection (yes or no): j/© If yes, volume pumped: tallaas -- How was quantity pumped determined? Reason for pumping: TYPE 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) _ InnovativelAlternative 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): 4D Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /,,)/ �'i7s l-2FA 4ZL�' Aly dt4ly6(1c/L iull/ Owner. 2)'Vvn120 Date of Inspection: oS BUILDING SEWER (locate on site plan) Depth below grade: _-1/ ` Materials of construction � iron 40 PVC other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): RE /—_o jt s o 1.4. 1 A -J B ffsFA- a&t—, SEPTIC TANK: _ (locate on site plan) Depth below grade: ..3, 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: /o o o 6 -?1-1,j o .vSludge depth: depth: jot " Distance from top of sludge to bottom of outlet tee or baffle: 7t Sc �LEM o uG r' Scum thickness; / a N Distance from top of scum to top of outlet tee or baffie: 1- Q6PL,+C F D —,7)Y Distance from bottom of scum to bottom of outlet tee or baffle: _ s cK 4t L) PUC 'VF- AAl'D How were dimensions determined: _��,ysuQt� Sic V— NES `61 Eye' Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 'TJ9N14_ IN OK, CJND� O 1-7 -Z.tsi ✓Z eve -v COV e2 Nn p��.yuvG- TA A GREASF, TRAPVIJ�{locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other (exPlairi): 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: /D/ rost E,2 2c,' f Owner: 71t- Date of Inspection: `j /mss-' TIGHT or BOLDING TANK: LVe (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: CaPacitT. Rallons Design Flow: �allonstday 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: (if present must be opene(Wocate on site plan) Depth of liquid level above outlet invert: 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.): &K jV 014, GdtiJ.^> I -s62 �y(Lc`�J.✓ � 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: /a/ Owner: T1L6-2 rnUN2pe 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: leading galleries, number: leading trenches, number, length: leaching fields, number, dimensions: S z C c>t= 1%LEl�l� vN K rva ��✓ overflow cesspool, number: innovativelalternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): _��� Di �lE�� hJ/Lal+•gLo EU,�a.�C�' pJNJ N 01- ,t 2E J yN D j4 Fi i ;-7t Fe Off- T2Ee 6 �o CESSPOOLS: 44!�(cesspool must be pumped as part of inspectionxlocate 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;e !(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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAddress: /Ol Fbs-1ZF1Z ITIly A"U ,9vy62 A"q Owner: Ty E2 �n OA) Jv (5F - 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. 2iuC Page 11 of 11 OFFICIAL INSPECTION FORM = NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _/y/ &-c —1 -Cit !;-,-r, No/z-j?-! A�VD00E00- -144 Owner TGE n�eoE Date of Inspection: as SITE EXAM Slope Surface water Check cellar $hallow wells Estimated depth to ground water (, feet Please indicate (check) all melhods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: A- 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: r e gn I- t> A to C,1 C0 4, Tr>o ' �nTorH c5� Sy57'�FM isS-� 6 r« Rec.ow Town of North Andover Office of the Health Department a? °t. `' Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 �ssgcHuset� Sandra Starr Telephone (978) 688-9540 Public Health Director Fax (978) 688-9542 NORTH ANDOVER BOARD OF HEALTH ORDER LETTER Issued under the provisions of the State Sanitary Code, Chapter II, Minimum Standards of Fitness for Human Habitation, 105 CMR 410.000. Date: January 2, 2002 To Owner of Record: Alphonse Bielevich 101 Foster Street North Andover, MA 01845 An authorized inspection was made of your property at the above referenced address by North Andover Health Department personnel on January 2, 2002. This inspection revealed violations of certain regulations of the State Sanitary Code, Chapter II, as listed on the attached Violation Form. You are hereby ORDERED to correct these violations within the time allotted on the enclosed form. Failure to comply within the specified time period may result in further action by the North Andover Board of Health. You have the right to request a hearing before the Board of Health if you feel this order should be modified or withdrawn. A request for said hearing must be made in writing and received by the Health Department within seven (7) days from the receipt of this order. At said hearing you will be given an opportunity to be heard and to present witnesses and documentary evidence as to why this order should be modified or withdrawn. All affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. You may be represented by an attorney. You have the right to inspect and obtain copies of all relevant records concerning the matter to be heard. Hand Delivery BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ORDER LETTER An authorized inspection of 101 Foster Street was performed by Board of Health staff on January 2, 2002 at which violations of 105 CMR 410.000 Chapter II of the State Sanitary Code, Minimum Standards of Fitness for Human Habitation were found. Failure to respond within the allotted time period may result in a Board of Health finding that the dwelling is unfit for human habitation. Violation Regulatory reference Re -inspection LIVING ROOM Entire premises in dire need of basic 410.602, cleaning; cobwebs and thick dust on 410.750(I) all surfaces in living room; smell of urine and feces throughout the house. Pile of trash knee-high on carpet in living room in front of fireplace; may also be garbage in pile. Numerous dead insects in cobwebs, on tables and window sills throughout living/dining area. KITCHEN Kitchen floor littered with bags of food and trash that spills into hall; floor also covered with spills, possibly fecal matter, and garbage. All surfaces covered in tiers of canned and bottled foods with some opened and/or spilled. Sink filled with food encrusted dirty dishes; stove has old spills, dirty pots and utensils covering all but one burner. The refrigerator is filled with rotten and rotting food, such as hamburger and tomatoes. Large dark spill down shelves, mold in food containers; good food mixed in with the rotten. BATHROOM Fecal matter on floor around toilet with used toilet paper. Soiled slacks on floor as well; bathtub soiled. MASTER BEDROOM Fecal matter on and beside bed, and on wall and electric heater. Bed sheets fouled with both fecal matter and urine, blankets, too. BEDROOM #2 Piles and bags of old newspapers on the floor and on the bed. LAUNDRY ROOM Downstairs laundry room filled with bags and cartons of canned goods, juices and mason jars. Five butternut squash lie on the floor at the foot of the stairs. The occupant of any dwelling unit shall be responsible for maintaining in a clean and sanitary condition and free of garbage, rubbish, and other filth or causes of sickness which may provide a food source of harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. VIOLATIONS TO BE CORRECTED WITHIN 14 DAYS Carpet should be washed/steam cleaned to remove stains and odors. Excess canned food in all rooms is to be stored in cabinets or removed. Kitchen counters are to be cleared, cleaned and sanitized. Spills on carpet are to be cleaned up and carpet cleaned. Refrigerator must be cleared of rotten food, thoroughly cleaned and sanitized, and spoiled food disposed of. Floors and walls to be washed, cleaned and sanitized as possible. Premises are to be dusted and vacuumed on a regular basis. According to 105 CMR 410.750(I) "Failure to comply with any provisions of 105 CMR 410.600, 410.601, or 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source of harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation of spread of disease" is one of the cited conditions which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Therefore, the homeowner and/or caretaker must immediately complete certain activities within 7 days. These are as follows: 1. The master bedroom, linens, mattress, floors and walls must be thoroughly clean:d and sanitized. n�•. �' S ivy t e. j S 2. All garbage and trash to be removed and disposed of properly. 3. Kitchen floor to be washed and sanitized 4. Stove to be cleaned and put into accessible working order. 0 5. Kitchen sink cleared and made usable.o 6. Bathroom floor, toilet, sink and bathtub are to be cleaned and sanitized with a 20% bleach solution. You may contract with a third party within five days to perform this work if you are unable to complete it yourself. If such a contract is executed, you must forward a copy to the Health Department at 27 Charles Street, North Andover. If you have any questions or concerns, please contact the Health Department either personally or by an agent of your choice at 978-688-9540. Sincerely, Sandra Starr Public Health Director CC: Board of Health File Alan Bielevich NORTH ANDOVER HEALTH DEPARTMENT 120 Main Street e North Andover, MA 01845 Telephone (508) 682-6483, Ext. 32 Mousing Inspection Report COMPLAINT # COMPLAINANT _ ADDRESS OF PREMISES OCCUPANT OWNER OWNER'S ADDRESS Aoz DATE OF INSPECTION HOUR ROOMS/VIOLATION: ,&1V7A&--,---7C06A4���� Z> K) z • --p. /--zzz c° . � R9 GG /tom I 1 �O tai cL"G ill /.d1 ISS- /9IR•1 Actlon Press 685.7000 INSPECTOR Bad situation mailbox:/C%7C/NETSCAPE/mail/INBOX?i... 18@homel.ne.mediaone.net&number=406 Subject: Bad situation Date: Sat, 30 Jan 1999 14:56:46 -0500 From: "Gayton Osgood" <gayton@world.std.com> To: "Sandy Starr" <jstarr@world.std.com> CC: 'Bob Halpin" <rhalpin@shore.net> Sandy, I was called by the Police Department today to go to a house at 101 Foster - Street for a problem with an elderly couple. This was another situation similar to the ones we recently had on Moody, Pleasant and Andover Streets only worse. The house was so bad that I had to condemn it on the spot and have the Fire Department take the two people to the Lawrence General. The people were Alphonse Bielevitch 78 and his wife Mary 83. I hated to do it because they did not want to leave. Mr. Bielevitch had to be forcibly removed from the house. He begged me to let him stay but I could not in good conscience leave him in that house. The house was so bad that I felt that their lives were at risk, all of the exits were blocked with trash and even a small fire would surely cause their deaths. There is food and garbage everywhere and the house was full of flies. The Police Department called Elder Services but because of it being a Saturday they did not respond. They are also going to try to find some relatives to see if they can help out. We are going to have to figure out a way to deal with situations like this because there are far to many of them to pass off as anomalies. I told the Police Department to let me know how they make out with contacting relatives because we will need to follow up on this to make sure the situation gets resolved somehow. This one really bothered me. Gayton Gayton Osgood 38 Osgood Street North Andover, Massachusetts 01845 gayton@world.std.com 1 of 1 1/30/99 7:05 PM TOWN O U, SYS EM PUMPING RECORD DATE: ` ✓` Y-0 S SYSTEM OWNER & ADDRESS DATE OF PUMPING: SYSTEM ]LOCATION (example: left front of house) RECEIVED APR 2 5 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT — r L��- S- QUANTITY PUMPED: CESSPOOL: NO �ESSEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowe11 Waste GALLONS d5Town of North Andover Of e f the Health Department �� fic 3j � o Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Cl Health Director — 40 Telephone (978) 688-9540 Fax(978)688-9542 ar, c� ct Exc�p 4- C4 bo -9) r� BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Town of North Andover Office of the Health Department F A Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 S""5 Sandra Starr q1R �� l �� Telephone (978) 688-9540 (W Health Director Fax (978) 688-9542 0a)0V& \,\r\AN-�o, �WV-Q& QQ*i) C SL V -Q, S'" op UYW- . U1C CQ BOARD OF APPEALS 688-9541. BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 \� � § � � 2 � } � � ± \ � 2 — \� J/ � / ( R\ �\ \ƒ±��) (t (oo § 7bQ <w9 � / � ° \ � � � § � � » % , q \7 , � \EmE / ` / � ( ƒ / � � � / \ � ƒ� �\ \ ) \k% E k ( J \t\ ' \\ \ / o \ X66 �G /\7 m\ \� �§) E ƒ9§ / e % j < & ; FOR M i�� OF PHONE_ AF MESSAGE r OF t PHONE AREA CODE MESSAGE 1 IGNED 48003 A.M. ATE T1 rA E P.M. NUMBER EXTENSION 48003 NOTES s NOTES a. n� 1 Town of North Andover * t%ORTk Office of the Health Department o ttLEC ,°Aar Community Development and Services Division i 27 Charles Street ° North Andover, Massachusetts 01845 4SsACHU Sandra Starr Public Health Director NORTH ANDOVER BOARD OF HEALTH ORDER LETTER Telephone (978) 688-9540 Fax (978) 688-9542 Issued under the provisions of the State Sanitary Code, Chapter II, Minimum Standards of Fitness for Human Habitation, 105 CMR 410.000. Date: January 2, 2002 To Owner of Record: Alphonse Bielevich 101 Foster Street North Andover, MA 01845 An authorized inspection was made of your property at the above referenced address by North Andover Health Department personnel on January 2, 2002. This inspection revealed violations of certain regulations of the State Sanitary Code, Chapter II, as listed on the attached Violation Form. You are hereby ORDERED to correct these violations within the time allotted on the enclosed form. Failure to comply within the specified time period may result in further action by the North Andover Board of Health. You have the right to request a hearing before the Board of Health if you feel this order should be modified or withdrawn. A request for said hearing must be made in writing and received by the Health Department within seven (7) days from the receipt of this order. At said hearing you will be given an opportunity to be heard and to present witnesses and documentary evidence as to why this order should be modified or withdrawn. All affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. You may be represented by an attorney. You have the right to inspect and obtain copies of all relevant records concerning the matter to be heard. Hand Delivery BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ORDER LETTER An authorized inspection of 101 Foster Street was performed by Board of Health staff on January 2, 2002 at which violations of 105 CMR 410.000 Chapter II of the State Sanitary Code, Minimum Standards of Fitness for Human Habitation were found. Failure to respond within the allotted time period may result in a Board of Health finding that the dwelling is unfit for human habitation. Violation Regulatory reference Re -inspection LIVING ROOM Entire premises in dire need of basic 410.602, cleaning; cobwebs and thick dust on 410.750(I) all surfaces in living room; smell of urine and feces throughout the house. Pile of trash knee-high on carpet in living room in front of fireplace; may also be garbage in pile. Numerous dead insects in cobwebs, on tables and window sills throughout living/ dining area. KITCHEN Kitchen floor littered with bags of food and trash that spills into hall; floor also covered with spills, possibly fecal matter, and garbage. All surfaces covered in tiers of canned and bottled foods with some opened and/or spilled. Sink filled with food encrusted dirty dishes; stove has old spills, dirty pots and utensils covering all but one burner. The refrigerator is filled with rotten and rotting food, such as hamburger and tomatoes. Large dark spill down shelves, mold in food containers; good food mixed in with the rotten. BATHROOM Fecal matter on floor around toilet with used toilet paper. Soiled slacks on floor as well; bathtub soiled. MASTER BEDROOM Fecal matter on and beside bed, and on wall and electric heater. Bed sheets fouled with both fecal matter and urine, blankets, too. BEDROOM #2 Piles and bags of old newspapers on the floor and on the bed. LAUNDRY ROOM Downstairs laundry room filled with bags and cartons of canned goods, juices and mason jars. Five butternut squash lie on the floor at the foot of the stairs. The occupant of any dwelling unit shall be responsible for maintaining in a clean and sanitary condition and free of garbage, rubbish, and other filth or causes of sickness which may provide a food source of harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. VIOLATIONS TO BE CORRECTED WITHIN 14 DAYS Carpet should be washed/steam cleaned to remove stains and odors. Excess canned food in all rooms is to be stored in cabinets or removed. Kitchen counters are to be cleared, cleaned and sanitized. Spills on carpet are to be cleaned up and carpet cleaned. Refrigerator must be cleared of rotten food, thoroughly cleaned and sanitized, and spoiled food disposed of. * Floors and walls to be washed, cleaned and sanitized as possible. Premises are to be dusted and vacuumed on a regular basis. BEDROOM #2 Piles and bags of old newspapers on the floor and on the bed. LAUNDRY ROOM Downstairs laundry room filled with bags and cartons of canned goods, juices and mason jars. Five butternut squash lie on the floor at the foot of the stairs. The occupant of any dwelling unit shall be responsible for maintaining in a clean and sanitary condition and free of garbage, rubbish, and other filth or causes of sickness... which may provide a food source of harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. * All trash, garbage and rubbish is to be removed and disposed of properly. Carpet should be washed/steam cleaned to remove stains and odors. Kitchen floor is to be washed or otherwise cleaned and sanitized. Excess canned food in all rooms is to be stored in cabinets or removed. Kitchen floors and counters are to be cleared, cleaned and sanitized. Spills on carpet are to be cleaned up and carpet cleaned. Refrigerator must be cleared of rotten food, thoroughly cleaned and sanitized, and spoiled food disposed of. Stove is to be cleared and cleaned. Bathroom is to thoroughly cleaned, and surfaces washed/sprayed with bleach solution. All sheets and blankets in master bedroom to be washed and cleaned; mattress should probably be steam cleaned or replaced. Floors and walls to be washed, cleaned and sanitized as possible. According to 105 CMR 410.750(I) "Failure to comply with any provisions of 105 CMR 410.600, 410.601, or 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source of harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation of spread of disease" is one of the cited conditions which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Therefore, before the homeowner returns to the dwelling, certain activities must be carried out. These are as follows: The master bedroom, linens, mattress, floors and walls must be thoroughly cleaned. 2. All garbage and trash to be removed and disposed of properly. 3. Bathroom and kitchen floors to be washed. 4. Stove to be cleaned and put into accessible working order. 5. Kitchen sink cleared and made usable. You may contract with a third party within five days to perform this work prior to your return home, If you have any questions or concerns, please contact the Health Department either personally or by an agent of your choice at 978-688-9540. Sincerely, Sandra Starr Public Health Director According to 105 CMR 410.750(I) "Failure to comply with any provisions of 105 CMR 410.600, 410.601, or 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source of harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation of spread of disease" is one of the cited conditions which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Therefore, the homeowner and/or caretaker must immediately complete certain activities within 7 days. These are as follows: 1. The master bedroom, linens, mattress, floors and walls must be thoroughly cleaned and sanitized. 2. All garbage and trash to be removed and disposed of properly. 3. Kitchen floor to be washed and sanitized. 4. Stove to be cleaned and put into accessible working order. 5. Kitchen sink cleared and made usable. 6. Bathroom floor, toilet, sink and bathtub are to be cleaned and sanitized with a 20% bleach solution. You may contract with a third party within five days to perform this work if you are unable to complete it yourself. If such a contract is executed, you must forward a copy to the Health Department at 27 Charles Street, North Andover. If you have any questions or concerns, please contact the Health Department either personally or by an agent of your choice at 978-688-9540. Sincerely, Sandra Starr Public Health Director CC: Board of Health File Alan Bielevich NORTH ANDOVER HEALTH DEPARTMENT 120 Main Street 9 North Andover, MA 01845 Telephone (508) 682-6483, Ext. 32 Housing Inspection dT�- COMPLAINT # COMPLAINANT _ ADDRESS OF PREMISES OCCUPANT OWNER OWNER'S ADDRESS DATE OF INSPECTION HOUR ROOMS/VIOLATION: 6107A% '-7?04QZj n / / ZAI 5,1,1 a -k) z -.-;F. T'zo e° . �I GG /�5 rn 11 QC�iGicL"� /ll /.11� � ev (i iia- -, 1.1Z) J50iI) �. INSPECTOR Form #HIR -1 Actlon Press 685.7000 ® - OW ORDER LETTER An authorized inspection of 101 Foster Street was performed by Board of Health staff on January 2, 2002 at which violations of 105 CMR 410.000 Chapter H of the State Sanitary Code, Minimum Standards of Fitness for Human Habitation were found. VIOLATIONS TO BE CORRECTED WITHIN 14 DAYS Violation Regulatory reference Re -inspection LIVING ROOM Entire premises in dire need of basic cleaning; cobwebs and thick dust on all surfaces in living room; smell of urine and feces throughout the house. Pile of trash knee-high on carpet in living room in front of fireplace; may also be garbage in pile. Numerous dead insects in cobwebs, on tables and window sills throughout living/dining area. KITCHEN Kitchen floor littered with bags of food and trash that spills into hall; floor also covered with spills, possibly fecal matter, and garbage. All surfaces covered in tiers of canned and bottled foods with some opened and/or spilled. Sink filled with food encrusted dirty dishes; stove has old spills, dirty pots and utensils covering all but one burner. The refrigerator is filled with rotten and rotting food, such as hamburger and tomatoes. Large dark spill down shelves, mold in food containers; good food mixed in with the rotten. BATHROOM Fecal matter on floor around toilet with used toilet paper. Soiled slacks on floor as well; bathtub soiled. MASTER BEDROOM Fecal matter on and beside bed, and on wall and electric heater. Bed sheets fouled with both fecal matter and urine; blankets, too. 410.602, 410.750(I) a Aj 6.)e -j 5 - 7Z)c,5, Z-. r6l7L- woeK. q 7?- -/ 7 V - d6 &C - 1'�Z /� ) VVI 1 n 1 rill') rUMIVI: --ed, or letter from owner permitting action. This covers the minimum two deep holes leach disposal area. Fee of $75.00 per lot for rm deep hole inspections. Professional Engineers can design septic Jlation tests are required for each septic system and at least one percolation test, at the jJitional tests within two weeks of testing. I� (no smaller than 1 "-100') shall be submitted to bn of all tests (including aborted tests). In forms shall be submitted. a) 0) M a - N LL O N 4--+ F- V) V) _Q) H L FtT c 0 a � >r � a� o G � y„ o r, m H s E c. r L ao a L � � L o g E C 0 g �°0 c .s+ re d N o E = L 2 M .0 (a 2 O co O m I �+ ro a C CL G Q t v-. O Q E m U O O C , Q� E a--� fu CL cn 0 n � J ' � �vl �� ate;l��r ev t Z— Ol i i �n c �5 �fi e ��✓�, V^cc O�pw/j is A Vo r e e r f° i ; I ��� ��� cc %,Lt 'IIt Q << L.-- Le e- I, f •v\p^^� \ 17 i i py 1 , Nll 5 N.s J U II �sr c, FL/,)--, CnllQr �i� , p✓� �Q �/�N Ll C r/e ® e `N t� , i •p� 1r`0 � LZ c f7 �G�rJ �S p �1 �� � ���z� 4pre y t r' c t ��, o f r -�r, y- , �9- �- N �OAA,v`+ ��-- �-u��%.�O\J �-. Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT ANIS SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director (978)688-9531 Mr. & Mrs. Alphonse Bielevitch 101 Foster Street North Andover, MA 01845 Re: Dwelling @ 101 Foster St. Dear Mr. & Mrs. Bielevitch, Fax(978)688-9542 April 7, 1999 An inspection was made on April 6, 1999 of the dwelling at 101 Foster Street, North Andover by the Health Department staff to check for violations of the State Sanitary Code 105 CMR 410.000 Minimum Standards for Human Habitation. No violations were found at this time and the dwelling may be re - inhabited at your convenience. Please call the office at the number listed below if you have any questions. Sincerely, Sandy Starr, R.S. Health Administrator BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 COMPLAINT #. COMPLAINANT ADDRESS OI OCCUPANT NORTH ANDOVER HEALTH DEPARTMENT 120 Main Street • North Andover, MA 01845 Telephone (508) 682-6483, Ext. 32 Housing Inspection Report OWNER - 45 l47- CLl / -7-cTT OWNER'S ADDRESS DATE OF INSPECTION' g HOUR 0-7 : a ROOMS/VIOLATION: • �'' -0 IM INSPECTOR `m #HIR -1 Action Press 885-7000 1 FEE- 1-99 1.4311 11:01 P1114 1ERTH 4 NH1 ,TR PHI"E Fri:; 1•dU. 50868111 1 P. 1 - � �� °—MioL E��ZZ� Affm -= �- Fcom the D E P A R T M E N T COMMUNICATIONS CENTER "Community partnership" 566 .MAIN STREET, NOXFK ANDOVEft, MASSACHUSETTS 01845-4099 • TELEPHONE: 978-683-3168 - FAX: 978-681-7172 TO: — C)Qr d. C'V 0+.a 1-1 ' TOWNONORTH �,NUVER/ ATTENTION: -5151AV S4 4r r- - _ r BOARS? OF HEATH ' n FAX NUMBER: FROM: C� fr -gs'-l�;z REGARDING: NOTES/COMMENTS: TOTAL NUMBER OF PAGES IN THIS FAX, INCLUDING CODER: NOTE.- If you have any questions or problems regarding the materials being faxed, please contact the undersigned at the above numbers. The information contained in this transmission is privileged, confidential and intended only for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on the contents of this facsimile transmission is strictly prohibited. If you have received this communication in error, please notify the North Andover Police Department immediately; by telephone. Collect and return the original message to us at the address shown above, via the U.S. Postal Service. We will reimburse you for required postage, telephone calls or any other expenses you may incur. FEB- 1-99 MON 11:03 AM NORTH ANDOVER POLICE FAX NO. 5086811172 P. 2 Z? Y 71 p. m -i N LJi:7 77i I Sc A Z 4 Z NA p ::i i Cl Q r, e iza Lp L m Ce uviil_y ✓. :5 .1 ta z, i^8 5i ei a -,i c s.,-, is lb e an a. I is a C, a in:. a w a 105 L a L e i: L i i s. 1 L, N �'i e L. s a Z% t e { v L- ij. i L L, c a"Z L ii :J..''a. z: i a L; i Q o.;i a r Q Zi a c4 -4C:: .._':1;._j T'Ju1:, aL j: Ll z? f a e f ii G -i4 LWs eli vv f n1C5 ri a L- if ;m 7 �i L .1 1 3 , w v, i " t I I I I R 11, POLICE FEE- 1-99 M01-1 11 :03 Al I-IORTH UiDOVER POLICE .1 Al ly, 11 10". 50816811171? P. 3 v c. . ... .... ... Commonwealth of Massachusetts re City/Town of System Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key "1 1�1 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before u ng local Board of Health to determine the form they use. The System Pumping Reco ifff the local Board of Health or other approving authority. Mnfig A. Facility Information TOWN OF NORTH ANDOVER 1. System LOT lOn: i HEALTH DEPARTMENT �� Off' �v v Address Citylrouen State w� 2. System Owner: Name Address (if different from location) Cityfrovm B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date Zip Code State Zip-Code Telephone Number 2. Quantity Pumped Cesspool(s) ILJ Septic Tank Gallons ❑ Tight Tank 4. Effluent Tee f=ilter present? ❑ Yes [ -iso If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: V'--\�� 7l� l 6. System. Name Vehicle License Number Company 7. Location a ntent r o Date rD t5form4.doc^ 06/03 System Pumping Record . Page 1 or 1