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Miscellaneous - 1050 FOREST STREET 4/30/2018
_ 1050 FOREST STREET 290/905.D-0978-0=.O _ \ t MAP #— LOT # -------- PARCEL STREET _._.___...._......._.. CONSTRtjC N_ .9DYES HAS PLAN REVIEW FEE BE N PAID? NO PLAN APPROVAL: DA /f �_ APP. DESIGNER: 61�.e6 ri/ � � ILI O _L1/Z-�__------/ 7C CONDITIONS— ........ ONDITIONS WATER SUPPLY: TOWN WELL WELL PERMIT .. .. �r� _ DRILLER. ..].__........__f/� _.. ._._.__..... ........... WELL TESTS: CHEMICAL DAIS AI'RftUVED BACTERIA I DA I E (IPPRUVLD BACTERIA Ii DA I-E APPROVED..........___.._..__.__.__ COMMENTS: FORM U APPROVAL: /°�� =� �APPROVAL TO ISSULC, yY � NU DATEISSUED _BY __._-____._.._._._.___..---..._..........._.._.. _....._..__-- CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES J NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DA I-E:. .. .. .-.,fir., ;�.:�. - ' ;;•: - . SES�SY�IEM�.NS.I94�,.��4N. IS THE' INSTALLER LICENSED? NO TYPE OF- CONSTRUCTION. - - --' : . NE —� REPAIR' NEW CONSTRUCTION. , CERTIFIED PLOT PLAN 'REVIEWS NO CONDITIONS OF..APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT `. ' _ YES NO -•DWC PERMIT N0. *INSTALLER: A/45/—),/� _ BEGIN INSPECTION ANO: .. .. '.-EXCAVATION ,INSPECTION: : NEEDED: PASSED By INSPECTION: BY ' CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: C, y APPROVAL TO BACKFILL: DATE: % BY G _ f INAL . GRADING APPROVAL: DATE AV Ictl BY FINAL CONSTRUCTION APPROVAL: DATE: BY PRINTED BY:Pamela DelleChiaie- PLEASE LEAVE IN PRINT-OUT TRAY.......THANK YOU. DelleChiaie, Pamela From: Osgood, Benjamin C. [BOsgood@Pennoni.com] Sent: Wednesday, December 08, 2010 7:53 AM To: DelleChiaie, Pamela Subject: 1050 Forest Street Pamela, We are doing some work for the owner of 1050 Forest Street and I was wondering if you could send me a copy of the Septic System As built plan so we can show the septic system on our plans. Thank You Ben Benjamin C. Osgood, Jr. , P.E. Sr. Engineer PENNONI ASSOCIATES INC. Suite 120 Suite 201 100 Burtt Road 93 Stiles Road Andover,MA 01810 Salem,NH 03079 Tel: 978-749-9929 x 3712 Tel: 603-226-1950 Fax: 978-749-9920 Fax:603-226-3235 Cell: 978-435-1324 Note: use the address 300 Ballardvale St.,Andover,MA for mapping http://www.pennoni.com I bosgood@pennoni.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. I IDFI DelleChiaie,Pamela N I " 'N w t . Q � LOT 4 / 3.16 ACRES LOT 3 W 2 STORY WOOD FRAME Is TOP FND,= 103.36' RON r PIN FOUND IRON WELL PIN FOUND ,l /y A I�QiQ`hs -4p � 7p�a•w � IRON LOT 5 / • (pt�BG1C N�JB' PIN 00• W IRON FOUND �AR1q PIN FOUND 3 81747' W 87.31' ILEVATIONS / DESIGN AS-9wtT INV. PIPE OUT OF HOUSE 97.35' 96•D4' AS-BUILT U B-S U R F A C E INV, PIPE INTO TANK 96.75' 97.50' INV. PIPE OUT OF TANK 96.Et0' 97,25' Imy, PIPE INV, PIPE IOUT OfNTO BDX BOx 99 23' 95.6 �96.02, a\�H of M,�ssAc DISPOSAL SYSTEM IN INV.END OF PIPE 96.00' 95.35' o STEVEN R. yep. NO..-ANDOVER, M A. CHOUINARD` PREPARED FOR; VI 5 P1M1LAN IS NOT A WARRANTY(W THE SYSTEM BUT A VERIFICATION NO.3 I 4 COLONIAL VILLAGE DEV. CORP OF THE LOCATION OF THE EXISTING STRUCTURES +� �•Q� � � PREPARED BY: STEVE CHOUINARD, P.E. 3 �►� SCALE: 1"=80' DATE: 3/30/95 d WdOO:Ftp SE, TE cHkl FROM : SOUCY'S SEWER SERVICE INC* PHONE NO. Apr. 29 1999 09:46AM P1 FA... r'u-'RANSM 1 14 ISS10"""N SOUCV'S SEWER SERVICE,INC. 830 UvwGSTON STPFgy TEWKSBURY. MA O 1 875 (978)85 1•8839 FAX: (978)$51-8839 To: North Andover Board of Health Date: April 29, 1999 Fax#: (978)688-9542 Pages: 2, including this cover sheet. From -fohn J. Soucy Sub*t., 1050 Forest Street. COMMENTS.- Enclosed OMMENTS:Enclosed please find an "As-Built".Plan for the above captioned address. SOUCY'S SEWER SERVICE, INC. 830 LIVINGSTON STREET TEWKSBURY, MA 01876 (978)851-8839 1050 FOREST STREET NORTH ANDOVER, MA GARAGE A B PORCH C A - C = 32' B - C = 36.5' 94.25 INLET 94.5 OUTLET TOW BOARS0,�,HEALTH FROM : SOUCY'S SEWER SEROICE INC* PHONE NO. Apr. 29 1999 09:46AM P2 ' "Q 11V4♦ 830 LIVINGS'ONS 5�'Rt.�j TEWKSBURY, MIA 01,87(., (978)851--8839 1050 FOREST STREET NORTH ANDOVER, MA GARAGE A B . PORCH C A - C = 32' B - C = 36.5' 94.25 INLET 94.5 oLyr,ET f NORT#t 0 > p SACHUS PUBLIC HEALTH DEPARTMENT Community Development Division December 4, 2007 Edward and Nancy Krovitz 1050 Forest Street North Andover, MA 01845 Dear Mr. and Mrs. Krovitz: Please note that due to recent reviews of Title 5 Reports, your property has been identified as maintaining a working garbage grinder that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage grinders are never recommended where septic systems are used, but if they are installed, the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this grinder could quickly cause a pre-mature failure of your septic system,resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdeptQtownofnorthandover.com.com. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. Sincerely Susan Y. Sawyer, REH S Public Health Director /pfd Enc: Septic System Information: http://www.mass.gov/det)/water/wastewater/dodont.htm 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com iviass lit✓r :: ivlwutyxesource Protection- peptic Systems/Title itle 5: information for hom... Page 1 of 1 How Do I as a System Owner Properly Care for my Septic System? Conventional on-site septic systems can function very well with minimal care.In fact,most septic tanks will only require an inspection and pumping out by a professional every three to five years if they are used properly.This does not pertain to 1/A_5ystems,which need more frequent oversight. DO... DON'T... Do have the system inspected and pumped every 3 to 5 Do not use your toilet or sink as a trash can by dumping years.If the tank fills up with an excess of solids,the non-biodegradables(cigarette butts,diapers,feminine wastewater will not have enough time to settle in the products,etc.)or grease down your sink or toilet.Non- tank.These excess solids will then pass on to the leach biodegradables can clog the pipes,while grease can field,where they will clog the drain lines and soil. thicken and clog the pipes.Store cooking oils,fats,and grease in a can for disposal in the garbage. More information On pumping Do know the location of the septic system and drain Do not put paint thinner,polyurethane,anti-freeze, field,and keep a record of all inspections,pumpings, pesticides,some dyes,disinfectants,water softeners,and repairs,contract or engineering work for future other strong chemicals into the system.These can cause references.Keep a sketch of it handy for service visits. major upsets in the septic tank by killing the biological part of your septic system and polluting the groundwater. Small amounts of standard household cleaners,drain cleansers,detergents,etc.will be diluted in the tank and should cause no damage to the system. Do grow grass or small plants(not trees or shrubs)above Do not use a garbage grinder or disposal,which feeds the septic system to hold the drain field in place.Water into the septic tank.If you do have one in the house, conservation through creative landscaping is a great way severely limit its use.Adding food wastes or other solids to control excess runoff. reduces your system's capacity and increases the need to pump the on-site tank.If you use a grinder,the system must be pumped more often. Do install water-conserving devices in faucets, Do not plant trees within 30 feet of your system or showerheads and toilets to reduce the volume of water park/drive over any part of the system.Tree roots will running into the on-site system.Repair dripping faucets clog your pipes,and heavy vehicles may cause your and leaking toilets,run washing machines and drainfield to collapse. dishwashers only when full,and avoid long showers. Do divert roof drains and surface water from driveways Do not allow anyone to repair or pump your system and hillsides away from the septic system.Keep sump without first checking that they are licensed system pumps and house footing drains away from the system as professionals. well. Do take leftover hazardous chemicals to your approved Do not perform excessive laundry loads with your hazardous waste collection center for disposal.Use washing machine.Doing load after load does not allow bleach,disinfectants,and drain and toilet bowl cleaners your septic tank time to adequately treat wastes and sparingly and in accordance with product labels. overwhelms the entire system with excess wastewater. You could therefore be flooding your drain field without allowing sufficient recovery time.You should consult your tank professional to determine the gallon capacity and number of loads per day that can safely go into the system. Do use only septic system additives that have been Do not use chemical solvents to clean the plumbing or allowed for usage in Massachusetts by DEP.Additives septic system."Miracle"chemicals will kill that are allowed for use in Massachusetts have been microorganisms that consume harmful wastes.These determined not to produce a harmful effect to the products can also cause groundwater contamination. individual system or its components or to the environment at large. http://209.85.165.104/search?q=cache:OSxS WhzZovAJ:www.mass.gov/dep/water/wastew... 1/22/2007 N \ \ i N 1 iN \ f \ \ N r AL FEMA ZONE-A \ / FEMA ZONE-.v AL AL AL ti \ AL LOT 4 LOT 3 I 3.16 ACRES 2 STORY 1� �,� WOOD FRAME \ IRO I / PIN V FOUND H IRON WEL PIN FouND LEACHING FIELD EPTIC a? X04. ac U TAN m. h IRON ^' PIN IRON LOT 5 (Pl/ VC ` FOUND PIN N`38'00• W FOUND STREET S 81*OV4r W 67.31' * LOT 4 LIES WITHIN A RESIDENCE 1 (R-1) ZONING DISTRICT NOTE: PLOT PLAN THE PROPERTY LINES SHOWN WERE TAKEN .� OF LOT 4 FROM A PLAN ENTITLED " PLAN OF LAND _ M FOREST ST., N. ANDOVER LOCATED IN NO. ANDOVER, MA," DATE 8/31/94 �. BY CHRISTIANSEN & SERGI, PL #12455 N.E.R.D. 909SOVEY � �► OWNED BY: MARK & JEANNIE MCGONIAGLE ss� SURVEY BY: $ R-JJSSELL J. BOUSQUET, P.L.S. SCALE: 1"=80' DATE: 10/10/97 Septic System Information 1050 FOREST STREET Printed On: Tuesday,December 04, 20 System ID: BHS-2002-0771 General System Information Latest Permit Information Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity: Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder: Yes No Soil Type: Depth: Laundry: No No Hauling/Pumping Listing Quantity Tvpe System Type Pumped Pumped By Transferred To Disposed At Date Pumped (gallons) Routine Septic Tank Soucy's Sewer Service 04/23/2007 1500 Comments: ok Inspections: Inspected: Expires: Inspector. Status: 11/07/2007 John Soucy Passes Comments: Title 5 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 { COMMONWEALTH OF MASSACHUSETTS zl �� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a rr ltt��-ers DEPARTMENT OF ENVIRONMENTAL PR '`ECTION a=IVED 0 V DEC 0 3 2007 !H' ©�NORTH ANDOVER aPARTMENT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Owner's Address: Same Date of Inspection: November 7,2007 Name of Inspector: (please print)John Soucy Company Name: Soucy Sewer Service,Inc. Mailing Address: 830 Livingston Street Tewksbury,MA 01876 Telephone Number: 978-851-8839 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 Needs Further Evaluation by the Local Approving Authority T— Fail 7� e f1l,Inspector's Signature: Date: 1 1 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. NOTE: This Title 5 is NOT a guarantee/warranty of the future function of the septic system. Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Date of Inspection: November 7,2007 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: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Date of Inspection: November 7.2007 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 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: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Date of Inspection: November 7.2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Date of Inspection: November 7,2007 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No x _ Pumping information was provided by the owner,occupant,or Board of Health x Were any of the system components pumped out in the previous two weeks? x _ Has the system received normal flows in the previous two week period? x Have large volumes of water been introduced to the system recently or as part of this inspection? x Were as built plans of the system obtained and examined? x _ Was the facility or dwelling inspected for signs of sewage back up? x _ Was the site inspected for signs of break out? x _ Were all system components,excluding the SAS,located on site? x _ 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? x _ 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 x T Existing information.For example,a plan at the Board of Health. x 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: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Date of Inspection: November 7.2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_330 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): no Seasonal use:(yes or no): no Water meter readings,if available(last 2 years usage(gpd)):private well Sump pump(yes or no): no Last date of occupancy: recent COMMERCIAL/INDUSTRIAL N/A Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgf,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: Home Owner Was system pumped as part of the inspection(yes or no):—yes_ If yes,volume pumped: 1500 gallons--How was quantity pumped determined?Gage on truck Reason for pumping:Inspection and Maintenance. 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: Built 1996,tank replaced in 2000 Were sewage odors detected when arriving at the site(ves 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: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Date of Inspection: November 7.2007 BUILDING SEWER(locate on site plan) Depth below grade: 42" Materials of construction: X 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: x (locate on site plan) Depth below grade: 36" 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'.5"x 6' Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 42" Scum thickness: 0" 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: 14" How were dimensions determined: Tape&Sludge Tool Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) N/A 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: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Date of Inspection: November 7,2007 TIGHT or HOLDING TANK:_(tank must be pumped at time of inspection)(locate on site plan)N/A 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.): Flow checked okay PUMP CHAMBER:_(locate on site plan)N/A 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: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Date of Inspection: November 7,2007 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'x43' _leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): No Sign of Hydraulic Failure. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)N/A Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan)N/A 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) Property Address: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Date of Inspection: November 7.2007 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. StIMMACE SOWAAM MPWAL SYSnU PSS►ECn=MW PARI C ^` SY^S'I_9-1/�1m/AT1011 fosIN+M01 Ownw: DM SKETCH OF SEWAGE DISPOSAL SYSTEM: incl-d,tin t-.t Teen two PMn.-.M Wm .Imd—*.of be-ehmnk. I....I—a,within I oo*ILoo.t,when Pb-w.tw.-.Y comm int-h---1 D\ou ha'�tt Ll v \ �1 I revised 9/2/98 PMp iJ of ll' Page 11 of 11 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1050 Forest Street North Andover,MA 01845 Owner's Name: Edward and Nancy Krovitz Date of Inspection: November 7.2007 SITE EXAM Slope Surface water Check cellar x Shallow wells Estimated depth to ground water 6' 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: x 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: Test pit info 3-14-03,also dug hole in low drop off area with auger. TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 05/04/99 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by John Soucy at 1050 Forest Street 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#N/A dated N/A. Septic tank replacement only. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector Town of North Andover, Massachusetts Form No.3 • MORTI{ BOARD OF HEALTH .° a1tior —19 �''°•,r.o ••'`� DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACHUSEj • r, Applicant /O�� �(;f�. L-Ll NAME U ADDRESS TELEPHONE Site Location A)b ME Permission is hereby granted to Construct ( ) or Repair (..,Kan Individual Soilbsorption Sewage Disposal System as shown on the Design Approval S.S. No. / 6WJ P - . CHAIRMAN, BOARD OF HEALTH Fee � ' C>G� D.W.C. No. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: L CURRENT INSTALLER'S LICENSE# LOCATION: (9 © rev LICENSED INSTAL R: D o c SIGNATURE: Z � TELEPHONE# ?'7 L I CHECK ONE: REPAIR: NEW CONSTRUCTION: 00-0, 7,�,e4,k Rt wc((Z_� IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yep. / No Approval Date: ,,I//42 71- . I Existing House - --- — --- — — �- Existing House F Story t 1 t prOpM d y 5' x 15 Three Season Room t t 16' 1600 Osgood Street North Andover,MA 01845 Phone 978 688-9540 Health Department Fax 978 688-8476 Fmc TO: Eddie Jr. F wm Susan Sawyer,REHS/RS J Fac 781935-4232 Pages: 4 Plim Datee 10 /07 1 L7 IC, Res addition cc: ❑Urgent x For Review ❑Please Con umt ❑Please Reply ❑Please Recycle Thank you Susan —J v c AON PIN FOUND Ap .. � r v 0 t�HIM I L f oom, RPE OUT Of HqU.St INV, PTE INTO TJUX 17".. J!j�' moo .... NOUN= . �: F!pE INTO D, xI 'log a40' OF INV. PIPE w . a. IO � HOW N MOM civil IWM�PLAN 13 NOT A Nr l y ole INC S°1"Mi �u V tI C fiQhi + OF THE !liOCA71014 OF TW �tt�'��� ��UGTtl�tES. 2 " d Fd N �1 LOT 4 3.16 ACRES r LOT 3 W 2 STORY WOOD FRAME Is' TOP FND.= 103.36' x �FWNO \ IRON WELL PIN FOUND F. 4, OI�I '7bNj:d.„ E' KAON LOT 5 �Aufklc . 1 N a`�ae op° w IRON FOUND Oil- ARIAFOUND kll1 ,� S 81'00'471 w EL°E�VATIONS OE61GN -AC-tUILT INV. PIPE OUT OF HOUSE 97.39' gal"INV, PIPE INTO TANK 96.75' 97.90' 6. 97,75' AS-BUILT B--S U R F A C INV, ploE OuT OF TANK 9 ' ('- �'` U` INV. PIPE INTO F 91 9&4Q, 91.02' H OF 4J I J P 0 S A �J YS T E M I N INV, PIPE OUT OF 0. BOK 98,23' 98.51' �A4� �IssA� /^1 p NIV. ENO PIP 96,00' rs.as' �, STEVEN R.af �Q� CwocuVli PREPARED FOR: YAi�PLAN 19 NOT A NAFOANTY OF THE BYf1EM BUT A VeRllhcA}ION Ne.3 4 COLONIAL VILLAGE DEV. CORP OF TME I.00ARON OF TME"S"o $TRUCTURES 4 PREPARED 6Y: STEVE CHOUINARD, P.E. '� bl SCALE: 1"=80' DATE: 3/30/9,5 2- 'd Wd80:E0 96, TE dUw AORT1i q O <t►.ao �s• �O O � IL t� e° �► O Lww6 {1 [OC4010,4.r 0 MICW MICM V SSAC HUS���� PUBLIC HEALTH DEPARTMENT Community Development Division Date: October 29,2007 Address: 1050 Forest Street Re: Application for 3 season/porch addition Dear: Mr. and Mrs. Krouitz, Youi application for the 3 season addition has been reviewed by the Health Department. The application was denied on, October 29, 2007, for the following reason as shown in red: 51. X issing information 2. Passing Title 5 inspection of septic system required per local N. Andover regulations Location of structure not acceptable 4. ❑ Undersized septic system To address the problem(s): If#1irked, please supply: a Floor plan of existing and proposed addition—all rooms b. Certified plot plan showing house, septic system and proposed project in scale(you may pick up an as-built septic plan at the Health Office) If#2 iVscked:ave the septic system inspected by a certified Title 5 inspector to determine whether it is operating properly: (inspector list attached) OR b. Tie-in to municipal sewer If#3 is checked: a. Relocate the project If#4 is checked: Options 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult a professional engineer or registered sanitarian to determine the flow capacity of the septic system. b. Hire a professional engineer to design a new septic system that meets State Regulations c. Request approval of a deed restriction agreeing to always be a_-bedroom home. i. Submit a request in writing to the Board of Health identifying why the need to upgrade the septic system is a severe hardship. ii. Attend a BOH meeting to address the board iii. If approved, record the deed restriction at the registry of deeds Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, �,. L IZ�,,7,_ S"sin Sawye5,PaClk He Director Cc: Building Department File 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townotnorthandover.com 1 2 i 11 :34 FAX 17P193542112 0 1 16002/002 T OVER% BOARD OF H BOARD OF 1111ALTN _ ----"r •--� Town of North Andover , Ila s ..... ...-• ate 19 APPLICATION FOR WELL &� I'U1 �pcation . is hereby made for permit to drill' a well ( Application is ade to install (y a pump system. .ocaCion : Address 050 I�a2C'.:,� �� • - . : Lot If Address Tel )w n e r_ / :,i e l l C o n t r a c t o / E'�( fl S� << Tel . " ;a u mp ContractorAddress-------- `JELL CONTRACTOR (To be completed at Lime of lump tesL -- ) T e of Well Well used for � Damt�-�1` yr . Diameter of Well (� Size of Casing Y Depth casing; into Bccl Itock Depth of Bed Rock Q Date. of .Testing No ( ) L� �( .Was Seal Tested , Yes _ Depth o- f !�1ell _ ds ' lJeLl landed in Wha.L. MaLerial7P� �c�IC-- Depth to Water_ / S Deliv�'rs Cals . Per Min . for 4 hour 1 . eeP Gt after pump in fours• at Drawdownf _ — Date of* Completion % - ) � - �i S' � Contractor 44#�agnL•u Cl'eI n':f:Y:Y'':f :. ., r.n•:f i:::•::.. ..:t i. :1�nif.�•f�C:. ., n ., n ., n .. .. .. ., n .. .. .. .. r n PUMP INSTALLER (To be,• f•i11cd i.n' before insla7.].aCion ) ze & Name Pump SS1In.� �.�' 6- ' •• Pump Type Used �t��)�or - a- _. _..__ . __..—._—. . . , • , SAL ' •' Size of 'Panic Z. k4ater Pump Delivers= CPM .— Pipe Material Used in Well : Cast Iron ( _) 0n1v:Mized Well Pit (_) or PiCless AdapLdr 1Jas sleeve used Co protect pipe? Yes (_) iJU(?C� '1'yl)c or Nainc tJell_)-fSca�l/cJ��� nate _j > >Vrtt�4�4�4�4t4i��4 �'t�'f�t�'r�t��t�r��f�4�4tYi'��'r�'r�'r►'r14i;:'f:^ iiiii�w.,1►`(VVIfGnif� '` � I►�r� Date (Dater analysis . report 'submitted to Board of lid alth Da _e release given tD owner of record & Iilds . Insp •:� �ti.�.�aw. <.�r ''s It�l ``�' !;} \..7...i i�c. :`• }.. ,e1 �Se'rlY;t'1..�.��ky`: T3 . v15t' 1W") • W7. 14` \r' ' tT�A... �r 54;�,rj;;���•. _�'���.,',v� 1�♦ {�tl a`�{G'1��`!t, 4�.`�'�•,;1. `i� 4 ' , r �. �.i- 44 •t.;�. lRlFti y fig y�•..`t" r 1. 1.J`1t ♦y � ,�-i1 �'� ; \r•. e\ +- :^.. 1. `' t I � �, �•1- ���� `)..y�'i�'r�i�4'ci.;•�'Ri`p'�ii: 31 1 �! _ti y3 j}' y11:.�'����-.x� �'4�::���� "`�t,�� ':-a+. le ` `�12.. �.�C.' • , ,� •�t .. ti. \ i „^. ��\ +Y' c�. �Ry, �'._rS��,,,� ..� x,�ti�{�1•�GZ'L�.,.� it:lit.. �r(� e'L a e t i s � i l T. �.3 yf l y e i �.�) l T.�� (l a y t .y• l �.`. r 'i R. j. .•y.� r�. �� t i .fit. t t .tyf'� } tiP x�} 1. 1,' R, r'� f,-f�:2.rt i!! y ) Y.: FEE NUMBER THE COMMONWEALTH OF MASSACHUSETTS $25. 00 NORTH ANDOVER TOWNof •-•--•--- - --------------------•---------------•------- Avellino Well & Pum -----------------------------------------------. This is to Certify that -•--•---••---•-••-----•---"' ' •-•----•-•--------•---- NAME -.--•---•-•--------------------•-----.---•---.---••-----.---_. ADDRESS IS HEREBY GRANTED A LICENSE For .---•--kTe11...IIr.filling---Pexmi t...---�o_t...#4---Eosest._. xeet-----_---•--------•------- ............................................................................................................................................................................ ..--•-•----•-•---•-•-•-•-•--•--•--••••-•--••-••--••----••••-•--•-----••---•--•-- ------• -•--•---------•---•--•--------------••--••--••---••-•.•--- This license is granted in conformity with the Statutes and ordinances relating thereto, and December 31 1995______________unless so �yded evoked. C expires._.. r.- � z;;, •....r ..`. �Y- r .- - 95 January -.19. ....� . --------- ew r Y FORM 433 HOBBS & WARREN, INC. / ��-✓'�� y ��%��� TC,f NOW ill AKOUVER/ RD OF HEALTH P.01 5-1995 14:33 BIOMARINE Cv^ Z O mj Biomerine 18 EAST MAIN STREET, P.O.SOX 1153,GLOUCESTER, MASS,01931.1153 TELEPHONE: (508)281.0222 FAX. (509)283.3374 CERTI F I CRTE OF RNRLYS I S AVEWNO WELL&PUMP REPORT NO.: 950108 244 HAVEN STREET JANUARY 25, 1995 READING MA 01867 WRTER gURLITY RNRLYSIS b(eN Des ripen_ New well located on Lot 4, Forest Street, North Andover, MA (Barrett). j&MU(I0W. Samples taken by Angelo Giano on January 23, 1995. Findings: • PRRRMETER RESULTS GUIDELINE! *1 FpH otal Coliform Bacterial Count/100 mL 0 0 7.42 Slightly Alkaline Value Moderate Hardness(011003,mg&) 101.4 i Specific Conductance(1.imhoalcm) 230 Nitrg n Content(mgQ 0.28 10 1 ,00.01 1.3 28 Co0-3 nt(mgA.) I 0.3 IronmgA.) 1 81 0 05Ma 28 ontent(mgA-) 0.3 4 Sodium tent(mgA_) 17.0 MAtb_Qdj: Analyses performed in accordance with Standard Methods for the P Examination of Water & Wastewater, 17th Edition, 1889. 'Guidelines are based on the recommended levels of the Mass Department of Environmental Protection Agency's 310 OMR S 22.00, "Drinking Water Regulations"and the"Safe Drinking Water Act"of the United States Environmental Protection Agency. lJ, Re : The Iron and Manganese levels detected may cause the water to taste"rusty"and P stain clothing and plumbing fixtures. Filtration Is available to correct these levels if continued usage and flushing of the well does not cause them to abate. ! lJc By: ^, _ I'i a J o hn Marietta Lab Direct or Dat JM/ds Dace " TIN Massachusetts Department of Environmental Management 101384, Office of Water Resources TYPE OR PRINT ONLY Well Completion Report 1. WELL LOCATION GPS (OPTIONAL) LATITUDE LONGITUDE Address at Well Location: iG so To(-0�t S- toperty Owner: C Auja c`(S Y C-y i Subdivision Name: Mailing Address: 0 5 L City/Town: 210CA6 AnC\OV P f City/Town: L.I C,C 6 0 `l-ef rn Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if no street address available Board of Health permit obtained: Yes ❑ Not Required 0' Permit Number Date Issued 2. WORK PERFORMED 3 PROPOSED USE 4. DRILLING METHOD ❑ New Well ❑ Abandon Domestic ❑ Irrigation ❑ Cable ❑ Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer ❑ Direct Push ❑ Replace ❑-Other A, T<nr ❑ Industrial ❑ Other ❑ Mud Rotary ❑ Other 5. WELL LOG iT Unconsolidated Consolidated 6.SITE SKETCH (use permanent landmarks with distances) W Permeability -0W T >Q > From (ft) To (ft) > High Low � m Other Rock Type a �1 1 150 r" I <-.- )low t ,\I OF NOR.H AMDO, ..J � c'�nQCS CQxt�o DEC 17 2001 7. WELL CONSTRUCTION 8. CASING Total Depth Drilled ISS' From (ft) To (ft) Casing Type and Material Size O.D. (in)---W ll Seat Type Date DA4A@l_CQMp1a14 }-c O&U6 CF. zom} Lo ll c�1 \ o0 8. SCREEN From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION From (ft) To (ft) Material Description Purpose Developed? ED Yes ❑ No Fracture Enhancement? CJ'Yes ❑ No Method Disinfected? E des ❑ No 12. WELL TEST DATA(PRODUCTION WELLS) 13. STATIC WATER LEVEL(ALL WELLS) Yield Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM) (hrs & min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) 1% 2 - ' i 7-Co I I - z -C'> 3 _A_ q 14. PERMANENT PUMP (IF AVAILABLE) 15.NAMEIADDRESS OF PUMP INSTALLATION COMPANY Pump Description Grn)\6 5 I O GS I Q�A:Z 7 Horsepower 1 Pump Intake Depth _(ft) Nominal Pump Capacity I D (gpm) 16. COMMENTS I a l d c(;_F<-ocYL UJ-i2_ lk �:1ouJ Snpryl. 17. WELL DRILLER'S STATEMENT This well was drilled and/or abandoned under my supervision, according to applicable rules and regulations, and this report is complete and correct to the best of my Ct �l:oknowledge. I Driller: ��. c� , nY. Supervising Driller Signature: Registration #:I-1_61 'Y 1 "I Firm: a 11 , 5 Date: Rig Permit#: NOTE. Well Completion Reports must be filed by the registered well driller within 30 days of well completion. BOARD OF HEALTH COPY FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone b� ? -1 S Z 3 LOCATION: Assessor's Map Number Parcel C� Subdivision Lot(s) 7 StreetSt. Number '0?C7 ************************O ficial Use Only************************ RECOMMEND TI NS OF TO AGENTS: 1441 1121, Date Approved II I� Conservation Administrator Date R �,GectlIed fq3� Comments ��. &4, 30 �L/1 QD Date Approved ` Town Planner Date Rejected Comments Date Approved Food Tnspect r-Health Date Rejected _ Date Approved Septic Inspector-Health Date Rejected Comments 7Vkb u,r yy r,�i rEs Public Works - sewer/water connections 7T-0 - driveway permi Fire Department Received by Building Inspector Date BOARD 01- HE"AL1'{i Town of North Andovcr ,Mass - , Date 19_ APPLICATION FOR WELL & PUMP I'L''RMI"I' r" lication Ls\ppi3.cation . is hereby made for permit to drill a well (X�• APP nade to install (.Y a pump system. ,�• Lot A- . . . .location: Address p50 fw2e S� ' Tel . ' )wner �ja Address ,tell Contractor r�(0 Address /�A���-r- S� • Tcl . -•S t� er Tel . • :,Pump Contractor Address_— -aELL CONTRACTOR (To be completed at time of pump ge—st ) ,.� Well used for ..rYPe of Well i 5 4 Size of C•asi.n�; Diameter of Well r Depth of Bed Rock q Depth casing into Bed Rock P ' Z � Date. � � 0 .,Was Seal Tested? Yes No (—) .of Testing- Well ' Well Endcd ill Wha.t. Materia1xlei,Depth — �---- Delivr°rs Gals . Per t•tin . for 4 hour Depth to Water_ / S - — E Drawdown 00 feet after pumping hours- t -L-2�• GI'�I _ a Date of Completion i natu eI Contractor 'n•%f iti:�'n SC ':. .. .. n .. r .:�:.• ..:ti:r:•C%�.%iii.%C�C•:. .. .. .. .. .. .. .. •. .. .. be fi.lTcd in' before insta7.l.ation ) PUMP INSTALLER (To Pirrnp 'rYf)e used Sohl,� Size & Name Pump --- Size of Tank � Z- 6 A L Water Pump Delivers /0 GPM -- Pipe Material Used in Well : Cast Iron ( —) C:nI vnrli zed (_) Plastic Well Pit (_) or Pitless Adapter ( ) NO (Af •1yhc or Well Seal— sleeve eal_ sleeve used to Protect pipe? Ycs vts ac- Was Date T r �► �ti� G 7;:D ;� Date dater analysis . repor--t 'submitted to Board of 11eal'th Do _e release given m owner of record & Bldg - Insp It— e—}l Inspector Town of North Andover, Massachusetts Form No.3 ot NORTH BOARD OF HEALTH 19 F F i DISPOSAL WORKS CONSTRUCTION PERMIT ,SSAOHUSEt Applicant- NAME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. c— CHAIRMAN,BOARD OF HEALTH Fee l- n D.W.C. No. JAN-25-1995 14:33 BIOMARINE P.01 Bion arine 16 EAST MAIN STREET, P.O.SOX 1153,GLOUCESTER, MASS,01931.1153 TELEPHONE: (508)281.0222 FAX: (508)283-3374 CERTI F 1 CRTE OF RNRLYS 1 S AVELLINO WELL& PUMP REPORT NO.: 950108 244 HAVEN STREET JANUARY 25, 1995 READING MA 01867 w - w WRTER QURLITY ANALYSIS Well Descrigliop,: New well located on Lot 4, Forest Street, North Andover, MA (Barrett). Samelio .. Samples taken by Angelo Ciano on January 23, 1995. Findings: PRRRMETER RESULTS GUIDELINE+ Total Coliform Bacterial Count/100 mL o 0 pH Value 7.42 Slightly Alkaline Hardness(CaCO3,mgA.) 101.4 Moderate Specific Conductance (Nmhoskm) 230 - Nitrate Nitrogen Content(mgA_) 0.26 10 Copper Content(mgA_) a0.01 1.3 Iron Content(mgA_) 1.81 0.3 Manganese Content(mgA_) 0.34 0.05 Sodium Content(mgA_) 17.0 28 MsthodW. Analyses performed in accordance with Standard Methods for the Examination of Water & Wastewater, 17th Edition, 1989. 'Guidelines are based on the recommended levels of the Mass Department of Environmental Protection Agency's 310 CMR 22.00, "Drinking Water Regulations"and the "Safe Drinking Water Act"of the United States Environmental Protection Agency. Remarks: The Iron and Manganese levels detected may cause the water to taste"rusty"and stain olothing and plumbing fixtures. Filtration is available to correct these levels if continued usage and flushing of the well does not cause them to abate. John Marietta Lab Direct or JM/ds Marc.CArtifiad Lahr MAWR and MAI 9.q 044 �o,esi AS-BUILT CHECK LIST and FINAL INSPECTION Pronosed Elevations As-Built Elevation House c7"7, s Tank IN Tank OUT D-box IN D-box OUT Trench Inverts Line 1 9,5-, z Line 2 Line 3 Line 4 Bottom of Exc. ��, ✓ stone OK? D-box checked? Pipes cemented? ORT Town of s - over s O No. 0,3 3 rt dover, Mass., �A�c-tun�z.�f 2 19 LAKE A- COCHICHEWICH A0RArEO PPS\ �5 a E BOARD OF HEALTH RMI ' T Food/Kitchen Septic System PE .. .. YBUILDING INSPECTOR PECTOR .................................. . .............. nz THIS CERTIFIES THAT ................ .................................................. \� has permission to erect. ildings on...kQ Sf ..... 4 �T....��T`..................... oug to,beoccu led as SAN `, . " 1rn� `' ���n.c�..... ... ... ,�d�,..��4(?Air .............. ......................... . imn y t pp this e�1nft shall in eve res eft conform to the terms of the application on file in provided that the person accepting t p every p Final this oMcq and to the provisions of the Codes and B Laws relatingto the Ins e��t#��QQrl,.MIMAnstration of Buildings% the Town of North Andover. Y p PERFUON LY PLUMB SPECTOR REGULATED BY PARA. 114.8.5. B.C. 3 s 1 j VIOLATION of the Zoning or Building Regulations Voids this Permit. yt 2? �� FEE PAID t 00_" PERMIT EXP IN M S"D qo , ELECTRICAL INSPECTO UNLESS CONS U T, ,tZT� W( o„gh 3/ r /qS''� �� PERI�IRFORFRAMEIBUILDINC ...r�... y..i. �...... .... ... Service T...f .... ..... .• ............... ...... = BUILDING INSPECTOR � !, Final 0`1 1�S ) L I DATE: FEE PAID:._._____. Occupancy Permit Required to Occupy Building GAS INSPECTOR 1 Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENTV1 Burner y2 12-IG4S Street No. PLANNING �- FINAL CONSERVATION FIN L - lQ� Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT �l .�7 44ez �-• rrv�n:� Month ouc}rs sewer service Inc. ����_• .____��( Date Address Owners Name Gallons um d "H,G,CjD,S Contents �� j ��/� tranfered to Condition of s rn 1 CJ S :31�00 � 6 51Joo�j� Za `uL+l s 10 11 12 13 14 15 16 17 1s JUL 2 TOWN OF NORTH A DOVER 19 - 1 ALTH DEPART RENT 20 r �T w 'C= Cesspool, D=Drywell, S= Septic, G= Greasetrap, H=Holding Tank \ r �• AL AL AL LOT 4 \ LOT 3 I 3.16 ACRES 2 STORY N WOOD FRAME I } a IRO 1 Iqy PIN Iy FOUND IRON H WE PIN FOUND era LEACHING _FIELD TAN C a? �'rC \bs M6 SCK` ` e. u '�-� s TQ I► E RON PIN 'PU84j C FOUND IRON LOT 5 PIN V,Rl N�. 00' W FOUND A8(e N�O ) STREEj s mvw4r w ersr * LOT 4 LIES WITHIN A RESIDENCE 1 (R-1) ZONING DISTRICT NOTE'- PLOT PLAN THE PROPERTY LINES SHOWN WERE TAKEN � FROM A PLAN ENTITLED " PLAN OF LAND OF LOT 4 LOCATED IN NO, ANDOVER, MA," DATE 8/31/94 o� R �� FOREST S T. N. ANDOVER BY CHRISTIANSEN & SERGI, PL #12455 N.E.R.D. fogsEt OWNED BY: v88. 39M MARK & JEANNIE MCGONIAGLE SURVEY BY: j$ SSELL J. BOUSQUET, P.L.S. (/ SCALE: 1"=80" DATE: 10/10/97 w AORTH OL O t� SpA COC«1cgwK«`y Sgc PUBLIC HEALTH DEPARTMENT Community Development Division Date: October 29,2007 Address: 1050 Forest Street Re: Application for 3 season/porch addition Dear: Mr. and Mrs. Krouitz, Your application for the 3 season addition has been reviewed by the Health Department. The application was denied on, October 29, 2007, for the following reason as shown in red: 1. X Missing information 2. X Passing Title 5 inspection of septic system required per local N. Andover regulations 3. ❑ Location of structure not acceptable 4. ❑ Undersized septic system To address the problem is). H#1 is checked, please supply: a. Floor plan of existing and proposed addition—all rooms b. Certified plot plan showing house, septic system and proposed project in scale(you may pick up an as-built septic plan at the Health Office) If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine whether it is operating properly: (inspector list attached) OR b. Tie-in to municipal sewer H#3 is checked: a. Relocate the project N#4 is checked: Options 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com f a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult a professional engineer or registered sanitarian to determine the flow capacity of the septic system. b. Hire a professional engineer to design a new septic system that meets State Regulations c. Request approval of a deed restriction agreeing to always be a_-bedroom home. i. Submit a request in writing to the Board of Health identifying why the need to upgrade the septic system is a severe hardship. ii. Attend a BOH meeting to address the board iii. If approved, record the deed restriction at the registry of deeds Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Sawyer blit Heal irector Cc: Building Department File 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com VL • � °pq c«w�wwrcw�. � J SSACHU`�� Ir PUBLIC HEALTH DEPARTMENT Community Development Division Date: October 29,2007 Address: 1050 Forest Street Re: Application for 3 season/porch addition Dear: Mr. and Mrs. Krouitz, Your application for the 3 season addition has been reviewed by the Health Department. The application was denied on, October 29, 2007, for the following reason as shown in red: 1. X Missing information 2. X Passing Title 5 inspection of septic system required per local N.Andover regulations 3. ❑ Location of structure not acceptable 4. ❑ Undersized septic system To address the problemts): If#1 is checked, please supply: a. Floor plan of existing and proposed addition—all rooms b. Certified plot plan showing house, septic system and proposed project in scale(you may pick up an as-built septic plan at the Health Office) If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine whether it is operating properly: (inspector list attached) OR b. Tie-in to municipal sewer If#3 is checked: a. Relocate the project If#4 is checked: Options 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com �10RT►� O��t�ec �6g4.0 lot n+ a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult a professional engineer or registered sanitarian to determine the flow capacity of the septic system. b. Hire a professional engineer to design a new septic system that meets State Regulations c. Request approval of a deed restriction agreeing to always be a=bedroom home. i. Submit a request in writing to the Board of Health identifying why the need to upgrade the septic system is a severe hardship. ii. Attend a BOH meeting to address the board iii. If approved, record the deed restriction at the registry of deeds Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Susan Sawyer, Public Health Director Cc: Building Department File 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER SYSTEM P'UMPINC RECORD 11 .x11 : `0 ffM OWNER & ADDRESS SYSTEM LOCATION (eXMPle: lefc iron( of house) .�� �� , U.\'I,C OF PUMPINC: QUANTITY f UMPCD X660 LLO� , C Sl'O0L: NO L-,A, _ YES SEPTIC TANK: NO YES — MATURE OF SERVICE: ROUTINE _ EMERCENCY fflI>UVAT IONS: GOOD CONDITION, FULL TO COVER HFAYY CREASG BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK . CXCESSI-VE SOLIDS —l-- FLOODED SOLIDS CARRYOVER O�HER (EXPLAIN) PUMP CD BY: � u�-I�IrNTs: UN I I-:NI TRANSFEIMED TO: Address .1�-: 9— ST Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action Department Board of Appeals - Board of Health - Planmmng Board - Conservation Commission - Building Departrnerit 4. ' COMMONWEALTH OF MASSACHUSETTS OF Et3i EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS`V)t RO OF HEALTH DEPARTMENT OF ENVIRONMENTAL PROTEMON ONE WINTER STREET,BOSTON MA 02108 (617)292-6600 I TRUDY COO Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: JCO)O FC) Name of Ovrner ��t'� r IG C.r�Cy'l,ta•��e. �ucl �l fAV\C`ov0-"C_ Address of Owner: 1 v Data of Inapection: � --a.3—:?9 . (� Dc , Q t 8 45 Name of(inspector:(Please Print) ire,` `a' `max 4Rs v,, 1 am a system" prssuarrt to Seetionn U.340 of Tide 5(310 CMR 15.0001 Company Narne: Q� .(- Mailing Address: I Y `Q.©t�`/-D Telephone Number: 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Pass nditionally Passes _ Needs Further Evaluation By the Local Approving Authority ignam Daft:s St The ^a3 System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS TOWN OF NORTH ANDOVER/ BOARD OF HEALTH revised 9/2/98 Page Iof11 ��Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address 1 o--S C-) VL<7 e:25V. s)-�-. Owner: (sate of Inspection: INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM C ITIONALLY PASSES: L One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the re lacement or reps r,as app oved b the,Bo r�d�of Health,will ass. t)42-1 �, 'l' \V '^ i Wq Indicate yes,no of determined Y,N,or ND). Describe basis of determinatiall instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank Is replaced with a complying se c tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box Is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipels). The system will pass Inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed F- revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERT_IFtI�C,ATION(continued) Property Address:I Q.�of��j-�- - Nod�`�` A_&� Owner: M b0vlICA . Date of Inspectilorr. 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(10)THAT THE SYSTEM IS NOT FUNCTIONING N A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE Ell"ONMENT: 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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. Method used to determine distance (approximation not valid). 31 OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 4 Property Address:Date of Inspection: Hc, a-- ate-�� D. SYSTEM FAILS: You must indicate either"Yes" or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. ' Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any porton of a cesspool or privy is less-than 100 feet but greater than 60 feet from a private water-supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of#10,000 gpd or greater flarge System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area:IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforjnation. s revised 9/2/98 Psge4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST w _ Property Address: 'o o -Fm,�s�,, kQ cxk Date of krspecdort: Check if the following have been done:You must indicate either"Yes" or"No" as to each of the following: Yes o _ Pumping information was provided by the owner,occupant,or Board of Health. None of the system components have been pumped for at least two weeks and the system has been•receiving ive.,.al flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this Inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. f� The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components,excluding the Soil Absorption System,have been located on the site. ��,,-� The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The.size and location of the Soil Absorption System on the site has been determined based on: 1-0 Existing information. For example,Plan at B.O.N. �� 0 terminad In the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) ]15.302(3)lb)] L _ The facility owner land occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5oru SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: C)-15-C) ��Q�n�� �(��T Owner: HC cx,�,4 Date of Inspection: FLOW CONDITIONS RESIDENTIAL: DesigD Cg.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual): 3 Total DESIGN flow-6,4�C`� Number of current residents: Ll Garbage grinder(yes or no):ED Laundry(separate system) (yes or no)-ND; If yes,separate-inspection required Laundry system inspected .lY�s or no) Seasonal use(yes or no):IV_C �+ Water meter readings,if yvpilable(last two year's usage(gpd):O`('N w Sump Pump(yes or no): Last date of occupancy:-7:-10 wC. eAA-�- COMMERCIALIINDUSTRIAL• Type of establishment: Design flow: apd (Based on 15.203) Basis of design flow 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: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: � � C) System pumped as part of inspection:(yes or no) u If yes,volume pumped: gallons Reason for pumping: TYPE OF STEM 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other l Q APPRO)OMATE AGE o f all components,date installed(if known)and source of information: "C 342� 0 tc� 1 Sewage odors detected when arriving at the site:lyes or no) tjo revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPEC HM FORM PART C SYSTEM INFORMATION konrtirwe fl Property Address:•lcxS;(-) tit'xA),, AAA4}D,t— owner: G �pn1 a q Date of inspection: J BUILDING SEWER: (Locate on site plan Depth below grade:4 Material of constu on: colt iron_9, C other Ol �( Vu��sr G f/ G rhOv Distance fromprivatewater supply well or suction line (✓Z Diameter-4i— Comments:(co ditto of'oints,venting, evidence of leakage,etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade:/ Material of construction:_ ncrate _metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ is V.I.e confirmed by Certificate of Compliance_(Yes/No) Dimensions: 10X.51 x -I' �< 7' -5- Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: Nr� A '1 /�H Scum thickness: 1 +1 /v Distance from top of scum to top of outlet tee or baffle: N/A A ,/� Distance from bottom of scum to bottom of outlet tee or baffle: A How dimensions were determined: Comments: (recommendation for pumping, dition of irdat and Qptlet tees or ba(fies,depth ot liquid level in reo t outl invert,structur intssty, eviden a of leakage,etc.) V� r � lati �►VW Vt a GREASE TRAP_\L 1 - (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: Irecommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural Integrity, evidence of leakage,etc.) Y revised 9/2/98 Nge7of11 .y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addresl: o o / 1 SS-_ Ocx-� 4,tA�ax- Owner: Hr-- Gcx- v `e- Date of Inspection: q �! a—a3 TIGHT OR HOLDING TANK:yYJV\*(Tank must be pumped prior to, or 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 Alarm level: Alarm in working order:Yes No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:L (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if le el anddistribfMon iequal evidence of solids carry or evid a of leakage into or out of box,etc.) PUMP CHAMBER:i�M (locate on site plan) v 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.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cartirweotl) Property Address:"JC.)50 Owner: Hc, Gov\\ctq le- Date of Inspection: SOIL ABSORPTION SYSTEM(SAS)-. (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number:_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool,number: Alternative system: Name of Technology: Comments: (not con on of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.) Q v CESSPOOLS: (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(cesspool must be pumped as part of inspection) 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.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM MSPECTION FORM PARI C SYSTEM M11FORMA71ON(continued) Property Addrea: I p 8n Owner: -� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) W ZA ka" ADO, . 114(. 11 0 p�x revised 9/2/98 Paploofli' a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(aontimod) Property Address: GPS's- <- Owner: M G�i V Date of Inspection: G c 1e NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Ef_1 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) L� Determined from local conditions hacked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) NoQ revised 9/2/98 Page 11 of 11 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: Owner: Date of Inspection: 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. '1 N - - -- - 7 \ Department of Enviror ,gement/Division of Water Resources \ WELL C� TION REPORT l WELL LO ATIO(V / GEOGRAPHIC DESCRIPTION i Address Of .7 Z r �� I I ly. 5 W of ^' a (feed rclel I City/Town / /T/1i�rJ t/lT -- j 5 `^ rroadl Well owner.. a• Address , 7.• N S W of (mi.in lenthsl drde) \ r \Board of Health permit obtained: yes no❑ intersect. w osdl F WELL USE WELL DATA L Domestic 14'Public❑ Industrial ❑ Total well depth -. --ft• ZONE-4 \ e th to bedrock ft. ONE-)( (_ Monitoring[I OtherDP \ ,,..- Water-bearing rock/unconsolidated material: Method drilled -LL \ Date drilled-j--:!-A Description Water-bearing zones: CASING 1) From I \ Type 2) From To ( h Length. —ft. Dia(.I.D.)__ 1—in• 3) From To Length into bedrock F ( ft. Gravel pack well: dia. Protective well seaal,,:�� Screen: dia. Grout-❑ Utherf ' Slot M length from_to I IRON PIN FOUND STATIC WATER LEVEL(all wells) Static water level below land surfaceft. Date WELL TEST(production wells) o / Drawdown-ft. after pumping hr...Z—mIn.at —_9Ptn How measuredAi2- -_Recovery100 it. after—hr. min. e- LOG of FORMATIONS COMMENTS N IRON LOT 5 PIN Materials From To FOUND s Driller 744 jig 4;�/ D S 81*00'47' w Firm Ave(ltrin WP.11 & PUMP 67.31' * 244A Maven Street Address Heading, MA 0186,7 City/Town CERT Supervising Driller Re # ' �E R TI F I E D PLOT PLAN I THAT , �, , . • � OF LOT 4 ON REST ST., N. ANDOVER THE mre of supervising re bred wet!dr!/ler MUNI• Pleastrprinrfirmly BOARD OF HEALTH COPY OWNED BY: CERT1FfCA lUR-I7FMSY MADE THAT THE STRUCTURE AS N0.38044 ONIAL VILLAGE DEV. CORP. SHOWN ON THIS PLAN IS NOT LOCATED WITHIN A SPECIAL 9fCISTE¢ SURVEY BY: FLOOD HAZARD AREA AS DELINEATED ON THE FLOOD o DANA J. S TA N D LE Y, P.L.S. INSURANCE RATE MAP FOR THE TOWN OF NORTH ANDOVER, COMMUNITY PANEL # 250098 012 C DATED: JUNE 2,1993 .G( a'^'_ SCALE: 1"=80" DATE: 2/6/95 DATE D/�// ' Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER c ` �l SUBSURFACE DISPOSAL DESIGN REVIEW FEE PERMIT # DATE RECEIVED/10 1.4 APPLICANT /LG s��,���7— ASSESSOR'S MAP ADDRESS PARCEL # LOT # ENGINEER -- STREET Gjf��J�/�ivS�,C� ADDRESS PLAN DATE /b/-J-AN REVISION DATE CONDITIONS OF APPROVAL: /- APPROVED DISAPPROVED �` PLAN REVIEW CHECKLIST ADDRESS ��y-s� �QSj ENGINEER GENERAL / / / 3 COPIES STAMP `� LOCUS L/ NORTH ARROW (/ SCALE CONTOURS/ PROFILE/ SECTION BENCHMARK°` SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER WELLS & WETLANDS�f WATERSHED_? AID DRIVEWAY (Eley) WATER LINE 0,C FDN DRAIN ��"� SCH40 V TESTS CURRENT? NIM- SEPTIC TANK MIN 1500G [// . 17 INVERT DROP GARB. GRINDER(+200% EDF) 25 ' TO CELLAR MANHOLE TO GRADE +-� ELEV GW D-BOX SIZE # LINES—L FIRST 2 ' LEVEL STATEMENT INLET--40 - OUTLET9s a3 = l 7 (2" OR . 17 FT) TEE REQ'D?J- LEACHING / MIN 660 GPD? v RESERVE AREA (--X41 FROM PRIMARY? L--"' 2% SLOPE 100 ' TO WETLANDS ✓ 100TO WELLS 4 ' TO S.H.GW 35 ' TO FND & INTRCPTR DRAINS 325 ' TO SURFACE H2O SUPP v' 4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER L/ FILL?4/6 (25 ' if above natural elev, 10 ' if elow) BREAKOUT MET? -- TRENCHES MIN 660 gpd `: SLOPE (min . 005 or 611/1001 ) L/� >31COVER?-VENT SIDEWALL DIST. 2X EFF. W OR D �/, IN6 ' S RESERVE BETWEEN TRENCHES?-6 IN FILL? V0 MUST BE 10 ' MIN. 4" PEA STONE? BOT alp 8 X LDNG 1n + SIDE-93(, X LDNGc?,�40 = TOT 10,0,9 (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) Copyright 0 1993 by S.L.Starr NORTN Ot"'50 " - 3? 0 LBOARD OF HEALTH � p # "s # 9 120 MAIN STREET TEL. 682-6483 �9S3 CHUSNORTH ANDOVER, MASS. 01845 Ext23 October 31, 1994 Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 RE: Lot 4 Forest Street Dear Phil: This is to notify you that the proposed plans for Lot 4 Forest Street, North Andover, MA, dated October 5, 1994 have been disapproved for the following reasons: 1 - Elevation of foundation drain is missing. 2 - Distance between trenches must be a minimum of '6 feet. (N.A. 17. 03) If you have any questions, please do not hesitate to call the office. Sincerely, Sandrea Starr, R.S. Health Administrator �f� t �' ~,t'�,r✓'t�i��r�Fii' `t'f�.�A''.r�dC'•.T�:fl�Yj�rr��F�yt//� r�'f Ji1•. - ., ;i r'• r. rel rr rt J`r1�r v.: �' r _ i� - - 1 ..,.1f1�•L.Y.:..iL..'1,1.1�`\�•:.: `..''`,,.i,. ff.:•�i,i'.a,•,'t i' .a� '' , ,; - . Town of North,Andover Massachusetts Form�.s ";;',.."a ,. BOARD OF HEALTH 030 civ tY,9- DESIGN APPROVAL FOR CNOs� SOIL ABSORPTION'SEWAGE DISPOSAL SYSTEM :{ ' Applicant Test No. t d , Site Location " `1 Reference Plans and Specs ; �' _SQ/y� ENGINEER DESIGN DATE Permission is granted for In individual soil absorption sewage disposal system to be installed in accordance with r'egulatlons ofBoard of Health. . ^^\\ y CH RM BOARD BOARD OF HEALTH �� '• ¢': E .F3 +r DV S ;fig y ' t, ri . S. .,:. Fee , ;fi Site System Permit NO.,(9( r ,�!• a , �.; Ix I � ti t,t r�Y�tyf�R��' d�.�V�l i.�.7 lab y, - t,1 y s ��;\!. , •r �� al t S ; fr yy t� .\� ' j Y �,! a.a-_ �1 }y �1t. ,n►,°aS��r .�t14'i 1 �` trrnF.F"'�t'1',•"`E`+*ri'Mx.-w..,.M T`Tr i1 S1 rri�'!t r<,aa. ,, y �h t hX � ��'�,t:�.+�' � '�'�';�t,M tF` t t'.�ts�>,"�\.1l t',�'fl�..;,ft i,``'?S1�• ){y'�.�,_ ��„• � '^Cl��t 7,!'j"y`'Z.-`• /\'^r-+,+�;'Tr-<.d 4 t'•k ` � '�'i` �y',N �� 1�{LLr Sa 1�1i�C� *�11i'.1�•�'l.�`t x'14 f{ }1,r` ti's t L�.,, ��t�•: C!t Lii (`� 1 .ti t. Uti+ 11 ? y1�� eft l� a�L k aSl Y }l L T �1 , E1ti� •'i� iVN, �• �• � S. �� ;�. � Y a,� t�•«J` � "� ��"� 1�".?7'ti �,F!"`Y,t\p il.� rt,�'���'�c 't �«i 't it tl��t•n '�s-f T�`� � � , � � �. ,y .� � n � r4�.••t,�� f� t� �, :t`�,[ 3 `p T,..! t�° ��il'` � Frr'ta� �\�Y r'f til 4��t atk 'l'- -.*s�r;. t`�, 1 �•",� t .�\'F �t• y=1 �{��:�} •.`a,��tY ���; tt�.'�t�et5����j� `�t�\�a,f�� i��aa��L ai`e�'ti'`'�.�4 a�yLS�•�}t` i t' 3 �' �� ��=:1�,��� �'Ss •�� C 'lti�Jl��I�i�l`£{`�t��� .f't�• t i{ t l J: FORM U - LOT RELEASE FORM r . : INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from 'T qu: Boards and Departments having jurisdiction have been obtained. This does not.relieve_ the applicant and/or landowner from compliance with any applicable or requiromen%. f=' APPLICANT FILLS OUT THIS SECTION 4 APPLICANT PHONE }.; .., LOCATION: Assessor's rMap Number PARCEL t : r�#a} UBDIVISION C/ LOT(S) ST. NUMBER D�}� •y. OFFICIAL USE ONL ' s RECOM NDATIONS OF TOWN AGENTS: ./TONSEIWATION ADMINISTRATOR DATE APPROVED i D - - r7 .,... DATE REJECTED r. is COMMENTS _4Aj 1jnr i TOWN PLANNER DATE APPROVED f{ DATE REJECTED I); COMMENTS 2 FOOD INSPECTOR-HEALTH DATE APPROVED +; DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED /d DATE REJECTED n. S COMMENTS ' + PUBLIC WORKS-SEWER/WATER CONNECTIONS ' DRIVEWAY PERMIT k FIRE DEPARTMENT , RECEIVED BY BUILDING INSPECTOR DATE Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH ���t QED ib�tiO o m APPLICATION FOR SITE TESTING/INSPECTION �9SSACHUS���h Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 3�oy�t`ED 6:6eOL 3 f 19 *'o APPLICATION FOR SITE TESTING/INSPECTION 7q ADRATED PPp,`.(y sSACHU Applicant�Ot-u" 6W'y ;t NAME ADDRESS TELEPHONE Site Location j'\JI�A�-C nn/J�n•/ °�' Engineer (,jofi NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee 55hu Test No. (-c;L6 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 3�Oh�t`Eo ib4, 16 00 19 R °4�Ews° APPLICATION FOR SITE TESTING/INSPECTION /, �oDRA TED P �h �SSACHUS�� Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH S,�Oy,'�E° '6�ti-0L 19� 0 APPLICATION FOR SITE TESTING/INSPECTION ��SSAcr+us���y Applicant NAME ,, )ADDRESS TELEPHONE C Site Location q .6 Jo-i .O G Engineer C/� � -- NAME ADDRESS TELEPHONE Test/Inspection Date and Time t CHAIRMAN,BOARD OF HEALTH Fee /5-D - Test No. &30 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. WELL DATABASE ADDRESS: l D ,5 0 �cs S-�t— Ao-; w AGE OF WELL. 2 ear WELL DRILLER: WELL PER;tiffT, : WELL LOCATION: _ IN) ¢' , WELL PERMIT DATE: I -02 5 . �S� DEPTH OF WELL: . TlTE OF WELL: a. DRILLED b. DUG c. Ui , 0WIN TYPE OF WATER BEARING ROCK: / WATER ANALYSIS DATE-- 5� 1EIGHIM G Q N HIGH IRON: N OTHER CONTAMINANT'S: N . f. WELL DATABASE r ADDRESS: AGE OF WELL: -3 i WELL LER: WELL PET: WELL L 0 TION: RF X IJ+ti ' WELL PERvffT DATE: 6 - ^ 9' DEPT T OF WE l: S TYPE OF WELL: a.. DRILLID b. DUG UN-KNOWN TYPE OF WATER BEARING ROCK: Ai o tL�, ,Q �` G�� 2a Q• WATER ANALYSIS DATE: 4;t /3 — 9 HIGH N NGANESE: HIGH IRON: Y N OTHER CONTAN HANTS: N l 2U./ o� ow F " 9 • : Town of North Andover �+�'•�;, o�: ,' HEALTH DEPARTMENT ,SSACHUSE� `! CHECK#: DATE: /ol ) �4 7 LOCATION: H/O NAME: CONTRACTOR NAME: ,F0 Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $� ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $_�J 05fit-le 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer t%ORTH d OF�,��eD �6'gti0 X � �' r •yy •� 04 conianww:w �' # qOq^TSD�,IP�.(y CHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division December 4, 2007 Edward and Nancy Krovitz 1050 Forest Street North Andover, MA 01845 Dear Mr. and Mrs. Krovitz: Please note that due to recent reviews of Title 5 Reports, your property has been identified as maintaining a working garbage grinder that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage grinders are never recommended where septic systems are used, but if they are installed, the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this grinder could quickly cause a pre-mature failure of your septic system,resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdeptgtownofnorthandover.com. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. Sincerely Susan Y. Sawyer, REH S Public Health Director /pfd Enc: Septic System Information: httv://www.mass.gov/dei)/water/wastewater/dodont.htm 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com iviass i)r r :: 1vIA utbr xesource Protection- peptic systems/1itle 5: informationforhom... Page 1 of 1 How Do I as a System Owner Properly Care for my Septic System? Conventional on-site septic systems can function very well with minimal care.In fact,most septic tanks will only require an inspection and pumping out by a professional every three to five years if they are used properly.This does not pertain to I/A systems,which need more frequent oversight. DO... __1 DON'T... Do have the system inspected and pumped every 3 to 5 Do not use your toilet or sink as a trash can by dumping years.If the tank fills up with an excess of solids,the non-biodegradables(cigarette butts,diapers,feminine wastewater will not have enough time to settle in the products,etc.)or grease down your sink or toilet.Non- tank.These excess solids will then pass on to the leach biodegradables can clog the pipes,while grease can field,where they will clog the drain lines and soil. thicken and clog the pipes. Store cooking oils,fats,and grease in a can for disposal in the garbage. More information onpuin Do know the location of the septic system and drain Do not put paint thinner,polyurethane,anti-freeze, field,and keep a record of all inspections,pumpings, pesticides,some dyes,disinfectants,water softeners,and repairs,contract or engineering work for future other strong chemicals into the system.These can cause references.Keep a sketch of it handy for service visits. major upsets in the septic tank by killing the biological part of your septic system and polluting the groundwater. Small amounts of standard household cleaners,drain cleansers,detergents,etc.will be diluted in the tank and should cause no damage to the system. Do grow grass or small plants(not trees or shrubs)above Do not use a garbage grinder or disposal,which feeds the septic system to hold the drain field in place.Water into the septic tank.If you do have one in the house, conservation through creative landscaping is a great way severely limit its use.Adding food wastes or other solids to control excess runoff. reduces your system's capacity and increases the need to pump the on-site tank.If you use a grinder,the system must be pumped more often. Do install water-conserving devices in faucets, Do not plant trees within 30 feet of your system or showerheads and toilets to reduce the volume of water park/drive over any part of the system.Tree roots will running into the on-site system.Repair dripping faucets clog your pipes,and heavy vehicles may cause your and leaking toilets,run washing machines and drainfield to collapse. dishwashers only when full,and avoid long showers. Do divert roof drains and surface water from driveways Do not allow anyone to repair or pump your system and hillsides away from the septic system.Keep sump without first checking that they are licensed-system pumps and house footing drains away from the system as professionals. well. Do take leftover hazardous chemicals to your approved Do not perform excessive laundry loads with your hazardous waste collection center for disposal.Use washing machine.Doing load after load does not allow bleach,disinfectants,and drain and toilet bowl cleaners your septic tank time to adequately treat wastes and sparingly and in accordance with product labels. overwhelms the entire system with excess wastewater. You could therefore be flooding your drain field without allowing sufficient recovery time.You should consult your tank professional to determine the gallon capacity and number of loads per day that can safely go into the system. Do use only septic system additives that have been Do not use chemical solvents to clean the plumbing or allowed for usage in Massachusetts by DEP.Additives septic system. "Miracle"chemicals will kill that are allowed for use in Massachusetts have been microorganisms that consume harmful wastes.These determined not to produce a harmful effect to the products can also cause groundwater contamination. individual system or its components or to the environment at large. http://209.85.165.104/search?q=cache:OSxS WhzZovAJ:www.mass.gov/dep/water/wastew... 1/22/2007 Fnil:.............................. No............ ............ THE COMMONVVE.ALTH OF MASSACHUSETTS BOARD OF' HEALTH 0 F f ,pp tic alio I I I fill: T-liliplilial 111111dut, TomVitnutioll va lit Application Is IlCrChV Iii:l(le for a Perwit to collst;,Uct (� or Repair all Individual Sewage Disposal System at: 5,014, 4— — ......................... .............. ..............rvj�� . ............. ........... ...... . ..... ....... ....... .................. .. ... '..,ic r o Ly IN o., Q.0 C� ..... ... ..... j.............. .ILA Adds ........................................................................ .................................................................................................. A.1dress -r as Size Lot..........:..............36 .. T�pe of l3pilding Dwelling-- No, of Redroon's .................q..I.......I..........Expansion Attic Garbage Grinder C)Lher—T)II)e of 1,"lildilIg ............................ No. of peraon.............................. Showers Cafeteria OtherlIxture... ......... ...........................................................................I......I...............I...........I.........I............ ....... Design .................................. g:tllons per person J-)el�day. Total dill flow.............4.&Z.............gallons. S/6 SCI)tic T:od� M;Illolls Length--lip..6 ................i...... D i, aching...........Depth .. .... Disposal Trcnch •- - No. ---O�........... \-Vidtll...,�I .......... .I.utal Length........41Q...... Total le. area.. ..sq. ft. Seepage Pit No........ .. ...... Dialllctci..................... Depth helow inlet.................... Total leaching area..................sq. ft. Other Distrihution box I, Dosing tallk 4-U AlAy Percol,ition Test Results Perfol-Ilwd 0.................. Date...v......�/fl....q�?Z� 16 Test Pit No 13 minute; per Inch Depth of Test pit: ....40.11.... Depth to ground water..../7Q ....... Y Test Pit No. .4 .... minutes inch Depth of Test Pit......//M.".. Depth to ground water........ ...... . ...... .......... ...........................�0.......... ....................... O Description of Soil...... ...... .... .... .. ..... ........................ .......... .................. .......I.`..... �. .....I..... . . . . .............. ................ .......................... ............................ ... ............ ............................ ........... ........................ ...............I..........................................................:................................. Nature of Repairs or Alterations— Answer \vllcn applicable..................................................................................... . . ..... ............................................................................................................................................................... .................... ......... Agreement: Sewage Disposal System in accordance with The undersigned agrees to instill the iforcdescribed Individual Sew,a the provision, of 51 of the Sutte. Sanitary Code — T Ile Undersigned further agrees not to place the system in operation Until a CCrtIljCLItC Of Compliance has been issued by the board of health. Siglwd...................................................................................... ................................ Dale ApplicationApproved 13y.................................................................................................. ............I.......Da.c.............. Application Disapproved for Nit! (Allowing reasons:................................................................................................................ . ..............................I....................................................................................................................................................Da.....tc................ PermitNo......................................................... Issued........................................................ Datc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... .....I........ ........OF..................................................................................... Terlifivatp of Timpliana THIS /.Y 7*0 CERTIFi-', Thm the SeA,:jge Disposal System constructed or Repaired by.................................................................................................................................................................................................... installer aIt..............................I.....................I.......................I.................................................I......—............................................................. 11;1" 1)(,(:Il lIlSl:IlI(-d PI will) III(• pl-civisl(II)s of TTTILF 5 of The State Sanitary Code as described in the applic:tti,)n far \Vorks Pconit No......................................... d-,Ited................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATI."............................... .......... .............................. Inspector.................................................................................... THE COMMONWEALTH'OF MASSACHUSETTS BOARD OF HEALTH No F. .................................... .. .... .. .................................. Fee........................ 11ritr., (911 itrarlitill VnIllit - P0.1-111issioll is hereby gr;illted—................ ......................................................................................................................... to C*ollstrilct ( ) or ( ) ;LI) 111(liVilliEll SCW;I„C DiSI)OSI'll SYSt"' atNo.... .. .. .... ............ ...... ... . ................ ....... .................................. ...................................................................................... ion Permit No..................... Dated.......................................... oil the applic;It it'll fw- \Vorl��; Construct ................................................................ .............................. I)AT .........1—................ ...................I........................ FJRIA 1255 HOBBS & WARREN. INC.. PUBLISHERS ----------- Fitu.............................. No......................... THE COtfiM(-)NV\/E/',LTFI OF MASSACHUSETTS BOARD OF' HEALTH Taw OF PQM /7L).... I�IVDOV-C.. . .... ?r,pphvafilm fol- -T-111il-1111ml 111111dut, Tomitnutioll Permit ,-\pj)IICatjojj Is licrcl)), io:t(le for :1 PCI-Illit to C011st;-Lict or Rcpair ,in Individual Sewage Disposal System at ....... 7el.— tl ............... ........... ...... ......... ................69 ....................... .......... N vc, \17�1-1 01 L 1 01 -Yr-r.Z.�..... 4) -P........... ........V.,eov.c�.....0i —tjj..:.A ifz)./D.77/.,.al .. U:1 ," Addresu ................ .......................................... .................................................................................................. A,Idics� JSize Lot.....13.................. U Type of Building Dwelling-- No, of Rc0roolil.-.................. ......................Expansion Attic Garbage Grinder howers Cafeteria Other—Tyl)v of Buildilig ..................... ...... No. of persons............................ S Other6xtiii-cs .. ...... ..........................................................................................................................I............. I-)esign Flow........................ ......I.......-gallolls per person per da Total daily How.............4-&.Z.............gallons. Leligd)..Ap..6 W i(It 11-0.1 Diameter................ Depth ....4. aching area....1�..Q Disposal Trench - - No. ....2........... W, idth...... ........... .rot:d Length........�,Q...... Total le. ....sq. ft. > Seepage Pit No........ . . . ...... I)i;ul1ctcl...... .............. Depth helow inlet.................... Total leaching area..................sq. ft. Other Distribution box (I Dosing tank Percolation Test Results Performed hy..!��� ...... ................. Date... Test Pit Nu.13 minutes per inch Depth of Test �,-Pn .... Depth to ground water....ay.w....... LL, Test Pit No. per Inch Depth of Test Pit...... Depth to ground water....... ........ .... ........... .. .................. ........ ............... .............. X......-.... .. .. ......................... Description of S 4- 0 oil.......J....-:7... ........................................................................................... U ..................I........................... ..... .......................................................................................................I......................I................................ ........................ J Nature of Repairs or Alterations—Answer when applicable................................................................................................ ............I................................................................................I..................................... ............................. .............I............ .... .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with tile provision, of 71 T i 7, 5 of III(-, Suitt: Sanitary Code — The undersigned further agrees not to place the system in .- , -i, operation until 't Certilkute of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Date ApplicationApproved 13y........ ............................I....................................I....................... ....................Da.t.C.............. Application Disapproved for NIC f0I/07VhI, reasons:................................................................................................................ ....................................................................................... .......I..........11...... ............I............................................... Date .Permit No......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......I..................................OF..................................................................................... &r1ifiratp jif Tumpliana THIS I.Y TO CIERT11--r', 'That the Individmd Sewage Disposal System constructed or Repaired by.................................................................................................................................................................................................... Installer aI..................................................................................................................................................................................................... 11:1" I)ccll installcrl III accovd:llwc with Illc of TITILE 5 of The State Sanitary Code as described in the application fnr Works Cowsn--,IeIioll I"crilliL NO......................................... dated................................................ THE ISSUANCE OF THIS CEMPICATE SHALL NOT BE CONSTRUEDAS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I)AT E'................ .............. ......... .......................I.......... Inspector.................................................................................... THE COMMONWEALTH'OF MASSACHUSETTS BOARD OF HEALTH No......................... 0 F. ................................... ............................................. FEE........................ ill.-p mt,tit R-lovit1-1 Q'Inwitrurtivil Permit P0.1-illiqsioll is herch), gv;l1lied......... ......... ......................................................................................................................... to Construct ( ) or ( I ;ill Illdw,1(ill:11 sc%va',c 1')isposal System atNo.. .. . .. . ........ ..... . .... .................... ........................................................................................................................... ................ Ditted.......................................... ;1>, shown ()It ill(! application f,),. \vorio; C:oustriliciinn Permit No ......................................................................................................... DATI..................................................................I............... F:)R-M 1255 HOBBS 6 WARnrN. INC.. PUBL.ISHI:nS