HomeMy WebLinkAboutMiscellaneous - 25 ESSEX STREET 4/30/2018 (2)/21'�� /
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TOWN OF NORTH ANDOVER
Certificate of Occupancy $
-pu+iding%Frome Permit Fee $
Found�7a�tion-Oer It Fie $
Other Permit Fee $
MA y 2 !,ewer Connection Fee
It
Wate�CCnnection Fee
TOTAL $ ��
Building Inspector
v Div. Public Works
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FORM U - IAT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
I
APPLICANT: ��1 SrP Y`C�" \ S Phone "
LOCATION: Assessor's Map Number
Subdivision
Parcel
Lots)
Street( j r St. Number
************************Official Use Only************************
RE OMMENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
Date Approved
Food Inspe6tto--r-�-Health Date Rejected
Date Approved
Septic Inspector -Health Date Rejected
Comments `T 4!fM iVJ`
Public Works - sewer/water connections
Fire Department
Received by Building Inspector Date
4
4
` Proposal
FROM �� r v 143 C I
�Q ( ��oad ft �/ — '
�e�r� ► �- 03039
Proposal No.
Sheet No.
Date
Proposal Submitted To
Work To Be Performed At
Name M J 11 erl-)
Street
Street SCt n'1 'e
City State
Date of Plans
Architect
City
State
Telephone Number
We ereby propose to furnish all the materials and perform all the labor necessary for the completion of
a 3 : -,
e ! iY G _otn C4
C ' !.. - C ,
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings
and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of
Dollars ($ 'J� 0&V '00).
with payments to be made as follows:
Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will
become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our
control. Owner to carry fire, tornado and other necessary insurance upon above work. Workmen's Compensation and Public
Liability Insurance on above work to be taken out by Z!!/-/' S7�� TC
- Respectfully submitted
Per
Note —This proposal may be withdrawn by us if not accepted within days
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as
specified. Payment will be made as outlined above.
Accepted Signature
Date Signature
TOPS FORM 3450 LITHO IN U. S. A.
PLOT PLAN OF
1N
NORTH ANDOVER
RICHARD F. KAMINSKI AND ASSOCIATES , INC.
LAND
MASS.
• NORTH ANDOVER , MA.
-v`A
PREPARED FOR: WILLIAM PARE
LOCATION LOT I • ESSEX STREET
NORTH ANDOVER , MASS.
SCALE: I" = 40' DATE'. JUNE 21,1990
PLAN REFERENCE
' BEING LOT (s) I ON A PLAN BY
E.N. R.D. PLAN No. 7078
DATED MARCH 8,1974 AND R ECORDED IN
ESSEX COUNTY No. DISTRICT
STREET
1 / F 101 LL
Property Line and Street Line Offsets Shown On This
Plan Are Specifically For The Determination Of Zoning
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w
The Foundation Located On Lot I
ANOF N
Is Not Located Within Zone "A"(area
of IOOyr. flood) As Shown On H.O.D. Firm
'A
A.
Comm. Pane I NO 250098 0005 8
Comm.
M:
Noo.. 3 30757
075
H
Dated:JUNE 15 , 1983
P�
P Tt ��'
I Hereby Certify That The Foundation
t lANd6
Shown On This Plan Is Located On The Gnd.
As Shown.
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Suggested Affidavit for Home Improvement Contractor Permit Application
For Onice Use Only NAME OF CITYI TOWN
Permit No.
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, inprovement, removal, demolition.
or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units .... or
to structures which are adjacent to such residence or building" be done by registered contractors, with certain exceptions, along with other
requirements.
Tyre of Work:j)'��LL
Address of We
Owner Name:
Est. Cost Z60 - 00
Date of Permit Application: S-20,73
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
_Job under $1,000
_Building not owner -occupied
_✓Owner pulling own permit
_Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL
c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contract r Name Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
,S^ 2o, Z
Date Owner Name
?O NCRr,, °
"
OFFICES OF: � °9 Town of
APPEALS
BUILDING NORTH ANDOVER
CONSERVATION @BCHUG DIVISION OF
HEALTH
PLANNING PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
120 Main Street
North Andover,
Massachusetts O 1845
(617) 685-4775
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S
150A.
The debris will be disposed of in:
t oLowe d CA),
(Locat on of Facilitv) ,
Signature of Permit Applicant
Date
NOTE: Demolition permit from the. Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
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BOARD OF HEALTH
TOWN HALL • 120 MAIN STREET
NORTH ANDOVER, MA 01845
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Thank you for using
Return Receipt Service.
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BOARD OF HEALTH
120 MAIN STREET TEL: 682-6483
NORTH ANDOVER, MASS. 01845 Ext. 32 or 33
March 21, 1991
Mr. William Pare
25 Essex Street
North Andover, MA 01845
Dear Mr. Pare:
On March 14, 1991, sewage was observed running from your
Septic System, over the ground and into a brook at 25 Essex
Street, North Andover, MA. Please be advised that this is in
violation of the State Environmental Code (310 CMR 15.00) Section
15.02 (11). Previous orders issued by the Board of Health
regarding this situation have not been complied with. Pursuant
to Section 15.23 of the State Environmental Code you are hereby
ordered to rectify this violation within fourteen (14) days of
receipt of this order. Failure to comply with this order will
result in a complaint being filed with the Lawrence District
Court.
Please be advised of your right to a hearing with the Board
of Health. All requests for a hearing shall be made in writing
to the Board of Health Office within Seven (7) days of receipt of
this order.
Since
ohn S. Rizza, D.M.D.
Chairman
North Andover Board of Health
JSR/cj p
Certified Mail #P-604 728 956
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1 �15PF.G FIon) PIPE �� k-tv� 1-0 T/J n� � a64 S5 `ice f`/01L
4PPROVEP GATC APFI�DvING ��r�toi�iry
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l. APP►�(Nv6 /S u i riot; I (y
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 CMR 15.354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
TEL. 682-6483
Ext23
This form must be submitted to the Board of Health no less than
five (5) days prior to date of abandonment and be accompanied with
a copy of the sewer connection permit.
Name Phone
Address 2-5
Contractor hired for work: L�
Name Phone
Address `�- G/ �a7'e Sl
Date for scheduled abandonment
Method of septic tank abandonment (check one).
( ) removal ( ) sandfill ( crush
Other
( ) other (describe
below)
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
Date
Inspecting Agent
Comments
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
MR. PARE - 25 ESSEX STREET:
TEL. 682-6483
Ext. 32
hul A-( 1552,
Ms. Conboy stated that Mr. Rosati said he did not feel
comfortable signing the occupancy and he wanted the Board to do
that. Mr. Rosati mentioned if the water sample came back clean,
he would not have a problem with that. The water sample came
back clean.
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: Phone
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street .5��`X ST St. Number
************************Official Use Only************************
RE OMMENDATIONS OF TOWN AGENTS:
Date Approved '1-
Conservation Administrator Date Rejected
Comments
Town Planner
Comments
Date Approved
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UNITED STATES POSTAL SERVICE
Official Business
Print your name, address and ZIP Code here
Jsfl wt�sh to -aceive, the
ms 2 101 dddftllWFl -CIV,GeS
::omp z,,m'' 3, anrj <.a ry h. foilow:ng services (for an extra
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451 Andover Street
North Andover, MA 01845
P 844 208 194
X-
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®SENQ`:R: Complete items 1 and 2 when additional services are desired, and complete items
3 and 4.
Put your address in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card
from being returned to you. The return recei t fee will rovide ou the name of the erson delivered to and
the date of deliverx. For ad itiona ees t e olF ing services are available. onsult postmaster or fees
and check box(es) tor additional service(s) requested.
1. ❑ Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery
(Extra charge) (Extra charge)
3. Article Addressed to:
4. Article Number
P 844 208 190
Mr. William Pare
Type of Service:
25 Essex Street
North Andover, RIA 01845
❑ Registered ❑ Insured
aCertified ❑ COD
❑ Express Mail ❑ Return Receipt
for Merchandise
Always obtain signature of addressee
or agent and DATE DELIVERED.
5. Signature — Addressee
8. Addressee's Address (ONLY if
X
requested and fee paid)
'
7. Date of Delivery
PS Form 3811, Apr. 1989 *U.S.G.P.0.1989-238.815 DOMESTIC RETURN RECEIPT
UNITED STATES POSTAL SERVICE
OFFICIAL BUSINESS
SENDER INSTRUCTIONS
Print your name, address and ZIP Code
In the space below.
• Complete items 1, 2, 3, and 4 on the
reverse.
• Attach to front of article if space
permits, otherwise affix to back of
article.
• Endorse article "Return Receipt
Requested" adjacent to number.
U.S.MAIL
PENALTY FOR PRIVATE
USE, 4300
RETURN Print Sender's name, address, and ZIP Code in the space below.
TO N. ANDln�OVER BOAR
N. ANDOVER, MA. 01845
844 208 190
?' Certified Mail Receipt
No Insurance Coverage Provided
Do not use for International Mail
mEpmm (See Reverse)
Sent to
Mr. William Pare
Street & No.
P.O., State & ZIP Code
Postage $
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing
to Whom 8 Date Delivered
Return Receipt Showing to Whom,
Date, &Address of Delivery
TOTAL Postage
& Fees —7$
2.29
Postmark or Date
Sent 2/21/92
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BOARD OF HEALTH
120 MAIN STREET TEL. 682-6483
NORTH ANDOVER, MASS. 01845 Ext. 32 or 52
February 20, 1992
Mr. William Pare
25 Essex Street
North Andover, MA 01845
Dear Bill:
At our last meeting, it was apparent that the breakout of
sewage effluent, which had temporarily ceased, began occurring
again. This letter is to remind you that this condition cannot
continue and is in violation of Title 5 of The State
Environmental Code 310 CMR 15.02 (20)
310 CMR 15.02 (20) Discharge to Surface of Ground
No sanitary sewage shall be allowed to discharge or spill
onto the surface of the ground or to flow into any gutter,
material discharge onto any private property.
You are hereby ORDERED to have the force main disconnected
from the D -box and the pump turned off so that effluent will not
enter the leaching facility. This shall be conducted within
seven (7) days of receipt of this letter. Your septic tank shall
then be pumped as often as necessary and maintained to keep it
from over flowing to the ground surface. This procedure shall be
followed until the proposed measures to fix the breakout
condition are completed. You are also ORDERED to complete the
required work to correct the break out condition by no later than
April 31, 1992. Please be advised that all the work specified
shall be witnessed by an Agent of the Board of Health and
arrangements for this should be made through the Board of Health
Office.
Failure to comply with all aspects of this order letter will
result in action being taken to have the premises vacated.
Page 2
Mr. William Pare
February 20, 1992
Please be advised of your right to be heard by the Board of
Health if you feel this order should be withdrawn or modified.
To obtain a hearing, you must file a written petition with this
office within seven (7) days of receipt of this letter.
You also have the right to inspect and.obtain copies of all
relevant inspection or investigation reports, orders, notices,
and other documentary information in possession of the Board of
Health.
Sincerely
ichaf l J
Health Agent
MJR/cjp
cc: Karen Nelson, Director, Planning & Comm. Dev.
BOARD OF HEALTH
120 MAIN STREET TEL. 682-6483
NORTH ANDOVER, MASS. 01845 Ext. 32 or 52
September 18, 1991
Mr. William Pare
25 Essex Street
North Andover, MA 01845
RE: 25 Essex Street
Dear Mr. Pare:
Past order letters from this department have required that
measures be taken to terminate effluent from running over the
ground. Although during the dry time of year this may not be
occurring, this department will not tolerate effluent running
over the ground in the spring since it will be extremely
difficult to conduct this work during the winter months it should
be conducted prior to December 1, 1991.
If you would like to discuss this matter further, I may be
reached Tuesday & Thursday between the hours of 2 P.M. and 4
P.M..
MJR/cjp
Sincerely,
Health Agent
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STEVENS ANALYTICAL LABORATORIES, INC.
38 Montvale Avenue, Stoneham, MA 02180, (617) 438-6114
FAX (617) 438-0173
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4/29/
4/29/93-
LABORATORY
/29/91
LABORATORY NUMBER: 12640 SAMPLE DATE:
DATE RECEIVED:
SUBMITTED BY: NORTH ANDOVER BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MA 01810
ATTN: ALLISON CONBOY
COLLECTED BY: CLIENT
SAMPLE SOURCE: ' ( 3 ) WATER SAHPLES (AS NOTED BELOW
REFERENCES: 1) STANDARD METHODS - FOR THE EXAMINATION OF WATER
AND WASTEWATER, 16TH EDITION 1985.
2) METHODS FOR CHEMICAL ANALYSIS OF WATER AND WASTES,
EPA/600/4-79-020, REVISED MARCH 1983.
SAMPLE SOURCE
-Zia
w Kieran Road
-25 Essex Street
Butcher Boy Rear
Authorized by:
FECAL COLIFORM
per 100 ml
10,500
240
<20
Alan P. Stevens, Laboratory Director
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STEVENS ANALYTICAL LABORATORIES, INC.
38 Montvale Avenue, Stoneham, MA 02180, (617) 438-6114
FAX (617) 438-0173
Allison Conboy
North Andover Board
120 Main Street
North Andover, MA
Dear Ms. Conboy:
of Health
01810
May 1, 1991
In recent months, we have implemented a purchase order system.
All samples received by our laboratory now require a written
purchase order number signed by an authorized representative of
your company. If a representative from your firm is dropping off
samples, a purchase order, as described above, must accompany all
orders before we can begin processing your samples Likewise, if
our field representative collects the samples or picks them up, a
purchase order must accompany the samples.
We do understand that many companies do not implement formal
purchase order systems. This being the case, we ask that you
submit a written statement by mail or fax authorizing Stevens
Analytical to perform the work with a reference number for our use.
This can be a blanket number for a year's period of time if you
desire.
If a different address is necessary for billing purposes, we
would also appreciate having this information at the same time the
purchase order is issued. Please notify all necessary personnel
of these changes. If you have any questions, feel free to call me
at (617)438-6114.
Thank you for your cooperation in this matter.
Sincerely,
Alan P. Stevens
President
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SEPTIC SYSTEM
INSTALLATION CHECK LIST
LOT: / G�SL�C
....
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PARCEL:
MAP:
1. DISTANCE TO.a. Wetlands ✓ '/
b. Drains ✓----- �O Ta !',��I
2. WATER LINE LOCAT'IUhJ ✓
3. NO PVC PIPE—"/ IPE✓/
4. SEPT I C TANK
2-/Cement
Tees - Length & To Clean Out Covers
Pipe to Tank - On Both Sides of
Tank
5. ,ISTRIBUTION BOX
Covers & Box - No cracks
All lines Flowing Equal Amounts
No Back Flow
6. LEACH FIELD OR TRENCH
/a. Dimensions
-Ab. Stone Depth
�c Capped Ends
/d. Clean Double Washed Stone
7. LEACH PITS
XTees
ions
Depth
C.Pads
. Pipe To Pit
f. Clean Double Washed Stone
8. NO GARBAGE DISPOSAL
9. FINAL GRADING INSPECTION
10. BARRICADING COVERED SYSTEM
11. AS BUILT SUBMITTED
,a Lot Location
/6. Dimensions of System
�. Location With Regard To Pere Test
�. Elevations
,e. Water Table
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RECEIPT FOR CERTIFIED ;,'.;.
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
Sent to
Mr. W' am Pare
Street and No.
25 Essex Street
P.O., State and ZIP Code
S1�
Postage S
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Return Receipt showing
to whom and Date Delivered
Return Receipt showing to whom.
Date, and Address of Delivery
TOTAL Postage and Fees
S
Postmark or Date
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BOARD OF HEALTH.
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
March 21, 1991
Mr. William Pare
25 Essex Street
North Andover, MA 01845
Dear Mr. Pare:
TEL: 682-6483
Ext. 32 or 33
On March 14, 1991, sewage was observed running from your
Septic System, over the ground and into a brook at 25.Esse.x
Street, North Andover, MA. Please be advised that this 'is in
violation of the State Environmental Code (310 CMR 15.00) Section
15.02 (11). Previous orders issued by the Board of Health
regarding this situation have not been complied with. Pursuant
to Section 15.23 of the State Environmental Code you are hereby
ordered to rectify this violation within fourteen (14) days of
receipt of this order. Failure to comply with this order will
result in a complaint being filed with the Lawrence District
Court.
Please be advised of your right to a hearing with the Board
of Health. All requests for a hearing shall be made in writing
to the Board of Health Office within Seven (7) days of receipt of
this order.
Sincerel
c
ohn S. Rizza, D.M.D.
Chairman
North Andover Board of Health
JSR/cjp
Certified Mail #P-604 728 956
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
TOs Residents Affected By The Greater Lawrence Sanitary
District
FROM: North Andover Health Dept.
REs Odor Survey
DATES September 6, 1989
------------------------------------------------
The Greater Lawrence Sanitary District has hired industrial
consultants to study the odor problem. The consultants will be
on call 24 hours a day to respond to complaints. Between 9/5/89
and 9/11/89 (and possibly longer) odors should be reported as
they occur to the temporary hot-line number 691-1097. There will
a representative available.
TEL: 682-6483
Ext. 32 or 33
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BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845 TEL. 682-6400
Dez 28,1984
Mr. Paul Hedstrom, Chairman
Planning Board
No.Andovr, Mass. Re Desilets Lot
Essex St.
Dear Mr. Hedstrom:
Copies of the septic system design for
this lot have -already been received and reviewed.
The soil condition, while less than ideal., are
acceptable and the plan does conform to State and
Town regulations.
The major problem on this lot is the
slope; excavation on the hillside will pose an
erosion threat and should be performed carefully.
It would be best if site wcrk was done in
summer, the dry season. There is a Froposed inter-
ceptor drain uphill of the leach ares which will
create a discharge of water that will -eventually
flow down hill in to the brook.
Sincerely yours,
Michael Graf, R.S.
Inspector
cc; J.Desilets
27 Cambridge St.,Lawrence
h-HUH fflfl'
TOWN OF NORTH ANDOVER
MASSACHUSETTS '
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,ITSACHUSE�
December 27, 1985
Board of Appeals
Mr. Frank Serio, Jr., Chairman
Town Hall
North Andover, Ma. 01845
KE: Lot 1 Essex Street - Desilets
Dear Chairman Serio:
The purpose of this letter is to inform you and your board that this
application before your board regarding Lot 1 Essex -Street was previously denied
by the Planning Board on March 20, 1985, and was subsequently appealed under
M.G.L. Chapter 40A, Section 17 on April 11, 1985. Item 7 of the application indicates
that no previous appeal under zoning has been applied for, when in fact it was
applied for through the Planning Board on November 15, 1984.
I find it quite unusual seeing the Planning Board deny a Special Permit and
then process the same application a year later requesting the same Special Permit
through the Board of Appeals. According to M.G.L. Chapter 40A, Section 16,
No appeal, application or petition which has been acted unfavorably
and finally acted upon by the Special Permit granting authority shall <
be acted favorably upon unless said Special Permit granting authority
finds specific and material changes in the conditions upon which the
previous unfavorable action was based.....
I hope that this information will help your board to render a decision. If you
need any further material or imput, contact me at my office.
CJ
enc.
cc: Conservation Commission
Town Counsel
Board of Health
Yours truly,
c
Karen Nelson
Town Planner
0
C
aECE IV40
CAMM t 500
NORTH n' m50VER
HAR Z1 2 o®~�85
MUM INK
TOWN OF NORTH ANDOVER
MASSACHUSETTS
N0,1Th
14,
,SSACMUSES
NOTICE OF DECISION
Any appeal shall be Mid
within (20) days after the
date of filing of this Notice
In the Office of the TOWH
Clerk ..-��
Date,.March 20
..........1985._....... ..
Date of HearingJanuary. 21: , 1985. .
Joseph
Petitionof , . , , , , ... ........................ ....................... .
Premises affected , . _Lot .1 Essex Street...... .
Referring to -k-ie = tiove petition for a special permit from the requirements
of the ............ ..2ouing.$ylaw.,. $pjptiQn.A•.j3.3.(d).......................... .
so as to permit ... . Abe .c.Qnstrixtimi. of .a drive.Wax .and .gWP1ljPg . ..........
within one hundred (100) feet to a watershed tributary
.............................................................................
After a public hearing given on the above date, the Planning Board voted
to p4NY ..........theSPECIAL,PERMIT.......................................
SEE ATTACHED DECISION
based upon the following conditions:
Signed - -
Michael P. Roberts, Vice Chairman
................................
John A. James, Jr., Clerk
................................
Erich W. Nitzsche
................................
John J. Burke
................................
........ningBoard
w
Any appeal shall be filed
f U tl l N U B B within (20) days after the
TOWN O F NORTH ANDOVER date of filing of this Notice
MASSACHUSETTS in the Office of the Town
Clerk.
t NORTH 1
K•
,SSACMUstt
March 20, 1985
Mr. Daniel Long, To -n Clerk
Town Office Buillir ;
North Andover, 01845
Re: Joseph Des;.lets - Lot 1 Essex Street
Special Pe. -mit Watershed District
Dear Mr. Long:
The North Andover Planning Board held - a public hearing on
Monday evening, January 21, 1985, in the Town Office Meetin(i Room
upon the application of Joseph Desilets. The hearing was advertised
in the North Andover Citizen on December 13 and 20, 1984. The
following members were present and voting:Paul A. Hedstrom,
Chairman; Michael P. Roberts, Vice Chairman; John A. James,
Jr.,Clerk; John J. Burke; Erich W. Nitzsche.
The petitioner seeks a Special Permit under Section 4.133(4) of
the North Andover Zoning Bylaw which requires a Special Per!Tlit to
allow construction to occur within 100 feet of a tributary in the
Lake Cochichewick Watershed. The premises is known as Lot 1, on the
East side of Ersex Street. The lot: is both situate9 in title
Residential 2 and Watershed Zoning Districts. Said lot possesses
44, 014 square i et of land area and 1 feet of f ron.t..igo on Rssex
Street.
At the hearing, 4r. Joseph Cushing, the applicants representative
from Richard F. :a,minski Associates informed the Planninq Roird the
following:
- In order 1.o meet the proper setback requirements for ')oth the
dwelling and sep A c system, the lot shape hampered their placement
further away froa the existing brook. However, thev have peen
located at the furthest possible point.
- There is an existing woodland path where the proposed
driveway is to be located.
- The subsurface disposal system satisfies Title V an:: the
local Board of Health regulations.
- The system will be pumped, and will not be by gravity.
- The driveway will remain at the present grade. A 12 inch
corrugated metal pipe will be placed at the driveway crossing.
- Riprap will be placed on the upstream and downstream side of
the 12 inch pipe.
Two abutters, Mr. Leary and Mr. Scully, indicated to the Board t}-iat
the referred ' w,.,odpath' never existed and that it had :)een
constructed in the recent past without the proper permits.
The Planning Board zknowledged the abutters remarks and will make a
visit to the site to look at,the present conditions.
The following mem,)ers were present and voting at the Marciz 13, 1985
meeting when the Board rendered the decision: Michael P. Roberts,
Vice Chairman; Join a. James, Jr., Clerk; John J. Burke, Erich W.
Nitzsche.
Upon a motion madam by Mr. Nitzsche and seconded by Mr. Burke, the
board voted unanimously to deny the petition and PLAN DATED NOVEMBER
15, 1984 BY RICHARD F. KAMINSKI & ASSOCIATES, INC. FOR LOT 1 ESSEX
STREET for the following reasons:
1. The applicant has not demonstrated that the construction of the
dwelling, driveway and septic system, in addition to the associated
alteration of the land around the wetland tributary will have no
environmental impact on the tributary and watershed;
2. The applicant has not demonstrated to the board that there is
no other alternative to gain access to the site. The applicant and
engineer have not pursued any other options;
3. No drainag., calculations were submitted to the board indicating
that the drivewa; wild not create a damming effect on upstream
flooding.
In denying 'his Special Permit, the Planning board finds,
pursuant to Secti-)n 10.31 Conditions for Approval of Special_ Permits_
of the Zoning Byl.w, the following:
A. Lot 1 Essex Street has not been determined as the most
appropriate locat.-on for the construction of a driveway, since it
crosses a watershed tributary;
B. The residential_ use in the watershed District as s'nown on the
submitted plan does not ensure that the development will not
adversely affect the neighborhood. The applicant has failed to
prove otherwise;
C. Based on site visits, the public hearing process and testimony
from town boards and departments; the location of the use and access
to the site is not in harmony with the general purpose and intent of
the North Andover Zoning Bylaw, specifically, Section 4.133:
'Watershed District surrounding Lake
Cochicheiick, our source of water supply,
is inten, ed to preserve and maintain the
filtration and purification function of the
land, the ground water table, the purity of
the ground water and the Lake, to conserve
the natural environment and to protect the
13ublic health, safety, and weLfare.'
Sincerely,
TU'Ua
Michael P. Roberts
Vice Chairman
MPR/kn
cc:
DEQE
Fire
Highway
Conservation
Public works
Police
Board of Health
Building
Applicant
Engineer
File
.A
06.
PEC�jyy I URIUU•iUU UUnUU
T tW.j.Tjf �F NORTH ANDOVER
O''Y"'14 SSACHUSETTS
NOR 'Y"' Q,500VSk
MAY 1510 14
,SS^GMUSES
NOTICE OF DECISION
Any appeal shall be filed
within (20) days after the
date of filing of this Notice
In the Office of the Town
Clerk.
Date... May. 12, ..19B.6 ...........
Date of Hearing .March .24,. A9$f
Joseph
Petitionof ....... . De ...... ....... ................. , _ .... • ..... .
Premises affected• ...... Lot. 1.... Essex. Stxeet .............................. -
Referring to the above petition for a special permit from the requirements
of the......... .
ZONING BYLAW, SECTION .10.8. Repetitive. Petitions.. , .... .
...... ......... .. . ... ....... ..........
Reconsideration of any.s ecific and. material
soas to permit ................................ o .........................
chancles .in, conditions, which, the. previous .Unfavorable. action. was...
based.
After a public hearing given on the above date, the Planning Board voted
to , DENY... , . , , ,the , , , SPECIAL. PERMIT. FOR. RECONSIDERATION. , , .. _ _ . , .. .
SEE ATTACHED DECISION.
based upon the following conditions:
Signed
Michael P. Roberts
. . .. .......... .. ... ... ... ... ... .
Paul.?; „Hodptrom,,,,,,,,,,,,
John Simons
................................
John J. Burke
................................
...............
Erich W. Nitzsche
'planning Boarcl�
G
PU1[M�lI��BDAB�
TOWN OF NORTH ANDOVER
120 Main StreetT�'�At,
r ' -R K
North Andover, MA. 01845 NORT�i ;`G;)YER
685-4775 MAY 15 10 14 SIM 186
f MOR7H , .
° 4a. a ti0
Any appeal shall be filed
within (20) days after the
date of filing of this Notice
in the Office of the Town
Clerk.
May 12, 1986
Mr. Daniel Long, Town Clerk
Town Hall
120 Main Street
North Andover, MA 01845
Re: LOT 1 ESSEX STREET - REPETITIVE PETITION
Dear Mr. Long:
The North Andover Planning Board held a public hearing on
Monday evening - March 24, 1986 in the Town Office Meeting Room upon
the application of Joseph Desilets. The hearing was advertised in
the North Andover Citizen on March 6 and 13, 1986 and all abutters
were notified by regular mail. The following members were present
and voting:
Michael P. Roberts, Chairman; Paul A. Hedstrom, Vice
Chairman; John Simons, John J. Burke and Erich W. Nitzsche.
The petitioner seeks a reconsideration of a Special Permit for
Joseph Desilets, Lot 1 on Essex Street, North Andover, MA pursuant
to MGL Chapter 40A, Section 16 - Repetitive Petitions and Section
10.8 of the North Andover Zoning Bylaw. The request for
reconsideration is to address any specific and material changes in
conditions which the previous unfavorable action was based. The
premises is known as Lot 1 Essex Street, on the east side of said
street possessing 44,014 square feet in a Residential and Watershed
Zoning District.
At the hearing, Mr. Desilets representative, Mr. Joseph
Cushing, presented the application.
A copy of Superior Court Document No. 85-911 - First Set of
Interrogatories - Joseph Desilets and Elaine Desilets, Plaintiffs
vs. Planning Board for Town of North Andover was inserted as part of
the record.
The hearing was closed on March 24, 1986.
Is
. The following members were present and voting at the May 5,
1986 meeting when the Board rendered their recommendation for
reconsideration: Michael P. Roberts, Chairman; Paul A. Hedstrom,
Vice -Chairman; John Simons, John J. Burke and Erich W. Nitzsche.
Upon a motion made by Erich W. Nitzsche and seconded by Paul A.
Hedstrom, the Planning Board unanimously voted to deny the request
for reconsideration:
The Planning Board does not find 'specific and material
changes in conditions' upon which the previous unfavorable
action was based.
Sincerely,
PLANNING BOARD
dnte_z" P
Michael P. Roberts
Chairman
MPR:nrs
PB: 12
cc: Highway Surveyor
Board of Public Works
Tree Warden
Conservation Commission
Board of Appeals
Building Inspector
Board of Health
Assessor
Police Chief
Fire Chief
Applicant
Engineer
File
PB�BBIByB BB�BB
TOWN OF NORTH ANDOVER
MASSACHUSETTS
HOATH
O n�
SA St
NOTICE OF DECISION
Si
Rc':�ldE���
t�
Jut, `t� 3
9
Date.. ..... ....................
Date of Hearing ..4/0/89 _ ... , , . , ,
Petition Of Joseph and Elaine •Desilets . • .. • ,
... ... ...........................
Lot .
Premises affected , . .. Essex
. . Street ....... .
Referring to the above petition for a special permit from the requirements
Zoning Bylaw Section
ofthe.......................................................................
The construction of a driveway and a dwelling within 100'
soas to permit..............................................................
to a watershed tributary
..............................................................................
After a public hearing given on the above date, the Planning Board voted
to................the........................................................
* Pursuant to an order from the Mass. Superior Court, Dated 6/20/89 (attached)
The Planning Board hereby grants this petition for the Special Permit.
cc: Director Public Works
Board of Public Works
Highway Surveyor
Conservation Commission
Board of Health
Building Inspector
Assessors
Police Chief
Fire Chief
Applicant
Engineer
Filo Trio, ---4..a
based upon the following conditions:
Signed
Paul Hedstrom, Chairman
................................
George Perna
................................
Erich Nitsche
................................
John Simons
................................
SOIL PROFILE & ,PEEIRRGOLATION TEST DATA
North Andover, Mass, Street No Lot, No
Loc/Subdiv. _ Pl and Owner
se
Obrver
Invbstigator
SOIL PROFILE DATES
1.''%lev.Eley .1ev 4.Elev
3•
�'V
0 I_ 0 Z 0 °
-
Ties to Test
— Pits
2 2 2 -- 2
3_ 3 3 - 3
�+ 4 - - 4
5 --
5 5 - -- - 5 --
7
10 - --- _ 10 - --- — -- 10 -
Benchmark Location -.-- -.---
;levation - - — - --- - --- . - _._ Datum -- - — --- — --- --
1'P CO?ATION '2rS`iS
DATES - -
Pit Nurabcr - --1 -- - -- ---2. 3 � ------��-
- -- - -
Start Saturation--
SoA .4inutes - - - -
cuar
Drop of 5H -Time
Drop_ of 6"--Tjme--- - - —__- - -- --- -- - -- -_ _ - - - - --.
M6ns.jst'` drop -
Mi.ns.2nd Dr(:p- -_
pureol ata on
OFFICES OF:
APPEALS
BUILDING
CONSERVATION
HEALTH
PLANNING
O, "ORTH 1 r
o� ' Town Of
a
NORTH ANDOVER
�aB^CHUBEts DIVISION OF
PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
To= Planning Board
From= Health Dept.
Date= April 25 1989
Re= Desilets Lot, Essex St.
I have rereviewed this Lot and its proposed Septic
System plans, and renewed the original approval.
Sincerely
---�����-----------
Sanitarian HZea Dept.
120 Main Street
North Andover,
MassachusettS U 1845
(617) 685-4775
or�D BOARD OF HEALTH
120 MAIN STREET
�9SS�c►+uSEt�� NORTH ANDOVER, MASS. 01845 TEL. 682-6400
February 19 1986
Planning Boatd:
Re=Lot 1 EssexSt.
Desilets
Revised plan
Feb 15 85
•I.have reviewed the new plan for this Lot and
found the Septic system it self is the same as shown on a
previous plan that I approved. Now I had heard a comment that
the breakout fill for the leach area does not meet Titl,g 5,
but I will be glad to demonstrate that the D.E.Q.E.approves.
such designs to anyone who is interested.
As far as erosion control is concerned, I will
repeat my recomendation that any construction at this site be
limited to the relatively drier summer months.
mg/gc.,
N
Sincere y-) yours,
Michael Gra
R.S.
Inspector
TOWN OF NORTH ANDOVER. MASSACHUSETTS
OFFICE OF
CONSERVATION COMMISSION ,
TO: Planning Board
FROM : Willie Vicens, Chairman
RE: Lot 1 Essex Street
DATE: December 24, 1985
TELEPHONE 683-7105
The purpose of this note is to provide you with our input on the upcoming
watershed special permit request for the above noted project. The NACC issued
an Order of Conditions on this lot last May 6, 1985 with two special conditions:
1) a not cut buffer zone within 30 feet on each side of the brook (except for the
driveway crossing) , and
2) increased capacity for the culvert under the driveway.. In our judgement,
the limited work on or near the wetland resource areas on the site met the
performance standards of the Wetlands Protection Act and Town Bylaw.
We made no judgement , and obviously have no jurisdiction; over matters
relating to the subsurface disposal system and/or watershed permits.( In fact,
the SSDS as designed may be closer than 100 feet to the large wetland on the
upstreaM side of the proposed drivewayl .
If we can be of further help, please let Tracy Peter or me know.
cc: Board of Health
0
0
OFFICES OF
APPEALS
BUILDING
CONSERVATION
HEALTH
PLANNING
OF NORr,,
o� ...
a Town of
NORTH ANDOVER
ms"CHU DIVISION OF
PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
TOo Mike Graf, Health Sanitarian
FROM# Chris Huntress, Env a 1 Planner
DATE' 4/12/89
REe Desiliets, Essex Street.
120 Main Street
North Andover,
Massachusetts O 1845
(617) 685-4775
I have been asked by the plarming board to have your office
supply a letter to me with regard to this property. We? are in the
process of settling this case with the defendant but would like
to have you take a second look at the septic design. It was
approved in 1984-1985 and we would like a more up to date
evaluation.
Thank you.
TV
O
O
ry
N
(o)z-
�
r
OFFICES OF:
APPEALS
BUILDING
CONSERVATION
HEALTH
PLANNING
TORiy
OF
a? 'Town of
` m
o w NORTH ANDOVER
;,S@ACHUS�t4g DIVISION OF
PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
To= Planning Board
From= Health Dept.
Date= April 25 1989
Re= Desilets Lot, Essex St.
I have rereviewed this Lot and its proposed Septic
System plans, and renewed the original approval.
Sincerely
--- L�--- - ----------
Sanitarian Hea t Dept.
120 MFI111 Street
North Amlover,
MiISSFICIWSeItS ()1845
(61 7) 685-4775
Health
-t_ aidover,Mass
APPROVO DATE
Provided:
SUBSURFACE DISPOSAL DESIGN CHBCS LIV
DIWPROPEO DATE
Reasons s
LOT15-`-En�j
Title V
Reg 2.5
-- -
FAIL.
OR
The submitted plan must show as a miniaim=
a) the lot to be served -area, dimensions lot #,abutters
b location and log deep observation hoes -distance to ties
location and results percolation tests -distance to ties
d design calculations & calculations showing required leaching area
e) location and dimensions of system -including reserve area
f) existing and proposed contours
(g) location any wet areas within 100' of sewage disposal system or
disclaimer -check wetlands mapping
(h) surface and subsurface drains within 100' of sewage disposal
system or disclaimer
(i) location any drainage easements within .001 of sewage disposal
system or disclaimer -Planning Board fil►s
(j) known sources of water supply within 20L of sewage disposal e _
system or disclaimer
(k) location of amy proposed well to serve ?A-1001 from leaching facility.
(1) location of water lines on property -101 from leaching facility
(m) location of benchmark .
(n) driveways
(o) garbage disposals
(p) no PVC to be used in construction
(q) profile of system -elevations of basement, plumb, pipe, septic tank,
distribution box inlets and outlets, dir ribution field piping and
Other elevations _
(r) maximum ground water elevation in area sewage disposal system
(s) plan mast be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
IC
Reg 6 Septic is Tanks
(a) capacities -150% of flow, water table, tees, depth of tees,
access, pumping
---- --- (b) cleanout
(c) 101 from cellar wall or inground swimadmg pool
(d) 251 from subsurface drains
Reg 10.2 Distribution Boxes
I(a) slope greater than 0.08
Reg 10.4 b) sump
BOARD OF HEALTH
120 MAIN STREET TEL: 682-6483
NORTH ANDOVER, MASS. 01845 Ext. 32 or 33
January 15, 1991
Mr. William Pare
Essex St.
No. Andover, MA 01845
Re: Lot 1 Essex St.
Dear Bill:
From recent meetings at your property, you were made aware
that your septic system was not functioning properly. It
appeared from my last inspection and from talking with your
engineer that effluent from your septic system was breaking out
of the ground and running into a brook that drains into Lake
Cochichewick.
This department realizes that you are trying to rectify this
situation, however, it appears to be taking longer than expected.
This Board can no longer tolerate this condition and is hereby
ordering that, until the problem can be solved, your septic tank
is to be pumped as often an necessary so that breakout of
effluent upon the ground ceases.
Please be advised that failure to comply with this order may
subject you to fines or further action by this Board.
Should you have any questions regarding this matter, please
do not hesitate to contact our staff at the Board of Health
office.
Sincerely,
Dr. John S. Rizza,
Chairman
MJR/rel
BOARD OF HEALTH
120 MAIN STREET TEL: 682-6483
NORTH ANDOVER, MASS. 01845 Ext. 32 or 33
March 21, 1991
Mr. William Pare
25 Essex Street
North Andover, MA 01845
Dear Mr. Pare:
On March 14, 1991, sewage was observed running from your
Septic System, over the ground and into a brook at 25 Essex
Street, North Andover, MA. Please be advised that this is in
violation of the State Environmental Code (310 CMR 15.00) Section
15.02 (11). Previous orders issued by the Board of Health
regarding this situation have not been complied with. Pursuant
to Section 15.23 of the State Environmental Code you are hereby
ordered to rectify this violation within fourteen (14) days of
receipt of this order. Failure to comply with this order will
result in a complaint being filed with the Lawrence District
Court.
Please be advised of your right to a hearing with the Board
of Health. All requests for a hearing shall be made in writing
to the Board of Health Office within Seven (7) days of receipt of
this order.
Sincerel
XohnChairman
S. Rizza, D.M.D.
North Andover Board of Health
JSR/cjp
Certified Mail #P-604 728 956
P 257 054 660
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
Sent to
William Pare
Street and No.
25 Essex St.
P.O.. State and ZIP Code
No. Andover, MT
01845
Postage
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'
SENDER INSTRUCTIONS
Print your name, address and ZIP Code
+Ibin
J
the space below.
• Complete items 1, 2, 3, and 4 on the
reverse.
• Attach to front of article if space
permits, otherwise affix to back of
article.
• Endorse article "Return Receipt
Requested" adjacent to number.
I
PENALTY FOR PRIVATE
USE, $300
RETURN Print Sender's name, address, and ZIP Code in the space below.
TO W
N. DOVER BOARD OF HEAL1JJ
120 MAIN STREET
:. ANDOVER, MA. 01845
•SENDER: Complete items 1 and 2 when additional services are desired, and complete items
3 and 4.
Put your address in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card
from being returned to you. The return recei t fee will rovide ou the name of the person delivered to and
the date of deliver .For additional fees t e o lowing services are available. onsult postmaster for fees
and check ox es) for additional service(s) requested.
1. E: Show to whom delivered, date, and addressee's address. 2. Restricted Delivery
(Extra charge) (Extra charge)
Article Addressed to:
Mr. William Pare
#25 Essex Street
North Andover, MA 01845
— Ad
b. -Signature ,agent
X
7. Date of Delivery
4 Article Number
❑ Registered ❑ Insured
Certified ❑ COD
❑ Express Mail ❑ Returrnn,R
Always obtain signature of addressee
or agent and DATE DELIVERED.
8. Addressee's Address (ONLY if
requested and fee paid)
PS Form 3811, Apr. 1989 *U.S.G.P.o.1989-238-815 DOMESTIC RETURN RECEIPT
t4ORTM
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•
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
February 21, 1991
Mr. William Pare
25 Essex Street
North Andover, MA 01845
Dear Mr. Pare:
TEL: 682-6483
Ext. 32 or 33
On February 21, 1991, Mr. Rosati visited the premises at 25
Essex Street for the purpose of verifying that the order issued
by the Board of Health on January 15, 1991 was being complied
with. Based on his inspection it was evident that sewage was
running on the ground. You are hereby ordered to have your tank
pumped immediately. Your tank should be pumped as often as
required to keep sewage from running over the ground. Copies of
pumping receipts shall be submitted to this office. Failure to
comply with this order could result in fines or eviction of the
premises.
Please be advised of your right to a hearing with the Board
of Health. All requests for a hearing shall be made in writing
to the Board of Health Office within seven days of receipt of
this order.
Very truly
yo rs,
John S. Rizza, D.M.D.
Chairman
North Andover Board of Health
JSR/cjp
•SENDER: Complete items 1 and 2 when additional services are desired, and complete items
3 and 4.
Put your address in the "ReTURN TCrSpace on the reverse side. Failure to do this will prevent this card
from being returned to you. The return receipt fee will provide you the name of thepeerson delivered to and
the date of deliver For additional fees the following services are available. Consult postmaster for fees
and check box{esl for additional service(s) requested.
1. " Show to whom delivered, date, and addressee's address. 2. --_ Restricted Delivery
(Extra charge) (Extra charger
3. Article Addressed to:
4. Article Number
P 257 054 666
Mr. William Pare
Type of Service:
25 Essex Street
-7 Registered Insured
North Andover , . MA 01845
LX Certified COD
L- Express Mail Return Receipt
for Merchandise
Always obtain signature of addressee
or agent and DATE DELIVERED.
5. Sign tu`re - Ad s
8. Addressee's Address (ONLY if
X
requested and fee paid)
6. Signature - Agent
X
7. Date of Delivery
PS Form 3811, Apr. 1989 •U.S.G.P.O.1989-238-815 DOMESTIC RETURN RECEIPT
UNITED STATES POSTAL SERVICE • m y�
OFFICIAL BUSINESS
SENDER INSTRUCTIONS
Print your name, address and ZIP Code
in the space below.
• Complete items 1, 2, 3, and 4 on the
reverse.
• Attach to front of article if space
permits, otherwise affix to back of
article.
• Endorse article "Return Receipt
Requested" adjacent to number.
U.S.MAIL
�0
PENALTY FOR PRIVATE
USE, $300
RETURN Print Sender's name, address, and ZIP Code in the space below.
TO
1
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P 2t7 05.4 666
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
SenUP
William Pare
Street and No.
2S Essex Stregt
P.O., State and ZIP Code
No. Andover MA
Postage
5
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Return Receipt showing
to whom and Date Delivered
Return Receipt showing to whom,
Date, and Address of Delivery
TOTAL Postage and Fees
5
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BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
Mr. William Pare
25 Essex Street
North Andover, MA 01845
Dear Mr. Pare:
TEL: 682-6483
Ext. 32 or 33
G-P'� �' 9,- �
P asp 6sy c, G c�
February 21, 1991
On February 21, 1991, Mr. Rosati visited the premises at 25
Essex Street for the purpose of verifying that the order issued
by the Board of Health on January 15, 1991 was being complied
with. Based on his inspection it was evident that sewage was
running on the ground. You are hereby ordered to have your tank
pumped immediately. Your tank should be pumped as often as
required to keep sewage from running over the ground. Copies of
pumping receipts shall be submitted to this office. Failure to
comply with this order could result in fines or eviction of the
premises.
Please be advised of your right to a hearing with the Board
of Health. All requests for a hearing shall be made in writing
to the Board of Health Office within seven days of receipt of
this order.
Verytruly po rs,
J6hn S. Rizza, D.M.D.
Chairman
North Andover Board of Health
JSR/cjp
William F. Weld
Go"mor
Trudy Coxe
Secretary, EOEA
David B. Struhs
Commissloner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: oZ S F�Q-�t N ' �UQ JC— Address of Owner
Date of Inspection: ��� �S{�^l (if different)
Name of Inspector: IKJ(;7�t .E-
Company
j-Company Name, Address and Telephone Number:
CERTIFICATION STATEMENT Qi?k
I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in (lie proper function and
maintenance of on-sitesewage disposal systems. The system:
,I Passes
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fai
P
q
Inspector's Signature: Date:— /
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
INSPECTION SUMMARY:
Check A, B, C, or D:
AI=1have
ES:
ot found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
BI SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why trot)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
(revised 8/15/95)
One Winter Street a Boston, Massachusetts 02106 a FAX (617) 556.1049 a Telephone (617) 292-5500
Q* Printed on Recycled Piper J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:`��2
Owner: CSv.�r ,Q S
Date of Inspection:
B] SYSTEM CONDITIONALLY PASSES (continued)
_ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the
Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box Is levelled or replaced
_ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Cenditianr oxUt which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ fit, '%>ir... i d- It >rUiI� 1"i IN ai—I SO:! aJSofp,,ion system and is within 100 feet to a sumac \Y2!er suprly or t,ibu!ary tc 2
surface water supply.
_ The st,•srem has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
_ The systen, has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is
free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5
ppm.
DI SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: d �SSQx - , NAIou—
Owner: G«s-�es N.�� Qw
Date of Inspection: /� , (R-5—
DI
5
D) SYSTEM FAILS (continued):
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Rortuired rumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 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
aereptablb wattpr duality analysis, If the well has been analyzed to be acceptable, attach copy of well water analyoio for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: OL
Owner: CU �p S
Date of Inspection: cc _ —qs-
Check if thefol�lo ing have been done:
_'� Pumping information was requested of the owner, occupant, and Board of Health.
G'- None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
��duuring that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
Wl s built plans have been obtained and examined. Note if they are not available with N/A. U_4,Y`Q. �QS Cp
�v�r cQoeSn-�-�
�The om�facility or dwelling was inspected for signs of sewage back-up.
The ystem does not receive non -sanitary or industrial waste flow
The site was inspected for signs of breakout.
(/AII system components, excluding the Soil Absorption System, have been located on the site.
1 -he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
L/ he size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non -intrusive methods.
he facility o :n(r (X111 occupants, if different from owner) were provided with information on the proper maintenance of Sub•
Surface Disposal System.
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
c� �) SYSTEM INFORMATION
:
Property Address ` ' ' "
Owner: GvC's `es
Date of Inspection: Ct
RESIDENTIAL:
Design flow:' Q all ns
Number of bedrooms:?
Number of current residents: a`
Garbage grinder (yes or no):
Laundry connected to system (yes or no):_Yes
Seasonal use (yes or no): NO
Water meter readings, if available: 33�e3
Last date of occupancy:
FLOW CONDITIONS
)'ri.5. = a4000gWvKs 365,
COMMIE RCIAUINDUSTRIAL:
Type of establishment:
Design flow:_gallons/day
Grease trap present: (yes or no),
Industrial Waste Holding Tank present: (yes or no)_
Non -sanitary waste discharged to ilia `Title a jyritetiii tyar or nn)_
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as pan of inspection: (yes or
If yes, volume pumped: gallons
Reason for pumping:
TYPE O"YSTEM
l� Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Other (explain)
S = I GS-,
APPROXIMATE AGE of all components, date installed (if known) and source of information: S i1—a3 — /d 'G�S �l
Sewage odors detected when arriving at the site: (yes or no) n1U
(revised 8/15/951
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: a N 'ate
Owner: V 't'`''k
Date of Inspection: C
SEPTIC TANK: L
(locate on site plan)
y� },Vl `1
Depth below grade: � ��� `\ \1bU�CQVuiC rj t
Material of construction: L,"concrete _metal _FRP —other(explain)
Dimensions: X Jc — X K • 5 ��V 1 j �S
Sludge depth: to < It
Distance from top of sludge to bottom of outlet tee or baffle: D11
Scum thickness: O If
Distance from top of scum to top of outlet tee or baffle: q �� tt
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping, Gond
integrity, evideK% of lepkag% etc.)
GREASE TRAP:11A:A�
(locate on site plan)
Depth belov,, grade:
Material of construction: _concrete
of inlet and outlet tees or baffles, depth,of ligpid level in relation to
metal _FRP —other(explain)
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle:
Distance from hotl(`n1 n .rjim i- onnon, or outlet tee or name.
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.(
(revised B/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: P, dtJQ�
Owner: a-c` -es { S
Date of Inspection:
TIGHT OR HOLDING TANK:bUyle
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP _other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:_v
(locate on site plan)
Depth of liquid level above outlet invert: 0
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no) Yes
(revised 8/15/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: ofr P �A�
Owner: t�.1.,C.e,� �e' vf'�l/�y1'°s
Date of Inspection: q,__90_/y�
SOIL ABSORPTION SYSTEM (SAS):____
(locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:_
leaching chambers, number:_ l . ^
leaching galleries, number: le3 ,�JLJ�CJ-�
leaching trenches, number,ngth: 4 a
leaching fields, number, dimensions:
overflow cesspool, number:
4,5, tow, G1_vic -
CESSPOOLS: Nj,)e
(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 groundv atec
inflow (cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY: �_ e,
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: j tiJ—Q s0t7_ fiQ(aM. �CX1.1i
Owner: C>llu--� VeVzkk
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent referent
locate all wells within 100'
�. �-c� S I � 5�' � ►r
A- -\ o s a 55, L4
S3 = 5� L4
ko YuCLXA",� (,D,
-
� 0 V -sow Ga t
� ko S t z:a Com' s
e)A-v Sa =.-
. 31'
�� �3 X 35
Lf I 'Ll
DEPTH TO GROUNDWATER
Depth to groundwater: /J feet
method of determination -pr approximation:
(revised 8/15/951 9