HomeMy WebLinkAboutMiscellaneous - 120 SALEM STREET 4/30/2018 (3) r 125 SALEM STREET
210/097.0-0032-0000.0 1
M
APPLICATION FOR SEWAGEDISPOSAL INSTALLATION
HEALTH DEPARTMENT--N(tRTH ANDOVERDIASS.
I hereby make application for a permit for a sewage disposal
installation at SALe OVI 4=L I will install this
system in accordance w t all., the 1-;v_rs of the Commonwealth of
Massachusetts and regulations of the Board of Health of the Town
of North Andover.
Further, I will construct the house sewer of bell and spigot
pipe, the minimum diameter being 4 inches, and will maintain a
minimum grade of if until 10 feet preceding the septic tank, where
the grade shall not exceed 2%. I will install a concrete septic
tank of __ in size. A manhole: (s) permitting easy clean-
ing wille pr vov. ed with removable cover (s) of iron or concrete
within 12 inches of the ground surface. I will provide subsurface
disposal field with open jointed bell and spigot Ackron pipe at
least 4 inches in diameter and laid in a series of 'trenches; the
bottom of which will provide a minimum of „�;,� e p:Cpes Lineal
(square) feet of effective absorption area. 'i�iwill be laid
on a 6 inch layer of washed gravel or crushed stone ranging in
size from 3/4 to 1 1/2 inches (dia. ) and the pipes will - be
surrounded by similar material to a height of42 inches above the
crown of the pipe. The joints of these pipes will be protected
from clogging and before filling the trench, 2 inches of gravel
or stone 1/8” to 1/4'? (da. ) will be placed over the course gravel
or stone. The disposal field will be installed at a grade of 4.
to 6 inches/100 feet. No single the line will. exceed 100 feet
in length and in any case, two lines of the will be installed.
A minimum of 6 feet will be maintained between the center lines o:
the disposal field trenches and the average depth of trench shall
not exceed 36 inches. No part of the installation will be less
than 100 feet from any private water supply, 25 feet from any
stream, 20 feet from any dwelling or 10 feet from any property
line. I further agree � to cover a X portion of this installation
until approve the ins ectioo orf1Zer, as provide e1ow, -a-F7
tt ncorporate any additional rests that may be attached to
the permit. Plot Plans must be submitted with application.
DATE
4��ure�o. �App �cant
I hereby issue the above permit .for the Hoard of Health of the
Town of North Andover, Massachusetts.
Date
gn oma •° gc�nt
I have inspected the uncovered system indicated above and find
everything done as described.
Datela.�,T
:1gtaature of inspeetiR-g officer
Percolation Test
Garbage Grinder
T
i
August 6,1955
Miss Mary Sheridan R. N.
Health Agent
Board of Health
North Andover,Massachusetts
Dear Miss Sheridan:
An examination has been made of the present sewage
disposal system of Mr. Hayford Battles. According to the
Owner it consists of A septic tank with two over flow cesspools.
When the examination was made their was no evidence of a present
overflow condition.
Since there is not sufficient land to install a drainage
field, it is recommended that finger drains, consisting of 60`lineal .feet
be installed from the cesspools. This would comprise a total of 120
I ineal faet:.
Mr Battles has been asked to submit a plan showing the
additions before his permit is issued.
Sincerely yours,
Ernest F. Romano
1
July 22.0 1955
Mr. Hayford Battles
125 Salem Street
North Andover, Massachusetts
Dear Mr. Battles:
The Department of Public health has recently completed a
sa,nitery survey of the watershed of fake Coehichewickp
the source of water supply for the town of North Andover.
This report states there exists on your premises 'Evidence
of past overflow of a septic tank,, a violation of Rule 31j,
of the Roles and Regulations adopted by the State Department
of Public Health in 1912for the purpose of preventing the
pollution of the graters of Lake Coehichowick. A copy of
the rules is enclosed.
You are hereby notified to correct this violation*
Should you care to discuss the matter further or obtain
any additional information heretofore# please consult the
North Andover Board of Health*
Yours very truly,
BOARD OF HEALTH
By-Mary F. Sheridan,r Agent
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FROM SOUCY'S SEWER SERVICE INC* PHONE NO. Nov. 21 1997 11:27AM P1
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ale. 7
SEWER SERVICE INC. $-Y`
JohnSoucy
President =`4�r:::::;
s......oyra;'
TRANSMITTAL COVER LETTER
DATE: ~ ?7
TO: �
RE: Y�f
COMMENTS: V-, AlAAl
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NUMBER: OF PAGES INCLUDING COVER LETTER: �
830 Uvin ston Street e
g Tewksbury, Mass. 01$76 • (508) 851-8839
The owner of house at 125 Salem St.
is Mrs. Hayford Battles 1
g-�S (Edith F. ) ,�
Please forward us as much of the folJOW4
Ing. information that is possible ;
1. Type of system Septic tank
2 • Age 26 years
3. Location, back yard
4 - Maintenance records and date of ldst pumping; out
When we first moved here we had trouble with it. We notified the
builder and .they put in extra long drain pipes, running parallel
with the street . We have never had any trouble with it since.
I do not have a garbage disposal and skim every bit of fat from
food. There are only .2 people living here so not as much water
is drained.
�. Documentation of repairs and reconstruction
6. Site conditions
7. Builder of system Unknown
8. Engineer who approved-
- Site
-- S-y s t em
A
9 a Instal lat ion Procedure
1.0. Problems
1
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name W A L-yiy4 V .be m F-'-S m
2. Street Address \2< sAL-eLun Si V)OCT" Qkzyc , SN
Q3. How many members are in your household. 3
4. What type of sewage disposal system do you have?
❑ cesspool
2' septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
❑ yes ❑ no CR' do not know" -_
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years"
Q' over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
�I
❑ yes Lino ❑ do not know
If yes, approximately how long ago? years. What was done?
S. ,Hoow frequently is your sewage disposal system pumped out? ❑ annually
Ie every 2-4 years ❑ every 5-10 years ❑ . over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes P' no =
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ "sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine I dishwasher garbage disposal
dehumidifier drain 4 sump pump toilet Z
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwashers Awa
clotheswasher
12. Does your property have a lawn? L9' yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre lJ 1/4 acre ❑ 1/z acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize yourlawn?
No. of applications per year ,
Season(s) of the year � �✓ Sia ul.., 4 �a.CL
14. Please state the brand and type (liquid or granular) of lawn fertilizer-you use:
Ed Check here if your lawn is maintained by a professional landscape contractor.
-D2A F oto
rO"ORtH,yO / o �l n ►��, .:go.l2D�' Ns.(��,,
OFFIC.�S OF: 3 °< TOWI1 Ol —y' �ty�O Main Street
North Andover. eF-
��I'I'r=,�►-� NORTH ANDOVER
lit I'll [Vli)SS<x:hUSCIIS )1845
(6171
CONSERVATION sS " y`�, 1)i\'ISION O1= (185'477
U f7i 1��
HEALTH
L_ANN NG PLANNING & COMMUNITY DEVELOPMENT
T►{
KAREN NELSO N. I)IREC:'1'()It 25
Wo2KSrlo�
January 25, 1988
To: Paul D. Sharon, Town Manager.
From: Karen H.P. Nelson, Direct ojr PCD
Re: Workshops with John Connery Associates
As I discussed with you last week, The Balanced Growth Committee, Planning staff
and I have agreed that two workshops will be scheduled as part of the continuation
of the implementation of the Balanced Growth Policy Plan. The two workshops are
tentatively scheduled for Thursday evening February 11th and 25th. We plan to
designate one evening to be held for the benefit of the Board of Appeals and any
other board that wished to attend, and the other for the Planning Board, Conservation,
Board of Health, and Building Department. We will strongly encourage all..members.
to. attend both workshops, in addition to staff in order to better understand the
recent zoning changes, and regulatory time frames, etc.
It will be very important that all members attend and I will probably be looking
to you for a memorandum requesting their attendance. Lastly, please pass the
invitation on the Board of Selectmen once we have finalized the dates.
Thanks.
cc Scott Stocking, Town Planner
.e
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SEPTIC SYSTEM INSPECTION FORM
ADDRESS C 2�
DATE INSPECTED
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS :
WA"i ER QUALITY TES►Eb ? 'RESULTS'
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
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This is an order: use P.p.#
Company; i�e'+'C'L. A.u.,.�p'�/4„ �,,,,QtI, Request for information- please
Fax Number: L88 9S�Iz- respond ASAP
From: Walter Demers Ext 25 d This is Other: quote
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A Division of Lawrence Plata Glass •417 Canal Street• Lawrence MA 01841•
Tel 978/ 683-7151 • Fax 978/ 794-0745
TO 39hd N831SH3 / 31VId 8MVI St7L0b6L$L6T 40:iT L66T/TZ/11
FROM SOUCY'S SEINER SERVICE INC* PHONE NO. Nd>v. 21 1997 11:27AM P2
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SIGNED
PHONED CALK RETU RETURNED[:] S AENTTSS TO AGAIN
ALI CALL E] WAS IN E] URGENT
EgElagll
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET,BOSTON MA 02108 (617)292-5500
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI
Governor DAVID B.3TRUHS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Conittussioner
PART A
CERTIFICATION
Property Address: 1 aS SoJ e-m St., W. 4net co-cr,l Pruama of O__Qa1 t-Cr yf mss
Daft of Mtepecticn: Address of Owner:
Name of Inspector.(Please Pring h.h Sn CA,i
I am a DEP approved system inspeaw pur inm to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: cS�;�._.t 5 S "r r :t'P, Mir.
Maine Address: T-SA
Telephone Ntmbee: _cl 7S -a ►- g�3 t'm
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 tim of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site a wage disposal systems. The system:
Passes
_ Condi'o ally Passes
_ Nes s4sy
n By the Local Approving Authority
_ Fa'
ktspactors Siprtsare: ✓ Date:
The System Inspecto she suspection reporttotheApproving Au hority(Board of Healthor DEP)within thirty 130)days of
completing this inspectio . If red system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the al 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
reV ged.. 9/2/98: : . raeeior>i a••
TUWN OF NOR3'H ArglDOi!ct�/
_ - ...._.._ ; ,. BOARD OF' ALTH
JUL 2 91999
N
t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property.Address: 1 a S Sc.! t S�, N. nct c J t r, M,4
Owner: De rne4-.S
Date of Inspection:
INSPECTION SUMMARY: Cheek A. B, C, o/ D:
A. S TEM PASSES:
1 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 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.
Indicate yes;no,or not determined(Y.N,or NO). Describe basis of determination in all 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 septic 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($)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pips(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 pipe(s). The system will pass
Inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
*NO'T'E: THE TITLE 5 INSPECTION IS NOT A GUARANTEE/WARRANTY OF THE FUTURE
FUNCTION OF THE SEPTIC SYSTEM,
revised 9/2/98
Page 2oru
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: la Scd ern S}., )J. A n clo o u,M A
Owner: I�+,1 fur �e.►ntrs
Date atlaspection:
C. FURTHER EVALUATION 1S 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(1)(b)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 toot of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
I ..
I
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPUER,IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I 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).
3) OTHER
revised 9/2/98 Page 3or11
i ' r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1 a
Owner: ►Jal�e� J�ms
Date of Inspection:
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 clogged 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.outle:invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 112 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pips(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 pp y 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 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform be 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(Large 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 II 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 information.
revised 9/2/98 Page 4of11
: 1
• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner: * 1-e_m-t�s
Date of Inspection:
Check if the following have been done:You must indicate either"Yes" or"No" as to each of the following:
Yew No
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 normal 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 NA.
_ The facility or dwelling was inspected for signs of sewage back-up.
_ 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,P q p depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_ Existing information. For example,Plan at B.O.H.
_ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
—
11 5.302(3)(b)]
The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: I;k-5 S 0'1 e vn S+. !� . At rl A a J cr, YYi A
Owner: b em-f-r5
Dene of Inspection:
RESIDENTIAL: FLOW CONDITIONS
Design flow: p d./bedro m.
Number of bedro ma(d 'gn): Number of bedrooms(actual):
Total DESIGN flow Al
Number of currentreal ents:�
Garbage grinder(yes or no)• 7�
Laundry(separate system) • or io �; If yes,separate inspection required
Laundry system inspected as or no
Seasonal use lyes or no):�U /
Water meter readings,if available(last years usage(gpd):
Sump Pump(yes or no): LQ
Last dote of occupancy:��
COMMERCIAL/INDUSTR W L•
Type of establishment:���.
Design flow: GO (based on 15.203)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)
'east date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and ource of information:
System pumped as part of in on: ye or no)_
If yes,volume pumped: gal ons
Reas n for pumping:
TYPE o SYSTEM
Septic tank/distribution box/sal 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 PP
of DEP Approval
Other A-10
APPROXIMATE AGE of all components,date installed(if known)and source of information:
Sewage odors detected when arriving at the site:(yes or no) 1/10
revised 9/2/98 Page 6of11'
• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: ►�5 Sa l e rt gfi.� N. {�ncQ o e r, 1'�i
Owner: WcU e r I-e m er s
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
L !�
Depth below grade:
Materiel of construction: cast iron_40 PVC_other(explain)
Distance from gtivote water supply well or suction line VV/44
Diameter •1�/wY
Comments ( ondition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK- 1/ .
(locate on site plan)
Depth below grade:
Material of construe on: concrete—metal._Fibergiass _Polyethylene_other(explain)
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions: ����10
Sludge depth:___!
Distance from top of sludge to bottom of outlet tee or baffle.
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:—
Distance
affle:Distance from bottom of scum to botto of,putlet tee or baffle:
How dimensions were determined: -7,—w0'
Comments:
(recommendation for pumping,con iti n of Inlet and outlet tees or baffles,depth of liquid level in relatio t�outlet invert,structural integrity,
evidence of leakage,etc.) �Pe N l/
u o
GREASE TRAP-
(locate on site plan)
Depth p below grade:
Material of construction:_concrete_metal_Fiberglass ,_Polyethylene _other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tae or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Data of last pumping:
Comments:
(recommendation 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.)
revised 9/2/98
Page 7ot11
• � 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: l Q-5 SGL)exn Si-- N- A �0 J
Owner. WO-►+e.(' 1�-P—Mt'rs
Date of Inspection:
TIGHT OR HOLDING TANK: ,���
_�' ank must be pumped prior to, or at time of. inspection)
(locate on site plan) b
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•_ 3O`,��~ Il ee)
(locate on site plan)
depth of liquid level above outlet invert:_
Comments:
(note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:/✓
(locate on site plan)
Pumps in working order:(Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
revised 9/2/98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: I X5- Sa,I E11 St,1 10, A-ri d o d'e'r, m H
Owner: -UA)+tr temP.r-a
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:_
Alternativa system:
Name of Technology:
Comments: .
(note Gond''on of soil i?n of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.)
CESSPOOLS:
(locate on site pl
Number and configuration:
Depth-top of liquid to inlet invert:
Depthof 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 ie 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 INSPECTION FORM
PART C
SYSTEM IIIIFORMATION(continued)
�
Address: ►a 5 doll errs Zt• W . n�D Jtr n1 R
WA.1�1-er �-em�s
Dote 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- -.�"'�,.'�..�'•."""`wr.r.- •+...�r""'�.wi'wr....w,ti.,... � .......,..,^'.gym. ,,,r✓""""•.��.
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revised 9/2/98
Pale 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION Icondrand)
Property Address: I a5 SA1fm 3+.-, W. 4nctoder, rAf}
Owner-. W m+--r —)-�ex s
Dan of Inspection:
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Dan website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater Feet
Please i cele all the methods used to determine High Groundwater Devotion::
Obtained from Design Plans on record •-- DHez C Ude d D
Observed Site(Abutting property,observation hole,basement sump etc.)
i
Determined from local conditions
Checked 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)
M9
A, S -fes
revised 9/2/98 Page 11 of 11
COMMONWEALTH OF MASSACHUSETTS
TOWN OF N. ANDOVER
SYSTEM PUMPING-REPORT
c C REPORT FOR MONTH OF -1
NAME OF PUMPING COMPANYyplrr.t'S c�'e�.)Fr c�Pr��i!'P� �a„�, N 0���:�,berI�i�i •
{1
CONTENTS CONDITION
OWNERS GALLONS *H G TRANSFERRED OF
DATE ADDRESS NAME PUMPED C D S TO SYSTEM
I.i I0 a- cd f4vL 31-, p i„)ao;►�`1 t o o a S �Cr,La wctnc a 5 .A t TAry li
l t-10- 1-1a X75 ��ymeacCoLjQA, Ver1Gil-or 15o0
.�1.._...t�- aq Ias Sale,n S� �Jeniers tsoc S C �."rtAiceZ&nitcry ::�or
i
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O�pLOftTry q
Zoning Bylaw Review Form
0
Town Of North Andover Building Department
� 27 Charles St. North Andover, MA. 01845
9�SaCHUsk� Phone 978-688-9545 Fax 978-688-9542
Street:
Map/Lot: 9 r7 / 3 Q,,
Applicant: LU a,I e2 \4
Request: �N+ �-
Date: 1 a-�{-ew
Please be advised that after review of your Application and Plans your Application is
APPROVED/DENIED for the following Zoning Bylaw reasons:
Zoning
Item Notes Item
Notes
A Lot Area
F _ Frontage
1 Lot area.Insufficient e S 1 Frontage Insufficient
2 Lot Area Preexisting 2 Frontage Complies
3 1 Lot Area Complies 3 Preexisting frontage es
4 Insufficient Information 4 Insufficient Information
B Use 5 No access over Frontage
1 Allowed e S G Contiguous Building Area
2 Not Allowed 1 Insufficient Area
3 Use Preexisting 2 Complies
4 Special Permit Required 3 Preexisting CBA ,e S
5 Insufficient Information 4 Insufficient Information
C Setback H Building Height
1 All setbacks comply 1 Height Exceeds Maximum
2 Front Insufficient 2 Complies
tv
S
3 Left Side Insufficient `j s 3 Preexisting Height
4 Right Side Insufficient 4 Insufficient Information
5 Rear Insufficient l Building Coverage
—
6 Preexisting setbacks} W S 1 Coverage exceeds maximum
7 Insufficient Information 2 Coverage Complies
D Watershed 3 Coverage Preexisting L1
1 Not in Watershed _ 4 Insufficient Information
2 In Watershed �-(e S Sign
3 Lot prior to 10/24/94 1 Sign not allowed
4 Zone to be Determined 2 Sign Complies
5 Insufficient Information
3 Insufficient Information
E Historic District K Parking
1 In District review required 1 More Parking Required
2 Not in district S 2 1 Parking Complies
3 Insufficient Information
Remedy for the above is checked below.
Item # I Special Permits Planning Board Item # Variance
Site Pian Review Special Permit C-3 Setback Variance
Access other than Frontage Special Permit larking Variance
Frontage Exception-Lot Special Permit Lot Area Variance
Common Driveway Special Permit Height Variance
Congregate HousinS ecial Permit Variance for Sign
Continuing Care Retirement Special Permit Special Permits Zoning Board
Independent Elderly Housing Special Permit Special Permit Non-Conforming Use ZBA
Large Estate Condo S ecial Permit Earth Removal Special Permit ZBA
Planned Develo ment District Special Permit S ecial PertYtif Use not Listed but Similar
Planned Residential Special Permit S ecial Permit for,, n
R-6 Densi S ecial Permit I, I+a Other S 1'eetai
Watershed Special Permit Su 1 Additional Information
The above review and attached explanation of such is based on the plans,request for or information submitted. No definitive
review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant
serve to provide definitive answers to the above reasons for this action. Any inaccuracies,misleading information,or other
subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion
of the Building Department.The attached document titled"Plan Review Narrative"shall be attached hereto and incorporated
herein by refer ce. T building dep ent will retain all plans and documentation for the above file.
r
1` /� .. . /a-y- bo
uilding Department (ficial Signature Application
Received Application Denied
Denial Sent: �
If Faxed Phone Number/Date:
Plan Review Narrative
The following narrative is provided to further explain the reasons for the action on the property
indicated on the reverse side:
DN� Cv r m fib
Referred To:
Fire Health
Police Zoning,Board
K Conservation
Department of Public Works
Othern Historical Commission
Other BUILDING DEPT
ZoningBylawDenia12000
.a
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example: left front of house)
�e-►cwt c��, ,;
a
er•
F,
j DATE OF PUMPING: i 1 Z .o QUANTITY PUMPED GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION / FULL TO COVER
HEAVY GREASE BAFFLES IN PLAOE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY: -,)ice-Evtc,
COMMENTS: 1
f
CONTENTS TRANSFERRED TO: �o r �'�` `13c'�
r .
�-i , LGt��1YPYIC /1n 1-rn� � +�
p r
FM282M1
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JAMES A TRUDEAYJ' r`
AdYusfinentServace.Inc ,
�: {
, { Thomas Murphy;.
James Trudeau
V "47,Gt00i, Uv&`Road'
P.,bBax 208y Gr�enfiefd,LVIA. 01301
Templeton,lV";. 0I 68 ; ' ^'
t1
Phone .978-039-1255 f- ;'Phone~413 774 5124,
Fax;`978-939-4234, ` i' Fax' 978 939 4234
x N1.once of Casualty.I<,oss of Bu►ld�ng
"' F t. j - r ,(
1 ( S:. ( 1 l i
4
Under Mas"sachusetts GeneraI D&S, ".'A ter 139,-S,,, i1.on 3B ,
V
..� '�
1 J _ N r f ..
February 1,1.2005 l! , .
L, /
1
Building Inspector1. I. '
' 400 Qsgood Sheet ,t "
North;Andovlt�er,M1 U184$Y
1. .j y M1 1 h 1 1
oard of,)qi # , ' '�` `.
treet
400 Osgood S_ z
:North Andover,MA 818451. '
<�
J 1 r {A r j S r _ I. l ', ,,f J
Fire•DepartmentP. 1. ,
Dept of Records `+
124'1Vlain Street ' 4. : y
North Andover,M�101'$4S`' 7
.t,c ,', ( 1. , , ..
Insured Matthe ':Fxeedman and Lilian Jovenhno. r;
I" ILoss LOCatIOl { I $ a1eih St North An over IYIA 1
Insurance C,amany , >P�referred,lYtutul Insucancs Co
Pohc Nb f t PHQ 0068754:9 ` `
Date of Lossi January 23,2005 f
File Number.. 05;03493,`
05=001770
Clam Number ,
I. G
Type:of Loss Nater Damage
F .
Claim has been made mt�gling'loss, darnage1 .1,.or dEstruchon,,of the:above captioned property, which may either
exceed $1 0'00 00 or cause "Mass Gen Laws'''Chapter 143 Section 6i' to be applicable If` i" notice under '
``Mass - -`Laws Chakter 139; Secttari 3B°' zs appropnate, please`,;iirect i. to the waster:and`include a',reference
to the captioned msi red ldcation,pohcy'n'prnber, da,(.. loss;and fxle of cJa1.iznrl�m",,, .
On thi1.s d1; Iate;I cause,copies of this notice io be sent to'the persons}named:above at the'address i, .c ed by first
class.mailt. 2
1 / 1. f' l
-Z t' .
1.
S ely
. . � I - .l . "_..,...:_l' .��.:. -:�, 1. .1, ' . . ��_,`_'. — ...� , — . _ -I.
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1. . Ja .V., - �
mes A Trudeau .. . I. .1 _ . q _ _ :,
: � "' ' - . — I;z;��;.,—, _'. � � . ,.,�:��.� ...'.."'.i, "; , ""'' . �� ..,....., 1��. - � . 7
. ,�' .1 , �. sll.l ; ,�..
In. '
Claims AdgusterI. '
b l J r� 1 1 1 t rl.Y \ '
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k ,, P J i S �(
P, , l� f7. :r y
Chp6Ltr(102)
i r t. d -t A k
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l ` . '.�41.1. .. ;,. � ( 1. At.�••. �. . . . , r `.1 ... -
JAMES A. TRUDEAU
Adjustmelit Service..nc
Thomas Murphy'
James Trud6u :
`47 Green River Rpracl
P.0.Box 208 : Greentietd b1A 0130.1
Teriipfetan M?1 0]468 Phone'413-774-51'24
Phone:978-939-2.255'. Fax 978-93-4-4234
Pax;978-939-4234 - — -F
Notice of Casualty-Loss of Building .
Under Massachusetts General-Laws, Chapter 1.39,Section 3B
February 1, 2005
nldiilg lnsector ;
400 Osgood Street
North Andover;MA 0.1845
Board of Health:
400 Osgood*Street
North.Andover, lVlA.01845
F',r<<Depallp-ent
-Dep t,ref Records.
124 MainStreet-'.
N'-or
th Andover, MA 01845
Insured: Matthew Freedman and Lillian Joventino-
Salem St. North-Andover,MA 01845
Loss L,ocatian: 125 _
Insurance Company", Preferred Mutual Insurance Co
Policy Ni).: PH00100687549
Date of Loss',- January. 2.3,2005
File Number: 05-03493,.
Claim Number. 05-061770
— ' r
Type of Loss Water Damage
. ._ .
China has"been made involving loss,,damage,dor destruction of the above captioned property,which may either
exceed.$1:000.00 or cause "Mass Gen.,Laws Chapter 143 Section 6".toreference applicable. If anyrnot�ce Linder,
1Vlass Gen Laws='Chaptei I39 Sectiori 3B''is appropriate; please direct it to the,writer and include a reference
= to the captioned insured,aocation;policy number, date of loss, and-file or claim number:.
On this date,'I cause copies of this notice to be(sent.to-the persons)named above'at the address indicated by first
class mail.
S
W
_,.lames Y1='Trudeau
Clalnis Adjustei
ChptrLtr(102)
Office of the Building Department
RECEI"f _ Development and Servvices Division � ;'w
JOYCE 3R� �
moi
TOWN CLERK William J. Scott, Division Director
NORTH ANDOVER 27 Charles Streetacr+�s��
North Andover,Massachusetts 01845 Telephone(978)688-9545
D. jb JiYi$et
12: 3 b Fax(978)688-9542
Building Commissioner
Notice of Decision
Any appeal shall be filed
within 1201 days after the Year 2001
date of filing of this notice
in the office of the town Clerk. Property at: 125 Salem Street
NAME: Walter Demers DATE: January 10,2001
ADDRESS: 125 Salem Street PETITION: 046-2000
North Andover, MA 01845 HEARING: 1/9/2001
The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, January 9,
2001 at 7:30 PM upon the application of Walter Demers, 125 Salem Street, North Andover, MA for a
Variance from Section 7, Paragraph 7.1&7.2,for relief of lot area, and side setback and for a Special Permit
from Section 9; Paragraph 9.2 to allow for the re-construction of a kitchen, bedroom,conversion of a screen
porch into a home office,for the extension of a non-conforming structure on a non-conforming lot within the
R-4 Zoning District.
The following members were present: Walter F. Soule, Raymond Vivenzio, Robert Ford, John Pallone&
Ellen McIntyre.
Upon a motion made by Wafter F. Soule and 2nd by John Pallone the Board voted to GRANT a dimensional
Variance for relief of an East side setback of 2:6'to allow the re-construction of a kitchen, bedroom,
conversion of a screen porch into a home office, and to GRANT a Special Permit from Section 9,
Paragraph 9.2 in order to allow for the re-construction of a non-conforming structure on a non-conforming
lot. In accordance with the Plan of Land by: John M.Abagis, PLS,#35773, 137 Chandler Road, Andover,
MA., dated: (revision)12/19/2000. Voting in favor. WFS/RV/RF/JP/EM.
The Board finds that the petitioner has satisfied the provisions of Section 10,paragraph 10.4 of the Zoning Bylaw and that
the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the
Zoning Bylaw.
The Board finds that the applicant has satisfied the provision of Section 9,Paragraph 9.2 of the zoning bylaw and that
such change,extension or alteration shall not be substantially more detrimental than the existing non-conforming structure
to the neighborhood.
Furthermore;if the rights authorized by the Variance are not exercised within one(1)year of the date of the grant,they
shall lapse,and may be re-established only after notice,and a new hearing. Furthermore,if a Special Permit granted
under the provisions contained herein shall be deemed to have lapsed after a two(2)year period from the date on which
the Special Permit was granted unless substantial use or construction has commenced,they shall lapse and may be re-
established only after notice,and a new hearing.
Town of North Andove
Board of Appeals,
MI/Decisions 2001/6 Raymond Vivenzio,acting Chairman
BOARD OF APPEALS 683-964.1 BUILDING 688 9545 CONSERVATTON, 638 9530 HEALTI-i 598-9-540 PL:L1q11NCi 688-8535
I
BOARD OF HEALTH
27 CHARLES STREET
NORTH ANDOVER, MA 01845
TELEPHONE# (978) 688-9540
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
Pursuant to Section 310 CMR 15.354
of the State Environmental Code, Title/V
Name "le,,- JPhone �7�
Address I2S— S�le.,.,q S Z-
Contractor hired for work:
Name / iCy �Xe2 61aarJ Phone � S=S // 3
Address r:X0- R&I 90 ✓ i..cYs�-� ./ fid
Date for scheduled abandonment 1-7 ,0 /
The septic system at the above address has bpen allandoned according to
Title V specifications.
IVY/
Signature of Contractor
Method of septic tank abandonment (check one). O removal O sandfill .
(,4 crush O other
Name of Offal Hauler
---,Sl
This form must be returned to the North Andover Board of Health.
PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH
REPRESENTATIVE'S USE ONLY.
low 7- 3
Inspecting Agent Date
BOAM)OF HE L 4
JUL 6 2w?
1688
APPLICATION FOR SEWER SERVICE CONNECTION
20%
North Andover, Mass. u iQ
Application by the undersigned is hereby made to connect with the town sewer main in ��"az�� Street,
subject to the rules and regulations of the Division of Public Works.
i
The premises are known as No. 7f2 L Street
or subdivision lot no.
i.
I
Owner Address
Contractor Address
;i
f
pplicant's S'gnatur �'
e��u��Lv�-T o.✓
r 71,
t.
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at Street
subject to the rules and regulations of the Division of Public Works..
Division of Public Works
By
Inspected by
I
Date yf
See back for rules and regulations r
�I