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Miscellaneous - 183 FOREST STREET 4/30/2018
E �_L\ Commonwealth of Massachusetts . City/Town of AUG - 5 X010 System Pumping Record NORTH ANDOVER TOWN OFNORTH ANDOVER Form 4 1 HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the -local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms on the Q,CeS �rj� computer. use —. w - i --- -- ----- -- — -- - --— — -- ---- -- - -- - only the tab key Address n 1 $ L C to move your f h Ovti� cursor - do not Stat — -- - - Zip Code use the return City/Town key. 2. System Owner: 1 1 \ � ISI -- ---- --- -- - Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) L14 Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes U/ No If yes, was it cleaned? ❑ Yes /No 5. ConditionofSystem: 6. System Pumped By: �_Im Got 11CAYI Name Vehicle License Number Company 7. Location where contents were disposed: Ipswich Water - ------------------ Treatment Plant Signature of Hauler-p—WicIlpa M � Signature of Receiving Facility Date t5form4.doc• 03106 System Pumping Record • Page 1 of 1 North Andover Board of Assn cors Public Access Page 1 of 1 0 poRTy 20�,ra•e . ih8 k x GHt1 Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales Tovm Of Xc>rtih Andover Rowd of Asses+scws MMI Property __ Record Card Parcel ID: 210/106.A-0040-0000.0 Community: North Andover Location: 183 FOREST STREET Owner Name: HOLLAND, DENNIS E SUSAN T HOLLAND Owner Address: 183 FOREST STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6 - 6 Land Area: 2.8 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2330 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 550,500 445,400 Building Value: 305,200 227,000 Land Value: 245,300 218,400 Market Land Value: 245,300 Chapter Land Value: LATEST SALE Sale Price: 209,000 Sale Date: 04/17/1997 Arms Length Sale Code: Y -YES -VALID Grantor: MCEVOY REALTY TRUST Cert Doc: Book: 04732 Page: 0282 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3 &Linkld=990801 7/18/2007 H I o N ¢ ox eo �, 00 O ; vj ¢ o rl Y .. z CIO 14 14 W W ¢ W d Cao p Q z O O ¢ d en pMp 0 N O •""' O NC B d b ° v O � C N � I O a •� I 3 I I C s. I � o O ° I V v N I Ia 0 0 o � N •tel O�0y� 0 V�1 0 O� cv a O x d A a� in. F E O I � E o v, O n C,CD 3 u v� ofo cc •� a� � i c.�aw z �� y°•, CC ' y ° L. L Vii W m m aA'v�3aa¢ z C w w 0 o Z z z p 00 v1 'C 0. 0 0 a z o Wo�ta ,.,. •� d G. 0 to •t U � Moa M•• Cy � x w '� [� 4 � E". •d 'C � ei •D 0 a 183 Forest Street - Hollander O DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, May 16, 2008 10:17 AM To: 'bosgood@neengineeringinc.com' Subject: RE: 183 Forest Street - Holland Importance: High Page 1 of 2 Hi Ben, I sent Sue Holland a sample of a deed restriction that I had. I will contact Jim. Thanks. Pam -----Original Message ----- From: Ben Osgood Jr. [mai Ito: bosgood@neengineeringinc.com] Sent: Friday, May 16, 2008 10:12 AM To: DelleChiaie, Pamela Cc: 'Kimberly Brown' Subject: RE: 183 Forest Street - Holland Pam, You will have to contact Jim K regarding the cutting of the well line and the sign off. As far as the deed restriction is concerned I will type one up and get it to you on Monday. Ben From: DelleChiaie, Pamela [mai Ito: pdellech@townofnorthandover.com] Sent: Friday, May 16, 2008 10:07 AM To: Osgood Ben (E-mail); Kimberly J. Brown (E-mail) Subject: 183 Forest Street - Holland Importance: High Hello, Following up on this file. Several things are missing, and a COC has not yet been issued. The system was installed in 2006 by Jim Kellett. We received the As Built and Certification forms in July 2007, but Jim never signed off. We have also not received a copy of the deed restriction for the three bedrooms. In addition, we need the assurity that the well line has been cut, and it needs to be witnessed by a BOH agent based on the motion from a BOH meeting in Feb. 2006. I spoke with the h/o about the issues as well. She had called looking for a copy of the As Built, as she needs the system pumped next week. I do have that, and will send it to her. Can you get back to me on these items? Thanks. 5/16/2008 t. JUL 2 4 2007 TO,,, -^ -TH ANDOVER HEAL— _ _ iMENT 0 TOWN OF NORTH ANDOVER `-- t N°RTM ffice of COMMUNITY DEVELOPMENT AND SERVICES o= HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 'sSACHWU ` 978.688.9540 — Phone Susan Y. Sawyer, REHSIRS 978.688.8476 — FAX Public Health Director E-MAIL: healthdeptAtownofnorthandover.com WEBSITE: http://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; ( repaired; by (Print Name) located at 183 Forest %&Lo. j AVrJ1.. (Installation Address) was installed in conformance with the North Andover Board of Health approved plan, originally dated and last Revised on , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: 2 Final inspection date:2 Installer: And - Print Name Go E weer epresentati (Signature) C. oxl Jr. pf- And - Mnt Name LlngineefRepresentative ignature) ©35 e..� And -Print Name (Signature) Date: Engineer: Je� C U (Signature) And - Prfnt Name / I Date: o � .. � t� ,tf'. �. �. �, +� . .•t i . k � 1 ^� ,. 1�f tom) S �, ,, T. "��} r, „„ .. - •• �� t � N Igj"�'. Y f r y r �,. �. .. �n, � r • .�a'a' . • �I `f . i• 1. � • ! t f �J J„ (� t (', 1 � �� � `_ ,. r t , 0 It is the responsibility of the applicant to recordthe requireddeedrestriction per 310 CWR1S.0007itfe S. The following is a su estedormat, but the finaldocument should 6e approved 6Y your atto2my prior to recording. NOTICE OT v.,4 RIANCE / DEED RE STRICVON Pursuant to 310 0112,15. 000 Title 5, and as a condition of septic plan approval6y the North Andover (Board of 9fealth, notice is hereby given that real estate located at: , North Andover, Wassachusetts, (aka Assessor's Wap /Lot ), as descri6edin a deedfrom to dated , 20 and recorded in the Esse. County Registry of Deeds in 000k and(Page , andas Document # , is the subject of a variance from the Town of North Andover 9Kinimum 12fquirements for the Subsurface Disposal of Sanitary Sewage ,41.05 and 09.01(4) Said variance limits the ma.-,Cimum number of bedrooms at this dwelling to bedrooms. This variance is within the jurisdiction of the North Andover Ooard of Yfeafth. Signed andsealed this day of . 20 Property Owners) Signatures COWWONTM,ALT f OT WASSACxvSEITTS Esse-,G s.s. Date: , 20 Then personally appeared the above-named and acknowledged the foregoing instrument to be his/her/their free act and deed, before me. Name Notary Tubfic C DATE: BOARD OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS MAP & PARCEL: 1060d W LOCATION OF SOIL TESTS:dkfi OWNER 'I;C�IN� s A Susi vCpL�r4N TEL. NO.- OD ADDRESS: 116 3 t= oRF.s i ENGINEER: Krcut RACT ,AND TEL. NO.: "i la - (o6G — 17(0$ CERTIFIED SOIL EVALUATOR: �J-(TkM%K C. Intended use of land: Is This: Repair testing X Residential Subdivision Undeveloped lot testing In the Lake Cochichewick Watershed? Yes Single Family Home Commerciale THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: Upgrade for addition T No 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep holes .and two percolation tests required for each disposal area, Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections - 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Pull payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than lr-100') shall be submitted to the Board of Health showing the •location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Wri is e N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: No ead> Nla� ��t, 1�,� TAvirL-�i((A�a Ul N�r�i 0 f x' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address /F? 3 . —s'1`� N -CA � c. Owner. �/^a 1, � 'T. %,4 c F✓ �/ Date of Inspection: q 1 Z7(R6 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' g6 -I DEPTH TO GROUNDWATER Depth to groundwater._feet N -V (b -5. c) i 9 O Page 1 of 1 DelleChiaie, Pamela From: Lisa LeVasseur [lisal@millriverconsulting.com] Sent: Thursday, August 04, 2005 1:41 PM To: Sawyer; Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela; dano@millriverconsulting.com Subject: Soils for 183 Forest Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com 8/4/2005 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ILS Commonwealth of Massachusetts City/Town of /(%r+A Avtdaver Percolation Test Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. A. Site Information Dennis & Susan Holland Owner Name 183 Forest Street Street Address or Lot # North Andover City/Town Contact Person (if different from Owner) B. Test Results Observation Hole # Depth of Perc Start Pre -Soak End Pre -Soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate (Min./Inch) Benjamin C. Osgood Jr., P.E MA 01845 State Zip Code (978) 686-1681 Telephone Number 8/2/05 9:35 Date Time PT1 96'717" 9:35 9:51 9:51 10:20 11:02 42 min 15 min per inch Test Passed: Test Failed: ❑ Test Performed By: Andrew McBrearty, Mill River Consultinq Witnessed By Comments Date - Time Test Passed: ❑ Test Failed: ❑ t5form12.doc• 06/03 Perc Test • Page 1 of 1 Commonwealth of Massac usetts City/Town of lVot+A AA over w Percolation Test o Form 12 M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. A. Site Information Dennis & Susan Holland Owner Name 183 Forest Street Street Address or Lot # North Andover City/Town Contact Person (if different from Owner) B. Test Results Observation Hole # Depth of Perc Start Pre -Soak End Pre -Soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate (Min./Inch) MA State (978) 686-1681 Telephone Number 0/7 Inrz r%.7C PT1 96717" 9:35 9:51 9:51 10:20 11:02 42 min 15 min per inch 01845 Zip Code Date Time Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Benjamin C. Osgood Jr., P.E. Test Performed By: Andrew McBrearty, Mill River Consulting Witnessed By Comments t5form12.doc• 06/03 Perc Test • Page 1 of 1 FORM .11.- SOIL EVALUATOR FORM Page 1 of 3 — .. :... .. Date: 8 /4PS Commonwealth of Massachusetts S AJ0r+� .4A-Jovei^ , Massachusetts Performed B . Date: /O /1 spa._ Witnessed By:...�:n..���,,.�....�'��.�.f��t'�...../��....... > •-----... �� ft 1163 Fores+ 15tr49t rAo - ow�•s w�• Iw?e+►+nis �' SvgA;,� i� 0114 /Vof-4 A✓\Jover ..� Td . $ 3creSE .�tre�t ction ❑Repair A )e.>rAh �1cver-, At A o f Bis Office Review Published Soil Survey Available: No ❑ Yes Year Published �. $.J.... Publication Scale 11 ..tJ� 4o a•$ - Soil Map Unit Drainage Class •leo �........ .-.._.. Soil Limitations ,p�..�_....err 1..... .......................... Surficial Geologic Report Available: No % Yes ❑ Year Published M ., . Publication Scale Geologic Material (Map Unit) ...................... . _. dfocm_._....... ........_ ........._�__..___. ................. foodIns _.._ — ._....._. ......._. Insurance Rate Map: --•- - ._.......... Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands ConservancyP:............................_...........-..... __ - - ._..:....____ .. rogram Map (map unit) 'Current Water Resource Conditions SGS : Month Range :Above Normal WNormal ❑ Belcw Normal ❑ Other References Reviewed: E�; DEP APPROVED FORh1 - 12/07/95 ;FORM 11 =SOIL FVALUAT012 I�ORhs Page 2 of 3 Location Address or Lot No. i 83 �o f esf On-site Review Deep Hole Number Date:.._t� Time::1190 Weather qIf Location (identify qn site plan) Sicl�„r6Kf „ Land Use „„?1.d.:��:._...... ..._:Slope (%) Q. Surface Stones. . Vegetation �f..:s�.S�.::_:.:._..:.:........ w::...�...�.„...._„...�,:...A.:: „ ......:_ .:.......... ., ............ .: Landform A!'&r►.,.:.:..x::::.:.:::..,..::.:. . ......:...... Position on landscape (sketch on the back) Zlvi Distances from: e Open Water Body ,�!v�.., feet Drainage way.aa?,, feet PossibleMet Area ed....., feet Property Line . [ -. ..w feet -Drinking Water Well ..,.0„....., feet Other DEEP OBSERVATION HOLE LOG* Depth from I Sou Horizon Sail Texture Soil Color! p•N,er Surface.(Idches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, 96 t IbyR Z iayR ��. 15y SN ,l SY*5 j D% otos MINIMUM OF 2 HOLES REQUIR AT EV rvz�tu DISMSAT AREA Parent Material (geologic) _ AI4_ m _[ s(t . , Depthtol3edrock- -- . Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: ^ li Estimated Seasonal High Giound Water: DEP APPROVED FORM - 12/07/95 �= o : TOmm 11 : SOIL EVALUATOR FORM " ` Page 2 of 3 Location Address or Lot No. reSt f 4 o/ hdwer On-site Review S Deep Hole Number Date-.Ala? Time:.: R' D-� _,Fair. Weather ...? '� Location (identify n sitefplan) Land Use�Slew'�!..t:k:............ Slope Surface: - - - - �- Stones Vegetation_T.'C.'Q�SS..,..:...:.:..;.:N.....,._:. .. �....,....v..:...-... ..:.. Landform' —OA-_n,.:.:::...:_.:.,.,::...:.::.:. _.:...:...::.�M,.:.....:.:..... .�:.:::� Position on landscape (sketch on the back) Distancesfrom: ...�.�.v....::.........,,..�..:.r:....-k...�,.._:,.,-.w:-,N.. ........,...:..w.. .,'..., :;.:. ...� , 1 ; Open Water Body x.1,5 % feet Drainage way.4�H- feet Possible:We Area.?...,, feet Property Line .: a feet -drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* Depth from Sod Horizon Sail Texture Soi! Co! SM! p-., Surfaee.Unches) (USDA) (MunseW Mottling (Structure, Stones. Boulders, Consistency, Gravep O -?(6 F11-1 1-( Vp&%2,S - 7 _ 96 6w :.: . tdy(ia Parent Material (geologic)��i-iC OeptMoBedrock: Depth to Groundwater: 'Standing Water in the Hole: Weeping from Pit Face: '— Estimated Seasonal High Gi nd Water: _ Q01 DEP APPROVED FORM - 11107195 '. FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. ! $3 Eo/'es'f .5 ieefA Ant Determination ,for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ..............:.... inches ❑ Depth weeping from side of observation hole ................... inches Depjh to soil mottles .......... _.: inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date ................... Index well level ................... .Adjustment factor Adjusted ground water level ........................................................ Depth of Naturally Occurring Pervious Material. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system?_ If not, what is the depth of naturally occurring pervious material? Certification certify that on ay. 1 RS' (date) I have. passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date 19! 0-5- DEP APPROVED FORM - 12/07195 Commonwealth of Massachusetts RECEIVED® � City/Town of System Pumping Record NORTH AN DOVE I Z AUL Q 3 2014 -_ Form 4 TOWN OF NORTH ANDOVER HFQI Fra RTMENT ta DEP has provided this form for use by local Boards of Health. Other forms mayae=tical=tt information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When lilting out 1. System Location: forms on the computer, use only the tab key Address p �— to move your cursor - do not ate - . - Zip Code use the return CityrTown key. 2. System Owner: Name Address {if different from location} City(rown State Zip Code Telephone Number - - B. Pumping Record 1. Date of Pumping — _ _._. 2. Quantity Pumped: Gair—� -- - Date 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes [j-kafi If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of S7ys 6. System Pumped By: z Name Company Vehicle License Number 7. Location where contents were disposed: G.L.S.D. Signature of Hauler Date --- ---- --- Signature of Receiving Facility Date 15form4.doc• 03/06 System Pumping Record • Page 1 of 1 I=f_ - Commonwealth of assac usetts City/Town of System Pumping Recor Form 4 BIVLED JUL 3 1 2008 TOWN OF NORTH AN ✓ R DEP has provided this form for use by local Boards of Health. Other fo ms—Fw the used;1bu°# information must be substantially the same as that provided here. Before using this form, the h your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms the computer, use J only the tab key Address \ 1 `A to movA your )qp, "Ch ASL I � ��,� 1v 601 © I t.l cursor - do not use the return City/Town State Zip Code key. 2. System Owner: ��nn�s No11c:�nc� Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping a _0S 2. Quantity Pumped: i add Date Gallons 3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes [2"No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: Goo 6. System Pumped By: Pon 'Ross Name Vehicle License Number Wino ►��vt ��yironTN) enaal Company 7. Location where contents were disposed. Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 S a Form 4 -- System Pumping Record Commonwealth of Mossachusetss : Massachusetts System Pumping Record Location Type: Emergency 'ne ✓ Cesspool: No Yes Septic tank: No =Yes ©� Date of Pumping: b � Quantity Pumped: o L-,-) Gallons System Pumped By: Wind River Environmental, LLC Permit #: Contents transferred to: Contents Disposed at: Date: 9 /l W/O ) Pumper Signature: Dep Approved From - 12/07/95 �L, Commonwealth of Massachusetts lipC1tyffown of System Pumping Record .NORTH ANDOVER Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Purnpitig Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351, A. Facility information Important Men filling out $ towns on the Town" computer, use -- • , ...5 .. �....._ _...— -- - ornly Lhe tab key / to move your —......... ....••,. -_. - Zip Code cursor -do not �i -� State use the return key' 2. System owner: VQ —j o ...... Name �^ Address (it different tram location) ... ..__ $ ..._•--- • • •—• tate xlp Code Gi�1ylTcwn Telephone Number — B. Pumping Record 2. Quantity Pumped: — — -- 1. Date of Pumping Date Galton 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No if yes, was it cleaned? ❑ Yes ❑ No 5. C4r►dition of System: 6. System Pumped By: Company 7. Location where contents were disposed: Vehicle License Number sigrtalwe or iiauLer _ — _ pate Signdlure of Receiving Facility Date Motth AndO� i torma.doc• 03106 System Pumping Record • Page f of 1 Q r FORM 4 - SYSTEM PUMPING RECORD CURRIER SEPTIC & DRAIN SERVICE 107 FOREST.STREET; MIDDLETON, MA 01949 (978) 774-2772 COMMONWEALTH OF MASSACHUSETTS Nl o r ky e- r , MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: N. A o ku-es SYSTEM LOCATION: }�ePl�eern�/l�- s �- DATE OF PUMPING: �:' % ? - 9y M: CESSPOOL: NO YES SYSTEM PUMPED BY CONTENTS TRANSFE QUANTITY PUMPED: A)oo GALLONS SEPTIC TANK: NO 0 YES DATE: 9— / 7' 9eFINSPECTOR: t0Y S �` `-� r1ORTFf 0 -Jt-F° 116�ti O OL O to 09 [OCNKMlwKw _ 1' PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 183 Forest Street MAP: LOT: INSTALLER: Jim Kellett DESIGNER: PLAN DATE: 8/12/05 Rv 9/8/05 BOH APPROVAL DATE ON PLAN: 6/9/06 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: 51) q 10� DATE OF FINAL CONSTRUCTION INSPECTION: 6/9/06 DATE OF FINAL GRADE INSPECTION: bj' .3I6� SITE CONDITIONS Comments: SEPTIC TANK ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading 2 -PC construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com If r1ORT11 q O ra. N 02 'p_ COCMK ■wKll PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® 3 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: DISTRIBUTION -BOX ® Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to 6 in into C soil "LD layer, as provided on plan U(� Y(`�� I CO Size of SAS excavated as per plan 5W d0d 6y` t1AeAIL ® Title 5 sand installed, if specified on plan 40 Mil HDPE barrier installed �Y ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Infiltrator Quick 4 ® Number of chambers per row 8 ® Number of rows (trenches) 4 ❑ Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORTH O .'6q�0 o n PUBLIC HEALTH DEPARTMENT Community Development Division SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN 100.17 100.24 Septic Tank OUT 9990 99.96 Pump Chamber IN 99.68 Pump Chamber OUT 99.67 Distribution Box IN 9981 99.88 Distribution Box OUT 9964 99.70 Lateral 1 HIGH 9954 99.68 Lateral 1 LOW 9954 99.68 Lateral 2 HIGH 9954 99.68 Lateral 2 LOW 9954 99.67 Lateral 3 HIGH 99.54 99.68 Lateral 3 LOW 9954 99.68 Lateral 4 HIGH 9954 99.65 Lateral 4 LOW 9954 99.69 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, June 07, 2006 11:49 AM To: 'Daniel Ottenheimer (E-mail)'; 'Lisa LeVasseur (E-mail)'; Marianne Peters (E-mail); 'McBrearty Andrew (E-mail)' Subject: 183 Forest Street - ASAP Request Please schedule a Final Construction Inspection ASAP with Jim Kellett for this site. 781.953.7146. Thank you. Note: Homeowner, Dennis Holland sent a fax stating that he spoke to Kellett Excavating and has an agreement with him to also hook him up to town water. Therefore, he would like to have the Final Inspection on the septic asap. This would be helpful so they can run the pipeline for town water while his machines are still on their property. Bag! Raguadg, P�tiwa�w DaB�aG�lli�ria Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 978.688.9540 - Phone 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com 0 JUN -07-2006 10:12 ��G EDWARDS 978 250 0892 P.02 0 h ke i 1.e C44 cue. `ID !20 0k ccs cef -r- cts� ! IlcP-. 4 �i,�-c.. �!-t..� �. v� ccL5Ye� e -k mv.J Sef 4 c, IQs w �u,Le. 1,u: ✓u,�,t � tee. s�,,�Q � �.,. P• 8uw Izaw° L6" - � , .9 --? / TOTAL P.02 r 0 Page 1 of 1 DelleChiaie, Pamela From: Lisa LeVasseur [lisal@millriverconsulting.com] Sent: Wednesday, July 19, 2006 1:20 PM To: Sawyer, Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela; dano@millriverconsulting.com Subject: Construction report 183 Forest Street Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting. corn 7/19/2006 183 Forest Street - ASAP Rimiest O Page 1 of 1 DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Wednesday, June 07, 2006 3:21 PM To: DelleChiaie, Pamela; 'Daniel Ottenheimer (E-mail)'; 'Lisa LeVasseur (E-mail)'; 'McBrearty Andrew (E-mail)' Subject: RE: 183 Forest Street - ASAP Request I'VE LEFT A VOICEMAIL MESSAGE ON JIM KELLETT'S CELLPHONE TELLING HIM WE COULD DO THIS ON FRIDAY @ 9:00, BUT THAT HE NEEDS TO CALL BACK TO CONFIRM.... I'VE GOT IN ON THE CALENDAR, BUT WILL AWAIT HIS CALL. THANKS, MARIANNE From: DelleChiaie, Pamela [mai Ito: pdel lech ia ie@townofnorthandover.com] Sent: Wednesday, June 07, 2006 11:49 AM To: Daniel Ottenheimer (E-mail); Lisa LeVasseur (E-mail); Marianne Peters (E-mail); McBrearty Andrew (E-mail) Subject: 183 Forest Street - ASAP Request Please schedule a Final Construction Inspection ASAP with Jim Kellett for this site. 781.953.7146. Thank you. Note: Homeowner, Dennis Holland sent a fax stating that he spoke to Kellett Excavating and has an agreement with him to also hook him up to town water. Therefore, he would like to have the Final Inspection on the septic asap. This would be helpful so they can run the pipeline for town water while his machines are still on their property. Bag! Regwzds, Pwft.004 DaBB100019 aio Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 978.688.9540 - Phone 978.688.8476 - Fax http://www.townofnorthandover.com /www.townofnorthandover.com healthdept@townofnorthandover.com 6/7/2006 -IL William F. Weld Govwnor Argo Paul Celluccl LL Gowmor o I&-38 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Trudy Coxe S--" David S. Struhs Commfabner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: /83 / `�P�-s 5*"71 PO - /71f1(1i'a.0 Date of Inspection: Sbl� & Address of Owner. (If different) Name of Inspector- Benjamin C. Osgood Jr. Company Name, Address and Telephone Number. New England Engineering Services, Inc. 33 Walker Road, North Andover, Ma 01845 CERTIFICATION STATEMENT Tel. 508-686-1768 Fax. 508-685-1099 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: !/ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails I—pector'a Signature Date: �l_;; �j V & The System Inspector shall submit a y of this inspection report to the Approving Authority 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 oi original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria 10 CMR 15.303. as defined in 3 Any failure criteria not evaluated are indicated below. ((Sizer G- ULei,(, f vc.A{�vwJ BI SYSTEM CONDITIONALLY PASSES: 6L- 41 Ar., rVis One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yea, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why sot) The septic tank is metal, 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 Conforming septic tank as approved by the Board of Health. (revised 11/03/95) One Winter Street • Boston, Massachusetts 02108 • FAX (617) 556-1049 • Telephone (617) 292-5500 A ii Printed on Recycled Paper 0 96-s8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A p CERTIFICATION�CA�ION (continued) Property Address: /9--? Toeas SIV,,.7I Owner. -C-4-0h& T IAA C 17!/49 t/ Date of Inspection: g/" i /y e, B] SYSTEM CONDITIONALLY PASSES (continued) 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 pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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. I) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. 71r ✓ The system has a septic tank and soil absorption system and 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. 3) OTHER Tho Ow yae— //#6 sv,40ziVO "o e i/1.5 lin S/�rc./..� u�rLC �I� K �i/IALV3,,5 �e OoGair/ ij,9e Aee`A god i,t l 4/14 yd.'s Fu ie �/'OGs . 30�y Rio Pa �S waQ.t '�o�ef"o,r..►ra 13 -f YoL�c / LA-eLii +100s...0 e" —/4 ,-s A)o jee,,0AVs9,1 rgrio,S w, :hnTh,-3e ,car Po 0/3 45 %hei !s re1Z if 1-0 %3 T4"s ZAS��'c 17i�r.� Mijo u l3/fid %hry Dvn/i vitpl?e %h�J z�SP<t �sd5 Of�3i1�I��a`� (revised 11/03/95) j/ 2 -rO7 e S,/S 1 5 SS" T2am Thr w iZC L . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address 183 To ems S7`teC'7- , Owner. eq -0k ti Date of Inspection:` l z V y D] SYSTEM FAILS: 560 s8 I have determined that the system violates one or more of the following failure criteria as defined 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. — 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 outlet invert due to an overloaded or clogged SAS or cesspool. — Liquid depth in cesspool is less than 6" below invert or available volume is less than L2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(.). 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 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 bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: 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: — 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 Il of a public water supply well) The owner or operator of any such system shall bring the system and facility intofull compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16:,, -Fu eiz S`f Ve e f` � (Vv � .1 dv ✓v.Q � vrt✓,� Owner- =to h e. I-, mc- IT V 0,4 Date of Inspection: 8 /17 9 (.- Check if the following have been done: 56 -38 Pumping information was requested of the owner, occupant, and 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. A!�As built plans have been obtained and examined. Note if they are not available with N/A. fj 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. r _ 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 existing information or approximated by non -intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub - Surface Disposal System. (revised 11/03/95) 4 Property Address: /93 Owner. ,jo hn Date of Inspection: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION noersf SAewl,, Nw 1.4,deQe, h!s T. we /z v,, y .5/;t7 /r4- 96 -S8 - RESIDENTIAL; FLOW CONDITIONS Design flow pUona Number of bedrooms:— Number of current residents: 2^ Garbage grinder (yes or no): h/ Laundry connected to system (yes or no): /7/ - Seasonal use (yes or no) h,— Water meter readings, if available: 0 /U ll. e L— Last date of occupancy: Cy e e,,K T COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non -sanitary waste discharged to the Title 5 system: (yea or no)_ Water meter readings, if available: Last date of occupancy: OTHER (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of System pumped as part of inspection: (yes or no) -V If yea, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: d7 �Veep Sewage odors detected when arriving at the site: (yes or no) & (revised 11/03/95) 96 -S8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /p,3 ibeest- Sfe,3fl% A ,, • Owner- Date wner Date of Inspection: 81x719e SEPTIC TANK:_ (locate on site plan) Depth below grade: / C Material of construction: loncrete _metal _FRP —other(explain) Dimensions: Co u v► n T" k Y'bi1441, Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: S L V D C - 40—A— 0 SC u wN 13 e tir lq L 4 - Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Sp Leo•+. Tu p iv v 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.) 7 -k -L k & -- w d s iP, `a ?.`N G- • Ter s 1-o o k Tu *iii Z-1 O K _C?., . p•` k 0w r GREASE TRAP: (locate on site place) Depth below grade: Material of construction: _concrete _metal _FRP _other(ezp)ain) Dimensions: Seam 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or banes, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMAT/ION (continued) Property Address: X83 To e(ZS f S f -Pi,jr! 7 - Owner. Owner. .4"v1 -n T. In c (�✓v ./ Date of Inspection: TIGHT OR HOLDING TANK._ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Q Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) 'D - Ile X T ©L b 4-10 L- i L (. Pe49 9 6 LC j 1V 4 r o r,4 T h iz- fy t* tuyE . X z s;pe or aox To bereeiveoAe d, /i11.00'Wc1z c n L ;b S 044 rV ove*f . PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address 1,R3 TO s f0/4 57rgg-, Owner. -To " 77- /V, Date of Inspection: i SOIL ABSORPTION SYSTEM (SAS): (locate on site Plan, if Possible; excavation not required, but may approximated PProximated by son -intrusive methods) If not determined to be present, explain: 6-M leeching pits, number:_ leaching chambers, number._ leaching galleries, number. leaching trenches, number,length:t %QzyG ked leaching fields, number, dimensions:pie�n overflow cesspool, number: 59i' -S'F (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetationetc.) 192 �1 .r�.n Tti�ov dS fL Qyi NL/1 O1= i�Cvy �, M 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: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address /8 3 �" S h Nq,�Cv __,4 ._ c, Owner. .961 -i T. iyt r �✓ Date of Inspection: / SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' e S s DEPTH TO GROUNDWATER Depth to groundwater:_feet method of determination or approximation: (revised 11/03/95) 9 1 �� Q John T. McEvoy 183 Forest St. No. Andover, MA 01845 Route 28 PO Box 900 Windham, NH 03087-0900 (603)898-4232 • Fax(603)898-9581 (800) 992 -PUMP Number 7025 508-682-0001 Date 09/25/96 Water Analysis Results ------------ Maximum Contaminant Level ------------------------------------------------------------- Nitrates------------ 0.93 ( 10 PPM EPA Pri Std) Coliform Bacteria --- Absent ( 0 EPA Pri Std) E Coli Bacteria ----- Absent ( 0 EPA Pri Std) Ammonia -------- <0.50 ( mg/1 EPA Sec Std) ----------------------------- —------------------__ Tested by Certified Laboratory Number 1015 Test Results Entered By zz�o *** Denotes over limit of Standards (either Secondary or Pr' ry). -------------------------------------------------------------------------- This sample meets EPA primary standards for safe drinking water based upon the sample we received and the items which were tested. Other standards (Ex: FHA, VA, State & Localities) may differ from EPA standards and these may need to be considered. Bacteria was tested using the EPA approved Presence/Absence method. Providing Professional Water Service .Since 1966 WATER SYSTEMS Artesian Wells Pumps Booster Jet Submersible Sump Motor Controls Parts & Accessories Pipe & Fittings Water Tanks SEWAGE SYSTEMS Alarm Systems Alternating Panels Pumps Effluent Sewage Parts & Accessories Pipe & Fittings WATER TREATMENT Aeration Filters Cartridge Filters Chemicals Softener Salt Well Sanitizer Neutralizers Reverse Osmosis Sand Separators Water Conditioners SERVICES 24 Hr. Emer. Serv. Portable Puller Hoist Truck Water Testing P Route 28 PO Box 900 Windham, NH 03087-0900 (603) 898-4232 - Fax (603) 898-9581 (800) 992 -PUMP WATER SYSTEMS Artesian Wells Pumps ANALYST BP Booster SAMPLE SOURCE 117026 °o SURROGATES RECOVERY Jet 104% 4-BROMOFLUOROBENZENE Submersible 96% 1,2 -DICHLOROBENZENE -D4 Sump DATE RECEIVED SEPT 26 96 Motor Controls DATE TESTED OCT 02 96 € Parts & Accessories Pipe & Fittings VOLATILE ORGANICS METHOD 524,2 :water Tanks (nd-None Detected Lketection Limit a0.6uq/l) RESULTS RESULTS COMPOUND UGlL COMPOUND uoti DICHLORODIFLUOROMETHANE nd DIBROMOCHLOROMETHANE nd SEWAGE CHLOROMETHANE nd 1,2-DIBROMOETHANE nd SYSTEMS VINYL CHLORIDE nd CHLOROBENZENE nd BROMOMETHANE nd 1,1,1,2 -TETRACHLOROETHANE nd Alarm Systems CHLOROETHANE rid ETHYLBENZENE nd Alternating Panels TRICHLOROFLUR OM ETHANE nd TOTAL XYLENES nd Pumps 1,1-DICHLOROETHENE nd STYRENE nd Effluent METHYLENE CHLORIDE nd SROMOFORM nd Sewage TRANS-I,2-DICHLOROETHENE nd ISOPROPYLBENZENE nd Parts &Accessories 1,i-DICHLOROETHANE nd 13ROMOSENZENE nd pipe &Fittings 2,2-DICHLOROPROPANE nd 1,1,2,2 TETRACHLOROETHANE nd CIS -1,2-DICHLOROETHENE nd 1,2,3-TRICHLOROPROPANE nd BROMOCHLOROMETHANE nd N-PROPYLBENZENE nd CHLOROFORM nd 2-CHLOROTOLUENE nd 1,1,1 -TRICHLOROETHANE nd 4-CHLOROTOLUENE nd WATER CARBON TETRACHLORIDE nd 1,3,6-TRIMETYLBENZENE nd TREATMENT 1,1-DICHLOROPROPENE nd TERT-RUTYLBENZENE nd Aeration Filters BENZENE nd 1,2,4-TRIMETHYLBENZENE nd Cartridge Filters 1,2-DICHLOROETHANE nd SEC-BUTYLSENZENE nd TRICHLOROETHENE nd 1,343ICHLOROBENZENE nd Chemicals 1,2-DICHLOROPROPANE nd 44SOPROPYLTOLUENE nd Softener Salt DIBROMOMETHANE nd 1,4 -DICHLOROBENZENE nd Well Sanitizer BROMODICHLOROMETHANE nd 1,2 -DICHLOROBENZENE nd Neutralizers CIS-1,3-DICHLOROPROPENE nd N-BUTYLBENT,.ENE nd Reverse Osmosis TOLUENE nd 1,2-DIBROMO-3CHLOROPROPANE nd Sand Separators TRANS -1,]-DICHLOROPROPENE nd 1,2,4 TRICHLOROBENZENE nd Water Conditioners 1,1,2 -TRICHLOROETHANE nd HEXACHLOROBUTADIENE nd TETRACHLOROETHENE nd NAPHTHALENE nd 1,3-DICHLOROPROPANE nd 1,2,3 TRICHLOROBENZENE nd SERVICES 24 Hr. Emer. Serv. Portable Puller Hoist Truck Water Testing Authorized by _��-- Providing Professional Water Service Since 1966 O - O Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F. Weld Gammor Argeo Paul Ceiluccl LL Ciovemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -- Trudy Coxe S—VlA y David e: Struhs cornmhsioner PART A CERTIFICATION Property Address: { �d (`ts 5� n Date of.Ina tion: 3 � %U. �'^ S�°�ifJ` 'Mc- Address of Owner. p°O 612 T 1 q6 (If different) Name of Inspector. Benjamin C: Osgood Jr. Company Name, Address and Telephone Nuinber. New `England Engineering Services, Inc. 33 Walker Road, North Andover, Ma 01845 CERTIFICAT16N STATEMENT Tel. 508-686-1768 Fax. 5Q8-685-1099 I certify that I have personally inspected the sew disposal system at this. address and that the information reported below is true, accurate 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: Passes �ondiiionally Passes eeds Further Evaluation By the Local Approving Authority Fails Inapcctor's Signature: e2n DatI Z7/94, The System Inspector shall submut a copy of this inspection report to the Approving pprovuag Authority within thirty (30) days of completing thisinspection. 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; INSPECTIION SUMMARY: Check A,' B, C, or D: A] 'SYSTEM PASSES: Ihave not found any:information which indicates that the system violates 'any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.. B) '.SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection: Indicate yes, no, or not determined (X, N. or ND).. Describe basis of determination in all instances. If "not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or enfltration .or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) I One Winter Street • Boston, Massachusetts 02108 0 FAX (617) 556 1049 • C•s i Printed on Recycled Paper Telephone (617) 292,5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property'Addres& I53 Fj;•exQ!a Owner: T-. M eCvoy Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distr cation 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 pipe(a). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FUR EVALUATION I9 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.' SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE. SYSTEM IS NOT FUNCTIONING INA MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Ceaspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh, 2)' SYSTEM.WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF.APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING .IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system h24 a septic tank and soil absorption system and 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 weli.is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. s6sl-c1 ►s as( f"o W�tI 3) OTHER (revised 11/03%95) 2 f {J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) Property Address 1 �', 3. F.� re s A) • Owner. �vlin 1 . M� j Date of Inspection: �1271a� Dl SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. 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. 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 outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invertor 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 60 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. ooliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: 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: the system is within 400 feet of a surfacedriaking 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 GWPA) or a mapped Zone Il of a public water supply well) The owner or operator of any such system shall bring.the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.; (revised 11/03/95) 3 Y t' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property.Addreax i 3 C—o reSi- stn e-+ N fA...3+ v a. AkA. Date of laspeotion: elL� 1�6 Check.if the following have been done: V Pumping information was requested of the owner, occupant, and 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 N/A. -""The facility or dwelling was inspected for signs of sewage back-up. The system does riot receive non-sanitary..or industrial waste flow The site was inspected for signs of breakout. V 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 existing information or approximated by non-intrusive methods. 4Z'The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface .Disposal . System. (revised 11/03/95) Property Addrem- Owaer Da.te of Inspection: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION N, <,- /t4 4 5271°!6 FLOW CONDITIONS RESIDENTIAL, Design. flow:-----_-Bauons Number Of bedrOOm6:---L Number of current residents: Garbage grinder (Yes or jao):,,d/ Laundry connected to system (yes or noVill Seasonal use (yes or no):_ Water meter readings, if available: n L4 I -p - Last date.of occupancy COMM ERC IAL/INDUS TRIAL, Type of establishment: Design flow:--� -_gallO.ns/day Grease trap present: (yes.or no)_ Industrial Waste Holding Tank present: (yes or no) Non -sanitary waste discharged to the Title 6 system: (yes or no) Water meter readings, if available: LAst. date of occupancy OTUER. (Describe) Last date of occupancy;. GENERAL INFORMATION PUMPING RECORDS and source:o'f inf System pumped as 'part of inspection: (yes or no) If yes, volume Pumped; Reason for pumping*. TYPE OF SYSTEM Septic tank/distribution box/soil absorption system. Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspe . ction records, Other. (explain)if any) APPROXIMATEI . AGE Of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no),-" (revised 11/03/95) y(-' - 13 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) . Property Address: 19 Fpreu s7nr /1,�. �.,SJu-r /1A Owner. Jif-�n 'T. vic C✓OJ Date of Inspection: 812j /-76 SEPTIC TANK (locate on site plan) 9h 3 b r� Depth below grader Material of construction: ncrete metal —FRP —other(explain) Dimensions: Sludge depth-- Distance epth:Distance from top of sludge to bottom of outlet tee or baffle: 5 ,d4 C- c2 jj S e V cLe C c Scum thickness: V Distance from top of scum to top of outlet tee or baffle: ,� v 1+ c4 -�'V tb tU bo f-�"V "V%. Distance from bottom of scum to bottom of outlet tee or baffle: Comments (recommendation for pumping, condition of inlet andoutlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) :rAA) lA e7 Irelos GREASE TRAP- (locate RAP (locate on site plan) Depth below grade: Material of construction: _concrete metal ,FRP _other(ezplain) 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: . Commentsi (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 11/03/95) 6 %6 _3a =t` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Aadreaa 183 Fro �s # s.�c r N• fi„ Sacv- a Dof Inap eotionsJ�a t, n T. /w c E ✓ v) B� 27 TIGHT OR HOLDING TANK- (locate ANK(locate on site.plan) Depth below grade: Material of construction: _,_,concrete _metal _FRP ,•_other(ezplain) Dimensions: Capacity: gallons Desiga'flow:_ _gallons/day Alkrm level:° Commenta: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert:._ Comments: (note if level and diatn'but' is equal, evidence of solids carryover, evidence of leakage into or out of box, etc,) PUMP CHAMBER:- (locate HAMBER(locate on site plan) Pumps in working order:(yes or no)' Comments: (note condition: of pump Chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 �s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: / f t/ 7S IV, lq St Owner Ta inn T. tit c C Date of Inspections :. 810,194 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if pole; excavation not required, but may be approximated by non -intrusive methods) If not determined to be present, explain: leaching pits, number: leaching chambers, number leaching galleries, number: leaching trenches, 7•� number, length: Y/ er,CLeS leaching fields, number, dimensions: or '_0' overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of pondin , condition of vegetation,etc.) S CESSPoULs: (locate onsite 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 ofgroundwater:_ inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil sigh of hydraulic failure, lever ofn po ding, condition of vegetation, etc.) PRIVY: _ (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note 'condition of soil, algae of hydraulic failure; level ofn po ding, condition of vegetation, etc.) (revised 11/03/95). SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addrosa Owner. Jct 'T. /!� r F✓ vl Daae of Inspection: �� Z7i�16 SKIEPCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' S 17� 37.s' DEPTH To GROUNDWATER Depth to groundwater: _feet method 'of determination or approximation: TOWN OF NORTH ANDOVER C� NOR7p Office of COMMUNITY DEVELOPMENT AND SERVICES ti A HEALTH DEPARTMENT 400 OSGOOD STREET "°^► " NORTH ANDOVER, MASSACHUSETTS 01845 �'SSACMUs Susan Y. Sawyer, REHS/RS 978.688.9540 —,Phone Public Health Director 978.688.9542 — FAX September 27, 2005 Dennis and Susan Holland 183 Forest Street North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 183 Forest Street, Map 106A, Lot 40 Dear Homeowner: The proposed septic system design plans for the above site dated August 12, 2005 and received on August 16, 2005 have been reviewed. The plan includes requests for the following variances. These variances were approved at a regularly scheduled meeting held on September 26, 2005. The design has been approved for use in the construction of an upgrade onsite septic system. This approval is generally valid for three years from the date of the approval and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. To allow a three bedroom septic system be designed with a deed restriction limiting the number of bedrooms to three in lieu of designing a four bedroom septic system Reduction in offset distance between the leach bed and an irrigation well from 100 feet required to 84 feet. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement Since i san Y.,$awyer, REHS/RS Public Health Director cc: Owner File C O O NEW ENGLAND ENGINEERING SERVICES ik INC September 9, 2005 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 Re: 183 Forest Street, North Andover, MA Septic System Design Plan Re -Submittal Dear Ms. Sawyer, rCEIVED SEP - 9 2005 TOHEALTH DEPARTMENT ANDOVER OF NORTH The following plans for the above referenced property are being re -submitted for approval. The following issues have been addressed: 1. A lot locus detail has been added to sheet 1. 2. In the system profile, the label for the pipe from septic tank to distribution box now shows a slope of 1.8%. 3. In the system profile, the water table elevation 95.00 (TPI) has been moved down to the 95.00 increment. No changes have been made with respect to design criteria, calculations, or system location. These changes are a result of a phone conversation at 4:00 PM on September 7, 2005 between Susan Sawyer and Thomas Hector. Please contact this office with any questions or concerns. Sincerely, Thomas Hector Project Engineer 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX September 7, 2005 Benjamin Osgood, P.E. New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 183 Forest Street, Map 106A, Lot 40 Dear Mr. Osgood: The proposed septic system design plans for the above site dated August 12, 2005 and received on August 16, 2005 have been reviewed. The plan includes requests for the following variances. 1. To allow a three bedroom septic system be designed with a deed restriction limiting the number of bedrooms to three in lieu of designing a four bedroom septic system 2. Reduction in offset distance between the leach bed and an irrigation well from 100 feet required to 84 feet. These requests will be presented for approval at a Board of Health meeting on September 26, 2005. Assuming the BOH approves these variances, this plan will be approved on September 27, 2005. A final approval will follow that meeting. Sincer S Y. Sawyer, REHS/RS !� Public Health Director cc: Owner File 0 TOWN OF NORTH ANDOVER �oRTH Office of COMMUNITY DEVELOPMENT AND SERVICES o< •' _ -" '• °gyp HEALTH DEPARTMENT F? 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 CHtI5Et Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX September 7, 2005 Benjamin Osgood, P.E. New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 183 Forest Street, Map 106A, Lot 40 Dear Mr. Osgood: The proposed septic system design plans for the above site dated August 12, 2005 and received on August 16, 2005 have been reviewed. The plan includes requests for the following variances. 1. To allow a three bedroom septic system be designed with a deed restriction limiting the number of bedrooms to three in lieu of designing a four bedroom septic system 2. Reduction in offset distance between the leach bed and an irrigation well from 100 feet required to 84 feet. These requests will be presented for approval at a Board of Health meeting on September 26, 2005. Assuming the BOH approves these variances, this plan will be approved on September 27, 2005. A final approval will follow that meeting. Sincer S Y. Sawyer, REHS/RS !� Public Health Director cc: Owner File Town of North Andover HEALTH -DEPARTMENT 27 Charles Street North Andover, MA 01845 O5/ 978.688.9540 healthdepWownofnorthandover. com SEPTIC PLAN SUBMITTAL FORM DATE OF SUBMISSION:_ IJ SITE LOCATION:_ %�'3 S'� .S+ e�- /V 4-70161A ENGINEER 2047 1'a'I 1 ill (�,� �sfillDbl , / .. 0 -c- NEW NEW PLANS: YES $225.001Plan /Check#: (Includes f4ft—"U0and one Re Review Only) REVISED PLANS: YES $ 75.00/Plan Check #: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO Telephone #: "I 7' 62C�-� 17�0� Fax #: ,?s /6 9� E-mail:0 ,,2,6 cart HOMEOWNERNAME:_ �� nmS (,tA S�1Qa) M 141 -k -Y OFFICE USE ONLY When the submission is complete (including check): 1. Date stamp plans and letter z Complete and attach Receipt �. 3. Copy File; Forward to Consultant 4. Enter on Log Sheet and Database G O O NEW ENGLAND ENGINEERING SERVICES INC August 12, 2005 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 Re: 183 Forest Street, North Andover Variance Request Dear Ms. Sawyer, This office is submitting a Septic System Design for the above referenced property. A Local By- law Variance is anticipated. We hereby request to be placed on the agenda for the next Board of Health meeting on September 22, 2005. Local By-law Variance Required Allow a three bedroom septic system design with a deed restriction limiting the number of bedrooms to three in lieu of designing a four bedroom septic system. 2. Reduction in setback distance from a leaching facility to an irrigation well from 100 feet required to 84 feet. Please contact this office with any questions or concerns. Sincerely, -44��4� Steven E. Pouliot Project Manager 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 0 NEW ENGLAND ENGINEERING SERVICES INC August 12, 2005 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 Re: 183 Forest Street, North Andover Septic System Design Plan Submittal Dear Ms. Sawyer, The following plans and enclosures for the above referenced property are being submitted for approval. 1. (3) Copies of the Septic System Design Plans. 2. (2) Copies of the Form 11 Soil Evaluator Sheets. 3. (2) Copies of the Form 12 -Percolation 'Test Sheets. 4. (1) Copy of the Septic System Submittal Form. 5. (1) Letter for Local Bylaw Variance. 6. Check for the Town approval fees. Please contact this office with any questions or concerns. Sincerely, J4�� Steven. E. Pouliot Project Manager 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, July 18, 2007 2:43 PM To: Osgood Ben (E-mail) Subject: 183 Forest Street - Dennis and Susan Holland - owners Hi Ben am following up on some aging files.... For 183 Forest Street, I am missing the Final Grade Request, As Built Plan, and Installation Certification form, Deed Restriction and assurity that the well has been abandoned. The system was repaired by James Kellett. The original DWC Permit was issued on April 23, 2006, so it's been quite awhile. Is there some type of hold up with this particular site? Please let me know when this information will be forthcoming. Thanks. BQsf Rdgwzds, P41*¢040 D¢1e¢G 1.0io Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 2978.688.9540 - Phone A 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com Page 1 of 1 O DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, June 07, 2006 8:44 AM To: 'Marianne Peters' Cc: Osgood Ben (E-mail) Subject: RE: Jim Kellett; 183 Forest Importance: High Ben of NEES called me on Monday and stated taht it is all set for a Final, however, the well still needs to be converted to an irrigation well. Jim Kellett has not called me to say it is ready. Pamela Note to Ben -- you may want to call Jim Kellett and remind him to call us to let us know when ready. Thanks. -----Original Message ----- From: Marianne Peters [mailto:mpeters@millriverconsulting.com] Sent: Tuesday, June 06, 2006 1:31 PM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; 'Marianne Peters'; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Jim Kellett; 183 Forest Jim Kellett called and asked Lisa if we've gotten the okay for 183 Forest Street yet; (and we haven't), but thought I'd let you know. Won't do anything until I hear from you. Thanks. n Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx 6/7/2006 No DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, February 17, 2006 10:25 AM To: Sawyer, Susan Subject: 183 Forest Street Variance Here are the notes from the meeting: C� I1. 183 Forest Street- Proposal from Thomas Hector, Project Manager, of New England Engineering to request the following: Local By-law Variance Required a. Allow a three (3) bedroom septic system to be designed with a deed restriction limiting the number of bedrooms to three (3) in lieu of designing a four (4) bedroom septic system. b. Reduction in offset distance between the leach bed and an irrigation well from 100 feet required to 84 feet. This is a single story dwelling with a well on the Northwest side of the house. Town water is proposed to be tied in, but the homeowner would like to use the well for irrigation purposes. There. are outcrops which turn into wetlands towards the back of the house. There are issues with the neighbors well being close to the property as well which is another reason that the distances need to be altered. The homeowners would like to enlarge the kitchen and family room. However, the home will still remain a three bedroom home, and there will be a deed restriction completed for this. Motion - Mr. Markey makes a motion to allow the Local By-law Variance as requested and to have the homeowner cut the waterline between the well and the foundation to ensure that the well would not be used for drinking water in the future, and a Board of Health Agent must witness that this is complete. All were in favor. 8agf Ragwad8, RAW && DB�BaG�l6iwie Health Department Assistant Town of North Andover 400 Osgood Street North Andover, MA o1845 978.688.9540 - Phone 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com CI TOWN OF i+TORTH ANDOVER. � gORTN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH D""I" PARTMENT 4G, OSGOOD STREET • °? z- 4 • NORTH ANDOVER, MASSACHUSETTS 01845 �'SS�CH�g Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX September 27, 2005 Dennis and Susan Holland 183 Forest Street North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 183 Forest Street, Map 106A, Lot 40 Dear Homeowner: The proposed septic system design plans for the above site dated August 12, 2005 and received on August 16, 2005 have been reviewed. The plan includes requests for the following variances. These variances were approved at a regularly scheduled meeting held on September 26, 2005. The design has been approved for use in the construction of an upgrade onsite septic system. This approval is generally valid for three years from the date of the approval and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period, for which this plan is valid. To allow a three bedroom septic system be designed with a deed restriction limiting the number of bedrooms to three in lieu of designing a four bedroom septic system Reduction in offset distance between the leach bed and an irrigation well from 100 feet required to 84 feet. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement Since' r . ..... sanY.,4awyer, REHS/R .� Public Health Director cc: Owner File 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT 'I7en n � 5 Q std PHONE 9 7 - 6 8� - /� k/ LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET /-0 f ST. NUMBER-/ OFFICIAL USE ONL RE COMMENDATIONS OF TOWN AGENTS: APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm / 4'•11' S " _ - 5 1" . - 15'-0" TD,",r,ging osed Addition 7Masteredroom Room l___—J New Bathroom � II m DECK m t a -r . s• -s -� in y�vl {G AREA Dennis & Susan Holland 183 Forest St. No. Andover, Ma. 21'-11" ( Dennis & Susan Holland 183 Forest Street N. Andover, MA. 01845 Design Objectives for House at 183 Forest St., N. Andover, MA. Scope: The plan is to build an addition 30'x28' off the rear of the existing one story house. The purpose for the addition is to add a dining room and a new master bedroom with a bathroom. The house presently has 3 bedrooms and would remain so as a result of a reconfiguration of the existing master bedroom to a family room. The kitchen will be redesigned and have new cabinets and countertops, as well as new task lighting. Entry to the new dining room will be an archway where a 4' casement window is to be removed. A 6' sliding door next to the casement window will be removed and the opening resized for a single hinged door. Both the dining room and bedroom will have sliding patio doors leading to the rear yard. All the doors to have wood landings with stairs with rails leading to the back yard. The existing septic system will be used as is. The well currently supplies water to the residence and will remain so. The design stays well within the setback requirements of the town of N. Andover. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: Z -2-2Z - CURRENT INSTALLER'S LICENSE#. LOCATION: ,Y cls-l-Yv f�yL/ ✓� ✓vb l � /�'� � 'tom S� .rZ�vpri��� �r /L LICENSED INSTALLER:—C SIGNATUREE�,� � C� z��_ TELEPHONE# lam'% �2 CHECK ONE:: REPAIR: Zl NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. $75.00 Fee Attached? Foundation As -Built? Floor Plans? Administrative Use Only Yes_ No Yes No Yes No Approval Q �� Date: 0 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the individual subsurface disposal system constructed ( ) or repaired ( x ) D -Box by North Andover Licensed Installer David Currier at 183 Forest Street, North Andover, MA 01845 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 Number 1039 dated 9/8 1998. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. 4AM d4-' ` I toard of Health Inspector 0 0 Town of North Andover No oT� ti Community Development and Services Division Office of the Health Department •� 400 OSGOOD STREET • °,e ... 4' North Andover, Massachusetts 01845 S�cHus Susan Y. Sawyer, RENS/RS Public Health. Director (978) 688-9540 -Phone (978) 688-8476 - Fax Date: June 22, 2005 Address: 183 Forest Street Re: Application for: Addition Dear: Mr. & Mrs. Holland Your application for an addition at has been reviewed by the Health Department. The application was denied on, June 2,2005 for the following reasons: 1. X Missing information 2. X Passing Title 5 inspection of septic system required 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. Certirmd Plot plan showing house, septic system and proposed project in scale If #2 is checked: a. Dave the seodc system inspected by a certified Title S inspector to determine the size of the system and whether it is operating properly, b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project If #4 is checked: a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult an engineer to determine the flow capacity of the septic system. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, ichele E. Grant Cc: File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 310 CMR: CPARTNIENT OF ENVIRONMENTAL PROTECT -_—_J IF 15 -?.01: continued Basin boundaries shall be determined by reference to the most recent edition of the Massachusetts GIS maps. If all of the components of a system are not located in the same basin, then the system shall be inspected during the earliest of the applicable inspection years. (7) Shared systems shall be inspected annually. (8) When a facility is divided or the ownership of two or more facilities is combined as specified in 310 CMR 15.010(2) or (3), all systems serving the facility or facilities shall be inspected. (9) All systems shall be inspected when the owner or operator thereof is ordered to do so by the local approving authority, the Department or court. (10) The results of any inspection(s) required by 310 CMR 15.301 shall be submitted to the approving authority on a System Inspection Form approved by the Department within 30 days of the inspection by the approved System Inspector, provided that this sentence shall not be construed to require the owner of a system or a System Inspector to submit to the approving authority the results of a voluntary assessment of the condition of a system that is not performed to comply with a requirement of 310 CMR 15.301. Any system determined to require upgrade pursuant to 310 CMR 15.303 or 310 CMR 15.304 solely as a result of a voluntary assessment shall not be subject to the deadlines for completion of upgrades in accordance with 310 CMR 15.305 unless the owner or operator of the system is ordered to do so by the local approving authority, the Department or court. Inspection forms for systems with design flows over 10,000 gpd and shared systems shall be submitted to the Department by the approved System Inspector and the owner. All inspections required by 310 CMR 15.301 shall be conducted by a currently approved System Inspector. 12/27/96 310 CMR - 546.1 310 CMR: CPARTMENT OF ENVIRONMENTAL PROTEC'� —, V 15.1: continued and upgrade, if necessary. In a nominee trust situation, whoever has authority to add a new beneficiary is responsible for the inspection. An inspection conducted up to three years before the time of transfer may be used if the inspection report is accompanied by system pumping records demonstrating that the system has been pumped at least once a year during that time. (4) Exclusions. Inspection of a system is not required at the time of transfer of title of the facility served by the system in the following circumstances: (a) a certificate of compliance for the system has been issued by the approving authority within two years prior to the time of transfer; or (b) the owner of the facility or the person acquiring title has signed an enforceable agreement with the approving authority to upgrade the system or to connect the facility to a sanitary sewer or a shared system within the next two years following the transfer of title, provided that such agreement has been disclosed to and is binding on the subsequent owner(s); or (c) the facility is subject to a comprehensive local plan of on-site septic system inspection approved in writing by the Department and administered by a local or regional governmental entity, and the system has been inspected at the most recent time required by the plan. A comprehensive local plan may prioritize systems to be inspected on the basis of proximity to water resources, soil or geological conditions, age or size of systems, history of performance, frequency of pumping or other routine maintenance activity, or other relevant factors, and may establish different schedules and frequency of inspection on the basis of such criteria, provided that all systems are inspected at least once every seven years by a System Inspector approved by the Department. i (5) A system shall be inspected upon any change in use or expansion of use of the facility served, for which change or expansion a building permit or occupancy permit from the local building inspector is required. Unless the system is a cesspool, failing as set forth in 310 CMR 15.303 and 15.304(1), or a significant threat to public health, safety and the environment as set forth in 310 CMR 15.304(2), upgrade of the system is not required if the system was designed to accept design flows resulting from the change in use or expansion of use. Upgrades to accept increases in actual or design flow to any cesspool or to any other system above the existing approved capacity shall be in accordance with 310 CMR 15.352. Whenever an addition to an existing structure which changes the footprint of a building with no increase in design flow is proposed, the system inspection shall be an assessment to determine the location of all system components, including the reserve area, in order to ensure that the proposed construction will not be placed upon any of the system components. If official records are available to make a determination regarding location of system components, an inspection is not required for footprint changes. (6) Facilities where the total design flow generated on the facility equals or exceeds 10,000 gallons per day at full build out, shall be inspected by the last day of the calendar year pursuant to the following schedule in accordance with the provisions of 310 CMR 15.006 and the applicable provisions of 310 CMR 15.300 through 15.354 or 314 CMR 5.00 and 6.00. Such systems shall be reinspected during the fifth calendar year following the applicable year of initial inspection listed below and then during every fifth calendar year thereafter. An inspection of a system conducted within 30 months prior to the last day of the applicable year of initial inspection may be used as -the initial inspection, provided that a System Inspection Form approved by the Department is submitted to the Department within 30 days of the inspection. Year of initial Basin in which system is located inspection 1997 Charles, Housatonic, Hudson (Hoosic), North Coastal, Ten Mile 1998 Blackstone, Chicopee, Connecticut, Nashua 1999 Boston Harbor (Neponset), Cape Cod, French & Quinebaug, Merrimack, Narragansett Bay/Mt. Hope Bay, Parker 2000 Buzzards Bay, Deerfield, Ipswich, Islands Millers, Shawsheen 2001 Concord (Sudbury, Assabet, Concord), South Coastal, Farmington, Taunton, Westfield 12/27/96 310 CMR - 546 Of,.•a .• y° Commonwealth of Massachusetts Map -Block -Lot o Board of Health ------00- - Permit No • :: North Andover BHP -2006-0073 •,, ' --i . P.I. FEE. ,sSACwusti F.I. — $250.00 Disposal Works Construction Permit I Permission is hereby granted JAMES KELL ETT to (Repair) an Individual Sewage Disposal System. at No 183 FOREST STREET ------ ------------- ----- as shown on the application for Disposal Works Construction Permit No. BHP -2006-007 Dated April 03, 2006 ---------- ---- Issued On: Apr -03-2006 rr— dard of 1-4 &altli ~ORTM o•Map-Block-Lot ,..•A Commonwealth of Massachusetts p F �D Board of Health 106_A- 0040- North Andover ;s �,•� ='<� Certificate of Compliance sic Must THIS IS TO CERTIFY, That the Individual Sewage Disposal System (Repair) by JAMES KELLETT ------ ------- Installer -. at No 183 FOREST STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2006-007 Dated April 03, 2006 -------------- Printed On: Apr -03-2006 -------------------------- - Board of Health Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 12 (ewn i A Applicat�r- for Septic Disposal Sy ConstruAion Permit- TOVN O RTH Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component A. Facility Information -----I-o,s t— ----- Address or Lot # -_ado JUia_ City/Town _- 2.- *TYPE OFAEPTIC SYSTEM*: ❑ Pump Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component ❑C ventional System (pipe and stone system) Infiltrator or Biodiff user (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Name _ 1 '�3 j-0 a C ar Address (if different from above) / City/Town State Zip Code Telephone Number 3. Installer Information Name Name of Company Address City n State Zip Code Telephone Number (Cell Phone # if possible please) a. Designer Information /V _6es os juc/ E- Name Name of Company a Address City/Town State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit - Page 1 of 2 Z to Z a6ed . liwaad uoponilsuoo walsesodsip jol uoileogddy C —oN —saA : (Aluo uo!jonajsuoo Mau) z suplg toolI •s (upld parzocddp sp 31VIS azups) —oN —sad :(Aluor uo 3nrjsuoo Mau) ppng-sy uoi;ppuno r -p —ON /j�sM IiuuaglpauPdI.7 O oa qop;ly `os fI P'3I-s s ucng •C' —oN n s 3 //� zpagopliVuuol uoiiv�zlgo caypuvNllalOJg 7 ON sdA Zplgovvv aad I duo ash oolijo .Io j mosew 6uinnolloj ay; Jo; panoiddesia uogeoilddy ale(] we 7 (an!;e;uesaadaa y;;eeH Jo paeoa 9 panoaddd u ogddy I qq aled 491W e N •y;/ ao paeo8 siy; Aq pa ! uaaq sey aoue!ldwo:) }o a;ey!vs:) a 1pun uopejado ui we;sAs ay; aoeld o;;ou pue `rsAopud WJON jo uMol ay; rol suopeln6aa lesodsiQ aoeunsgnS leoo-7 ay; se Ilem se `opoo le;uewuonnu3 ay; so g a;;!l }o suoisinosd ay; y;ins eouepi000e ut wa;sAs /esodsip 96emes a;is-uo paq!aosep-ajoje ay; jo eoueua;view pue uoi;ona;suoo ay; ainsue o; saar6e pou6tsiapun ayl Juauaaei6d -8 ieioiawwooE]ao 6uyianna iei;uapisaaF::i : u!pl!n8;o a j, •9 `` d ••••penuiluo3 uoijeuaaojuj 4!1!oe:l •d ZJOZ3Jbd ;uauodwoC) 00-9Z4$ S b81. 0 VW Q IAOUN V H T►L QOM aiedaa 11n.1 - 00'09Z $ �. >c'•� 30 �k10►I, — �!uaaad uo!��na�suo� W r�I 31VO S,.ld0O1 'o - -- - - - W04s S !eso s!a 3!1es aoj uo!leo!! d 2 U INSTA LER PROJECT MANAGEMENT OB>L-k'Y' ATIONS As the North Andover licensed installer for the construction of the septic system for the property at 1-3-Pn-o,( S-�' relative to the application of� In �p(L It dated for plans by dated �-/Z- 6`5 with revisions dated P65c and I understand the following obligations for management of this project: As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date:d6 FINAL GRADE INSPECTION Date: ��Aflll Address Lr/LOAMED? �EEDED? COVER PER PLAN? Other: wv< DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, May 16, 2008 10:16 AM To: 'suetholland@comcast.net' Subject: 183 Forest Street - Septic Information and As Built Importance: High Ed 23 L_J Message from Message from Message from KMBT 600 KMBT_600 KMBT 600 Hi Susan, Per our phone conversation. I have scanned the information from your file as well as the As Built so you can pump the system next week. I sent an e-mail to Ben re: the sign -off on the certification form. One of the items I scanned is a sample of a deed restriction that I have. You can use that if you choose, and bring it to the registry of deeds and have it recorded. Once we receive this information and the other work is complete, we can issue the final Certificate of Compliance. Please call if you have any further questions. 941 R¢gw.-d8, PAfyaew Da00¢G0iP1410 Health Department Assistant Town of North Andover 1600 Osgood Street Building 2o, Suite 2-36 North Andover, MA 01845 2978.688.9540 - Phone A 978.688.8476 - Fax http://www.townoftiorthandover.com healthdept@townofnorthandover.com e -o, 1- lam.-, r., s I r m 1val 7 -�L= � �%, i ,tea b �*-��'�w�., 5 , I-�. -- h-c�✓ �-1 t17, 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, May 16, 2008 10:16 AM To: 'suetholland @comcast. net' Subject: 183 Forest Street - Septic Information and As Built Importance: High LJ 2 21 Message from Message from Message from KMBT_600 KMBT_600 KMBT_600 0 Hi Susan, Per our phone conversation. I have scanned the information from your file as well as the As Built so you can pump the system next week. I sent an e-mail to Ben re: the sign -off on the certification form. One of the items I scanned is a sample of a deed restriction that I have. You can use that if you choose, and bring it to the registry of deeds and have it recorded. Once we receive this information and the other work is complete, we can issue the final Certificate of Compliance. Please call if you have any further questions. 8¢g! R¢04vd8, Pa�ri¢G�u Da��¢G�lifAf¢ Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 9978.688.9540 - Phone & 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com r� ��v� ,��