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Miscellaneous - 492 SALEM STREET 4/30/2018 (2)
492 Salem St. Lot B r �w Commonwealth of Massachusetts N W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Asses mentRECEIVED 492 Salem St. Property Address Joy Au u liaro Owner TOWN OF NORTH ANDOVER information is Owner's Name HEALTH DEPARTMENT required for every North Andover MA 01845 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Chad Jablonski use the return Name of Inspector key. Jablonski & Sons, Inc. rea Company Name 167 Willow Ave. Company Address Haverhill MA 01835 City/Town State Zip Code 978-360-9358 4574 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �/13-/� I spe §' ature Date The s to Inspector shall submit a copy of this inspection report to the Approving Authority (Board of He 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always 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 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System and all components in good working order 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 structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. El Y N ND (Explain below): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 . Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M a' 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. CitylTown 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 supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply"well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** i 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 overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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 absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 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 ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)) Attached-350 gpd Detail: Irrigation Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons 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 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 492 Salem St. f Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: North Andover BoH Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: na gallons How was quantity pumped determined? na Reason for pumping: na Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i Commonwealth of Massachusetts z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 492 Salem St. SyO Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 9 rs As-built plans dated 12/10/00 Y Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 8" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): na Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Watertight at foundation Septic Tank (locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: na years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' x 68 x 68 Sludge depth: 3" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 25" Scum thickness minimal Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measuring tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank structurally sound, tee's in good working condition Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ 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: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM ° 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip 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.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 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 0" 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.): Box level and distributing equally with little solid carryover. 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: t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection F rm 0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .° 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-53' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): no sign of hydraulic failur or ponding 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 ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip Code Date of Inspection D. System Information 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.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town 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 ❑ drawing attached separately L4 7? I �► s 17b t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 492 Salem St. Property Address Joy Auqugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4' from bottom of stone feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12/10/98 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: Perc test performed 12/10/98 by Alex Parker and witnessed by Carleton Brown Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 492 Salem St. Property Address Joy Augugliaro Owner Owner's Name information is required for every North Andover MA 01845 9/14/09 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 ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Summary Record Card generated on 9/15/2009 1:33:12 PM by Lisa Evans Page 1 ` Town of North Andover I Tax Map # 210-038.0-0002-0000.0 Parcel Id 10226 492 SALEM STREET AUGUGLIARO, JOY 492 SALEM STREET NORTH ANDOVER, MA 01845 _ Class 101 Single Family Property Type 1 Residential Size Total 1.63 Acres FY 2010 UB Mailing Index NamelAddress Type Loan Number Active/Inact. From Until AUGUGLIARO,JOY Payor 492 SALEM STREET NORTH ANDOVER,MA 01845 Il UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 16460.0-492 SALEM STREET Last Billing Date 7/8/2009 3160434 03 Cycle 03 Active UB Services Maint. Account No.3160434 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 181.88 /1 UB Meter Maintenance Account No.3160434 Serial No Status Location Brand Type Size YTD Cons 16748857 a Active 00 METE METE w Water 0.63 0.63 240 Date Reading Code Consumption Posted Date Variance 6/2/2009 1896 a Actual 43 7/20/2009 11% 3/6/2009 1853 a Actual 41 4/29/2009 -16% 12/3/2008 1812 a Actual 47 1/20/2009 15% 9/4/2008 1765 a Actual 57 10/10/2008 6% 1708 a Actual 52 7/16/2008 31% 6/3/2008 40 4/11/2008 -16% /5/2008 1656 a Actual 3 12/5/2007 1616 a Actual 44 1/22/2008 -24% 9/12/2007 1572 a Actual 64 10/12/2007 33% 6/11/2007 1508 a Actual 49 7/20/2007 7% 3/8/2007 1459 a Actual 45 4/16/2007 -2% 12/5/2006 1414 a Actual 44 1/19/2007 -23% 9/7/2006 1370 a Actual 58 10/20/2006 8% 6/9/2006 1312 a Actual 47 7/10/2006 21 3/22/2006 1265 a Actual 49 4/17/2006 -14% 12/12/2005 1216 a Actual 52 1/17/2006 -27% 9/12/2005 1164 a Actual 79 10/14/2005 53% 6/3/2005 1085 a Actual 46 7/15/2005 6% 3/5/2005 1039 m Manual estimate 43 4/5/2005 -1% 12/6/2004 996 a Actual 43 1/14/2005 -26% 9/9/2004 953 a Actual 64 10/8/2004 -12% 6/4/2004 889 a Actual 39 7/30/2004 64% 4/13/2004 850 a Actual 60 5/17/2004 0% i Summery Record Card generated on 9/15/2009 1:33:12 PM by Lisa Evans Town of North Andover Tax Map # 210-038.0-0002-0000.0 Parcel Id 10226 492 SALEM STREET AUGUGLIARO, JOY 492 SALEM STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residentia Size Total 1.63 Acres FY 2010 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until AUGUGLIARO,JOY Payor 492 SALEM STREET NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 16460.0-492 SALEM STREET Last Billing Date 7/8/2009 3160434 03 Cycle 03 Active UB Services Maint. Account No.3160434 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 181.88 /1 UB Meter Maintenance Account No.3160434 Serial No Status Location Brand Type Size YTD Cons 16748857 a Active 00 METE METE w Water 0.63 0.63 240 Date Reading Code Consumption Posted Date Variance 6/2/2009 1896 a Actual 43 7/20/2009 11% 3/6/2009 1853 a Actual 41 4/29/2009 -16% 12/3/2008 1812 a Actual 47 1/20/2009 -15% 9/4/2008 1765 a Actual 57 10/10/2008 6% 6/3/2008 1708 a Actual 52 7/16/2008 31% 3/5/2008 1656 a Actual 40 4/11/2008 -16% 12/5/2007 1616 a Actual 44 1/22/2008 -24% 9/12/2007 1572 a Actual 64 10/12/2007 33% 6/11/2007 1508 a Actual 49 7/20/2007 7% 3/8/2007 1459 a Actual 45 4/16/2007 -2% 12/5/2006 1414 a Actual 44 1/19/2007 -23% 9/7/2006 1370 a Actual 58 10/20/2006 8% 6/9/2006 1312 a Actual 47 7/10/2006 21% 3/22/2006 1265 a Actual 49 4/17/2006 -14% 12/12/2005 1216 a Actual 52 1/17/2006 -27% 9/12/2005 1164 a Actual 79 10/14/2005 53% 6/3/2005 1085 a Actual 46 7/15/2005 6% 3/5/2005 1039 m Manual estimate 43 4/5/2005 -1% 12/6/2004 996 a Actual 43 1/14/2005 -26% 9/9/2004 953 a Actual 64 10/8/2004 -12% 6/4/2004 889 a Actual 39 7/30/2004 64% 4/13/2004 850 a Actual 60 5/17/2004 0% TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 02/28/01 This is to certify that the individual subsurface disposal system constructed (X ) or repaired ( ) by Ben Osgood, Jr. at Lot B Salem Street I has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector v i, TiOWN OF NORTH ANDOVE;/ BOARD OF HEALTH 21 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System 00 constructed; ( )repaired; by C 0-5 C-o y c7 J !L located at yT �� �( � 5c, I e vy, ae-e was installed in conformance with the North Andover Board of Health approved plan, System Design Permit#j)09, dated , with an approved design flow of y yd gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection dater Cv c L Engineer Representative Final inspection date: Engineer Representative Installer: Lic.#: Date: _ p OF Design Engineer: % __ Date: C. TANGARD y � e ASO �G/ST0 �F` /ONAL EAG 4 AS-BUILT CHECKLIST LOT NUMBER, STREET NAME V ASSESSORS MAP &PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE i/ TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA Ll LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER GAS ELECTRIC LINES CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK& D-BOX / ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW LOCATION & ELEVATIONS OF BENCHMARK USED { INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO Initials / A. Bottom of Bed 1. Excavation to proper depth 2. With trenches,sides of excavation are beneath B horizon 1/ 3. Edge of excavation specified distance from foundation,etc. Comments: B. Retaining Wall 1. Wall height andd width as specified 2. Waterproofed .,% 3. Wall minimum 10'to leaching facility 4. Wall meets specifications oTplan Comments: C. Building Sewer j `1 1. Pipe diameter minimum 4" f i 7y 2. Schedule 40 pipe 3. Watertight joints 4. Inlet to tank cemented 5. Slope minimum 0.01 or 1/8"per foot minimum 6. Pipe properly set on compact firm base 7. Pipe laid on continuous grade in straight line 8. Cleanouts precede all change in alignment and grade T 9. Manholes at any 90°change 10. 10' minimum offset to water line Comments: D. Septic Tank 1. Level 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to grade 5. Manholes over center and each tee 6. 3-20"manholes 7. Inlet tee minimum 12"under invert 8. Outlet tee minimum 14"under invert 9. Outlet line cemented 10. Air space 3"above tees 11. 2"-3"drop from inlet to outlet 12. Pipe set 13. Compact base with 6"of V crushed stone under tank 14. Tank is watertight Comments: Yes NO E. Pump Chamber 1. If separate from tank,compact base with 6"of/<"stone underneath 2. Minimum 2"pipe to d- box if gravity system 3. 20"access manhole 4. Tank level 5. Watertight +, 6. Tank size agrees with planpecification 7. Manhole to grade 8. Check valve and bleeder ho e,,present 9. Alarm in building on separate c\uit 10. Alarm functions 11.- Manual operating switch 12. Pump delivers liquid to d-box Comments: F. Distribution Box 1. D-box level 2. Minimum 0.IT'(2")drop from inlet to outlet 3. Minimum 6"sump _ 4. Outlet pipes show equal distribution / 5. Compact base with 6"of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe Comments: G. Soil Absorption system / 1. All stone double-washed-3/."- 1 ''/z" -pea stone / Bucket test done? 2. Minimum 2".ofpea stone above distribution lines 3. Minimum 6"stone beneath pipe 4. Distribution lines capped or connected together E� 5. Grading meets 3:1 slope 6. Minimum of 9"of fill graded over system 7. Toe of slope stops minimum 5' from edge of property; if not,then Swale. Comments: H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agree with plan. (Max.length 100') 3. Width of trenches agree with plan-Minimum 2';maximum-4'. I'll 4. Vent present if<50 feet or specified 5. Distance between trenches minimum 4' and maximum of 6' ✓ 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6"per 100' 8. Depth of trenches below outlet invert minimum of 6". Yes NO 9. Pipes set on stable base. Comments: 1. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6".per 100' 3. Separation between pipe 6'maximum 4. Pipes connected at end s k 5. Separation between adjacent fields.10'minimum 6. Pipes set on stable base 7. Maximum 4' separation from edge Jof field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: i I Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12"and 48"wide 4. Access manholes on each pit NI, 5. Pipes cemented with hydraulic cement' Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond C,/c, v Zz�Ilk �� �- B `� . Town of North Andover, Massachusetts Form No.3 !►OR7h BOARD OF HEALTH t L 1O A '°•,;.o'��` DISPOSAL WORKS CONSTRUCTION PERMIT 9SSACHU`�E� LApplicant NAME I AYDRESS TELEPHONE Site Location Permission is hereby granted to Construct (/or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. //60 CH AN, BOARD OF HEALTH Fee D.W.C. No. �� INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 41 q2 15.-a les., relative to the application of �e � ©ryas dated L s' v0 for plans by C,41J and dated A lbs with revisions dated 51131o3 I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed—generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from " engineer must be submitted to BOH,after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. . c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation-or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: � 5 BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: I I of D� CURRENT INSTALLER'S LICENSE# LOCATION: �f q',2 S�leo" S7`2cy� LICENSED INSTALLER: f_�e. C 6 scrodD j 2 SIGNATURE: C TELEPHONE# q18 -6,96 /7,:C $ CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval _ Date: All � f Town of North Andover E NORTN 1 OFFICE OF 3a o�'`' COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street :%o ^" North Andover, Massachusetts 01845 ^,� 5 WILLIAM J. SCOTT 9SSAcHUSE�t Director (978)688-9531 Fax (978)688-9542 March 30, 2000 Mr. Ben Osgood, Jr. New England Engineering 60 Beechwood Drive North Andover, MA 01845 Re: 492B Salem Street,No. Andover Dear Ben: This is to inform you that the revised septic system plan dated 3/14/00 for the site referenced above has been approved for maximum nine (9) rooms. If you have any questions, please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, ;t Sandra Starr,R.S., C.H.O. Health Director SS/Smc cc: Cyrus Construction File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Mar-22-00 09:40A Paul D. Turbide, PE/PLS 978-465-0313 P.03 March 22, 2000 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V fourth review for 429 Salem Street, Lot B (revision date of March 13, 2000) Dear Sandra, 1 find that the concerns outlined in my report dated February 22, 2000 have been I adequately addressed by the revised plans. If you have any questions or comments please feel free to contact me. Sincerely Carlton A. ro PE/PLS Sa1em429b4.doc 4298 Salem Street PORTit I [NGINIIHING Civil Engineers& Land Surveyors One Barris Street Newburyport,MA 01950 (978)465-859 �e NEW ENGLAND ENGINEERING SERVICES INC March 13, 2000 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: Lot B Salem Street,North Andover, Septic system design Dear Sandra: Enclosed you will find five copies of a revised septic system design for the above referenced property. These plans are being submitted for approval. The following changes have,been made to address your comments. 1. The leach trenches have been moved closer to the street in order to provide the proper breakout offset between the edge of the trenches and the driveway at the garage. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, Benja ?C. Osgood, Jr., President MP►R 14 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 i Town of North Andover t pkORTh OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES A 27 Charles Street ► ^ : North Andover, Massachusetts 01845 �9SSAc►+uSEt�y. WILLIAM J. SCOTT Director (978)688-9531 Fax (978)688-9542 February 28, 2000 New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 RE: 492 Salem Street, Lot B Dear Mr. Osgood: This letter is to inform you that the proposed septic plan for Lot B Salem Street, North Andover has a technical deficiency that needs to be addressed before an approval can be issued. The deficiency is as follows: • The proposed dwelling will have a garage-under with a floor elevation of 203.5'. Since the required grade at the corner of the foundation is 206', the stone retaining wall beside the driveway must be an impervious barrier. Please do not hesitate to call the office at 978-688-9540 if you have any questions. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: Cyrus Construction W. Scott File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Feb-22-00 02 :38P Paul D. Turbide, PE/PLS 978-465-0313 P.03 February 22, 2000 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover,MA 01845 RE: Title V third review for 429 Salem Street, Lot B(Revision date of Feb. 16, 2000) Dear Sandra, I find that the plans adequately address the regulations except for the following: The proposed dwelling will have a garage-under with a garage floor elevation of 203.5 . Therefore the stone retaining wall shown on the plan running along the side of the paved driveway until it hits the foundation must be an impervious barrier(at the corner of the foundation the required grade is 206', yet the garage floor will be 203.5'). If you have any questions or comments please feel free to contact me. Sincerely l �_ Carlton A. Town, PE/PLS Salem429b3.doc 429A Salem Street PORTit I ENGINEERING Civil Engineers& Land Surveyors One Harris Street Newburvport,MA 01950 (978)465-8594 NEW ENGLAND ENGINEERING SERVICES INC February 17, 2000 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: Lots A&B Salem Street,North Andover, Septic system design Dear Sandra: Enclosed are five copies of new septic system designs for the above referenced properties. These plans are being submitted for approval. The following additional items are also being submitted. . 1. Application forms. 2. Checks to cover the fee. These plans are intended to replace the previous designs that were submitted and approved by Eastern Land Survey. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, BenjaZ C. Osgood, Jr.,EIT President To%M1 OF 6 2000 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 Town of North AndoverNORTH OFFICE OF ��°h 4"`° ",tioc COMMUNITY DEVELOPMENT AND SERVICES ° . A 27 Charles Street WILLIAM J. SCOTT North Andover, Massachusetts 01 845 �Iss aeHus���y Director (978)688-9531 Fax (978) 688-9542. May 12, 1999 Eastern Land Survey Associates, Inc. 104 Lowell Street Peabody, NIA 01960 RE: 492 Salem Street, Lots A, B, and C Dear Mr. Morin: This letter is to inform you that the proposed septic plans, dated 4/16/99 for Lots A, B and C at 492 Salem Street, North Andover have been approved. Please call the Health Department at the number below if you have any questions. Sincerely, PCZ Sandra Starr,R.S. Health Administrator Cc: Cyrus Construction File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 May-11-99 01 :39P Paul D_ Turbide, PE/PLS 508-465-0313 P_03 May 11, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01 845 y9 � RE: Title V second review for--W—Salem Street, Lot B Dear Sandra, I find that the concerns outlined in my report dated March 22, 1999 have been adequately addressed by the revised plans. If you have any questions or comments please feel free to contact me, Sincerely Carlton A. Brown, PEIPLS - Salem429b2.doc 429B Salem Street P011TIt I ENGINEERING Civil Engineers& Land Surveyors One Harris Street Newburyport,MA 01950 (978)4.65-8594 May-i 03-99 02 : 29P Paul D. Turbide, PE/PLS 508-465-0313 P.02 May 3, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Correction to Title V review forte Saler Stfeet, Lot D Dear Sandra, On my review letter dated March 22, 1999 for the above-mentioned premises, I stated that there was confusion about the numbering of the test pits. This led me to believe that the determination of ESHW was in error, and that the proposed leaching bed should be raised to be 4 feet above ESHW. After talking with Alex Parker, soil evaluator, I realize that there is no confusion and that the plans correctly show the test pit numbering and ESHW elevations. Therefore Items 913, 14 and 15 in the March 22,1999 report are not problems and should be deleted from the report. If you have any questions or comments please feel free to contact me. Sincerely Carlton A. Brown, PE/PLS Salem42942.doc PORT ENGINEERING Civil Engineers& Land Surveyors One Harris Street Newburyport,MA 01950 (978)465-8594 '-y Professional Land Surveyors&Civil Engineers ESSEX SURVEY SERVICE 1958- 1986 OSBORN PALMER 1911 - 1970 BRADFORD&WEED 1885- 1972 April 21, 1999 TOWN OF NORTH OTHAr DO��EP� BOARD OF HE'Al�' . Sandra Starr, R.S., Health APR Z 2 099 Administrator Office of Community Development and Services 27 Charles Street North Andover, Massachusetts 01845 RE: F 11074 Lot B 492 Salem Street North Andover, MA Dear Ms. Starr: Please accept the following responses to your letter of March 29, 1999, relative to the referenced lot. The reserve area is now located four (4) feet from the primary area (i.e., between the proposed trenches). A breakout wall of reinforced concrete construction is nowP ro- posed instead of the slope. The breakout wall is proposed to be five (5) feet from the line of Salem Street. Trenches are now proposed. The invert elevations have been revised to correct the one foot drafting error. A notation that the distribution lines be connected with solid pipe has been added to the Plan. The slope of distribution lines has been added to the profile. The vent has been noted as a vent/monitoring well in the plan and profile views. Note 7 has been amended to include the Board of Health. 104 LOWELL STREET PEABODY, MASS. 01960 TELEPHONE: 978-531-8121 TELECOPIER: 978-531-5920 E-MAIL: elsai@prodigy.net Ms. Sandra Starr Town of North Andover April 21, 1999 Page 2 Four (4) inch pipe is now specified on the distribution box detail. The Owner/Applicant's name and address are now noted in the title block. The driveway elevations have been clarified by the addition of spot elevations. The location and elevation of the proposed foundation drain has been added to the Plan. The elevation of the perc tests have been added to the Plan. A benchmark with 75 feet of the proposed septic system has been added to the Plan. Accompanying this letter are three (3) copies of the Proposed Construction Plan, revised April 16; 1999. Any questions regard- ing to the responses may be directed to Clayton A. Morin, P.E. or the undersigned. Very truly yours, H. Mao ( 41 rn JHM/tlm James H. MacDowell Enclosures cc: Cyrus Construction i 1ha49m lgmd ginw Daaoa�n�9aa Joao Town of North Andover NORTH E � OFFICE OF 3�°�'" ", +o c COMMUNITY DEVELOPMENT AND SERVICES ° : p 27 Charles Street :0 North Andover, Massachusetts 01845 '� H WII,LIAM J. SCOTT 9SSACHuS�� Director (978)688-9531 Fax(978)688-9542 March 29, 1999 Eastern Land Survey Associates, Inc. 104 Lowell Street Peabody, MA 01960 RE: 492 Salem Street,�L--ot_B) Dear Mr. Morin: This letter is to inform you that the proposed septic plan for Lot B Salem Street, North Andover has been disapproved for the following reasons: • The reserve area is less than 4' from the primary leaching area (NA 9.04) • There is less than 15' to the property line from the toe of slope, so 3:1 slope and 15' cannot be achieved. Please rectify. • Full is shown running right to the street lire of Salem Street. The regulations require that the toe of fill stop at least 5' from a property line or a Swale must be installed. (310 CMR 15.255(2)) • Profile of system appears to have drafting errors. Please check. • Trenches shall be used wherever possible. Please jus u ,use of field. (310 CMR 15.240(6)) • Distribution lines of field shall be connected with solid pipe-profile. (rnT A 15.n1) • Distribution lines missing slope specification . (310 CMR 115.251(9)) • Vent detail is for a monitoring;yell,not just a vent. • Note 7- "Any change of conditions...." Please add"and the Board of Health". • In d-box detail pipe is not specified as 4". • Addresses of owner and applicant are missing. (NA 8.02k) Driveway elevation missing. (NA 8.n2t) • Location and elevation of foundation drain missing. (NA 8.02y) • Elevaticr,of perc test missing. INA 8.02-n) • Benchmarks within 75' of the proposed septic system are missing. (310 CMR 15.220(4)(q)) BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 I I Please do not hesitate to call the office at the number below if you have any questions. Sincerely, Sandra Starr, R.S. Health Administrator Cc: Cyrus Construction W.Scott File i 11/16/98 To: Joseph Pelich-Cyrus Construction Corporation From: Michael &Debra Demirdjian Regarding: 492 Salem Street soils tests Dear Mr. Pelich, Please let this letter serve as our permission to perform any and all testing/review so as to obtain any and all tests and evaluation needed by the Town Of North Andover for permits,approval,or anything required by the Town Of North Andover. This includes permission for any and all boards or persons within the Town Of North Andover to take steps through you for the development of the property at 492 Salem Street,North Andover. We grant this approval as owners of record of the property. Sincerely, I Michael&Debra Demirdjian I I Town of North Andover, Massachusetts FO""No. 1 MOR7M BOARD OF HEALTH i DESIGN APPROVAL FOR sSACH 115E� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM E I Applicant ' Test'No. r s Site Location jA- Reference Plans and Specs. ' f6 y DESIGN D E 1 ENGINEER i i Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. + CHAIR"AtyrB$ARD OF HEALTH r E Fee 3'? Site System Permit No. r i May-27-99 12 : 45P North Andover Com. Dev . 508 688 9642 P . 01 SEPTIC PLAN SUBMITTAL FORM LOCATION: p7- P, NEW PLAINS: � $125.00/111an_ REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES <zn) P9,EU 10 u st, S Jg AAT►j DATE: z V71 DESIGN ENGINEER: 10EW ENL&j�j9N E-A-) (g-1N E P_tyC DATE TO CONSULTANT:/ 7- *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. 1ii�l1k e 4e '_ .44v SEPTIC PLAN SUBMITTAL FORM LOCATION: NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO,� DATE: DESIGN ENGINEER:(f DATE TO CONSULTANT: /161' *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. I�1 May-27-99 12 : 45P North Andover Com. Dev . 5O8 688 9542 P . Ol SEPTIC PLAN SUBMITTAL FORM LOCATION: NE�w' PLANS: YES $125.00/111an REVISED PLANS: YES $ 60.00/I'lan SITE- EVALUATION FORMS INCLUDED: 'ES NO DATE: � o� DESIGN ENGINEER: t v-i DATE TO COivSLrLTANT: *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. MAR � 4 I` v-05-98 10 - 14A No_Y-0 h Andover Com. Uev .. SUri burs `J54L N . U1 a all BOARD OF HEALTH TEL. 688-9540 ORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: November 16, 1998 LOCATION OF SOIL TESTS: 492 Salem Street Assessor's map & parcel number: Map 38 Parcel 2 Lots B,C arD OWNER: Michael J. Demird'ian TEL. NO.: ADDRESS: 492 Salem Street North Andover, MA 01845 ENGINEER:-Clayton A. Morin TEL. NO.: (978)531-8121 CERTIFIED SOIL EVALUATOR: Mary Godwin (978)282-3138 Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing x N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. PERCOLATION TEST DATA PROPERTY ADDRESS SALEM ST., NORTH ANDOVER MA. PERFORMED by ALEXANDER PARKER NAME OWNER MR. + MRS. DEMIRDJIAN WITNESSED by MR. CARLTON BROWN MAP 38 LOT 2 DATE 12/10/98 LOCATION IN FRONT YARD TIME 15:00 PERK# P-BI LOCATION IN FRONT YARD TIME 15:30 PERK# P-B2 IN FRONT OF THE MAIN IN FRONT OF THE MAIN HOUSE HOUSE OBSERVATION HOLE TP-Bl OBSERVATION HOLE TP-B2 DEPTH of SHELF 42" DEPTH of SHELF 40" DEPTH of HOLE 18" DEPTH of HOLE 18" START PRE-SOAK 15:10 START PRE-SOAK 15:30 END PRE-SOAK 15:25 END PRE-SOAK 15:45 TIME at 12" 15:25 TIME at 12" 15:45 TIME at 9" 15:32 TIME at 9" 16:01 TIME at 6" 15:43 TIME at 6" 16:31 TIME 9"to 6" 11 MIN. TIME 9"to 6" 30 MIN RATE 4 MPI RATE 10 MPI SITE PASSED PASSED SITE PASSED PASSED COMMENTS COMMENTS CONDITIONS AT SITE OWNER DID NOT WISH 4 HOUR SOAK at this TIME OWNER WISHES to TRY PERK in DRIER TIME OWNER WISHES to THINK ABOUT IT CREDIT FOR HOURS WILL BE GIVEN TO OWNER or TIME TAKEN OFF INVOICE at this TIME(CUSTOMERS CHOICE) DEEP OBSERVATION HOLE LOG for TEST PIT # TP-B1 DATE 12/10/98 TIME AM WEATHER SUNNY, 30 F ADDRESS and LOCATION SALEM ST., NORTH ANDOVER MA. LAND USE SLOPE LANDFORM VEGETATION SURFACE STONE UNDEVELOPED 0-1% OUTWASH PLAIN VARIOUS NONE DISTANCES from in FEET: INKING WELL OPEN WATER POSS. WET AREA DRAIN WAY PROP. LINE 1001+ 2001+ 1001+ 501+ 301+ DEPTH HORIZON TEXTURE COLOR MOTTLES STRUCTURE, STONE, ETC. 0-20 Ap FINE SANDY 10YR 3/2 NONE SEEN FRIABLE, GRANULAR, WEAK, LOAM MOIST 20-26 Bw FINE SANDY 10YR 5/6 NONE SEEN FRIABLE, GRANULAR, WEAK, LOAM MOIST 26-110 C1 FINE/MEDIUM 2.5Y 7/4 AT 33" 7.5YR 6/8 LOOSE, SINGLE GRAIN, SAND 2.5Y 8/1 STRUCTURELESS, MOIST NO REFUSAL PARENT MATERIALGLACIAL OUTWASH DEPTH BEDROCK 110"+ STAND WATER ND WEEPING ND ESTIMATED SEASONAL HIGH GROUNDWATER AT 33" SKETCH PROVIDED YES FLAGGING YES I DEEP OBSERVATION HOLE LOG for TEST PIT # TP-B2 DATE 12/10/98 TIME AM WEATHER SUNNY, 30 F ADDRESS and LOCATION SALEM ST., NORTH ANDOVER MA. LAND USE SLOPE LANDFORM VEGETATION SURFACE STONE UNDEVELOPED 0-1% OUTWASH PLAIN VARIOUS NONE DISTANCES from in FEET: INKING WELL OPEN WATER POSS. WET AREA DRAIN WAY PROP. LINE 1001+ 2001+ 1001+ 501+ 301+ DEPTH HORIZON TEXTURE COLOR MOTTLES STRUCTURE, STONE, ETC. 0-9 Ap FINE SANDY 10YR 3/2 NONE SEEN FRIABLE, GRANULAR, WEAK, LOAM MOIST 9-23 Bw FINE SANDY 10YR 5/6 NONE SEEN FRIABLE, GRANULAR, WEAK, LOAM MOIST 23-96 C1 FINE/MEDIUM 2.5Y 7/4 AT 43" 7.5YR 6/8 LOOSE, SINGLE GRAIN, SAND 2.5Y 8/1 STRUCTURELESS, MOIST NO REFUSAL PARENT MATERIALGLACIAL OUTWASH DEPTH BEDROCK 96"+ STAND WATER ND WEEPING ND ESTIMATED SEASONAL HIGH GROUNDWATER AT 43" SKETCH PROVIDED YES FLAGGING YES FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments Navin Jur sdiction have i been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLIC ,� PHONE tS ASSESSORS MAP NUMBER `--2a LOTNUMBER D6 IZP-- SUBDIVISION LOT NUMBER SIRE STREET NUMBER -Y,9cZ- OFFICIAL USE ONLY i RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED 0 ) CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS U TOWN P DATE APPROVED CANNER DATE REJECTED COMMENTS DATE APPROVED j FOOD INSPECTOR-BEAI. DATE REJECTED SEPTIC INSPECTO - HEALTH DATE APPROVED / R DATE REJECTED CON*AENTS CP 7C 1 W)cv m PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMI:'NT DATE APPROVED DATE REJECTED CONOAENTS RECEIVED BY BUILDING INSPECTOR DATE it NORTH Town of over No. ZaL /tow I; COCMICMEWIO dower, Mass. � , Ao� P���RATED P' S H � BOARD OF HEALTH PERMIT T Dwtb{ Food/Kitchen 15�F1 Septic Syste Z ' ;� / � ... b l�'C B DING INSPECTOR THIS CERTIFIES THAT... ..............�.0s fo/V.........44 ............................ .............. . Foundation.'I +m(6' has permission to ect..............L..................... buildings on .. .. ....... ....... . ........I........ Rough AAA C0____1 to be occupied as... room,..�.'� .. .� .,�.. .. .'.�...� .� .,�N$611 Chimney provided that the person accepting this permit shall in every respect conform to the terms of the applicatiole in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspecti , Alteration and Construction of Buildings in the Town of North Andover. as 1019 PLUMBING INSPECT VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS 1 l UNLESS CONSTRUCTION STA ELEC I / SPECT ou / (1 taw BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR � � r y,lC' Display in a Conspicuous Place on the Premises — Do Not Remove a No Lathing or Dry Wall To Be Done FIRE EPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE S40-29-29"E 125.01' FOU N DATION ENLARGEMENT 40.0±' 0 90 �wo 0 0N tco 0 0 40.0±' I+ LO.13.8 ,n 12.3±' Z N AS—BUILT FOUNDATION LOCATION PLAN EXISTING LOT B SALEM STREET FOUNDATION NORTH ANDOVER, MA. 52.7±' OWNED BY CYRUS CONSTRUCTION 30.8± Scale: i '_80' October 18,2000 m N W 107.74' JAM s 5E. �, 17.26 N39-19'20"W � _ No.37046 N37'27'50"W a C[STV SALE M STREET This plan is for the use of the Building Inspector of the Town of; North Andover for .the purpose of, determination of zoning compliance. It is my opinion that the location of the foundation complies with the requirements of the Zoning Bylaws of the town for the R3 zone. This plan is the result of a survey performed and monumentation found on 10/13/2000, based upon NEW ENGLAND ENGINEERING SERVICES, INC. the deed in Bk2213 Pg240 and plan #13488 60 BEECHWOOD DRIVE NORTH ANDOVER, MASSACHUSETTS jef jef (978) 686-1768 I