HomeMy WebLinkAboutMiscellaneous - 1050 FOREST STREET 4/30/2018 (4) Q
PRINTED BY: Pamela DelleChiaie-PLEASE LEAVE IN PRINT-DUT TRAY.......THANK YOU.
DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Wednesday, December 08, 2010 10:38 AM
To: 'Osgood, Benjamin C.'
Subject: I.R. -Septic- 1050 Forest Street-Copy of Scanned File
Attachments: 20101208102850626
Hello Ben,
Here is a copy of the Health Dept.file for 1050 Forest Street as you requested. Please call the office with any questions.
scat Rgaada,
Pamela DelleChiaie
Departmental Assistant I Community Development I Health Department
Town of North Andover
1600 Osgood Street I Bldg 20 1 Suite 2-36
North Andover,MA 01845
2 Office-978-688-9540
2 Fax-978-688-8476
Eil Email-pdellechiaie(a)townofnorthandover com
'2� Website hiip://www.townofnorthandover.com/Pages/index
"We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous
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FROM : SOLICY'S SEWER SERVICE INC* PHONE NO. : Apr. 29 1999 09:46AM P1
A A N S M I S S 1.0
SOUC'Y'S SEWER SERVICE,INC.
830 Ltva asTom STpast
TKWKSBURY, MA O(876
($78)851.8839
FNc; (978)88(-s839
North,Andover Board of Health Date: April 29, 1999
Ffm#: (978)688-95-42 Pages: 2, including this cover sheet:
From. John J. Soucy
Subject: 1050 Forest Street
Enclosed please find an "AS�Btult".plan for thg above captioned address.
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830 LIVINGSTON STREET
TEWKSBURY, MA 01876
(978)851-8839
1050 FOREST STREET
NORTH ANDOVER, MA
GARAGE
A B
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C
A - C = 32'
B - C = 36.5'
94.25 INLET
94.5 OUTLET
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FROM SOUCY'S SBIER SERVICE INC* PHONE NO. : Apr. 29 1999 99:46AM P2
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830 L7VIMSWN
TEWICSBURY, MA 01876
(978)851-8839
1050 FOREST STREET
NORTH AMOVER r MA
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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 Iarge 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:
healthdept townofnorthandover 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: htAn://www.mass.gov/dei)/water/wastewater/dodont.htm
1600 Osgood Street, North Andover,Massachusetts 01845
Phone 978.688.9540 Pax 978.688.8476 Web http://www.townofnorthandover.com
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 YA-sysk s,which need more frequent oversight.
DO.,. DON'T...
o have the system inspected and pumped every 3 to S Oo not use your toilet or sink as a trash can by dumping
ears.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.
Mire inf9�elation on Rim it
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 pum ed 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 drainfieid 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 li-Q=Ad s s
toM
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 he flooding your drain field without
allowing sufficient recovery time.You should consult
our tankprofessional 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 bo 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 athmd 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
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* LOT 4 LIES WITHIN A RESIDENCE 1 (R-1) ZONING DISTRICT
NOTE: r, 4 PLOT PLAN
THE PROPERTY LINES SHOWN WERE TAKENof
FROM A PLAN ENTITLED " PLAN OF LAND � � OF LOT 4
LOCATED IN NO. ANDOVER, MA," DATE 8/31/94 m FOREST ST., N. ANDOVER
J.
BY CHRISTIANSEN & SERGI, PL #12455 N.E.R.D. log 49" � OWNED BY:
MARK & JEANNIE MCGONIAGLE
$� SURVEY BY:
s SSELL 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 1D: 8HS-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
Haulina/Pumpina Listing
uan "
Tm SVstem Tyne Pumped Pumped BTransferred To Disposed At Date Pumped al/ons
Routine Septic Tank Soucy's Sewer Ser Woe 04/23/2007 1500
Comments: ok
Inspecti01?S:
Inspected: Ex
vires. Inspector: Status:
11/07/2007 John Soucy Passes
Comments: Title 5
GeoTMSO 2007 Des Lauriers Municipal Solutions,Inc. Page 1 of 1
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PR TION rl�
b _
SEC 4 3 2047
,�t4ORTH ANDOVER
TITLE 5 � D-".PARTMENT
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 Krovftz
Owner's Address: Same
Date of Inspection; &vember 7 2007
Name of Inspector: (please print)John Soucy
Company Name: Soucy 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�'
Inspector's Signature: ' ry Date: 1 7lonn
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 bow 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 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: Edrpard and Nancy Krovitz
Date of Inspection: November 7.20Q7
Inspection Summary:Check A,B,C,D or E/AL A S complete all of Section D
A. System Passes:
__&_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 Ngnev Krovitz
Date of Inspection: Noyember 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 fall 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 DBP 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%day flow
X Required pumping more than 4 times in the last year_N-QT 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 I 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.]
NQ(Yes/No)The system LA ls.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.
NO 5 of 1 I
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&2LI z
Date of Inspection: Novel er 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
—2L 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?
_A_ 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?
xc ^ 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?
xc _ 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 Cis 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 7J&7
FLOW CONDITIONS
RESIDEN'T'IAL
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):_go _
Water meter readings,if available(last 2 years usage(gpd)):PriX09 well
Sump pump(yes or no):_Ug_
Last date of occupancy: recenj
COMMERCIALANDUSTRIAL N/A
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: UgMe Owner
Was system pumped as part of the inspection(yes or no):_ygg_,
If yes,volume pumped: 1500 gallons--How was quantity pumped determined?Gage on jMck
Reason for pumping:Inspection and Maintenance.
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
Single cesspool
_^Overflow cesspool
Privy
—Shared system(yes or no)(if yes,attach previous inspection records,if any)
_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:
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)9 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 battle: 8)t
Distance from bottom of scum to bottom of outlet tee or baffle: 14"
How were dimensions determined: T e&Sludge Togj
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: stallons/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.): FIo ch-ecked 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 Krovit
Date or Inspection; &Xember 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'x431
_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.): NQ-Sign of Hydraulic Failure
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site pian)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.):
Mage 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 andmney Krovitz
Date of Inspection: November 7,20Q7
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,
suesu��e sewAa[aerosAt srsrer�srrcnor.aw •
FM7 C
r1 ^-, ,,,,`` tY�TENtLtlitl1nnA110Nf�+tA
prow 04aas 10 SU
Daft d Fwpalae l'1c{xMM e-
Swell Ci 6WAae ow om 4TSMs
t Jod.an Come traa twe Oamtn+�t rde�tnnlrEiath�a bancMert,
itatt tt*at,MpMn low llttttt Whl o Put"MlM*.Wyt&ms Imp NMI)
Lja ►�('t{" ^'�aw,lc
I
revised 9/2/98 tpe�Itss
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
cEµORTN BOARD OF HEALTH
~o
70
�,'��,..°•�^ DISPOSAL WORKS CONSTRUCTION PERMIT
sS�crus�
Applicant Sn(A
C)
NAME ADDRESS _ TELEPHONE
Site Location I 's
)6 �
i
Permission is hereby granted to Construct ( ) or Repair (van Individual Soil.Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN,BOARD OF HEALTH w
Fee �' �� D.W.C. No. GiCf
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
If DATE: CURRENT INSTAL
LER S LICENSE#
r
LOCATION; _"O
LICENSED INSTAL R: q0 LA c
SIGNATURE: TELEPHONE#
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
I' NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
$75.00 Fee Attached? Yes—,,/ No
Foundation As-Built? Yes No
Floor Plans? Ye No
Approval Date: 7
.
tog�v
BUILDING PERMIT woerh
Of�ttian X6'9
i - TOWN OF NORTH ANDOVER
o .�
APPLICATION FOR PLAN EXAMINATION 4
Permit N0: Date Received ��,,AVID-
CAU
Date Issu6d:
IMPORTANT:Applicant must complete all items on this page
..:µ
l; .} -..�r2k. ; - . .r`-1•�`a t'1•,����;M��r 4..?�1�2`Z ,f� {� �;ti
•{ate'..• ��f ?�€• ..r. f". •"a._� ...�. •-y��� � �(
- '.f'. .ii. 'L
/}��
�y •.'>?`f .`_5�: +L} =�ai ; N :�i'•�f�i��_. �..^1' .3Cx?^.h �� :1 1
TYPE OF IMPROVEMENT PROPOSED USE
.Residential Non- Residential
New Building Onefami y
ditto wo or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
D_emolition _W. Other
c• a'i. _.� PROW,� :.c!'.v.r•x.-r<.,�' 1., v a-=1" "s�i�,. �. _ �..(L�'�'iir",;"
5z1Y�i'r •.�t �te1:IY ilY+�•�i•,�^%SY8 _ 'r %a-: �F.f.:�.a•.':d.. _ n _�..a�'. iFr.'_ OQ°
DESCRIPTION OF WORK TO BE PREFORMED:
t
�u(rC� G //0' /b/ 35co(sa)u iswo ,
Identification Please Type or Print Clearly)
OWNER: Name: 1Voe rj.1 P 41I3nu IT--L Phone: 979 -oG!s^
� U5Z) �oaeST S 'rT. 935
Address: , -
,' ., 'c -.vy=•;.�r'trti j,. 'u'r - � 'y? _2 S -, y _k ` t � P ..
•-!�1rj: ,gip ^��,' - � .-ie - ._' - r d� :.� `fir �� c'�! -+$ Y«• i
—g
a i�7hT
�f .e �L�U?�S?:��i •�, _ L .�f , ��`f� �.y ..u..:._- E �73Jf`Y,� ?YS:.-��.r=i'�.�^.. .'`_ _.
r .,/ �• ` ` •.fly,•"9_�� •CSn�IC�'� _ -. ` ��j
toe.
ARCHITECT/ENGINEER 1-14M45 CUSS! � Omas l-, Phone:
Address: 3.0' &4-eftl7 Sr 1206--tcrA'I Reg. No.
FEE SCHEDULE.BULDING PERMIT.$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ K, 6lSU ' FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
�V1111@ 0
racto
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Twming/MassageBody Art Swimming Pools
JWell Tobacco Sales Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
DATE JECTED DATE APPROVED
1
CONSERVATION
COMMENTS..M AICIZI <,L -?C-_
/ D TE REJECTED DATE A VED
HEALTH
COMMENTSw�°=�-; D /•fr
Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection Driveway Permit
Located at 384 Osgood Street —
lRE' EI'ARTM ENT: -
'�- -
�Q •rr`r`�stet` - �{. -
txi• ori�s4` _ rf .�
'Loc4e414'424'Nlaid'Streess--
'r ani>✓�.,y;.f."ssr.': :},c.. .,r i%: ..raj�rc::4�:�7:c..�..,t.• ..�t��,`i- •_�-4 - _ r-
- . _.. +�•.•."Fvr,?,•ti.. =;�:'' .:} :�i".�;i..•.�-,:- Cy-r'r::y V,.•
ry,� ^f.'E'r:: -` 3�;_��p�•rr'. ° ,�.a':r'i�'"a y:..j•!•..
f Fare'..De attrrent`si}:.r ` r'e' af:.N r :_ _ ..,
i7.e_';1•_'iti.1':- ,l::.ti: •�' -t.s....,.i, :£. -``.�o._ ,�__ J Y�Y: .��•.�,y .,�'.. -.,,.''
:r.e.. ?;-'. .:�5�.%s?-[ - v�- '- - z.1:-.• 'y,:..`.'+`r:.�t 'i
'.Ce.+i-. ''=�lT. _ _ :1�: <a _ ;.b:.•.pl. v4...•y`¢ } il:'_`.`- :5,;,-.t"' r�: :`ew��4t,.<%:. .�..
,u_T+..a. _ -ri•-'`- = i•.y.!:?.t':^' +?:t°-:;.. ,y<�:::i•.^».•... .t.. \"moi: !'.. _ •:.y,".�',f...'�'.i•1'.�...t,::..
z.y;,; �:j`� •.3'r-t ,�_.- '�Y ..Et:'�::� ..�,:..v.t_.^c.., a :�"--'.may*''„,:t��w��` ':>..1:_. - tea:••.-. '.`.
.1S � - - - rFiJw � .S..�I.. !:•1:. ,.�-i+��i+s: ..)-2 .p�':i�:?'`=;:i...,r_�.. --,?.�'-}__ �y•\��•
S_
'•_CO,
.4:` .�\. 1_�t:t:;.i� .�.yr...s.r.-_•:. -i.ti.:Y.'L-� h�'��-.raY.. Ch`1:;�
I Existing House
Es�ng douse �- -- _ _ �... �
2 Story
I
I 3
_ I
I �
Propowd -15'x'15'Threes Son=Room
mm 4w arca
4�
1600 Osgood Street
North Andover,MA 01845
Phone 978 688-9540 Health Department
Fax 978 688.8476
Fwc
Toe Eddie Jr. From Susan Sawyer,REHS/RS
Fam 781935-4232 Pages: 4
t
Phoney Dater 10,F,4/07..
Re addition cc
❑Urgent x For Review 0 Please Comment ❑Please Reply 13 Please Recycle
Thank you
Susan
S
IRON
PIN
FOUND
' Al 3
WT. tW HER aF14N
U
�NVf PIPS INTO TAN .35'
TANK: .
�'� �f �,+'�
yL INTO O►lox f&�O` . �8�p�`
ANY, 9 QFnPE
CHO l
: . ch
LAN 18 NOT A WMFt ?4
'OF TME LOCA110M - CW 141 11Y M OJT A VOOCAJIaN
f�°INO �fit�O'f1f���
M
LOT 4
/ 3.15 ACRES
r
LOT 3'
2 STORY
WOOD FRAME
�M TOP FND,= 103.35'
rwNo
WELL
Pin
F«UNO
a
k b4l
40V/ r+ar LOT 5
PIN
fOUNo
Vpp�'�DL6' rouHa
� ►� � j,,!jTW4Y W
KLEYATIONS
e
i
OUT SM puss 97.36' 9SS 114'
«,
INV. ,�� AS-
BUILT
mm ALAS 9 ,7!
I , p1pr ft my 4Lot
CHOUINARD '
civi PREPARED FOR:
MAN 1$NOT A WAhANTT a TH s=BUT A nrtir Ne;8 a • COLONIAL VILLAGE DEV. CGRP
OF TME i.ocAnos a mt atamio�annscnxrra PREPARED BY;
LSTEVE CHOUINARD, RE,
SCALE; - !"�8Q' DATE: 3/30/9,5
2'd Maimi
Wd80:e0 S6, TE NUW
' � NORTk
O 4iweD 06'qy
or d << 116
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to
760
"pA GOG.NGItt WKN V
��SS4C14Us
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,
Youir 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 issing information
. Passing Title 5 inspection of septic system required per local N. Andover regulations
42I00vLocation
of structure not acceptable
4. ❑ Undersized septic system
To address the problem(§):
H#1 ' ' cked, please supply:
lam'' 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 cked:
a. ave the septic system inspected by a certified Title 5 inspector to determine
E
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 Fox 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
M. 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,
,Sosin Sa wky—eq—uMic Heal0f Director
Cc: Building Department
File
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web www,towoofnorthondover.com
Wit
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AND
ov�ti4
80ARD OF H
BOARD 01' I I E A L'IWR'!� 2 a
G•—e---�4 �;
• •--..y Town of ,Nort:h Andover,Ma S .
?mi t
APPLICATION FOR WELL &`- I'UI.,
r
.)pi.`a:ca0i.on .ins hereby made for permit: * Uo drill- a well. (><f. Application
ade to install Q�j a pump says tem%
.ocaci.on : Address . OJO f v2•P..J' S LoC"�f
-------
1w n e r f���r� tL Address Tel .-
� . .
ell Contractor �l` v:; Adclress ,( � ,/ � �- S� • 7'c l. . c�^•5"
�r 1r
Tel . -
ump Contractor Address - '
CLL CONTRACTOR (To be completed at Li "Ic of pump LcsL }
e of t4ell / ,.1 Well used for
rr ,
►iameter of Well _Size of Casi.nl; '
iepth of Bed Rock DepLh casing into Bed Rock
las Seal. Tested? Yes + No {_) A.ate. of .Tcsti.ng._
r
ps' ' tJekl landed in W11a.t. Ma Leri al P a�
)eP rh to Water / S� 1 Delivrrs -Cals . Per Min . for 4 ho
)rawdown��feet after pumpin9�_,hours• at _�2 • CI'M
r *.
)ate of Completion
4Xgnatu • e� Contractor
k J(X�n SC�Y iC iC it n'•iC iC i[5'C iC ii St i'C i•C•i(,•nil7!1�iC 7C}•C iC'n it iC S•C iC SC S'i iC iC::i[iC i C is SSC:•C iC iC iC'n iC i�ii iC n•iC n�C:C ii iC iC iC if'n Sir��•n•�
, r
PUMP INSTALLER (To be'' f-illed i.n' before i �i:;tal.lation }
}�pType Used a
Name Pump -
._ 4_ (j �- L1 f' .-1� IG'I ' tI 1
. , •+ L
►dater Pump Delivers/0C PM Size of ;1'<�st1c,--��' 2- A �----
Pipe Material , Uses! in Well. : C.,ls•t Iron {^) G,� l vani zed {-) Plastic
Well Pit . (_) or pitless AdapLdr
Was sleeve used to - protect pipe? Yes (_) 1�fU{?C� Type or Name Well Seal
3 �
�*�t�tYtlrtttt�rt�rtYttt4tYtVtYtY�titYtlrtlr>Yt4t�r�rtYt4>4t�t�t4tYtkt4�rtirCY�4tVuutrert�t� . ; .. .������i�+sr�r •�it►ror.
Dade t•?aCer analysi's . r'epdxG 'submitted to Board of 11eal'th
D4 -e release given ID owner of record & 111(19 .• Insp
:,1x�C� •,'uMI' ;3�'' �3! :i , •.� •�,.t.` ..t,. �. •r•av _t s ;�
:\ I .,.5 :. :»�'�h�Y } ,:{�3•'1:'.i7j 4ti. ;:j v�!.� alrli. ::. ( Z`�}� 1'Q i� a \I. it>i.�y3j: .'\'Z`
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ji ,' ,.;�:}, , .t ;;,f ,j t ,�rt. ti11±�{` ., ;.`ij i�; ti 4 �, 1'�y�1••12 ..�ti= :
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1j}wZ:': l�}�iYl��:.,s:;ti .. ♦ t. i...i�' ev. �.,t
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' -�'� `t• ,t:' �:S\''��•i: its:..} >::<:�..:.,o�r .l��7•` !,,1 "':t.�'+ij .y,
• .•iii-; }-.j r'•' •.�t�,•:'1 t" � ',i� • '.,r
l•
NUMBER FEE
THE COMMONWEALTH OF MASSACHUSETTS $2 5.0 0
TOWN ._...... of .................................................NORTH ANDOVER
- ....................... .
'
Thisis to Certify that ............................................................Pump................................................
NAME
.....244A...aamen...Street.,....Re,-Adinga....M&...R. $47..............................................................
ADDRESS
IS HEREBY GRANTED A LICENSE
For ........We.1 ....ar.illinn...P.ermit.........LO.t..#4...F.Oxest...Street...............................
............... ....
This license is granted in conformity with the Statutes and ordinances relating thereto, and
expiresDecember 31 1995 ,••unless sop oparAed evoked.
.....- .�: ..
Jan114 Y....Z7.1...................19......95 ��:.......�.... �
. ... ... ...
.
.............. . t . ......
-,
FORM 433 HOBBS 8 WARREN. INC. jr
FN ANDOVER/
RD OF HEALTH
P.01
5-1995 14:33 B10MARINE 2 O
Biq arine
i$EAST MAIN STREET,P.O.$0X 1163,GLOUCESTER,MA$8,01931.1153
TELEPHOkF-' (608)281.0222 FAX: (608)283.3374
CENTIF I CRTE Of ONRLYS{S
WELL PUMP REPORT NO.: 850108
AVELUNp
244 HAVEN STREET' JANUARY 2t3, 1995
READING MA 01867 t•,
now
WATIRR. gUOL)TVAN LYSiS
[gp: Now well looate.d on LOA.Forest Street, North Andover, MA (8arrott).
� .
SAMg1
in Samples taken by Angelo Llano.ori.40huary 4. 198b,
Ftndin�s: • • •
PRRRMETER RESULTS fttllgEllN *
Total CoSifarm Bacterial CountM00 mL . 0
.0
pH Value 7,42 SIIBhtiy Alkaline
• Hardness(09003,111Q4 1E-4 . Moderate
1 ap®alfip Catductance(pmhoskm) -
Nitrate N110wen Contant(rtv&) 0.28 14
1 Copper ConWnt(mgA.) <0.01 1.3
iron Cor>tant(m A.) 1.81 0.3
Manganese Cpntsnt(MOA-)
0.3 4 0.06
28
Sodium Content(frog&&) 17.0
ylgth2dj: Analyses performed In accordance with Standard Methods for tho
•P RXaminotion of Wale' & Wpstswster, 17th Edition, 1889. 'Guidelines are based on the
S. recommended levels of the Mass.Department of Environmental Protection Agency's$10 CMR
22,00, Drinking Water RegulatlQns"and the"Safe prinking Water Act"of the United States
Environmental Protection Agency.
14, The Iron and Manganese levels detected may cause the water to taste"rusty"and
P i stein clothing and plumbing fixtures. Flltratlon is available to correct those levels 9 continued
usage and flushing 4f the well dose not cause.them,to abate.
BY
Wt
John Mal eft
Dat
Lab Direct or
JM/ds
Da C e
Massachusetts Department of Environmental Management
Office of Water Resources 101384
TYPE OR PRINT ONLY Well Completion Report
Address at Well Location: 1050 V-0USk toperty Owner: eAL&-XA <- Y- C OV 9%
Subdivision Name: Mailing Address: 10 V-1 0-0 SAL Sk
City/Town: WO(-i 1A A nA Chi R r
city/Town:N c)c-A,kA YA Y-)(A cw-P r
Assessors Map—Assessors Lot#: NOTE:Assessors Map and Lot# mandatory if no,6tr6bt:addt6'ss available
Board of Health permit obtained: Yes El Not Required [T PermitNumber "� Jssueid: --,
IS
El Now Well El Abandon 0Domestic 0 Irrigation El Cable
C1 Deepen 0 Recondition 0 Monitoring 0 Municipal D'Air Direct Push
0 Replace 0 Other . 0 Industrial 0 Other El Mud-Rota rV�, Other
Unconsolidated Consolidated
T59
emwmy
From (ft) To (R) High Low
Other Rock Type
5
N.
<
uI/
-foii iiNl OF P
F OVU
D 0,
I FO) LT I
A�jl)A
Orr.
DEG 1 72001
1, 000MMON', 51, N.
Total Depth Drilled I-S-0 From (ft) To (ft) Casing Typo and Material Size 00,,.
Date Drilling-Complete r-cat-106
-1.00 1
From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter
40(L WOO
MAU
Developed? El Yes [71 No
From (ft) To (ft) Material Description' Purpose Fracture
Enhancement? ® Yes 13 No
Method
Disinfected? 12-4s 1-1 No
*0(�LELT
W,,00
Yield -:-Tim6 Pumped Drawdown to Time Recovery to Deoth Below
Date Method (GPM) min) (Ft. BGS) (hrs& min) (Ft. BGS) - Date Measured Ground Surface (FT)
-g
*A- j$jj kj:
Pump Description G, Horsepower 1-
Pump Intake Depth - (ft) Nominal Pump Capacity (gpm) r
VIMfc,IV 'S
1rVA'&,CQ-�<-Ckcy- QX;"A W-0-k\ SAOr".
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 knowledge.
AA
Driller:-Da t-�) �A%11)COQY, Supervising Driller Signature:,.& W, "egistration #J I (Pi q 141
Firm: i S Date: 20ol RigPermit#: L-L—L—L I
NOTE.,Well Completion Reports must be filed by the registered well d1ifler-within 30 days.of well completion.
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
LOCATION: Assessor's Map Number Parcel 2--7
Subdivision Lot(s)
Street r_,9,10,. s `� St. Number !r}?D
************************0 ficial Use Only************************
RECOMMEND TI NS O ;TW/ArG.ENTS:
Aa/ Date Approved / k/ /
Conservation Administrator Date- RW[4
cted
Comments 0- Ju Y ;� � �� 7 ,
Oik Ak/.
j cra g�QQQ Date Approved
Town Tlanner Date Rejected
Comments
Date Approved
Food Tnspect r-Health Date Rejected
Date Approved
Septic Inspector-Health Date Rejected
Comments _ LJ N re re,5
Public Works - sewer/water connections
- driveway permit
Fire Department \ �.--
Received by Building Inspector Date
I)VNI\1/ Vi- 991ir%ua ..
' Tnwn of North Andover,Mass .
i Date
.'ermi t #
APPLICATION FOR WELL & PUMP PERMIT
P.Cation .i.s hereby made for permitto dri ] 1 a weld ( AppLfcati.onp •
,nade to install. (�j a pump system.
.,ocation: Address . 050 f�2
Address Tel .
)wner �-
tAddress / d�r�` . Tcl . ir/- 5 �
:� ell Contractor { - �--•-.
Tel . -
Contractor-
WELL
<< Address
•? "
CONTRACTOR (To be completed at tune of pump test )
xY P
e of Well ,.� Well used for
�. -
Diameter of Well (c� � Size of Casing
Depttl casing into Led Rock
Depth of Bed Rock
•
of Testing f ZU 5
,Was Seal Tested? Yes No {,..,,} Date. •-
th of 'ala• - - d I Well Ended ill Wila.t. Material le _C6-C*—
e
r Delivers Gals . Per I`Iin . for 4 ho
Depth to Water-
feet / S - •-
` ` • at
Drawdown�O� after pumping hoursDa.
to of* Completion - 4
Vinatk4. e Contractor
• • t• •..•.t' ' • • •••�•••i•C7Ci.irSC::;:S•::CiCi.:Ci•CSCif:CriS::Ci.7in
iY�C X;k�.•C�Y�C iC n SC•�C'�Sl•!r i.SC 7�•3•C"C n .n C.3C')'C iC.0 iC SC i. .� �
PUMP INSTALLER {To be'• f'i..11ed i.n before
installation )
�} ��Zy:' •_ ' Pump 'Type Used � o ,
Size & Name Pump � . ' •;'^Size of '7'atilc � 2-- 6`AL
Water Pump Delivers-
Pipe Material Used in Well : Cast Iron (_) r.� l vans zed (_) I'Iastic
Well Pit { ) or Pitless Adapter
rotect pipe? Yes ( ) NU{?Cf Type or Name Well Seal
Was sleeve used to • p I� P - be �u•e.5�a�
Da t e �� ,�,�
Date 'later analysi's . report. 'submitted to I3oard of Iical'th
Davi -release given tD owner of record & 111(19 .- Insp
II!` ei lth Inspector
Town of North Andover, Massachusetts Form No.s
NORTH BOARD OF HEALTH
Ott,Us*"'�.y
19
r
•' .AVID
I'.h«fir DISPOSAL WORKS CONSTRUCTION PERMIT
S�CHU
Applicant_ —1 1 ry'\
NAME ADDRESS TELEPHONE
Site Location--_ U-17
Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No. ,
cJ� �HAlRMAN,BOARD OF HEALTH
Fee j (.� D.W.C. No. 1 X
1
JAN-25-1.995 14:33 B 10MAR I NE P.01
410 B ory .. rine
18 EAST MAIN STREET, P.O.BOX 1163,GLOUCESTER, MASS,01931-1153
TELEPHONE (508)281.0222 FAX: (508)283.3374
CERTIFICRTE OF RNRLYSIS
AVELLINO WELL&PUMP REPORT NO.: 950108
244 HAVEN STREET JANUARY 28, 1995
READING MA 01867
WRTER QURLITM RNOLYSIS
WWI Desediallaw. New well located on Lot 4, Forest Street, North Andover, MA (Barrett).
ll aB: Samples taken by Angelo Claw on January 23, 1995.
Findings:
PRRRMETER RESULTS GUIDELINE*
Total Coliform Bacterial 0ount/100 mL o 0
PH value 7.42 Sltghlly Alkaline
Hardness(02003,mg&) 101.4 Moderate
Specific Conductance(Nmhoskm) 230 _
Nitrate Nltrogen Content(mgQ 0.28 10
Copper Content(mg1L) <0.01 1.3
iron Content( A.) 1:81 ..0.3
Manganese Content(nq&) 0:3 a 0.06
Sodium Content(mgA.) 17.0 28
M-ath.odg: Analyses performed In acoordanoe with Standard Methods for the
Examination of Water & W"tewater, 17th Edition, 1989. 'Guidelines are based on the
recommended levels of the Mass Department of Environmental Protection Agency's M CMR
22.00, "Drinking Water Regulations"and the"Safe Drinking Water Act"of the United States
Environmental Protection Agency.
8201aft The Iron and Mang nese levels deteoted may cause the water to taste"rusty"and
stain olothing and plumbing fixtures. Filtration Is available to correct these levels tf continued
usage and flushing of the well does not cause them to abate.
By: -ct
Jahn Marietta
Lab Director
JM/ds
AS-BUILT CHECK LIST
and
FINAL INSPECTION
proposed Elevations Aa-Built Elevation
House q7, 36' l
\ ' 7,J-0
Tank IN 9111. 7-
Tank OUT �(D'`T b 2.
91
D-box IN ._
D-box OUT
Trench Inverts
9,3
Line 1 9 23 - �l�DZ} , z 3 , 6 i >
Line 2
Line 3
Line 4
Bottom of Exc.
Stone OX? D-box checked?__� Pipes cemented?
:Itis
77,
of tAndover
.. 11
0
O:
No. 033 _ :,� \..
*ffll Z _ YY
over, Mass., A��r Z 7 19
_ T o LAKE T .
A_ coc"Ic"ewicx
BOARD OF HEALTH
Food/Kitchen
septic SWW1
BUILDING INSPECTOR
~ HIS<CERTMESTHAT tAL V.ctLAE.fc...,~DMVeLO+Pf� ....................................... ....... ^
�t oundation 3
s Merect ..0 LBuiidin s on...1. ..... . .... .....................
o�FIssion:to
. :- to:be accupNd as ......N ..................... c ?.! ���n. 4I� ...Z..CAf�....c:4 1�....................................... n
::;:';, Final
rovld" •;the 6accepting this pee k shag in everyrespe conform to the terms of the application on file in
=''rc thin 'and to1he; rovisions of the Codes and By-Laws relating to the Ins o i a���Gonstruction of
p Y 9 � ' � INDATfON ONLY
{` BugdinQ& '`the Town of North Andover.
REGULJM BY PARA 114" B.O. PLUMB SPECTOR
} VIOLATION`of the Zonin�.'er Building Regulations Voids this Permit.3 / S a
Mrr FEE PAID �cl�
PERMIT EXP --1N. M s�a-- �o ELECTRICAL INSPECTO
UNLESS CON U TRT _.. ��� ough 3/ /` �
`PERIR FOR FRAMEILDtN .._.�.. .. ' serer.
;.;.;.,. .. ..... ..... ..... . ............ ... ... .
l7t *, � '_•.f. BUILDING INSPECTORATE. IEE PAIM
Qccupancy Permit Required to Omoy Building GAS INSPECTOR
Roughs
: :-;Display"in a Conspicuous Place on the Premises — Do Not Remove Final
• a
No Lathing or Dry Wall To Be Done FIRE DE
Until inspected and Approved by the Building Inspector. Ekirner ,
Li 12-�a45 �{
Street No.
L FINAL CONSERVATION FIN L
PLANNING
Smoke Det.
pORTF{
.0-to 16gti�
O m
C
Co
Col..9 �1
7 Arf D
9SSAC HUS��
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
Date: October 29,2007
Address: 15 Long Pasture Road
Re: Building application for sunroon
Dear: Mr.Nigro,
Your application for the sunroom 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(s):
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 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
J
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 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com