HomeMy WebLinkAboutMiscellaneous - 27 BOXFORD STREET 4/30/2018C) ;10
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Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
LOCT 2? Z013
T TOWN OF NORTH ANDOVER
OW 0 0
T I
HEALTH DEPARTMENT
DEP has provided this form for us& by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using.this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1 . System Location: Left / Right front of house, Left C§1� �qfhousi6, Left / right side of house, Left
Right side of building, Left Right front of building, Left / Right rear of building, Under deck
Address
Cityt-rown State Zip Code
2. System Owner
Name
Address (if different from location)
City/Town stat Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping
3. Type of system. E]
F-1 Other (describe):
Date 2. Quantity Pumped
Cesspool(s) M—Septic Tank
Gallons
El Tight Tank
4. Effluent Tee Filter present? M Yes 3-9-0--� If yes, was ft cleaned? E] Yes E] No
5. Condition otSysteny
6. System Pumped By. -
Nell Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. LL e contents were disposed:
GaL S. Lowell Waste Water
Sign e It Hasulelk./
t5form4.doc- 06103
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Date
System Pumping Record - Page I of I
Commonwealth of Massachusetts
ECEIVEE
City/Town of
F 'U11
System Pumping Record NOV JU Z
=o%rrn A
TOWN OF NORTH ANDOVE
'�R
HEALTH DEPART�MENT
I
DEP has provided this form for use by local Boards of Health. Other forms may 15muli
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left / Right front of house, Left / Right rear of house, Left / right side of house, Left
Right side of building, Left / Right front of building, Left Right rear of building, Under deck
Address
City/Town
2. System Owner:
Name
Address (if different from location)
Cityrrown
B. Pumping Record
M
State
b�uvll�
C— [ 6 -(('
Zip Code
State
C
Telephone Number
1. Date of Pumping Date 2. Quantity Pumped
3. Type of system: El Cesspool(s) 2--S'eptic Tank
[j Other (describe):
Gallons
El Tight Tank
4. Effluent Tee Filter present? 0 Yes 2-9-0 If yes, was it cleaned? [] Yes R No
5. Conditign of System:
�j 67 �'CO-O'L � V�"- '+Z�— �
6. System Pumped By:
Neil Bateson
Name
Bateson EnterDrises Inc
Company
7. Lo� �fihere contents were disposed:
(!20GLS Lowell Waste Water
.- 1) A (-) —A -
F5821
Vehicle License Number
Date
t5form4.doc- 06/03 System Pumping Record - Page I of 1
1, . -�- 1. -N I � . I I I
Commonwealth of Massachusetts
kvCity/Town of
System Pumping Record
Form 4
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key -
VQ
DEP has provided this form for use by local Boards of Health. Other fo
information must be substantially the same as that provided here. =tull
local Board of Health to determine the form they use. The System Pumping
the local Board of Health or other approving authority.
A. Facility Information
1. System Location:
<-:�)
Address t Clt sn—
cityrrown State
2. System Owner:
Name
Address (if different from location)
P.
RECELVED
AUG 18 2008
VC0e\.Y§e-d1','P1UV0eE-R
9[this4orrmichl- vat i your
ecord muWBF-s-56ft ted to
Zip Code
Cityrrown St Zip qcde
Telephone Number
B. Pumping Record
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Type of system: El Cesspool(s) Q-Se—p-t-icTank Ej Tight Tank
F1 Other (describe):
4. Effluent Tee Filter present? 0 Yes 9-<O If yes, was it cleaned? 0 Yes El No
5. Condition of System:
n, D c j�,A v�-
6. System PumpedBy
Name OVehicle License Number
Company XA
7. Location ere contepts weri isposed:
�/� 7 L, - < - n,
Date
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TONVN OF �'l -.)W6\'fCr
SYSTEM PUMPING RECORICDW-WO-RTHi��LL
FtbAQr
0 OF I 4EALTH -1
DATE:
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house)
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,r— - kmsf-
DATE OF P . UMPING: 20 - d QUANTITY PUMPED: J-60-0 GALLONS
CESSPOOL: NO YES - C TANK: NO YES
NATURE OF SERVICE: ROUTINE 7wmEMERGENCY
OBSERVATIONS:
GOODCONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELDRUNBACK
FLOODED
OTHER (EXPLAIN)
sysTEm PUMPED BY: Bateson Enterprises, Inc.
CONIMENTS:
CONTENTS TRANSFEMIED To: G.L.S.D___k,,/ Lowell Waste
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Board of Her-Ith
North AudoverqMass.
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SEPTIC SYSTEK
INSTAUATICK CHHCK LIST
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Distance Tot
a. Wetlands
b. Drains
0. Well
Z2. Water Line Location
No PVC Pipe
V11d4 Septic Tank
I
��b, 0 Tess - Length & To Clean Out Covers
b. Cement Pipe to Tank - On Both Sides of Tank
Distribution Box
a. Covers & Box - No Cracks
b. All Lines Flowing Equal Amounts
c. No Back Flow
Leach Field or Trench
a. Dimensions IX g4i
Stone Depth
Capped Ends
d. Clean Double Washed Stone
7. Leach Pits
a. Dimensions
b. Stone Depth
c. Splash Pads
d. Tees
e . C e_P_,zp`6 to Pit Both Sides
f. C Double Washed Stone
i/E8. NeGarbage Disposal
Anal Grading Inspection
I-
I vered-Ar.9-tem
3.1. As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location with Regard -to Pere Test,
d. Elevations
eo' Water Table
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OF NORTH ANDOVER
REPORT OF PERC TEST
NORTH ANDOVER BOARD OF HEALTH
ADDRESS OF SYS TEM 40 //�,Z,< g, DATE /5j-/,7./
NAME OF PROFESSIONAL 'ENGINEER OR SANITARIAN CONDUCTING TESTS
a0t..'— 6"a —art,
NAME OF LOT OWNER 4e J/0
/0 ADDRESS
SHOW APPROX114ATE LOCATION OF PITS ON SIETCH ON REAR OF THIS SHEET
Total
Soil Log: Topsoil .Subsoil Depths & Tvoes Wnt.p-r T.P-vrp-1 Pi i-. T)r-nt.b
Time to Time to
Xere 'rests Depth Saturation Time Drop 12ft - 911 Drop qff - 61t
Other Considerations:
Recommendations:
Signature
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Time to Time to
Xere 'rests Depth Saturation Time Drop 12ft - 911 Drop qff - 61t
Other Considerations:
Recommendations:
Signature
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16�1 - , ,
Town of North Andover
. OMCE OF
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
KENNETH R- MAHONY North Andover, Massachusetts 0 1845
Director (508) 688-9533
September 19, 1995
Marcie Cobb
19 Boxford Street
North Andover, MA 0 1845
Dear Ms. Cobb:
In the autumn of 1994 the leaching area of your failed septic system
was replaced. You were notified that the Board of Health would permit you
to repair your septic system in two phases, the first being the replacement of
the leaching area, and the second, the re-routing of the interior plumbing to
connect with a new septic tank located outside of the house foundation. This
second phase was to have been done *in the spring of 1995. Our records
indicate that the second phase, that of the installation of the new septic tank
and the abandom-nent of the old tank has not as yet been started.
On receipt of this letter, please contact the Board of Health to discuss
the date that the second phase will begin. If we do not hear from you within a
reasonable amount of time, an order letter will have to be issued, requiring the
work to be done within a stated amount of time.
We will be happy to answ er any questions you may have about this
matter. The Board of Health hours are Monday through Friday from 8:30
A.M. until 4:30 P.M.
Sincerely,
- jldl)tdo
Sandra Starr, R.S.
Health Admim*strator
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Julie Parrino D. Robert Nicetta Nfichael Howard Sandra Starr Kathleen Bradley Colwell
.1
BUTTERWORTH & O'TOOLE, INC.
P.O. BOX 8294
SALEM, MA 01971-8294
ADJUSTERSIAPPRAISERS
FOR INSURANCE COMPANIES ONLY
TELEPHONE (978) 741-5731 FAX (978) 740-9109
'C'
May 09, 2003 P0, 'i
MAY 2 9 2003
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
TO: Building Commissioner or
Inspector of Buildings
City/Town Hall
ADDRESSES
North Andover, MA 01845
RE: Insured: Eugene Hunt
Address: 19 Boxford Street
Policy No. :
Board of Health or
Board of Selectmen
City/Town Hall
North Andover, MA 01845
North Andover, MA 01845
F0108690
Loss of: 5/01/03
File or Claim No.: 031-1212
Claim has been made involving loss, damage or destruction of the above
captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws,
Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws,
Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer
and include a reference to the captioned insured, location, policy number, date
of loss and claim or file number.
If no reply is received from your office within ten days, we will assume
you have no liens of any type against this property and we will recommend to the
insuring company that this claim is paid.
Vicki Gardner
Adjuster
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
STEM OWNER & ADDRESS
19 1�694��Zl
SYSTEM LOCATION
(example: left front of house)
U.\,I,c OF PUMPING: q -l(-6 QUANTITY 'PUMPED
1: P0 0 L: N 0 )Z— YES SEPTIC TANK: NO YES V,
"� ATURE OF SERVICE: ROUTINE X EMERGENCY
ui�.SFRV.�\TIONS:
GOOD CONDITION
HFAVY CREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVEI�
BAFFLES IN PL,ACE
LEACHFIELD RUNBACK
FLOODED
O�jHFR (EXPLAIN)
DI
UNIAH)ED BY: y V�, 177
C U � I'yl P.NTS:
� UNTT',NT� TRANSFERRED TO:
OFFICh-%S OF:
APPEALS
0
BUILL)ING
CONSERVA,riON
HEALTH
PLANNING
PLANNING & COMMUNITY DEVELOPMENT
Building Inspector
KAREN H.P. NELSON, DIRECTOR
120 Main Street
North Andover,
Massachusetts 0 1845
(617) 685-4775
August 6 1987
re= 19 Boxford St
New swimming Pool
,on August 4 1987 this lot was inspected to
verify that -the swimming pool as installed is over 20 feet away
from the leach area as required. It is and this office has no
objection to the installation.
Sincerely
Sanitarian Board�of Health
cc= Kelly, 19 Boxford St.
No. Andover. Mass.
TOWn Of
NORTH ANDOVER
DIVISION OF
PLANNING & COMMUNITY DEVELOPMENT
Building Inspector
KAREN H.P. NELSON, DIRECTOR
120 Main Street
North Andover,
Massachusetts 0 1845
(617) 685-4775
August 6 1987
re= 19 Boxford St
New swimming Pool
,on August 4 1987 this lot was inspected to
verify that -the swimming pool as installed is over 20 feet away
from the leach area as required. It is and this office has no
objection to the installation.
Sincerely
Sanitarian Board�of Health
cc= Kelly, 19 Boxford St.
No. Andover. Mass.
FrcQ:
, I - 0
To: Date: 7 10 E37
VFor vour information D Please return El Please call me
0 As requested N./Please handle El Please approve
El A,.e you interested YPlease comment 0 Please forward to:
�rz �
COMPLIMENTS OF THE NAIMAN PFiESS - 1-617-682-1291
---*CFFlCES OF:
.BUILDING
CONSERVATI()N
HEALTH
1:31-ANNING
0,
Town of
NORTH ANDOVER
DIVISION OF
PLANNING & COMMUNITY DEVELOPMENT
i
Linda 9 (ViU-iam Ketty
19 Box6o)td St)Leet
No&th AndoveA, MA
DeaA WL. 9 -Mu. Ketty:
KAREN H.P. NELSON, Dll:',EC'I'OR
Juty 20, 1987
120 Main Street
North Andover,
Massachusetts 0 1845
(C) 17) 685-4775
It ha,5 been buught to ouA attention that you have instatted a swimmi�ng
poot which iz ove)L 2 6t. in height and deteArhine'd to. be a sttuctme;
theAe6me, you GAe AequiAed to 6iee the necmufty buitding petmits and
mechamicat peAmit-6, i4 needed, 6o,,L same.
Faitme on yowt patt to compty with thi6 ditective within one week
6Aop! �Leceipt o6 this tetteA, wiU cause the Town to bting tegat action
agG-,(,n,st you to cmAect this zonLng viotation and impo.6e a �jine o�j
$30D peA day 4o,% each day the viotation continum .
Ve,�.y ttuty you�us,
Daniet McConaghy,
AWt Buitding Tnzpectot
McC: b
cc: Dia., DPCD
0 4"P
niT
41
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,LORTpl
".'4cku
Applicant
Town of North Andover, Massachusetts
BOARD OF HEALTH
DISPOSAL WORKS CONSTRUCTION PERMIT
C
Site Location / --B(DX,,c-eCb -,�)-7-
Form No. 3
/9'-19
ILL
Permission is hereby granted to Construct ( ) or Repair (4- �anlncrividual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
Fee
17 t'
-q,
P
1A
A L7
CHAIRMAN, BOARD OF HEALTH
D.W.C. No. -� I D
.1V
1 .1
William F. Weld
Ga�pernor
Argeo, Paul Celluccl
U. Gcovernor
Commonwealth of Massachusefts ov-
901
V,
V-1109le P1*10
Executive Office of Environmental Affairs 0 W,
Department of
Environmental'Protec Jon
0.0.1,14,
Trudy Coxe
Secretary
David B. Struhs
Cornmisosionet
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: Address of Owner.
Date of Inspection -
(If different)
Name of Inspector.
Company Name, Address and Telephone Number. BATESON ENTERPRISES, INC. TEL: �508) 475-14,14
Excavating - Water & Sevver Lines - Septic Systerms & PurnpIng Service FAX- (508) 475-54 . 51
L/ 7A,40 111 Argilla Road 6 Ahdover, Mass. 0 1810
CRUTIFICATION STATENF4N
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, . accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
— Conditionally Passes
— Needs Further Evaluation By the Local Approving Authority f
FWalils
Inspector's Sign& ture:
The System Inspector shall subh*d't a a ",is on 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 gredtdri the inspector and the system owner *hall submit the
report to the appropriate regional office of the Department of Environmental Protection. -� - � � o's , , 7, , " ' : -t, � I �,t 'I;
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority,
INSPECTION SUMMARY:
Check A, B, C, or D:
A] SYST71M SES:
I __ =1have not found any information which indicates that the system Violates any of the failure criteria . as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, . Passes
inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exriltration, or tank failure is
imminent. The system will pass inspection it the existirig septic tank is replaced with a ponforming septic tank as approved
by the Board of Health.
(revised 11/03/95)
I
I r'�"%' 1, , " _I . , I.
One Winter Street 0 Boston, Massachusetts 02108 0 FAX (617) SWI049 0 Telephone (617) 292.&SW
4) % Pnnled orl Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (odntinued)'
ct
Property Addrew:
Owner.
Date of Inspection:
BI SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of
Health): broken pipe(s) are replaced
obstruction is removed!
distribution box is levelled'or replaced
A
The system required pumping more than four time's a year due to broken or obei F rucied pipe(s). The syste�:wiIl pass
inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed i
3
CI FURTHER EVALUATION IS REQUIRED BY THE 90ARD OF HEALTH:
Conditions exist which require fiather 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 r'r-MRONMEN1%.
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is,iArithin 50 feet of a bordering vegetated wetlana or a- �Wt niarsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER-SUPPLIEM IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A'MANNER THAT PROTECT THE PU13LIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
— The system has a septic tank and soil absorption system and is within a Zone I of a public water supply W�li.
— The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well.
— The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from . a private water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indieatetthat the well.is &to
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
�'j
3) OTHER
(revised 11/03/95) 2
SUBSVRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Addrew
OVVner.
Date of Inspection: j t
DI SYSTEM FAILS-
-rp
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS or oess
POO
— Discharge or ponding of eMuent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
— Liquid depth in cesspool is less than 6" below invert or available volume is leas than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or.obstructed pipe(s),
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface watonsupply.
Any portion of a cesspool or privy is within a Zone I of a public weU."v
Any portion of a cesspool or privy is within 60 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet froth a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water I "ysis for
coliform bacteria, volatile organic compounds, ammonia hitr6gehland nitrate nitrogen.
40
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
— the system is within 400 feet of a surface drinking water supply
— the system is within 200 feet of a tributary to a surface drinking water suppLv
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a I mapped zone n of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into M compliance with the groundwater treatment p . r*gmm
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for ftuther information.
(revised 11/03/95) A 3-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST.,
Property Addrem-
Owner.
Date of Inspection: to -
Check if the foil have been done:
—P information was requested of the owner, occupant, and Board of Health.
�No., 'of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
do t period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
have been obtained and exan-dned. Note if they are not available with NIA.
As
�y or dwelling was inspected for signs of sewage back-up.
e �he does not receive* non -sanitary or industrial waste flow
.i InSpected.for signs of breakout.
components, excluding the Soil Absorption System,,have been locaw on the site.
�4e 7weptic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condiiion of baffles or
tees rial of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
0_1
4 -The ie and location of the Soil Absorption System on the site has been determined based on existing information or
app by non -intrusive methods.
L' --The facility owner (and occupants, if different from owner) were provided with. infoFmation on the proper maintenance of Sub.
Surface Disposal System.
J .'�b v
14
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: tcl
Owner.
Date of Inspection- ouc
FLOW CONDITIONS
RESIDENTIAL -
Design flow:
_ j �Dllons
Number of bedrooms: 3 -
Number of current r.;,7d.nt.: S
Garbage grinder (yes or no): j70 -
Laundry connected to system (yes or no):_Y�3
Seasonal use (yes or no):_LL0 '2 "A Ick
_V _.) _t I Z�=
Water meter readings, if available- a — ( UU -t- c- V0, L
q'1;_ — !L�aOL -'?QQ Ar S�7420 4- qCVO -5-4z 13624�� 4SQ,
TG - -370,0-4 qlo,34,37oo
Ll -3 6 -3 r7 I -�- �30
Last date of occupancy
4
COMMERCIALANDUSTRIAJU
�Yk VX
Type of establishment:
Design flow:
_p1lons/day
Grease trap present: (yes or no)—
Industrial Waste Holding Tank present: (yes or no)
Non -sanitary waste discharged to the Title 5 system: (yei or no)
Water meter readings, if available:
Last date of occupancy:
OTHER. (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RWORDS and source of information: Cf
4r
System pumped as part of inspection: (yes or no)
C)CO
If yes, volume pumpe�: dlQns I
Reason for
pu-ping:
TYPE OIE,�M
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)
A'gR0=TE AGE of all components, date installed
if9own) and source of information
-k-%-qA L_ �� o ( . . '..' ' (-(-
(.1 L4 Ck S b'�\
Sewage odors detected when arriving at the site: (yes or no)
(revised 11/03/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued).'
10,
Property Address:
Ow,ner. k
Date of Inspection: C-
SF4MC
(locate on site plan)
Depth below grade:
FRP other(explain)
Material of construction: _Z��concrete —metal
Dimensions: '7 5 21 ' V
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top'of outlet te, �or bffie, t,
Distance from bottom of scum to bottom of outlet tee or,baffle: -t
Comments:
. umpmT3n 'd I I lation to tiet invqrt, ath-tcturpl inte
(recommendation for p dit, d tlet ttes or bqffles, doilth of,�qui eve in I ou gri
�ioninle an ou
V
eyidence.oLlaakage, eto 4 "4
Ajoc's� (&,P— VkQ V 0 >k
GREASE TRAP*,z*t- Oav&-I—CL
(locate.on site plan)
Depth below grade:_
Material of construction: —concrete __,_metal —FRP —other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or bafne:_
Distance from bottom of scum to bottom of outlet tee or bafne: I
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth oi liquid .1evel in relation to outlet invert,. structural integrity,
evidence of leakage, etc.)
o
J -
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEhi INFORMATION (oont . inued)
Property Addrem- L
Owner.
Date of Inspection:
TIGHT OR HOLDING TANX*
(locate on site plan)
Depth below grade:
Material of construction: —concrete —metal _FRP —other(explain)
Dimensions:
Capacity: mHons
Design flow:__________gaUoria/day
Alarm level:
t
Comments: i
(condition of inlet tee, condition of alarm and float switthes, etc.)
DISTRIBUTION BOX.
(locate on site plan) r
Depth of liquid level above outlet invert:
Comments:
PUMP CRAMBEIL
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, et4.).
(revised 11/03/95)
7
i 1* " , � , '. , ". . ,
A-
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner. vio'x-c\ SOW241.slkw
Date of Inspection:
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;
leaching pits, number:
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions: tc_� ek-
overflow cesspool, nuznber:_
�tion jt!9ei4p of hydraulic fail
\C1
CESSPOOLS:V~
(locate on site plan)
of V,
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 (ompool must be pumped 08 part of inspection)
Comments: (note condition of &oil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
-V
PRIVY:
(locate on site plan)
Materials of construction:
Dimensiorim.
Depth of solids:
Comments: (note condition of soil, signs of hydraulic faililre, level of pohding, bondition of vegetation, etc)
(revised 11/03/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: --vz,� s�v. 0 - A,,�
Ovvner. �.S' "-C� C,\
Date of Inspection:
SIWMH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent j
locate all wells within 100'
P3
Pj+0 -), -:t
(�+o -3
as
DEPTH TO GROUNDWATER
landmarks or
�Aou a �'
A
4P
Depth to poundwater: feet
method of determination or approximation:
(revised 11/03/95) 9
I
Page 2
Minutes: September 28, 1995
On a motion by Dr. Rizzal' seconded by Dr. Rizza, the Board voted
unanimous to grant the Health Agent the powers to oversee repairs
and to grant appropriate variances for repairs -only. when no zoning
or wetland setback issues are not involved.
REQUEST FOR A MASSAGE ESTABLISHMENT LICENSE .-.. CAROL RAY:
Ms. Ray is a Registered Nurse . and practices,massage therapy from
her home on 678. Mass Ave. Mrs. Starr stated � that she had inspected.
the facility and found it,,to -be entirely�_appropriate and
professionally run.
on a motion by Dr. Rizza,, seconded by,Dr. Rizza, the Board voted
unanimously based on the fact that Ms. Ray is a Registered Nurse,
to allow the operation of a massage iherapy-establishment at 678
Mass Avenue, North Andover,, MA. The.license would,be-valid through
December 1996i
At this point Dr. MacMillan arrived and Gayton.Osgood updated him
on the meeting.so fari
RESIGNATION OF-THE.fHEALTH-NURSE,--�GIRNY,-FOULDS.0
--that-Mrsu Fc
Mr si'.'.Sta'rr; r epotted ten`de'"red," er iresignation,
as , of December 1,-.1995 1 because sfie',ke'e'ls, t . e,. j qb ding and
.,Tis,ex an
P
she does not have the time to do thei*job.. Mrs.,Starr. recommended
that a new job description, beJormulated and, the, possibility of
more hours for the nurse's position be�looked at."
on a motion by Dr. RizzaF seconded by Dr. Macmillan, the Board.
voted unanimously that the criteria for the job description be
looked at and analyzed at tho.hext meeting, before the., job is:
advertised.
RECOMBINANT DNA MOLECULE REGULATIONS:
All Board Members agreed to hold,a public -hearing before adopting
the Recombinant DNA Molecule Regulations.
VARIANCE FOR REPAIR FOR 30 OAKES DRIVE:
The Board Members directed Mrs4 Starr to handle this matter.
Cli��l�6X—F-oRi)-gTREET--�--tbRD SUNDSTROM:
Mr. Sundstrom related,tthe-., ibf, his house -,and, septic.,system:
.4_ist6ry,7,
ir
repailr.' The leach �*ng, drea..was repAixedAn -the-fqf -. 1 19 9 4 ince,,
of
the septic tank i . under' the- concrete slab of 'the 'foundation it 'is'
a problem -4 - The tank � was - - to have,. been -- repl acedr this past spring.,
Mr. Sundstrom told of his dif f iculty - in trying to have his tank
replaced. Af ter a lengthy discussion it was agreed that since"the
Page 3
Minutes: September 28, 1995
tank seems to be working properly that it could be left as is.
OTHER BUSINESS:
ARRroval of Minutes 8124/95: -
on . a motion by Dr. MacMillan, seconded by Dr. RizzaO the Board
voted unanimously to approve the minutes of 8/24/9S as written.
Dr. Rizza stated he wished to amend the minutes of the June 22,'
1995 meeting to explain why a particular motion was made relative
to 59 Bridges Lane and the Contrada family. Instead Dr. Rizza
wrote his changes and they will be included in these.minutes4
on:
Tobacco Control RegMlations - Restaurants.in Violati
Dr. Rizza stated th at Harrisons' Restaurant is in violation of the
Tobacco Control Regulations and requested that Mrs. Starr visit the
restaurant and -speak to them. only three restaurants in town have
any smoking now, The Ninety -Nine Restaurant, Beijing Restaurant,
and The Loft Restaurant, Mrs. Starr reported that The Loft has as
yet not submitted any documentation or reports .on the methods used
to keep smoke from the non-smoking.floot-:1
ADJOURNMENT
on a motion by Dr. Rizzaf seconded by Dr. MacMillan# the Board
voted unanimously to adjourn the meeting at 8 :30 p.m.
John S. Rizza, DiM�D6, Clerk
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Commonwealth of Massachusetts
LJL�-&)-LtX"AM assachusetts
System Pumping Record
System Owner
Date of Pumping:
Cesspool: No Yes
System Pumped by: 64&44W 460avMae4
System Location
It
Quantity Pumped: (ae-1 gallons
Septic Tank: No [ ]
License #
Contents transferred to: Greater Lawrence Sanitary District
Date: Inspector:
Yes [4 --
-C-\ Commonwealth of Massachusetts
Vffim City/Town of
4 System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
Cityrrown
Zip Code
State C—) -V—� , Zip Code
rl�2 (�� '/ <�r
Telephone Number
B. Pumping Record 6 1 ( -->>
1. Date of Pumping Date r— %Xuantity Pumped: Gallons
3. Type of system: F-1 Cesspool(s) 2—S--e-ptic Tank El Tight Tank
F1 Other (describe):
4. Effluent Tee Filter present? El Yes B-`No� If yes, was it cleaned? El Yes El No
5. Condition of System:
6. System PI u" Jay:
Name V I Vehicle License Number
Company —
7. Location;�re contents weretnosed:
L e=N'
Sianature of HAIer// Date
t5form4.doc- 06/03 System Pumping Record - Page I of 1
A. Facility Information
Important:
When filling out
forms on the
1 System Location:
computer, use
only the tab key
Address
to move your
cursor - do not
use the return
CityfTown
St&e
key.
2. System Owner:
Name
Address (if different from location)
Cityrrown
Zip Code
State C—) -V—� , Zip Code
rl�2 (�� '/ <�r
Telephone Number
B. Pumping Record 6 1 ( -->>
1. Date of Pumping Date r— %Xuantity Pumped: Gallons
3. Type of system: F-1 Cesspool(s) 2—S--e-ptic Tank El Tight Tank
F1 Other (describe):
4. Effluent Tee Filter present? El Yes B-`No� If yes, was it cleaned? El Yes El No
5. Condition of System:
6. System PI u" Jay:
Name V I Vehicle License Number
Company —
7. Location;�re contents weretnosed:
L e=N'
Sianature of HAIer// Date
t5form4.doc- 06/03 System Pumping Record - Page I of 1
I t�k-,r-J7;' V- F
01f
, "41�1 .; i 1,,,, 1.
ZZ
"M
rin.
Q;M!
yi 1�
_p
""t cr
le
py
Yil eAve ve where
By M11 Gaithei�:.�`."-, andSton4i r
Ea le Tribune Writer zene and'other, Pchiemica s,, were. I,"
found in the surface water.
ANDOVER �.'P* I Until ihe'results of those tests
ORTH ap
I coll is willing to chance- livinj
)ris -are known, -the Board of Health
an occu an pyi
near, A �'poisoned well to protect i will not issue p
I.: . I
mit for Driscoll's home.
his investment.' -_1 - I I ". . I . I
Those,'.Aests could
-The town's Board of'. Health take two 5_
JmFon'tlethim. 'I,week.;,, to.'complite and',may,cost _1'1_.�,�,.,`t
Driscoll, a'new-home builde' ' more than ;�00_ L
r;
can't sell his new house on Box-. T
Driscoll'said"a potential buyer 01
-ford - Street because. of , reports
backed iway. af ter, reports surfac
that', benzene, - 4 `chemical% that*
ed thatI, the �Environmental Pro -
causes cancer,:.was found n"
i the tection had
ti,::Agency
home's well. w.,
benzene 'In surface
buyers,!'
Dhicoll wanted 'to move into. Driscoll said
self to keep fr
th house him' 0M -'� young baby ind said - the,
r
losing money, but -the Board of filght,
.benzene ened them..*
Health last night 'refused, him
Ea9l;:i, 4'0j.�iA� iiii 6.1�
permissionto move in.". - i, "She':Just had;-a,�6aby and ibu
�d t"''
State'tests re schedul O_P lease see HOUSE Paul Driscoll's.7w home,4ar sit I e of benzen'e con"ti`ci�m'inotic
day on the well at,Boxford Street Back pagei thii section
4�7
epols.o,ne
11"'Cou
a: haye-'trpuble
14�tting them use it for washing.
b-
Hopser From page one _'."We.)'ari d6aling'; with a su
s ce-that' causes -'cancer," 'he
tan
wants to breast-feed it, so I guess ,,n said.'.',
J understand her. worry,", Drigeoll, EPA -tests showed,more than
,said. "But I have a lot of money �0 parts.per-billion Mrsamples of
tied up in that place and Fdbn't..,.',' surface water taken from, the
,want to have to file b.ankruptcq to property. In a report to the health
',,,protect it.". board last jn6nth, r EPA recom-
"I will bring m
in, spring water ended no one be allowed to live
-on
and move into'the ho.we'rpyself,'_ the. propere&ntil tests,of, the
put'iiiy* own well"were'cond4cted:,,,!
'�Driscoll said.,"I'll
home'up for sale- and move � into.1.J - Board.of Health "member Gay-
'��the new house until the tests are
ton Osgood said he believed the
�Sed,' r "an industri-
completed.". site'was once as
..,.The board rejected: his re-
al'dump..,. Large amounts of plas-
riiiit will be
tic, considered, stable and not a
,,quqst, insisting no pe
liss ed until the tests,are_c0m-11,- threat,'�were ifound at the site
i pleted. .when land -clearing began.
.,As,the medical.member. of Osgood told the boardi a bull -
this board,�- I do not feel comf ort� dozer unearthed and punctured a
able letting 'people i move into a,. drum of chemicals at the site'and
house and i ingest water'that ma
Y ' "isuggested the'benzene may. have
i. have benzene in it,",r Dr." John 6ome f rom* that accident.,
epols.o,ne
11"'Cou
a: haye-'trpuble
14�tting them use it for washing.
b-
Hopser From page one _'."We.)'ari d6aling'; with a su
s ce-that' causes -'cancer," 'he
tan
wants to breast-feed it, so I guess ,,n said.'.',
J understand her. worry,", Drigeoll, EPA -tests showed,more than
,said. "But I have a lot of money �0 parts.per-billion Mrsamples of
tied up in that place and Fdbn't..,.',' surface water taken from, the
,want to have to file b.ankruptcq to property. In a report to the health
',,,protect it.". board last jn6nth, r EPA recom-
"I will bring m
in, spring water ended no one be allowed to live
-on
and move into'the ho.we'rpyself,'_ the. propere&ntil tests,of, the
put'iiiy* own well"were'cond4cted:,,,!
'�Driscoll said.,"I'll
home'up for sale- and move � into.1.J - Board.of Health "member Gay-
'��the new house until the tests are
ton Osgood said he believed the
�Sed,' r "an industri-
completed.". site'was once as
..,.The board rejected: his re-
al'dump..,. Large amounts of plas-
riiiit will be
tic, considered, stable and not a
,,quqst, insisting no pe
liss ed until the tests,are_c0m-11,- threat,'�were ifound at the site
i pleted. .when land -clearing began.
.,As,the medical.member. of Osgood told the boardi a bull -
this board,�- I do not feel comf ort� dozer unearthed and punctured a
able letting 'people i move into a,. drum of chemicals at the site'and
house and i ingest water'that ma
Y ' "isuggested the'benzene may. have
i. have benzene in it,",r Dr." John 6ome f rom* that accident.,
i" AL -Z
CL, I IUN i,
REGION I
60WESTVIEWSTF4ET, LEXINGTON, MASSACHUSETTS 02173.
May 9, 1984
Mr. Charles Foster
Building Inspector
Town of North Andover
Town Hall
North Andover, MA 01845
Dear Mr. Foster:
On March 8, 1984, the Driscoll Development site butting Boxford Street,
North Andover, MA. was inspected by EPA personnael in response to your
inquiry regarding buried plastic wastes on the property.
During the inspection, air monitoring field reconnaissance instruments
did not indicate the presence of an Immediately hazardous condition on
the property. The'field inst *
rument data revealed:
• Radiation (alpha, beta, gamma) None
• Oxygen Concentration Normal
• Combustible/Explosive Cases None
• Hydrogen Sulfide Gas None
• Total Organic Vapor 0.3 ppm
Groundwater, leachate, and soil samples were taken by EPA personnel. The
results of the analysis of the samples iu parts per billion (ppb) are:
o Groundwater Toluene 70 ppb
Acetone 140 ppb
• Leachate Benzene 53 ppb
• Soil Fluoranthene 1500 ppb
Phenanthrene 60,000 ppb
Pyrene 600 ppb
The above results were sent to the Centers For Disease Control (CDC) in
Atlanta, Georgia for evaluation by toxicologists and health advisors.
The CDC evaluation and the recommmendat ions of the EPA regarding the
I
disposition of the Driscoll Development site are:
Due to the presence of benzene in the recharge area for the
lower aquifers', the groundwater at the site may be unfit for
long term human consumption. As a precaution, the present
structure(s) should remain unoccupied until the extent and
R cw; migration of �onsite contaminants are defined by additional
, T T groundwater s4mPling and
E -h11— study. It may be prudent to
WIt -on—goi ng :Cons t rOction at this time.
0
I�VRTH ANDovER
SUILDIfIG 0--pT.
r.
y1 _
T/' ,y n i
Mw�
6
VIC
2) Since the existing house(s) and the on-going construction is to
be suoplied by private groundwater wells for potable waterb
additional sampling must identify the total extent of soil
contamination, the total extent and migration of contamination
present in the shallow aquifer (vadose zUe), and the bedrock
aquifer (saturated zone). Based upon the results of the study,
the necessity for removal pf the contaminants, and future land
use at the site can be evalu'ated.
3) The appropriate town officials require the owner/developer ofj
the property to execute the additional sampling and si'tenevalua—
t ion. U
4) This office has notified the Massachusetts Department of
Environmental Quality Engineering (MA DEQE) regarding �Pe results
of the EPA site visit. Questions regarding the dispooftion of the
on—site plastic wastes, study results and technical assistance
requests should be referred to the MA DEQE, Division of Solid
and Hazardous Waste', 323 New Boston Street, Woburn, MA 01801;
(617) 935-2160.
5) If necessary, this office can provide additional technical
assistance by calling (617) 223-7265.
If you have further questions, please do not hesitate to contact me at
(617) 861-6700.
Sincerely,
C.7
bert J.t
Robert J. titus
Environmental Engineer
RJA/dab
cc: Edward Scanlon, No. Andover Board of Health.
Richard Chalpin, MA DEQE