HomeMy WebLinkAboutMiscellaneous - 292 CANDLESTICK ROAD 4/30/2018 (2)f. A
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MAP qO_
PARCEL # STREET »n`�"��
�������.�������������
C�NE�AU��%ON_AP��OVAL
HAS PLAN REVIEW FEE BEEN PAID? YES NO\
\
PLAN APPROVAL: DATE APP. BY
DESIGNER: PLAN DATE
CONDITION \
WATER SUPPLY:
WELL PERMIT__
WELL TESTS:
WELL
CHEMICAL DAlE APPRUVED______
BACTERIA I DAlE U[`PROVED _
BACTERIA II DA[E APPROVED
' ----''----
COMMENTS:
/
'
� .
FORM U APPROVAL: A NO
DATE ISSUED^
'
CONDITIONS:
__............ ___...... ............... ...
____
` F%NAL APPROVAL:
` ALL PERMITS PAID VES NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO /
^
^ '
NO
ANY VARIANCE NEEDED
FINAL_ BOARD OF HEALTH APPROVAL: DATE:_ BY:
|' _/
/
IS THE INSTALLER LICENSED? NO
TYPE OF CONSTRUCTION: REPAIR
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO
CONDITIONS OF APPROVAL YES NO
(FROM FORM U)
ISSUANCE OF DWC PERMIT YES NO
DWC PERMIT NO. INSTALLER: rr)y))5
BEGIN INSPECTION (:Y DES NO:
EXCAVATION INSPECTION: NEEDED:
PASSED By
CONSTRUCTION INSPECTION: NEEDED:
13,-_ eA) - AIIE6
AS BUILT PLAN SATISFACTORY:
APPROVAL- TO BACKFILL: DATE:
DATE By.
FINAL.GRADING APPROVAL:
FINAL CONSTRUCTION APPROVAL: DATE: dzez��_.By_'Zzj
4f I
FORM U
TOWN OF NORTH ANDOVER
LOT RELEASE FORkI
SUBDIVISION
ASSESSORS MAP
SUBDIVISION LOT(S)
PERMANENT ADDRESS (ASSIGNED BY D.P.W.)
STREET
APPLICANT PHONE 5-af
DATE OF APPLICATION
TOWN USE BELOW THIS LINE
CONSERVATION COM�IISSION
CONSERVATION ADkIIN.
BOARD OF HEALTH
HEAL
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY-PER11IT
SEWER/WATER CONNECTIONS
FIRE DEPT.
RECEIVED BY BUILDING INSPECTION
DATE
I
DATE APPROVED
DATF RFjFrTrn
DATE APPROVED
DAT
X REJECTED
PATE APPROVED
DATE REJECTED
This form shall be signed by the agents of the Planning and Health 13oards,
the Conservation Commission prior to the issuance of any building permits
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
,AORTN
0
Town df North Andover
-IDEPARTMENT
HEXLT!
CHECK#:
LOCATION:
H/ 0 NAME:
CONTRACTOR NAME:
Type of Permit or License: (Check box)
0 Animal $
0 Body Art Establishment $
0 Body Art Practitioner $
0 Dumpster $-
0 Food Service - Type. $
0 Funeral Directors $
1:1 Massage Establishment $
0 Massage Practice $
1:1 Offal (Septic) Hauler $
0 Recreational Camp $
0 Sun tanning $
0 Swimming Pool $
0 Tobacco $
11 TrashlSolid Waste Hauler $-
0 Well Construction $
SEP77C Systems
0 Septic - Soil Testing $
0 Septic - Design Approval
13 Septic Disposal Works Construction (DWQ
1:1 Septic Disposal Works Installers (DWI)
0 Title 5 Inspector
01 --Title 5 Report
$
5
El Other (Indicate) $
1765 t
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
DelleChiale, Pamela
From: Stephen Richard Kareta [stephenrkareta@hotmail.com]
Sent: Wednesday, July 14, 2010 4:27 PM
To: DelleChiaie, Pamela
Subject: RE: I.R. - 292 Candlestick Road - Scanned copy of Health Dept. File
Thank you very much
Stephen R Kareta
292 Candlestick Road
North Andover MA 01845
H - 978-208-8218
C - 978-314-7376
• From: pdellech(5)townofnorthandover.com
• To: stephenrkareta(cbhotmail.com
• Date: Wed, 14 Jul 2010 15:21:27 -0400
• Subject: FW: I.R. - 292 Candlestick Road - Scanned copy of Health Dept. File
> Attached is the file information for 292 Candlestick Road that you requested this afternoon.
• Best regards,
• Pamela DelleChiaie
• "We can never see the path of our life if we are too busy focusing on the pebbles under our
feet. "--Anonymous
* Health Department Assistant
* TOWN OF NORTH ANDOVER
* Health Department
* 1600 Osgood Street
* Building 20; Suite 2-36
* North Andover, MA 01845
* 978.688.9540 - Phone
* 978.688.8476 - Fax
* 12de I lech i a ie0btownofnortha nd over. co rn - E-mail
* http://www.townofnorthandover.com/Pages/index - Website
> Notes:
> If copied to BOH Members - Reference Copy Only - no response requested at this time
• ----- Original Message -----
• From: noreply(dtownofnorthandover.com rmailto:noreply(,atownofnorthandover.com1
• Sent: Wednesday, July 14, 2010 3:12 PM
• To: DelleChiaie, Pamela
• Subject: I.R. - 292 Candlestick Road - Scanned copy of Health Dept. File
> This E-mail was sent from "RNPOA428C" (Aficio MP C5000).
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RECEVV--E—D�
il) 7 -7 L/ — q"O
AUG 2 8 2006
0 �o
TOWN F N F TH AND VER
T
LHEALTH PARTMENT
FILE #NAnd'9Q?06A
TITLE V INSPECTIONS
Dean G. Luscomb 11 & Sons
P.O. Box 135
Middleton, MA 0 1949
978-774-4065
Licensed Plumber #20285
ME C E I V 'E D
AUG 2 8 2006
nTO"WIN OF NORTH ANDOVER
0 NO '5 '
E iC T p -MENT
ALTH DEP/A�Rltl-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INPSECTION FORM
C '
PROPERTY OWNERS NAME '�)+e-Ve- K0 re -+o -
PROPERTY ADDRESS Q 9 Q C-'O.nd le-s+cc L F,
N - A r) d p oer- MA 0 j 3 J 5
ADDRESS OF OWNER (if different) S 0- M e -
DATE OF INSPECTION-Apa-) Qg', aDO(Q
NAME OF INSPECTORE)�ar) S. LUSC-0rnJZ, -J-1-
QUALITY IS NUMBER ONE TO US
COMMON,WEALTH OF MASSACHUSETTS
ExEcuwvE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
DEAN G. LUSCOMB II .& SONS
P.O. BOX 135
MIDDLETON, MA 01949
1-978-774-4065
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: .21?e—
Owner'sName:
Owner's Address: Se_��
Date of Inspection: .2 e
:2_0 0 * 6
Name of Inspector: (please print) Dean G. Luscomb II
Company Name: Dean Q. Luscomb II & Sons
Mailing Address:p - 0 - Box 135
Middleton, MA 01949
Telephone Number: 978-77�1-4065
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was perfon-ned based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I- am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
V/Passes
Conditionally Passes
Needs Further.Evaluation by the Local Approving Authority
Fails
Inspector's Signature:
Date:
The system inspector shal I submit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flowof 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The originalshould be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments
""This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform -in the future under the same or different
conditions of use.
L.)fedll " . LjUbL;L)u1V JL.L Ot oullz>
P.O. Box 135
Page2ofll Middleton, MA 01949,
1-978-774-4065
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMUNTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: c;2 -9Z- Caf1d(eS:76Ck
Owner:
Date of Inspection:
Inspection Summary: ChecoA CD or E I ALWAYS complete all of Section D
A. System Passes:
V/1 have not found any information which indic atesthat any of the failure criteria described in 3 10 CMR
15.303 or in 3 10 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the "Conditional Pass" section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, wi I I pass.
Answer yes, no or not detennined (YNND) in the for the following statements. If "not determined" please
explain.
�—) The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if 'a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
A,) Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s) or due to a broken, settled or uneven distribution box.,Systern will pass inspection if (with
approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if (with approval of the Board of Health):
ND explain:
broken pipe(s) are replaced
obstruction is removed
2
Dean G. Luscomb II & Sons
t).O. Box 135
Page'3 of I I
middleton, MA. 01949
1-978-774-4065
OFFICIAL INSPECTION FORM - NOT FOR. VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property.Address: '92—
&2. A noloyer—
Owner: 'r-ellu�
Date of Inspection:
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b) that the
system is not functioning in a manner which will protect public health, safety and the environment:
A-) Cesspool or privy is within 50 feet of a surface water
10 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health, safety and environment:
�J The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
�J The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
/J The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria 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, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3 Other-
tki
P.o. Box 135
Page4 of I I Middleton, MA 01949
1-978-774-4065
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection: 112LI-66
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or "no" to each of the following for all inspections:
Yes No
10 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
jO7 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Liquid depth in cesspool is less than 6" below invert or available volume is less than _ day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped _.
AJ Any portion of the SAS, cesspool or privy is below high ground water elevation.
Owl Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. IThis system passes if the well water analysis,
performed at a DEP certified laboratory, 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, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
ffei� �ohe system fails. I have determined that one or more of the above failure criteria exist as
described in 3 10 CMR 15.303, therefore the system fails. The system owner should contact the Board of
Health to determ ine what will be necessary to correct the failure.
E, Large Systems:
To -6t-cQnsidered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate i er "yes" or "no" to each of the following:
(The following criteriaa ly to large systems in addition to the criteria above)
yes no
— — the system is within 400 feet of a s�% drinking
the system is within 200 feet of a tribu a s-orface drinking water supply
the system is located in a ni en sensitive area (Interim we Protection Area - IWPA) or a mapped
Zone 11 of a public r supply well
If you have ansyvefed "yes".to any question in Section E the system is considered a significa-A'm4reat, or answered
"yes" in-.S�Ion D above the large system has failed. The owner or operator of any large system co-m�qered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance wi&34-0 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
P.O. Box 135.
Page*5 of I I Middleton, MA 01949
1-978-774-4065
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: Z!Zz- C2-40t"-Cc�-
Owner: arat-a-,
Date of Inspection: YAO r.
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Y -No
Pumping information was provided by the owner, occupant, or Board of Health
-Z-Were any of the system components pumped out in the previous two weeks ?
Has the system received normal flows in the previous two week period ?
Have large volumes of water been introduced to the system recently or as part of this inspection'?
Were as built plans of the system obtained and examined? (If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage backup?
Was the site inspected for signs of break out ?
1Z, — Were all system components, excluding the SAS, located on site ?
L// — Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition
of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scurn ?
L11 — Was the facility owner (and occupants if different from owner) provided with information on the proper
maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes, no
t/ — Existing information. For example, a plan at the Board of Health.
�/ — Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [3 10 CMR 15.302(3)(b))
5
LA �3. LIU,
P.O. Box 135
Page6oflt Middleton, MA 01949
1-978-774-4065
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 2 92— &,Adle—s7k r -
/j,– '4,14OL-cr—
Owner:
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): Number of bedrooms (actual): 3L
DESIGN flow based on 3 10 CNIR 15.203 (for example: I 10 gpd x 0 of bedrooms): ��zv'l'per-
Number of current residents:
Does residence have a garbage grinder 6je or no):
Is laundry on a separate sewage system (yes orQ: rJ0 [if yes separate inspection required]
Laundry system inspected (yes orQ: ZQ &
Seasonal use: (yes orQ: L�
Water meter readings, if available (last 2 years usage (gpd)):
Sump pump (yes orQ JU-0
Last date of occupancy: �7
establishment:
Design d6o**based on 3 10 CMR 15.203): gpd
Basis of design flowTse�ersons/sqft,etc.):
Grease trap present (yes or no : —
Industrial waste holding tank prese
Non -sanitary waste di e to the Title 5 syste s or no):
Water met�pwdmgs, if available: —
LastAit6'c�f occupancy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of information: /4z
=d'
Was system pumped as part of the inspe&ion (yes otO):
If yes, volume pumped: allons -- How was quantity pumped determined?
Reason for pumping: P. kk�f�
TYYE OF SYSTEM
Aj��, Septic tank, distribution box, soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (it yes, attach previous inspection records, if any)
Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
—Tighttank _Attach a copy of the DEP approval
— Other (describe):
Approximate age of all components, date installed (if known) and source of infornj�ation:
Were sewage odors detected when arriving at the site (yes orQ 1)p
R
VC=1 %J. UUM-%�-48tW
P.O. Box 135
P�ge*7 of I I Middleton, MA 01949
l.-078-774-4065
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Addrew 0�1? CQAOK051k�L PIC,(
Owner:
Date of Inspection: (0
BUILDING SEWER (locate on site plan)A/a
Depth below grade: o
Materials of construction: — cast iron V140 PVC —other (explain):
Distance from private water supply well or suction line:
Comments (on coqd�ion ofjoints, venting, evidence of leakage, etc.):
�Z '.' L
e, A, a-WU 41() P 11.0 - �,Al AJ4 SI -T ') <7 f 4L'A% jQr-4 41e PAS'
1 4 .
SEPTIC TANK: Y,-S(locate on site plan)
Depth below grade: /'�-
Material of construction: I ncrete __jnetal —fiberglass ___polyethylene
ai 'P
____pther(exp1 n) re-cc-c�k-
If tank is metal list age: LVf'�- is age confirmed by a Certificate of Compliance (yes orQ: tJO(attach a copy of
certificate)
Dimensions: 42 k
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: <,Z- 4'
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or bajffln�e�-:t4
How were dimensions detenriined- 13, Sls-cjks' �a4-( 774Lpe,~,o-!00rT<-,.
Comments (on pumping recommendatons, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
71c 77a, k 6S �'n Venfil'j 4-4 9 -n r� 8111AV,
GREASE TRAP:L110ocate on site plan)
below grade: _
concrete —metal —fiberglass ___polyethylene —other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum�tt-otop of �outlet tee or
Distance from bottom of scum to bottom of outlet
Date of last pumping:
Comments (on pumping recomplonda �tonsjnlet and outlet tee or baffle
as related to outlet inveaeViTence of leakage, etc.):
7
integrity, liquid levels
P.O. Box 135
Page 8 of I I Middleton, MA, 01949
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: C�a4a(4?�,V&d4- RW1
Owner:
Date of Inspection:
TIGHT or HOLDING TANK: tj 0 (tank must be pumped at time of inspection)(locate on site plan)
Depth below g—ra-de-�,_
Material of construction:
metal fiberglass ___polyethylene_,,,�other(explain):
Dimensions:
Capacity: ____gallons
Design Flow: gallons/da �,
Alarm present (yes or no):
Alarm level: in working order (yes or no):
rm
Date of last pu
3
Cornmen�condition of alarm and float switches, etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan) 'b -130y-
Depth of liquid level above outlet invert:
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.): 1
-71LZ 0 - /3ok- 1 J- /"-,) 1, - &�f
'7y ra'01?iA7-Y al"- '777,r. io
PUMP CHAMBER: jjV (locate on site plan)
Pumps in working orrUe'r (yes-or_no):
Alarms in working order (yes or oT--
n
Comments (note condition of pump chamber,RoWditjon,�p=Vs �andappurtenances, etc.):
91
'CUL %3,
P.O. 'Box 135
Page 96f 11 Middletont MA, 01.949
1-978-774-4065
OFFICIAL INSPECTION FORM.- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
. PART C
SYSTEM INFORMATION (continued)
Property Address: aa&S-kck XOG
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): Y95 (locate on site plan, excavation not required)
If SAS not located explain why:
Type
— leaching pits, number:
— leaching chambers, number:
leaching galleries, number:
leaching trenches, number, length:
leaching fields, number, dimensions:
overflow cesspool, number:
innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.): ' I
J j
CESSPOOLS.&O (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:_
Depth —top of I iquid to inlet
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool: _
Materials of construction:
Indication of groundwater in
Comments (note conditiowa
PRIVY:k LL) (locate on site plan)
yeT Sor no):
signs of hydraulic failure, level of ponding, condittompf vegetation, etc.):
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of
9
of ponding, condition of vegetation, etc.):
to -T
to
p
D
P.O. Box 135
Page.10 of I I Middleton, MA 01949
1-978-7744065
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Ad�ress: c2qz n,,Ao,�+�ak W,
Owner: llr;�relr'-
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
CJC 0
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P.O. Box 135
Page 11 of 11 Middleton, Mh 01949
1-978-774�4065
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 12-Q?- C'0Ad4e9Kck_R0L
Owner:
Date of Inspection:
SITE EXAM
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(/Surface water /-4on-c-
,,/Check cellar �� rj t -)Q
(,/Shal low wells
Estimated depth to ground water (0 feet
Please indicate (check) all methods used to determine the high ground water elevation:
L/ Obtained from system design plans on record -If checked, date of design plan reviewed:
,-/ Observed site (abutting property/observation hole within 150 feet of SAS)
,,,/Checked with local Board of Health -explain: a 4LA'A PUL--�% ov, C"It.r-,
Checked with local excavators, installers- (attach o m ntation)
L/ Accessed USGS database -explain- -r4a 1-T I
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You must describe how you established the high ground water elevation:
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BOARD OF HEALTH
120 MAIN STREET TEL. 682-6483
NORTH ANDOVER, MASS. 01845 Ext. 32
5:45 P.M. - TOM NEVE - JERAD PLACE II SUBDIVISION - PERIMETER
DRAIN REQUIREMENTS:
Mr. Janusz, owner of the property was present. Mr. Neve stated
that a lot of the permits have expired but Lot #39 has not
expired. Mr. Neve explainrd that the Building Inspector
is
requiring a foundation drain be placed around all the structures
and that he hired a soil scientist to go out there and dig extra
tests pits where the foundation is and try to determine where the
water table elevation is. They determined that the water table
was within one (1) foot of elevation of the basement foundation
that Mr. Neve is proposing. Mr Neve added that he gave Mr.
Nicetta a copy of the report and he would like to see a
foundation drain around it, still. Mr. Neve and Mr. Janusz have
no problem with installing a foundation drain but need Board of
Health approval because the Board has a local regulation which
states that foundation drains must be thirty-five (35) feet away
from the leaching field. Mr. Neve stated that Title V requires
that the foundation drain be twenty-five (25) feet away from
leaching fields.
Mr. Neve stated that Lot #39 is on a high and dry lot and they
are still keeping the foundation up one (1) foot higher than the
water table and will put a drain around the foundation.
Ms. Conboy asked if this is just one lot? Mr. Neve responded,
yes. Ms. Conboy stated that Mr. Rosati's impression was that it
was all four (4) lots and he did not want the Board to make any
decisions on all four (4) lots until he sits down with Mr. Neve
and Mr. Nicetta to get some kind of consensus on the issue..
Mr. Neve stated that they have an approved septic permit on this
lot (#39) but Mr. Nicetta has put them in a difficult spot
because now he is enforcing what he never enforced before.
on a motion by Mr. Osgood, seconded by Dr. Rizza, the Board voted
unanimously to grant the variance of ten (10) feet in order to
build a septic system within twenty-five (25) feet from the
dwelling on Lot #39 Jerad Place.
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