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HomeMy WebLinkAboutMiscellaneous - 221 FARNUM STREET 4/30/2018 221 FARNUM STREET 210/107.-A-0053-0000.0 4 ` North Andover Board of Assessors Public Access Page 1 of 1 pORTit North Andover Beard of Assessors Of 4•�ao<�1�0 3?��;d. ...w.•� Ot r �Ow�no✓•'tom COW aiProperty Record Card Click Seal To Return Parcel ID :210/107.A-0053-0000.0 FY:2009 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e Search for Parcels Search for Sales Summary Residence Detached Structure Condo 221 FARNUM STREET Commercial Location: 221 FARNUM STREET Owner Name: RUCKER,JOAN A. Owner Address: 221 FARNUM STREET City: NORTH ANDOVER State: MA Zip: 01845 eighborhood: 5.-5 Land Area: 1.00 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2704 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 517,100 533,900 Building Value: 319,700 336,500 Land Value: 197,400 197,400 Market Land Value: 197,400 Chapter Land Value: LATEST SALE Sale Price: 110,000 Sale Date: 11/29/2007 Arms Length Sale A-NO-FAMILY Grantor: RUCKER,JEFFREY K. Code: Cert Doc: Book: 10984 Page: 011 I http://csc-ma.us/PROPAPP/display.do?linkld=1465685&town=NandoverPubAcc 4/9/2009 ' r a .f MAP # LOT #__ - .__._._......._....... ......__.........._._....._............ PARCEL # __-- STREET._._._ _ ---.... .�... . _.. CONSTRUCTION APPROVA HAS PLAN REVIEW FEE BEEN PAID? NO �'V;t PLAN APPROVAL: DATE ��Z/ _z�— APP. BY... DESIGNER: J� ��G�'S PLAN Dn f E;____ /Z,��Z_ CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMIT DRILLER WELL TESTS: CHEMICAL DATE AI'{�fZUVED...._.__........__..__._.....__. BAC"IERIA I DALE OPPRUVED BAC IA II DATE APPROVED COMMENTS: FORM U APPROVAL: APPROVAL 1'U ISS = YE U DATE ISSUED CONDITIONS: O�_._G_�..._. FINAL APPROVAL: ALL PERMITS PAID < ES > NO WELL CONSTRUCTION APPROVAL Yc NO SEPTIC SYSTEM CONSTRUCTION APPROVAL _ YES NO OTHER -S NU ANY VARIANCE NEEDED YES NU FINAL BOARD OF HEALTH APPROVAL: DA1'E:. �_ Z ..,BY: w SEPTI-Q 5_Y_SZE.M_-LW5..T.-9.4.L,.A IS., THE. INSTALLER LICENSED? YES NO TYPE. OF CONSTRUCTION: <� NL-W REE SIR NEW CONSTRUCTION: CERTIFIED PLOT PLnN REVIEW Y1=s IJO CONDITIONS OF APPROVAL YE NO (FROM FORM U) ISSUANCE OF DWC PERMIT (::Y::E , NO DWC PERMIT N0. INSTALLER: �Ia na,- - ---- BEGIN .INSPECTION YES 0: i .EXCAVATION . INSPECTION: NEEDED: . ,. . .. PASSED lr� /�` BY --------------___---._..---------- CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: YES• —_,___- _._.___– APPROVAL TO BACKFILL: DATE: BY FINAL GRADING APPROVAL: DATE BY ----- ------ FINAL CONSTRUCTION APPROVAL: DATE: 8�7 _BY_ 'm_____—,___ 4leed &?sermer 1 v!2 -e' : 3470 hJ Of ORT:1h V 7 ' O F? AL : Town of North Andover HEALTH DEPARTMENT eSS"CHU CHECK#: LOCATION: H/O NAME: ` CONTRACTOR NAME: f Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ 'r ❑ Body Art Practitioner $ 'r ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ 4 ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5,,Inspector $ ©"Title 5 Report $ ❑ Other.(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer R DC, 4-Ir Commonwealthdof Matasachusetts G (c#c W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No. Andover MA 01845 5/21/08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: When filling out A. General .Information forms on the computer,use 1. Inspector: only the tab key to move your Benjamin C. Osgood, Jr. cursor-do not Name of Inspector use the return key. New England Engineering Services, Inc. Company Name VQ 1600 Osgood Street Suite 2-64 Company Address No.Andover MA 01845 City/Town State Zip Code 978-686-1768 Telephone Number License Number B. Certification 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, c^— '!�p '9— — S�2rlaa ln—spect5K Signature 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. **** I, This report only describes conditions at the time of inspection and under the conditions of use p Y p at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 115 l I i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5121/08 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: 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 components mores stem as described in the"Conditional Pass" section need to be Y replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed TITLE 5 FORM MASTER.DOC-08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "r 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5/21/08 every page. Cityrrown State 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(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of 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 Y p supply well. TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 221 Farnum Street Property Address Joan Ricker Owner Owners Name information is required for No.Andover MA 01845 5/21/08 every page. 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 all inspections: Yes No ❑ Eq,-, Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ a Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ E3,, Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ a 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. TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5/21/08 every page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ 21, Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 52' Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0' 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.] ❑ 3,- 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 ❑ 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. TITLE 5 FORM MASTER.DOC-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 , F Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information required for ormation is No.Andover MA 01845 5/21/08 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 2' ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ E�- Were any of the system components pumped out in the previous two weeks? [3"" ❑ 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? B ❑ Was the site inspected for signs of break out? [� ❑ Were.all system components, excluding the SAS, located on site? L� ❑ 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? Er- ❑ 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. ❑ a- 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)] TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ye 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required or No.Andover MA 01845 5/21/08 f every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): I DESIGN flow based on 31.0 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: H Does residence have a garbage grinder? ❑ Yes 0 No is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes 5 No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes R No Water meter readings, if available(last 2 years usage(gpd)): / KN 6111i7 Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "r 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information:- -� , 2 �'^'f' 45 ' nc/2- C>-IJAAJL- Was system pumped as part of the inspection? ❑ Yes ,® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: �C] Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: (+ 194,2 PCA A-s ;aurc,i Were sewage odors detected when arriving at the site? ❑ Yes ® No TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5/21/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): �o t Depth below grade: feet Material of construction: ❑ cast iron tZ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feed^ Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------- ----------------------------------------------------------------------------------------------- Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3 Y Scum thickness 2 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form go Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5/21/08 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.): T oril1— tN la IJ.0 -il6n_ GAN 17�1�✓� , lv+-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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tt jo,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): TITLE 5 FORM MASTER.DOC•08106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) N(o}Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): Pl�x 1 h oil, C'>"P--11 11 sflw►C -DCT EGL►o Z41-1&,I . orp P Eaf} N2 L5 C2 I AI 4- Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .�" 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5/21/08 every page. Cityrrown 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): � �hR.EkF v� T/L c N cK�s /�c�KS ,✓o�A2� �✓� I-���"a r�� :Y A^4 s cy PGL vNtJsy.9� TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Al`'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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N' 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.): TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5/21/08 every page. City/Town State Zip Code Date 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. ------------------- bti All. � y33 � WtJ IV TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Farnum Street Property Address Joan Ricker Owner Owner's Name information is required for No.Andover MA 01845 5/21/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ['Check Slope [�Surface water Ajo/-E [l-Check cellar v O S v--?/P fl`j B'Shallow wells vi o Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: 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) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Lei KCGK P4 l S v��► D R-ti� IIS TITLE 5 FORM MASTER.DOC-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 i 1. t )i f 7 �i ;y7- r4- �Y- U 4 l y� t � �fz;l -;7' SEPTAGE HAULERS INSPECTION CHECKLIST Date: Owner's Name: Company's Name: Address: City/State: Telephone: Vehicle License ID#: State ID#: Vehicle Inspection Procedures: Company name printed on vehicle: Yes ❑ No ❑ Gallons marked vehicle: Yes ❑ No ❑ a Any leaks detected: Yes ❑ No ❑ Vehicle Equipment Condition: 1. Tires: 2. Tank condition: 3. Suspension: A r___ Commonwealth of Massachusetts City/Town of No Andover System Pumping Record Form 4 FsmTayv CEIVE-D DEP has provided this form for use by local Boards of Health. Other forbe used, but the information must be substantially the same as that provided here. Befo a usi l f�� rAck vyith your local Board of Health to determine the form they use. The System Pumping ecord must be subrtaitted to the local Board of Health or other approving authority within 14 days fr�ffirttL?,lobmping;dateCinER accordance with 310 CMR 15.351. HEALTH DEPARTMENT A. Facility Information Important:When filling out forms 1. System Location: on the computer, use only the tab �,1 F rO(JM S key to move your Address - cursor-do not No Andover Ma use the return key. City/Town State Zip Code 2. System Owner: Name norm Address(if different from location) City/Town State Zip Code Telephone.Numlr er_ B. Pumping Record 1. Date of Pumping '" 1 I1 /5 3 p g 2. Quantity Pumped:ed:Date Gallons 3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No if yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped B 11 Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 S�ign atuLre.4 auler Date ure of Receiving Facility ate t5fonn4.doc•03/06 System Pumping Record•Page 1 of 1 DelleChiaie, Pamela Subject: Septic- FW: 221 Farnum Street-Health File Start Date: Thursday, April 09, 2009 Due Date: Thursday, April 09, 2009 Status: Completed Percent Complete: 100% Date Completed: Thursday, April 09, 2009 Total Work: 0 hours Actual Work: 0 hours Owner: DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday,April 09, 2009 12:57 PM To: 'jar228@hotmail.com' Subject: FW: 221 Farnum Street- Health File Attachments: SKMBT 60009040912400.pdf Hello Mrs. Rucker, Attached is a copy of your Health Department file with the septic information, including the septic as- built plan. Please call if you have any further questions. Pamela DelleChiaie Pamela DelleChiaie Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20; Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 - Fax pdellechiaieCaD-townofnorthandover.com - E-mail i Usu /C J J 1+��j C rvo� 1�101�1 '7J© /�_Ll W`e�O�i^►o� '�4 S f ti1t!"',) �J net f-v o� G 1 i o 1.yam! r-,t v"-a--a O MJ-. A--AI.J_'-z'R'11'� J � \ 43asn Sn,4%3aLL,W bl Zbl zz n 141 1SfhL QN-1 n15CY1y."� ��SI w'Eet i`lt Sah a oyYbt= =�N sfl CiQ1 =",?) awl- J-V hlCIO - s,�.y� gra ro11�2l�.�r+� • aftaL snt -A'"h Z �Tw, N � t / N 1 r � a AL PLANNANG _`I AL own oT :�'CNSERVAMJOI HNAL SLAVLRIVY '! IN f 6 n over 0 No. 169 ADRIVEWAY ENTRY PERMIT /A 1.3 —1 9pa C -ic Mass ass9 0/� BOARD OF HEALTH PERMIT T LD I v I ir 81171,cl,�7 THIS CERTIFIES THAT..j*-6W- -A44........ ...F opm.'W� . BUILI)ING IrISPECTOR A? . .......A!m 3.4 Ro.gh01kUJ-(! 4rSVI�'�" has permission to er OP. RMA ruildings on?M.?P.?...XA Chimney to be occupied as A NA"AL)OP•...37WAr"IN&.................. Final lz�U4� provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in PLUJBI ASPECT U' 67and Construction of T this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY REGULATED BY PAR 114.M B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. 9ELECTW1CALRS(Cj0_R PERMIT EXPIRES IN 6 MONTH Z— FEE PAID — Rough UNLESS CONST gITG7), STARTS Service PERMIT FOR FRAMUBUILDING Age- Final ro ft id _FECTO BUIrDTNG INS G S lNSP CTOR DATE.q/2.66z- FEE PAID- 40/Z-, 00 Ro g /// 7 . 00 Ro 9 Occupancy Permit Required to Occupy BuildkKMERMIT . . - ZWWWPWII� _=FDA /00- 00 .n 6. Display in a Conspicuous Place on the PrMRMEPERMIT$ /0/0?'Oo 1 FIKE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by 0,�. Smoke Det. Building Inspector I RECEIVED NOV 13 2006 C*yfTQ -WOf ^+�i�s OVER MW Pumping RecordNT FOM 4 FlUnVing RIM TIM A.Fac • ieRf C 1. S*MLWOW AftM uae �2 Nva Sfi vo +*fir A/ -- ow oy J/LyJI/A � dqwt Vcle�� V.�ii�+b�,TfianbvMxil. G,a Q 25 Te�pltOAe 1�4urtber �� SepEic Tank r Tek 3 '�• ttTs6 fftw pMgnM ❑ Ya ❑ No YU N �rAc.u/�`3 Sc •` Cott wt�Contanis�t�, _ LETTER OF TRANSMITTAL North Andover Health Department HORTM 400 Osgood Street 0 0• North Andover,MA 01845 A 978.688.9540- Phone # 978.688.8476 - Fax www.thownofnorthandover.com a Website -mail Page of ��ss�►tNus TO: DATE: � y� 1r", COMPAQ FROM:Pamela De1leChiaie, Health Dept.Assistant Phone: Fax: We are sendin ou: 0 Copy of Letter OPlans all in below) S These are transmitted as checked below: •OApproved as Noted OAs Requested OAs Required OResubmit copies for approval OFor approval OFor Review and comment OFor Your Use OSubmit copies for dist REMARKS: COPY TO: COPY TO: i COPY TO: SIGNED: / t�102r-t�-1 A u v o v 4;E:- L47T 3 31,cao' I C=X.1S�, �dallo• -op FNS V li 1� N Z Nbb�c IuSP�G 1�1E Cb►.��T�oN o� �1�5 -tt�Rrc,i1�c Ce��t'cGaGi1a►� d = N 1U o. Nuc w ra�w,K ;.Iq�' �1 ��.C-c51'IU.XYG W1Tu Our raNK? 63,0 Tt�1;.. S►GRS SAY- 192.a�. -JUe E�+a PAPE 1 :X42.3'1 Cvof� lti� '7'Q`gL « WA—fZ.T1;ry -rNF, ,;r ',,�"`��. c�'�S,E-z-� V'�iE ®�' -r-ti-+c, a c�«.,r��►.l� � u s�cTo� �M a W p w�.t C�r•+c. c7�.J�y a�...,v ��4-i v S E � � �'�,�,,, R T►i THE L'-gA►�llCs ' 7'Y"�2��►.� AT�otJ a� �.o� tkiems, t,..e+►�e i•S o/�=' CouF'ce_" fT'-/ 02, UCor.J�'a 1 TY Inn \tI N E.U C O u ST�u(Z, P k � f � t TOWN OF NORTH ANDU VEt, RECEIVE® UA t't; SY37$M PUMPIN(,? UC � 1 _D JUL - 6 2005 SYSTEOR& 11npRS3 SYSTEM LOC QlgOF NORTH ANDOVER HE H DEPA TME T A16, cllrld ,�e2J DATE OF PVWNQ: ���— t 'QUANTITY PUMPED: t' �SPOOL: NO. ......YBS.. S opuc 1 cnk; NU Yes NA PUREi p!' BGRYICE: K(?U't'iN Y� !~MRU�NC'1 Uld�i>rI�VA'f!C?NJ; / GOOD CONDITION ZP Ll_ ly.} (,ovu Kuyy ov.WB BAPP'LBS IN PLACL, itOOT13 w.._. LWKN LD RUNBACK Oxcu87Y6 SOLIDS FLOODED . $OLIDCAKAYQYER„�_OTHER EXPLAIN �;7•tom Pumpcd by . .,.t::�70_. .r..i.! VUMMENTs. tirVN I'f~N'i'S fltltN�1°'1✓Ki�D !'tt t TOWN OF`NO$TH ANDOVER SYSTEM PLWING RECORD DATE_dayjJC 'J SYSTEM OWNER&ADDRESS SYSTEM LOCATION S-T- 1� ONdove-c, Mo. DATE OF PUMPING Z�T QUANTITY PUMPED 150 D CESSPOOLW / NO Y`ES SEPTIC TANK NO YES V T \. NATURE OF SERVICE;;,RO[TTINE ' EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BY 77 COMMENTS: i CONTENTS TRANSFERRED TO " i '!027H ANDOVgr/ S Y ST E i'1Z P Um P I N!C trTC C. ,� _ OEG 5 2002 & .ADD CSS S YSTWNI L -- -- - -- Flo Alf,� 'UUL NO X YES SEPTIC T A K iCE 0 '' SERYICE ROUTINE [ F UU " JrlUI 10N L •_ ._ ' _ FAVY C :�EASC _ BAFFLES In � -- --- itUOTS LCACHi live' ----- EXCESSIVE SOLIDS _ i!OODED SOL; !)` CARRYOVER --- O;HER 'EX !':_ --- - F T. � ItA;� S FE Iz Iz u I'O TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: 3 D( QUANTITY PUMPED,600 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: 4 FORM 4-SYSTEM PUMPING RECORD CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 COMMONWEALTH OF MASSACHUSETTS /v• �! C/o v 2 ,MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: SYSTEM LOCATION: 1 LA C ke, F/I fi DATE OF PUMPING: do/t57/(03QUANTITYPUMPED: �6 d GALLONS � CESSPOOL: NO [:P�YES 0 SEPTIC TANK: NO F7 YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: leDATE: INSPECTOR: ! c 14 i _u FORM 4-SYSTEM PUMPING RECORD CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET;MIDDLETON,MA 01949 (978)774-2772 COMMONWEALTH OF MASSACHUSETTS / L A n d oy P c ,MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: n U C K Ke C e ` SYSTEM LOCATION: Ffo yi O cwt f Ck nd-e DATE OF PUMPING: �- 13 - / QUANTITY PUMPED: JS700 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: L-S D DATE: /-�" / INSPECTOR: Geo(2< TC'vviu OF NORTH ANDOVE21/ EC'NRD CF HEALTH -91999 i FORM 4-SYSTEM PUMPING RECORD RRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET;MIDDLETON,MA 01949 (978) 774-2772 COMMONWEALTH OF MASSAC ETTS 3�Z' 2eaLeX2S�i MASSA S �I SYSTEM PUMPING RECORD w SYSTEM OWNER: SYSTEM LOCATION: p«w -A r DATE OF PUMPING: -G-I l QUANTITY PUMPED: GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: DATE: 3-Z / • l "� INSPECTOR: 107 FocestSt. hOFORM 4-SYSTEM PUMPING RECORD MidtUe". MA 01949 3` T , 50\]ER/ WN OF i`�og `� _a.-"tR t, To k ROA Co onwealth of.Massachusetts Massachusetts % i'; - 91996 1 System Pumping Record System \\mer System Location v i r� um WOY 6;vl Wf Date of Pumping: Quantity Pumped: '�tgallons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes E System Pumped by: License #: Contents transferred to: Date 7 .� Inspector i AS-BUILT CHECK LIST and FINAL INSPECTION Proposed Elevations As-Built Elevation House I qy y Tank IN Tank OUT D-box IN D-box OUT 1 Qa. 8 3 !9a, 7q Trench Inverts Line 1 Line 2 /coo-30 Line 3 /S 7�D- 18 710 9 9 I,g 7,<11 Line 4 Bottom of Exc. 19/, 1885 Stone OK? t,-"'� D-box checked? Pipes cemented? /'-/z C ; U (4' 17ci V . 1 i J � pORTq BOARD OF HEALTH ♦ s 120 MAIN STREET TEL. 682-6483 "SS��M�SEt�y NORTH ANDOVER, MASS. 01845 Ext. 32 September 10, 1993 John Silveri 221 Farnum Street North Andover, MA 01845 Dear Mr. Silveri: On a recent inspection at 207 Farnum Street I noticed the masonry wall that was being built on your property and the filling associated with it. I believe the location of the wall is directly over the leaching area of your septic system. This violates numerous state and local regulations, namely: 310 CMR 15. 00: Minimum Requirements for the Subsurface Disposal of Sanitary Sewage State Environmental Code, Title 5. 15. 01 - Reserve area, which states that no permanent structures are to be constructed upon the reserve area of a septic system. 15. 02 (16) and 15. 14 (11) - Cover material. Earth materials used to cover septic systems are to be free from large stones. . . masonry. . . . 15. 06 (12) - Access manholes. Manhole covers for septic tanks serving single family dwellings shall not be more than 12 inches below finished grade. 15. 06 (13) - Accessibility. Septic tanks shall be located on the lot so as to be accessible for servicing and cleaning. Town of North Andover Board of Health Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. 2 . 17 - Cover material. 2 . 23 - Reserve area. No permanent structure to be constructed over the reserve area. 9. 12 - Access manholes. 9 . 13 - Accessibility. 17. 11 - Cover material. 17 . 16 - Ventilation. - Trenches with more than three feet of cover material shall be vented. In light of these violations and under the authority of the State Environmental Code Title V, you must cease and desist from the building of this wall and remove the masonry wall and all additional fill material over the septic system within 30 days from receipt of this order. ti You are entitled to a hearing before the Board of Health to show cause as to whether this order should be modified or withdrawn. All requests for hearings must be made in writing and be received in the Board of Health office within 7 days from date of receipt of this order. Please note that any person who fails to comply with any order issued under the provisions of this Title shall, upon conviction, be fined not less than 10 nor more than 500 dollars for each day the violation exists. If you have any questions, do not hesitate to contact the Board of Health office. Sincerely, Sandra Starr Health Agent cc: Karen Nelson, Director Town of North Andover, Massachusetts Form No.3 • BOARD OF HEALTH • ,►ORTFj O�t«.o••,�O /V s '�•,..o.�' n DISPOSAL WORKS CONSTRUCTION PERMIT �SSACMUSEt Applicant -NAME ^ ADDRESS TELEPHONE Site Location f�7 `3 Nd4 Ann, "^^ : Permission is hereby granted to Construct SVor Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. 41A, [4z00_._ CHAT RJAN,BOARD OF HE LTH Fee D.W.C. No. ��' rub :tA���h���'r`9 3 ,�y t 9 •xrC a v t:['1�i„r y�'d',+.. scEn � + Town of North Andover MassachusettsR N Y S BOARD OFrHEALTH "�. . . = DESIGN APPROVA ''° i,�s , SOIL ABSORPTION SEWAGE:DISPOSAL SYSTEM 1 'y 1•Y,' w BSc- > '4 f ._ 1' rr ,NestN0 Applicant ., :,�; nit �, 4-3s s.i• �t t� r -- Site Location j Reference Plans and Specs. DESIGN 5 DATE ENGINEER Permission is granted for an.individual soil;absorption sewage,disposal syrstem to bei stalled ,�in accoo�rdaance with regulations of Boa/r of Health CHAIRMAPE BOARD OF HEALTH =,4'1a. �Site System Permit No s ,,• �dyV,. d r ,! `§fi rl �•W�jf�47� �,.< 0[ 5:;': .i+ r7'Irra„„ ,i�,.+ r w'� .µ i AF!i.`.'�# fi' 2 a r. ti d�+•3^.{ Sf�§ SrF ` r�fpr; �t1+ t. °('fytil r4 5 ba'jK4,�. x�� "as'[ aak. 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BOARD OF HEALTH � p 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 September 10, 1993 John Silveri 221 Farnum Street North Andover, MA 01845 Dear Mr. Silveri: On a recent inspection at 207 Farnum Street I noticed the masonry wall that was being built on your property and the filling associated with it. I believe the location of the wall is directly over the leaching area of your septic system. This violates numerous state and local regulations, namely: 310 CMR 15. 00: Minimum Requirements for the Subsurface Disposal of Sanitary Sewage State Environmental Code, Title 5. 15. 01 - Reserve area, which states that no permanent structures are to be constructed upon the reserve area of a septic system. 15. 02 (16) and 15. 14 (11) - Cover material. Earth materials used to cover septic systems are to be free from large stones. . . masonry. . . . 15.06 (12) - Access manholes. Manhole covers for septic tanks serving single family dwellings shall not be more than 12 inches below finished grade. 15. 06 (13) - Accessibility. Septic tanks shall be located on the lot so as to be accessible for servicing and cleaning. Town of North Andover Board of Health Minimum Requirements for the Subsurface Disposal of. Sanitary Sewage. 2 . 17 - Cover material. 2 . 23 - Reserve area. No permanent structure to be constructed over the reserve area. 9. 12 - Access manholes. 9 . 13 - Accessibility. 17 . 11 - Cover material. 17. 16 - Ventilation. - Trenches with more than three feet of cover material shall be vented. In light of these violations and under the authority of the State Environmental Code Title V, you must cease and desist from the building of this wall and remove the masonry wall and all additional fill material over the septic system within 30 days from receipt of this order. I r You are entitled to a hearing before the Board of Health to show cause as to whether this order should be modified or withdrawn. All requests for hearings must be made in writing and be received in the Board of Health office within 7 days from date of receipt of this order. Please note that any person who fails to comply with any order issued under the provisions of this Title shall, upon conviction, be fined not less than 10 nor more than 500 dollars for each day the violation exists. If you have any questions, do not hesitate to contact the Board of Health office. Sincerely, _ Sandra Starr Health Agent cc: Karen Nelson, Director DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, May 12, 2008 1:48 PM To: Kimberly J. Brown (E-mail) Subject: 221 Farnum Street Importance: High Message from Message from Message from Message from KMBT_600 KMBT 600 KMBT_600 KMBT_600 $¢8t R¢gwads, Pw�wa�w De�BeG��fwf¢ Health Department Assistant Town of North Andover 1600 Osgood Street Building 20,Suite 2-36 North Andover,MA 01845 9978.688.9540-Phone A 978.688.8476-Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com 1 Page 1 of 1 DelleChiaie, Pamela From: Kimberly Brown [kbrown@neengineeringinc.com] Sent: Monday, May 12, 2008 12:56 PM To: DelleChiaie, Pamela Hi Pam, Do you have an as-built on file for 221 Farnham Street No Andover? Thanks, Kim Kimberly Brown Office Manager New England Engineering Services, Inc. 1600 Osgood Street Suite 2-64 North Andover, MA 01845 978-686-1768 www.neengineeringinc.com No virus found in this outgoing message. Checked by AVG. Version: 7.5.524/Virus Database:269.23.16/1428-Release Date: 5/12/2008 7:44 AM 5/12/2008 1 Uo7�T4-{ A I IDov�� N(ASS, 1� 43 'l l D SIF: � !n' N N t 1 , 31 Gn / n 0 / G ?vP FNS 1, O rt OFFICE TEL. 508 686.5634 PLANT TEL. 603 642.5564 m D / � I KIIVevS�®� e�NSTt"cnop cr, -A1\5 DIV.OFTORROMEOTRI LICKING Co. INC. Qa� 71S( SPLSr+ ►>.N� PLANT:DORRE ROAD � -M� {1� �eaRx�f1p►J OFFICE: FERRY ROAD KINGSTON,N.H. b.N� F�►��� C�R�dANCq CUSTOMER'S METHUEN,MASS. ORDER NO.. DATE ]" Q T N5 =04-� 1 1 rb4,K - 193,44 QGGC�2� W1T11 DELIVERED TO rr raNl�' �`t3 c� TNL L�S16►�'�S ADDRESS gO" 19za� TRUCK NO, DRIVER 2- 19 Z.'�`�, MPS�'KIpL�7 �� LANT PIT DEL. 3 c 14Z.� QUAN. SIZE MATERIALS �� 1 , IqZ g,1' Ccs NNFoRI� To T�1G TONS WASHED MASON SAND @ AMOUNT �°1o09•SZ IpLj�IJ CjP�C 1G V-Axlbtl TONS WASHED CONCRETE SAND 3- 41 kll � c,"p" `J�pQO� r l TONS WASHED CRUSHED STONE 1`^' ' "j&""' TONS DRY SCREENED SAND 1 I '71ar4L TONS CRUSHED BANK GRAVEL l t TONS FILLING TONS BANK RUN GRAVEL TONS PROCESSED GRAVEL TAX r TRANSPORTATION ow►,I A�-E �"OT�. THE TOTAL l3 UI v L►.t C� z u S PECTz> ��11 Of WAITING TIME CERTIFIED WEI(; T - a WEIGHER �"/�',44N/(,,,,..Z�jj (-l O� C�1T ��6 til 1�J C7r GR09S"► ) ES .1Es H '�- I-1o►._I Colo F'o2.M(TY 4 TARE �o +I gpP THIS E COMPANY WIL :NOT BE RESP SI BY TRU V IN MA E F NET DAMAGE CAUSED q[ ECD 6Y RIA BE TREET PAVEMENT. R �/,�� FLATFAK ®/ OGRE BVS ESS FO 38193 S 26-5 — ` �12 (a3 5-80 M ,INC-, N 5 j MABBACHUSETTB QUITCLAIM O[!U DY CORPORATION (LONG FORM) 793 Messina Development Company, Inc. a corporation duly established under the laws of Commonwealth of Massachusetts and having its usual place of business at 805 Winter Street, North Andover, Essex County,Massachusetts for considerationaid and in full consideration of ---Two Hundred Fifty-five Thousand and no/100p (�255, 000. 00) Dollars grantsto John Silveri and Stacey L.Silveri, husband and wife Of with qultr1ntm rourntcnin The land with the buildings thereon located in North Andover, Essex County, Massachusetts being shown as Lot 3AA on Farnum Street on a plan of land entitled "PLAN OF LAND IN NORTH ANDOVER, MASS. OWNED BY MESSINA DEVELOPMENT CO. INC. SCALE 1"=40 ' JUNE 30, 1992 v SCOTT L. GILES R.L.S. , 50 DEERMEADOW RD. NORTH ANDOVER, MASS . " o See said plan #12079 recorded in the Essex North District Registry of Deeds for a more particular description of said lot . Said lot contains 43, 791 square feet of land, more or less, according to said plan. This conveyance does not constitute 0 substantially all of the grantor 's property. all or z This conveyance is made with the following restrictions which aoi shall be binding upon the Grantee, its successors and assigns : no in-ground swimming pools shall be constructed upon Lot 3AA around , -P the area where the septic system is located, nor shall there ever be a change in grading or elevation on or around the area where the septic system is located. These restrictions apply only to the septic area and shall not apply to other portions of Lot 3AA . Being the same premises conveyed to grantor by deed of Barbara C. Neiley and Geoffrey C. Neiley, Jr . , Trustees of Coleman Realty M Trust by deed dated March 23, 1992 and recorded in the Essex North 41 District Registry of Deeds in Book to , Page . O -1-( r� U O r-1 on PAGE Date �— — \, F N0RT4 TOWN OF NORTH ANDOVER A ` Certificate of Occupancy $ 9 Building/Frame Permit Fee $ Foundation Permit Fee $ `s�►c►wset $ _� �� Other Permit Fee Sewer Connection Fee $ 4—Water Connection Fee $ L12Z TOTAL $ ildin spector PRUNE 75r s�h/5z0 ' Div.Public works TOWN USE BELOW THIS LINE i LANN NG BO RD AAAA DATE APPROVED 47— I 0 N PLANE .t DATE REJECTED — r ONSERVATION COMMISSION ~ DATE APPROVED HEALTH NSERVATION ADMIN. DATE REJECTED OARD OF HEALTH a BOARD 1)A1'1: APPROVi u 1ALTH SANITARIAN DATE REJECTED r LEcTMEN IEPARTMENT OF PUBLIC WORKS I IRIVEWAY PERMIT t�/CL V 1 fi�EcroR W4F*/WATER CONNECTIONS Pr FIRE DEPT. a--e� ZECEIVED BY BUILDING INSPECTION DATE Chis form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits [or the subject lot. This form shall not releive the applicant from the :ompliance of any applicable Town requirement or Bylaw. r r" 2- r a �. AQ 9. Lj __ C �I Pic - - -- - - --___r _ e� • 3t iz _ l_o Ad- t2t. u - - - -- l -«4--- -- -----r - - - ----- -- D: -- •n-3 f . 7.C:K t " I 1� I T � IFRO DAT TIMI I ./ + J ;{ + ' AREA ODE NUMBER + r.j j1 �j� + a L W 0 ©, a - S 'NED I — Q CAELRN@ Q: BACK AOM ALL PH�iEp f 1 S..E YOIi©QFWA. V_EY 1 URGENT! I _I AMPAD NO.23-176-400 SETS NO.23-376-200 SETS Town of North Andover, Massachusetts Form No. 1 AORTH BOARD OF HEALTH- �} 32Oy�s`ED 64eH�0 '! 1 '� ) r 'i 19 o APPLICATION FOR SITE TESTING/INSPECTION SSACHUS���� ! 1. Applicant-, �. ►lx,` -�_ ��C `,, .�=}{��__ .� NAME ADDRESS TELEPHONE Site Location---~..._4r Engineer �'�� -L�,. ii A.l.�. 7 U },�,, •ti-i•'- '� :�-cl�� �: r , ... .� NAME ADDRESS 6 TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee-/-D r1 Test No. c ' 1 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. UNITED STATES POSTAL SERVIC ��',�-E S w P rJ{ y -� � r Official Business �� PENH(TY FOA PRiVA7E :7 SEP USE TO AVOID RAYMENT� ._ /993 _OrPOSTAGE $3� __.�--� Print your name, address and ZIP Code here N. ANDOVER BARD OF HEALTH 12011f PAN STP; CT N. ANNOYER, ISA. 01845 IEh Hill HIHIH I=.!!11!1!!!1!!, m SENDER: I also;wish'Co rece `the 9 • Complete items 1 and/or 2 for additional services. M • Complete items 3,and 4a&b. following services (for an extra v H • Print your name and address on the reverse of this form so that we can fee): y return this card to you. m • Attach this form to the front of the mailpiece,or on the back if space 1. El Addressee's Address N L does not permit. D t - Write"Return Receipt Requested"on the mailpiece below the article number. 2 ❑ R2StrlCted Delivery y .� • The Return Receipt will show to whom the article was delivered and the date v C delivered. Consult postmaster for fee. d 3. Article Addressed to: 4a. Article Number N L a P 273 797 699 John Silveri 4b. Service TypeIX 0 221 Farnum ;street ElRegistered ❑ Insured 0 IM co . rth Andover:, RU, 01845 ®10ertified ❑ COD LU ❑ Express Mail ❑ Return Receipt for 2 OC Merchandise o Y. Date of Delivery O � Q 0 0 ozc 5. i na re ( e eel s� 8. Addressee's Address(Only if requested Y and fee is paid) LLI 6. ' ignature (Agent) f' 0 vJ PS Fnrm 3g I'I. DaremhPr 1991 tr u.s.c.P.o.:19W-3m-s3n INIMFCTIC RFTI IRIU RECEIPT