HomeMy WebLinkAboutMiscellaneous - 30 MILL ROAD 4/30/2018 (2)6
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System Owner
Type: Em
Cesspool: No
Date of Pumping:
System Pumped By:
Contents Transferred to:
Contents Disposed at:
�1., 01845
Commonwealth of Massachusetts
Massachusetts
5ystem Pumping Record
Routine
Yes
Wind River Environmental, LLC
Date: A) Pumper Signature:
Condition of System/Other Comments
System Location
Primary Home
`10 Hill Ro2d
Form 4 -- System Pumping Pe�ord
r
,Ecf I'VED
0 01 M5
'OF lvo 000\JER
'I -TV, OEPAI�110J
North Andcver, MA, 01845
(978)-294-2070
Jordzn Alan
o V,
6bPrinted on recycled paper Dep Approved Form - 12/07/95
Septic Tank: N� -K
'o� YesF
Quantity Pumped: / - Gallons
Permit #:
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
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Commonwealth of Massachusetts
City/Town of
System Pumping Record NORTH ANDOVE
Form 4
RECEIVED
A ir, r,� 7 2013
Uo
MN OF NORTH ANDOVER
HEALTH DEPARTMENT
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 within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
1 . System Location:
_ ja /21//// ---
Address
ltyfTo��
2. System Owner:
(y,-- ?'-, -,- .---
Name
Address (if different from location)
City/Town
B. Pumping Record
State
Zip Code
State zip uoae
'�'7k' 3?5;'
Telephone Number
1. Date of Pumping 2, Quantity Pumped:
Date Gallons
3. Type of system: Cesspool(s) Eg,&eptic Tank E] Tight Tank El Grease Trap
F-1 Other (describe):
4. Effluent Tee Filter present? 0 Yes E�?<o If yes, wa sit cleaned? E] Yes F� No
5. Condition of System:
< & jr:,� --r -7 X'
6. System Pumped By
7 9 -
Name Vehicle License Number
Company
7. Location where contents were disposed:
G.L.&D.
9 hm. e
Signature of Hauler ftdo"r Dat
Signature of Receiving Facility
Date
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DEP has provided this form for use by local- Boardsof Health . Othe r forms may be �used, but"the
inibrmation must be substaritially the Same as that orovided,here. Before usin , 9 this fo(M. check -with your
local Board of Health to determine the torm they i4se. The System Pumping'Record must.besubmitted.to
t . he local Bowd of Health or other approving authority within 14 days from thepumping date In
accordance WAh 310 CMR 15351. Man
cy
A. Facility information
1. System Location: d
A*lress
KC��J�) MA
Solt
2, System Owner:
jo�(dQn
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13. Pumping Record
I DEC & 5 41111
TOWN 09 NORTH M01
0,70
A) Code
2. Quantity Pumped -
Date of"Purnping Date Ganom
3. Type of system: El cPswoks) YSepfic Tank right Tank Gmale Trap
Other (describe):
4.. Effluent Tee Filter present? 0 Yes 91*'No it yes, -was i:t ctemaned? Yes 2"No
5. Condition of System.,
6. System Pumped By".
I
jirn �b J�L..
Name veoj6le License Numoor
Corn
parly
7. Location where contents were disposed:
ate
Signature of Receiving lFaalty Date
System P�mphV Record NO I of- I
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all neces . sary approvals/pernots from
Boards and 2--partments having jurisdiction have been obtained. This does no*t'relieve
the applicant andlor landowner from c,ompliance with any applicable or requirements.
-******APPLICANT FILLS OUT THIS SECTION
'APPLICANT PHONEZ2jj_� 7 57 - 7f._3
LOCATION: Aswsw(s Map Nurriber-Lor I PARCEL
L/ SUBDIVISION LOT (5)
'� STREET 3y A,71 /�d ST. NUMBER_
V/
A OFFICIAL USE ONLY**�***--- ft**N-�gpaw
NDATIONS OF TOWN AGENTS:
TION ADMINISTRATOR
COMMENTS
DATEAPPROVED
.DATE REJECTED
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
INSPECTOR -HEALTH
INSPECTOR -HEALTH
COMMENTS
-Y
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED_
-, 5- -,� ,-� -et, Z�,P- - --)'
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
cL.4--/9 3-7'-5. ,
RECEIVED BY BUILDING INSPECTOR DATE
QL
P -URD OP HE'a--lpi
kol�TH &Pnve),�IMA,
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APP)3ovvJ6
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OARD OF HEALTH
O.Andover, Njass.
I SUBSURFACE DISPOSAL DESIGN CHECK LIST 1�) jo*,v)
LOT #I A1 Q, fL
?PROM DATE_LZ
rovided:
DISAPPROM UTE
Reasonst
itle V
Bg
eg 6
eg 10.2
eg 10.4
FAIL
09
F The s�bmitted pian,mast show as a minimumi
,a) the�jot to 6 served-area3,dimensions lot #.,abatters
b I ition and log deep observation Oes-distance to ties
OcNion and results percolation tests -distance to ties
c loc
di design calculations & calculations showing required 'leaching area
location and dimensions of system -including reserve area
f) existing and proposed contours
location wiy wet areas within 1001 of sewage disposal system or
disclaimer -check wetlands mapping .
(h) surNee and subsurface drains within 1001 of sewage disposal
Byste6 or disclaimer
(i) location W drainage easements within 1001 of sesage disposal
systek or ' 'disclaimer -Planning Board files
(J) knom sow-ces of water supply within 2001 of sewage disposal
system or disclaimer
(k) location of any, proposed well to serve lot -1001 from leaching facility
(1) location of water lines on property -101 from leaching facility
location of benchmark
driveways
(o) g&Tbage 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., distribution field piping and
otter elevations
Zr) maximam ground water elevation in area sewage disposal system
plan mast be prepaked, by a Professional Engineer or other
pro!essional authorized by law to prepare such plans
SeT)Uc Tanks
(a) capacities -150% of flow., water table., teesj, depth of. tees.,
acceza ping
., pum
(b) clean)ut
10, f.-,om cellar wall or ingroand s-Anmiing pool
(d) 251 f)-om subsurface drains
7 Distribution Boxes
(a) 'sope greater than U -U0
b) BURP
'(e)
'(m)
'(n)
_(s)
Do)
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NORITH ANDOVER BOARD OF HEALTH
I
INSTALLATION CHECK LIST
APPROVED DATE DISAPPROVED DATE hXCAVATION OK
REM14S
AIL I
OK I
XDista e To:
lands
rains
We 1, 1
2. Water Line Location
3 �No PVC PiDe
4. Sept*ee
,,a , Tank
Tees - Length & To Clean Out Covers
Cement Pipe to Tank - On Both Sides of Tank
5. stribution Box 76r
-.���Box - No Cracks
All Lines Flowing Equal Amounts
-,���Flow
6. Leach Field or Trench
,--timensions*
.,Stone Depth
_.,Capped Ends
,,.,,Clean Double Washed Stone
7. Leach Pits
Dimensions
Stone Depth
Splash Pads
Tees
Cement Pipe to Pit Both Sides
Clean Double Washed Stone
I
No Garbage Disposal
Grading inspection
_10v--Rarracading Covered System
s - Built Submitted
Lot Location
Dimensions of System
Location with Regard to Pere Test
Elevations
Water Table
SOTL PROFILE & DERCOLATTON TEST DATA
Board of Health -North Andover, Mass.
Street A"- Lot No.
Subdivision' Owner
Investigator Observer ey/(-((
Date�
El ev.
Feet- Inches
0 0
SOIL PROFILES
2. Date 3. Date
Elev. Elev.-
4. Dat e
Elev.-
Ties to Test Pits
1.
4.
2-1
eV'Z.'M 0
A(LL
qote: Top & subsoil depth; depths of other soil types; depth of water table;
depth of refusal.
PERCOLATION TLESTS
PJR t P 10A Al -1) ODA -f- P . T)p +: f- -1),q -F P Tj::i t P
Pit Number
1
2
4
Start Saturation
Soak -Mins.
L.art Test -Time
jjq
Drop of 3" -Ti -me
?ass
of 611 -Ti.me
14'ns. Ist Dro-o
---0D
In.
Emmmm— U 1) 1. 1 c K 5
MEN U U 1) 1. 1 c W 0 r k� s
1% SUBSURFACE DISPOSAL SYSTEM CHECK LIST
NORTH ANDOVER BOARD OF HEALTH
APPROVED DATE PROVIDED: DISAPPROVED DATE TIME REASON
3
Y
719?
Title 5 The submitted plan must show as a minumum:
Reg. 2.51Fail1OK1
the lot to be served (area,dimensions,lot #,abutter.$)
(Planning Board files)
,b� location and log of deep observation holes -distance
to ties
location and results of percolation tests -distance
to ties;
�c� design calculations & calculations showing required
leaching area
�e� location and dimensions of system (including reserve
area)
�f�existing and proposed contours
location -of any wet areas within 1001 of the sewage
disposal system or disclaimer (check wetlands mapping)
�h4 surface and subsurface drains within 1001 of sewage
disposal system or disclaimer
etl'location of any drainage easements within 100' of
sewage disposal system or disclaimer (planning board
files)
known sources of water supply within 2001 of sewage
disposal system or disclaimer
location of any proposed well to serve the lot (1001
from leaching facility)
(-I-)—location of water lines on property (101 from leaching
facilities)
(i� location of benchmark
(iT-)- driveways
to-�- garbage disposers
no PVC is to be used in construction
a profile of the system (elevations of basement, plumbers,
pipe septic tank, distribution box inlets and outlets,
distribution field piping and any other elevations)
(r) maximum ground water elevation in area of sewage disposal'j.
system i
�A�plan must be prepared by a Professional Engineer or
other professional authorized by law to prepare such
plans
Septiz Tanks
Capacities - 150% of flow, water table, tees, depth
of tees, access, pumping,
(b) Cleanout
(c) 101 from cellar wall or inground swimming pool
(d) 25' from subsurface drains
North Andover Subsurface disposal system check list - Page 2
I -Fail
Reg.10.2
Reg. 10. 4
Reg. 11 .2
Reg.11 .4
Reg.11 .1C
Reg. I I . I I
Reg. 15. 1
Reg.15-1
Reg. 15.4
Reg. 15. 8
Reg. 3.7
Reg.14.1
Reg.14-3
Reg.14.4
14.5
Reg.14.6
Reg. 14. 7
Reg.14.10
Reg. 9. 1
Reg. 9. 6
Dijs,�-ribution Boxes
/(a Slope greater than 0.08
(b� Sump
Leaching Pits
Leaching pits are preferred where the installation is
possible
(a) Calculations of leaching area (minimum 500 S.F.)
(b Spacing
(c� Surface drainage 2%
M Cover material
LeachinZ//Fields
/WoGreater than 20 minutes/inch
c) Area (minimum 900 S.F.)
c C(
Construction of field
(d) Surface drainage 2%
(e) 201 from,cellar wall or inground swimming pool
Leaching Trenches
(a) Calculations of leaching area (min. 500 S.F.)
(b Spacing (4 ft. min. 6 ft. with reserve between)
Dimensions
W Construction
(e) Stone
(f) Surface drainage 2%
Do,Vnhill Slope
a) Slope y/x = (to be shown)
(b) -Ylx X 150 = (to be shown)
Pum -pa
(a) Approval
(b) Stand-by power
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TOWN OF NORTH ANDOVER RTH
Office of COMMUNITY DEVELOPMENT AND SERVICES Z
HEALTH DEPARTMENT
400 OSGOOD STREET
4�,
NORTH ANDOVER, MASSACHUSETTS 01845 C U
978.688.9540 — Phone
Susan Y. Sawyer, REHS/RS 978.688.8476 — FAX
Public Health Director E-MAIL: healthdept@townofnorthandover.com
WEBSITE: hqp://www.townofnorthandover.com
July 12, 2005
Belkis Salas-Jordan
30 Mill Road
North Andover, MA 0 1845
RE: 30 MILL ROAD SEPTIC SYSTEM
Dear Ms. Salas-Jordan:
I am in receipt of your letter dated July 11, 2005, and received at our office today regarding an appeal on my
decision regarding your septic system. You have been added to the agenda for the next Board of Health meeting on
Thursday, July 28, 2005 to appeal this decision to the Board of Health members. I have attached a copy of the
agenda for your reference.
The meeting will take place at Town Hall, 2 d Floor Meeting Room, 120 Main Street, North Andover. The meeting
begins at 7:00 p.m. Please contact us at the above numbers if you have any further questions. Thank you.
Sincerely,
Susan Y. Sawyer, REHS/RS
Public Health Director
Enc: 7.28.05 BOH Meeting Agenda
July 11, 2005
To: Susan Sawyer
Public Heath Director
Or to whom it Concern
j�E—&E—IVED
UUL 12 2005
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
1, Belkis Salas-Jordan of 30 Mill Rd, am requesting an appeal on the
order from the Health Dept. of North Andover. I can be reached at (978)
327-5963 or (978) 394-2070. 1 can supply documents that title V was done
for the transfer of ownership and testimony, upon request or at the hearing.
Any questions, please do not hesitate to contact me. Thank You
Sincerely,
ABelkis Salas-Jorda:nZ
Owner of 30 Mill Rd
4 . epc-
D
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I fill 1-11111 Of I I
I It
i Ui 't i I
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES V,
0
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Susan Y. Sawyer, REHSIRS 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
healthdcl)tCato,,,,,nofnorthandover.com
ww-w. townofnorthandover. coin
August 4, 2005
Belkis Salas-Jordan
,A 0 Mill Road
North Andover, MA 0 1845
Dear Homeowner,
Thank you for responding to the letter sent to you regarding the concerns at your property, 30
Miff Road. A site walk was held with you and Health Department staff on July 19, 2005. This
letter is a follow-up to that meeting,
Our visit began with you supplying a copy of an official Title 5 inspection dated October 24,
2002. This was the missing inspection that was conducted in accordance with state regulations
when the property was sold to you. Utilizing the inspection form provided and the existing town
record, during this second visit to your home, the staff was able to field locate your septic system.
These locations were viewed in relation to the previously identified side slope break out at the
property fine. .
It is important to note that on the second visit to the property there was no break out and no odor
detected as in the first inspection. Similarly, the ground water running down to the street from
#44 Nfill Street had dried up, and the wet area behind #20 was much dryer as well. These
simultaneous occurrences clearly indicate that this entire hill has a very shallow seasonal high
water table. The fact is that the water table appeared unusually high this season in many other
areas in North Andover as well.
The following comments are conclusions based on the limited knowledge gathered by this office.
It is the opinion of the Health Department that each property noted in this letter, #20, #30, #44
MR Road, all experience high water conditions on their properties that relate to their own ground
water situations. As of the date of the second inspection the ground water levels had gone deeper
and the location of any breakouts had essentially gone away.
1) Vtilizing the field location of the septic components of the system at #30, this information
indicates that the water observed coming from the side slope, recently cut during construction of
the home at #44, is not a typical break out of a failing system. It is also clear, by field locating
your system, that the wet area behind #20 is not related to you. Your systerns leaching area is not
in a location that could affect #20's property. Therefore, is it concluded that there is no need to
pursue a fine of Board of Health Orders at this time. For this reason, the Order Letter dated June
26* has been rescinded.
2) It is possible that the construction of the driveway for #44 intercepted a natural ground water
path, however, the slope with the apparent ground water problem is on your property, #30.
Therefore, all problems regarding this slope are assumed to be your concern. If in the future, it is
found that the condition of ground water from #30 causes odor complaints from the owners of
#44 Mill Road it is assumed that, you, the owner #30 will hire a professional engineer to address
the issue. The engineer would then contact the Health Office as in all cases of work on or around
a septic system.
It is also recommended that the owners of the properties adjacent to your property contract with
drainage professional as well, to address their own issues. A professional that is experienced in
high ground water conditions as well as methods used to mitigate or flifther investigate these
conditions would be better to assist in this matter. For example, one common problem is ground
water that intercepts organic material, such as old stumps, often causes an ofly, smelly, water slick
during high ground water times.
The Health Department generally does not order homeowners to relieve a ground water condition
that pertains to an issue that does not appear to pose a health issue to the public. It is important,
however, that those homeowners protect themselves if they find a circumstance that they feel
warrants action. Please contact the Health Department if you have any questions regarding this
correspondence.
ZSincer
S Sawyer, REHS
Public Health Director
Cc: Board of Health Members
Mark Rees, Town Manager
Owner, 20 Mill Road
Owner, 44 Mill Road
North Andover Board of Health
MEETING AGENDA
Thursday, July 28, 2005
7:00 p.m.
120 Main Street
Town Hall Building
2 d Floor Meeting Room
Hearing
1. Sam's Mobil — Tobacco Hearin — presented by Ron Beauregard of Healthy
Communities regarding second violation of tobacco sales.
New Business
1. Meetiqg Minutes Final Approval for March, April, May and June 2005.
11. 29 Bradford Street — Proposal from Steven Pouliot, Project Manager, of New England
Engineering to request the following:
Local Upgrade Approval Required
Allow reduction in offset distance between the leach bed and a foundation wall from 20
feet required by Tide 5, section 15.211 (1) to 10 feet
Local Bylaw Variance Require
Allow a design based on 3 bedrooms in lieu of a 4 bedroom minimum required by the
North Andover Health Bylaw. Approval of this plan requires that a deed restriction
limiting the dwelling to 3 bedrooms be recorded at the registry of deeds.
111. 94 Boxford Street — Proposal from Thomas Hector, Project Engineer, of New
England Engineering to request the following:
Local Upgrade Approval Required
Reduction in separation distance between the ESHGW and the bottom of leach bed
from 4 feet required by Tide 5, Section 15.212(A) to 3 feet.
Local Bylaw Variance Require
Allow a septic system be designed to serve three bedrooms in lieu of 4 bedroom
minimum required by North Andover Health Bylaw.
IV. 30 MiR Road — Request from homeowner, Ms. Belkis Salas-Jordan to appeal a decision
made on June 26, 2005 regarding the state of the septic system for this property.
Xote. The Boardofifeafth reserves the tht to take items out of order and to discuss andlor vote on
items that are not &tedon the agenda. .
July 28, 2005 - Nortb Andover Board of Healtb Meeting - &en
Pa
ge I of2
Board ofHealth Members: Thomas Trowbridge, DDS, MD, Chaiman, Jonathan Markey, Member; Chegl Barn7ak, Ckrk
Health Doartment Sta Susan Sauyer Health Director; Debra Rillahan, Public Health Nurse; Michele Grant, Pubhc Health Inspector; Pamela DelkChiaie,
Health De
partment Assistant
V. Sign revised Dumpster Regglations regarding temporary construction dumpsters
approved at the last meeting.
Old Business
I. Re -review of Tattoo / Body Art Regulations
Discussion
1. Monthly Health Department statistical reports — June/July
Il. Review progress on the Bioterrorism Project/ Guide/ Handbook
Correspondence
Note: The (BoardofYfealth reserves the tht to take items out of order and to discuss andlor vote on
items that are not listedon the agenda.
July 28, 2005 - North Andover Board of Health Meeting - Aeen
Page 2 of 2
Board q Health Members: Tbomas Trowbrid e, DDS, MD
,L— g , Chairman, Jonalban Marky, Member; CbegI Ban�ak, Clerk
Health Dogrgment S a Susan Sa er, Health Director, Debra Rallaban, Pub& Health Nurse, Micbek Grant, Pubhe Health Inspector; Pamela DelkCbme,
Lg� my
Health Department Assistant
I
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(Ransfer . from service label) 7003 1680i.0004 . 991S 8759
PS Form 3811. February 2004 Domestic Return Receiptr 102595-02-M-1 5 1 401
UNITED STATES POSTALSEIRVI
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Health Department
400 Osgood Street
North Andover, NIA 01845
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TOWN OF NORTH ANDOVER 't RT#j
41 0
rice of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone
Public Health Director 978.688.9542 - FAX
healthdeptLdtownofnortliandok,,er. coin
"rw.towndhorthandover.com
ORDER LETTER
Belkis Salas
30 Mill Road
North Andover, MA 01845
June 26, 2005
Dear Homeowner,
it has come to the attention of the North Andover Health Department that there is a public health
problem that may be related to your septic system at 30 Mill Road. On June 21, 2005, Health
Department personnel observed liquid breaking out from the slope of your property up gradient
and adjacent to the driveway of 44 MR Road. Accompanying the visual observation was a foul
odor that appears septic in nature. Upon reviewing your property's file, it was found that a portion
of your septic system is located near this possible effluent break out. For this reason, and in
accordance with the regulation noted below, the Health Department is ordering that a
Massachusetts state licensed inspector conduct a Title V inspection within 14 days of receiptof
this letter. A fist of licensed inspectors can be found at the Health office or online at
http://www.mass.gov/dep/brp/Wwm/owners/maintain.htm
MA DEP 3 10 CMR 15.301(9) "AD systems shall be inspected when the owner or operator
thereof is ordered to do so by the local approving authority, the Department or court."
It is also noted that according to the Town of North Andover assessor record, this property
changed ownership on December 12, 2002. The Health Department has no recent inspection
relating to that transfer. Except for exclusions provided in the state regulations, section 15.301
requires that a Title V inspection be done upon a transfer of title of all property. If you feel you
are exempt in this requirement, please provide any information regarding your position to the
health office. If there was not a Title V inspection done for this transfer and you are not eligible
for an exemption you may be in violation of the state code.
In closing, the Health Department is also requiring that a town representative be present during
the inspection. Please have the inspector contact this office at least 48 hours prior to the
inspection. If the Title V inspection results indicate that your property's septic system is the cause
of the break out of effluent, you will be required to immediately address the problem. Possibilities
for repair will not be fisted until the results of the Title V are submitted to this office.
Thank you -in advance for your cooperation in this important matter of public health. The Health
,,,Departrrknt is aware, by observation, that the adjacent properties at #44 and #20 Mill Road are
also experiencing a serious ground water problem coming off the hill. As neither of those
properties negatively affects other properties directly, at this time there will be no order letter to
.them. As these properties have been mentioned in this letter, a copy of this correspondence is
being sent to them.
Please contact the Health Department if you have any questions regarding this correspondence.
You have the right to request a hearing before the Board of Health if you feel this order should be
modified or withdrawn. A request for said hearing must be made in writing and received by the
Health Department within seven (7) days from the receipt of this order. At said hearing you will
be given an opportunity to be heard and to present witnesses and documentary evidence as to why
this order should be modified or withdrawn. All affected parties will be informed of the date, time
and place of the hearing and of their right to inspect and copy all records concerning the matter to
be heard. You may be represented by an attorney. You have the right to inspect and obtain
copies of all relevant records concerning the matter to be heard.
SinIcerel
u
U Sawyer, REHS/RS
Public Health Director
Cc: Board of Health Members
Mark Rees, Town Manager
Owner, 20 Mill Road
Owner, 44 Mill Road
Encl. 1986 copy of As -built plan of 30 Mill Road
COMMONWEALTH OF MASSAC
HUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL ATFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY 'ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
PrOpert's Address: 30 �L&
Owner's Name:
Owner"S Address: 3a
�
Date Of Inspection:
Name of Inspector: (please print) i5aLV19,40i
company Name:
:�llailing Address:__7
J -1v 4-C-7 -P? tv- H1, 0 _2 a -�'C/
Telephone Number; 1—(Y'00-9'5
CERTIFICATION STATEMENT
cen!\ that I have personally �nspectecl the sewage disposal system at ihis address and that the inforrnation.,�-,o77,,2
oe!o-A is rrue. accurate and complete as Of the time of the inspection, The inspection was performed basec! on
and experience in the proper Function and maintenance of on site sewage disposal systems I am 3 DE"i,
3 pproved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The sys[ern
Z'Passes
Conditionally Passes
Needs Further Evaluation by the Loc3; Appro%in�-AI_11,1`110rij%
Fails
Inspecfor's Signature: CG>1 — Date: /0 — 2—�4— 0 2_
I ne systern inspector shall submit a copy of this inspection repOrl 10 the Approving Authoric\ (Boar- ci�
DEP) within 30 days of compleiingth is inspection. If Lhe system is a sh&red system or has a des i an ilo�� ci�
�,-Dd or c -
- 7eatel.r. the inspector and the system owner shall submit the report to (he appropriate rezional ofrlc,- f �t
'_E? The original should be sent to the system owner and copies sent to the buyer, if applic2bi-e. and n,-
\c'es and Cornments
ALTHOUGH THIS REPORT MAY BE DEEMED R�71 T B!
CR GUARANTIES ARE EXPREESSED OR IMPLIEI�.
report only describes conditions at (he time of inspection and under the conditions of s;! a[ t r13 i
it mc. This inspection does not address ho�s the system Ni ill perform in the future under the sa nieu or diflr�, e;i,.
conditions of use.
.!;e 5 Inspection Form 6/15/2000 page 1
- Page 2 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORm
PART A
CERTIFICATION (continued)
Propert) Address: 3
Owner:
4ZE�
Date of Inspecti :. / 0 - 2-9- a
InsPection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D
A. SNsiem-Passes:
6/1-1 have not found any information which indicates that any of the failure criteria described in 3 10-
-, 10 CMR 15.304 exist Anv failure criteria not evaluated are indicated belo%k
-03 or un
Comments:
B. Ss stem Conditionalh Passes:
One or more system components as described 'in the "Conditional Pass" section need to be replaced or
rep2,.rec The system, upon completion of the replacement or repair, as approved by the Board of Health. will pass
ves. no or not determined (Y,N,ND) in the for the following statements. If "not determintt"
e 2 5
ne septic Lank is metal and over 20 ye�rs old- or the septic tarLk (whether metal or not) is structur-al:%
unsound. exhibits substantial infilrration or exCilntion or tarik failure is imminent. System will pass inspection if I"
.ms,.�ng is replaced With a complying septic Lank as approved by the Board of Health.
'A me!al Septic lardk will pass inspection if it is smucrurally sound, not leaking and if a Certificate ofCorr-;
_anra inai the tank is less than 20 years old is available.
ND exP.i31ni
Ob�ervauon of sewage backup or break out or high static water level in the distribution bo\ due to broKe.,� J.,
00s:nicied pipe(s) or due to a broken, seated or uneven distTibuiion box. System will pass inspection if (%k!t:l
--::.-oN =! of Bo3rd of Health):
broken pipe(s) are replaced
obsMiction is removed
discribution box is leveled or replaced
ND Cxplai!ri
Thz sysiem required pump'
ing more than 4 times a Year due to broken or obstructed pipeks). Tht s\ slt7
pass Lrispection if (with approval ofthe Board of Health):
broken pipe(s) are replaced
obsrruction is removed
I paqe -) of I I
OFFICIAL INSPECTION FOR -M - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSA-L SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: .7-0
Date of Inspectiin: o
C. Further Evaluation is Required by the Board of Health:
r -m e I �
Conditions exist which require ftirther evaluation by the Board of Health 'In order to dete in if he S%slerr.
-;s to protect public health, safety or the environment.
SYstem �� ill pass unless Board of Health determines in accordance with 310 CN1 R'] 5-303.
system is not functioning in a manner which will protect public health, safety and the en% ironment*
— Cesspool of privy is within 50 feet of a surface water
— Cesspool or privy is within 50 fee( of a bordering vegeLa(ed wetland or a salt marsh
I
S�slem will fail unless the Board of Health (and Public Water Supplier, if anv) determines that the
S.N stem is functioning in a manner that protects the public health, safety and environment:
The system has a septic Lank and soil absorption system (SAS) and the SAS is within I OC 'ec., 0:
surf , ace water supply or rribuLary to a surface water supply.
— The system has a septic tanR and SAS and the SAS is within a Zone I of a public water suppl\
— T�e systern has a septic ,zLnk and SAS and the SAS is within 50 feet of a private �%ziier suppl% �% e�'
— 'rhe s\sieni has a septic tank and SAS and the SAS Is less than 100 feet but 50 feet or
0'!\2!e -ater suppiv well" Method used to determine distance
'This system passes if the well water a.,i--,!vsls, performed at a DEP cerfified laboraton. for collionn
Dactv-:a and volatile organic compounds indicates that the well is free from pollution from that facilit% -�nc
the presence of ammonia nirrogen and nicrate.nicrogen is equal to or less than 5 ppm, provided that no other
Cailure criteria are rriagered. A copy of the analysis must be anached to this form.
3. Other:
'Paee 4 of I I
OFFICIAL INSPECTION FORAI — NOT FOR VOLUNTARY ASSESSMENTS
SUBSUR-FACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR -M
PART A
CERTIFICATION (continued)
Proper -TN' Address: SO
.
Owner:
Date of InspectWn: /0 2—
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or "no" to each of the following for all inspections:
Yes No
&- Back-up of sewage into facility or system component due to overloaded or C1022ed SAS or
__41 Discharge or ponding of effluent to the surface of.ihe ground or surface water -s -due to an ov'e'rlo'ac-,c or
clogged SAS or cesspool
Static liquid level in the dist-ribution box above outlet inven due to an overloaded or clogged SAS or
cesspool
Liquid depth Ln cesspool is less than 6" below inv,eri or available volume is less than V2 day Ao%k
Required pumping more Lhan 4 times in the,tasi:� year NOT due to.clogged or obsulicte
d
of times pumped
An\ portion of the SAS, cesspool or privy i's below high ground water elevation.
I/ An\- portion of cesspool or privy is within 100 feet of a surface water supply or rributary to a surface
water supply.
An� ponion of a cesspool or privy is within a Zone I of a public well.
Aln�- ponion of a cess?oo; or privy is within 50 feet of a private water supply well.
An� ponion of a cesspoo: or privy is less than 100 feet but greater than 50 feet from a priv.11le "atei,
supply well with no acceptzble water qualiry analysis. [This sys'tem passes if the well
performed at a DEP certified laborVOrv, for coliform bacteria and volatile organic compounds
indicates that The well is free rrom 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 criteri-a
are triggered.' A copy of the analysis must be attached to this form.1
A/ t Yts-No) The sNstem fails. I have determined that one or more of the above failure criteria exis�
described in 3 10 CMR 15.303. therefore the sysiern fails. The system 0-ner should contic. F
Health to deierrnine what will be necessary to corTect the failure.
E. Large SVS1eMS:
To be considered a large system the system must sen,e a facility with a design now of 10,000 cpd to 15.000
b
o pd,
�ou MUSE ifidlicate either "yes" or "no" to each of the following:
,'T'ht .ollo�,vina criteria apply to large Systems in addition to the criteria above)
\.,,s no
!he sN stem is -1thin 400 feet of a surface drinking water suppl\
— — the system is within 200 feet of a tyibutary to a sur -face dr&Lking water supply
,he sysiem is located in a nirrogen sensitive area (Interim Wellhead Protection Area - I" -PA i or a
Zone 11 of a public water supply well
�.Fvou have answered "yes" to any question in Section E the system is considered a significant threat, or answerec
"ves" ;n Section D above the large system has failed. The owner or operator of any large system considered a
tb-,eat under Section E or (ailed under Section D shall upgrade the system in accordance with 3 iO CNtR
T,
; ne sistem owner should contact the appropriate regional office of the Department
I Page 5 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSME,-N.-TS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORIM
PART B
CHECKLIST
Properr`y Address:
Owner*
Date of Insoecti&
Ciheck !f the followine have been done. You must indicate "Yes" or "no" as to each'of the followina,
Yes No
Pumping information %vas provided by the o2.nA�,ne occupant, or Board of He Ith"
I�Vere 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 laroe volumes of water been int-roduced to the system recently or as part of �his rispeci,or,
V — Were as built plans of the system obtained and examined" (If they were not available noie as N A
— 'Alas the facility or dwelling inspected for signs of sewage back up
Was -the site inspected for signs of break out
Were all system components, excluding the SAS, located on site
Were the septic tank- manholes uncovered, opened, and the interior of the t3nk inspected ,-or -e
ci�e oaffles or tees,_ material of conscruccion, dimensions, depth of liquid. depth of sludge and dep,.;-; o`sZ-_-r.
\Vas the facility owner (and occupants if different f�rom owner) provided \% ith inforrr.2!ion ,);l
01 . SL'bSLrface sewaQe disposal s\stems I
1'7:�e size and location of the Soil Absorption Syslem (SAS) on the site has been determiner, oasec.
ric, E*xtsting information. For example, a plan at the Board of Health.
Determined in the field (if any of the failure criteria related to Pan C is at issue appro\:m2!;,)-
;s .:nacceptable) 13 10 CMR 15.302(3)(b))
pa -pe 6 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR -M
PART C
SYSTEM INFORMATION
Properiv Address: -37,0, V
ct
Date of 14nspecti n: _ 4,2
RESIDENTIAL FLOW CONDITIONS
Number ol'bedrooms (design): Number of bedrooms (acru'al):
n 310 01AR 15.203 (for example: 110 gpd x #of bedrooms):
DESIGN flow based oi
Number of cuiTtnt residents: —3
Does residence have a garbage gruider ()w& or no):,!!L,"V
is * laundr'�. on a separate sewage system C0165 -or -no):
Laund,-.v system inspected (yes or -pie). Z -C-5 -ve (if yes separate inspection required)
Seasonal use: (Mor no)� 14/0
Water -neter reodings- If available (Wi 2 years usaQe (gpd)): '90,6,
Sump pump (��ror no)� /7/0
Last ate of occupancy:
COPOM ERCIA UINDUSTRIA L
Type of esLabitshment:
Desi2n qo)A (based on 3 10 CMR 15 —203): gpd
Basi�ofdesign ,low (seats/personsisqft,etc.)':
Grease rrap present (yes or no):
Inc'-'st-Nal -aste holding Lank present (yes or no):
�,on-sanitary waste dischar2ed to the Title 5 sysi
em (yes or no):
Water meter readines. ifavailable:
I
�,,st date of occupancy�use:
OTHER (describey
GENERAL INFORMATION
Purnping Records
So-- ' rce of!nFo.rmaiion
W!s S * N stern pumped as pan of the inspec,,ton (yes or no):
1" 1;!5. olume pumped.
_gallons -- How was quantity pumped determined"
Reason for z-L:mptne-
T YP E 0 F S YST E i%l
tank, distribution box. soil absorption system
— Single cesspool
— Overflow cesspool
— Pri%-,
— Shared System (yes or no) (if yes, anach previous inspection records, if any)
— 1nnovative/Altemative technology Artach a copy of the cur -rent operation and maintenance conrract (70 �e
JC'37n-d q1om systern owner)
Tiont Lart),
Amch a copy of the DEP approval
Other (describe):
-;Pn'0-2Ie 3Se ofall components, d3(t install ifknownl and source of information
',Ver- sewage odors detected when miving at the site (#*e -or no):
Page j of I I
. c; �, �T 793i
q"--7 Y- 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESS.,MENNTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORUM
PART C
SYSTEM INFORMATION (continued)
PrOpef`TV�Address: 10 1 Y&/
O'Aner:
Date of inspection: 0— 079—
BUILDING SEWER (locate on site plan)
Depth below grade
-�12(df`Qls Of cOnsrruction: _cast iron 40 PVC other (explain):
Distance from private water supply well —0T sucilon li"ne:
Comments (on condition ofjoinis. venting, evidence ofl��-gl —1ic
SEPTIC TANK: ��olcaie on site plan)
DeDth below gracle- /�4 ""
Material of consrruczion -concrete —metal —fiberglass ---polyethylene
other(expiam)
Tftawk is metal list age: _ Is age confu-med by a Cenificate of Compliance (yes or no)
Cer'111 - IC3!e) (artach a COPY of
Dimers:ons
S;uGee ce.D'n
Djs!ance ftOm top Of slucpe to oonorn
Sc': -n inic�Lness 5- of outlet tee or baffle
0!sianct rmm top Of scum to !OP of outlet !ee or baffle:
Distance from bonorn of scum to bonom ofo'Utle, te barne
Hc%, e,t dirnens!Ons determined
Comm�nis (on pumoin2 recommendations, inlet and outlet te r b
e o affle condmon. sauciral integrit%, !iq-:,: :e,c;s
:!s 2!vzz !o outlet invert. evidence of leak.,,2-. etc ) .
GRE. -\SE TR..kP: —0ocate on site plan)
I
be;ow grade
7—
Maier:al ofconsmcnon� _concrete —MeEal —fiberglass .. polyethylene _other
(explain)
Dimensions
Scum thicuess.
Distance from top of scum to top ofoullet lee or baffle:
Distance rrom bonorn ofscum to bonont ofou!!ef tee or bafflc�
Date of last pumping, _
Carnments (on pumping recommendations, inlet and outlet (cc or baffle condition, SiTuctural
as re!ated to outlet invert. evidence of leakage. etc.)-,
p2ge 8 of I I
OFFICIAL INSPECTION FORIM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR -NI
PART C
SYSTEM INFORMATION (continued)
Prooert� Address: 70
Owner:
Date of Inspectig. 16 �:'7
TICHT or HOLDING TANK: (mrik must be pumped at I'Ime of inspection)(locate on s7ite plan)
De ' Dth below grade:
Material of consrTuction: _conCTee metal fiberglass
----polyethylene
—other(explain',
Uimensions
Capacir% 0- a I Ions
Design FI�1— 231jonsidav
Alarm present (yes or no).
Alarm level. Alarm in working order (yes or no):
Date of last pumping:
Comments (condition of alarrn and 6�t switches, etc.):
D ISTRI B UTI ON BOX: _ (if present must be opened)(locate on site plan)
Dep�h of hQuiJ Ievei above oude, invert:
Com,ments (note if box is level and distribution to outlets equal, any evidence of solids carryover. 3n\, evicen,-e 0�
Iceakage into or out of bo.\. etc.).
PU \1 P CH A \1 B E R 7 (Iocaie on site oi3n)
PumPs in working order (ves or no) -
Alarms in—vorkin.g order (yes or no)
Comments (note condition of pump chamber. condition of pumps and appurtenances. etc.)
R
Page 9 of I i
OFFICIAL INSPECTION FOR -MI —-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION' FO RAI
PART C
SYSTEM INFOR.MATION (continued)
Pro pert%�-A dd ress:
0 w n e r:
Date of inspect on:
SOIL ABSORPTION SYSTEM (SAS): (10-te 00 Site Plan, excavation not required)
1 f S A S not located explain why:.
T� pe
— leachin2 p:is, number:
— leachinp chambers. number�
leaching galleries. number:
leaching rrenchts, number, lengi.h.
leaching fields. number. dimensions:
overflow cesspool, numberi
innovativelakernat, . ve system Type/name of iechnology:
Comments (note condition of soil, sign s of hydraulic- fa . ilure, level of poncliog, damp soil, condmon of
etc
CESSPOOLS: — (cesspool must be pumped as pan of inspect ion)(iocate on we pian)
- jeuracion-
Dep!n - top of liquid ic; inlet invert
Delp'r of solids layer-
D:-rensions ofcesspoo!
'�12t-rizls ofconscruction-
ipdjcation of ground-ater inflow (yes or no):
Comments (note condition of soil. signs of hydraulic failure
PRIVY: — (locate on site plan)
level ofponding. condition of veeetziuon. etc I
Niaien3ls of consmuction:
Dimensions
Depth -or soliii�_
Comments (note condition ofsoil, signs ofhydraulic failure, level ofponding, condition 0i'vegetation. etc
Page 10 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSM ENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.%y1
PART C
SYSTEM INFORMATION (continued)
Pr0perTV Address: -71
Owner:
Date of Inspection: lo
SKETCH OF SENVAGE DISPOSAL SYSTEM
Provide a Skctch ofthe se%4age disposal system including ties to at least two permanent reference landmz!rkj
benchmarks Locate all wells within 100 feet. Locate where public water suPPlv eniers*lhe building
lae,'A/ "z�
10
P22e I I of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORN1
PART C
SYSTEM INFORMATION (continued)
Property Address: 9,
Owl J
ner: L � 11 1
Date of Inspect on; d— 'L
ol—
SIT�u�m
�)uilace water
Shallow wells
Estimated depth to ground water feet
Please indicate (check-) all melhods used to determine the high ground water elevation:
,�btained from system design plans on record - If checked, date of design plan reviewed:
Observed site (abutting propen"-yobservacion hole Aft-hin 150 feet of SAs)
Checked with local Board of Health -explain:
Checked with local excavators, installers- (anach documentation)
Accessed USGS database -explain: —
You must scri
�10_ You es-tablished the high gr�ciunq7water elevation:
i� .
-7-.-�i�
� __
(j
i � : � ��� �
a
J TOWN OF NORTH ANDOVER oRry
Office of OMMUNITY DEVELOPMENT AND SERVtCES
HEALTH DEPARTMENT 14
400 OSGOOD STREET
"C
NORTH ANDOVER, MASSACHUSETTS 0 1845 4C
Susan Y. SawyeZREHS/RS 978.688'.9540 - Phone
Public Health Director 978.688.9542 - FAX
healthdeptna
,towndhorthandoyer.com
w"wtowndhorthandover.com
ORDER LETTER
Belkis Salas
30 Mill Road
North Andover, MA 0 1845
June 26, 2005
Dear Homeowner,
it has come to the attention of the North Andover Health Department that there is a public health
problem that may be related to your septic system at 30 Mill Road. On June 21, 2005, Health
Department personnel observed liquid breaking out from the slope of your property up gradient
and adjacent to the driveway of 44 Mill Road. Accompanying the visual observation was a foul
odor that appears septic in nature. Upon reviewing your propertys file, it was found that a portion
of your septic system is located near this possible effluent break out. For this reason, and in
accordance with the regulation noted below, the Health Department is ordering that a
Massachusetts state licensed inspector conduct a Title V inspection within 14 days of receipt of
this letter. A fist of licensed inspectors can be found at the Health office or online at
http://www.mass.gov/dep/brp/wwm/owners/maintain.htm
MA DEP 3 10 CMR 15.301(9) "All systems shall be inspected when the owner or operator
thereof is ordered to do so by the local approving authority, the Department or court."
It is also noted that according to the Town of North Andover assessor record, this property
changed ownership on December 12, 2002. The Health Department has no recent inspection
relating to that transfer. Except for exclusions provided in the state regulations, section 15.301
requires that a Title V inspection be done upon a transfer of title of all property. If you feel you
are exempt in this requirement, please provide any information regarding your position to the
health office. If there was not a Title V inspection done for this transfer and you are not eligible
for an exemption you may be in violation of the state code.
In closing, the Health Department is also requiring that a town representative be present during
the inspection. Please have the inspector contact this office at least 48 hours prior to the
inspection. If the Title V inspection results indicate that your property's septic system is the cause
of the break out of effluent, you will be required to immediately address the problem. Possibilities
for repair will not be fisted until the results of the Title V are submitted to this office.
Thank you in advance for your cooperation in this important matter of public health. The Health
Department is aware, by observation, that the adjacent properties at #44 and #20 Mill Road are
also experiencing a serious ground water problem coming off the hill. As neither of those
properties negatively affects other properties directly, at this time there will be no order letter to
them. As these properties have been mentioned in this letter, a copy of this correspondence is
being sent to them.
Please contact the Health Department if you have any questions regarding this correspondence.
You have the right to request a hearing before the Board of Health if you feel this order should be
modified or withdrawn. A request for said hearing must be made in writing and received by the
Health Department within seven (7) days from the receipt of this order. At said hearing you will
be given an opportunity to be heard and to present witnesses and documentary evidence as to why
this order should be modified or withdrawn. All affected parties will be informed of the date, the
and place of the hearing and of their right to inspect and copy 9 records concerning the matter to
be heard. You may be represented by an attorney. You have the right to inspect and obtain
copies of all relevant records concerning the matter to be heard.
S ncerel
�v
U Sawyer, REHS/RS
Public Health Director
Cc: Board of Health Members
Mark Rees, Town Manager
Owner, 20 Mill Road
Owner, 44 Mill Road
Encl. 1986 copy of As -built plan of 30 Mill Road
TOWN OF NORTH ANDOVER
Wo
Office of COMMUNITY DEVELOPMENT AND SERV"ICES
HEALTH DEPARTMENT 0 40 0-
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 CH
Susan Y. Sawyer, REHS/RS
Public Health Director
BeWs Salas
30 Miff Road
North Andover, MA 0 1845
June 26, 2005
Dear Homeowner,
978.688.9540 — Phone
978.688.9542 — FAX
healthdept&townofnortliandover.com
",w.towndhorthandover.com
ORDER LETTER
It has come to the attention of the North Andover Health Department that there is a public health
problem that may be related to your septic system at 30 Mill Road. On June 21, 2005, Health
Department personnel observed liquid breaking out from the slope of your property up gradient
and adjacent to the driveway of 44 Mill Road. Accompanying the visual observation was a foul
odor that appears septic in nature. Upon reviewing your property's file, it was found that a portion
of your septic system is located near this possible effluent break out. For this reason, and in
accordance with the regulation noted below, the Health Department is ordering that a
Massachusetts state licensed inspector conduct a Title V inspection within 14 days of receipt of
this letter. A fist of licensed inspectors can be found at the Health office or online at
http://www.mass.gov/dep/brp/�wm/owners/maintain.htm
MA DEP 3 10 CMR 15.301(9) "All systems shall be inspected when the owner or operator
thereof is ordered to do so by the local approving authority, the Department or court."
It is also noted that according to the Town of North Andover assessor record, this property
changed ownership on December 12, 2002. The Health Department has no recent inspection
relating to that transfer. Except for exclusions provided in the state regulations, section 15301
requires that a Tide V inspection be done upon a transfer of title of all property. If you feel you
are exempt in this requirement, please provide any information regarding your position to the
health office. If there was not a Title V inspection done for this transfer and you are not eligible
for an exemption you may be in violation of the state code.
In closing, the Health Department is also requiring that a town representative be present during
the inspection. Please have the inspector contact this office at least 48 hours prior to the .
inspection. If the Title V inspection results indicate that your property's septic system is the cause
of the break out of effluent, you will be required to immediately address the problem. Possibilities
for repair will not be fisted until the results of the Title V are submitted to this office.
Thank you in advance for your cooperation in this important matter of public health. The Health
Department is aware, by observation, that the adjacent properties at #44 and #20 MR Road are
also experiencing a serious ground water problem coming off the hill. As neither of those
properties negatively affects other properties directly, at this time there will be no order letter to;
them. As these properties have been mentioned in this letter, a copy of this correspondence is
being sent to them.
Please contact the Health Department if you have any questions regarding this correspondence.
You have the right to request a hearing before the Board of Health if you feel this order should be
modified or withdrawn. A request for said hearing must be made in writing and received by the
Health Department within seven (7) days from the receipt of this order. At said hearing you will
be given an opportunity to be heard and to present witnesses and documentary evidence as to why
this order should be modified or withdrawn, All affected parties will be informed of the date, time
and place of the hearing and of their right to inspect and copy all records concerning the matter to
be heard. You may be represented by an attorney. You have the right to inspect and obtain
copies of all relevant records concerning the matter to be heard.
SinIcerel
�v
U Sawyer, REHS/RS
Public Health Director
Cc: Board of Health Members
Mark Rees, Town Manager
Owner, 20 Mill Road
Owner, 44 Mill Road
Encl. 1986 copy of As -built plan of 30 Mill Road
Remote User
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[pPrinter Test Page
(D07105/05 09:48 AM
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North Andover Board of Assessors Public Access Page I of I
http://csc-ma.usNandoverPubAcc/jsp/SaveSearchjsp 6/20/2005
Driving Directions from 400 Osgood St, North Andover, MA to 30 Mill Rd, North Andov... Page 2 of 3
-W-1, 4V
Start:
400 Osgood St
North Andover, MA 01845-2909, US
300M
0
1 900ft I
44V
St 551"
133
Colo Steven
d Pond
P2005.1VIspauesi'vom, Inc. 5-.NAV.TEQ
Notes:
End:
30 Mill Rd
North Andover, MA 01845-5532, US
FHAVTE7G
VISM)".
All rights reserved. Use Subject to
License/Copyri- ht
These directions are informational only. No
representation is made or warranty given as to
their content, road conditions or route usability
or expeditiousness. User assumes all risk of
use. MapQuest and its suppliers as�ume no
responsibility for any loss or delay resulting
from such use.
http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt& I gi=O&un--m... 6/20/2005
Driving Directions from 400 Osgood St, North Andover, MA to 30 Mill Rd, North Andov.
MI.".
Start: 400 Osgood St
North Andover, MA 01845-2909,
us
End: 30 Mill Rd
North Andover, MA 01845-5532,
us
Page I of 3
StayaSpell RAMADA
W 0 Q k 0 W D t
@9WAIMUM
b Taw
ttrewardv
Directions Distance
1: Start out going SOUTHWEST on OSGOOD ST toward 0.3 miles
MILL POND.
2: Turn RIGHT onto BEACON HILL BLVD. 0.1 miles
3: Turn LEFT onto MA-133/CHICKERING RD/MA-125. 1.2 miles
Continue to follow MA-133/MA-125.
4: Turn LEFT onto MA- 1 14/MA- 125/TU RN PIKE ST/SALEM 1.4 miles
TURNPIKE. Continue to follow MA-114/TURNPIKE
ST/SALEM TURNPIKE.
5: Turn LEFT onto MILL RD. 0.1 miles
gz 6: End at 30 Mill Rd
North Andover, MA 01845-5532, US
Total Est. Time: 9 minutes Total Est. Distance: 3.33 miles
http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt&lgi=O&un=m... 6/20/2005
TOWN OF NORTH 'ANDOVI'�-R-C-
S.YSTEM PUMPINC R-ECORID 7-
TE
M OWNER ADDRESS
-w
4�,Y - 2 2003
S Y S T E M L 0 C A TY-0:7N
(Qx2mple: lef(fron(of hou�t)
p- C, )-/�
7
U.\,I,c OF PUMPINC: /* QUANTITY PUMPED L L
�J.'-�SPOUL: NO YES S E LPT ;IC �Tl �A NO YF's
-\TURC OF SERYICE: ROUTINE EMERCENCY
COOD CONDITION. FU L L TO CO V C, J�
HFAVY CREASE BAFFLES IN PLACE
ROOTS LEACHFIELD IZUNUACK..—
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER NHFR (EXPLAIN)
vs -v L.m P U m P C D B y:
C U MM P NTS:
� 0 N' 1'1,1'.NT� T) � A N S F E I Z I Z ED TO:
1-1 1
TOWN OF NORTH 'ANDOYE R
S�STEM PUMPING RECORD
A
—Z7 �14 2 2003
F M'�110—)W 'P11 9 R A D� D R E, S �S
dp 'A
dp SYSTEM LOCATION
(e)camplt. f
0 i of h ou�t)
left
.,q (example: left fron-i of houst)
C96 XV
ltl-'141-7a,le ve.4
OF PLjMpljyG:
Q VA NTITY 0 U m p C. D /-�W
CA L L O.N,,
"'I'SSVOOL: NO
SEPTIC: TANK: NO YES
\ATURE OFSERVICE: ROUTINE— 4.1-� EMERGENCY
()11-�PRVATIONS:
COODCOnDiTION. ---L--1uLL TO COVE i?
HFAVY CREASE BAFFUS IN PLACE
ROOTS LEACHFIELD I?U1yBACX-.
CXCESSI-YE SOLIDS FLOODED
SOLIDS CAR-RYOVER ip;Hi'-R (EXPLAJ(q)
iN's'ITIM Pumpc.b BY:
N TS:
!,I�A NSPE R RED TO:
0
11
C)
0
0
I
14E
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c
cn
CD
cn
—q
0
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