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HomeMy WebLinkAboutMiscellaneous - 193 GRAY STREET 4/30/2018 193 GRAY STREET J 21.0/107.D-0110-0000.0 1 J � I r Town of North Andover NpRTN Office of the Health Department Community Development and Services Division *^off 27 Charles Street North Andover,Massachusetts 01845 �Ssgcr+us�� Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 February 6,2002 Mr: Scott Twadelle 193 Gray Street North Andover,MA 01845 Re: Application for inground pool proposed at 193 Gray Street,North Andover,MA Dear Mr.Twadelle: The Health Department has reviewed your application for an inground pool. The application was denied on February 6,2002 for the following reason: 1. X Missing information 2. Passing Title 5 inspection of septic system may be required 3. Location of structure not acceptable To address the problem(s): If#1 is checked, please supply: NAAr plan of existing and pr-opesed addition(not applicable) b. Certified plot plan showing the house,septic system(including the reserve area),and the proposed project in scale. The plot plan must include associated grading,limit of work and any structures associated with the inground pool,such as a concrete patio or deck,pool shed and the necessary fence enclosure. If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If#3 is checked: a. Relocate the project Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincere , 4<J.LaGrasse, Health Inspector Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 10/18/99 This is to certify that the individual subsurface disposal system constructed O or repaired (X) by Todd Bateson at 193 Gray Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit# dated . D-Box Only The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Of Board of Health Inspector I i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTM M OF ENVMNMENTAL PROTECTION ONE WIAPl'ER.STREET,BOSTON MA 02108 (617)292-5500 TRUDY COXE ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION �i IIS Property Address: 193 Gray Street,North Andover Name of Owner:Chris Horan Address of Owner:193 Gray Street,North Andover,MA 01845 Date of Inspection:10115/1999 Name of Inspector.Neil J.Bateson I am a DEP approved system Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name:Bateson Enterprises Inc. Mailing Address:111 Argilla Road Andover,MA 01810 Telephone Number:(978)475-4786 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fa' Inspector's Signature: Date:10/15/1999 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,9 applicable,and the approving authority. NOTES AND COMMENTS Permit from North Andover BOH,install new d-box,inspection from North Andover BOH,system now passes Title 5 Inpection. r^'f 2 9 199 revised 9/2/98 Page I of 11 4 r COMMONWEALTH OF MASSACHUSETTS CTY EXECUTIVE OFFICE OF ENPIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02108 (617)292-5500 TRUDY COXE �9 ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor SUBSURFACE SEWAGE DISPOSAL SYST4 NSPECTION FORM Commissioner 9 PART A CERTRUTION Property Address: 193 Gray Street,North Andover Name of Owner:Chris Horan Address of Owner.193 Gray Street,North Andover,MA 01845 Date of Inspection: 10/8/1999 Name of Inspector:Neil J.Bateson I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: Bateson Enterprises Inc. Mailing Address:111 Argilla Road Andover,MA 01810 Telephone Number:(978)475-4786 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: Passes _X Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Data:10/811999 The System Inspector shall submit a copy of ' inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS Tc I �T 2 2 1999 revised 9/2/98 Page I of 11 Printed on Recycled Paper • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 193GrayStreet,North Andover Owner:Horan Date of Inspection:10/811999 INSPECTION SUMMARY: Check A, B, C,or D. A.SYSTEM PASSES: . I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: B.SYSTEM CONDITIONALLY PASSES: _X One or move system components as described in the'Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Needs d-box replaced. Indicate yes,no,or not determined(Y,N,or NO).Describe basis of determination in all instances.If"not determined",explain why not. _No The,septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _No— g Sewa a 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 leveled or replaced i _No`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): i broken pipe(s)are replaced obstruction is removed i i revised 912198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 193 Gray Street,North Andover Owner:Horan Date of Inspection: 10/8/1999 C.FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water. Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and sal absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and sal absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.Method used to determine distance (approximation not valid). 3 OTHER i i revised 9/2/98 Page 3 of 11 I � ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) I Property Address:193 Gray Street,North Andover Owner.Horan Date of Inspection:10/8/1999 D.SYSTEM FAILS: You must indicate either,"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No i 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 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. I 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. E.LARGE SYSTEM FAILS. You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area @ IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional office of the Department for further information. revised 912198 Page 4 of 11 I I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 193 Gray Street,North Andover Owner:Horan Date of Inspection:10/8/1999 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No —X Pumping information was provided by the owner,occupant,or Board of Health. I _X 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. _X As built plans have been obtained and examined.Note if they are not available with NIA. _X The facility or dwelling was inspected for signs of sewage back-up. _X _ The system does not receive non-sanitary or industrial waste flow.The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X_ s 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: I _X Existing information.For example,Plan at B.O.H. _X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [I 5.302(3)(b)] _X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. I I I i revised 912198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 193 Gray Street,North Andover Owner:Horan Date of Inspection:10/8/1999 I FLOW CONDITIONS RESIDENTIAL: Design flow::_150 ..g.p.d./bedroom. Number of bedrooms(design): 4_ Number of bedrooms(actual): 4_ Total DESIGN flow_600 Number of current residents:_3_ Garbage grinder(yes or no):_No_ Laundry(separate system)(yes or no):_No ,If yes,separate inspection required Laundry system inspected(yes or no) Seasonal use(yes or no): No Water meter readings,if available(last two years usage(gpd):June 97 to June 99=20,500ft3 x 7.5=153,750 Gals./730 Days=210 Gals./Day Sump Pump(yes or no):_No_ Last date of occupancy:_Current_ COMM ERCIALIINDUSTRIAL: Type of establishment: Design flow: god(Based on 15.203) Basis of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy:' OTHER:(Describe) Last date of occupancy; GENERAL INFORMATION PUMPING RECORDS and source of information: Pumped June 96,Owner System pumped as part of inspection:(yes or no)_Yes If yes,volume pumped:_1500_gallons Reason for pumping:Inspect tank&tees TYPE OF SYSTEM _X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: 13 years, 12/19/86,as built plan. Sewage odors detected when arriving at the site:(yes or no)_No revised 9/2/98 Page 6 of 11 I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) f Property Address: 193 Gray Street,North Andover Owner:Horan Date of Inspection:110/8/1999 BUILDING SEWER:X (Locate on site plan) Depth below grade: 13" Material of construction:—X— cast iron_X 40 PVC _ other(explain) Distance from private water supply well or suction line: Diameter:4" Comments:4"cast iron thru wall to septic tank.3"PVC in house. SEPTIC TANK:X (locate on site plan) Depth below grade: 1"i Material of construction:_X_ concrete metal Fiberglass_Polyethylene_other(explain) If tank is metal,list age_Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 10'x 5'x 4' x 7.5=1500 gallons. Sludge depth:6" Distance from top of sludge to bottom of outlet tee or baffle:21" Scum thickness:6" 1 Distance from top of scum to top of outlet tee or baffle:8" Distance from bottom of scum to bottom of outlet tee or baffle:15" How dimensions were determined:Subtract scum&sludge depths to tee length. Comments:Pumped septic tank,inlet tee&baffle ok.Outlet tee ok.Depth of liquid at outlet invert.No evidence of leakage. GREASE TRAP:None (locate on site plan) Depth below grade: Material of construction: concrete_metal_Fiberglass_Polyethylene_other(explain) l Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: I I revised 9/2/98 Page 7 of 11 + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 193 Gray Street,North Andover Owner:Horan Date of Inspection: 10/8/1999 TIGHT OR HOLDING TANK:_None (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: Material of construction! concrete—metal_Fiberglass Polyethylene_other(explain) Dimensions: Capacity:_gallons Design flow: allons/day Alarm present Alarm level: Alarm in working order.Yes_No Date of previous pumping: Comments: DISTRIBUTION BOX.: X_ (locate on site plan) Depth of liquid level above outlet invert:0 Comments:D-box level&distribution equal.Evidence of solid carryover.D-box has bad corrosion,needs replaced.No leakage. PUMP CHAMBER:_None,gravity system_ (locate on site plan) Pumps in working I order..(Yes or No) Alarms in working order(Yes or No) Comments: Revised 912198 Page 8 of 11 •• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)) I Property Address: 193 Gray Street,North Andover Owner,Horan Date of Inspection:10/8/1999 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number leaching chambers,number: leaching galleries,number leaching trenches,number,length:3 trenches 50'long. leaching fields,number,dimensions: overflow cesspool,number: Altemative system: Name of Technology: Comments:Soil ok.Vegetation ok.No sign of ponding to surface. i CESSPOOLS: None (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: i PRIVY:None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: i revised 912198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:' 193 Gray Street,North Andover Owner:Horan Date of Inspection,:10/8/1999 1 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Driveway House Water Meter A B Deck i Atol = 15' 1 Ato2= 18'6" A to 3=22'4" 2 Septic A to D-box 52' 8" Tank 3 B to 1 =60'9" Bto2=61' 9" Bto3=62'9" B to D-box=,77'5" 50' i D-box 4 revised 9/2/98 Page 10 of 11 ,y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 193 Gray Street,North Andover Owner:Horan Data of Inspection:11001999 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 5 Feet Please indicate all the methods used to determine High Groundwater Elevation: _X Obtained from Design Plans on record _X Observed Site(Abutting property,observation hole,basement sump etc.) X Determined from local conditions —X—Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local'excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. Must be completed) As per design plan. revised 9/2/98 Page 11 of 11 Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 11 I Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 193 Gray Street , North Andover Owner: Horan Date of Inspection: 10/8/1999 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such,report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system i c Neil J. Bateson Bateson Enterprises, Inc. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE LOCATION: 1 `� 3 G LICENSED INi STALL d D �R -eSd�J SIGNATURE: TELEPHONE# 1477 - /y7 OFF, CHECK ONE: �� REPAIR: NEW CONSTRUCTION: _.. IF NEW CONS7T) TION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only 575.00 Fee Attached? Yes V// No Foundation As-Built? Yes No Floor Plans? Yes No �d /z Approval I r Date: r L r TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 10/18/99 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by Todd Bateson at 193 Gray Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit# dated . D-Box Only The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector I i I .,TH Mass . M SUBSURFACE DIMSAL DESIGN CHECK LIST U L0T # I COY S1 DATE "2 /' DISAPPROVED DATE er (o�J d Reasons: Ctle V FAIL 09 Dg 2.5 The submitted plan must' ahow as a minimum: a) the lot to be served-area,dimensions lot #,abutters b location and log deep observation hoes-distance to ties c location and results percolation tests-distance to ties d design calculations & calculations showing required leaching area (e) location and dimensions of system-including Eeserve area f) existing and proposed contours (g) location any vet areas idthin 100' of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer location any drainage easements within ]A01 of sewage disposal system or disclaimer-Planning Board files (J) knosm sources of nater supply within 2001 of sewage disposal a system or disclaimer (k) location of any proposed well to serve lot-1001 from leaching facility (1) location of water lines on property-101 from leaching facility (m) location of benchmark (n) driveways (o) garbage disposals (p) no PVC to be used in construction (q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and other elevations (r) maximum ground water elevation in area sewage disposal system (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (a) capacities-150% of flog, water table, tees, depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground swimming pool (d) 251 from subsurface drains ,eg 10.2 Distribution Boxes (a) Rope greater than 0.08 ,eg 10.1 (b) mop •d 21URD OP Z/ avy sz: Nal�TN �ti povEl�, MA, bWnl O wEu- AP oyCD D�JG SS Steric Sys i�M vES��:�1 �PPi�ovl:D DArt APR�0vIN6 AoTtioi�iry �o�UI�ITi0�v5 D15APPKovEp p�i� �u�JS /�CRi/JGty 1N3�� ""/ r�N woT r� R�45oNS DwC 5,pr f(,- SV5TEM pjsT4u,4T1OAJ L 7 U�J�tc�1J )��c�: EGT�o� v/JrG Q 04155 E] F�iL FINAL l tiSpF�rlo� PPRoVED /JPI�i;�Ovrn)G �4DDIT(p�,QL I�Sr l(ON j Xli A►Jy) D(SAP�'�?vv�.f7 D,arC I 9 ,PR - 2 1 — 92 TLIE 1 2 57 CAPEY ! PEDRELL I P r 0 1 L. A, Ruiz AssoCiates, Eric 868 WOrreycer 5uvel, Wellesley, ,NIA 02181 617 • '�� • O�i fG PAX NO. 2�-q<?C� DATE FROM: No, of pages including cover sheet; COMMENTS : �` " •:' / — d f, �' . u�,,. / Ile 64 if this fax is not received clearly, please call (617) 230 -0146- /,,,,�� ,�' C..✓�C7� ,��C'.�C '��rid r�/ ''���� �'?_]c A:7 PR - 21 - 92 TUE 12 : 57 CARE '-rs- PELREL_ L I P . 02 FORM U TOWN OF NORTH ANUOVElt LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANUX ADDRESS (ASSIGNED BY U. P.W. e'STREET --UPLXCANT .�u. - .JCCyi�� 1'1lU1dL ;�-'� G ��� ��°•rc� DATE OF APPLICATION TOWN USE BELOW '1'1115 CBE - -- PLANNING BOARD DATE AI PROV1:1) TOWN PLANNER UAIE REJECIED - --~ CONSERVATION COMMISSION L) 'E AFFROVEU CONSERVATION ADMIN. ATI KEJECTLu BOARD OF HE HEALTIf SAN I IAN DEPARTMENT OF PUBLIC WORKS DRIVEWAYPERMIT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the ,agents of thu Vlouoinf; nsssl 111- 100 Ise r,rlrt , the Conservacio s Commission prior to the 1ssu.111c:c ui' +ally Irs1 11x1 Los; { rinl rR for the subject lot. This form shall not rc lc iva tlsn npp l l< c{Int t i mil t !se cvmpilance of any applicable 'down requirement or Bylaw. S APR - 21 - 92 TIDE 12 : 58 CAREY .- PEDRELL I P _ 03 i IZ4 1ya� & Ar �- a p �X a WN 4-1,QY 5r OF 150 - y r ,0E.S1,6N C4 El✓dT/ON Ar....,r...(MR DF S70AIS) - ,PiONAI E�G�� ce,Y1671M7 44el d770N .dT r,.r,r r r RE'4U/Rc�D A144 , 06.SA�N A. 454114r INt/, P/PF OeIr OF,.1061,5E 4r,J7 �•- - - //VV PIAF INTO T„4NIf 91 10 INV Pi?E DUT OF UAl �,r 7"L IN!! PIPE INro G! em, 90•4Z 10,14 - lM/. PIPE' OUr OF D 80.1' C�o,Z 5 10-55 !N IN1f END OF PlAe 9ar,Do INE N o re 7" N NG) ovE P, +� r ge.,aa' M 07.9 4 --6.f .fb Frta,B+ ,�'dR ZA r4VL`R,4GE. 57"ONE ®''tea SCOLE; l ,u 9/0 L .4T'E /2- /9- B4 rOL,cPrW d7- P,eo&c Cye"/�T/,4N,56,/.V 6MVMFMIN6., INC, NarF, rwl.5 PL,4N Is Nor Q yt oeedlvrY I14 /r'EN4-'',k ave:, AId lEel-111-4,IM4, 4f" r�E .SrSrEM BUT Q VFR1F/CATIO1v OF 7XIe 60C. rlaN Off• T,qF E•.YISTINq sreUcrUl��`s. AOR - 21 - 92 TUE 12 : 58 C A R E Y :f P E D R E L L I P 0 4 t S ..1 � l � C3 3 � � I n 7 z� 11 14 W -- - CL .. r W -1 1- -a . - - - - ri VN Zf XA Guo��r h���6+_� �"` fa..oyr,•�c6� Gee00�/ Al - f a7Y� qPR-21-92 TUE 13:56 POSTFAX NO. 5089770100 P, 01 �... P Tel. (617) 524A710 FAX (617) 524-9201 THE BARLETTA CO. , INC. 10 WHIPPLE AVENUE P, 0, BOX B ROSLINDALE, MA 02131 April 17 , 1992 ._-- Weston & Sampson Engineers Post-It^ brand fax transmittal memo 7671 +r of-pages ► Five Centennial Drive TOMO From Peabody, Massachusetts 01960 C 'ksrN r-E77-,4 co . ;c- /'rrFyFr�vr PS Attn: Mr. James Finegan Dept Re: North Andover W.T.P. pari -69 - 2;991 �5 L. -EA) Doors & Hardware I Dear Jim: Reference is made to your letter dated 3/30/92 regarding the doors and hardware. I In effort to resolve the problem with the less than perfect doors we reluctantly are prepared to revise our original credit of $100. 00 offered thru our January 17, 1992 letter to an amount of three hundrod dollars ($300 . 00) . We hope this will satisfy the town. I v,� y,t ly yours, ETTA CO. , INC . rnest .I Nwanaguy -� Project anagen I EAN:dmb I c Irt✓Ow �'✓ 17- cc : rcc : HCI/Craftsmen Attn: Mr. Joe Izzow''� V � 2 : 58 C A R E Y - P E D R E L L I Tu . 12 : 58 CAIREY -IPEDRELL I P _ 03 f I i J.. ►Z4. '7 r 43,X911Y Sir i 1 1 .tel 3it f • � a fir, I , -�` coral 4-Qy �7' I � 0ES/GN f'L El/,GT/ON AT, ,..,..,(TOf� OF STONES ' N EX1$71 446ri/GT/ON .4T.,,.,..., k'EQ[//CEO F/LL 000 # Commonw © 4 ealth of Massachusetts 1 Executive Office of Environmental Affairs AN©ovER/ Department of ���,IN0FR0OHN�A�t" Environmental Prote ti �� u 199 Govelam F,Weld -- Trudy�Coxe Governor Argo*Pul Celluccl ' 84retery U.Governor Da yid-Comohs SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A /� eCERRTIFICATION Property Address': Ua I`NA�- Address of Owner. Date of Inspection: (?- G (If different) Name of Inspector: 2 1�, @S�n Company Name,Address and Telephone Number. BATESON ENTERPRISES, INC. TEL:(508)475-1.374 5-0 a- L4 IT'19! L-196 o Excavating-Water&Sewer Lines-Septic Systems&Pumping Service FAX:(508)475-5451 CERTIFICATION STATEMENT CCJJ 1 i l Argilla Road Andover,Mass.01810 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 ' poral systems. The system: + r asses T Conditionally Passes OF urther Evaluation By the Local Approving Authority s Inspector's SignatureDate:'The System Inspectorsit co of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the 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. INSPECTION SUMMARY: I Check A, B, C, or:D: A) .SYS SES: . I have 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(Y, 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 exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1048 a Telephone(617)282-5500 iJ Printed on Recycled Paper ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner. Date of Inspection: BI 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 ( g 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 } f C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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. ( t ` 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 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 indieatsr oluu thes)J til tGr+ from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 9) OTHER (revised 11/03/95) 2 I i T SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A IIcy CE(R�TIFICATION (continued) Property Address: tot 3 �(�' ��• f--1'lti �}Q� Owner: �� � Date of Inspection: ; DJ SYSTEM FAILS: I 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 I 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 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 .i 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 wall. 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 I the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall 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 oMee of the Department for further information. (revised 11/03/95) 3 s �Yd SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: c_l 3 sz'-. °V Owner. �,,,(,� Date of Inspection: PIC j Check if the folio ' have been done: _Pump information was requested of the owner, occupant, and Board of Health. one offjthe system components have been pumped for at least two weeks and the system has been receiving normal flow rates d that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As plans have been obtained and examined. Note if they are not available with N/A. i The f ty or dwelling was inspected for signs of sewage back-up. The m does not receive non-sanitary or industrial waste flow e s' as inspected for signs of breakout. All m 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 of construction, dimensions, depth of liquid, depth of sludge,depth of scum. ?,Xmaterial d location of the Soil Absorption System on the site has been determined based on existing information or ap ted by non-intrusive methods. _The facility owner land occupants, if different from owner]were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C n SYSTEM INFORMATION Property Address: I�3 ��• b(,lpif r i DO of Inepeotion:W' FLOW CONDITIONS RESIDENTIAL- Design ESIDENTIADesign flow:. ?gal]ons QS ( Je v��10,A., + Number of bedrooms: } +.Number of current residents: Garbage grinder(yes or no):_Va Laundry connected to system(yes or no): 'S Seasonal use(yea or no):Na Water meter readings, if available: W Iasi date of occu1) c3': 1 J � COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:___.gallons/day Grease.trap present: (yes or no) ! ` a .Industrial Waste'Holding Tank present"(yes'or no) Non•sanitary"waste discharged to the Title 5 system: lyes or noJ_f' Water mete rea , dings,,if available: • Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Systemi pumped as part of inspection: (yes or no) QS If yes, volume pum : 166 o ' Reason for pumping: V\ TYPE OF YS Septic tank/diatribution box/soil absorption system Single cesspool Overflow cesspool Privy �—Shared Jsystem(yes or no) (if yes,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of components,da installed(if known)and source of information: 1QOl>S� (�`�a,A Sewage odors detected when arriving at the site: (yes or no) 0 i (revised 11/03/95) 5 I i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. �C� �+t -2- 1 Date of Inspection: /^ SEPTIC TANK_✓ i ) ; (locate on site plan) 1 f, f 1�p�® \v1l C� uDQ C)N a-` % C'« 169 l � `t Q2 / Depth below grade. V Material of construction:.concrete—metal_FRP—other(explain) Dimensions: D' X S' Sludge depth' i " M Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:: t _ , AC- �1Q�- �1e C Ci Distance from top of scum to top of outlet tee or baffle: tf . � Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pain condition o inlet and outlet tees or baffle , de,th of liqui level in relation to outle invert,st integrity, evide ce of a etc.) (� C. J�1e \ Q O c�'us�e� GREASE TRA'.)00wQ , Ge CCUsKe-j2k--?T)a (locate on plan) Depth below grade: Material of construction:_concrete_metal_FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: r 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.) t (revised 11/03/95) 6 I I j"- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: ` `s . Owner. Date of Inspection: TIGHT OR HOLDING TANK: &P jO, (locate on site plan) Depth below grade: Material of construction: concrete metal_FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day t Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) # f DISTRIBUTION BOX:_V (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if 1 vel and distribution . equal evidence of solids carryov r,evj*ce pf 1 akage into or out .) — ( / ZIAo t \� cQ ° C G PUMP CHAMBER: 9 (lobate on site'plan) Pumps in working order:(yea or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) i I (revised 11/03/95) 7 y n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: Owner. I . Date of Iaspeotion: �/v'C SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) U not determined to be present, explain: Type: leaching pits,number:_ leaching chambers,number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: mme (note eqnditign pf soil ' of hydraulic fail le f ponding, condition o v getati etc.) .o '� �� �V\v�e_ � 'o Ij 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: i + inflow j(cesspool must be pumped as part of inspection) t Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) .v. PRIVXOY�Q^ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments:(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.) (revised 11/03/95) 8 I . ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address: 9 � — Owner. Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �I t, S ` lel A � � � V•� A-A-o53 SC) B4,) P� B B4,) 1 �o�� DLeA` eyio S3 DEPTH TO GROUNDWATER Depth to groundwater: E feet �au� method of determination or approximation: • 1 V (revised 11/03/95) g y � TUE 12 : 57 CARLY --` PEDREL. L I P . 02 I FORM U TOWN OF NORTH ANDOVElt LOT RELEASE FORM i SUBDIVISION .,__..._.._.._. ASSESSORS MAP SUBDIV'ISIO'N LOT(S) PERMANRI ADDRESS ASSIGNED BY 0. 1'.W. ✓STREET , 1UPLZCA1T g 64 ir, . t DATE OF APPLICATION TOWN USE 13ELOWvTI _bt L1 E PLANNING BOARD DATE AF1111kO I.I) TOWN PLANNER UATE REJECTED CONSERVATION COMMISSION U 'E AFFROVEIJ CONSERVATION ADMIN. ATE REJECTLL) BOARD OF HE HEALTI SAND IAN DATE 1t1,J1,C1'L1J i DEPARTMENT OF PUBLIC WORKS,' i DRIVEWAY ,PARMIT SEWER/WATER CONNECTIONS FIRE DEPT. i -- J RECEIVED BY, BUILDING INSPECTION DATE i This form shall be signed by the agents of tilt' k'1;ttttilttit; nsil Itr ri I �E� It1rc1;9 , the Conservation Commission prior to the is+unrncc Qf iany h�� 11cJ inti; Its rm l t n for the subject lot. This form shall not rc lc ive th(� Compliance of any applicable Town requiretnent or Uylaw. i CdllulltlNN�MJill wl AMa�r11rl1utelllt Mug gElCilug�tlg�:i�,of NORTH ANDOVER/ t B04RD OF HEALTH JUL - • g 'ilaltr'UIt'11U —''Sj'iteiii'Lncilla t�l10111l1}, rtullltl�trl , J Cell Vele of 11u10111na ` s << 1`t� lJ fi�1�1r� �r'd111•1 ti1,+ CI• LICElis! NI Sylte111 11ut1111ed r►+t �. Cu111e1tl�.littusle11et1 t�f! • + � �' � , JA • ' �Iit�,lriut ,; 1