Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 101 GRANVILLE LANE 4/30/2018
Q:D I W � MAP # LOT # _������\l�� �� PARCEL # STREET ____._________�~�^____ GONE-[RUCTION-]qPPROVAL HAS PLAN REVIEW FEE BEEN PAID?(az) NO PLAN APPROVAL: DATE APP. BY_`�n�^�. DESIGNER: 151PLAN DATE _............. WATER SUPPLY: TOWN WELL PERMIT DRILLER__ r4,vo_ WELL TESTS: CHEMICAL DA[E APPRUVED____ BACTERIA I DA|E UPPRUVED _ BACTERIA II DAIE APPHOVED... .......... _ COMMENTS: . . Is FORM U APPROVAL: DATE ISSUED CONDITIONS: APPROVAL TO ISSUE NO BY FINAL APPROVAL: ALL PERMITS PAID NO WELL CONSTRUCTION APPROVAL NO SEPTIC SYSTEM CONSTRUCTION APPROVAL NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: ��|'_BY�� " ^ , IS THE INSTALLER LICENSED? TYPE OF'CONSTRUCTION: NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW CONDITIONS OF APPROVAL ` (FROM FORM U) ISSUANCE ISSUANCE OF DWC PERMIT ' YES DWC PERMIT No. ' INSTALLER:__ NO REPAIR NO NO ` BEGIN INSPECTION NO: ' / EXCAVATION INSPECTION: NEEDED: BY__ NEEDED: APPROVAL TO BACKFILL: TE Y FINAL GRADING APPROVAL: DATE --BY FINAL CONSTRUCTION APPROVAL: � - ` lJATE: Y NO REPAIR NO NO ` BEGIN INSPECTION NO: ' / EXCAVATION INSPECTION: NEEDED: BY__ NEEDED: APPROVAL TO BACKFILL: TE Y FINAL GRADING APPROVAL: DATE --BY FINAL CONSTRUCTION APPROVAL: � - ` lJATE: Y Permit NO: Date Issue i• i 4 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received , U 3�7- .6+�N4 O t .•y l� Residential TYPE OF IMPROVEMENT PROPOSED USE / Phone: %zk XJ 1i 6 Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ers: ❑ Demolition ❑ Other �^e�ypt�irl SF�'!�♦���.i.YRy�I� �x.QtQf/�RYY DESCRIPTION OF WORK TO BE PREFORMED: Identification Plea e Type or Prit Clearly) OWNER: Name: �/ ��dn�t/��► Phone: Haaress: COIC� • i-.' /ktt;`5`S` ms`s s �q uperylsor'Verts� Home ImDr o e(rrent"Liu ARCHITECT/ENGINEER/ Na —4)4(1011 / Phone: %zk XJ 1i 6 Add ress:!6�� �� f 14,t �``�� f�.2 �G ��, Reg. No. FEE SCHEDULE: BOLDING PERMIT: $1 0 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 12_ FEE: $74 f Check No.: Receipt No.: NOTE: Persons contracting with u egistered contractors do not have access to the guarantyfund Signsttare of AgenU4w Signature of contractor *1 f c Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools Well Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS / DATE REJECTED DATE APPROV HEALTH ❑ � �' Z -- COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments 1✓N. L ` \ 1"�v �.• YA �'^� C, ':�FC'i�i tl 4i . 1 d V�yyV7y \/_V•`�` \V, Y� � t �{1�i14 � C �v�J� t �� n �' ti� .t ■ 1 � N o o N 1 o o \ ok�U rz 0 1 E° o ' f I ao.c 1 wU�O� � r o �0 U V t r W�•� I � � r `•` % oO`� \\�Z xi;10, • � � -- � — OAC � •k0 N W3 p�QC?� od5/ .. ........... of .�5. . COQ �V \ 4f q R Q �,�, �� � • / � � ``ago / s O 76 V c '� 3 \ O ^ \ ^ ^ ^ ♦- L v I .Y C cu 01 C O n d c0 ... O N ca 2 U 11 U U .ZfL N U) I I 0 II . Q 0 O Q- a� U II U It i 144 90 Seo --r -r l_. C-sI�ES �..(✓.S. kjoiZ->r1-1 ASS. .*- 5 31.9 T -rCost. ,.. �a t4- A— A 15a,Gac,ST j � 1 43 0 ti �D 1 `' F�'r�C. CE•TT�F'cE.a 3, �' ll l t4j4o ov�T vF H Sir— 1 14.42 Lo (V 1►..ITO TAw1� 113.S�e Cjd17— oJT TAwJIC. 113•S4 0 Qj� t�.tTo D.lE3. 11 ('..loco t , 111.20 5, 111.18 GE.2Tl)=� THAT o t='FS�TS S+Iow►J A1z..E. T02 THE. Aid or Si-ld`a.! 1� C�caMPl�y O 1:1C..ry A ti.1 fl S vGH VSE. 1 S ���i � �+ \.c.J rr 4 f -z- w..t AT l o I.J o t= ti cy 13972 8-/ L.Aka S o !✓' C.o ►.,.1 F ot2, hal tT 7' oTZ. I- J a �..t :.lo Auraovlc2��A. \T'� k-1 HE. �..a Go �.i ST2�uGTE.D. �'�^R11�S \a1<✓T tl 1 14-I 4o -40 MER SEPTIC & DRAIN SERVICE 107 r�OREST STREET; MIDDLETON, MA 01949 (978) 774-2772 FORM 4 - SYSTEM PUMPING RECORD C MM NWEALTH OF MASSACHUSETTS MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER; /Up � -AL, � � L o t 00 SYSTEM SYSTEM LOCATION::l '(' a,/\- � C�L L�. 3 DATE OF PUMPING: �a o QUANTITY PUMPED: J jC6 v GALLONS CESSPOOL: NO EEtYES SEPTIC TANK: NO YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: L DATE: Commonwealth of Massachusetss Massachusetts System Pumping Record !;tem Owner System Location ••,C T-tt Aisr!"v°j. :�.� IYLR4 (22 Type: Emergency Routine Cesspool: w 4/ 1 Yes Date of Pumping:�76(5— U System Pumped By: Wind Neer Envirommnfo% LLC Contents transferred to: Contents Disposed at: Date: Pumper signature: Condition of System/Other Comments Form 4 -- System Pumping Record Dep Approved Form - 12/07/95 17IP4 -,-p I-rj'`(7 f GT Septic tonic w ayes Quantity Pumped: 6allons Permit #: RECEIVED AUG 0 4 2004 TONAOF NORTH LTH ER DEPARTMENT HEALTH 14� F THE COMMONWEALTH OF MASSACHUSETTS %o/5' TOWN OF NORTH ANDOVER ` APPLICATION FOR LICENSE N0. (General) 30 19�© To the Licensing Authorities: The undersigned hereby applies for a License in accordance with the pro- visions of the Statutes relating thereto ANNUAL REGISTRATION DISPOSAL WORKS INSTALLER Full name of person, firm or corp. applyiNt -11 11 ng) / .;5- TO CONSTRUCT& REPAIR SUB SURFACE DISPOSAL SYSTEMS (State clearly purpose for which license i,(�s-requested) AT � �q ���t A e � I V, (Give. -location by street and number) in said Town of North Andover, Mass. in accordance with the rules and regulations made under authority of said Statutes. „ Received_ A. M. HOUR P.M. 19 .FEE: Payable to Town of North Andover $100.00 ( gnatureeo pplicant) C ie VMA (Address) Approved 19_ License Granted 19 5 LL V- O v 4-1 z c6 W- C CL 0 Q� L Q) ry FT. F C B I I c c V U O � p � o � m v, � c Q. R a L a v --T c L o e L � d � "d c o ¢ OG 'o A !II CL c v o E c � a� .o mOQ 0 -a ru O m Q) c a Q t 0 Q -0 (D ro o E m O V O c . AMERICAN ENVIRONMENTAL LABORATORIES, INC. 60 Elm Hill Ave. Leominster, MA 01453 SAMPLE INFORMATION Requested By: Robert Napoletano Address : 72 Buckman St. City : Everett, MA 02149 Sample ID: Tap Matrix : Water REPORT NO. 1 89120--944 '(508) 534-1444 LAB ID #MA076 . 800 -LAB -0094 Date Received : 08/20/51 Date Analyzed : 08/21/91 Collected By : Same ampe ocation ( different). 101 Granville Lane North Andover, MA PARAMETER RESULT MCL LIMIT BRIEF DESCRIPTION Coliform Bacteria [P] Neg Pos or Neg Animal/vegetational. batt. Fecal Bacteria NT Pos or Neg Animal bacteria Standard Plate Count NT No Limit General water bacteria Sodium 11.10 20.0 mg/1 Mass O.E.P. Guideline Potassium [S] 1.30 No Limit A component of salt Copper [S] NO 0.1.0 mg/1 Indicates plumbing corrosion Iron [S] 0.1.5 0-0.30 mg/1 Brown stains, bitter taste Manganese.[S] >K 0.07 0-0.05 mg/1 May cause laundry staining Magnesium 6.10 No Limit A component of hardness Calcium 27.80 No Limit A component of hardness Alkalinity [S] 80.00 No Limit Ability to neutralize acid Chlorine NO 0-0.05 mg/1 A disinfectant ( bleach Chloride [S] 5.00 0-250 mg/1 A component of salt Hardness 94.50 No Limit 0--75 soft Nitrate [P] ND 10.0 mg/1 Indicator of biological waste Nitrite NO 1.0 mg/1 Indicator of organic waste Ammonia ND No Limit Gas from organic breakdown Sulfate [S] 14.50 No Limit A mineral, may cause odor PH [S] 7.76' 6.5-8.5 The acidic/basic condition. Conductivity 201.00 No Limit Elec. resistance, umbos/cm Sediment Neg Pos or Neg Presence of sediments Total Dissolved Solids [S] 120.60 0--500 mg/1 Total minerals present Color [S] 2.00 0--15 cu Clarity/Discoloration,(0--15) Odor [S] 1.00 0--3 ton Odors due to contamination Turbidity [P] 2.40 0-5 to Presence of particles Comments: For those items tested this sample meets the following EPA criteria for drinking water [x] Primary [ ] Secondary [ ] Neither. Complete Analyst: Scott Richmond OMMMEMN it = Exceeds EPA Proposed MCL Limits *PLEASE NOTE* MDL = Minimum Detection Limit The results here, can not be reproduced in whole or in part without our prior consent. The results apply only to the actual sample tested. MCL LIMIT = Proposed EPA Maximum contaminant level American shall be held harmless from any liability arising out of the use ND = Level present is below detection limit of such results. The integrity of the sample and results is dependent on NT = Not Tested the quality of sampling. BOARD OF )11;ALTII Town of North Andover,1lass - Date 19 APPLICATION FOR WELL & iv,it, PrRmn 1-r atIon is here y made for permit to drill a well ( Application LS OJnstall. ((--Y a pump system. CIO 0 11,: -Addres Lo U ALE=(" d d ss re e S S C 6t12 �-R ,0e-_-2 (I d r c s s�� ontractor r Address Te 1. A ontractor :O,N . TRACTOR (To be completed at t:i[I)c of pkIIIII) test:) �f Well. .elr of Well of Bed Rock iai Tested? Yes to -Water Well o-Water Well used for Size of Casillg__ Depth casiT19 into Bccl "Ocl" No (—) Date of Testing Well Ended in What. Material Delivers Gals -Per "il-1- for it hours )wn.,. feet after pumpin8___)1OtJrq' at G PH )f` completion Signature J IT—C -0 -11 r a c t o r INSTALLER (To b"e' f I . Iled i.n- before i 11-SU01. lat ion) Pump' Name Pump Type Used Purnp Delivers GPM Size Of . 1*alll�__ iar-e'rial Used in Well: Cast IrOT-1 G-1 v;1 11' zed or Pitless,Adaptdr .e e v'e used to protect Pipe? Yes U "OU "'Y" or Name Well Se, .I.aLer analysi's repor-t. submitted LO ItOar(l of 11,C 31111 release given wowner of record & Bldg, IIIsP_ health _Inspector ARMSIAN MLL DRILLING 10 PROCTOR HYL l7a4D • HOLL4 RH 030.;9 • (CO3) 8?94M J PAY THE ORDER �� CJ OF LLLD DATEq p CHECK NO. LOWELL INSTITUTION FOR SAVINGS 0� 624. / V 53-7108/2113 2. 61 9 ,2�1 ' `�/) CHECKAMOUNT c/ r T V " AU HOR2ED SIGNATURE 10'0022691111 1:21b37MBD: M EIC532-0r' 3 Department of Environmental Management/Division of Water Resources ;: to WATERVE1.11 COMPLETION REPORT WELL LOCATION f GEOGRAPHIC DESCRIPTION Addres S E W of r (feet) (circle) City/Town 4L Well _ A Well own (road Ad ress$ ( 'x W Of Board of Healtt#permit: yes ❑ no ❑ intersect. w/ road) J WELL USE Domestic 0 Public ❑ Industrial ❑ WELL DATA Total well depth�t. Monitoring ❑ Other Depth to bedrockft. Water -bearing rock/unconsolidated material: Method drilled Date drilled %tp.� Description�� CASING Water -bearing zones: 1) From To Type .n��,• /(, Length __5,P ft. Dia(I.D.)_ in.. 2) From To / Length int bedrockft. 3) From To Gravel pack well: dia. Protective we I sea Screen: dia. Grout.❑ Other Slog length from_to WELLTEST Static water level below land surface_ ft. Date — Drawdown. AO ft. after pumping hr._/_�Cmin. attA'— gpm How measured aLp Recovery.;Z ft. after---j—hr. min. LOG of FORMATIONS I COMMENTS Materials OAF W1510,011, .3r ..,,fit •/ / 11f� + .i .rr, ♦ i..�.. BOARD OF'HEALTH COPY r BOARD OF' 111�ALT11 wn of North Aiidover,Hass . e� Da19�C/ ' APPLICATION FOR WELL & I'UHP PERHIT ication.is hVa y made for permit to drill a well (� Application Ls Co install pump system. tion: Address1.4 Lot It d cess7d2 �cl. i Contractor ddress 7•e l �J'"�� '��% Contractor- %-� Address Tel. CONTRACTOR (To be completed at time of pump test) i of Well Well used for a`01 Teter of Well cla Size of Casing :h of Bed Rock Depth casing; into L'ed i:ocic ��`yy'2 Seal Tested? Yes (1'r No (_) Date. of Testing; ,O— .h of—!,le=-1— —^-- Well Ended in What. Material Delivers_ 4�Gals.I'er Hin. for 4 hours :h to Water / • idown `feet after pumping -4_hours+ at Gltt`1 of Completion_ g�naturc IeII oilt cit r INSTALLER (To be' filled in before in:.�t��l.l.ati.on) r & Name Pump %--'.-----.--Pump 'type Used,��;� ar Pump Delivcrs�GPM Size of Tanlc Material Used in Well: Cast Iron (_) Ga)v:rr>>zed (_) Plastic L Pit ( ) or Pitless.Adapter(LAY-- sleeve used to protect pipe? Yes (^) 1J0(1lYpc or Marne Well Scab Ye ()rtirsit t:,:.:..,;,(,( rt e Water analysis. repor-t• •submitted to Board Of Ileallh e release given tD owner of record & Bldg. Insp IIeaIth Inspector 3 cn \k � «««R 2Rd ® \k> Ro C/) »Pm o \/cn 2 %em 0 0 0 FS 7�� 0 #R0 00 _ 4 2 G m«m \ / / ƒ / co CD ©� GE�i-1 r-=-► Ec:> Fou Li C:mi�T► o PJ T::1- A " L.oGATEt� 1 U ��TN Au�dvE-2.3 LASS A'-'<'- 2, 194 0 T H AT THE. aF'FSfc_T'S SKaw4..1 C�vMPC..y `.J Cr 4; THE, zAl,j lkX- L.AkA S Q=:> F ►Jo RuavyF_2a�A. \Ad 64 c ---`i E�> U % L -T oF'7"FSl5--T-S �Hdkl►J AT�E� (=oT� THE f 'T+-+ rc. u �. n ►, t u s P�crb>z �E.T E.2 t-�l � ti► AT l o ►,_J o � �c � � ti/ 6 C ro L t F o t2, t-, tT 7' aT2. L-A a k -A C.o k -j F4=P2dq- \T' y k� H E. t`1 Go ►--1 ST 2, V GT C—,C as 1 S 139727 STI%k pp LAC' ZAI GEST' l p"1 Et=� Fo<) U H7-1 o L.oGATEc� 1 U ��'TN Hu��T/�2. � MASS =: GE, THE, oF'F'S>�TS Sy l _ Ak(S o t✓ lc l 41 E�L1 U l L__.'T- o t= FS�TS SHow t„1 A>ZE. X02 TNE. U`JE. of 'T 5-+E, lEa>UILrpt►.16 �uSPECi27Q O ►,.1 C_.y A� fl S t.�G H VSE. l S �o �.� �E,T E�2 til � w� AT l o ►..j C:>j F' �.o ti.► i �J G. C.o u f= care, t-1 lT Y oT2. ►J, a k.,1 Go ►-.y FCACA A- \T' -K \A� H E.. ►-.t Go ►--► ST 2r V GT *--D . &1XRb Of-- MCAUT l- I NoI�-rM Aupove)�I MA, t oT I L A r9RAAJ&,La:7 (,uq�-G`� s�i'► r.Y.. _ Q.fc�w�l� L7 WELL APi-�oucDJ}�T�. -I j /MNz UW6 Auilyoi�)ry X15,4 PPlzo v5p D/�TE RF-,ASUNS DSL -- StPl cc Sv5rE,4,1 1,k,5`AUA- In,U e XAV4'f 1ON )"S(,� E G T io &J l,VSPEGrIon� P4,1 Q PITS El VA1L F(FE F(2o&A iso ro T/30r PA5) �i F/0)1- ,4PPRWEP Dig-rC AWITIOMAL. i�l5i c_j �tiaj �1{--/)Ijy) ---- �'X�G )) Izo Dt5�C1Pt'�Zvvi:l� D,�1 �= FRAL APPIN)VAL ��l ri � 577 MAIN STREET HUDSON, MA 01749 800-499-1682 WIXDRIV-ER ENVIRONMENTAL RE ,EC VED SEP - 3 2N4 TOOF NORTH ANj)OVER NER&O_P ARTM ENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNER'S NAME: NAPOLITANO, ROBERT PROPERTY ADDRESS: 101 GRANVILLE LN., NO. ANDOVER, MA 01845 ADDRESS OF OWNER: SAME (IF DIFFERENT) DATE OF INSPECTION: AUGUST 19, 2004 NAME OF INSPECTOR: THOMAS CHIGAS 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: 101 GRANVILLE LN NO. ANDOVER, MA 01845 RECEIVED Owner's Name: NAPOLITANO, ROBERT Owner's Address: 101 GRANVILLE LN. NO. ANDOVER, MA 01845Date of Inspection: AUGUST 19,2004 Name of Inspector: (please print) THOMAS CHIGAS Company Name: Windriver Environmental Mailing Address: 577 Main Street Hudson, MA 01749 Telephone Number: 800-499-1682 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: Inspector's Signature: YES Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F�ilc AUGUST 19.2004 The system inspector shall submit a copy of fids inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this in*' ection. 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. Page 2 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1.01 GRANVILLE LN NO. ANDOVER, MA Owner: NAPOLITANO Date of Inspection: AUGUST 19, 2004 Inspection Summary: Checlo B, C, D or E / ALWAYS complete all of Section D A. System Passes: YES 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: NO 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. NO 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: NO 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): NO broken pipe(s) are replaced NO obstruction is removed NO distribution box is leveled or replaced ND explain: NO 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): NO broken pipe(s) are replaced NO 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: 101 GRANVILLE LN NO. ANDOVER, MA Owner: NAPOLITANO Date of Inspection: AUGUST 19, 2004 C. Further Evaluation is Required by the Board of Health: NO 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: N/A Cesspool or privy is within 50 feet of surface water N/A 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: NO 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. NO The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. NO The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. NO 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: N/A Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 101 GRANVILLE LN NO. ANDOVER, MA Owner: NAPOLITANO Date of Inspection: AUGUST 19, 2004 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 N/A Liquid depth in cesspool is less than 6" below invert or available volume is less than'/2 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. N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone 1 of a public well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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 N/A the system is within 400 feet of a surface drinking water supply N/A the system is within 200 feet of a tributary to a surface drinking water supply N/A 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 101 GRANVILLE LN NO. ANDOVER, MA Owner: NAPOLITANO Date of Inspection: AUGUST 19, 2004 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. N/A 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 101 GRANVILLE LN NO. ANDOVER, MA Owner: NAPOLITANO Date of Inspection: AUGUST 19, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 4 Number of bedrooms (actual): 4. DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder (yes or no)? NO Is laundry on a separate sewage system (yes or no): NO [if yes separate inspection required] Laundry system inspected (yes or no): N/A Seasonal use: (yes or no): NO Water meter readings, if available (last 2 years usage (gpd)): WELL ON SITE Sump pump (yes or no): NO Last date of occupancy: CURRENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): _gpd Basis of design flow (seats/persons/sqft, 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: OWNER Was system pumped as part of the inspection (yes or no)? NO, LAST PUMP 7/6/04 If yes, volume pumped: 1500gallons -- How was quantity pumped determined? SIZE OF TANK Reason for pumping: CHECK FOR LEAKAGE TYPE OF SYSTEM YES Septic tank, distribution box, soil absorption system, pump chamber NO Single cesspool NO Overflow cesspool NO Privy NO Shared system (yes or no) (if yes, attach previous inspection records, if any) NO Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) NO Tight tank Attach a copy of the DEP approval N/A Other (describe): Approximate age of all components, date installed (if known) and source of information: INSTALLED 8/23/91, ASBUILTS AND OWNER Were sewage odors detected when arriving at the site (yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101 GRANVILLE LN NO. ANDOVER, MA Owner: NAPOLITANO Date of Inspection: AUGUST 19, 2004 BUILDING SEWER (locate on site plan) Depth below grade: 25" Materials of construction: 4"cast iron 40 PVC other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): _ SEPTIC TANK: YES (locate on site plan) Depth below grade: 16" Material of construction: YESconcrete 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'L X 5'W X 5'H OUTLET INVERT (a, 50"=1500 GALS Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle: 22" Scum thickness: <2" Distance from top of scum to top of outlet tee or baffle: 5" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined? ROD AND RULER Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): THERE IS A METAL MAN -HOLE COVER 4" BELOW GRADE. THE LIQUID LEVEL WAS AT NORMAL HIGHT, AND THERE WERE NO SIGNS OF LEAKAGE IN OR AROUND TANK. THE INLET AND OUTLET BAFFLES ARE CEMENT CONSTRUCTION AND IN GOOD CONDITION. GREASE TRAP: NO(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: 101 GRANVILLE LN NO. ANDOVER, MA Owner: NAPOLITANO Date of Inspection: AUGUST 19, 2004 TIGHT or HOLDING TANK: NO (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: YES (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0" DEPTH BELOW GRADER 2" 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.): THE BOX IS LEVEL. THERE IS ONE INLET AND FIVE OUTLETS, ALL SCH2O PVC THERE WERE NO SIGNS OF LEAKAGE OR FAILURE SOILS WERE CLEAN AND DRY. PUMP CHAMBER: YES (locate on site plan) Pumps in working order (yes or no): YES Alarms in working order (yes or no): NO Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): THERE'S A SMALL PUMP CHAMBER IN BASEMENT THAT WAS GOING TO SUPPORT A BATHROOM IN BASEMENT, BUT CONSTRUCTION WAS NOT COMPLETE. THE PUMP IS IN GOOD WORKING ORDER AND THERE'S SCH40 2" PVC WITH CHECK VALVE ALL IN GOOD CONDITION. Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101 GRANVILLE LN NO. ANDOVER, MA Owner: NAPOLITANO Date of Inspection: AUGUST 19, 2004 SOIL ABSORPTION SYSTEM (SAS): YES (locate on site plan, excavation not required) If SAS not located explain why: Type Leaching pits, number: Leaching chambers, number: Leaching galleries, number: Leaching trenches, number, length: YES Leaching fields, number, dimensions: 301W X 50'L LEACHBED 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.): THERE WERE NO SIGNS OF BRAKEOUT OR FAILURE IN OR AROUND AREA, SOILS WERE CLEAN AND DRY. THE LEACHLINES ARE SCH2O PVC AND THERE IN GOOD CONDITION. CESSPOOLS: NO (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: NO (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.): SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101 GRANVILLE LN NO. ANDOVER, MA Owner: NAPOLITANO D,gt . of Inspection: AUGUST 19, 2004 H OF SEWAGE DIS a sketch of the sewage irks. Locate all wells v FC c)UCJI=%T%C;,Kj RA t`(oQTFd AuflovE.e�MASS. v -r t4 P, -A 5.2't Ao. if landmarks or C�. 20�&-f Wt�jl jv l/l,'2k— 7 uJe1 J fa D-� = t37 ll � l4-(40 � oJT of HSE. 114.42 IUTO Tga.1►r 113.6 �s o.JT T.A...I IL 113.SY 1 \.lTo =).15. 1 1 L r-r- oUT O.b. 11+_.44 1. Ill•Zo S. 111.16 T H l S ►..�dT I S �i yr 1 Ll � ♦= Levo O S Grt.2TlFy T�,=7-- TN E. 1� or THS ol= FSrcTS U5E of TNE, FSU1L,01� 16 Z L+SF'6C1V A u O S S G'o W lT4{ 'THE. z�oU1 �rcT Er2.M %,-j ATIofJ Ol= �.0 �.11tiJ Cy " i! ..y H Eb-/ C ,o u P- o»s l-� r r- Y ore- 1-1 01..1 Co 1.1 Feet—l- 1ry` "T l�/$ Uo_ A"��">=Q.,_MA. \T -y bel HE. k-1 Go til 6T P.r 4 -'JC -r F.D. 't .;C LJ.N�r' S 2 40 - it B�X3/4/ Page I 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101 GRANVILLE LN NO. ANDOVER, MA Owner: NAPOLITANO Date of Inspection: AUGUST 19, 2004 SITE EXAM Slope: YES Surface water: NONE Check cellar: YES Shallow wells: NONE 106.2 Estimated depth to ground water 6befprrw1 feet Please indicate (check) all methods used to determine the high ground water elevation: YES Obtained from system design plans on record --If checked, date of design plan reviewed: 8/2/90 YES Observed site (abutting property/observation hole within 150 feet of SAS) YES Checked with local Board of Health -explain: INFO NO Checked with local excavators, installers- (attach documentation) YES Accessed USGS database -explain: MAPS You must describe how you established the high ground water elevation: THE HOME HAS 8' PRECAST FOUNDATION AND NO SUMP PUMP. WHILE DIGGING IN YARD LOCATING SYSTEM THERE WERE NO SIGNS OF HIGH SEASONAL WATER IN OR AROUND AREA. THERE WERE N09 SIGNS OF ABUTTING PROPERTY'S. WELLS OR WETLANDS WITHIN 150' FROM SYSTEM. There were God Tet -S 1`ci0lpe on 516188 wafer k beta 106.'4 FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP OZ (r, SUBDIVISION LOT(S) PERMANENT ADDRESS (ASSIGNED BY D.P.W.)l (� ` STREET /`lfq �r-gndv,�l� L�inG APPLICANTy /lam, t OV C,,') c PHONE DATE OF APPLICATION G / (I / !Z o TOWN USE BELOW THIS LINE PLANNING BOA. -- "�*,w)I TOWN PLANNER CONSERVATION,COMMISSION CONSERVATION'ADMIN. BOARD OF HEALTH HEALIVS DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT -rs�WATER CONNECTIONS _ M FIRE DEPT. t7LL RECEIVED BY BUILDING INSPECTION DATE �~ DATE APPROVEDli DATE REJECTED DATE APPROVED V[TE REJECTED DATE APPROVED 912. 0/5; 9 DATE REJECTED 0 �l�vl�G (3lCc, E-- R This form shall be signed by the agents of the Planning and Health Hoards, the Conservation Commission prior to the issuance of any building, permlts for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw.