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Home My WebLink AboutMiscellaneous - 208 BOSTON STREET 4/30/2018 (2)N_ J O O O w z ori 0m o m North Andover Board of Assessors Public Access ! Page 1 of 1 tMO oTN1 O a•`'■ a NO SwCHus Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial North Andover Board of Assessors �roperty Record Card Location: 208 BOSTON STREET Owner Name: SOLOMON, DORIS H., LT SOLOMON, HENTSCHEL, HARRINGTON Owner Address: 208 BOSTON STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5 - 5 Land Area: 6.61 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1971 sgft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 437,700 448,000 Building Value: 197,700 208,000 Land Value: 240,000 240,000 Market Land Value: 240,000 Chapter Land Value: LATESTSALE Sale Price: 1 Sale 01/04/2006 Date: Arms Length Sale F-NO-CONVNIENT Grantor: SOLOMON, DORIS Code: Cert Doc: Book: 9977 Paee: 38 http://csc-ma.us/PROPAPP/display.do?linkld=1465952&town=NandoverPubAcc 8/10/2009 I Fr t p,SRTI, , Commonwealth of Massachusetts Or,.,.eo ,ittid Board of Health a North Andover 4•, ....•� ;`* ' P.I. Ss.PL.sE�fi F.I. Map -Block -Lot 107.130033 ----------------------- Permit No BHP -2010-0773 ----------------------- FEE DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Cra1g_ Waelty ----------------------------------------------------------------------- to (TANK REPLACEMENT ONLY) an Individual Sewage Disposal System. at No 208 BOSTON STREET $125.00 -------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP -2010-077 Dated--November_24,-2010 -------------------------------- Issued On: Nov -24-2010 Board of Health "4RTh Commonwealth of Massachusetts Map -Block -Lot 107.6 ---------- 0033 Board of Health • North Andover CERTIFICATE OF COMPLIANCE ACM THIS THIS IS TO CERTIFY,That the Individual Sewage Disposal System (TANK REPLACEMENT ONL by... Craig_Waelty--------------------------------------------------------------------------------------------------------------------------------- Installer at No 208 BOSTON 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-2010-077------ Dated--- November _24,-2010 ---------------- ------------------------------------------------ Printed On: Nov -24-2010 Board of Health ---------------------------------------------------------------------------------- Of NORT .1y I 2 V �? • L9 i r Town of North Andover `�'•�;, o:: HEALTH DEPARTMENT ,SSACNUSf� CHECK #: //� DATE: LOCATION: oea�i H/O NAME: CONTRACTOR NAMV: / Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic -Design Approval $� eptic Disposal Works Construcficon (DWC) $1� ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ '70�4 - Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ Application for Septic Disposal System !Construction Permit - TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 $ 250.00 — Full Repair $125.00 - Component 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* 54 Repair or replace an existing system component — What? 2e[C _I:CLK G A. Facility Information 2:0? [�>05T-I)Az Address or Lot # 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ravity (choose one) ***If pump system, attach copy of electrical permit to application*** ®Ko'nventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (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 Address (if different from above) City/Town State Zip Code 79 i+ $ / 15.23 3 7 Telephone Number 3. Installer Information Name Name of Compa y Address 0(0 City/ I own State Zip Code Telephone Number (Cell Phone # if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 '�Application for Septic ®isposal System NOR7 TODAY'S DATE ��AConstruction Permit - TO��N OF ORTH PAGE 2 OF 2 A. Facility Information continued.... 01845 $ 250.00 - Full Repair $125.00 - Component 5. Type of Building: Oresidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal - 1/z 3 /W lz� Nam'? --Date Gr Applic t 7 By: ( rd of Health Representative) // /�� d Na Date `Application Disapproved for the following reasons: For Office Use Only: L Fee Attached. Yes No 2. Project Manager Obligation Form AttachedP Yes No J. Pump Svstem? If so, Attach copy ofElectrical Permit Yes No 4. Foundation As -Built? (new construction ronly) (Same scale as approved plan) Yes No 5. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, September 14, 2010 8:18 AM To: DelleChiaie, Pamela Subject: RE: 208 Boston Street - Sally Hentschel FYI I called. All set From: Sawyer, Susan Sent: Monday, September 13, 2010 12:58 PM To: DelleChiaie, Pamela Subject: RE: 208 Boston Street - Sally Hentschel I spoke with her. Please print out these T -V's and put in file. Also note that this tank at this address does need replacing so you can keep the file out front. Thx S From: DelleChiaie, Pamela Sent: Tuesday, August 31, 2010 11:31 AM To: Sawyer, Susan Subject: 208 Boston Street - Sally Hentschel Phone: 339.788.3397 - cell Phone: 781.871.3837 — home — Rockland, MA Mrs. Hentschel called with questions about her Title 5 report. I did not have a copy of it in the file. Therefore she sent it to me electronically. I printed it out and will bring it into you with the file folder. Would you please call her to follow-up on her questions? You can reach her on her cell phone today. Thank you. __P Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA o1845 ph: 978-688-9540 fax: 978-688-8476 "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. "--Anonymous Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. �r DelleChiaie, Pamela From: Bill and Sally Hentschel [sashw2h@msn.com] Sent: Tuesday, August 31, 2010 2:52 PM To: DelleChiaie, Pamela Subject: Title V inspection for 208 Boston Street -- System 1 -- Pages 1-5 Attachments: Title 5 Inspection -- 208 Boston St -- System 1, Pg 1 Jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 2.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 3.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 4.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 5.jpg Hi Pamela, For your records, I'm sending the Title V inspection report for System #1 (the smaller of the two) at 208 Boston Street. This should be on file with your office as well as the System #2 file sent earlier today. Thanks for you help, Sally Hentschel DelleChiaie, Pamela From: Bill and Sally Hentschel [sashw2h@msn.coml Sent: Tuesday, August 31, 2010 2:57 PM To: DelleChiaie, Pamela Subject: Title V inspection report for 208 Boston Street -- System 1 -- Pages 11-15 Attachments: Title 5 Inspection -- 208 Boston St -- System 1, Pg 11.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 12.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 13.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 14.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 15.jpg DelleChiaie, Pamela From: Bill and Sally Hentschel [sashw2h@msn.com] Sent: Tuesday, August 31, 2010 2:54 PM To: DelleChiaie, Pamela Subject: Title V inspection report for 208 Boston Street -- System 2 -- Pages 6-10 Attachments: Title 5 Inspection -- 208 Boston St -- System 1, Pg 6.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 7.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 8.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 9.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 10.jpg Ot NOR7p ,� 5315 13 Town of North Andover HEALTH DEPARTMENT SACHUSf CHECK #: DATE: xall,�11,141'-2 LOCATION: H/O NAME: �! CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction Q SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑�ttle nsp for $ eport ❑ Other. (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 41M Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ILEI r + Commonwealth of Massachule-etts' Title 5 Official Inspection Fo Subsurface Sewage Disposal System Form - Not for Voluntary j 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner's Name North Andover MA 01845 City/Town State Zip Code DEC 14 wo 12/4/2010 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Benjamin C. Osgood, Jr. Name of Inspector none Company Name 16 Hillside Avenue, Unit 3 Company Address Amesbury City/Town 508-328-4633 Telephone Number B. Certification MA 01913 State Zip Code 870 License Number I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspecto s Signature 12/4/2010 Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner Owner's Name information is required for North Andover MA 01845 12/4/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 1"Voffij Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner's Name North Andover MA 01845 12/4/2010 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: EJ 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner's Name North Andover City/town B. Certification (cont.) MA 01845 State Zip Code 12/4/2010 Date of Inspection 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to 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 '/2 day flow E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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 ❑ Z the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts r Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner information is Owner's Name required for North Andover MA 01845 12/4/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of 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 1 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. '[This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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 ❑ Z the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner Owner's Name information is required for North Andover MA 01845 12/4/2010 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner Owner's Name information is required for North Andover MA 01845 12/4/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Dwelling has two separate systems. System # 1 consists of a 1000 gallon septic tank and two trenches and is locatedto the left of the garage. System # 2 consists of a new 1500 gallon tank and two trenches and is located to the rear left of the dwelling. Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: ❑ Yes ® No current Date Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: ❑ Yes ® No current Date Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner Owner's Name information is required for North Andover MA 01845 12/4/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date Unknown for system 1. Within 2 weeks for system 2 which has a new septic tank gallons Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Yes ® No ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Both systems are of the same configuration Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner Owner's Name information is required for North Andover MA 01845 12/4/2010 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: unknown Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): ❑ Yes ® No System 1 -1.5' system 2 - 2' feet Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipe OK in garage for system 1 and basement for system 2 Septic Tank (locate on site plan): Depth below grade: Material of construction: sytem 1 -1' system 2 - 2' feet ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) System #1 is a 1000 gallon round tank. System # 2 is a 1500 gallon tank with 2 risers to just below If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons/1500 Gallons Sludge depth: 3"/0" Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner's Name North Andover MA 01845 12/4/20 Cityrrown State Zip Code Date of Ir D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 38"/36" Scum thickness 111/0" Distance from top of scum to top of outlet tee or baffle 8"/8.. Distance from bottom of scum to bottom of outlet tee or baffle 10'712" How were dimensions determined? Measure Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank #1 in good condition. Concrete tee in good condition. Tank #2 is new with new sch 40 PVC tees. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner Owner's Name information is required for North Andover MA 01845 12/4/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No XA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner Owner's Name information is required for North Andover MA 01845 12/4/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0"/0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box #1 in good condition. Distribution equal. No evidence of soilids carryover or leakage in or out. Box #2 in good condition. Distribution equal. No evidence of solids carryover or leakage in or out. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner Owner's Name information is required for North Andover MA 01845 12/4/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system 2 trenches/2 trenches Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Area of both leach field looks normal. No evidence of ponding, damp soil, or unusual vegetation. Cesspools (cesspool must be pumped as part of inspection) (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 ❑ Yes ❑ No Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner's Name North Andover MA 01845 12/4/2010 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington and Sally Hentschell Owner Owner's Name information is required for North Andover MA 01845 12/4/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand -sketch in the area below f-1 drawing attached separately brsTR�-tES '2-T1 IZ 1 I -_T2 34,5 2 -TZ -Zl•4 ' DCt1L D Pj 28�y � I I T2 t� 2 uv Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner Owner's Name information is required for North Andover MA 01845 12/4/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated de th to hi h round water' 4 p to g feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record ►1 If checked, date of design plan reviewed: Date Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database - explain: usgs maps You must describe how you established the high ground water elevation: Both system built very close to the old original grade. Inspector knowledge of the area is that water tables are between 4 and 5 feet below the old original grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. a r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Street Property Address Richard Soloman, Cynthia Harrington, and Sally Hentschell Owner's Name North Andover MA 01845 12/4/2010 Owner information is required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file PUBLIC HEALTH DEPARTMENT Town of forth Andover Community Development Division fE12,7IFICAq Off' COMPLIANCE As of: December 7, 2010 This is to cenify that the individuaCsu6surface dirposaCsystem received a SA7ISTAC2ORT 19VS(EC 7ON of the: 2t p1acement of an M-20 Septic 2'anJ�,+ for an On -Site Sew, age �osa[Svem By: �+9 (S4ppWae)�h' 208 Boston Street 9Kap-107.8 TarceC— 0033 NoithAndover, WA 01845 2re Issuance of this certijicate shaft not 6e construed as a guarantee that the system wilt' function 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 0R f t a , n PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division ffA. j RTj(FjCAq-(P o� � Co��rA�vCE As of: December 7, 2010 This is to cenify that the individualsubsurface d4osaCsystem received a SATTSTACT0RT 15VSPEC 707 of the: ft&cement of an M-20 ,peptic 2ankfor an On -Site Sewage osa[System By: crat iSkfP�'Waefty At: 208 Boron Street 9Wap--10ZB Tarcel— 0033 NorthAndover WA 01845 The Issuance of this certificate shall not be construed as a guarantee that the system will function St&Ain 1Y. Saw ft6& mea" 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnarthandover.com •. ^� �.' .., ,. � "'",� •, Vic. x h t � PUBUC HEALTH HPARTMENT Town of North AaJover Community Development Division FgT7�F'ICAq OfC09y1'LIANCE As of: December 7, 2010 9his is to cert that the individual subsurface d4osa(system received a SATISTACTORTINYPEM05V of the: ft&cement of an -20 Septic Tankfor an On -Site Sewage O oSa[System By: Cra+y (S4p)'waeft,' 208 Boston Street 9Wap-107. B Farrel- 0033 NorthAndover, WA 01845 The Issuance of this certificate shall not 6e construed as a guarantee that the system will' function Susan ey Saw M& Mea" 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com PRINTED BY: Pamela DelleChiaie - PLEASE LEAVE IN PRINT-OUT TRAY....... THANK YOU. DelleChiaie, Pamela From: Sawyer, Susan Sent: Friday, December 03, 2010 10:50 AM To: DelleChiaie, Pamela Subject: RE: certificate of compliance for new septic tank -- 208 boston st Fyi, thx From: Bill and Sally Hentschel Lmailto:sashw2h@msn.com1 Sent: Friday, December 03, 2010 10:36 AM To: Sawyer, Susan Subject: Re: certificate of compliance for new septic tank -- 208 boston st Thank you! Yes, we have a signed purchase and sale and the closing is tentatively scheduled for December 15. If the certificate can be ready nest week, that will work fine. Best regards, Sally Hentschel ----- Original Message ----- From: Sawyer, Susan To: 'Bill and Sally Hentschel' Cc: DelleChiaie, Pamela Sent: Friday, December 03, 2010 10:29 AM Subject: RE: certificate of compliance for new septic tank -- 208 boston st Thank you. It will be ready next week. Is there a closing date pending? Susan Sawyer Health Director From: Bill and Sally Hentschel jmailto:sashw2h@msn.coml Sent: Friday, December 03, 2010 10:18 AM To: Sawyer, Susan Subject: certificate of compliance for new septic tank -- 208 boston st Dear Ms. Sawyer: My contractor, "Skip" Waelty, has offered to pick up the certificate of compliance for the replacement of a septic tank at my house at 208 Boston Street. I am writing to give my permission for you to give the certificate to him. Thank you, Sally Ann Hentschel Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: hftp://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. I OF I DelleChiaie, Pamela PRINTED BY: Pamela DelleChiaie - PLEASE LEAVE IN PRINT-DUT TRAY....... THANK YOU. DelleChiaie, Pamela From: Sawyer, Susan Sent: Friday, December 03, 2010 10:30 AM To: 'Bill and Sally Hentschel' Cc: DelleChiaie, Pamela Subject: RE: certificate of compliance for new septic tank -- 208 boston st Thank you. It will be ready next week. Is there a closing date pending? Susan Sawyer Health Director From: Bill and Sally Hentschel jmailto:sashw2h@msn.coml Sent: Friday, December 03, 2010 10:18 AM To: Sawyer, Susan Subject: certificate of compliance for new septic tank -- 208 boston st Dear Ms. Sawyer: My contractor, "Skip" Waelty, has offered to pick up the certificate of compliance for the replacement of a septic tank at my house at 208 Boston Street. I am writing to give my permission for you to give the certificate to him. Thank you, Sally Ann Hentschel Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. I OF I DelleChiaie, Pamela PRINTED BY: Pamela DelleChiaie - PLEASE LEAVE IN PRINT-OUT TRAY....... THANK YOU. DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, December 06, 2010 8:41 AM To: DelleChiaie, Pamela Subject: 208 Boston Road Tank repair Attachments: 20101203094919.jpg; 20101203094838.jpg Please add to the file. All set to issue. I sent the info Friday. Please let Skip know when it will be available to pick up. thx S -----Original Message ----- From: Skip Waelty jmailto:skipwaeltykcomcast.netl Sent: Friday, December 03, 2010 10:07 AM To: Sawyer, Susan Subject: Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/vreidx.htm. Please consider the environment before printing this email. I OF I DelleChiaie, Pamela •FF'r .r� ._ ,w 'r �.V�a 'tom 7��.3�" r•'' � ',`�.�� .g,��..«. �;'�,; ' .r� ':.' �C Y� Ti«,' iq `Fw `Vji •c. W�F-� � ,4 - y �. Jr �{,� � •"IIy �' _ '�J�' 4. 'f`,R 7b- (�„� t. e.,'447 (F � +p,'dl .�1� A �te�.ss�Y1'�t � �.� k •�.sy. f"9:�`p4e L•3* u:.. �`jJ..f�+�xyj'y��1`r.��'{y,�,�"�' 'u� �,`�°? e � {. iAi`1, l+'~ �� p �' 1 V' °C � � + A�,R•�F �W�"`= y } , try ' 1 � ♦ 'xC � �(S fv� '4! �y,� � �. SC =1� 1'r fi rS '3 �'tl x w iNr 'a.• r� 'a�-.t;,,'�'4�r]i.,�4� �`�.,,�.� q- -ss` �i • M. '•�v��'�7fx (9'w't,. Edi �t.'� .1 9..�7 " 41 r• � tib' Sii • , �� yfP _�'�• �'•iS, . ' • it ♦ •. [y . . L `^j, � `� \r�w� �"' '� og�•�:':h � �"' � ' � "� „-�S, � -^ '^.r.y,�._.rr'^ ' `rzl r � � .!`•'�.� i� `�{. � �'[' Sk. t' . 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St'" N, �� t '� fi� {' �'"• t t i -Vol 1 , w tae K aft" • "4•�1 tr�`y�, dfa'r T- :;f�.. f " pORTF1 r6q�� OL F• t 70 O�_ [OCMICMIwK�t 1' PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: MAP INSTALLER:�1 �--- DESIGNE PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: LOT: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base K—/ ❑ Cleanouts per plan Bottom of tank hole has 6" stone base Weep hole plugged 1P gallon tank has been installed loading �� ❑ Monolithic tank construction ❑ Watertightness of tank has been achieved by 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, November 12, 2010 11:32 AM To: 'valerie.previte@century21.com' Subject: I.R. - 208 Boston Street - Septic Information Attachments: Title V inspection report for 208 Boston Street -- System 1 -- Pages 11-15; Title V inspection report for 208 Boston Street -- System 2 -- Pages 6-10; Title V inspection for 208 Boston Street -- System 1 -- Pages 1-5; Title V Report for 208 Boston Street -- Pages 11-15; Title V inspection for 208 Botston St. -- Pg 1-5; Title V Report for 208 Boston Street -- Page 6-10 Hello Valerie, Thank you for your patience this morning. I am just unable to make sense of these reports with the way they are printing for me, so I hope that you have better luck--! Here they are electronically. Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 2 Office - 978-688-9540 2 Fax - 978-688-8476 0 Email - pdellechiaie@townofnorthandover.com '1� Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. "--Anonymous DelleChiaie, Pamela From: Bill and Sally Hentschel [sashw2h@msn.com] Sent: Tuesday, August 31, 2010 2:52 PM To: DelleChiaie, Pamela Subject: Title V inspection for 208 Boston Street -- System 1 -- Pages 1-5 Attachments: Title 5 Inspection -- 208 Boston St -- System 1, Pg 1 Jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 2.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 3Jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 4.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 5•jpg Hi Pamela, For your records, I'm sending the Title V inspection report for System #1 (the smaller of the two) at 208 Boston Street. This should be on file with your office as well as the System #2 file sent earlier today. Thanks for you help, Sally Hentschel DelleChiaie, Pamela From: Bill and Sally Hentschel [sashw2h@msn.com] Sent: Tuesday, August 31, 2010 2:52 PM To: DelleChiaie, Pamela Subject: Title V inspection for 208 Boston Street -- System 1 -- Pages 1-5 Attachments: Title 5 Inspection -- 208 Boston St -- System 1, Pg 1 Jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 2.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 3.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 4.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 5.jPg Hi Pamela, For your records, I'm sending the Title V inspection report for System #1 (the smaller of the two) at 208 Boston Street. This should be on file with your office as well as the System #2 file sent earlier today. Thanks for you help, Sally Hentschel DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, September 13, 2010 12:58 PM To: DelleChiaie, Pamela Subject: RE: 208 Boston Street - Sally Hentschel I spoke with her. Please print out these T -V's and put in file. Also note that this tank at this address does need replacing so you can keep the file out front. Thx From: DelleChiaie, Pamela Sent: Tuesday, August 31, 2010 11:31 AM To: Sawyer, Susan Subject: 208 Boston Street - Sally Hentschel Phone: 339.788.3397 - cell Phone: 781.871.3837 — home — Rockland, MA Mrs. Hentschel called with questions about her Title 5 report. I did not have a copy of it in the file. Therefore she sent it to me electronically. I printed it out and will bring it into you with the file folder. Would you please call her to follow-up on her questions? You can reach her on her cell phone today. Thank you. __P &a ReP464, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 ph: 978-688-9540 fax: 978-688-8476 "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. "--Anonymous Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. DelleChiaie, Pamela From: Bill and Sally Hentschel [sashw2h@msn.com] Sent: Tuesday, August 31, 2010 2:57 PM To: DelleChiaie, Pamela Subject: Title V inspection report for 208 Boston Street -- System 1 -- Pages 11-15 Attachments: Title 5 Inspection -- 208 Boston St -- System 1, Pg 11.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 12.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 13.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 14.jpg; Title 5 Inspection -- 208 Boston St -- System 1, Pg 15.jpg owner information is required for every page. Important: When Poing out fortes on the computer, use only the tab key to move your cursor • do not use the return key. VQ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam - Not for Voluntary Assessments 208 Boston Stret sy 3TirM © IF 2— Property Property Address Richard Soloman Owners Name No. Andover cityrrown MA 01845 5/8/08 state zip Code Date of inspection Inspection results must be submitted on this form. Inspection forms may not be altered In any way. A. General Information 1. Inspector. Beniamin C. Osgood. Jr. Name of Inspector New England Engineering Services, Inc. Company Nam 1600 Osgood Street Suite 2.64 60 �- No. Andover Cityfrmn 978-686-1768 Telephone Number B. Certification MA 01845 state Zip code License Number certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system Inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: asses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority )9� e*— V � .2 Inspector ignature 3—Z$— 08 Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report do the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ''"This report only describes conditions at the time of Inspection and under the conditions of use at that time. This inspection does not address how the system will perform In the future under the same or different conditions of use. owner infom pion is required for every pap. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dlsposal System Form - Not for Voluntary Assessments 208 Boston Stret Property Address Richard Soloman owners Name No. Andover MA 01845 5/8/08 City/Tom state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ave not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: �T�M 4S ec.D AAIfl rt'f A> nss i 8 r FXPeRiCA-*c P4 04 B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass° section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If "not. determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or extiltration or tank failure is imminent System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): 0 F broken pipe(s) are replaced obstruction is removed ,C\ Commonwealth of Mawmchuseft Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Stret property Address Richard Soloman Owner Owner's Name required fo � No. Andover MA 01845 518/08 required for every Page. Ckyrro" Stage zip Code Date of inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation Is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1Nb) that the system Is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a sart marsh 2. System will fail unless the Board of Health (and Public Water Supplier, N any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection` Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Stret Property Address Richard Soloman Owner's Name No. Andover MA 01845 5/8/08 cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation Is Required by the Board of Health (cont): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"« Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for ALI inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 8- Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 201- 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 % 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 SAS, cesspool or privy is below high ground water elevation. ❑ 2-11 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Banton Stret Property Address Richard Soloman Owner Owners Name information is No. Andover MA 01845 518108 required for every page. cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ go" Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [a- Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ GJ--� Any portion of a cesspool or priory is less than 100 feet but greater than 50 fleet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. Gk The system ffils. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either °yes' or one to each of the following, in addition to the questions in Section D. Yes No ❑ [ the system is within 400 feet of a surface drinking water supply ❑ Q^ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes* to any question in Section E the system is considered a significant threat, or answered "yes' in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Owner information is required for every page - Important: When filing out forms on the computer, use only the tab key to move your cursor • do not use the return key. Yh Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Stret Property Address Richard Soloman Owner's Name No. Andover Cityrrown S C> t= MA 01845 5/8108 State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered In any way. A. General Information 1. Inspector. Benjamin C Osgood, Jr Name of Inspector New England Engineering Services, Inc. Company Name 1600 Osgood Street Suite 2-64 Company Address No. Andover ttrRown 978-686-1768 Telephone Number B. Certification MA state License Number 01845 zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: asses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9--� v D .2 inspector' ignabrre 's -2s-08 Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "*"This report only describes conditions at the time of Inspection and under the conditions of use at the time. This inspection does not address how the system will perform In the future under the same or different conditions of use. Commonwealth of Massachusetts Title 5 Official Insp Subsurface Sewage Disposal System Form 208 Boston Stret B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No [Q' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 9- 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 fleet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ D1*1 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ a The system fes. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ [ the system is within 400 feet of a surface drinking water supply ❑ Q^ the system is within 200 feet of a tributary to a surface drinking water supply ❑ Cj--' the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department ection Form - Not for Voluntary Assessments Property Address Richard Soloman Owner Owner's Name infom ation is No. Andover MA 01845 518/08 required for wry pop- CitylTovm stateZip Code pate of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No [Q' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 9- 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 fleet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ D1*1 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ a The system fes. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ [ the system is within 400 feet of a surface drinking water supply ❑ Q^ the system is within 200 feet of a tributary to a surface drinking water supply ❑ Cj--' the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Stret Property Address Richard Soloman Owner Owner's Name infmmabon is No. Andover MA 01845 5/8/08 required for City/Tovvn state zip Code Date of Inspection every page. B. Certification (cont.) B) System conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation Is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1 Nb) that the system Is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of 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 any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. owner infomratbn is required for every pap. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Stret Property Address Richard Soloman owner's Name No. Andover Ckyrrown B. Cer'tif catioft (Cont.) MA 01845 5/8/08 state Zip Code Dabs of Inspection Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: R i shave not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: AA1fl y" A4 ✓tai i� �� vr►g �.. c s ~ d"T 77I1-1 -77,44d B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If °not determined,* please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltrabon or tank failure is imminent System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): U W broken pipe(s) are replaced obstruction is removed Commonwealth of Massachusetts Title 5 Official Insp Subsurface Sewage Disposal System Form 208 Boston Stret B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [� Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ U-*' Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes N the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ a The system b—Ift.1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility, with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either °yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ [.� the system is within 400 feet of a surface drinking water supply ❑ Q^ the system is within 200 feet of a tributary to a surface drinking water supply ❑ Cl--- 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 If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in acoordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. ection Form - Not for Voluntary Assessments Property Address Richard Soloman Owner Owner's Name information isrequired No. Andover MA 01845 5/8/08 f6r wry PW. Cdyfrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [� Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ U-*' Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes N the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ a The system b—Ift.1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility, with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either °yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ [.� the system is within 400 feet of a surface drinking water supply ❑ Q^ the system is within 200 feet of a tributary to a surface drinking water supply ❑ Cl--- 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 If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in acoordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Owner information b required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foran - Not for Voluntary Assessments 208 Boston Stret Property Address Richard Soloman owner's Name No. Andover MA 01845 5/8/08 City/Town State zip Code Date of Inspedion D. System Information (cont.) NIA. Cesspools (cesspool must be pumped as part of inspection) (locate on site plah): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N 14 Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Commonwealth of Massachusetts Title 5 Official Insp Subsurface Sewage Disposal System Fa 208 Boston Stret D. System Information (cont.) N JA- Tight or Holding Tank (coni~) Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert b t Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): �.> X t ti D K GD rJ fl •'i�,n. r aTR.�{3 Jit �t t Q.,�.4 i=- AeQ SJR D ,&%cc o f d X G� ou-tic,. m) ra Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. 0 Yes ❑ No ection Form - Not for Voluntary Assessments Property Address Richard Soloman Owner Owners Name information is required for No. Andover MA 01845 5/8/08 every page. CityITown State Zip Code Date of Inspection D. System Information (cont.) N JA- Tight or Holding Tank (coni~) Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert b t Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): �.> X t ti D K GD rJ fl •'i�,n. r aTR.�{3 Jit �t t Q.,�.4 i=- AeQ SJR D ,&%cc o f d X G� ou-tic,. m) ra Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. 0 Yes ❑ No jQN Commonwealth of Massachusetts IFTitle 5 Official Inspection Form Subsurface Sewage Disposal System Foran - Not for Voluntary Assessments 208 Boston Stnet Property Address Richard Soloman Owner Owner's Name requir efotion is No. Andover MA 01845 5/8/08 required for every page. City/Town state Zip Code Date of Inspection D. System Information (Cont.) I.! JA- Tight or Holding Tank (cont.) Dimensions: Capacity: Design Flow: Alarm present Alarm level: Date of last pumping: gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? Distribution Box (if present must be opened) (locate on site plan): ❑ Yes ❑ No Depth of liquid level above outlet invert d t Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 1;.>X t,-; a K Gdri Q , M ^.b i ctAL3J'�� a t Q�.4c AI'Q rh'-N D #Acc o F Lcr4-tAr4frE d>x c'� 6U4 --t. m) va Pump Chamber (locate on site plan): Pumps in working order. ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 208 Boston Stret Property Address Richard Soloman owner Owners Name intmquir a for r3 No. Andover MA 01845 5/8/08 required for every PW. CkYrra" state ZIPde CoDate of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. -TgNK M ect Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Stret Property Address Richard Soloman Owner Owner's Name information is No. Andover MA 01845 5/8/08 required for wry page. C4rrown state zip Code Date of Inspection D. System Information (cont.) "IA- Cesspools (cesspool must be pumped as part of inspection) (locate on site plah): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N 14 Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Stret Property Address Richard Soloman Owner Owners Name hftrmaftn is No. Andover MA 01845 5/8/08 very p forage. eCRyrrown Stats Zip Code Dabs of Inspeftn every p D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑■ NN ❑6 Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) Q( Accessed USGS database - explain: You must describe how you established the high ground water elevation: V SC.r� itX"s t N p% c 4fL—F Es K 4w i s C_ O, b e la..,, 4 1*0,00.'fl Sys m cM-o" 3 96 e�o.✓ -c M.,.A n. Ma V%510A%. Ems•otwcc d V- PA -$ i AAC(L.aP Du E- s` w or�Yt 'T'rPi• 8 tE rt o w C 'tfLt27*F % o n Commonwealth of Massachusetis Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Boston Stret Properly Address Richard Soloman Owner Owner's Name information is No. Andover MA 01845 5/8/08 required for State Zip Code Date of inspection every pale. City/Town D. System Information (corn.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Aibsorptlon System (SAS) (locate on site pian, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number. ❑ leaching chambers number. ❑ leaching galleries number: leaching trenches number, length: ❑ leaching fields number, dimensions: Cl overflow cesspool number ❑ innovative/aitemative system Type/name of technology: y.✓Kara —.v Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): M-&+ O ?'- t k r`PM i.00 Kr 0 (L._ S ?�b NdIF I A. CL CA.a _ OR V Nuav PtL uG(r[igrna" Commonwealth of Massachusetts Title 5 Official Insp Subsurface Sewage Disposal System Foam 208 Boston Street D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: ection Form - Not for Voluntary Assessments ❑ leaching pits number: ❑ leaching chambers Property Address ❑ leaching galleries number: Richard Soloman leaching trenches number, length: Owner Owner's Name number, dimensions: ❑ required for requir reqdonuired No. Andover MA 01845 5/8/08 evvy PW- Ckyrrown State Zip code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): P4:a+ �sZ�M i.Ot3 Yr✓ n I!._ S Tb tirr l > CL r—&4A-J dv0 D Q•.1 N� Ey �D t/�t� C� � }�J N.p.�.� � p r4.M P t 4� L , pi 0 VuaJA'L VG&.[ T)0rna" Type: ❑ leaching pits number: ❑ leaching chambers number. ❑ leaching galleries number: io leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): P4:a+ �sZ�M i.Ot3 Yr✓ n I!._ S Tb tirr l > CL r—&4A-J dv0 D Q•.1 N� Ey �D t/�t� C� � }�J N.p.�.� � p r4.M P t 4� L , pi 0 VuaJA'L VG&.[ T)0rna" :Re 00 OeRhi I 1. 1 Qt QTOY� A. F a- 71 1 T Hon NOV 10 2009 C57, m n QM Cl R AV, Io o'. Ic. X PH H'g S E T-7 4.11 '.. ' • '•'.,,1�::'.r. ,f 1:1,1,1•• �•� L9 YP f 91 ly $wic Te T T -7m e" Y44 '-; yo, CD No -t� MMA ma �yj N 7.7n7l -, - — , , , � I� TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD I).A TF : D ,YSTEM OWNER & ADDRESS /o . '7�� SYSTEM LOCATION (example: left front of house) j�,f� �,sr l U:a'I'E OF PUMPING: Q'� ✓ `09 QUANTITY PUMPED %&E -D GALLU-.') C. I'SSPO0L: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS GOOD CONDITION FULL TO COVER HEAVY CREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER �JJHER (EXPLAIN) i >>"1 LM PUMPED BY:7 ��`�1�'Yl V C.UN1'vIENTS: (.UN"I'ENTS TRANSFERRED'T'O: April 8, 1961 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Boston Street building site of Sam G. Solomon. The land in general is high. The subsoil in the area was of clay content and a 7 --minute percolation test was conducted. It is recommended that a 1,000 gallon concrete septic tank be installed together with 200 lineal feet of drain pipe. Very truly yours, W�C"4William . i co WJD:hd � _."Z' y � �t- APPLICATION FOR SEWAGE DISPOSAL INSTALIATION HEALTH DEPARTMENT - NORTH ANDOVER IHSS. I hereby make app ication for permit for a cordance with all the laws of the Commonwealth of the Board of Health of the Town of North Andover. sewage disposal installation at will install this system in ac - Massachusetts and regulations of Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of�in size. A manhole (s) permitting easy cleaning will be provided with remova a cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of G v lineal (egtere) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DA TE l D /2/,/ Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE_ o S gnature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DA Signature of Adpecting Officer Percolation Tes t� Garbage Grinder ' 1 0 -7� BOARD OF HEALTH TORN OF' NORM ANDOVERV MASS. f yyyy _ M r �O 1000(SAL,GOC, Sr-DTIC-r4Qk 2a' n 137 DATE � . 2. ADDRESS . , /Z4, CSL ' LCT N0. . . . . . . TEL. 0:r ; ; 3. N0. OF BEDROOMS :: DEN YES NO.. 4. GARBAGE GRINDER YES . . . NO.. X. . . 5. SHOW DIi. PSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DITJ ENSIOM OF LOT / $. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL q. NOTE LOCATION AND DISTANCE OF WELL FROR:T SEWMAGE SYSTEM 10. SHOW LOCATION OF BROOKSt STREAh'S! DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TAM{ OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD HE READ CAREFULLY. DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: s ugust 31, 2010 11: F� To: Sawyer, Susan Subject: 208 Boston Street - Sally Hentschel Attachments: 'Title V-Reeport fo os on Street -- Pages 11-15; Title V inspection for 208 Botston St. -- g -5; Title Report for 208 Boston Street -- Page 6-10 Phone: 339.788.3397 - cell Phone: 781.871.3837 — home — Rockland, MA Mrs. Hentschel called with questions about her Title 5 report. I did not have a copy of it in the file. Therefore she sent it to me electronically. I printed it out and will bring it into you with the file folder. Would you please call her to follow-up on her questions? You can reach her on her cell phone today. Thank you. NNP &a Reqdsd4, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA o1845 ph: 978-688-9540 fax: 978-688-8476 "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. "--Anonymous DelleChiaie, Pamela From: Bill and Sally Hentschel [sashw2h@msn.com] Sent: Tuesday, August 31, 2010 10:52 AM To: DelleChiaie, Pamela Subject: Title V inspection for 208 Botston St. -- Pg 1-5 Attachments: Title 5 Inspection -- 208 Boston St -- System 2, Pg 1 Jpg; Title 5 Inspection -- 208 Boston St -- System 2, Pg 2.jpg; Title 5 Inspection -- 208 Boston St -- System 2, Pg 3.jpg; Title 5 Inspection -- 208 Boston St -- System 2, Pg 4.jpg; Title 5 Inspection -- 208 Boston St -- System 2, Pg 5.jpg Hi Pamela, Here are the first 5 pages. The report talks of "system 2" -- That's because we have 2 septics. I guess you don't have either report? Anyway, the #2 system is the one I have the question about. Let me know about the second report, and I'll send that later this afternoon if you need it. Thanks for your help, Sally Hentschel belleChiaie, Pamela From: Bill and Sally Hentschel [sashw2h@msn.com] Sent: Tuesday, August 31, 2010 10:58 AM To: DelleChiaie, Pamela Subject: Title V Report for 208 Boston Street -- Pages 11-15 Attachments: Title 5 Inspection -- 208 Boston St -- System 2, Pg 11.jpg; Title 5 Inspection -- 208 Boston St -- System 2, Pg 12.jpg; Title 5 Inspection -- 208 Boston St -- System 2, Pg 13.jpg; Title 5 Inspection -- 208 Boston St -- System 2, Pg 14.jpg; Title 5 Inspection -- 208 Boston St -- System 2, Pg 15.jpg