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HomeMy WebLinkAboutMiscellaneous - 414 FOSTER STREET 4/30/2018 414 FOSTER STREET �" 210/104 B-0011-0000.0 };">j1 ?:?;C:T i`, ,•,?.;i; 'i,,:�t''ii ti';_•`' }'(t}:___ .r=-i-E- t.-ICi(? (J) }V j', 1:C A Mic Coal Tar I;c:utza7- T. NS �. A F• L I'�' — ------ -- cresylic � r'j._�_- -- -- - - - - L Aerial. , rUt:arV CTu:;ter, }ilawei-';_._ Cupric Meta AI_sen.ite GIle -- --=- ITS Dimethri-n G I. ` -- -- - _--___-_ hand ori::is a ; Dursban* LC, G L; AKT,. (1,C) Tl1j.CCa CC.'. 1 Ur ci t?"n,.a:`- DDVP I, & A f Ogg ince ---, Trained acr--onnel ofi:a e...c'n, EPN Is tricts, C,OJi agencie ;, [--.u11C1: t).es, counties �I; S T U C) Forinulation (2) o'n r0l, PC T, Day 29 9 3 F,n 1 ex OS u,; outdoor foggcr S13P 1382 D-Trans lhom(� usc� Ij ri (1) Trac-lemarks registered in u. S. and Forc--;;;n Patent Office indicated by an asterisk t. (2) Formulation: D - Dust EC - Emulsifiable concent,.aL.0 G Granular LV Low volume OS Oil_ il- solublc P Pellet S Spray. ULV- 11 1 I-r,-i lriw IMIIIMA WP - Wettable povmder 7. (3) Mosquito Stage: L = Larva, A 1�dult s 7 si:• ,� .�•. �Y sr�O�V 'tvl -A 10 � r - '� BAYTEX 4 EMULSIFIABLE INSECTICIDE -- L,_,\ wv sru oxiv.v reT coN•vos o.vvarov:.co.w[:wrnJsnrrNsl4 -'' l� --✓ A �� Mr•:NtiITN OINCI.I •NO tiVF510CY vOOUC{vi I . .\. ' \_;=F 1 `i Ilsr coNrsNTs c�s.oNs^ .+...., �•• I I - i ` , s � i,w, rl I1 RNING �f�t v Ell Y 4' �y,'?-{ -yT' i L'A.•'� `ALX For Use Only by Pest Control Operators, Commercial Nurserymen, ciAP�w.Y ' Public Health Officials, and Livestock Producers. nAYTEX 4 emulsifiable insecticide is an organic phosphate BAYTEX 4 is effective against both adults and larvae—even on ^;ecticide which gives effective control of mosquitoes and flies, strains resistant to DDT and malathion. It can be applied to r. well as insect pests on ornamentals. BAYTEX 4 is formulated most surfaces, including freshly whitewashed surfaces, without wxcifically for application by Mosquito Abatement Districts, loss of biological effectiveness. i. -,blic health officials and other trained personnel responsible I! t;,r area mosquito and fly control programs, and for insect Applications can be made by air or ground spray, fog or mist control in farm buildings. to both populated and rural areas. 1 BAYTEX is a Reg.TM of the Parent Company of Farbenfabriken Bayer GmbH, Leverkusen. ( Com - WU .. ; RECOMMENDED USES Mosquito Larvae,Mosquitoes, House Flies COMPATIBILITY Believed to be compatible with most of the commonly used insecticides and fungicides,except those of an alkaline nature. ACTIVE INGREDIENTS: Fenthion 0, 0-Dimethyl 0- [3-methyl-4-(methylthio) phenyl] phosphorothioate t . . . . 45% INGREDIENTS Aromatic Petroleum Distillate . . . . . . 47% INERT INGREDIENTS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8% 100% Contains 4 lbs Fenthion 0. 0-Dimethyl 0-[3-methyl-4-(methylthio) phenyl] phosphorothioate per gallon. W.S. Patent No. 3,042,703: EPA Reg. No. 3125-73-ZA PACKAGING Non-returnable metal can: 5 gallons net. Shipping weight 48.5 lbs. 2 gal. (U.S.) steel can.Shipping wt. 21.1 lbs. t ; 117 BAY rEX4 i . full amount of water or oil and then agitate. Do not apply oil mixtures to forage crops or rice, if a mixture of BAYTEX 4 into fr fEX 4 in oil is to be held in storage,it is necessary to add an anti-sludge agent to the mixture. Request information from your ro n the type and amount of anti-sludge agent to use. r f�;AGE: Use specified dosage of BAYTEX 4 in the amount of water or oil necessary o to give uniform coverage. In the treatment t r,,rage lands and rice,water only should be used as a carrier.The type of equipment used will determine the concentration required. o larvae control, applications should be made to moist areas, standing water pools, marshes, swamps and SPRAYING: For mosquito I to onds lakes reams or tidal areas. Also spray around and in catch basins and similar areas where mosquitoes breed. t a -ply--�— lications other bodies of water containing fish. Allow at least three weeks between applications. For large area mosquito control,app should be made to wet grassy, bushy or woody areas. For localised adult mosquito control,applications should be made to surface of d around outdoor light fixtures. For fly control, spray around windows and on other buildings, screen doors, window frames an ere food or feed products are present. surfaces frequented by flies on or in buildings,except wh MIST APPLICATIONS: Outdoor applications for adult mosquito control may be made by thermal fogging mist spraying, FOG AND s , or residual spraying. Do not apply to po tiveeMIS nds,lakes,streams or other bodies of water containing fish.Allow at least 3 airplane ks between mist applications. Fog applications may be repeated as necessary. FOR CONTROL OF INSECTS ON ORNAMENTALS,NURSERY PLANTS, FOREST AND SHADE TREES: For use by Pest Control Operators and Commercial Nurserymen Only. To control ants,aphids,mites,leafhoppers,armyworms,juniper scale,lecanium scale,and bagworms on the ornamental plants listed below. Tulip tree Arborvitae Dogwood Oak Viburnum Ash Fuonymus Spruce TREES AND SHRUBS Aspen Juniper Sweet gum Yew Birch Maple Lilies Phlox Snapdragons Begonias Petunias Verbena Chrysanthemums Marigolds FLOWERING PLANTS Y peonies Roses Zinnias Geraniums Do not apply to hawthorn,American linden,sugar maple,or the rose variety,Delightful,because of possible plant injury. HOW TO MIX SPRAY: Add 2 teaspoonfuls BAYTEX 4 to 1 gallon water (2 pints per 100 gallons).The resulting emulsion is suitable for use in any conventional hand-operated or power-operated spray equipment. HOW TO APPLY: Spray when air is still to avoid drift.Do not treat plants and emp- lowerrsurrfac s of leaves..Avon direct sunlight id wetting plants excessivelythe beat of day or when e t only erature is in excess of 900 F. Apply thorough coverage to pp 2.474 a fine mist is required. Repeat as necessary. 1TRICTIONS: 1, Do not apply oil mixtures to forage crops or rice. 2: Do not apply�+l�n weather Bond;bons favor drift of spray. 3. Do not use Inside homes or in buildings where food is processed or stored, applications will not 4, Ua not apply oil sprays directly to!towers*or other ornamental plants which may be damaged by the oil.Fog app cause ,plant injury. 5, Do not apply directly to animals,except livestock grazing in alfalfa and pasture grass at time of application to these crops. G. Do not use on or allow spray treatment to drift onto water supplies.Do not contaminate teed,drinking water,milk or milk handling equipment. FISH AND WILDLIFE CAUTION: This product is toxic to fish and wildlife. Birds feeding on treated areas may be killed. Do not reated.Do not apply where runoff is likely to occur. Do not contaminate water appy when weather conditions favor drift from areas tnot ' by cleaning of equipment,or disposal of wastes.Shrimp and crab may be killed at aPhirclabel Keep out of!lakes station rates recommended reams or ponds Use , apply where these are important resources.Apply this product only as speer dont s _ d log ponds. only i;intermittent-flooded areas,standing water,temporary rain pools,sloughs anbe obtained from This product is highly toxic to bees exposed to direct treatment or residues on crops. Protective information may your Cooperative Agricultural Extension Service. L: Do not re-use container. Destroy it by perforating or crushing. Bury or discard in a safe WASTE AND CONTAINER DISPOSA place. Do not contaminate water by cleaning of equipment or disposal of wastes. WARNING: May be fatal if swallowed, inhaled,or absorbed through the skin. Rapidly absorbed through the skin. Do not get in eyes, on skin,or.on clothing.Do not breathe spray mist.Wash thoroughly with soap and warm water after handling.Wash clothing with soap and hot water before re-use. Avoid contamination of feed or food. Keep out of reach of children. TO PHYSICIAN: eutic doses. Repeat as necessary to the point of tolerance.2-PAM is also antidotal Antidote—Administer atropine sulfate in large therap and may be administered in conjunction with atropine. Use ' f• :Fluid Ounces INSECT AYTEX 4 REMARKS Mosquito 1Yz SPRAY: Apply specified dosage (0.05 as. active or oil to obtain uniform coverage, or ) Per acre in sufficient water Larvae 9 per 1Yz gallons of water or oil` for localized applications. Apply as a light uniform spray. Allow at least 3 weeks between applications. THERMAL FOG: Mix specified dosage per gallon of oil.* This is equivalent Mosquitoes , to 1 to 2 gallons of spray concentrate per 100 gallons of oil. Apply with 1/to 2% standard fogging machines calibrated to deliver 40 gallons gg g 9 per hour at a machine speed of 5 m.p.h. to cover a swath width of up to 350 feet. Repeat as necessary. NON-THERMAL AEROSOL: Mix specified dosage per gallon of water or Mosquitoes oil". This is equivalent to 1 to 2 gallons of BAYTEX 4 per 100 gallons.Apply Adults to 2Y2 with a non-thermal aerosol generator calibrated to deliver 40 gallons per hour at a machine speed of 5 mph to cover a swath width of up to 350 feet. Repeat as necessary. p MIST SPRAY: Apply specified dosage (0.05 to 0.1 Ib. active) per acre. For Mosquitoes , mist-blower machines calibrated to deliver 100 gallons per hour traveling at a a 1Y2to3 speed of 4 m.p.h. to cover a swath width of up to 350 feet, use 2-1/8 to 4-1/4 gallons of spray concentrate per 100 gallons of water. Allow at least 3 weeks between applications. AIRPLANE APPLICATION: Use BAYTEX 4 at dosages of 0.05 to 0.1 Ib. Mosquitoes active ingredient per acre in water or oil. Mix 1% to 2Yz gallons of spray (See Remarks) P , concentrate.in 100 gallons of water or oil' and apply 1 gallon of this mi per acre. Allow at least 3 weeks between applications. xture it RESIDUAL SPRAY: For long residual control of mosquitoes and for residual i Mosquitoes fly control,apply specified dosage in 1 gallon of water for application per 500 House Flies 2 to 4 square feet or to run-off in localized areas on patios or other outdoor structural surfaces, in buildings including dairy and beef barns and poultry houses. Do not apply directly to animals. Residual control lasts 7 to 8 wee 0 for the lowerweeks rate and even longer at 9 the higher rate. Repeat as necessary. Do not apply as a !,pace spray. 'Kerosene-type oils fuel oil, 2-0-74 s,diesel oils,and other baso oils suitable for insecticide use. AREA kp$pUITO APPLICATIONS TO POPULATED AND RURAL AREAS ARE TO BE MADE ONLY BY MOSQUITO ABATEMENT DISTRICTS, PUBLIC HEALTH OFFICIALS, PUBLIC MOSQUITO CONTROL OFFICIALS, AND COMMERCIAL PEST CONTROL OPERATORS. • MOSQUITO CONTROL: BAYTEX 4 emulsifiable insecticide is recommended for use wherever mosquitoes and flies except in water where shrimp, crabs, or crayfish are of value. BAYTEX 4 should not be used on food crops other than rice. 4 provides Ion s area problem, g residual control, and is effective against both non-resistant strains as well as those resistant to cert • BAYTEX i hydrocarbons. The spray can be applied to most surfaces, including freshly whitewashed areas,without toss of biological ain chlorinated MOSQUITO CONTROL ON g cal effectiveness. ALFALFA AND PASTURE GRASS: Apply 1% to 3 fluid ounces (0.05 to 0.1 Ib. active BAYTEX 4 in a water emulsion as directed above. Apply once per cutting on alfalfa, and u without removal of grazing livestock. ) per acre of ss p to 4 times per year on pasture grass MOSQUITO CONTROL IN RICE (CALIFORNIA ONLY): A in a water emulsion as directed above. A pply 1 Y2 to 3 fluid ounces(0.05 to 0.1 Ib. active to a second rice crop in areas where above. cloApply no more than 3 times per crop year, nor within 30 da ) Per acre of BAYTEX 4 PPing is the agricultural practice. Ys of harvest of rice. Do not apply MIXING: BAYTEX 4 forms an emulsion when type oils,fuel-oils.diesel oils,and diluted with water, or a solution when diluted with oil carriers such as kerosene- other base oils suitable for insecticide use.The resulting mixture is suitable for use in hand or power- operated sprayers or thermal loggers as well as with aircraft or air mist-type sprayers — - - te applicators.To mix with water or oil pour required 118 \ - ---_ t( PHONE: 762.3681 N(�ROL .COUNT MOSQUITOL PROJECT BUILDING N0. SND COTT STREET NOR ASSSEjTS ALBERT W. HEUSER 11 Superintendent y 1 f SOIL PROFILE & PERCOLATION TEST DATA N✓�-�'-' '"a Town/City No.&Street7COS t� A Lot No. _ Loc./Subdiv.� Plan Owner > �� G'Gt✓C�r L �L Investigator /,,na //o Observer � �a�� �U 76 Q SOIL PROFILES-DATE 0 1• Elev. Elev. Elev.� G 2• J" 4'Elev. -- l 0 0 0 0 v\ 2 2 2 2 fd 3 Vl 3 3 3 0 v 4 4 4 4 �► �► v 5 5 5 S fj •� 6 6 6 6 v � 8 8 8 8 9 9 9 9 • V 10 10 10 10 A� Benchmark Location J �evat' n Datum Percolation Tests- at b O� z 17 /v" 23 Pit Number 1` - 2 3 4 5 IV Start Saturation. Z- -Z _ Soa'c-Mins. Start Test-Time 2: Drop of 3"-Time 3 Z- j 10 ,7 Drop of 6"7Time .o / Mins.lst 3"Drop .22rn# Mins.2nd 3"Drop 3 2rr, Jy, Notes & Sketches on Back Frank C. Gelinas & Associates, North And. JO ea •� "- '' ��¢ �'��r c.c.s./� 3�U4 0 o� -�Zia Aec' �� e, / dk - e August 12, 1980 Dr. William Conrov Jr 4iL 'ob ter vt. North Andover, Mass. Dear Dr. Conroy: Your latter to the Selectmen about =s uitoes has been referrod to this Board. .For a number of years this tovm participated in the ''ssex. County Control. Progran throu�i the Tree and Fest Control Department, Director Leo La,fond. The federal government controls on various pesticides lowered the effect of the spraying. This, together t;2th the non-participation of 5arroudi.ng towns, made the pro7am almost useless. There have been no funds for spraying approved at the annual Town Neeting for a number of years. Each year tae receive cotmlcint s from ppople in the out-lying districts and z.re alms teU them they chould present their requests through an article at the annual Torsi L'�eA vi11�• Articles are accepted at the Solec,r—n l s offire from rad fall until the warr?nt closes in Decen.ber. Very truly yours, F. George Caron ;.c tin • Ch-:irmmn gc;mj r TOWN OF NORTH ANDOVER, MASSACHUSETTS OFFICE OF BOARD OF SELECTMEN NORTH q 20 ,,�e° TELEPHONE 682-6483 s *s,9'Oa—ED a°"�4y♦ SSACHUS� June 9, 1980. Julius Kay, M.D. Chairman, Board of Health Town Building North Andover, Mass. Re: Mosquito Spraying Dear Dr. Kay: 1 Enclosed is a copy of a request from a Foster Street resident that the Town spray for mosquitoes. Upon our investigation, we found that the Selectmen have no authority in this area and that it rightfully belongs with the Board of Health. We are referring this letter to you so that you may respond to their concerns. Very truly yours, CX-Z '�7 TJM:aml ` Thomas J. McEvoy, Enclosure. Chairman. cc:Dr. & Mrs. Eilliam G. Conroy, Jr. �- f 7 G/9A, JUN 3 19W 414 Foster Street North Andover y. Massachusetts 01845 June 1, 1980 Board of Selectmen Town Hall Main Street North Andover, Massachusetts Gentlemen: I am writing this letter in hopes that the Town of North Andover will take action against a virulent pest in its midst: the mosquito. This is our third summer as residents and taxpayers of North Andover. It is also our third summer of admiring the joys of the season from behind screened windows and doors. Indeed, I do not mean to be facetious. The fact is that I feel this is a dangerous situation. I am unable to step outside my door for five minutes at any hour of the day or night without incurring six to ten mosquito bites. Our dog, who lives outside, tied on a run* is on heart- worm pills, but, frankly, I cannot believe that ,Yie:.L will long survive under these conditions. I believe that the situation as it now exists, is potentially detrimental to the health of North Andover residents. If dogs can contract heartworm from mosquitoes , how will be the mosquito affect human beings? The situation has gone beyond the tolerable. I can understand the Town's reluctance to spray. However, as I have stated, I truly believe the situation has gone beyond the tolerable. The detrimental effects of the mosquito must surely far surpass, at this point, the detrimental effects of the spray. I urge you gentlemen to take action on this matter. I look forward to a response to this letter and thank you for your consideration of this. Sincerely, Dr. and Mrs. William G Conroy, Jr. 0 d a - � ti 30� \\cn 1 ��_t�.,S r_'__ sE SER ---,I_��•.o v G� �v o •n G �qr '„1� c� i,�JbSSbW 3p NL�� . /J�`/YC�i/Yr/`1 R� �ci�S %-__ C' • C�S�`f1_.,C�'ra .Ia North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location Fa ility) P ignat re of Permit A plicant � r Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector CERTIFICATE OF LIABILITY INSURANCEDATEIMM/DD/YYI 01/03/2002 PRODUCER' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lockton Risk Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO BOX 410679 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Kansas City, MO 64141-0679 INSURERS AFFORDING COVERAGE INSURED Archadeck of Metro West INSURER A: Legion Insurance Company INSURER B: 48 Mechanic Street INSURER C: INSURER D: Ne ton MA 02464 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POTC EFFECTIVE POLICY EXPIRATION LIMITS R POLICY NUMBER A GENERAL LIABILITY CP11933420 1/01/2002 01/01/2003 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one lire) $ 300,000 CLAIMS MADE D OCCUR MED EXP IAny one person) 6 10,000 PERSONAL 6 ADV INJURY t 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 1 2,000,000 X POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) li HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE ` (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT E ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS LIABILITY UM11943139 01/01/2002 01/01/2003 EACH OCCURRENCE $ 1,000,000 X1 OCCUR a CLAIMSMADE AGGREGATE $ 1,000,000 6 DEDUCTIBLE 9 X RETENTION $10, 000 A WORKERS COMPENSATION AND WC11933421 03/23/2002 03/23/2003 X TORYTATuT OTR EMPLOYERS'LIABILITY E.L.EACH ACCIDENT 5 500,000 E.L.DISEASE-EA EMPLOYEE 6 500,000 E.L.DISEASE-POLICY LIMIT 6 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Proof of coverage CERTIFICATE HOLDER ADDITIONAL INSURED: INSURER LETTER: CANCELLATION Archadek of Metro West SHOU ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE EREOF, THE ip SURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NO C THE CERTER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL STBATI NY KIND UPON THE INSURER,ITS AGENTS OR RE SENTATIVES. AUTHORIZED REPRESENTA VE ACORD 25 S (7/97) 0 ACORD CORPORATION 1988 Alw o/" j� JJar�u setts BOARD OF BUILDING REGULATIONS s License: CONSTRUCTION SUPERVISOR Number: CS 066851 4j Birthdate: 08/21/1946 Expires: 08/21/2003 Tr. no: 1004 Restricted: 00 JAMES R FINLAY 2 WATERTOWN ST ..o,r, _ LEXINGTON, MA 02421 Administrator �!7! lnn)11)110)lfl/P(l:(�!1 O�� ��(IJJI!!'f7fliQ�.i 2s Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 111975 Expiration: 01/28/2003 Type: DBA METRO WEST RES.CONT.INC/AR JAMES FINLAY 48 MECHANIC ST NEWTON, MA 02464 Administrator Z a The Commonwealth of Massachusetts Department of Industrial Accidents d Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: " --�-A-IxV Location, l 4- If od)1 (Ir74 '�T�y2�'1?-� Citv NOMA- A4)00 Phone # I am a homeowner performing all work rhyself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. 0 t4 Company name YT�M Ar- ,ZJKFLIT ZOIA Address A City: H"" " j r"`v ►5� • Phone#: ( 1 (1 �3 6) J Insurance Co. 11�r6CA� .T ti 74,5� ��N`'� Policy# 73421 Company name: - - Address Citi Phone#: Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one impri on ment.aswell_as_civil.penattiesin.fhe.forrnda-STOP WORK_ORDFR..and-a fine-of.(.$1D0.00)arlayagainstme. I understand a cop of is statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herebyrf and r e p 'ns and penalties of perjury that the information provided above is true and correct.Date 2— Signature .-- Print nam U M��LikA, Phone#�11 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required Licensing Board p Selectman's Office Contact person: Phone#: E:] Health Department Other 414 F®ster St., North Arb®ver D*c 16 SEPTEMBER 02 Office Metro West EXISTING RESIDENCE Job Number. Mol-001 5'-0" 4'-0" —�— Job Name MOIR RESIDENCE ChimneyZZ Drawn by. JOE MCKEOWN - Pressure-Treated 0 5/4" X b" Decking 6l Property Of ARCHADECK design / copmht by Archadeck MW All Rights Reserved Unauthorized Duplication Is A Violation 31„ Of All icable Laws. Pressure-Treated Railing and Rail Cap Pressure-Treated Treads, Risers, Railing 4'-0" 0 -011 �� �� . \�`\.a �_ -- _ ,\ \._:i ���: — '/ /' Moir fRes i derce Dabs 15 NOVEMBER 02 offer METRO-WEST 414 Foster 5t., North Ardover ,lob Name MOIR wsmNGE Dfawn by: JIM FINLAY FR.,.A� lNe FLAN EXISTNG RESIDENCE Double Joists frame around chimney DECK STRUCTURE NOTES: -0° 4'-0" - All framing is 02 or better PT SYP - Design Live Load = 60 psf i z 46 A - Presumptive soil capacity is 3,000 psf - Deck is attached to house w/�" dia. galvanized lag screws, 12" o/c 1 -¢� Footings' are are 3,000 psi concrete in 12" dia. sonotubes, 4' deep - Columns are 46 PT - Beam is (2) 2x10 - Joists are 2x8, 16" o/c 4Mp 350 W 4M - Flooring is 5/4x6 PT SYP, fastened w/ gale. screws Property Of ARCHADECK Footings 21-011 T-011 design / copyright by Archadeck MW I6'-0All Rights Reserved Unauthorized Duplication Is A Violation C� All icabk Laws. Note' With vinyI or elurninum siding, the bend may 1-)E) bolted directly to The house without flashing or removal of elding. 2 x 2 Tr lm 5/4 x 6 Cap �-2 x 4 Rall 2 x 2 Pickets Extortor Wall --. 4 x 4 RaII post (Wood or Masonite) 4: (max. 5' o.c.) — — — — — — 5/4 x 6 Decking Flashing - �—2 x 4 na I 4 2 x 8 Jolsts ® 16" O.C. 2x8 House Band t— 3/8' x 4" Carriage Boll J0131 hanger ova 1 x 4 Trim '—(2)2 x 10 Beam SCALIE 3 4"-1'-0" 1/2 x 6" Carriage Boll Houaa Band: Fasten Willi '12" x S' leg screvs Support Columns — 9x6 2"o.C. Securo column to Fig. with drift pin or Post at —' �� 1 Foolingq y (min. 3aao1 ps concrete) , • • . TYP . DECK AND RAIL DETAIL -- Scale, 3/4•-1'-e' �) 1 to r 414 Foster 5t./ North Arb®ver Date 16 SEPTEMBER 02 Offkx Metro West EXISTIW a RESIDENCE Job Number Moi-001 5'_m�� 4'-0" — Job Name: MOIR RESIDENCE - ------- - =---_-- — Chimney -- Drawn by: JOE MCKEOWN Pressure-Treated 5/4" X 6" Decking ell Property Of ARCHADECK design / copyright by Archadeck MW All Rights Reserved Unauthorized Duplication Is A Violation 31•• Of All ic" Laws Pressure-Treated Railing and Rail Gap Pressure-Treated Treads, Risers, Railing 4'-0" I i/ // f:_1\ \� .\ v - �:� Moir fides i d erce Date 15 NOVEMBER 02 offim MEQ-WEST 414 Fo6ter 5t., North Andover ,kb Nw= MOIR FRESIDENCE Drawn by: JIM FINLAT FRA� INC3 PLAN EXIST NG RESIDENCE Double Joists frame around chimney L -oil DECK STRUCTURE NOTES: oil 4'-011 - ,411 framing is 02 or better PT 6YP - Design Live Load = 60 psf - Presumptive soil capacity is 3,000 psf - Deck is attached to house w/} " dia. galvanized lag screws, 12" o/c 1 -� - Footings are 3,000 psi concrete in 12" dia. a sonotubes, 4' deep - Columns are 4x6 PT - Beam is (2) 2x10 - Joists are 2x8, 16" o/c ,os 41 4W - f=looring is %x6 PT SYP, fastened w/ gals. screws _ x Property CSF ARCHADECK Footings2,- ®°T2' 6'-®° 6'-®° r_0" design / copyright 6y Archadeck MW All Rights Reserved Unauthorized Duplication Is A Violation C All AWka6le Laws. Note: With vinyl or aluminum siding, the band may be bolted directly to the house without flashing or removal of siding. — 2 x 2 Tr lm — _ L 5/4 x 6 Cap — — +-2x 4RalI 2 x 2 Plckets EXtot lot wall --� f `� 4 x 4 Rall post (Wood or Masonite) 4: (max. 5' o.c.) — — — — Fri— — 5/4 x 6 Decklnp Flashing +-2 x 4 fall _ + 2 x 8 Joists ® 16" o.c. 2x8 House band L 3/8' x 4" Cordage holt Jo I s t hanger,-*' I nva i b`1 1 x 4 Trkn •--(2)2 x 10 Beam SCI�L�t 3 4"-1'-tl" 1/2 x 6" Carrlage Boll- Houae Be" Fasten wlth '12" x S" leg screws Support Columns - y xd 121,o.c. Securo column to Ftg. with drllt pin or -----� pos I anchor Fog lIfig: ••• q (min. 3aoo j psi • ', concrele) - o � r TYP . DECK AND RAIL DETAIL -- Scale, 3/4'-1'-8' �) i FORM 4 - SYSTEM PUNTNG RECORD Commonwealth of MassachuserRECEIVED ;lv�--fly-Q�v� Massachusetts -- 9 2010 Sstent pum rn Record TOWN OF NORTH ANDOVER �yste nvrner ystem ovation w 6vt Bif— u^,-4 er las Apo c. 1/1`/ s� i 02,33 Type: Emergency ❑ Routine tz Cess Pc .,)I: No ElYes ❑ Septic Tank: No ED Yes 5- �GO Quantiry Pumped: /,Geigy _ gallons Date c :' Pumpine: -T-- ,BO RACZEK'S Permit Svstei:: Pumped by (Company): = - Contc .ts transferred to: Cont. .it.s disposed at: L ED pate �'2�'�a Pumper Signat-ure Con( ition of system other comments: OfP APPROVID FORM • I:/07I9S tJo/11/",Utju 15:J r JUb 71,ibbll 5I tWAt-.I/ANUUVth; PAGE tJl JVbr . ANn6ver 0.6 t+, 1.34o,n -cf. sr&mrlS SEPTTC TMNe i� A nim,,ou , 47 RAIIRQAD g BRADFMD, MA 01835 978-372-7471 Mom or I ILY REPORT FCR MW OF aml MESS e 6rcbK. 6oc� �- 3�o G(�/rJ der 51`- 1�ckj � I6 a rq J '�' S3 S'heruloop y r �r y F�s,N kSd� 4 I 04 /Vao C�.e-9f Po( (�M & �/ l�dv icy Rjac 1, 6-dd/l �1 �l 197 45r,� v /4..7c �r Sum�J�l f- DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, June 25, 2012 8:51 AM To: DelleChiaie, Pamela; Grant, Michele Subject: FW: Sery Safe Attachments: HEALTH.docx fyi From: Shattuck, Mary [maiIto:mshattuckCabnecc.mass.eduj Sent: Friday, June 22, 2012 12:20 PM To: Sawyer, Susan Subject: Sery Safe Hello Susan, My name is Mary Shattuck. I have become the new Program Manager for the Sery Safe classes that we offer in our non- credit area of Northern Essex Community College. As your office is a resource to the community for information regarding various health/safety-training programs that are offered in the area, I just wanted to send you our class information in case people or businesses contact you to ask where they could attend these types of classes. If you have any questions please feel free to call. Thank you. Mary Mary Shattuck Program Manager Workforce Development and Community Education Northern Essex Community College 360 Merrimack St, Bldg 9,4th Floor Lawrence, MA 01843 mshattuck@necc.mass.edu (978)659-1237 Mary Shattuck Program Manager Workforce Development and Community Education Northern Essex Community College 360 Merrimack St, Bldg 9,4th Floor Lawrence, MA 01843 mshattuck@necc.mass.edu (978)659-1237 Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/ore/l)reidx.htm. 1 Northern Essex Community College HEALTH AND SAFETY ServSafe Certification Safe food handling is critical to keeping customers and co-workers safe.Offered in association with the National Restaurant Association Educational Foundation,ServSafe is a comprehensive eight-hour course that provides an overview of basic sanitation policies and procedures and prepares you to pass the ServSafe Certification exam given during the last class.Students who pass the exam will be awarded the ServSafe Certification by the National Restaurant Association Educational Foundation.Instructor: Heidi Riccio,Certified ServSafe Instructor 940 SVSF1004-RWE:Tu,5-9pm,2 wks, 10/9-10/16,$152+$71 materials fee,Riverwalk 941 SVSF1004-RWF:Tu,5-9pm,2 wks, 11/27-12/4,$152+$71 materials fee,Riverwalk BARTENDING Bartending Learn the basic skills needed to be a bartender, including essential techniques, popular shaken and stirred drinks, beer, wine, garnishes, and glassware use. On-the-job problem solving and customer service basics will be discussed.The ServSafe Alcohol Certification exam will be given in class. Must be 18 years or over to take class. 901 BART 1003-RWE:Tu,6-8:30pm,6 wks,9/25-10/30,$285+$24 materials fee for ServSafe Test and book. Riverwalk— weeks 1-2,Methuen- weeks 3-6 902 BART1003-RWF:Tu,6-8:30pm,6 wks, 11/6-12/11,$285+$24 materials fee for ServSafe Test and book. Riverwalk— weeks 1-2,Methuen-weeks 3-6 Please note: Bartending program includes both of the following modules: 1.ServSafe Alcohol Awareness Certification-Weeks 1 &2 will be a classroom session at the Riverwalk.The certification test will be on week 2. 2.Fundamentals of Mixology-Weeks 3-6 will be hands-on classes at the Timony School in Methuen. Any questions contact Mary Shattuck at 978-659-1237 or Vanessa Pepin at 978-659-1207. FOR MORE INFORMATION OR TO REGISTER PLEASE CONTACT: MARY SHATTUCK (978)659-1237 mshattuck@nece.mass.edu Northern Essex Community College HEALTH AND SAFETY ServSafe Certification Safe food handling is critical to keeping customers and co-workers safe.Offered in association with the National Restaurant Association Educational Foundation,ServSafe is a comprehensive eight-hour course that provides an overview of basic sanitation policies and procedures and prepares you to pass the ServSafe Certification exam given during the last class. Students who pass the exam will be awarded the ServSafe Certification by the National Restaurant Association Educational Foundation.Instructor: Heidi Riccio,Certified ServSafe Instructor 940 SVSF1004-RWE:Tu,5-9pm,2 wks, 10/9-10/16,$152+$71 materials fee,Riverwalk 941 SVSF1004-RWF:Tu,5-9pm,2 wks, 11/27-12/4,$152+$71 materials fee,Riverwalk BARTENDING Bartending Learn the basic skills needed to be a bartender, including essential techniques, popular shaken and stirred drinks, beer, wine, garnishes, and glassware use. On-the-job problem solving and customer service basics will be discussed.The ServSafe Alcohol Certification exam will be given in class. Must be 18 years or over to take class. 901 BART1003-RWE:Tu,6-8:30pm,6 wks,9/25-10/30,$285+$24 materials fee for ServSafe Test and book. Riverwalk— weeks 1-2,Methuen- weeks 3-6 902 BART1003-RWF:Tu,6-8:30pm,6 wks, 11/6-12/11,$285+$24 materials fee for ServSafe Test and book. Riverwalk- weeks 1-2,Methuen-weeks 3-6 Please note: Bartending program includes both of the following modules: 1.ServSafe Alcohol Awareness Certification-Weeks 1 &2 will be a classroom session at the Riverwalk.The certification test will be on week 2. 2.Fundamentals of Mixology-Weeks 3-6 will be hands-on classes at the Timony School in Methuen. Any questions contact Mary Shattuck at 978-659-1237 or Vanessa Pepin at 978-659-1207. FOR MORE INFORMATION OR TO REGISTER PLEASE CONTACT: MARY SHATTUCK (978)659-1237 mshattuck@necc.mass.edu DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, June 25, 2012 8:51 AM To: DelleChiaie, Pamela; Grant, Michele Subject: FW: Sery Safe Attachments: HEALTH.docx fyi From: Shattuck, Mary jmaiIto:mshattuck(s:bnecc.mass.edu] Sent: Friday, June 22, 2012 12:20 PM To: Sawyer, Susan Subject: Sery Safe Hello Susan, My name is Mary Shattuck. I have become the new Program Manager for the Sery Safe classes that we offer in our non- credit area of Northern Essex Community College. As your office is a resource to the community for information regarding various health/safety-training programs that are offered in the area, I just wanted to send you our class information in case people or businesses contact you to ask where they could attend these types of classes. If you have any questions please feel free to call. Thank you. Mary Mary Shattuck Program Manager Workforce Development and Community Education Northern Essex Community College 360 Merrimack St, Bldg 9,4th Floor Lawrence, MA 01843 mshattuck@necc.mass.edu (978)659-1237 Mary Shattuck Program Manager Workforce Development and Community Education Northern Essex Community College 360 Merrimack St, Bldg 9,4th Floor Lawrence, MA 01843 mshattuck@necc.mass.edu (978)659-1237 Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/are/oreidx.htm. 1 The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Bureau of Environmental Health Food Protection Program V 305 South Street, Jamaica Plain, MA 02130-3597 (617) 983-6712 (617) 983-6770 - Fax Massachusetts Food Protection Manager Certification Exam and Trainer Directory This directory was compiled to assist individuals and retail food businesses to find optional training programs and/or examinations for compliance with the food protection management certification requirement in 105 CMR 590.003(A)(2). Trainers listed in this directory: 1) meet the recommended instructor qualification identified in the Massachusetts Guideline for Food Protection Manager Training Programs, 2) use one or more of the Food Protection Manager Certification exams recognized in Massachusetts.The exams are provided by one of the three accredited test development organizations listed below, and 3) include in their training, the provisions of 105 CMR 590.000 that are unique to Massachusetts. When choosing a trainer,we strongly recommend that you contact as many trainers as possible and obtain the following information: ■ Examination offered (see list below) ■ Educational background of the trainer ■ Length of training/class schedules ■ Food safety experience of the trainer ■ Cost of exam and/or training ■ References from previous students Nationally Accredited Exam Organizations Recognized in Massachusetts Thomson Prometric(Formerly Experior Assessments) ServSafe 1260 Energy Lane The Educational Foundation of the National Restaurant St.Paul,MN 55108 Association 800-786-3926 250 South Wacker Drive,Suite 1400 Chicago,IL 60606-5834 National Registry of Food Safety Professionals 800-765-2122 1200 E.Hillcrest St.,Suite 303 Orlando,FL 32803 800-446-0257 Note:All exams carry a five-year expiration date. The Massachusetts Department of Public Health does not in any way endorse or recommend any of the individuals or organizations presented on this list nor does the Department preclude anyone not on the list from conducting food safety training. The Department does not evaluate trainers and does not guarantee the success of their programs.Please note that this is not a comprehensive list and,although it is periodically updated,there is no guarantee that all information is current. You may also contact industry and regulatory organizations as well as telephone directories for further listings.Please note that all exams recognized by the Department carry a five-year ,expiration date.Directory last updated on 05/10/11 SEP-20-2017' t1: 1.'+ F`1 CJI iEER I f 'FL DOS 61^ 884 1'_+1�: MORTGAGE INSPECTION PLAN SULLIVAN SURVEY 45 LEWIS ST, READING MA, 01867 TEL, (617) 944-8750 FAX, (617) 942•-2437 ,COTe �uH Of Offs • � ¢� BARRY 'S r� 9ULLIVhN No.33428 3TEAt� "e- i loge t THIS TAPE SURVEY, CERTIFICATION & MORTGAGE INSPECTION PIAN ARE MADE FOR THE USE FOR __— FOR MORTGAGE PURPOSES ONLY BASED ON MY KNOWLEDGE:, INFORMATION & BEL.IEF', I CERTIFY THAT rHF.. BUILDING [S] CONFORM [S] TO THE 'ZONING BY--LAWS (DIMENSIONAL_ REQUIREMENTS] 01F THE 1 OWN 0I-diar&A&,Qa41"_MASSACHUSE:'C1 S THE STRUCTURE IS] IS/ARE OtY IN THE SPECIAL FLOOD HAZARD AREA AS SHOWN ON THE FEDERAL EMERGENCY MANAGEMENT AOE.NCY MAP IAF TIME TOWN/CITY OF,,Yd",Y- P-iOY..A-hIASSACHUSE'FTS COMMUNITY PANE't.. ^FLOOD INSURANCE RATE MAP .C-FFF EC--T�IVE DATE tfiJV/ryl/ CITY _T DATE I REGISTRY RFF-rRFNr'Fr- TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING T11is Sedws for BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/In for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 414 (605wif- 61"XiA 104- e> a t*,-% , Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required tre R red Provided Required Provided v 1.7 Water Supply M.GL.C.40. 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record ame(Print) Address for Service CG Ll C�3o • C '1s gnature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES go 3.1 Licensed Construction Supervisor: Not Applicable ❑ -� 1 "65 F Nom, / Licensed Construction Supervisor: a&lD Pr/ O G 2 k 4(8 rvoiftc sc,. .L.,Ttj License Number Address (� r �Z G 3 /S7 r Expiration'Dater. Signature L Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v AgC-94 X.k- vn n-YE�o wb:;r 1— g _ Company Name M /-(,y J0 ` A � 1 Registration Number Address ( 17=70 r 7 l 1-2 r/,03 - 611 G 7G L Expiration Date ^� Signature "Telephone G) SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes...... No.......❑ SECTION 5 Description of PrIposed Work check au appficable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 1 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: TR=H bqWr, -carwkrN�s r-1qLQ �"UL'A- -r(4�yqo bKck—, (5Aftl?- 512_�q) A�- Lo CA 1, T1 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Cothplbted by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 . 00 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 9 10 P Muthorized Agent of subject property ereby authoriz WWYL to act on e alf,in a natters relative to work authorized by t is b irding permit appl�t;oh. Aignature of drmer Date V SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION IJAMe, I:c 14 LA� ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge ,and.belief IL Am� Fly int N e A A4 ature f Own /Agent D to OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DT�NSIONS OF GIRDERS FIEIGIIT OF FOUNDATION THICKNESS SITE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A N� \ L76I ---� P�;� ZONE 13 / PR O; 14 / \. -----� --__ i Tom• P �/ice- ti it 11ij NOTES THE LOCATION OF THE EROSION ANDSEDIMENT CONTROL 1. CONSTRUCTION ——. DEVICES WDURING BE FIELD DETERMINED ENVIRONMENTAL INSPECTOR % BY A MARITIMES& NORTHEAST EMA og�\ \ rI \ j ` •� \ I f/ (TIMES& NORTHEAST SOIL +\,( /` IN ACCORDANCE WITH THE MAROL GUIDELINES(SESCG). EROSION AND SEDIMENT CONTR SEDIMENT CONTROLS THE LOCATION OF EROSION AND INTENDED TO BE D DEPICTED ON THESE WETLANA9-� PLANS ARE(NTE JMBER USED AS A GUIDELINE ONLY. OLS LOCATED ACROSS THE (LAND ND-1 2.EROSION AND SEDIMEM CESE JMBER R.O.W.ARE TEMPORARY.THESE WILL 8E TEMPORARILY REMOVED REPLACED DAILY WETLAND --- DURING --AN3 G ACTNE CONSTRUCRON AND •� I I I / " IN ACCORDANCE WITH THE SESCG. 75 LINES 3.PROPERTY LINES SHOWN ARE BASED ON EXISTING MAPPING, E IDENCE. I `\ T CURRENT DEEDS AND POSSESSION EV MAPPING PERFORMED BY / / ERVAL FEET / 4.PLAN COMPILATION AND TOPOGRAPHIC MAPP \,I % / I 1 --"... .......... M.J.HARDEN ASSOCIATES,INC. J CCESS ROAD P 11 5.WETLAND DELINEATION CONDUCTED 999-2002 NE ENGINEERING \ \\/ �\ ' ACCESS ROAD �-J & SERVICES,INC.AND EARTHTECH 6.THE APPROXIMATE WETLAND BOUNDARY(AWB)IS BASED ON FIELD \•\ I / (\ ACCESS ROAD DETERMINATION ANDOR M,,Gls DEPARTMENT OF ENVIRONMENTAL PLAN PROGRAM INFORMATION. IFA BOX ® PROTECTION WETLAND CONSERVANCY 0 - 40 20 0 4 7.STATIONING SHOWN IS HORIZONTAL STATIONING. r, SEDIMENT CONTROL -J�J-L^L,1 B.PLANS ARE FOR PERMITTING USE ONLY, SCALE IN FEET _ 3NMENT SHEET62602 REVISE EROSION CONTROL LOCATION DRAFTING DESIGNER © ENGINEERIN( Q DRAWN BY: Q DRAFTING SUPERVISOR BLS Q DESIGN ENGINEER JEO Q DESIGN MANAGER JTP Q DESCRIPTION INITIAL: cFERENCE DWG. REV DS CK � �i ?an d� L.ra;d -Fvo,,,, '�;,P-4'4,e_ 11 9 00 5368 3. SEE PLAT N 90A 1. 1 � 195 96 �� 69 ��° 194 i 70 192 54 a 193 ,. oQ* 71 c�j $ a z rr. 72 �0 73 ,2,A� es 46�°1 '` • a a 4 9 203 ab sc 93 74 4 10 sc 11 PG t' AC 58 N. 20y, 1• 3�� SPG 91 75 �o2A 8 s• o,1P�'' 90 76 A 1 2055 .• s � 204 94 PG s s 50 89 og AG. 181 pG• G'O 25 ,°1 PG. ; , q ta° 3p1 213 8878 15 �10 211 c 32 9C 6.02 AC n Q 212 86 87 � ' �. Frontco 214 o• 221 85 a 79 52 154 �° p x or 1 84 1.01 A 7.,> 1•53AC. 5N 219 y 81 N 80 26 ^� 18 17 216 215 82 5 o 3 0 4 83 � n OV 1w ST. ns m m 47 z a 41 ac 222 173 os AG 'Open Space'"Area 1" 3 207 �'� 90, 27 15.47 AC. N. .O. 40 175 k �51 2.oti 206 209 48 ac. ro PG. _ 208 G 3.00 roc 52.272 S.F 132 39 53,578 S.F. - A 8.96 AC. � . 131 14 �S 42 16 55 "' 28 220 AC. 1/ 37 11 38 0.76 ac. POWER LI R.( 36 � � 1�4� 17.2 ac. �' 109 .f 189 S . — s� 65 164 r -• ,a as 17 's 158 163 ,5 , of. 62 G.f 22 166 161 •a s 167 47,158 a 21 18.0 8C. a � 1� M,860 S.F. Ag 6� 169 45.983 43.978 S.F. �gWS•F ' cc j?.eP(c�� e io xih 1< o 1.0 w r� FORM U LOT RELEASE FORM m n r U r _ INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT �, mom PHONE L30 - Is b LOCATION: Assessor's Map Number k O 4'` PARCEL-1 l SUBDIVISION LOT(S) STREET ���� 5Ter►1 cIr ST. NUMBER I L ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: ,/CONSERVATION ADMIN17AATOR DATE APPROVED DATE REJECTED 1 02 O a, e,NO� COMMENTS e- art KIA - worK r'ownJ �is-�ufban�e �n l0 1Je.�and GloSe 40 50' nb bald TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED 5 DATE REJECTED cl,/ SE TIC INSPECTOR-HEALTH DATEAPPROVED DATE REJECTED COMMENTS�e C�� z7P� +` c Q�-fii!' t�`�e �e. [ .'�; �1�� •�'" t��� �� fui� n'�,�.( e'�<�...�c.�'--4j.J �ru�us�v� PUBLIC WORKS-SEWERMATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm TO: NORTH ANDOVER, MASS 19 77 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at L a ,o�cs'..ST,EA Ste" North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans ecifications dated -IV NOISE 19 �a1\a�'i3-S1 0��dv a p� UN n s ltl Sada � J Reg. W ger/ anitarian �y�bsSf/W 10 N��a Of MORT.,� 4858 O Town of North Andover HEALTH DEPARTMENT CHECK#: /l/ DATE: LOCATION: /��f ! H/O NAME: CONTRACTOR NAME•�� .� 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) $ L❑ Title nspector $ itle 5 Report $ � ❑ Other:(Indicate) $ ea th Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth ofIAassachusetts "Film 'Title 5 �##ac aJ I spe-c#w F� m U 201 Subsurface SewageDisposal System Form-Not for Voluntary A sesst`ents rl l S (('z S f' TOWN OF NORTH ANDOVER • Prope Add ss , Owner Owne s ame _ information is Qar. required for IV—,4A)N N every page. City/Town State Zip Code Date of Inspection Inspection resu.lts„must.be submitted on this;form. Inspection forms may of be altered an way.Please see completeness checklist at the end of the form. __7 /yam, Important: When filling out A. General Information G . forms the computer, use 1. Inspector:. only the tab key to move yourQ cursor-do not �%N use the return Name of Inspector key. f 2e/��J S'C nkc D'a "' 11-c— Company LNme Ze�/ Comp Address u..DY_it- 03 S Y/ City/Town State Zip Code &G3-3ZC- (,oo5 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 gaining 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 /Inssignature Datem 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•09108 Title 5 Offidel Mtiapectlpi Ftxrtc Subsurface Sewage Disposal System•Pape 1 of 17 ' Commonwealth of Massachusetts Title�S:.Q## c- ia-1 -Inspection .Form Subsurtace`Sewage Disposal System Form -Not for Voluntary Assessments — Property A dress Afa hot'-.0 a 41 PV Owner Owner's Name information is required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check.A,i3,C,D orf/atways-complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or,in 310 CT AA 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Sys S l ✓ lgDoti+ co �l l�►e 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 structuraliy unsound, exhibits substantial Infiltration or exfiitration 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•OWN Title 5 olfidal Inspection Forth:Subsurface Sewage Disposal System•Pape 2 of 17 Commonwealth of Massachusetts -- Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments q J ul t. y. r Property Adores f Owner - M� N1Gj� YG1Y�1►' l Own --- information is er s Name required for / M�O�� /N 4 0/` y - every page. City/Town State ZIP Code B. Certification (cont.) State Date of Inspection 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 aOprovai 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 Title 5 official Inspeglon Forth:Substyfaoe sewage Disposal system,page 3 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Four, Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments Property A,d�dre s 1140 Owner Owner's Name /_ information is �� s lY Za—lu required for 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, 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 suppty 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 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 ❑ 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 overloadec or clogged SAS or cesspool ❑ ,Liquid depth in cesspool is less than 6° below invert or available volume is less --!ha 'a-ay-flaw t Sins 09108 ---- Title 5 Official Inspection Forth:subsurface$eaa8e Olsposal System• age 4 o I Commonwealth of Massachusetts Title 5.'Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments Property Add rySs /yMe)wtQ lig LAI fw - Owner Owner's Name information is 4 — required for jv^A.Ajvv r every page. City/Town n --�'=`� `'—Z�^/� 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: ❑ 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.absentand 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.] ❑ rn The system is a cesspool serving a facility with a design flow of 2000gpd- f�' 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 considereda large system the system must serve a-facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section 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. c5ms•09/08 Title 5 Official Inspection Form:Subsurface Sewage Dusposel Systmn•Page 5 of 17 Commonwealth of Massachusetts Title 5. OffiCAal Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ly 6Sjf(' Property Address Owner Owriers Name information is ^<"►N required for A-1 <�f I�oyC� every page. Cityrrown 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 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? ❑ -60 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-distanoe-is-unacceptable)[310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3Co 6P D t5ins•osroe Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 6 of 17 Commonwealth.of Massachusetts Title &'0f f1c_a1 Iris-pec# ori ,dorm Subsurtace Sewage Disposal System Form-Not for Voluntary Assessments I q Fosf cr sy Property/A.�dd�less /"'Or!&Ayd YO Mw Owner Owner's Name information is Al-�4�Dy�c< �,/� ®/ 6_25-70 required for �' every page. City/Town State Zip Code Date of Inspection D. System Information Description: jv/f- o Number of current residents: ems_ Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes No Laundry system inspected? ❑ Yes Z No Seasonal use? ❑� Yes ;6 No Water meter readings, if available(last 2 years usage(gpd)): — -- Detail: r 1/ �/5A it ;v 6-*d COAAK,), 9t /4,t Ar*e Sump pump? Yes ❑ No Last date of occupancy: 4 D(i 2.6 to Date Commercial/Industrial Flow Conditions: Type of Establishment: ---- Design flow(based on 310.CMR 15.203): -Galton per day(gpd) Basis of design flow(seats/persons/sq.ft, etc.): - Grease trap present? .❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title bDaidd Inspection Form:Subsurface SewapsDisposal System•Pape 7 of 17 Commonwealth of,Massachusetts T ,tle5# #Giar \.:v r ,...{,.,X u�.ev 'e��t¢Eyi.. a. '. .r :., � ,.: -'� .t,, -:.., .�... , Subsurface Sewage Dlsposal System Form-Not for Voluntary Assessments fiosfU SL Property Add ss J:I0 0N4� /A!w!�✓ Owner Owner's Nameinformadon is - _to required for ,V onys .2s, every page. City/Town' state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: oats �= Other(describe below): w � General Information Pumping Records: Source of information: N� Was system pumped as.part of the inspection? Yes ❑ No If yes, volume pumped: gallon How was quantity pumped determined? 6-Q5 r, oN -11-v,-A- f pl�rt (3,q Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (Yes or n...o, . e.sattach.previous inspection records, if any) ❑ InnovativelAltemative 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) t t5ins-09/08 .7W e 6 Offidel inspeWon Famt Subsunawe Sewage Disposal System-Pop 8 of 17 Commonwealth of Massachusetts Title 5.O ficial-Inspection.--Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Add (°ss i, /4l0�0,. 'iM it Al Owner Owner's Name information is ,�QQ required for ./I/ (I,J 0ot/� �,� d�$C S-' _ '/O every page. City/Town State Zip Code Date of Inspection De System Infolrmatiow(cont.) Approximate age of all components, date installed Jif known)and source of information: • �9�6 Were sewage odors detected whin giving at the site? ❑ Yes No Building Sewer(locate on site plan): \ Deptl below grade: 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.): Septic Tank (locate on site plan): G Depth below grade: feet Material of construction: concrete F Elmetal El fiberglass Elpolyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?{attach a copy of certificate) ❑ Yes ❑ No Dimensions: i f l' I s- Sludge depth: t5ins•09/08 71119 6 Mal Irapectlon Form:SubsWaoea Di S •Page 9 17 Sewap Disposal Systern e9 d Commonwealth of Massachusetts Title' 5_,0ffjciaJ inspction form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments PropertyA dre Owner ` NIA/ information is Owner's Name required for i✓ QVQr L'Z M � 4 every page. City/Town State -Zi Code L_ P Date of Inspection D. System Information (cont.) • Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle �3 3 Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle // '/ How were dimensions determined? A DVr!J Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t /c. Zl' �.,. h 6 c.., Grease Trap (locate on site plan): Depth below grade: .feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑pol eth lene Y ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t8ins•09/08 Date Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments q1y Fol+ s� Property Add X�"') Owner Owner's Name information is � tr p�C�- G—ZS'l0 required for �/'`� V every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and.outlet tee or.baffle.condibon, structural integrity, liquid levels as related 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 construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene E] other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date ---- Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No tsins•09/08 Title 5 Oficial Inspectltm Form:Subsurface Sewage Disposal System•Pepe 11 d 17 LN Commonwealth of Massachusetts Title 5 Official Inspection f=orm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Ad�res � Owner //LL1; information is Owner's Name required for /1/ 2�'lU �N�171�Q1� ,1/1 f every page. City!Town 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 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.): s4t_s I'C f i IL"rC �l 9v�s� (,v�c1 /Cvt( - 1 c'j Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: err._ Commonwealth of Massachusetts TitleS.I. Off1ciaa l spec#ia F rn Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Add 'Nc 90"P&I G A 0,i N Owner Owner's Name information is �.�,p 0 vu- 2s required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: Ikleaching fields number, dimensions: s 20 ❑ 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.): �� Cesspools (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 groundwater inflow El--Yes 0 No t5ins•09M Tile 6 pBdal kWecdw Form:SubsWace Sewage Dlaposel System-Page 13 or 17 Commonwealth of Massachusetts Title .5 .O#titial Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Add /Lf 0�iowwo9 CI W1 Owner. Owner's Name information is1,_ �NQ0vU �Jn O/ /5' required for V" CI' (�' `.— every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs..of hydraulic failure,level.-of.ponding,condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r «ns-09M rue 6 OlBdal hspecbon 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 Property Addre s MoMgd Y61wt�N _ Owner Owner's Name information is N—dA,povCt' �,4 0�IVI- / 2-Y-/0 required for �7 V every page. CityrTown 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 to 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 '>Rl: drawing attached separately t5ms•09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 15 of 17 Common'wealth of Massachusetts ', Title al Inspec#ionTorm Subsurface 3ewage.Qisposal System Forth Not for Voluntary Assessments lug X11 y Fov cc- Sk PropertyAddre �o o� gf�tr'A/ Owner Owner's Name information is required for /V '-f DOver onyY - G-LS-/0 every page. Cityrrown State Zip Code Date ofInspection 11'System Information (cont.) Site Exam: 4 Check Slope ❑ Surface water Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please in all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: 1976 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: op Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Oaidai kWection Form:Subwrrace SO""DiepoeW System-Pepe 16 d 17 Commonwealth of Massachusetts Title 5 Official -inspection -Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lug L//CI / oS icc Sf Property Adlam4d ess(7 \AGh r,v Owner information is Owner's Name,../� required for 1ND dVe r �� mla4rf' (p_Zs•ld every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist 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 'ET'—S--ketch of Sewage Disposal System either drawn on page 15 or attached in separate file t51ns•097o8 Title 5 Official Inspection Forth;Subsurface SeweQe Disposal System•Pape 17 of 17 M .47 COTE' ,c/D 4 q2 Cor rNE lo/,�oA 7,44e7 PX �56WA6E b cSf�OGeIN C IVOT BE U/l/T/Z- i ti 5L E!/q Ti /, 7, 5 (00 LIJELL a OF MAssgc IoSUVI/ -,\ „/ =7 7 2/77, "Ysf 0,4 at-C', z 4. LI North.",dover Board of Assessors Public Access ' ` ' Page 1 of 1 tORT" I��rfh Andover Board of Assessors Of sr�ao a'�.y0 F 9 • oa+a r 4 s"CN" roperty Record Card Parcel 113 :210/104.13-0011-0000.0 FY:2012 Community : North Andover Click on Sketch to Enlarge Click on Photo to Enlar e 414 FOSTER STREET E Location: 414 FOSTER STREET I Owner Name: 39 COTUIT STREET,LLC YAMIN,MOHAMMAD Owner Address: 32 PALOMINO DRIVE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:5-5 Land Area: 1.30 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1992 sgft Total Value: 375,300 375,300 Building Value: 175,700 175,700 Land Value: 199,600 199,600 Market Land Value: 199,600 Chapter Land Value: LATEST SALE Sale Price: 242,000 Sale Date: 06/04/2010 Arms Length Sale Code: S Grantor: US BANK Cert Doc: Book: 12058 Page: 0032 http://csc-ma.us/PROPAPP/display.do?linkld=1894461&town=NandoverPubAcc 7/26/2012 Residential Property Record Card PARCEL ID:210/104.B-0011-0000.0 MAP:104.B BLOCK:0011 LOT:0000.0 PARCEL ADDRESS:414 FOSTER STREET FY:2012 PARCEL INFORMATION Use-Code: 101 Sale Price: 242,000 Book: 12058 Road Type: T Inspect Date: 05/28/2008 Tax Class: T Sale Date: 06/04/10 Page: 0032 Rd Condition: P Meas Date: 05/28/2008 Owner: Tot Fin Area: 1992 Sale Type: P Cert/Doc: Traffic: M Entrance: X 39 COTUIT STREET, LLC Tot Land Area: 1.30 Sale Valid: S Water: Collect Id: RRC Addrress:ess: YMOHAMMAD Grantor: US BANK Sewer: Inspect Reas: C 32 PALOMINO DRIVE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 8 Main Fn Area: 1128 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R1 Story Height: 2.00 Bedrooms: 4 Up Fn Area: 864 Bsmt Area: 1128 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1.000 197,326 Ext Wall: AV Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0 0.300 2,280 Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 1992 VALUATION INFORMATION Foundation: CN Bath Qual: T RCNLD: 175741 Current Total: 375,300 Bldg: 175,700 Land: 199,600 MktLnd: 199,600 Kitch Qual: T Eff Yr Built: 1980 Mkt Adj: Prior Total: 375,300 Bldg: 175,700 Land: 199,600 MktLnd: 199,600 Heat Type: HW Ext Kitch: Year Built: 1978 Sound Value: Fuel Type: O Grade: AG Cost Bldg: 175,700 Fireplace: 1 Bsmt Gar Cap: 2 Condition: A Aft Str Val 1: Central AC: N Bsmt Gar SF: Pct Complete: Aft Str Va12: Aft Gar SF: %Good P/F/E/R: /100/100/82 Porch Type Porch Area Porch Grade Factor M 357 SKETCH PHOTO 17 M 357 Sq.Ftr 21 21 FU/FM/B FM/B 864 Sq.Ft 264 Sq. t 24 22 414 FOSTER STREET '- Parcel ID:210/104.13-0011-0000.0 as of 7/26/12 Page 1 of 1 1 , 1 DelleChiaie, Pamela From: Hughes, Jennifer Sent: Thursday, July 26, 2012 11:32 AM To: 'Gayle Dawson' Cc: Gaffney, Heidi; Wedge, Donna; DelleChiaie, Pamela Subject: RE: I.R. -414 Foster Street, North Andover-Additional Information -Original Septic Plan A delineated wetland line is only valid for 3 years.Any proposal to do work on the property would require a new delineation. Jennifer A. Hughes Conservation Administrator Town of North Andover 1600 Osgood Street,Suite 2035 North Andover,MA 01845 Phone 978.688.9530 Fax 978.688.9556 Email 0hughes@townofnorthandover.com Web www.TownofNorthAndover.com • From: Gayle Dawson [mailto:gdawsonbrad(abgmail.com] Sent: Thursday, July 26, 2012 11:27 AM To: DelleChiaie, Pamela Cc: Gaffney, Heidi; Hughes, Jennifer; Wedge, Donna Subject: Re: I.R. - 414 Foster Street, North Andover -Additional Information - Original Septic Plan Thank you. On Jul 26, 2012 11:11 AM, "DelleChiaie, Pamela" <pdellechgtownofnorthandover.com>wrote: To: Gayle Dawson 978-361-5783 Dear Ms.Dawson, Here is some additional information regarding your information request for 414 Foster Street,North Andover. Attached is a scanned copy of the Original Septic Plan. This will show you where the wetlands lines are,but the plan is so old,you may want to contact Conservation to see if the wetland line has changed at all. Their number is: 978-688-9530. You may speak with Jennifer or Heidi. Thank you. 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, July 26, 2012 11:11 AM To: 'gdawsonbrad@gmail.com' Cc: Hughes, Jennifer; Gaffney, Heidi; Wedge, Donna Subject: I.R. -414 Foster Street, North Andover-Additional Information -Original Septic Plan Attachments: 20120726102358261.pdf Importance: High Follow Up Flag: Follow up Flag Status: Flagged To: Gayle Dawson 978-361-5783 Dear Ms.Dawson, Here is some additional information regarding your information request for 414 Foster Street,North Andover. Attached is a scanned copy of the Original Septic Plan. This will show you where the wetlands lines are,but the plan is so old,you may want to contact Conservation to see if the wetland line has changed at all. Their number is: 978-688-9530. You may speak with Jennifer or Heidi. Thank you. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email DdellechiaieCDtownofnorthandover.com Web www.TownofNorthAndover.com 1 �5� ,�/OrE; PLA�1 sNOtvi/vU ' /(/D l�/1�'t3.IC,E PROPGtSED sassaRFww SEwwsrm I�16P�LS4e_ -SYSTEM IWII/ 64F AA457-Ae_66b /h./ .4N-0 LOT 2 / THE /7%�OeOe.56n ZW664IA14, PRoPGBEG Lor gfe4blA16 SCALE46 1976 Ok/NEe: h ei'/�a�• ) THE OCnP�EL� SI/BSC/.C>FACE BEAJCNM/ICK COA16 CO- ���' / 56WA6E 0/.SPL25AL 5Y,57 7E K/��E3ClC:Y, .tet/A •�. ey c)0o cNGY!/.t/ D/./ Tf/(S ,oL AN cSL/AL L y NOT �iE <:ONcSTPl1CTE0 LOCAT/oN: GST 2, Fa�r�+a =T�1Er UNT/G 7//E WATER TABLE i(✓n. , f��/i�'>vE /I�/.9ss. Ec57Ase ASN6D �/ `y 0�. J / I /V•;THE SP&I lAle5 OF /977 L1E5/4NER t&.S.SAY cT• BARBA4AZI_O R.S WEsrWARA ORdt-6 I y k"�.ao/Nt, , /VJASS. 3 GG4-49}3 065/6 Ai OATA TYPE of e!//GD/NCa: 3 q, QA.eA4E CEGGAk PLUMB/N4 FAG/C/T/ES: GACl//b2Y Westlo \ 8EL!/AfsE FLOW E'ST/MATE: .dao Q.�?D. \ SEPT/G TANK : /d 00 4.44c O-/ ABSdjepr'/ON AREA: .`/OD s F Ati O�t'f'T/��ti1 AREA ®PERICOCRT/OA/ TESIS Al v2 #`3 +0¢ J �'• \ DArB 9-7L /0-23-76 MP EGEI/Ar/oN :/7.el- /D2.O i i \ 34rlle,4r/ON /.5'.Ni&4 /.5'M/N. Wim•__,, \ / � � � � /2"ro 9" DROP Gl.H/N, G "/A/' �CarYl)1 I � � 9••ro G" DRoP ZG ari../. $ McN. �\ rj 4EAVOIAr/o v RASE 9 n./..v. 3.7 1 \ ' 0 TEST P/Ts #/ 4*9 04. DATE � � / d✓ TDP EIFVAT/ON J J 4 , "V(V p SO/C TYPES �Z OoNEY '��v.po A�vo rcc cvAree TABLE wnrrxG-'az 1 1� GocArit�N � BOTTOM 6[EI/Ario 86. TE5T5 eCA1&_leTED BY 417,0d~440,T2s TESTS W1rN6sSEa BY: c/o.4A/ocvEx. AL-447H vEDr. \� { J P1_,gN a•DEsicN CR/rE,e%a c5HEET i • - •- •_ - . . �"�sEAcE� �/.vr, Soc/o Pl/C. P/PE . .• _ _' rOR EQL//!/AGENT) " CAPPED ENDS S"D" 5'-O" Z'-L;" y PEQFaQATE� P.Ile. P/PE COR EL7U/✓AGENT) L 2 2D' v P_A,eT/AL BED ENp E T/ON h &CALE �2 _��Qu . AREA --.:; _, (FOR SPEC/F/CAT/ONS-SEE <SECT/ON AT LOWE,2 .2/l�i/T) D�,re�auriov Qzr 'n a 4'¢cAsr reo U, S OZ -/Doc> OAL.CONC,QETE SEPT/C TgNK / � 45 -¢"Y•6SOL/o P.�/,C.,SEALEO TO/NTS n A,8-f0,fPT/ON BEL) 1:)4AiLl 1�9 /UDT TO Ye,4LE X05 pr.�� i F_�_n/-C 'MU�c EQ^E� .SELECT &Z soc/o L�4cKF/LL - ' 'F- 101 ".a �J.,.a -- ��, '.• • . NF �•' 101 -S� e „ /�"ro ,-WASN&'v E� --I�MOVE A(-L LOAN ¢`d PECFOFATEU ,� TOP6G�L lrl Q£�AKE/�# M �� REDLAC£ W(TN EOU/✓AGENT ORAUEL To EL.101.00 O Q O O C_ �y/¢••TD G...... STONE � Q O O C doUBCE WASHER O 1/J hl O To MEET A.A. % ABSORPT/ON BEO cYEerloA W OO 1 �i i $ SCALE P'=/`-O" v I � _c1GG'ALE f-YO.Q. /�/=TO' [�E.eT ��/'�� PROF/LE Ah/o ABS�,ePT/ory BEO PLAN ANv SECT/o NS c�NEET Z aFZ DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, July 26, 2012 11:07 AM To: 'gdawsonbrad@gmail.com' Subject: I.R. -414 Foster Street, North Andover Attachments: 20120726102346958.pdf Importance: High To: Gayle Dawson 978-361-5783 Dear Ms.Dawson, Attached is the scanned file information you requested for 414 Foster Street,North Andover. Please call if you have any further questions. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email Pdellechiaie(cDtownofnorthandover.com Web www.TownofNorthAndover.com 1 • ��\ {_ .• Iia 1 s. ' 1: l w`, Commonwe�lith of Massachuseitts ` - , a , .. •. + '-s a,•• . a a a Ti( ##a��al' I�nspec ion...,: . m Subsurface Sewage Disposal System Form Not for VoluntaryA sessiiakts 'f S �t'r s TOWN Or NORTH ANDOVER Pope Add sS , IL Owner s am Ma 1� Owne information Is / required for M—+)N every page. City/Town State Zip Coda Date of Inspection Inspection results M90 be submitted on this,form. Inspection forms may/00 t be altered an Way. Please se@ completeness eheckiist at the end of the form. wrenfllingout A. General Information forms on the S 5 computer,use • 1 Inspector: only the tab key to move your �a tS cursor• not �(v C Z-Lk % Name of ins ector use the ret urn p f key. (2 �J s� •Cr Company N me _ Compa y Address arc`'. s 1 _ d City/Town r State Zip Code &G3-329- (0005 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 Inspecdo Was performed based onirty 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 Insp or's Signature Date e 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 shalt submit the report to the appropriate regionat office of the-DEP, The odginal-sfiould 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 us( at that time.This inspection does not address bow' 'the system will perform In-the future under the same or different conditions of use. 15ina•09108 Tido 6 Offtdai hspecdon Form&baurfece sewage otapoaai syatam•Pape t of 17 commonwealth.-'6f Massachusetts Title'.5.._Off>;cia.l...inspection forMY Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c75 �.t S�_ PropeA�A dress OwnerOwner's Name -- information Is required for every page. City1rown State ZIp Code Date of Inspection B. Certification (cont) inspection Summary: Check.A,6,C,D or*E-1 afways-complete all of Section D A) System Passes: (I have not found any information which Indicates that any of the failure criteria described / in 310 CMR 15.303 or.in 310 CAA 16.304 exist. Any failure criteria not evaluated are Indicated below. Comments: SYsf cj� is ,Alltooth t-pccgk�t ;o�- �y►'� �l/�1 e 13) System Conditionally Passes: ❑ One or more system components as described In the"Conditional Pass`section need to be replaced or repalred. 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 structurallj unsound, exhibits substantial Infiltration or exflltration 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. e 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. t' L7 Y ❑ N (] ND (Explain below): ism-osroe TWO 6 Otride?kwpoWon Form:SubsWN*6"a MWosel Sysiom-Page 2 of t Commonwealth of Massachusetts - Title: 5 Oficial Inspection Form _ Subsurface Sewa to Disposal System Forma Not for Voluntary Assessments Property Addres . Owner — �MU ot'V - col '.v rnformalion s Owners Name/`�, — — required for k-'100W-f0/ iz�`S ---— every page. City/Town S/l'at`e, 1 ( ZIP Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes,(cpnt.): `. ❑ 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 a0proval of Board of Health): ❑ broken plpe(s) are replaced Q Y ❑ N Q NO (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 Q 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 prot safety and the environment: ect public health, ❑ 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 Title 5 Offioa!Lupemon Form:SubuAace Sowapo Qiaposaf Syuom•Pape 3 of 17 Commonwealth of Madsachusetts rA Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments Property Add re s /wp lolhaJ \far"(Al Owner Owner's Name / information is N_�N�V�{ _ 0/ required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (coat.) 2. System will fall 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: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water stippFy 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 wate supply. El 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 coliforr 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 ❑ 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 water: due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an.overload< or clogged SAS or cesspool ❑ .Liquid depth in cesspool is less than 6" below invert or available volume is les: rSins•U5rU8 TM&5 OffidW Inspection Form:Subsurface Sewage Disposal System•PageWor', Commonwealth of Massachusetts Title 5 Official In Form s Subsurface Sewage,Disposal System Form - Not for Voluntary Assessments Property Addr s ` Owner 6-w– er's Name information is — required for /V-/)NJo er every page. CiRrown 1 ---vr 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: El Any portion of the SAS, cesspool or privy is below high ground water elevation ❑ Any portion o"f 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 wel, ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet I from a private water supply well with no acceptable water quality analysis. [Thi, System passes If the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria-Indl-cates-absentand 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 chaln of custody must be attached to this form,] ❑ rn The system is a cesspool serving a facility with a design flow of 2000gpd- Y�' 10,000gpd. ❑ The system falls. 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-tacility.with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must Indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section 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. t!,�ns•W08 Me 5 ofndd hWaco«n Form,sub"soe Sewage Disposal sru«rr-page s a 17 Commonwealth of Massachusetts Title 5.-Off!Ojai inspection. Form Subsurface Sewage Disposal System Foran-Not for Voluntary Assessments Property Address '410 110kal Owner Owner's Name s information is required for every page. City/Town State Zip Code Dale 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 El �` Were any of the system components pumped out In the previous two weeks? El xp�`L 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 NIA) '[P— ❑ 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-iistanoe Is-ineoceptable)[310 CMR 16.302(6)) D. System Information Residential Flow Conditions: Number of bedrooms(design); .Number of bedrooms(actual): -�--- DESIGN flow based on 310 CMR 16.203(for example: 110 gpd x#of bedrooms): _?CO 6-p a 15ins•O 08 Trds 6 DOSdaf Inspection Fomt:Substrfaoe Sewage Disposal Systern•Pape 6 of 17 Commonwealth.of Massachusetts Title:§:.0ff o1a1 Inspection- �-g rm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Add �pas /i'r©/tm�aoja�tr�N Owner Owner's Name Information is r'1�J��Oy<< m� �—zs-y0 required for every page. Cityfrown State 1p Code Date of Inspection D. System information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes N Is laundry on a separate sewage system?(if yes separate Inspection required] ❑ Yes m N Laundry system Inspected? ❑ Yes Z N Seasonal use? ❑ Yes ;6 N Water meter readings, if available(last 2 years usage(gpd)): — Detail: Sump purnp? P(Yes ❑ N Last date of occupancy: Data Commerclaf/industrial Flow Conditions: Type of Establishment: Design flow(based on 310.CMR 16.203): -Gallons per day(4pd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ Nc Industrial waste holding tank present? ❑ Yes ❑ Nc Non-sanitary waste discharged to the Title 6 system? ❑ Yes '❑ Nc Water meter readings, if available: Wns•09108 Title 60 idd hWectlon Forst St$ptrtace 8ewapeDlaposal Syclam•Pape 7 of 17 Commonwealth.of Masslachusetts T .tLe:5 �0 ic : �rSpeat� :� or-r�., . . Sub$ur<ace Sewage.Dis,posal 3ystera Farm-loot foc Voluntary Assessments Sf- Property Add.�pas Owner Owner's Name . / information Is g required for N�2p�cr l Yr W�" to every page City/Town' state 71p Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No Was system pumped as,part of the inspection? .I Yes ❑ No If yes, volume pumped: M°f3 gallon How was quantity pumped determined? �� °� ��" � " (3'a Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no).(if.ygs, 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 1.13 Tight tank,Attach,a copy of th®;DEP a roval, 11 Other(describe): t; 15ira 09M y -.Title 6 MW hWection Fame Subwrrooe 6u~D**W System-Pepe 8 d 17 Commonwealth of Massachusetts Title $ .Official-Inspection Torr Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r I/N 57{r S'A Property Add(°as /�01100,oM 7gMI'A/ Owner Owner's Name Information Is �/,4N()OUtr �1.� a �/is -1— zvvo required for �T every page. Citylrown State Zip Code Date of Inspection D. System Information"(cont) Approximate age of all components, date installed'(if known) and source of Information: /976 Were sewage odors detected wlWn striving at the site? ❑ Yes No Building Sewer(locate on site plan): Depths below grade: 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 off leakage, etc.): . rp�,pP{s a►vi' �r/!�I(-3 �t�'L fw �i�c7Vct CC9�I�taA� Septic Tank (locate on site plan): Depth below grade: feet Material of construction: concrete t Elmetal El fiberglass ❑ polyethylene ❑ other(explair If tank is metal, list age: years Is age confirmed by a dertificate of.Compliance?{attach a copy-of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: tSins'09roe rltle 6 Official Inspectlon Form:&bpxfaoe$ewage Disposal system psoe 9 of t ILN Commonwealth of Massachusetts Title' 5-Official.Inspection -Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property A are Owner 0 ` information is owner's Name required for N QVC gY zs every page. Citylrown IV _ �I Cr — <y b. System Information (cont.) p DateofInspection Septic Tank(cont) Distance from top of sludge to bottom of outlet tee or baffle 33 Scum thickness Distance from top of scum to top of outlet tee or baffle _ Distance from bottom of scum to bottom of outlet tee or baffle zz or/ How were dimensions determined? _ Aq)yrtj Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet Invert, evidence of leakage, etc.): Nx" T etile C w G-cxIc f Grease Trap(locate on site plan): Depth below grade: -feet Material of construction: ❑concrete El metal ❑ fiberglass ❑_polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top.of outlet tee or-baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5tns•0 ua Data We a tNldat Ytspadon Form:Subaudace Sewage 04pos431 System.P ege 10 of 17 Commonwealth of Massachusetts Title 5 .Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I /q Property Addr Owner Owner's Name information is CC,, required for N uer D Ts 6—zs-l0 every page. City/Town State Zlp Code Date of Inspection D. System Information (cont.) , , Comments(on pumping recommendations, inlet and.outlet tee or.baffle.condition, structural integrity, liquid levels as related 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 construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain); Dimensions: Capacity: gallons Design Flow; _ gallons per day Alarm present: ❑ Yes ❑ No Alarm.level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date --- - Comments (condition of alarm and float switches, etc.): �t *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins 09!08 nue 6 OHidal 4upedon Form Substrfaco sewage OlWosal system•Pape 11 Or 17 k Commonwealth of Massachusetts Title 5 ..Oficial Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments qlq S Cr J1 Property�d�(Pw'ad � � ss Owner 1 information is Ownets Name required for ,�/l ! � every page. City/Town Stale Zip C ode Date of Inspection D. System information (cont.) . Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invertvim{ 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.): Lc3- Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: .RE • ;F 'r. l', kr � Commonwealth of Massachusetts Title-5'Official InspectionTo" Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Add�°ss /I'I�s2'l�olM Owner Owner's Name information is o v /..�y�p u- — required for . every page. City/rows State Zip Code Date of inspection b. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers ,. „ number: ❑ leaching galleries number: ❑ leaching trenches number, length: )R, leaching fields number, dimensions: S– yS ❑ 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,): Cesspools (cesspool must be pumped as part of Inspection) (locate on site plan): Number and conflguratIgn Depth w top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction - Indication of groundwater Inflow ❑ Yes ❑ No 1.5ins•0G= Us 5 Of idal hspedlon Form:Subwrface Sewage Disposal System•Pape 13 of 17 Common'wealth.of Massachusetts Title 5 .Officlal Inspection -Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wsr Property wnA dr ss /�o�low� Owner Oers Name information is / required for N��v 0/%YS (��ZS-to every page. Citytrown state Zip Code Date of Inspection d. System Information (cont) Comments (note condition of soil, signs of hydraulic failure,level-of.ponding, condition Df vegetatio etc,): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.): tsins•oam Title 6 oflfdW hsp"Von Farm:6ubsufeoo sowepe Disposal Byuan•pegs 14 of t Ctimmpnwea,4h of Massachusetts Titi 5.Of bias Inspection..form subsurtaas sewage.ptsposal System Form-Not for Volunt ry Assessments ja— "off Cc" 5� Property wnAddre s ► Owner O"Pta information is Owner's Name required for 2oov(r A 0 yr 6-2-s--/o every page. CftylTown State _� ZIP Code Date of Inspectionb. System Information (cont.) Site Exam: Check Slope ❑ Surface water �( Check cellar ❑ Shallow wells Estimated depth to high ground water; feet Please in all methods used to determine the high ground water elevation: Obtained from system design plans on-record If checked, date of design plan reviewed: 1976 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, Installers-(attach documentation) Q Accessed USGS database-explain: You must describe how you established the high ground water elevation: 1G�1 of Before filing this inspection Report, please see Report Completeness Checklist on next page. tsin:•09M Inda b Oflidd WPOWan Form gubwrrsas sewage Dicpoasl Sy,fom•p ape IS a i 7 6 Car rH6r a�'a 716 4 �56WA6 i XDT 6 ti �• U�/T/L. /A/; ThQ Rk4 )o��p o r' V�J oop M 4r U F /C7 V6 , OV ' r% -76 t� �f3 ox /A _ 1 a%-'-3 L51c G 19r ' U ) Y I NIV j0 FORM a • sysmN PUNTLNG RECORD Commonwealth of Massachuseis RECEIVE® �- 6. ,,. c)v-C( , Massachusetts „UN -• 9 7010 S tent tcm t n ,R ee rd TOWN OF NORTH ANDOVER �>yste :i caner yslem Location I . ` 61/nro4 er �a d J y/v-C- y i T`,pe: Emergency ❑ Routine Cess Pc•o!: No ❑ Yes ❑ Septic Tank: No ❑ Yes Date c. :' Pumping: Quantiry Pumped: ��GUt� _ gallons — - --- -� iBORACZEK'S Permit - S\-ster:: Pumped by (Company): Cow .is transferred to: Cont: .its disposed at: S Dutc -z� �� Pumper Signature Condition of system other comments. Df9 n.YPROY7ID S'OR.S4• 1:/07/4S ),� Cern StTSS SEPTIC MW SMnCE 47 Ne MUIRom $rZ, BPADP=t MA 81835 1.1.,uI 41 978-372-7471 Y RRPMTFOR TaINOF BMs _ ` V/ 8rcb lC NI'S dy she�-ctJ4G , to �� ekg __ laces /yMo,� A-4f/ 7 45KIC-TI47 v 5A /oda !� F54 1�d LJ 4j- � 1� PLA AJ LVA14O MJ47 ' A16 lf-7 4R8 C76: 61-5 POS AL P�eOPOSED SUBSU,eF/QGE ,.S,&WAc,E DISfO-s4e- cS 'STEW //v 4AID PRoPosEb Zo r aiQAMAIC, 0 SCALE / �_¢� TE Gla . Ae, /r9. 7� = R �.so� Tf/� P.2��PGZs�l� s/1B.5�/.E'FAGE` Ow.c/Ee90UC1-1M,4P-K <56WA6E ,b1.5.PQ5.4L S Y/�S7-E-M /.39 /�/KE ST,CzEE 7 cS�/4WV D!-/ 7?VI,5 PG AN 91-141-L �1,4�s. �UDT 8E cOr(/cST.t'UCTEI> �o 'QV' �1° Loc.a rio N: r o PVA7E2. 7,449G6 /977 .DES/6AASW A 1� � ,` P����.' ( tTOSEPH cT BA�E'6AUALL O , /�s• r` - .,�.rMpy� �. ►� ,op , i ` WE.SrWARb ORCLE iD nti� i I AAP. A;'EAZ/NG , MASS. 00 1 �,� SEL. G ¢-�� 3 �, • _ l;�� �t. LL- DE•siC AI OA TA TYPE OF QZ!!L D/MG: \ \ GARAGE e CELLAR PWAISI 14 F,4C/41T/ES= GQUA/D.QY' u1ELL \\ S,5WACE FGOW EsT/MATE: X300 4, A D. SEPT/C- r4AI-IG Dom,/ ABSeRPr/ON AREA : -900 a \`� PERCOLAT/OA/ TL-STs 7-Z-74� /61-23-76 TOP E4E!/.4rlovv -174 11,522,10 EZEY4TA::W 93¢ 9,9, o .S4TU.e4 r1OAl /,S,GI in✓, /,6- M/Ai, WaL---_- 1 /Z^'ro 9" DROP ZZ 44^4, All 14, acr%lv) 1 / i` 9" ra 6" DRoo Z PE.PGOLAT/oiV RATE 9 .3.'7 H1�. oD TEST PITS �/ �z #3 �4 ` 1 1 ° DATE -io-7� TOP ELEVAT/OA/ y 7 V ' y , ANO _ WATER TA6LE tvATtK@4Z" LOCA r'11bA/ g) 607-TOM 6Z.=VA7-1oN 66.? TE5T5 6 arV&JC-TED BY : V'b..L-CPf/ 3: X59l'6g44Z40, QS TESTS u//T-A/EssED BY : ,c/o. AA/vo vEW- ��tt:rtt vEvr, \� 01-4A �' DEslG�c! Cr,e/TEie/A cS'HEET I OF 2 Cole EG.tU/vALEn/T� 6 . . •' e. 0--L61, 02 CAPPED E/vo S doe Ec,?uivAcE/Vr) 20' P4,eT/,4L. BED EA./D SECT/OA-1 h i� s CAZ-E (F0,2 SPEC/F/CAT'/O/t/S - SEE SECT/O Al �!T LOWE,2 ,e/Ca/-/7-> �IzEA = 90o S.F h N D1,�reiBur1ov Box � � t ti /oo0 4qL. CD,VC2ET� SEPT/C TANK 4S" TO/NTS S OGLS 148,50.e P T'/ON -5ED �DL.A AJ 'C/ 0 7TO cS ALE 4S' Al Pro � /N. G 1OS SEAQ ED - \ ��� �SELEGT -.- ,• SPo�/o ' , BAC K F/G.L. ' _ Ole qi4 — r0 3/8„ Gf�45h'EI� � o. C.E'USNE� STOh./E' o.o e •o o ee o" _ `' �.,�W M.. e$ oe 'a a e�e`g•` ge M VE AL(- LOAN e m TaPsaL I IQ 6ED Ak,& N PGPLAC-C W1TF4 EQtJ/v.ILENT CaQAUQ T-b EL. l ol.00 ' A ED ry 97.00 �,� •-f 3/¢"To //zwASI/ED 0 �1 d C) G STOnIE O O DOUBLE vt/ASNE� N ti O \ a o Q N O 0 y3 XSECT1oAj a ) ��v � «. c ��,, � ��d