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Miscellaneous - 352 FOSTER STREET 4/30/2018 (3)
t N b N O O m ;o cn X m Z !!G �i. �.�, J � z -c.. � ./' i �% Com✓' , � '�'_� � ` S Cs USS /r''t'!/� v r G4b 11 i- GjA Pyr• 7�% 0- Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. r,• ietmn " Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record \\\j Form 4 DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: APR -6 2010 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Addr W JAL Isk Dat) H &— ait".— City/Tow State Zip Code 2. System Owner: V _ elt K�et}�e1 Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State Zip Code _ 181- 10-1(_5o Telephone Number Date 2. Quantity Pumped Cesspool(s) Septic Tank 4. Effluent Tee Filter present? ❑ Yes Z No 5. Condition of System: r� Gall n60O ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 6. System P mpedy: G^� _ A 00 — Na e Vehicle License Number AAVA Company 7. Location where contents were disposed: tp$�I�� wat��' Treatment Plant Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect 15form4.doc• 06/03 System Pumping Record • Page 1 of 1 i5form4.doca 03106 of Massachusetts MAR 0c 2014 .\ C ,mn—lonwealth _ City/Town of Record NORTH ANDOVER Sy stem Pumping Foal-+ 4 may be used, but the local Boards here. Before using this form, check with your has this form for use DEP provided that prow del the information must be substantially Record The Systemy therffo,mgta��hos must be submitted to in local Board of Health to determine fromthepumping date authority within 14 da t^e local Board of Health or other app accordance with 31 o CMR 15.351. _ A, Facility information importan°. When filfnc out 1 System Location: r _ forms on the computer, use only the tab key Address r1Cdv2/ � e �_ _ ... .-. - Zip code to move you State cursor - do notuse the return key. �. System Owner: Name ; dress (if different from location) ., State Zip Gdde CilyrTown G Telephone Number - — p, Pumping Record 2. quantity Pumped: Gallons Date of Pumping Date Tight Tank ��Ptic Tank ❑ 9 ❑ Grease Trap ;;. Type of system: ❑ Cesspool(s) ❑ Other (describe): — - - � Yes o if yes, was it cleaned? ❑ ❑Yes ❑ No 4, Effluent Tee Filter present. 5. Condition of System'. 5. System Pumped By: �Z / l� License Number Name - Company 7. Location where contents were disposed:. _ _.._. - ....._. Date Signature of Hauler __ —_.-....__. Date Signature of Receiving Facility System Pumping Record • Page i of t i5form4.doca 03106 pt MO RT{1ti Town of North Andover itis o ::tom' HEALTH DEPARTMENT sACHUSt CHECK #: LOCATION: H/O NAME CONTRACT 6951 Type of Permit or License: (Check box) $ ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $� Title 5 Report $ ❑ Other. (Indicate) $ Health gent Initials White - Applicant Yellow - Health Pink - Treasurer FILE# NA nd 03014 TITLE V INSPECTION Dean G. Luscomb II & Sons RECEI:ANDER P.O. Box 135 Middleton, MA 01949 JUL 0 7 978-774-4065 TOWN OF NORTH HEALTH DEPAR Licensed Plumber # 20285 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNERS NAME J O h h W PROPERTY ADDRESS �J o� f o s+e- fr N, A oCID ver- M A DATE OF INSPECTION J LL h °L .� O NAME OF INSPECTOR L)e Q l-� G. L u s C o ►y) h� QUALITY IS NUMBER ONE TO US Mahm z Owner information is required 'or every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Asses, 352 Foster St. Property Address John Walsh Owner's Name North Andover City/Town �■� IMA — Pr JUL 07 2014 TOWN OF NORTH ANDOVER HEALTH DFPARTMFMT MA 01845 June 30, 2014 State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer, use 1. Inspector. - only the tab key to move your Dean G. Luscomb II cursor - do not use the return Name of Inspector key. Dean G. Luscomb II & Sons Company Name VQ P.O. Box 135 Company Address Middleton MA 01949 City/Town State Zip Code 978-774-4065 S1848 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority June 30, 2014 Inspe or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 352 Foster St. Property Address John Walsh Owner Owner's Name information is North Andover MA 01845 June 30 2014 required for , every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Chec�B,C,D or E / always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or 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, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) 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 lJ 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Foster St. Property Address John Walsh Owner Owner's Name information is required for North Andover MA 01845 June 30, 2014 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within '50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Foster St. Property Address John Walsh Owner Owner's Name information is required for North Andover MA 01845 June 30, 2014 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 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, D safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No iI ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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 Y day flow t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design'flekv of 10,000 gpd to 15,000 gpd. For large systems, y ust indicate either "yes" or "no" to each of the followin i addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a ce drinking water supply ❑ ❑ the system is within 20 et of a tributary to a ace drinking water supply ❑ ❑ the system is to ed in a nitrogen sensitive area (I ten ellhead Protection Area — IW P or a mapped Zone II of a public water supply we If you have answered "ye ' o any question in Section E the system is considered a significant threat, or answered "yes" in ction D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Foster St. Property Address John Walsh Owner information is Owner's Name required for North Andover MA 01845 June 30, 2014 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: 6 ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 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. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design'flekv of 10,000 gpd to 15,000 gpd. For large systems, y ust indicate either "yes" or "no" to each of the followin i addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a ce drinking water supply ❑ ❑ the system is within 20 et of a tributary to a ace drinking water supply ❑ ❑ the system is to ed in a nitrogen sensitive area (I ten ellhead Protection Area — IW P or a mapped Zone II of a public water supply we If you have answered "ye ' o any question in Section E the system is considered a significant threat, or answered "yes" in ction D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M 352 Foster St. Property Address John Walsh Owner Owner's Name information is North Andover MA 01845 June 30 2014 required for , every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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 I lot available note as N/A) ® ❑ Was 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 tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 gpd t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° , •'°° 352 Foster St. Property Address John Walsh Owner Owner's Name information is required for North Andover MA 01845 June 30, 2014 every page. CityfTown State Zip Code Date of Inspection D. System Information Description: owner and town Number of current residents: Yes 5 No ❑ Yes Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No T--� Water meter readings, if available (last 2 years usage (gpd)): lOrvK �'la-_'C_ Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establl nt: Design flow (based on 310 15.203).- Basis 5.203):Basis of design flow (seats/persons/sq.ft., Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharge he Title 5 system? Water meter read* _ s, if available: Gallons per day (gpd) ❑ Yes ® No current Date ❑ Yes ❑ No ❑ Yes ❑ No Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Foster St. Property Address John Walsh Owners Name North Andover MA 01845 June 30, 2014 City/Town State Zip Code Date of Inspection D. System Information (cont.) Last Date Other (describe below): General Information Pumping Records: Source of information:1''�-�� Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: How was quantity pumped determined? Reason for pumping: gallons No need at this time Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form a a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Foster St. Owner information is required for every page. Property Address John Walsh Owner's Name North Andover MA 01845 June 30, 2014 City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Asbuilt is from 1979 - 35 vears old - town records Were sewage odors detected when arriving at the site? ❑ Yes ®.No Building Sewer (locate on site plan) Depth below grade: 28"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Main line and joints are in very good condition. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal Precast rectangular - 1000 aallons If tank is Is Dimensions: Sludge depth: 16" feet ❑ fiberglass ❑ polyethylene ❑ other (explain) of Compliance? (attach a copy 5'x5'x8'-1000 gallons 1" t5ins - 3/13 Title 5 official Inspection Forth: Subsurface Sewage Disposal System -. Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Foster St. Property Address John Walsh Owner information is required for every page. t5ins • 3/13 owners Name North Andover Citylrown D. System Information (cont.) MA 01845 June 30, 2014 State Zip Code Date of Inspection Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? sticks and tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The septic tank and baffles are in very good condition. The liquid in the tank is running at it's correct working heigth. The solids in the tank are light and do not require pumping at this time Grease Trap (locate on site plan): Depth below de: feet 17 Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ poly Dimensions: Scum thickness Distance from top of scum to top of tlet tee or baffle Distance from bottom of sc to bottom of outlet tee or baffle Date of last i)ummno: ❑ other (explain): Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G N 352 Foster St. Owner information is required for every page. Property Address John Walsh owner's Name North Andover City(rown MA 01845 June 30, 2014 State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, iquIelid eve"ated to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): © Depth below grade: Material of c'd) struction: ' ❑ concrete ��❑ metal ❑ fiberglass ❑ polyethylene /herexplain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: Comments (condition of alarm and gallons gallons r day Yes ❑ No ol Alarm in orking order: ❑ Yes ❑ No Date switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 11 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Foster St. Property Address John Walsh Owner's Name North Andover MA 01845 June 30, 2014 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Zero 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.): The d -box is 36" below grade. The d -box is level and in good general condition. The liquid in the d - box is running at it's correct working heigth. The soil in this area is clean and dry with no signs of any Pump Chamber (locate on site plan): U.. Pumps in order: ❑ Yes ❑ No" Alarms in workingorder: de . ❑ Ye No Comments (note condition of pump chamber, c n of pumS4.appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): 5 If SAS not located, explain why: The SAS was located by asbuilt drawings. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 C Commonwealth of Massachusetts . - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 352 Foster St. Owner information is required for every page. t5ins - 3/13 Property Address John Walsh Owner's Name North Andover City/Town D. System Information (cont.) MA 01845 June 30, 2014 State Zip Code Date of Inspection 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: 3 Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS is in good general condition with no signs of any problems. The soil in this area is clean and dry with no signs of ponding or breakout. must be pumped as part of inspection) (locate on site plan): Number and configur ' 0.. Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of gr dwater inflow ❑ Yes ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Foster St. Property Address John Walsh Owner's Name North Andover MA 01845 June 30, 2014 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, etc.): Privy (locate on site plan): U Materials of cons ion: Dimensions Depth of solids Comments (note condition of soil, signs etc.): / of vegetation, level of ponding, condition of vegetation, t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Foster St. Property. Address John Walsh Owner Owner's Name information is North Andover MA 01845 June 30, 2014 required for I, every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties t at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately kJo V$ t5ins • 3113 M Ak T=5!9" (34-'=35` D -161# 04 P(= -2S 8 qt = 31"11" A 1021, 5( ANP.3-- ?q a&P?C� 83 `/0' Fs4-e� SS+ 9C_rQ`,1e_ Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Foster St. Property Address John Walsh Owner Owner's Name information is required for North Andover MA 01845 June 30, 2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ��pp""""�/ ® Check Slope Gr6tRrr a ® Surface water A/orn2 ® Check cellar 'De -y QO ® Shallow wells /1%19Ae� Estimated depth to high ground water: 8 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 9-1-79 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Permit, previous title v and asbuilt on file. ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database - explain: Topsfield 1 You must describe how you established the high ground water elevation: Basement is 8' deep with no sump pump and no water. The bottom of the system is 5'6" below Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 352 Foster St. Owner information is required for every page. Property Address John Walsh Uwners Name North Andover City/Town State E. Report Completeness Checklist 01845 June 30, 2014 Zip Code Date of Inspection ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 3/13 Title 5 official Inspection Forth: Subsurface Sewage Disposal System - Page 17 of 17 i i Commonwealth of Massachusetts DEC 112012 City/Town of Record NORTH ANDOVE�RdOFiJOE'r,'., `"'w`: System Pumping ,•.",,TMDFPN;''" rwT Form 4 y DEP has provided this form fqr 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. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. A. Facility Information 1. System Location 3 sz Address City/Town 2. System Owner: Name Address (if different front location) /W/"*I- State of-evr Zip Code Zip Code ------- ------ State Cityfrown Telephone Number _ B. Pumping Record /2 7//Z 1. Date of Pumping -D---- te ----- 2• Quantity Pumped: Gallons a 3. Type of system: ❑ Cesspool(s) [4flS^eptic.Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): - — - 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By. ----- Vehicle License Number Name Company 7. Location where contents were disposedL&D - - - - - ---------- ---- NorthAndovet--- A;- Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 DEP has provided this forth for use by local Boards of Health. Other forms may be used, but the information must be substantially the some 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 da ep accordance with 310 CMR 15.351. daW inrMirliv A. Facility Information OAC - 5 SII Important Vahan suing out 1. System LLocatiom TOWN OF NOIttTH ANOIO'VIl$ forms on the J ( HI ALTH 011 AI�YMpN`r computer. use 3 C) J� - - - -- — – - - • -• _. . . only the tab key Address ` /� �A�� io move your hJov W\ f�i`t1�avc;( aI� cursor -do notuse the return Cdyrrotnm State 7Jp Code key" 2. System Owner. Name lei Address (if diNwent from location) -- - --- -- — ---- _• - -- _ 7- City/Tom -- — — State Zip Code Telephone Number B. Pumping Record 500 1. Date of Pumping Date 2. Quantity Pumped: Gan s— -- 3. Type of system: ❑ Cesspool(s) Q�Septic Tank ❑ Tight Tank ❑ Grease Trap [j Other (describe): 4. Effluent Tee Filter present? ❑ Yes Q�Nlo 5. Condition of System; 6. System Pumped By: %3\11^ Go A k ung Company 7. Location where contents were disposed: CLt.,M Naft Andave% MA, Signature of Hauler If yes, was it cleaned? ❑ Yes [/No Vehicle License Number Date Signature of Receiving Facility Date t5fom*doc• 03106 System humping Record - Page 1 or 1 _ZN, Commonwealth of Massachusetts = City/Town of System Pumping Record NORTH ANDOV Form 4 R DEP has provided this form for use by local Boards of Health. Other forms aW, e_steA$,4jj information must be substantially the same as that provided here. Before us n 1tl>3SftrnW)83hW local Board of Health to determine the form they use. The System Pumping Record must be s the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351 5. Condition of ystem- 6. System Pumped By: _ /�h % ---- -- Name Company 7. Location where contents were disposed: Signature of Hauler Signature of Receiving Facility --------------- Vehicle License Number Date Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms on thecomputer, ---- --- --- -- ---- —._. __ use only the tab key to move your __=Z -.f-�.---- Address C i— cursor - do not City/Town State Zip Code use the return key. 2. System Owner: Name Address different from location) (if City/Town State Zip Code 9�/- Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: S ---- - ---- Gallons Date 3. Type of system: ❑ Cesspool(s)eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): -------- -------- -- - --- - - ------------- 4. 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of ystem- 6. System Pumped By: _ /�h % ---- -- Name Company 7. Location where contents were disposed: Signature of Hauler Signature of Receiving Facility --------------- Vehicle License Number Date Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 N y o 0 0 Q G O �- �0 d 3 .p 0 c � m y H y 0 0 0 0 � O .° v c CL N N N 0)00 Z 3 J J 0 0 0 G O a w c a c w a co U Q y cn J 0 O 1 as O a a C y G w i ,w Q ci w ayi c Gor d a I w CL CL m C N 0 U) CO W �'. O O 6 O w U J Z Z Z � J V � � C a y� m � o Y Y Y C C C O y a a a y o Z Z Z w In fn In LO co C) y k a) Co N = W c N C)) my a ��� c dog o \U O y a o 0 30 0 0ami 5 W U. o m — m tq (9 V i° co C'9 0 a� rn m a NOPTN n • Town of North Andover "�.'•�,; :o :: HEALTH DEPARTMENT �ds�cHus°� CHECK #: S.1 i LOCATION: J.7', H/O NAME:f%/� CONTRACTOR NAME: o ?l g-s�&q % Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 pector $ Title 5 Report $ �® ❑ Other. (Indicate) $ ni w. 2033 G Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer I F`�TI ECTIONS Dean G. Luseomb II & $ons P.O. Box 13 5 Middleton, MA 01949 1-978-774-4065 LICENSED PLUMBER #20285 FILE # N8a)1200671 RECEIVED NOV 2 2 2006 TOWN ut- NORTH ANDOVER I HEALTH DEPARTMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNERS NAME:_ Q l:j r�_ (ZjS I7 PROPERTY ADDRESS: 35a _ U S+e f r��Q 7-�MA ADDRESS OF OWNER: aq e___ ---------- (if different) DATE OF INSPECTION: c.r1(S__ LL SCO NAME OF INSPECTOR: _� __ _jy),-L QUALITY l S NUMBER. O N. E TO- U S COMMONWEALTH OF MASSACHUSETTS EXECUTIVE 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 ASSESSMENT_ S SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 36-Z F-04 _ S5 - Owner's Name: Vii,^ Owner's Address: S'r .. Date of Inspection: j+f,1.,#,m d r` . Zoo G 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: 978-774-4065 RECEIVED NOV 2 2 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails ff — Inspector's Signature: �� Date: The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow'of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 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. Page 2 of I I Dean G. Luscomb II & Sons P.O. Box 135 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: Z root ei StL. Owner: Date of Inspection: l �rCd D 6 Inspection Summary: Chee4 B,C,D or E / ALWAYS complete all of Section D A. System Passes: Ll/"I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or 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 Bard of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined" please explain. A-) The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: /—� Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: /`-'' The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Dean G. tuscomb II & Sons Page 3 of 11 P.O. Box 135 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: FoSL ' A Owner:tJ,ltS( 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(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: N Cesspool or privy is within 50 feet of a surface water t-) 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: 3. tj 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. 0 The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. 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 Page 4 of I 1 Dean G. Luscomb P.O. Box 135 Middleton, MA 1-978-774-4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address- 3,52- FS�Ier` 3f Owner: [x�S Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: II & Sons 01949 Yes No _ rj Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 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 Any portion of the SAS, cesspool or privy is below high ground water elevation. I i 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. fJ 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. (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.] I``' U (Ye6o)'he system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to gpd-`� You must indicate eitQ- des" or "no" to each of the following: (The following criteria apply�ge systems in addition to the criteria above) yes no the system is within 400 feet of a sur c rinking water su the system is within 200 feet of a tributary to a s. ce drinking water supply _ the system is located in a nitrogen sepsifive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone 11 of a public water suppl ell If you have answered "yes" to pKquestion in Section E the system is considered a signifreant threat, or answered "yes" in Section D above tbefarge system has failed. The owner or operator of any large system considered a significant threat un or action E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The systrnowner should contact the appropriate regional office of the Department. 4 Page 5 of 1 I Dean G. Luscomb II & Sons P.O. Box 135 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: Owner: l.Ja.l,5 ( Date of Inspection: Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No f_ Pumping information was provided by the owner, occupant, or Board of Health 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 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 tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _✓ _ 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: Yew no ✓ _ 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 Page 6 of 11 Dean G.Luscomb P.O. Box 135 Middleton, MA 1-978-774-4065 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: p_r?_ FOS , Owner Ach Date of Inspection: o Q FLOW CONDITIONS II & Sons 01949 RESIDENTIAL Number of bedrooms (design): _i_ Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: Does residence have a garbage grinder (yes o no _ LJO Is laundry on a separate sewage system (yes o(): IUD[if yes separate inspection required] Laundry system inspected (yes oQ:N a Seasonal use: (yes or IQ Nv A wZf G' Water meter readings, if avaable (last 2 years usage (gpd)): wv� �� `'' 2 % 55 qa, � �a1� Qn Sump pump (yes o no : NO Last date of occupancy: ZLAZ COMMERCIAL/INDUSTRIAL Type of establishment: Desiflow(based on 310 CMR 15.203): gpd Basis of de *,flow (seats/persons/sgft,etc.): Grease trap present "r—m Industrial waste holding tank Non -sanitary waste discharge Water meter readings, iai Last date of occuo v/use: describe): no): _ Title 5 s7j ste4nJyes or no): GENERAL INFORMATION Pumping Records Source of information: las � R.,jogA wwk C G Was system pumped as part of the inspection (yes ori: /00 If yes, volume pumped: C� £allons -- How was uantity pumped determined? 3y�Alure.�tn�i� Reason for pumping: K). K:'e,,.,a� 1S q{-'„�,, L a,,, /4c 6u S TYPE OF SYSTEM Septic tank, distribution box, soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) _ Tight tank _ Attach a copy of the DEP approval _ Other (describe): Approximate ague+ of all components, date installed (if known) and source of information: ASS�r 11� 7r rvn. 19/7,7 .Z? r -c 'nQ Were sewage odors detected when arriving at the site (yes orQ: 100 M Page 7ofII Dean G. Luscomb II & Sons P.O. Box 135 Middleton, MA 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:,5 z `ait r A. N Owner S Date of Inspection: ® O BUILDING SEWER (locate on site plan) Y10 -15 - Depth below grade: 79-V' Materials of construction: _cast iron L,/40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leaka a etc.): SEPTIC TANK-)L,?,(locate on site plan) Depth below grade: � Material of construction: k ncrete _metal _fiberglass _polyethylene _other(explain) (Pre7c- , �; �e•kaL c'I "' Cancn2 If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: S �De ,K5 Sludge depth: c I u Distance from top of sludge to bottom of outlet tee or baffle: JO u Scum thickness: Distance from top of scum to top of outlet tee or baffle: G H Distance from bottom of scum to bottom of outlet tee or ba /S„ How were dimensions determined- N uA i CIQS GL." Comments (on pumping recomnlendati ns, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outltet inve , evidence of leak ge, etc.): i; C"e ter (, G ' � a U"{pnrj a GREASE TRAP:(locate on site plan) Depth'behow,grade: _ Material of constr"ii etion: concrete _metal _fiberglass _polyethylene tt e (explain): Dimensions: Scum thickness:„' Distance from top of scum to top of outle ore'"r baffle: Distance from bottom of scum totem of outlet tee or baffle: Date of last pumping: r `` Comments (onpufrtpmg recommendations, inlet and outlet tee or baffle condition, st`r-ai etural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.):_ %/ Dean G. Luscomb II & Sons • P.O. Box 135 Page 8 of 11 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addres :35a jce r st N _ A rd o QCrVg-A Owner: WO -1S Date of Insnectio : I l 426 :)6 TIGHT or HOLDING TANK: PO (tank must be pumped at time of inspection)(locate on site plan) Depth below grad: Material of cohstr ction: concrete metal fiberglass Dimensions: Capacity: gallons"'�- • r' Design Flow:gallons/day Alarm present (ye or no): Alarm level: Alarm in worki ., er (yes or no): Date of last pumping: Comments (condition of a)arth and float switches, etc.): other(explain): DISTRIBUTION BOX: `le S (if present must be opened)(locate on site plan) ' D-t3c>J� S f :—y /3.21104-✓ 4�— k. Depth of liquid level above outlet invert: Z2ro 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.): h -4&,x is L� /an®l 4,Z r an moven 1-,rt.a �� /G��� ,74Z Awa/ 4�z A ->--T ok INC 9-Anf-11'v'e4 PUMP CHAMBER: tjy (locate on site plan) Pumps in working order (yes or no): Alarms in working order ?yes' Comments (note condition of pump clam ndition of pumps,z6a appurtenances, etc.): M-� E. Page 9 of 11 Dean G. Luscomb P.O. Box 135 Middleton, MA 1-978-774-4065 OFFICIAL INSPECTION FORM -- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35Q �o -t- r S+. N,Ar)dl ucr ry-)rl Owner: S e Date of Inspection: % (� SOIL ABSORPTION SYSTEM (SAS):Y!!�(locate on site plan, excavation not required) If SAS not located explain why: 4yi +s Ns� fro, 11179 II & Sons 01949 Type C%inPl Pt��'S -P" � I iS -,,-" leaching pits, number: leaching chambers, number: �or /Z fj�'QW crrrCi.o� leaching galleries, number: 3 leaching trenches, number, length: p fuY leaching fields, number, dimensions: ma's{— ��4. 6' 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 1 - Giles /10 — ,' r1 Seor+h n r u Sri 1 :n Kis"z i S ii Ir01, W/ juv S` 'o n r o 4 aK., is f'E?4I..e m CESSPOOLS: P O (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwaterinflo s or no): _._. Comments (note conditiofi o soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: 1 (locate on site plan) Materials of construction: _ Dimensions: Depth of solids: Comments (note condition of of hydraulic failure, level of W of vegetation, etc.): Dean G. Luscomb II & Sons P.O. Box 135 Page 10 of 11 Middleton, MA 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:,35 Q f7p sr St '� r VL Owner: � K _ Date of Inspection: I i C> 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. Z-Ttox 35; f0s�'-5�. ,U, fI,,dooe,- Frove�aC 144� 40aa 1-0 r : Lt --e ,��� gh>D 742 It to Pt 3414 "j// c iAIF f o Pt 57'3', 1-0 r : Lt --e ,��� Page I 1 of I 1 Dean G. Luscomb II & Sons P.O. Box 135 Middleton, MA 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: 3 1: «fit Owner: Date of Inspection: 10(1 SITE EXAM uAlope r .mss 1tu l.e�► Surface water ►� L/Check cellar -D pity 0 t/Shallow wells lJar,e.- I Estimated depth to groundwater Sfeet 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: 45 Observed site (abutting property/observation hole within 150 feet of SAS) p y Checked with local Board of Health -explain: �Slawi�� pf Grp Oh t i 4Z Checked with local excavators, installers- (Attach documentation) i/ Accessed USGS database -explain: _F �• You must describe how you established the high ground water elevation: 11 nOV 14 Ub U5:31P i Summary P.ecord Carel generated on 11/14/2006 3:24:19 PM by Lisa Warren Town of North Andover Tax Map # 210-104.B-0017-0000.0 352 FOSTER STREET WALSH, JOHN P. 352 FOSTER STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type Size Total 1 Acres IFY 2007 UB Mailing Index NametAddress WALSH, JOHN P. 352 FOSTER STREET NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 17807.0 - 352 FOSTER STREET 3170472 03 Cycle 03 UB Services Maint. Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance Type Loan Number Active/Inact. From Payor Occupant Name Active/Inactive Last Billing Date 10/16/2006 Active Rate Charge Multiplier/Users 1 1 9.18 1/ 01 ALL METER SIZE 851.14 !1 Serial No Status 7/10/2006 Location 16371961 a Active 110 ERT HH Date Reading Code 9/13/2006 3292 a Actual Trouble Code -.03 48 1/14/2005 6/13/2006 3109 a Actual 3/812006 3040 a Actual 12/22/2005 3006 a Actual 9/20/2005 2896 a Actual Trouble Code:03 6/28/2005 2204 a Actual 3/25/2005 2099 a Actual 12/14/2004 2041 a Actual 9/27/2004 1993' a Actual 6/23/2004 1779 a Actual 4/12/2004 1725 a Actual Brand Type METE METE w Water Consumption Posted Date 183 10/20/2006 69 7/10/2006 34 4/17/2006 110 1/17/2006 692 10/14/2005 105 7/15/2005 58 4/5/2005 48 1/14/2005 214 10/8/2004 54 7/30/2004 81 5/17/2004 Size 11 P.1 Page 1 1 Residential Until YTD Cons 0 Variance 180% 59% -62% -86% 645% 92% -7% -72% 197% 8% 0% Commonwealth of Massachusetts (� City/Town of NORTH ANDOVER, MASSACHUSETTS R System Pumping Record ? 4 o /r Form 4 DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location - forms on the 3 2 computer, use JJJJ only the tab key Addressgo, r to move your � cursor - do not use the return City/Town State Zip Code key. 2 �uctcm (l�n�nar r ray iA B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date / �, 12,26, 2. Quantity Pumped: tszcc Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? J6 Yes 9?'No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: �evilli- TA TQC ff IAI .4ftnme tem Ave QC�ucester,:M�.0.1a30, ---.— Company 7. Location where contents werftsftchburg MA. Signature of Hauler http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect kv OIv61e41 Vehicle License Number Date /'1/6 /d t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 NOV-6-c006 U,S 49P FROM: T0I M09i78P8 P. i Commonwealth of Massachusetts City/Town of ,FORTH ANDOVER, MAS§ACHUSETTS. System Pumping Record i; Form 4 Important: When 11111141 (K I forma on Ihir computer, lice only the tali ki r to move yoL- cursor • do ii)l use the ratur i key, ~'lel DSP has provided this form for use by local Boards of Health. The System Pumping Rocord mus be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System l.0 0 ' Address cityrrown % 2. System- owner , Sleta Zip. Code Stets zip Code Telephone Numhsr B. Pumping Record 1, Date of pumping ate 2. quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Y.Aeptic Tank ❑ Tight Tank U Other (describe): --- Y —~- 4. r`ffluent Yee f=ilter present? d Yes ,/❑.,'Ao If yet;, was It cleaned? ❑ Yes 0 No ta. Condition of System: � f �.c411- 6u)__� .� a�G fill 1W !JE&Q47 vehicle License Number Company 7. Location where Contents wett;.Chburg r! Signature of H6uler .i iaso-gov/dep/water/approvals/tdforme.hUWrmpect ►6rorm4.dr;r D6103 System Pumping Record 9 Paas 1 of 1 11 1�0_e 1-1// i� �C ". mss' • e �'�' i+- . vv •vim ._. - .sem v -+ 0 3G. Oct ' - � �►. t 71, All MAMA VA ANNI Odwrl" -A 4411ni574 -1 P, 4p, se -A IAS 0 Or AlAill-b-ittG 3 L I AII- dr 45 f I io elf 71, All MAMA VA ANNI Odwrl" -A 4411ni574 -1 P, 4p, se -A IAS 0 Or AlAill-b-ittG 3 L I AII- dr 45 f I io iz �� f f`µ iz �� f /OP I -6 6 lu # SmOrMb it— pq ry A I -T oor I Z : r. fit lu # SmOrMb it— pq ry A I -T oor NORTH Of �t4to r61ti0 .�? FO- Ra * a * t, Ln CM HO . � �1,'q°��rfo ►P4,�46J SS�C14US� PUBLIC HEALTH DEPARTMENT Community Development Division Date: October 16, 2006 Address: 352 Foster Street Re: Application to enclose a deck Dear: Mr. And Mrs. Walsh, Your application for the enclosure of the deck at has been reviewed by the Health Department. The application was denied on, October 16, 2006, for the following reason as shown in red: 1. Missing information 2. x Passing Title 5 inspection of septic system required per local N. Andover regulations 3. ❑ Location of structure not acceptable 4. x Undersized septic system - Existing septic system was installed in 1977 for a 4 bedroom (maximum 9 -room) home. Plans submitted, with the application, show a proposed increase to a 12 -room home. To address the problems If #1 is checked, please supply: a. Floor plan of existing and proposed addition — all rooms b. Certified plot plan showing house, septic system and proposed project in scale N #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com N #4 is checked: Options a Provide additional information proving that the existing septic system meets current capacity requirements. Please consult a professional engineer or registered sanitarian to determine theflow low capacity of the septic system. b. Hire a professional engineer to design a new septic system that meets State Regulations a Request approval of a deed restriction agreeing to always be a 4 -bedroom home. i. Submit a request in writing to the Board of Health identifying why the need to upgrade the septic system is a severe hardship. ii. Attend a BOH meeting to address the board iii. If approved, record the deed restriction at the registry of deeds Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sawyer, Public Health Cc: Building Department File 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Sincer lye, S an Y. Sawyer, REHS/RS Public Health Director Encl: list of licensed septic system installers Cc: New England Engineering Services Inc. i ouu usgood Weet, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com N. Andover Health Department Fax 978 688-9546 Phone 978 688-9540 -fa cs' t e kansr�r um, To: John Walsh Fax: 781391-7828 From: Susan Sawyer, Health Dir Date: 10/23/2006 Re: Building permit Pages: 3 ❑ Urgent 0 For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle Attached is t oornespondenoe I mentioned in our conversation. I hope it clears up a few it ms. Please note that the original has red highlighted items. I will rqxmt itusing bold italics, so you can distingt ishthemamongthe # :hst.A's'I.meattionad, our room mmrber determination is based upon am adsting rtecords. If you dtsagm, and wishto submitanupdated$oarplanorimiteustoyourhome, wewill reevaluatethe total. This process is Conducted on each building application applied for in the Town of N. Andover. Once you have had a chance to review it, I will be happy to run through the options once again Sincerely, Susan Sawyer, Health Dmx%x . . . . . . . . 0 . . . . . . . . . . . . . . N. Andover Health Department Fax 978 688-9546 Phone 978 688-9540 0-4 fir a tmmmiffal. To: John Walsh Fax: 781391-7828 From: Susan Sawyer, Health Dir Date: 10/23/2006 Re: Building permit Pages: 3 CC: ❑ Urgent 0 For Review ❑ Please Comment ❑ Please Reply Cl Please Recycle PleasedmcgRid the previous document_ In review, I realized I had not highlighted the item 2, which will apply ifthem .is n a need to replace the existing system. A connplete Tide V inspection will be requesoedonly ifthe "Cjid=Mnwdmft=eM Tltene w unlit the size of the system is resolved this item does not need to „r bead_ Thank yoa, Susan Sawyer, health Dffewr TRANSMISSION VERIFICATION REPORT TIME 10/23/2006 09:54 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 0004J120960 DATE,TIME 10123 09:53 FAX NO./NAME 817813917828 DURATION 00:00:59 PAGE(S) 03 RESULT OK MODE STANDARD ECM N. Anda Flralth Aapfto t Fax 978 688.9546 Fhm 978 688-9540 To: John Walsh Fax: 781391-7828 Fmm: Susan Sawyer, Health Dir Imo: 14/23/2006 Re: Building pen,Wt Pages: 3 CC: CJ Urgent 0 For Rowlaw ❑ please Comment 13 Pkfte Rept CI Pkm@ Rfyde At' • • Thmkym Swan &Myer m akh Dirvcw -.3f Health 'Aac�over �Maaa. (CHID DATE OK SEPTIC SYSTEM INSTALLATION CHICK LIST LOTIn / �ID AVATI OS FAIL 1. Distance Tot a. Wetlands b. Drains c. Well 2. Water Line Location 3• No PVC Pipe / 4. Septic Tank -- a. Tees -_Length & To Clean Ont Corers _ b. Cement Pipe to Tank- Oa Both Sides of Tank = 5. Distribution Box j a. Covers & Box - No Cracks b. A11 Lines Flowing Equal Amounts c. No Back Flow 6. Leach Field or Trench ' a. IHsi Stone Depth c. Capped Eads d. Clean Double Washed Stone ?. Leach Pits a. Dimensions / b. Stone Depth c. Splash Pads d. Tees / e. Cement Pipe to Pit - Both Sides f. Clean Double Washed Stone No Garbage Disposal Final Grading Inspection 10. Barricading Covered System r 1].. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard -to Perc Test d. Elevations e: Water Table e Lz ion �� s NOR iii ANDOVER BOARD OF HEALTH SUBSURFACE DISPOSAL SYSTEM CHFGK LIST APPROVED PROVIDED DISAPPROVED J�7 1110 eneral Information Reg. 2.5 Fail OE The submitted plan must show as a minimum: () the lot to be served (area, dimensions, lot , abutters) ' (b) location and dimensions of system (including reserve area) design calculations (d} -calculations showing reouired leaching area )"e d propo .,contours 5 �� ocation d 1ps�deep observation holes -distance to ties location - d r ults of percolation tests -distance to ties location of any wet areas within 100' of the sewage disposal system or disclaimer i surface and subsurface drains within 1001 of sewage disposal system or disclaimer location of any drainage easements within 1001 of sewage disposal system or disclaimer .-( ) known sources of water supply within 200' of sewage disposal system or disclaimer lip location of any proposed well to serve the lot (100' from lea.cl-dng facility) -Prr} location of water lines on property (10' from leaching facilities), `-� - maximum ground Crater elevation in -rea of sewage disposal system location of benchmark > � plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans driveways r} garbage disposers l.s a profile of the system (elevations of basement, plumbers pipe septic tank, distribution box inlets.,and outlets, distribution field piping and any other elevations) (t) no PVC is to be used in construction S is Tanks Reg. 6.1 apacities - 150p of. flow Reg. 6.7 ( Water table Reg. 6.$ Tees Reg. 6.9 ) Depth of tees Reg. 6.1 e) Access Reg. 6.1E Pumping g) Cleanout Reg 3.7 (h) 10 from cellar wall or inground swimming pool (i) 25' from subsurface drains .s Reg: 9.11 _E!�FApproval Reg. 9.6 (b) Stand-by power . SOIL PROFILE & PERCOLA.ION TEST DATA No.&StreetCl Lot No. / 0� Loc./ Subdiv. .,,- y -rte /9/ ff Plan Owner ✓✓U G . InvestigatorC,4, Gt �G'c /� _Observer 4 19/%7 SOIL PROFILES -DATE l Elev. 2. Elev. 3. Elev. 4'Elev. �0 0 0 0 \�\ 2 3 - - 4 21 31 __ 4 1 5 1 1 5 7 3 8 9 M 7 1-M _9 10 10 10 1 Benchmark- Location_ Elevation Datum Percolation Tests -Date 75e ; 7 2 3 4 5 6 7 8 9 10 Pit Number 1 2 3 4 S Start Saturation Soak -Mins. / S Start Test -Time /S Drop of 3 "-Time 12 : / Dro of 6" -Time /2.'33 Mins.lst 3"Dro Mins.2nd 3"Dro Notes & Sketches on Back Frank C. Gelinas & Associates, North And. 0 �S S /tn-Z '117 fir r I d "1 m� 1 � � �l �S S /tn-Z '117 fir r I V, -d `1 Any appeal shall be filed within (20) days after the date of filing of this Notice in the Office of the Town Clerk. TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION JO"GE t NORTH _! DOYER 4UG 16 3 `_7 °x''95 Date August 16, 1995 Petition No. 041-95 Date of Hearing 8-8-95 Petition of John P. Walsh, Trustee of the KJJ Realty Trust Premises affected -352 Foster Street Referring to the above petition for a variation from the requirements of Section 7, para 7 1, 7.2 & 7.3 and Table 2 of the Zoning Bylaw so as to permit relief of 43,539 square feet of lot dimensional area from the requirements of 87,120 square feet, relief of 25 feet from the street frontage requirement of 175 feet, relief of 16 feet for the addition, from the side setback requirement of 30 feet and relief of 20 feet for the unattached garage from the side setback requirement of 30 feet. The applicant is also requesting a Special Permit under Section 9, para. 9.2(1) so as to construct an addition -.onto a legal non -conforming structure. After a public hearing given on the above date, the Board of Appeals voted to Grant the Special Permit & Variance_ and hereby authorize the Building Inspector to issue a permit to: John P. Walsh, Trustee of the KJJ Realty Trust for the construction of the above work, nlya== c 1I The Board finds that the petitioner has satisfied the provisions of section 10, para. 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. The Board finds that the applicant has satisfied the provisions of Section 9, para. 9.1 of the Zoning Bylaw and that such change, extension or alterationCshall Board of Ap A�airm not be substantially moreWilliam Sullivan, an detrimental than the existing non- conforming structure to the John Pallone Joseph Faris neighborhood. Scott Karpinski Ellen McIntyre KENNETH R. MAHONY Director R: r. Town of North Andover N0E,1lI ER OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES'--) 146 Main Street North Andover, Massachusetts 01845 (508) 688-9533 John P. Walsh Trustee of the KJJ Realty Trust DECISION 352 Foster Street Petition# 041 -95 North Andover, MA 01845 3?b� t�OL A # t r The Board of Appeals held a regular meeting on Tuesday evening, August 8, 1995 upon the application of John P. Walsh, Trustee of the KJJ Realty Trust requesting variances under Section 7, paragraph 7.1, 7.2 & 7.3 and table 2 of the Zoning Bylaw so as to permit relief of 43,539 square feet of lot dimensional area from the requirements of 87,120 square feet, relief of 25 feet from the street frontage requirement of 175 feet, relief of 16 feet for the addition, from the side setback requirement of 30 feet and relief of 20 feet for the unattached garage from the side setback requirement of 30 feet. The applicant is also requesting a Special Permit under Section 9, paragraph 9.2(1) so as to construct an addition onto a legal non -conforming structure located at 352 Foster Street, Zoning District R-1. The following members were present and voting: William Sullivan, Scott Karpinski, Joseph Faris, John Pallone and Ellen McIntyre. The hearing was advertised in the North Andover Citizen on 7.19.95 and 7.26.95 and all abutters were notified by regular mail. Upon a motion by Scott Karpinski and seconded by Joseph Faris, the Board voted unanimously to Grant the Variances as requested. Upon a motion by Scott Karpinski and seconded by Joseph Faris the Board voted unanimously to Grant the Special Permit as requested. Voting in favor: William Sullivan, John Pallone, Joseph Faris, Scott Karpinski and Ellen McIntyre. The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. The Board finds that the applicant has satisfied the provisions of Section 9, paragraph 9.1 of the Zoning Bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing non -conforming structure to the neighborhood. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Partin D. Robert Nioetta Michael Howard Sandra Starr Kathleen Bradley Colwell Dated this 16th day of August, 1995. BO OF PEALS, W' iam Sullivan o Pallone Joseph Faris Ellen McIntyre Scott Karpinski Z J Q W 2 U) FORM U - LOT RELEASE FORM ¢o INSTRUCTIONS: This form is used to verify that all njces ('--Dapprovals/permits from Boards and Departments having uri tib have been obtained. This does not relieve the applicantor landowner from compliance with any applicable local or st law, regulations or requirements. **************jµ �A(S� **Applicant fills out this section***************** APPLICANT: 1hPhone (w) c n- A) LOCATION: Assessor's Map Number Parcel Subdivision Street �i5tFz Sf Lots) St. Number 35Z ************************Official Use Only************************ RECOMMENDATI NSOF TO AGENTS: Date Approved /04/15- Conservation Administrator ttff y r Date Rejected Comments - _t It t Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit /Fire Department Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: / SYSTEM OWNER & ADDRESS lUalJ44 SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED 15)y GALLONS CESSPOOL: NO - YES SEPTIC TANK: NO YES^ NATURE OF SERVICE: ROUTINE — k EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) Memorandum To: Jim Rand, DPW CC: Sandra Starr, Health Director From: Susan Ford, Health Insp. Date: 01/03/2001 Re: 352 Foster St-reet'?FYI Jim, I am writing to you regarding a property known as 352 Foster Street, located at the corner of Foster Street and Vest Way. This property has come to our attention because of the many additions to the house and the property itself. One addition, which may be of concern, is the wall that has been constructed along Foster Street. At first the Health Department was concerned about this wall because the septic pits are located in the front yard of the property. We believed that if the walls were located outside of the Town right of way it would likely be located over the septic pits. However, upon review of the septic As -Built it was determined that the wall is more likely built within the bounds of the right of way. The information gathered appears to satisfy the Health Department's concerns about the septic. However, as we have recently become aware, your office is very concerned that homeowners maintain the Town's right of way. This leads to my writing this memo to you. As we continue to increase the effectiveness of our cross -departmental communication this information seemed like something you should know. It is may be that you are already aware of this, but I just wanted to pass it on. If that is the case feel free to disregard this notice. Thanks for your time. }F'�i4 il'�'�\o, Y Yt'L� S��, /�•t+1 I�1'��8`4 �l' /�LJli1 � + ♦Y k 7 ♦ r �! L � r4 1/7ri. ,y l.,, L''� 14+G.r, yah i; a 0F NORMA N,�- SYSTEM PUMpIN0 SYSTEM LOCATION (ez�m�le; Icf� (rona-f-i o 1 'QUANTITY I'UMf'ED : , r »I'UUI. 'NO ES SEPTI CTANK. �0 Y,.; NUKE OFSER.YICE, ROUTINE EM ERCENCY '=CUV,4 C�,NUITLON- `F'UL L, 0 COYER. urlr'•i'Y C;H'rtSC ,) : -DA FFLES IN I�l,Acl -Q( Tate �:CXCESSI�Y.,E LEACHFICLD IiuNu ' SO1�'l�S: � FI;OO.DED �— 5041U,�'ICARR.:X.0 R A HER (EXf'LA.IN) + I r'T.�(u ,�yllt�id, rtii)�I�r(�•A%`l I,'(S S' �J{ rr�t r•� �'`I �• ii 6...� .... • � � °.�,,'14' fY I �r r�;J'�t+�krl'�;✓'frt K I � i r � � � ' 1 RY "�, ' r , , i r r, -------------- ' 4 qd U I I�,�r r�' TizaNS'rcl D'r�; TOWN OF NVRTH ANDOVER SYSTEM PYNPING RECORD DA ['I- I SYSTEM OWNER & ADDRESS SYSTEM LOCATION owl A—vrov DATE OF PUMPING: -r7-VY __j ---___QUAN,nTY PUMPED:. 60 CESSPOOL: NO / YES Septic Tank: NO YES / NATURE OF SERVICE: ROUTINE---/ EMERGENCY OBSERVATIONS - GOOD CONDITION -\/FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER— OTHER EXPLAIN System Pumped by COMMENTS: CONTENTS TRANSFERRED TO DATE. 61 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD SEP - 7 2005 TOWN OF NORTH ANDOVER HEALTH DE?ARTMENT (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED C ���GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: G_ EMERGENCY FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN)