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HomeMy WebLinkAboutMiscellaneous - 498 SALEM STREET 4/30/2018 / 498 Salem Street St J r 1 i *r Lot & Street , Map/Parcel I )J CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit' Plan Approval: Date: lla Approved by: Designer: [ ��a;, /19o-,,-,—Plan Date- -- Conditions:. Water Supply: Town - Well. - Well Permit: _.Driller: Well Tests: mical Date Approved Bact I Date Approved Bacteria Date Approved Plumbing.Sign-Off _ Wiring Sign-Off- 's. -" Form "U" Approval / Z ` 17Approval to-Iss YE NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other YES NO Any Variance Needed? YES NO FLVAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: 06' 416 'r SEPTIC SYSTEM INSTALLATION Is the installer licensed? NO Type of Construction: REPS New Construction: --_Certified Plot Plan Review NO -Floor Plan Review NO _— Conditions of Approval from Form U Es NO -Issuance of DWC permit: - NO _DWC Permit Paid? �YE' NO . ---DWC Permit#4Y Installer. GJ_. S - / j� - ----__-. BegixrInspection:_ _ -._::._ S NO --- _Excavation Inspection: -Needed- Passed: By: Construction Inspection: Needed: As-Built_Plan Satisfactory- YES- Approval atisfactory:YES:Approval of Backfill: Date: ,5 DOD By: ---Final Grading Approval: Date: ,3,�' y-Oy:� ,> Final Construction Approval: Date: - By: Certificate of Compliance: Approval: Date: 1 E�wCommonwealth of Massachusetts OF 07 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments CIO P i 498 Salem Street Property Address Danielle Brazillgas information is Owner's Name zr-_ required for North Andover MA 01845 3/29/17. every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information RECEIVED When filling out forms on the APP 18 2017 computer,use 1. Inspector: only the tab key - to move your Warren Pearce Jr TOWN OF NORTH ANDOVER cursor-do not HEAI TH DEPARTMENT use the return Name of Inspector key. Pearce Construction Company Name 196 Park Street Company Address North Reading MA 01864 fed07 City/Town State Zip Code 978-664-5264 S11959 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: f ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority l� P---,- Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street =p'1' dress F" N7, 1 ( Dani4l Brazill er- — Owner's me fb required for North Andover MA 01845 3/29/17 every 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: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ' ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 4 / Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if ` pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): I ❑ 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. 'I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 5 ' Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner Owner's Name _. information is North Andover required for MA 01845 3/29/17 every page. City/Town 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 as water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® 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 Y2 day flow t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. CitylTown 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 El ® 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 i t Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were 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: T 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•3/13 Title 5 Official Inspection Forth:Subsurface pedi Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts 1w. _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 321 GPD 9 ( Y 9 (gP ))� Detail: 3/4/2015 to 3/3/2017 234,124 Gallons Sump pump? ❑ Yes ® No Last date of occupancy: 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? El Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts TiOfficial a tle 5 Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover - MA 01845 3/29/17 every 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: Pumped June 2014 per the owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ /\j C) 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•3/13 Title 6 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Installed 3/30/2000 17 years old per the certificate of compliance Were sewage odors detected when arriving at the site? - ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12 inches feet Material of construction: ❑ cast iron 040 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): All appears to be in good shape inside the house. Septic Tank(locate on site plan): Depth below grade: 5" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ 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: 10'6"x 5' 8"x 5 feet deep Sludge depth: 6 inches t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazils Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. Cityfrown 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 321/2" Scum thickness < 1 inch Distance from top of scum to top of outlet tee or baffle 6.5 inches Distance from bottom of scum to bottom of outlet tee or baffle 13.5 inches How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place. Liquid is at the proper level (8 inches to fluid). Tank appears to be in good shape 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts ; Q Title 5 Official- Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary'Assessments i 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. Cityrrown 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 lastumpin : p 9 Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 � S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments re 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. Citylrown 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 inches 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.): D-box appears to be level. Distribution is equal. Minimal solids. D-box is in fair shape. Cover is newer. All works OK. 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.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: ' r t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 L Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leachingits number: p ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (3) 68ft long ❑ 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.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner owner's Name information is required for North Andover MA 01845 3/29/17 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.): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. Cityrrown 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. Cityrrown 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: 41 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: 3/13/2000 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Reviewed files ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole data from design plan dated 3/13/2000 by Clayton Morin P.E. Site was built up for proper separation to ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts _ Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 498 Salem Street Property Address Danielle Brazill Owner Owner's Name information is required for North Andover MA 01845 3/29/17 every page. Cityrrown 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.3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 498 Bon Water ' Driveway ; A i i Septic Tank 2 1 7 i toss �" R rye 1 D-Boz ' i' i A to 1=14' ; Ato2=15' A to D-Boa=26'5" 3 B to 1=3511" B to 2=4311" j B to D-Boz=5419" s s i ; t i i 1 Summary Record Ce►d generated on 3271201712:54:46 PM by Tare Hurley Pegs 1 Town of North Andover 1 Tax Map # 210-038.0-0321-0000.0 Parcel Id 11198 ff;+ 498 SALEM STREET ` /` ?r �4 ylS BRAZILL, BRYN Since Jan 2011 BRAZILL, DANIELLE 498 SALEM STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.57Acres FY 2017 UB Mailing Index Name/Address Type Loan Number Activetinact From Until BRYAN&DANIELLE BRAZILL Owner 498 SALEM STREET NORTH ANDOVER,MA 01845 IMPRESCIA,RICHARD Previous Customer Inactive 10/30/2007 498 SALEM STREET NORTH ANDOVER,MA 01845 I� STERGIOUS PAPADOLOS Previous Customer Inactive 2/12/2009 498 SALEM STREET NORTH ANDOVER,MA 01845 UB Account Malnt. Account No Cycle Occupant Name ActivelInactive Bldg Id.16467.0-498 SALEM STREET Last Bitting Date 1/13/2017 3160420 03 Cycle 03 Active UB Services Maint. Account No.3160420 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 1 1 9.18 1/ WTR WATER 01 ALL METER SIZE 68.40 /1 UB Meter Maintenance i Account No.3160420 i Serial No Status Location Brand Type Size YTD Cons 13240241 a Active 00 ERT HH METE METE w Water 11 838 Date Reading Code Consumption Posted Date Variance 3/3/2017 1301 a Actual 16 -9% 12/5/2016 1285 a Actual 18 1/23/2017 -82% 9/6/2016 1267 a Actual 105 10/24/2016 265% 6/6/2016 1162 a Actual 30 8/212016 101% 3/2/2016 1132 a Actual 14 4/22/2016 -29% 12/3/2015 1118 a Actual 20 1/20/2016 74% , 9!3/2015 1098 aActual 77 10/16/2015 131% 6/3/2015 1021 a Actual 33 7/24/2015 169% 1 3/4/2015 988 a Actual 12 4/28/2015 -5% 12!5/2014 976 a Actual 13 1/15/2015 -79% i 9/4/2014 963 a Actual 62 10/15/2014 261% 6/4/2014 901 a Actual 17 7/16/2014 13% 3/5/2014 884 a Actual 15 4/11/2014 141/6 12/4/2013 869 a Actual 13 1/17/2014 -76% E 9/512013 856 a Actual 55 10/15/2013 48% 6 61712013 801 a Actual 38 7/24/2013 171% 3/712013 763 a Actual 14 4/22/2013 -24% I 12/5/2012 749 a Actual 18 1/9/2013 -66% I 9/6/2012 731 a Actual 53 10/1512012 112% 617/2012 678 a Actual 25 7/16/2012 150% a h I N RTM 1 7820 F`• 9 Town of North Andover �ti'•o,,,,,'::' ,' HEALTH DEPARTMENT ,SS^CMUSE4 CHECK#: DATE: LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) U ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ xTitle 5 Report XM-5-5' $� ❑ Other:(Indicate) $ Heatth4gent Initials White-Applicant Yellow-Health Pink-Treasurer PEARCE CONSTRUCTION 8284 Town of North Andover 4/14/2017 Title V Submission Fee-498 Salem St 50.00 i i r CITIZENS BANK 50.00 Tbwn of North Andover Health Department Date: Location: (Indicate Address,L;;17hal,or me of Bush/ Check#: ®' Type of Permit or License:(Circle) $67 CAO ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) s i Health Agent Initials 1575 White-Applicant Yellow-Health Pink-Treasurer 41, c. t Twn of North Andover Health Department Date: - � Location: (Indicate Address, if Residential,.or N me of Bu�) Check#• ' Type of Permit or License:(Circle) ®, ➢ Animal $ .' ➢ Dumpster $ 5 ➢ Food Service-Type: $ ➢- Funeral Directors $ . ➢ Massage Establishment $ ,41k ➢ Massage Practice $ 3 ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ :< ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works,Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ '¢ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ )'w TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) 1 Health Agent Initials 1575 :` White-Applicant Yellow-Health Pink-Treasurer COMMONWEALTH OF MASSACHUSETTS / JD EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS IZL�Db �6 a d DEPARTMENT OF ENVIRONMENTAL PROTECTION W F RECEIVED � See JUN - 5 2006 TOWN OF NORTH ANDOVER TITLE 5 HEALTH DEPARTMENT OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Pro Address: 498 Salem Street (� ��0, d Perp' — North Andover_ Owner's Name:_Richard Imprescia_ Owner's Address:_498 Salem Street North Andover,MA 01845_ x" Date of Inspection: 5/26/2006 Name of Inspector: Neil J.Bateson— Company Company Name: Bateson Enterprises Inc. ` '9 7 Mailing Address:_111 Argilla Road_ _Andover,Ma.01810 Telephone Number:_(978)475-4786 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my i i systems.I am a DEP trainingand experience in the proper function and maintenance of on site sewage d sposa y P In P � approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority /"F ils Inspector's Signature: Date: _5/26/2006_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. s Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_498 Salem Street_ North Andover_ Owner•_Imprescia Date of Inspection:_5/26/2006 Inspection Summary: Check i B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_498 Salem Street_ _North Andover_ Owner: Imprescia_ Date of Inspection: 5/26/2006 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 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— "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and g P 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. I r Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_498 Salem Street_ _North Andover— Owner: Imprescia_ Date of Inspection:_5/26/2006_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: _ No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6"below invert or available volume is''/Z day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No Any portion the SAS cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis most be attached to this form.) No Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described i 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 Systems: Large S E. g y To be considered a large system the system most serve a facility with a design flow of 10,000 gpd to 15,000 You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. y Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_498 Salem Street_ _North Andover_ Owner:_Imprescia_ Date of Inspection: 5/26/2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes _ Pumping information was provided by the owner,occupant,or Board of Health _No Were any of the system components pumped out in the previous two weeks? Yes_ ` Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? N/A — Were as built plans of the system obtained and examined? Yes — Was the facility or dwelling inspected for signs of sewage back up? Yes — Was the site inspected for signs of break out? Yes_ _ Were all system components,excluding the SAS,located on site? _Yes_ _ 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? _Yes_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No _ No Existing information. _Yes_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_498 Salem Street _North Andover– Owner: Imprescia Date of Inspection: 5/26/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_N/A_ Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203 N/A– Number IA_Number of current residents: 5 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No Laundry system inspected(yes or no): _ Seasonal use:(yes or no):_No Water meter reading: Yes,_ Sump pump(yes or no):–Now- Last o_Last date of occupancy: Current COMMERCIAL/INDUSTRM L Type of establishment: Design flow(based on 310 CMR 15.203):lgpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available:_ Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Pumped 2005,owner_ Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500 gallons--How was quantity pumped determined?_Measured tank Reason for pumping: Inspect tank&tees_ TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool_Overflow cesspool P'in'y Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank —Attach a copy of the DEP approval —Other(describe):_ Approximate age of all components,date installed(if known)and source of information:_Unknown,Owner_ Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 498 Salem Street_ ^North Andover_ Owner: Imprescia Date of Inspection: 5/26/206 BUILDING SEWER_X_ (locate on site plan) Depth below grade:_24" Materials of construction: _X_cast iron _40 PVC other Distance from private water supply well or suction lime:' Comments(on condition of joints,venting,evidence of leakage,etc.) 4"PVC thra wall to tank_ SEPTIC TANKS: X Depth below grade:_12" Material of construction: X concrete metal_fiberglass oolyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:_10'x 5'x 4' Sludge depth 2"_ Distance from top of sludge to bottom of outlet tee or baffle: 24"_ Scum thickness:_2" Distance from top of scum to top of outlet tee or baffle:-8"— Distance affie_8"Distance from bottom of scum to bottom of outlet tee or baffle: 18"_ How were dimensions determined:_Tape Measure_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc Pumped septic tank.Inlet tee ok. Outlet tee ok.Depth of liquid at outlet invert.No evidence of leakage. GREASE TRAP:_(locate on site plan) Depth belowgrade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_498 Salem Street_ North Andover– Owner: Imprescia_ Date of Inspection: 5/26/2006 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_X_ Depth below grade _24"_ 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.)_D-box cover broken,replaced it.D-Bog level&distribution equal.Evidence of carryover,pumped d-bog to clean.No evidence of leakage._ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):— Alarm in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_498 Salem Street_ _North Andover— Owner: Imprescia_ Date of Inspection:-5/26/2006 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _ _ leaching chambers,number:_ leaching galleries,number: _X leaching trenches,number,length: 3 trenches 68'long_ leaching field,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.):_Soil ok.Vegetation ok.No sign of ponding to surface._ CESSPOOLS: Number and configuration:— Depth—top of liquid to inlet invert:— Depth of sludge layer:— Depth of scum layer:_ Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no):, 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.): Page 10 of 11 0 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:_498 Salem Street _North Andover— Owner: Imprescia_ Date of Inspection: 5/26/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. House Water 6eter Driveway A B\% Septic Tank 2 1 D-Boz Ato1=14' Ato2=15' A to D-Boz=26'5" B to 1=35'1" B to 2=43'1" B to D-Boz=54'9" Page 11 of 11 a OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 498 Salem Street_ _North Andover — Owner: Imprescia_ Date of Inspection: 5!26/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _>6'_ Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:_ Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain: _Essex County Soil Map_ You must describe how you established the high ground water elevation: Essex County Soil Map,Sheet#30, Canton Soil,Water>6'Deep.Neighbor house has a pump system above water table.This house has higher leach system than neighbors._ i i • Summary Record Card generated on 6/1/2006 2:27:11 PM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-038.0-0321-0000.0 4 498 SALEM STREET + IMPRESCIA,.RICHARD 498 SALEM STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.57 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until IMPRESCIA, RICHARD Payor 498 SALEM STREET NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 16467.0-498 SALEM STREET Last Billing Date 4/10/2006 3160420 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 1 1 9.18 1/ WTR WATER 01 ALL METER SIZE 127.62 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 13240241 a Active ERT HH METE METE w Water 1 1 0 Date Reading Code Consumption Posted Date Variance 3/22/2006 320 a Actual 32 4/17/2006 -3% 12/12/2005 288 a Actual 30 1/17/2006 -46% 9/12/2005 258 a Actual 62 10/14/2005 97% 6/3/2005 196 a Actual 28 7/15/2005 -5% 3/5/2005 168 m Manual estimate 29 4/5/2005 -1% 12/6/2004 139 a Actual 29 1/14/2005 -33% 9/9/2004 110 a Actual 48 10/8/2004 -17% 6/4/2004 62 a Actual 31 7/30/2004 53% 4/13/2004 31 c Correction 51 5/17/2004 0% C/O 20+ERT 31 =51 12/4/2003 630 n New Meter 0 12/4/2003 0% Tel: (978) 475-4786 Fax: (978) 475-5451 d BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report m Property Address: 49= Sale Street, North Andover Owner: Imprescia Date of Inspection: 5/26/2006 'I My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. F I Residential_Property Record Card#1 of 1 Parcel Year:2018 PARCEL ID: 210/038.0-0321-0000.0 MAP 038.0 BLOCK 0321 LOT 0000.0 PARCEL ADDRESS: 498 SALEM STREET as of:3/27/2017 PARCEL INFORMATION Use-Code: 101 Sale Price: 439000 Book: 12058 Tax Class: T Sale Date: 6/4/2010 Page: 0125 Tot Fin Area: 2223 Sale Type: P Cert/Doc: Tot Land Area: 1.57 Sale Valid: Y Owner#1: BRAZILL, BRYN Grantor: PAPADOPULOS eLL, DANIELLE Address#1: 498 SALEM STREET Inspect Date: 10/16/2006 Road Type: T Exem t B/L%: 0/0 Address#2: Meas Date: 8/17/2001 Rd Condition: P Resid-B/L%: 100/100 NORTH ANDOVER MA 01845 Entrance: X Traffic: M Comm-B/L%: 0/0 Collect ID: SGC Water: Indust-B/L%: 0/0 Inspect Reas: M Sewer: Open Sp-B/L%: 0/0 RESIDENCE# 1 INFORMATION LAND INFORMATION NBHD CODE: 5 NBHD CLASS: 5 ZONE: R3 Style: CL Tot Rooms: 9 Main Fn Area: 988 Attic: Seg Type Code Method Sq-Ft Acres Influ-1/2/3 Value Class Story Height: 2 Bedrooms: 4 Up Fn Area: 1235 Bsmt Area: 988 Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1 N 206910 Ext Wall: AV Half Baths: 1 Unfin Area: Bsmt Grade: A 2 R 101 A 0.57 N 4332 Masonry Trim: Ext Bath Fix: 1 Tot Fin Area: 2223 Foundation: CN Bath Qual: M RCNLD: 298290 Kitch Qual: M Eff Yr Built: 2000 Mkt Adj: Heat Type: FA Ext Kitch: Year Built: 2000 Sound Value: Fuel Type: G Grade: G Cost Bldg: 298300 Fireplace: 1 Bsmt Gar Cap: 2 Condition: VE Att Str Val1: DETACHED STRUCTURE INFORMATION Central AC: Y Bsmt Gar SF: Pct Complete: Att Str Val2: Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond %Good P/F/E/R Cost Class Att Gar SF: %Good P/F/E/R: ///93 Porch Type Porch Area Porch Grade Factor W 100 VALUATION INFORMATION SKETCH 0 Current Total: 509500 Bldg: 298300 Land: 211200 MktLnd: 211200 Prior Tot: 509500 Bldg: 298300 Land: 211200 MktLnd: 211200 100 Sq.Ft. 10 10 PHOTO 10 FU`0.25/FU/FM/B 988 Sq.Ft. E -� M 26 26 498 SALEM STREET ' 38 Septic System Information 498 SALEM STREET Printed On: Tuesday, June 13, 2006 System ID: BHS-2002-1399 General System Information Latest Permit Information -Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity: Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder. No No Soil Type: Depth: Laundry: No No Hauling/Pumping Listing Quantity Type System Type Pumped Pumped By Transferred To Disposed At Date Pumped allons Routine Septic Tank Andover Septic 03/22/2002 1500 Routine Pump chamber STEWARTS SEPTIC 04/14/2005 1500 Inspections: Inspected: Expires: Inspector: Status: 05/26/2006 Neil J. Bateson Passes Comments: Title 5 Title 5 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 Residential Property Record Card PARCEL_ID:210/038.0-0321-0000.0 MAP:038.0 BLOCK:0321 LOT:0000.0 PARCEL ADDRESSA98 SALEM STREET PARCEL INFORMATION Use-Code: 101 Sale Price: 370,000 Book: 05711 Road Type: T Inspect Date: 08/16/2001 Tax Class: T Sale Date: 03/29/2000 Page: 0190 Rd Condition: P Meas Date: ' 08/16/2001 Owner: Tot Fin Area: 2470 Sale Type: P Cert/Doc: Traffic: M Entrance: X IMPRESCIA, RICHARD A Tot Land Area: 1.57 Sale Valid: Y Water: Collect Id: RB ANNETTE M IMPRESCIA Grantor: PETERSON REALTY Sewer: Inspect Reas: S Address: 498 SALEM STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LOW Indust-B/L% 0/0 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 9 Main Fn Area: 988 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R3 Story Height: 2 Bedrooms: 5 Up Fn Area: 1482 Bsmt Area: 988 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 1 182,080 Ext Wall: AV Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0.57 2,679 Masonry Trim: Ext Bath Fix: 1 Tot Fin Area: 2470 VALUATION INFORMATION Foundation: CN Bath Qual: M RCNLD: 313780 Current Total: 530,000 Bldg: 345,200 Land: 184,800 MktLnd: 184,800 Kitch Oual: M Eff Yr Built: 2000 Mkt Adj: 1.1 Prior Total: 495,500 Bldg: 324,200 Land: 171,300 MktLnd: 171,300 Heat Type: FA Ext Kitch: Year Built: 2000 Sound Value: Fuel Type: G Grade: GV Cost Bldg: 345,200 Fireplace: 1 Bsmt Gar Cap: 2 Condition: VE Att Str Val 1: Central AC: Y Bsmt Gar SF: Pct Complete: 100 Att Str Val2: Att Gar SF: %Good P/F/E/R: 100///100 Porch Tvoe Porch Area Porch Grade Factor W 100 SKETCH PHOTO 10 W 10100 Sq.R. 10 r FU"0.5/FU/B/FM 988 Sq.R. 26 26 498 SALEM STREET 38 Parcel ID:210/038.0-0321-0000.0 as of 6/13/06 Page 1 of 1 � I North Andover Board of Assessors Public Access Page 1 of 1 Parcel ID: 210/038.0-0321-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge 498 SALEM STREET ) Location: 498 SALEM STREET Owner Name: IMPRESCIA,RICHARD A ANNETTE M IMPRESCIA Owner Address: 498 SALEM STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 5 - 5 Land Area: 1.57 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2470 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 530,000 495,500 Building Value: 345,200 324,200 Land Value: 184,800 171,300 Market Land Value: 184,800 Chapter Land Value: LATESTSALE Sale Price: 370,000 Sale Date: 03/29/2000 Arms Length Sale Code: Y-YES-VALID Grantor: PETERSON REALTY Cert Doc: Book: 05711 Page: 0190 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=803545 6/13/2006 Septic System Information 498 SALEM STREET Printed On: Thursday,July 05, 2007 System ID: BHS-2002-1399 General System Information Latest Permit Information Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity: Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder: No No Soil Type: Depth: Laundry: No No Hauling/Pumping Listing Quantity Type System Type Pumped Pumped By Transferred To Disposed At Date Pumped allons Routine Septic Tank Andover Septic 03/22/2002 1500 Routine Pump chamber STEWARTS SEPTIC 04/14/2005 1500 Inspections: Inspected: Expires: Inspector: Status: 06/27/2007 Benjamin C.Osgood,Jr. Passes Comments: Title 5 05/26/2006 Neil J. Bateson Passes Comments: Title 5 Title 5 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 Town of North Andover "�°'•,,,,,:: HEALTH DEPARTMENT ,S'gACHUSt� 5 CHECK#: DATE: LOCATION: H/O NAME: r 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 $ t ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Q_,,,T�i't e7" 5 Report $ �✓[�. ❑ Other:(Indicate) $ $t 2506 Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer f. Commonw of Massachusetts �► RECEI. r �r� L j u Title 5 Official Inspection Form �G -- Subsurface Sewage Disposal System Form -Not for Voluntary Assessm nts JUL O 5 Or �M 498 Salem St TOWN OF NQ -10 Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in an p Y Y way. Important: When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Benjamin C. Osgood Jr. cursor-do not Name of Inspector use the return key. New England Engineering Services, Inc. Company Name r� 1600 Osgood Street Suite 2-64 Company Address No. Andover MA 01845 City/Town State Zip Code 978-686-1768 Telephone Number License Number B. Certification 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: asses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 0 (o/Z 2/a 7 Inspecto' Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 498 SALEM NO ANDOVER.DOC-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM yvey 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. Cityffown 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: 2<1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 i Commonwealth of Massachusetts u W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 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. 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts N W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 ❑ 2,- Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Q'. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ©- Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ a Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ []j/,, Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ [;I' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [g' Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 1�r 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 ❑ D,' the system is within 400 feet of a surface drinking water supply ❑ Q' the system is within 200 feet of a tributary to a surface drinking water supply ❑ E3/ 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. 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No IR L 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? ❑ R"' Has the system received normal flows in the previous two week period? ❑ g,, Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ❑p 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? 2' ❑ Was the site inspected for signs of break out? 2 ❑ 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? 211- ❑ 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)] 498 SALEM NO ANDOVER.DOC-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection 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): y q6 G'p Number of current residents: 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 P No Seasonal use? ❑ Yes © No Water meter readings, if available(last 2 years usage(gpd)): ;?50 G Q D Qz,,05 "iD (-/zm7 Sump pump? ❑ Yes © No Last date of occupancy: 1 MZvi-1 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: Last date of occupancy/use: Date Other(describe): 498 SALEM NO ANDOVER.DOC-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title, 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: y�l H�o.S het �3o K 2c��2n 5 Was system pumped as part of the inspection? ❑ Yes E& No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: aQ,1-I- 2c,oa Vet go K F::---.<< Were sewage odors detected when arriving at the site? ❑ Yes g[ No 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N�s4- feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): ri Depth below grade: feet Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ 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: Sludge depth: L Z Distance from top of sludge to bottom of outlet tee or baffle 39 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 �y How were dimensions determined? ibr� 5yr2C S??c�� 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every 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.): 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 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): 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts N w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert D 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.): 13 C'7c / N N1115N. Nt.. it DCKLE CSF S a-,D.S c/fRRy o-Gt v2 ��AKafrC t�.� d2 0�� D �TR�gy7oN tQsr4Cf Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: [� leaching trenches number, length: ? re•zc�¢ ❑ 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, dam soil condition of ( . 9 Y P 9� P vegetation, etc.): A-lLG4 o -Mee,cRL 15 yEWLy 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts N W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St G„M Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No. Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 498 Salem St SVO� Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No.Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. D 1 g-r-AAJ c Es 2—T 41.0 (-vg Z"& z-Dg .52,0 �12tt145, Mo�Sfs 1 T Dg W SCLC M ST12 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 498 Salem St Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for No.Andover MA 01845 06/27/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ['Check Slope D-Surface water N o NE [� Check cellar A.o -4 Shallow wells m o,.j G Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record Tcsz' P i S fl 0 AJ&—I' If checked, date of design plan reviewed: 12.10-g 4 By A-1-EX rpe-Ae kDate ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ElChecked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: 498 SALEM NO ANDOVER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF NORTH AN•DOVSK �f/ u^11SYSTEM PUMPINQ UCpR T` SYSTEM OWNER do ADDRESS SYSTEM LOCA71ON Cs� SSA DATE OF pUMp(N0;^, s.. QUANTITY P UMPED, 7_77- k:tSSPOOL: NO YES .. Sn 'c funk: Pu NO. YES.. . 7 NA rVKU OF SERVICE: KOU'flN,~ EMERU�NC'1' _ RECEIVED ObSERVA•I'10NS: , OOOD CONDITION FUU., •� CovER MAY p 6 2005 aAYY 01.188 BAFFLES IN PLACL•. .ROOTS - Tp�yiy ur NU I N ANDOVER _ _ L6•tiCf ReLD RUNBACK HEALTH DtPARTMENT 6XC63SIVE SOLIDS ,,,. , FLOODED -SOLID.CARRYOYER,_,_.On$'ER EXPLAIN Syetom Pumped by _. •....• G.. VUMMIdNTS• CVN I'EN'i'S fK,1NSF'lrRR.EU I'l� , TOWN QFNO$TH ANDOVER SYSTEM PUMPING RECORD ;'; DATE p " f �.._ -----�'- SYSTEM OWNER&ADDRESS SYSTEM LOCATION mpre s�/ s i r6 AFI iv- a��dve„�, lVQo DATE OF PUWIN9 ? QUANTITY'PUMPED I S S CESSPOOL NO YES!_ SEPTIC TANK NO YES NATURE OF SERVICE;:,RQT)TINE Z EMERGENCY OBSERVATIONS; GOOD CONDITION FULL TO COVER 4AVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS 'FLOODED SOLID CARRYOVER- OTHER EXPLAIN SYSTEM PUMPED BY Am �. GLG . lJY' sem' COMMENTS: CONTENTS TRANSFERRED TO `1�'`'V0 .I7 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 3/30/00 This is to certify that the individual subsurface disposal system constructed (X) or repaired ( ) by Dean Chongris at Lot C Salem Street(498) 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 I I TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) �m 2� I J DATE OF PUMPING: QUANTITY PUMPEDGALLONS a CESSPOOL: NO ✓ YES SEPTIC TANK: NO YES i 1 / NATURE OF SERVICE: ROUTINE 1/ EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) I SYSTEM PUMPED BY: �?,� I i COMMENTS: I CONTENTS TRANSFERRED TO: I 1I TOWN OF NORTHANDOVER SYSTEM PUMPING RECORD r r• — � I) •� 7200 1'EM OWNER & ADDRESS „ SYSTEM LOCATION._ -W-�- (example; left front of house) se s 57 1"C OF PUM1)NC.u`� QUANTITY PUMPCD 0 LL()� 1 C. 1:.�.�11001-: NO YES SEPTIC TANK: NO YESy _ a ATURE OF SERVICE: ROUTINE _L"EMERGENCY I GOOD COND11'ION. NULL TO COVE HRAYY CREASE BAFFLES IN PLACE ROOTS LEACHFICLD RUNBACK.. CXCESSIVVE SOLIDS FLOODED SOLIDS CARRYOVER O�HFR (EXPLA.)N) vsI LM PUMPCD BY: � U11wlFNTS. !'ItANSFCIZRED TO: fit/ Commonwealth of Massachusetts RECEj City/Town of System Pumping Record JUN 2 2 Form 4 L' &, bTUJt-qh=-;-e oa=NORM P DEP has provided this form for use-. local Boards of Health. Other forms may b P Y Y information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location4g)Rig vont of Nous Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address �J4� CCity/rown State �yZip Code �4 2. System Owner. Name' Address(9 different from location) City/Town State Zi �� Telephone Number t B. Pumping Record P 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes al o If yes, was it cleaned? ❑ Yes ❑ No: " 5. Condition of System:� Uj"—,u 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company 7. =Locae contents were disposed: Lowell Waste Water 5 Sig HaulmU Date t5form4.doc-06/03 System Pumping Record•Page 1 of 1 NORT#i o' vm Of over No. ;o ��; C: L t dover, Mass., lot S 5� 7 BOARD OF HEALTH Food/Kitchen PERMIT Septic System THIS CERTIFIES THAT..... ..J.P.04 Cdy M V �v�V BUILDING INSPECTOR C.......... ....................... Foundation I'd* .,...� /�9 9 LA has permission to erect............... buildings on .W y a ..a laws s Roughu./I�(, _ s1� to be occupied as.... ........................ .................. ....... ................................�.....................���'.��'ri Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMTING INSPECTO VIOLATION of the Zoning or Building Regulations Voids this Permit. �1' zC—- 3 PERMIT EXPIRES IN 6 MONTHS ` UNLESS CONSTRUCTION T S ELEC �I E Len9=2 "Z1110, P oug ............ BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough L - No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE 3 .2,z Smoke Det. MURPHY, M ACK ENZIE , M ICHAELS & SULLIVAN , LLP MAY 3 0 ATTORNEYS AT LAW ONE LIBERTY SQUARE BOSTON, MASSACHUSETTS 02109 Steven . Marullo - -- — y I Telephone: (617)350-7700 sjm@mmmslaw.com Facsimile: (617) 350-0007 May 26, 2000 Sandra Starr, R.S., C.H.O. Health Director Town of North Andover 27 Charles Street North Andover, MA 01845 Re- 492 Salem Street, Lot C. Dear Ms. Starr.- This office represents Richard Impressia with respect to Lot C, 492 Salem Street, North Andover. Pursuant to Massachusetts General Laws, Chapter 66, Section 10, please provide a copy of your entire file with respect to Lot C, 492 Salem Street to the undersigned. Such copies should include, but not be limited to correspondence, notes, interoffice memoranda, diaries, telephone messages, lab reports, engineering reports, notices and meeting minutes. Thank you for your anticipated cooperation. Very truly yours, Steven J. Marullo SJM-d cc: Richard Impressia CERTIFIED MAUJRETURN RECEIPT REQUESTED #7099 3400 0008 1774 8492 MURPHY, M ACK ENZIE , M ICHAELS SULLIVAN , LLP ATTORNEYS AT LAW ONE LIBERTY SQUARE BOSTON, MASSACHUSETTS 02109 Telephone: (617) 350-7700 Facsimile: (617)350-0007 June 7, 2000 Susan Ford Health Inspector Town of North Andover 27 Charles Street North Andover, MA 01845 Re: 492 Salem Street, Lot C Dear Ms. Ford: Pursuant to our telephone conversation of Monday, June 5, 2000, I am enclosing a check in the amount of$28.60 for a copy of your file. Thank you. Very truly yours r; J Steven J. Maru ���/��� cc: Richard Impressia x JUN 4 8 � MURPHY, M ACK ENZIE , M ICHAELS MAY 3 0 & S ULLIVAN , LLP ATTORNEYS AT LAW ONE LIBERTY SQUARE BOSTON, MASSACHUSETTS 02109 Steven J. Marullo Telephone: (617) 350-7700 sjm@mmmslaw.com Facsimile: (617) 350-0007 May 26, 2000 Susan Ford Health Inspector Town of North Andover 27 Charles Street North Andover, MA 01845 Re: 492 Salem Street, Lot C Dear Ms. Ford: This office represents Richard Impressia with respect to Lot C, 492 Salem Street, North Andover. Pursuant to Massachusetts General Laws, Chapter 66, Section 10, please provide a copy of your entire file with respect to Lot C, 492 Salem Street to the undersigned. Such copies should include, but not be limited to correspondence, notes, interoffice memoranda, diaries, telephone messages, lab reports, engineering reports, notices and meeting minutes. Thank you for your anticipated cooperation. Very truly yours, Steven J. Marullo SJM:d cc: Richard Impressia CERTIFIED MAIL/RETURN RECEIPT REQUESTED #7099 3400 0008 1774 8485 r;.* RT1�`, Town Of North Andover � -`�'•�� William J. Scott Community Development & Services Director �* 27 Charles Street (978) 688-9531 " North Andover, Massachusetts 01845 SACHU`�� Fax 978-688-9542 Board of Appeals (978) 688-9541 April 18, 2000 Building Department (978) 688-9545 Richard Impressia 498 Salem Street Conservation North Andover, MA 01845 Department (978) 688-9530 Re: Lot C 492 Salem Street Health Department . p Dear Mr. Impressia. (978)688-9540 This letter is in regards to the septic system located on your property known as Public Health Lot C Salem Street. Although the Health Department has already signed off on Nurse this property we feel it is important to inform you of an potential problems we (978) 688-9543 P P Y P Y Y P may observe. Planning It was recentlynoticed that a paved as halt walkway was installed from the house Department P p Y (978) 688-9535 to the driveway. The location of the walkway appears that it may be located over components of the septic system. The fact that a pavement several inches thick has been located in the septic system area is a cause for concern for the integrity of the system. Another issue for concern is the type and weight of the equipment or vehicles that may have been on the system leach area, since direct pressure can cause fatal damage to the system. Please remember that at no time should a rubber tired vehicle of any kind be allowed on top of your septic system as this may cause a disruption or cessation of system functioning. Also note that there is likely less than one foot of cover protecting your system which is_also needed for protection. We sincerely hope that all of the components of this system remain accessible and that the increased impervious surface does not have any negative impact on the system function. y ' If you do not have a septic system as-built for your property, a copy of the in-ground location of your system can be obtained at this office. Although these systems are underground and out of sight, for the sake of longevity they must be maintained and protected. The staff in the Health Department believes that it is in your best interest that we share this information with you. Please feel free to contact this office with any questions regarding the protection of your system. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: W. Scott file L AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER j LOT LINES &LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE ' TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS e/ 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 t/ ORIGINAL STAMP & SIGNATURE `f IMPERVIOUS AREAS - DRIVEWAYS, ETC. i/ NORTH ARROW o/ LOCATION &ELEVATIONS OF BENCHMARK USED TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby Certify that the Sewage Disposal System (?) constructed- ( ) repaired, by J �i�X located afi !_ r e A �L�AI�r� free t was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # dated with an approved design flow of A40 gallons per day, The materials used were in conformance with those specified on the approved plan; the system was installed iu accordance with the provisions of 310 CN1R 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 subnz tied to the Board of Health. Bed inspection date: ;- - Design n Final inspection date: 3-z� -zao� En " Represent7 ' Installer, i .#: � a� i Engineer: � /� Date- ton ate: � o s to r Y n ti d Morin G v { 30969 p� CIVIL Q �' G/STERE t`�2 ��/aNAL fN�' 03/30/2000 19:47 1-978-683-6166 EPM CONTRACTING INC PAGE 01 3al 13 TOWN OF NORTH ANDOVER SEWAGE nZSP.OSAL SY'ST'EM INSTALLATION CERTIFICATION The utdcrsignd hereby cer*that the Sewage Disposal System constructed, ( ) waked, f located at f,� JW�'yL��' ,�o C- was installed in conformance with the North Andover Board of Health approwd plan, System Design Permit , dated .with as approved design gow of 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,grid the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built wbich has beta submitted to the Board of Health. Bed inspection date,. 8nginaeir Representative Final inspection date- Engineer Represeatative L�BtaUar: laic.# Date: Design Enneer: Date, TO 30ad o NoiionNisNoo SnNAO Z1gMsees 8Z IEt 000E/Wee 76"1 Town of North Andover t NORTH , OFFICE OF 3�°c�, .o 6 ° COMMUNITY DEVELOPMENT AND SERVICES ° � A 27 Charles Street North Andover, Massachusetts 01845 4°^, °•° �y WILLIAM J. SCOTT 9SSACHUS Director (978)688-9531 Fax(978)688-9542 March 22, 2000 Mr. James Mac Dowell Eastern Land Survey Associates, Inc. 104 Lowell Street Peabody, MA 01960 Re: 492C Salem Street,No. Andover Dear James: This is to inform you that the revised septic system plan dated 3/13/00 for the site , referenced above has been approved. If you have any questions, please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, a � �r 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 Professional Land Surveyors&Civil Engineers ESSEX SURVEY SERVICE 1958- 1986 OSBORN PALMER 1911 - 1970 BRADFORD&WEED 1885- 1972 March 14, 2000 Ms. Sandra Starr, R.S., C.H.O. Health Director Town of North Andover Office of Community Development & Services 27 Charles Street North Andover, Massachusetts 01845 RE: F 11074 Lot C Salem Street North Andover, MA Dear Ms. Starr: Accompanying this letter for your review and comment are four (4) prints of a Plan for the referenced lot showing a breakout wall to the northwest of the leach area. As we discussed, it is hoped that this Plan can be incorporated as a supplement to the ap- proved design. The wall is proposed in response to a change in the design of the house, whereby the garage is now to be located in the basement. Please contact the undersigned or Clayton A. Morin, P.E. with any questions. A check in the amount of $60.00 accompanies this letter. Very truly yours, � I JHM/tlm James H. MacDowell MAR 16 ; ^1 Enclosure cc: Joseph Pelich 104 LOWELL STREET PEABODY, MASS. 01960 TELEPHONE: 978-531-8121 TELECOPIER: 978-531-5920 E-MAIL: elsai@prodigy.net Mar-22-00 09:41A Paul D. Turbide, PE/PLS 978-465-0313 P.04 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 third review for 429 Salem Street, Lot C (revision date of March 13, 2000) Dear Sandra, The concrete foundation and garage floor as built require that an impervious barrier be installed. I find that the plan dated March 13, 2000 of the proposed concrete retaining wall impervious barrier adequately addresses the regulations. If you have any questions or comments please feel free to contact me. Sincerelyarn, Carlton A_ PE/P S Salem429c4.doc 429C Salem Street PODT iti EIvGINEEGING Civil Engineers& Land Surveyors One Harris Street Newburyport,MA 01950 (978)46S-8594 2 Town of North Andover H°RTH OFFICE OF 3?°y�` ° °1�° COMMUNITY DEVELOPMENT AND SERVICES ° 1- A 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT SAC US Director (978)688-9531 Fax (978)688-9542 March 17, 2000 Eastern Land Survey Associates, Inc. 104 Lowell Street Peabody, MA 01960 Re: 492C Salem St.,N. Andover Dear Mr. MacDowell: The four plans and check for the review of the retaining wall at the above referenced site have been received by the Health Department and sent to the consultant for review. We expect to have a response by early next week. This letter comes to remind you that in compliance with 310 CMR 15.255(x) and (b), once the wall has been constructed the Designing Engineer must certify that the wall has been constructed of poured concrete, has no weep holes and is waterproof. The Board of Health must also inspect the wall for compliance with the plan. I understand that the transfer of the title is scheduled for March 29`h and am hoping that with your assistance and cooperation we can finish this project prior to that date. Please call if you have any questions or concerns. 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 4 Town of North Andover Ot NORTIy , OFFICE OF 3? y°`«,c BOOL COMMUNITY DEVELOPMENT AND SERVICES ° 27 Charles Street ° ' North Andover, Massachusetts 01845 A..y`°� •°.•P��y WILLIAM J. SCOTT SSACMus� Director (978)688-9531 Fax(978)688-9542 January 25,2000 Cyrus Construction Corp. Joe Pelich P.O.Box 583 North Andover,MA 01845 Re: 492 Salem Street,Lots C&D Dear Mr.Pelich: I am concerned that over two weeks have passed since Susan Ford of this office sent you a letter detailing the remaining items required for the completion of the above two septic system installations. We have had no requests for final grade inspections,nor has your engineer communicated with us or submitted the as- builts required Typically we do not send reminders,however we are concerned about the progress of your development and the fact that we have not had communication from you,your installer,or engineer. Apparently the building department is also confused as to the lack of progress.According to the building department there have been no requests for a final building inspection on Lot D or any inspection on Lot C other than for the footings. In addition,since we have not had a request for a final grade inspection,I am very concerned for the integrity of the septic systems which according to our records are open to the weather. I strongly urge you to complete the septic installation process as soon as possible to avoid further risk to the integrity of the septic systems. The longer these systems are open to the weather the greater the possibility of problems in the future. We are extremely concerned for the future homeowners,since septic systems tend to be very expensive. In reference to our prior discussion during the initial stages of your construction,Mr.Scott approached me recently asking about our conversation regarding your timing of the work in the winter season and the December Is'cutoff date for installations. I directed Mr. Scott to your memorandum of December 8, 1999. In the memorandum you recalled that I called your office on December 5th to inquire about the status of the system,indicating that if no work had been done then the best thing for the system was to finish it in the spring. As you may recall you stated that the trenches were installed,and had actually been done over the weekend. I asked that you have your engineer call the office according to protocol once his inspection was complete and then have the installer call to set up a time for an inspection.Those calls came in on the 6t6 and the inspection was set up and begun by Susan Ford and your installer on the 7''of December. I strongly urge you to have your engineer complete and submit the as-builts,have your installer finish any grading and all other work detailed in Ms.Ford's letter and call the office for final grade inspections. Please complete this installation process so that we can issue the Certificates of Compliance. If you have any questions about Susan Ford's letter about what is needed to finish the installations,feel free to call the office,or better yet have your licensed installer contact us. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 1 None of the septic systems that have been approved by the Health Department since Susan Ford and myself have begun work here over 7 years ago have failed. We consider this as testimony to our commitment to ensure quality septic review and installations for the homeowner. We do not allow installation of systems that do not meet the required specifications. Please do not confuse our high standards as obstacles to your progress.Before you move forward to complete more construction projects beyond the ones you have accomplished in North Andover,your own home and your current project,I would encourage you to communicate with us to learn the regulations and required process prior to beginning a construction project. Since your engineer has never prepared plans within the context of our regulations I would recommend that he join us in a review of our procedures. The vast majority of general contractors have their subcontractors,who originally applied for the permits,manage the installation of their trade.Your project management desire to be the sole focal point for your projects requires that you become the expert. Many new contractors have sat down with us prior to construction and gone over the necessary steps to insure an expedient and quality installation. Incidentally, if you have a future homeowner that has any questions or concerns,please let them know that we would be happy to speak with them at any time. Sincerely, Sandra Starr,R.S.,C.H.O. Health Director Cc: Scott BOH File 'JAN24 [1 1= Cyrus Construction Corporation Post Office 583 North Andover,Massachusetts 01845 Phone(978)683-3605 Fax(978)683-2913 Date: 1/24/00 To:William Scott From:Joseph Pelich Regarding: Board Of Health Pages:fax only Message: I have not contacted you since 1/5/00.1 was asked to get the"sign offs"then we could speak I want to know if you would like to speak with me concerning what transpired.I have put on"hold"any further action and have not provided further documentation to any concerned party,or legal council. Just the fact that I was told to stop work on December 1, 1999 by Ms.Starr is suspect enough,over twelve systems were being installed at that time and I was singled out to be stopped. This is just one of many grievances with regard to Ms.Starr. It's absolutely amazing to me that there are references being made to the fact that my involvement has confined things.Ms.Starr contacted me directly to shut me down.I never contact her until after that incident.Read the correspondence in the file. This is a very serious matter I have incurred costs in excess of ten thousand dollars from Ms.Starr's actions.The homeowners will also incur similar costs and will be contacting you shortly. This matter could have been resolved and these costs avoided if someone had responded to my numerous requests for a meeting and a resolution. I feel strongly you and I should meet to discuss matters before they go further.i suspect a subsequent meeting with the homeowners will be required on your part as they are looking for an explanation and action. Sincerely, /Joseph P�eli4ch4V TO 39Vd 0 NOIlonaiSNOO snl JAO ZL9Z9£S80S L6:60 0002/tZ/T0 I Town of North Andover , NaRTs, OFFICE OF �o , :COMMUNITY DEVELOPMENT AND SERVICES r' 27 Charles Street + ° North Andover, Massachusetts 01845 g WUJ IAM L SCOTT �Ss�cr+uset� Director �. (978)6887953.1'` Fax(978)688-9542 Cyrus Construction Corp. Joe Pelich P. 0. Box 583 North Andover,MA 01845 January 10,2000 Dear Mr. Pelich, This correspondence is in regards to the property,known as Lot D Salem Street, North Andover. As we approach the completion of the septic system installation I felt it necessary to review the final steps of the process. I believe that this communication will benefit all parties involved. Typically,this correspondence is directed to the Design Engineer,however,it is clear that you would like to be the lead person in this matter, therefore,I am sending this to you. Prior to the Health Department recommending the issuance of a Certificate of Occupancy the following tasks must be completed and the listed paperwork must be submitted 1) The installer should request an inspection of the final grade of the system 2) The engineer should submit an As-Built plan of the septic system 3) The As-built plan must show the resolution of the engineer's decision to eliminate the structural break-out wall 4) The installer and engineer must sign an original Installation Certification Form and submit it to the Health department See below for additional descriptions 1) On January 6,2000,Health Department personnel and the installer conducted the final inspection of the pump system. This approval allows the septic installer to proceed with the final grading of the site. When the looming and grading is complete please have the installer,Dean Chongris,contact the Health Department to request a final grading inspection so that we may perform the inspection in a timely manner. Note: Please be careful to not allow any heavy,rubber tire equipment on this system, as it may damage the underground components and firture functioning of the septic system(appropriate size track machines only). BOARD OF APPEALS 68&9541 BIJU DING 688-9545 CONSERVATION 68&9530 HEALTH 688-9540 PLANNING 688-9535 2) As required by the Title V regulations, a final As-Built,drawn up bythe Design Engineer, must be submitted to the Health Department Please see the attached sheet titled,As-Built Checklist. To be considered complete,the final As-Built �- must contain the items listed Since your engineering firm,Eastern Land Survey Associates, does not have extensive experience in the Town of North Andover's Procedures, it helpful to forward this list to m. may be hel P the 3) In regards to the"final contours". It is especially important that this item is shown on the As-Built due to the changes in the field during the installation of the septic system.. As you should recall, on November 30, 1999,I conducted the final D-box inspection on Lot D. At that time I noticed that the proposed wall which is shown on the approved plan had not been installed Per the requirements of the plan"notes"(see attached),I contacted the engineer from your phone and spoke to him about this error. The engineer told me that alteration to the planned location and elevation of the driveway could be made so that the structural wall would not be necessary. Under his direction the installer would be able to achieve conformance with the requirements of section 15.255 3-6(see attached Title V regulation excerpt and#.13 of notes). I stated that this would be acceptable only if the required slope could be achieved The importance of this requirement is that if the breakout slope does not meet the requirements set by the state,the effluent from the septic system could leak out on the side of the yard and end up running down the driveway. Therefore, if it is determined by the engineer that the slope does not conform to State Title V, the structural wall, as shown on the approved plans,must be constructed on this lot. 4) The installation certification form,received upon issuance of the Disposal Works Construction Permit,must be signed and dated by both the installer and the engineer and submitted to the Health department This form indicates that the system was constructed as per the approved plan. Thank you for your anticipated cooperation in this matter. If you have any questions regarding any of the above procedures please do not hesitate to call the Health department at the phone number listed below. Sincere , usan Ford Health Inspector Cc: Eastern Land Survey Associates, Clayton Morin,P.E. Bill Scott,No. Andover CD&S Director . • Memorandum To: Sandy Starr ' From: Mike McGuire Date: 1/25/00 Re: Peterson Farm LLC 4 lot Form"A"Plan Please be advised that upon review of the status of the above noted project the following has been ascertained. 1) Permit for lot`D" 10/1/99 Footing& foundation 10/8 & 10/14 Rough inspection 12/6 insulation inspection 12/13 Awaiting for final inspection request 2) Permit for lot"C" 11/4 Footing& foundation 11/8.& 11/15 As built received and transferred 11/18 No other inspection request to date 3) Permit for lot"A" 12/10 Footing& foundation 12/13 & 12/20 As built received and transferred 1/24/00 No other inspection request to date 4) Permit for lot`B"DEMOLITION of barn only issued-1/20/00 No other request"for inspections or correspondence. Unknown From: Donna Mae D'Agata Sent: Wednesday,January 05,2000 3:25 PM To: William Scott Subject: Joseph Pelich Joseph Pelich called the office. He wishes he could speak with you. He doesn't want to call the Town Manager, speak to you. He will be here today. He will call call the Selectmen. He would like just to s he doesn't want to 1 P some Selectmen. He thought Clayton Brown was going to inspect two systems. Clayton inspected ONE system old Mr. Brown to inspect one system only.only and d passed. Mr. Pelich contends, Sandy Starr t p Ys Y Mr. Pelich will be into see you as he wants a resolution to this. He requests you call him: Beeper#444-7370. DMD Page 1 i Unknown From: Donna Mae D'Agata Sent: Wednesday, January 05, 2000 3:21 PM To: Sandra Starr Cc: William Scott Subject: Joseph Pelich Joseph Pelich just called the office. Clayton Brown was out at his site, he checked the sytem and it passed. Mr. Pelich contends that you told Clayton to check only one system, not the two systems. Mr. Pelich plans to come to this office to see Bill Scott. He is having some Selectmen call Bill also. Can you provide some back-up to this issue today please? Thanks, DMD Page 1 December 28, 1999 Mr. Joseph Pelich Cyrus Construction Corporation P. 0. Box 583 North Andover, MA 01845 Re: Lot C Salem Street Dear Mr. Pelich: This letter is in reference to your letter dated December 27, 1999, which was fax December 28th, 1999. In reference to our testing it is m received by aY g Y t the site and collected the samples.understanding that UTS appeared a les. If this is p true, please provide a letter to the Health Department, from UTS indicating that the material tested was as a result of their site visit and collection of the material from the site. In reference to the back filling of the system, I do not have the authority to approve such action. As indicated in prior correspondence from the Health Department (December 9th) you should contact the department so that they can call the consulting engineer and schedule an inspection. The UTS testing occurred on December 10th, your letter requesting an inspection (dated December 27"d) was faxed to my office 18 days later on December 28th. Further, it appears that your plan was approved on May 12, 1999 and your application for construction occurred on November 12, 1999, 5 months later. The timely submittal of information will insure a more expeditious installation. I have reviewed the files to determine what has "transpired" it appears that the letters you have forwarded are recapitulations of discussions, and letters, with the Health Department. The Health Department has been clear that the stone testing and the process for such testing should be followed. That includes meeting Title 5 specifications for cleanliness of stone and insuring that there is no possibility of contamination of the material to be tested. I would recommend that Mr. Joseph Pelich Page 2 December 28, 1999 you close the process by obtaining a letter from UTS to certify that they tested the material on site. The UTS form and information refers to the Torremeo Pit and does not clearly indicate that the stone tested was the stone currently on site. Call the Health Department to schedule an inspection by the outside consulting engineer. In reference to the installer performing the work (your letter of 12/08/99, received 12/09/99 by fax), the Health Department has been clear to all applicants that the installer is responsible for all aspects of the installation. Please understand that there is a past circumstance where the Health Department has discovered work by persons other than the licensed installer and that installer's license was suspended for two months. The importance of the installer conducting the installation and the necessary approvals is clearly an issue that has been and continues to be important for all applicants. A request that the installer performs the work should not be considered as an insult, it should be considered as a reminder that the installer legally has responsibility for the installation. It appears that the Health Department in every case has responded quickly (within the same day of your letters) and professionally. The Health Department is taking the additional step of placing the matter in the hands of the consulting engineer to provide you with an expeditious inspection. Further, 'it appears that you have a solution to the situation, which can be easily achieved, with your actions. Sincerely, William J. Scott Director Cc: Town Manager, Robert J. Halpin w/Encl. Board of Health Chairman, Gayton Osgood w/Encl. Sandra Starr, Health Administrator w/Encl Cyrus Construction Corporation Post Office 583 Forth Andover,Massachusetts 01845 Phone(978)683-3605 Fax(978)683-2913 Date:2/1/00 To:Bill Scott From:Joseph Pelich Regarding: Sandy's letter Pages:farAaly el- p Message: cJ� A k-er ,� � � � le14 Cyrus Construction Corporation TO 39Vd 0 NOIiona1SN00 snaAO iL9 96S8OS LE:S0 000�/T0/�0 r Cyrus Construction Corporation Post Office 583 North Andover,Massachusetts 01845 phone(978)683-3605 Fax(978)683-2913 Date:2/l/00 To:Sandra Starr From:Joseph Pelich Regarding: Your letter dated 1/25/00 Pages:fax only Message: I received your letter dated 1/25/00 on 1131/00.I do not have the time this week to respond.Given that you have included the building department in your correspondence I will take a closer look at my file and forward this to my attorney. What relevance does the building department have with regard to the septic systems??You are incorrect in your statement that there is confusion with the building department. Are you the new construction manager for my company? I am horrified and dismayed that you reference the building department. Mr_ Scott asked we complete lots c and d prior to continuing our disagreement.I had all intentions of doing such,permanently,until receipt of this letter. m requests for a meet now-you suggest that I have not You rebuffed man Y $g tact me.Yo Y 9 m8 1 do not con Y Please kept in contact with the Health Deparnnent.Have Susan or Bill call or write to discuss any issues. I will provide an as built for lot D approximately the end of next week ands, 70seph Pelich--President Cyrus Construction Corporation I0 39Vd 0 NOIionalSN00 sn8AO ZL9z96G80G 9-:G0 000Z/Z0/z0 1 Town of North Andover NO oTN OFFICE OF �r „•`" °oma COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover,Massachusetts 01845 WII.I.IAM L SCOTT sSAGNVsb Director (978)688-9531 Fax(978)688-9542 January 25,2000 Cyrus Carlstruction Corp. Joe Pelich P.O.Box 583 North Andover,MA 01845 Re: 492 Salem Street,Lots C dt D Dear Mr.Pelich: I am concerned that over two weeks have passed since Susan Ford of this office sent you a letter detaii'mg the remaining items required for the completion of the above two septic system installations. We have had no requests for final grade inspections,nor has your engineer communicated with us or submitted the as- builts required. Typically we do not send reminders,however we are concerned about the progress of your Wlok ve opmen unicabon from y in Apparently the building department is also confused as to ifie lack of progress.According to the builduig S department there have been no requests for a final building inspection.on Lot D or any inspection on Lot C than for the footings. In addition,since we have not had a request for a final grade inspection,I am very concerned for the integrity of the septic systems which according to our records are open to the weather. I strongly urge you to complete the septic installation process as soon as possible to avoid further risk to the integrity of the septic systems. The longer these systems are open to the weather the greater the possibility of problems in the future. We are extremely concerned for the forum homeowners,since septic systems tend to be very expensive. In reference to our prior discussion during the initial stages of your construction,Mr.Scott approached me recently asking about our conversation regarding your tiling of the work in the winter season and the December l'cutoff date for installations. I directed Mr.Scott to your memorandum of December 8, 1999. In the memorandum you recalled that I.called your office on December 5th to inquiet about the status of the system,indicating that if no work had been done then the best thing for the system was to finish it in the sprung. As you may recall you stated that the trenches were installed,and had actually been done over the weekend. I asked that you have your engineer call the office adding to protocol once his inspection was complete and then have the installer call to set up a time for an inspection.Those carts came in on the 6iD and the inspection was set up and begun by Susan Ford and your installer on the 7°t of December. I strongly urge you to have your engineer complete and submit the as-builts,have your installer finish any grading and all other work detailed in Ms.Fad's letter and call the office for final grade inspections. Please complete this installation process so that we can issue the Certificates of Compliance. If you have y questions about Susan Ford's tetter about what is needed to finish the installations,fuel free to call the office,or better yet have your licensed installer contact us. Cori A) U-k BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Z0 39hd 0 NOIlonaiSNOO snaAO cL9Z96S00S L6:S0 000(Z/T0/Z0 Town of North Andover NORTIy OFFICE OF 3a cg`" "14,0 COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street AL North Andover,Massachusetts 01845AArlo oOT�O P` y WILLIAM J. SCOTT SS,4 USS Director (978)688-9531 Fax(978)688-9542 i Cyrus Construction Corp. Joe Pelich P. 0. Box 583 North Andover,MA 01845 January 10,2000 Dear Mr. Pelich, This correspondence is in regards to the property, known as Lot.D Salem Street, North Andover. As we approach the completion of the septic system installation I felt it necessary to review the final steps of the process. I believe that this communication will benefit all parties involved. Typically, this correspondence is directed to the Design Engineer, however, it is clear that you would like to be the lead person in this matter, therefore, I am sending this to you. Prior to the Health Department recommending the issuance of a Certificate of Occupancy the following tasks must be completed and the listed paperwork must be submitted. 1) The installer should request an inspection of the final grade of the system 2) The engineer should submit an As-Built plan of the septic system 3) The As-built plan must show the resolution of the engineer's decision to eliminate the structural break-out wall 4) The installer and engineer must sign an original Installation Certification Form and submit it to the Health department See below for additional descriptions 1) On January 6, 2000, Health Department personnel and the installer conducted the final inspection of the pump system. This approval allows the septic installer to proceed with the final grading of the site. When the looming and grading is complete please have the installer,Dean Chongris, contact the Health Department to request a final grading inspection so that we may perform the inspection in a timely manner. Note: Please be careful to not allow any heavy, rubber tire equipment on this system, as it may damage the underground components and future functioning of the septic system(appropriate size track machines only). BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 2) As required by the Title V regulations, a final As-Built, drawn up by the Design Engineer, must be submitted to the Health Department. Please see the attached sheet titled,As-Built Checklist. To be considered complete, the final As-Built must contain the items listed. Since your engineering firm,Eastern Land Survey Associates, does not have extensive experience in the Town of North Andover's procedures, it may be helpful to forward this list to them. 3) In regards to the"final contours". It is especially important that this item is shown on the As-Built due to the changes in the field during the installation of the septic system.. As you should recall, on November 30, 1999, I conducted the final D-box inspection on Lot D. At that time I noticed that the proposed wall which is shown on the approved plan had not been installed. Per the requirements of the plan"notes"(see attached), I contacted the engineer from your phone and spoke to him about this error. The engineer told me that alteration to the planned location and elevation of the driveway could be made so that the structural wall would not be necessary. Under his direction the installer would be able to achieve conformance with the requirements of section 15.255 3-6 (see attached Title V regulation excerpt and#13 of notes). I stated that this would be acceptable only if the required slope could be achieved. The importance of this requirement is that if the breakout slope does not meet the requirements set by the state,the effluent from the septic system could leak out on the side of the yard and end up running down the driveway. Therefore, if it is determined by the engineer that the slope does not conform to State Title V, the structural wall, as shown on the approved plans, must be constructed on this lot. 4) The installation certification form, received upon issuance of the Disposal Works Construction.-Permit, must be signed and dated by both the installer and the engineer and submitted to the Health"department. This form indicates that the system was constructed as per the approved plan. Thank you for your anticipated cooperation in this matter. If you have any questions regarding an of the above procedures lease do not hesitate to call the Health g g Y p p department at the phone number listed below. ;Sincerean Ford Health Inspector Cc: Eastern Land Survey Associates, Clayton Morin,P.E. Bill Scott,No. Andover CD&S Director e TOWN OF NORTH A-NDOVER SENVAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersiped hereby certi=y that the Sewage Disposal System ( ) constructed; ( ) repaired; by located at was installed in conformance with the North Andover Board of He th approved plan, Svstem Desiamn.Pernit r—r' dated 'Mth an approved design Ilow of gallons per day. The materials used were in conformance with those specined on the approved plan; the system was installed in accordance with the provisions of 310 OMR 15000, Title 5 and local renulations, and the final qradina agrees substantially with the approyed plan. All work is accurately represented on the As-built. which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer: Lica: Date: Design Engineer: Date: e f OF 6" INTO THE PARENT MATERIAL THE BOTTOM .OF THE LEACH BED EXCAVATION SHALL BE LEVEL. NOTES a I. SAFETY MEASURES, DAY—TODAY CONTROL OF THE WORK AND CONSTRUCTION METHODS SHALL BE THE RESPONSIBILITY THE CONTRACTOR. ' E 2. PROPOSED BUILDING FOUNDATION CONFIGURATION AND LOCATION ON THE LOT AS SHOWN HEREON SHALL BE VERIFIED AS TO CONFORMANCE WITH. FINAL ARCHITECTURAL PLANS AND ZONING BY—LAWS PRIOR TO ANY CONSTRUCTION. 3. UNLESS SPECIFIED OTHERWISE HEREON, SYSTEM CONSTRUCTION —SHALL CONFORM TO TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND LOCAL BOARD-OF HEALTH REQUIREMENTS. 4. ANY INTENDED REVISION OF PROPOSED ELEVATIONS AND / OR ` HORIZONTAL LOCATIONS AS SHOWN HEREON SHALL BE APPROVED BY 8 THE ENGINEER AND THE LOCAL BOARD OF HEALTH PRIOR TO .yk . IMPLEMENTATION. , 1' 5. THIS PLAN IS FOR DESIGN AND CONSTRUCTION OF THE SEPTIC SYSTEM ONLY. 6. ALL WORK ON LINES, GRADES AND DETAILS SHOWN IS TO BE DONE BY A LICENSED 'DISPOSAL WORKS INSTALLER', THE CONTRACTOR SHALL NOTIFY THE PROPER INSPECTORS AND ALLOW SUCH TIME AS IS REQUIRED FOR INSPECTIONS. 7. ANY CHANGE OF CONDITIONS AT THE SITE SHALL BE BROUGHT TO THE ATTENTION OF .THE ENGINEER AND THE LOCAL 80ARD 0� OF HEALTH PRIOR TO PERFORMING THE RELATED WORK. 8.. NO WELL, IS TO BE LOCATED WITHIN 100 FEET OF THE LEACHING FACILITY. NOR SHALL THE FACILITY BE LOCATED WITHIN 100 FT OF ANY WELL. AT: 9. 'THE SEPTIC TANK SHALL BE. INSPECTED ANNUALLY AND PUMPED A AS REQUIRED. D 10. WATER SAVER. TOILETS AND SHOWER HEADS SHOULD BE USED WITH DW w. THE SYSTEM. 11. THIS SYSTEM HAS BEEN DESIGNED FROM DATA REVIEWED AND 10 ACKNOWLEDGED BY THE LOCAL BOARD .OF HEALTH. 1 Z THE ISSUANCE. OF:A CONSTRUCTION PERMIT AND/OR..A CERTIFICATE 'S OF COMPLIANCE SHALL NOTA IMPLY-AS_.A GUARANTEE THAT: THE SUBSURFACE SEWAGE;.DISPOSAL :SYSTELt WILL FUNCTION SATIS— :r a FA' DRILY. – - 11 CONSTRUCTION OF LEACHING FACILMES IN CLEAN' GRANULAR ' SAND: CLEAN GRANULAR SAND.-SHALL-BE AS DIED IN THE'. . 0. ` STATE ENVIRONMENTAL CODE,,.TITLE REGULATION r: 55(3 FILL SHALL 61E..GRADED AND-PLACED IN ACCORDANCE WITH 6 THE REQUIREMENTS OF 15.255. -- 2 r f AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATION & DEMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAMS, WATERCOURSES Wim' 150' OF SYSTEM LOCATION OF WATER,--GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D-BOX STAMP & SIGNATURE IlYTERVIOUS,AREAS - DRIVEWAYS, ETC. NORTH ARROW FINAL CONTOURS LOCATION & ELEVATION OF BENCKMARK USED LOCUS PLA-NL t_MK: utNAK 1 N1t�1 OF V IRUNNIE\TAL PROTEC'1IU� 15..5.: continued (5) Two or more chambers or galleries connected in series shall constitute a chamber or gallery system. The application of 310 CMR 15.2530)(c) (pits separation distances) shall be applied to adjacent chamber or gallery systems as a unit rather than to the individually connected chambers or galleries. (6) .Inlets to chamber and gallery systems installed in trench configuration shall be provided at intervals not to exceed 20 feet. Chamber or gallery systems in bed configuration shall be provided with at least one inlet for every 40-foot square section. 15.254: Dosintt (1) Gravity Distribution. (a) Dosing systems employing gravity distribution to the soil absorption system shall be restricted to systems designed to accept less than 2,000 gpd. (b) The dosing chamber and pumps shall be designed in accordance with 310 CMR 15.231. (c) Distribution lines to the soil absorption system shall have a minimum diameter of two inches and shall otherwise be in conformance with the provisions of 310 CMR 15.251 (Trenches). (d) Septic tank effluent shall be dosed to the soil absorption system based on the system design flow in accordance with the following frequency: Soil Type Dosing Frequency Sands.Loamy Sands 4 Doses Per Day k Sandy Loam, Loams I Dose Per Day Silt Loam 1 Dose Per Day Clays, Silty Clay Loams 1 Dose Per Day (2) Pressure Distribution. (a) Pressure distribution of septic tank/recirculating sand filter effluent to the soil �•~ absorption system shall be required for all system d,-signs in excess of 2,000 gpd. y (b) The dosing chamber and pumps shall be designed in accordance with 310 CMR 15.231. (c) The pressure distribution system shall be designed in accordance with the procedures set forth in Department guidance. (d) Pumps, alarms and other equipment requiring periodic or routine inspection and `maintenance shall be operated, inspected and maintained in si ict accordance with the manufacturer's specifications.In no instance shall inspection baperformed less frequently than once every three months. The results of such inspections shall be submitted to the approving authority. 15.255: Construction in Fill (1) An where fill is required to lace topsoil,subsoil or other unsuitable or Y system rW nP P •P� impervious soil layer above the requisite four feet of naturally occurring pervious material shall be considered as a system constructed in fill. Any system constructed in 511 which extends either wholly or partially above natural grade for the purpose of complying with 310 CMR 15.212 (depth to groundwatef) is a mounded system. All'soil absorpdon systems constructed in fill shall be sized cuing the soil type of the underlying naturally pervious material. (2) The -finished side slopes of a mounded system shall not be steeper than 3:1 (horizontaLwatical). A minimum 15 foot horizontal separation distance shall be provided between the soil absorption area and the adjacent side slope as measured from the edge of the top of the two inch layer of Hifi to 'i inch washed stone aggregate cover. The toe of the slope shall be a minimum of five feet from any adjacent property line; or a swale or other drainage system directing runoff away from the adjacent property shall be installed. _ Adjustments to the above side slopes may be allowed if a suitable impervious barrier(such as a vertical concrete retainingwall constructed in accordance with 310 CMR 15.255(2 is 1) installed to mitigate potential sewage breakout. 43/2 /95 'v R (Effecu a 3x31/95) 310 Ctit - 530 ?i C\1R DEPARTMENT OF E\\lRO\\lE\T.AL PROTECTIO\ _. . .,•mnuec (a) The retainine wall shall be constructed of reinforced concrete, shall'have no weep holes. and shall be waterproof i b r The retaining wall shall be designed by a Registered Professional Engineer, who shall certify that the above condition is met by the submitted design. (c) The upgradient side of the retaining wall shall be waterproofed. (d) Construction of the retaining wall shall be supervised by the design engineer. (e) An as•built plan shall be prepared and certified by the design engineer that the wall has been constructed in accordance with his approved design plan. (f) The elevation of the top of the retaining wall shall be no lower than the "breakout" elevation,which is the elevation of the top of the two inch layer of 14 inch to 'h inch washed stone aggregate cover. (g) The distance from the wall to the edge of the leaching area should be at least ten feet. (3) Fill material for systems constructed in fill shall consist of select on-site or imported soil material. The fill shall be comprised of clean granular sand, free from organic matter and deleterious substances. Mixtures and layers of different classes of soil shall not be used. The fill shall not contain any material larger than two inches A sieve analysis,using a#4 sieve.shall be performed on a representative sample of the fill.U to 45% weight of the fill sample may P P P P by gh sa p e be retained on the t4 sieve. Sieve analyses also shall be performed on the fraction of the fill sample passing the 44 sieve, such analyses must demonstrate that the material meets each of the following specifications: SIEVE SIZE EFFECTIVE %THAT MUST PARTICLE SIZE PASS SIEVE _n # 4 4.75 mm 100% #50 0.30 mm 10%- 100% 100 0.;5 mm 0%- 20% 9:00 0.075 mm . 00i10- 5°1 A plot of the sieve analyses of the portion of the sample passing the#4 sieve shall fall on or between the lines on the following graph: PARTICLE SIZE DISTRIBUTION #200 111.00 #5o k Sieve S:e To 9C + s0 70 z I l j l I ! jl 'I I I I jl I I I I II II � — I i III i �� j I I � II • rL 30 I I ! zo io t m 0 i AAttton 6o 200 600 2 6 10 mm 1_/1195 (Effective 11/3/95)-corrected 310 CNIM-531 I I Town of North Andover of NORT►, OFFICE OF �a g•` COMMUNITY DEVELOPMENT AND SERVICES ° 27 Charles Street °9 North Andover, Massachusetts 01845 �9SSgcNUs�`�� WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 December 30 1999 VIA: Facsimile & Regular Mail Mr. Joseph Pelich Cyrus Construction Corporation P.O. Box 583 North Andover, MA 01845 Dear Mr. Pelich: Since my letter of the 28th, you have not responded by scheduling an appointment for an inspection. To complete this project I have taken the liberty of scheduling an appointment for the final inspection at Tuesday January 4th at 2 PM on site. In all other cases we require that the installer arrange the inspection. However, since the installer is not requesting the inspection and you are concerned about progress we scheduled the appointment. The following must be done to insure the Final Inspection occurs. 1. The system must be completed. 2. The letter from UTS certifying that they tested material from the site must be in the Health Department prior to Tuesday, January 4th. 3. The Installer must call the Health Department 688-9540 prior to 9am on Tuesday January 4th to confirm that they are available for the above inspection, and the system is complete and ready for an inspection. 4. The Installer must be on site for the final inspection. The effort we are putting forward is unique to any other installer or contractor. We are scheduling the appointment, we are doing so without confirmation that the system is complete, and we are engaging an engineer to allay any concerns you have. It is my understanding that the last time the Health Department was at the site the system was not even connected to the house. Please understand that if the system is not installed completely and/or improperly that the system will not be approved. Take the above simple steps and you can have a completed inspection. Sincere , William J. Scott Director Cc: Rob J. Halpin, Town Manager Sandra Starr, Health Administrator Gayton Osgood, Board of Health Chairman BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover of MO oTH OFFICE OF a� •' °� COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover,Massachusetts 01845 WILLIAM J.SCOTT Ss�c►+us� .Director (978)688-9531 Fax (978)688-9542 January 25,2000 Cyrus Construction Corp. Joe Pelich P.O.Box 583 North Andover,MA 01845 Re: 492 Salem Street,Lots C&D Dear Mr.Pelich: I am concerned that over two weeks have passed since Susan Ford of this office sent you a letter detailing the remaining items required for the completion of the above two septic system installations. We have had no requests for final grade inspections,nor has your engineer communicated with us or submitted the as- builts required Typically we do not send reminders,however we are eouoeined about the progress of your vc oilmen unication horn ur instaUcE,!121[!11:1111 Apparently the building department is also confused as to a aeric of progress.According to the built g S 7 department there have been no requests for a final building inspection of Lot D or any inspection on Lot C than for the footings. In addition,since we have not had a request for a final grade inspection,I am very concerned for the integrity of the septic systems which according to our records are open to the weather. I strongly urge you to complete the septic installation process as soon as possible to avoid further risk to the integrity of the septic systems. The longer these systems are open to the weather the greater the possibility of problems in the future. We,are extremely concerned for the future homeowners,since septic systems tend to be very expensive. In reference to our prior discussion during the initial stages of your construction,Mr.Scott approached me recently asking about our conversation regarding your timing of the work in the winter season and the December l"cutoff date for installations. I directed Mr. Scott to your memorandum of December 8, 1999. In the memorandum you recalled that I.called your office on December 5th to inquire about the status of the system, indicating that if no work had been done then the best thing for the system was to finish it in the sprirlg. As you may recall you stated that the trenches were installed,and had actually been done over the weekend. I asked that you have your engineer call the office according to protocol once his inspection was complete and then have the installer call to set up a time for an inspection.Those calls came in on the 6m and the inspection was set up and begun by Susan Ford and your installer on the 7'of December. I strongly urge you to have your engineer complete and submit the as-builts,have your installer finish any grading and all other work detailed in Ms.Fad's letter and call the office for final grade inspections. Please complete this installation process so that we can issue the Certificates of Compliance. If you have y questions about Susan Ford's letter about what is needed to finish the installations,feel free to call the office,or better yet have your licensed installer contact us. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688.9540 PLANNING 688-9535 Z0 3EJhd O NoiionaiSNOO sn8AO ZL9Z9CS80S /-6:S0 0001Z/Z0/710 Cyrus Construction Corporation Post Office 583 North Andover,Massachusetts 01845 Phone(978)683-3605 Fax(978)683-2913 Date: I/28/00 To:Sue Ford From:Joseph Pelich Regarding: Board Of Health lot c&d Pages: fax only Message: Thank you for your letter,I forwarded it to my engineer and requested he follow it to the"letter",I have never had a situation where you have not been prompt,courteous,and professional.Thank you for all the assistance you have provided. We received inspection for lot c on 1/5100 by the independent engineer and you inspected lot d on 1/6/00. Mr. Scott asked why we had not completed a grading plan and submitted it for fatal review. It took approximately one week to locate all the material and trucking for backfill.Some material was on site,frozen.I could not store additional material on site to eliminate the one-week wait and if it had been stored it would have been frozen solid. Essentially,if you want material in winter you need to locate a very large stockpile and"rip"to the center where it is not frozen.Trucks then must be on site to truck the material and a dozer on site to spread the material. We attempted to locate loam for final grading in the past two weeks or so.Due to the extreme cold every thing was frozen solid.Last week we attempted to dig into a large pile and ripped the face off the bucket of an excavator. The snow acts as an insulator and we have access to loam today.Our intention is to use a bulldozer to clear off the snow. We will then determine grades and do final grading with the loam product. J I0 39hd 0 NOIonalSNOO snaAO ZL9Z9SS80S TT:b0 0002/8Z/T0 i The loam being provided is screened loam using i"-screens.If any stone larger than 2"is in the immediate area we will hand pick it and remove.If such a stone were to be present it would be a stone that existed naturally in the material around the septic area and not part of either the back fill or loam.Sometimes stones can get caught in the tracks of the excavator or dozer and"redeposit"on the septic bed while grading. We will use extreme caution to avoid stones larger than two inches being mixed with the final material. You can see the loam is screened as it is being delivered as I complete this correspondence. When this is complete I will have my engineer do the as built and I will make all necessary arrangements for your fmal review.If you have any questions please do not hesitate to contact me.Please feel free to stop by today to check progress on the site,your input is welcome. Sincerely, Joseph Pelich Z0 39Vd 0 NOIion81SN00 snNA0 ZL9Z98S80S ZZ:b0 000Z/8Z/Z0 Cyrus Construction Corporation Post Office 583 North Andover,Massachusetts 01845 Phone(978)683-3605 Fax(978)683-2913 Date: 1/24/00 To:William Scott From:Joseph Pelich Regarding: Board Of Health Pages:fax only Message: I have not contacted you since 1/5100.1 was asked to get the"sign offs"then we could speak.I want to know if you would like to speak with me concerning what transpired.I have put on"hold"any further action and have not provided further documentation to any concerned parry,or legal council. Just the fact that I was told to stop work on December I, 1999 by Ms.Starr is suspect enough,over twelve systems were being installed at that time and I was singled out to be stopped. This is just one of many grievances with regard to Ms.Starr. It's absolutely amazing to me that there are references being made to the fact that my involvement has confused things.Ms. Starr contacted me directly to shut me down.I never contact her until after that incident.Read the correspondence in the file. This is a very serious matter;I have incurred costs in excess of ten thousand dollars from Ms.Starr's actions.The homeowners will also incur similar costs and will be contacting you shortly. This matter could have been resolved and these costs avoided if someone had responded to my numerous requests for a meeting and a resolution. I feel strongly you and I should meet to discuss matters before they go further.I suspect a subsequent meeting with the homeowners will be required on your part as they are looking for an explanation and action. i Sincerely, �"4441� 1 Joseph Pelich Z0 39hd 0 NOIion8lSN00 sn8AO ZL9Z9£S80S L£=60 000Z/bZ/T0 . Donna Mae D'Agata From: Sandra Starr Sent: Wednesday,January 05,2000 3:29 PM To: Donna Mae D'Agata Subject: RE: Joseph Pelich —Original Message— From: Donna Mae D'Agata Sent: Wednesday,January 05,2000 3:22 PM To: Sandra Starr Cc: William Scott Subject: Joseph Pelich Joseph Pelich just called the office. Clayton Brown was out at his site, he checked the sytem and it passed. Mr. Pelich contends that you told Clayton to check only one system, not the two systems. Mr. Pelich plans to come to this office to see Bill Scott. He is having some Selectmen call Bill also. Can you provide some back-up to this issue today please? Thanks, DMD The inspection,as far as was discussed ws for Lot C Salem Street-no other lot. As far as any of the correspondence discussed,this was the ONLY lot that wasa in question and it was because of the stone. I have no other knowledge of any other request for any other inspection on any other lot. Inspections by Port Eng. cost US money-$50.00 a whack. I okayed and Bill set up this one inspection because of the problems with the stone and Mr. Pelich's apparent desire to create trouble. Whether any request for a final inspection on Lot D came into this office is unknown to me. �r�`o-arlor�lr�A��ea.rL FO DATE IMESgt� M. % O PMflNED :` W �j' ° RETUANEq PHON YOURCALL AR OOE NUMBER EXTENSI V MESSAGE (LEASE CALL:; GN Coil Page 1 w i 01/03/2000 06:24 5085362672 CYR.US CONSTRUCTION C PAGE 01 Cyrus Construction Corporation Post Office 583 North Andover,Massachusetts 01845 Phone(978)683-3605 Fax(978)683-2913 Date: 1/3/00 To:William Scott From.:Joseph Peiich Regarding: Septic Lote/d Pages:5 Message: Reply to your 12f28 letter.Reply to your fax dated 12/30.Copy of letter from UTS. Sincerely, Joseph Pelich 01/03/2000 06:24 5085362672 CYRUS CONSTRUCTION C PAGE 04 CgM,5 C0n,5ftC#0n C0rP0re2#0)7 P.O. Box 583 North Andover,MA 01845 (978)688-4080 1/3/00 William Scott Communiry Development And Services 27 Charles Street North Andover,Massachusetts 01845 Dear Mr. Scott I am in receipt of your fax dated I2/30/99.Please consider this my reply. I did not reply to your letter dated 12/28 because I did not receive it until 12/30,the date of your fax. Thank you for your efforts in scheduling the appointment for inspection.I know you are extremely busy,it is unfortunate that these events have transpired. Be assured that items one thru four will be complete.I have enclosed with this correspondence a copy of the Notarized letter from UTS stating that the sample was taken from Lot C. Given the events surrounding this situation I would disagree that these efforts should be categorized as unique, I think I deserve the effort. Are you aware Ms, Starr also failed my back fill on Lot D?I had two spend an additional 52000 on"dead sand"to make sure it would meet with her satisfaction. I wish you well in the New Year. Sincerely, Joseph Pelich-President 01/03/2000 06:24 5085362672 CYR.US CONSTRUCTION C PAGE 03 Regarding the statements in reference to installation.Ms. Starr took exception with my presence during installation and the presence of the machine operator.The licensed installer was on site when required. When you are made aware of all the facts You will understand why I am particularly concerned by Ms. Starrs comments regarding both installation and requesting I shut down for the winter,both which she confirmed. Regarding your final paragraph,Ms.Starr's actions have not been professional. Indeed they have been at a minimum unethical and my attorney states illegal.Other paxties will ultimate!y decide those points. I do not believe I have a solution to my problem,nor should you.My problem with the Board of Health (Ms.Starr)is much larger than the stone issue. Sincerely, Jose Fetich-Fresident Cyrus Condlrudfon Corporabon 01/03/2000 06:24 5085362672 CYR.US CONSTRUCTION C PAGE 02 Cgrmy C0n,5ftC#0n Corporallon P.O.Box 583 North Andover,MA 01845 (978)688-4080 1/3/00 William Scott Community Development And Services 27 Charles Street North Andover,Massachusetts 01845 Dear Mr. Scott, I am in receipt of your letter dated 12/28/99.I called'Thursday morning and spoke with your assistant inquiring why I have not had a return phone call. She said you sent out a letter yesterday(12/29199)and it should be"there"today(12/30). 1 immediately went to the Post Office box and indeed the letter was there. I am in receipt of your fax dated 12/30/99.Thank you for a prompt reply,(I received your letter 12130) unfortunately this does not relieve my concerns. This is not a personal attack on you, as you are not aware of what has"transpired".This is not a simple "stone"issue.I only wished to end the continued problems with Ms.Starr,not The Board Of Health, and get an explanation for the actions she has taken since 1998. I thought it made sense to discuss any problems directly with the parry I had issue with.I requested a meeting with Ms.Starr,she declined and stated a meeting would be"superfluous". I called you and did not receive a return phone call.I was told by the Selectman to contact you directly and not speak with the Board Of Health for inspections. Regarding your letter of 12/281 think it deserves reply.Paragraph two,the Selectman told me that they spoke with you/Mr.Halpin and I should deal directly with you.The UTS report was dated 12/10,that was the stone pick up date,I faxed the report to you the very day I received it Indeed cony septic was approved 5/12199 as you state.Unfortunately,your local by-law does not allow a system installed until the foundation is poured. I don't always build houses on speculation and prefer a pre- sale,as in this case.A septic cannot be built until the house is sold and the foundation is built."Expeditious installation" is a moot point.Possibly you should review this if you believe systems should be installed when permitted. Paragraph three,a representative of my firm will elaborate and provide documentation with regard to the unethical actions taken against me by Ms.Starr.l would have preferred to first discuss this with Ms. Starr but was declined.I would have preferred to discuss this with you,but you declined. I will close the process by obtaining the letter from UTS.I was told Ms.Starr would,not come to my site; please inform me if this is not true. CHRONO 492 SALEM STREET LOT C • November 17, 1998 -Application for site testing 3 days before end of season—SS explained testing season ended 11/20/98 per regulation. Another contractor argued successfully to BOH chairman that he should be allowed to test. SS requested that this application be given same extension. • December 4, 1998—Port Engineering re-notified that testing could proceed on this parcel. • December 11, 1998—Testing performed by Port Engineering. • March 15, 1999—Proposed septic system plans submitted to BOH • March 16, 1999—Plans sent to Port Engineering for review. • March 22, 1999—Response from Port that plans had some problems. • March 29, 1999—Letter from BOH to engineer detailed technical deficiencies. • April 22, 1999—Letter received from Eastern Land Survey Associates, Inc., applicant's engineer with new pians addressing problems. • May 11, 1999—Correspondence from Port Engineering that revised plans addressed concerns of previous letter. • May 12, 1999—Letter from BOH that plans were approved. Design Approval signed. • July 29, 1999—Form U rejected because of missing floor plans. • November 2, 1999—Form U approved by BOH. • November 12, 1999—Existing foundation as-built received by BOH. • November 12, 1999—Complete application from Dean Chongris for Disposal Works Construction Permit. Disposal Works Permit issued by BOH. • November 22, 1999—Bottom of Bed excavation approved by Susan Ford. • December 5, 1999—Discussion of status and allowed continuance of system installation. • December 7, 1999—Final Inspection by Susan Ford begun. Concern about condition of stone. SS called and agrees that stone does not appear to be sufficiently clean. JP stated that the stone had been delivered in that condition. SS said that if he wanted to have it tested by a lab she would be willing to testify in court on his behalf against Torromeo. SS Instructed JP on proper collection procedures. • December 8, 1999—JP requested an inspector on site to observe collection for the lab. JP did not have sealable bags for proper collection. JP stated that the lab requested two 5 gallon buckets half filled. SF observed JP collect stone randomly. Also, while on site SF &JP conducted the DEP recommended bucket test. The stone failed the test. JP disputed the chain of custody issue by fax and brought up non- technical concerns. • December 9, 1999—SS sent letter regarding"chain of custody". She offered an alternative to retesting by allowing the engineer to certify the stone as meeting the requirements of Title 5. In response to concerns of personal bias, SS sent letter stating that the department's engineering consultant would perform the next inspection on Lot C once the system was ready. • December 12, 1999—UTS of Mass Inc. —collected sample from Lot C site. Page 1 of 2 nabohmass From: Gayton Osgood <gayton@mediaone.net> To: Bosrd of Health <nabohmass@msn.com> Sent: Friday, November 19, 1999 3:09 PM Subject: FW: board of health regulation -----Original Message----- From: kkimmell@bck.com [mailto:kkimmell@bck.coml Sent: Friday,November 19, 1999 9:54 AM To: gWon@mediaone.net Subject: board of health regulation Gayton, here is a draft of a proposed regulation: Repetitive Applications: No application for any permit, license, certificate, or other Board of Health approval which has been denied by the Board of Health shall be heard again by the Board of Health within two years of the date that the Board of Health?s denial becomes final, unless the Board of Health affirmatively votes to hear such application and the applicant demonstrates that 1)there are specific and material changes to the application; 2) such . specific and material changes could not have been presented to the Board of Health prior to the denial of the application; and 3) hearing the application a second time would not cause an undue burden upon the Board of Health. In order to issue this regulation, the Board must notice in a newspaper of . general circulation a summary of the regulation. In this case, the regulation is so short that its entirety can be published. You are not obligated to issue the notice prior to the meeting in which you vote on it, but it probably makes sense to do so to give any interested person an opportunity to attend. Given that your next meeting is December 16, it probably makes sense to publish notice in the next few weeks. Pls. call with comments on this regulation. 11/19/99 • December 22, 1999—JP sent fax stating stone was determined to meet Title 5 standards. JP faxed Bill Scott about situation. • December 28, 1999—Received fax—grain size distribution Test Report. • December 30, 1999—Bill Scott sent letter to JP listing all items needed prior to inspection. BS set up appointment w/consultant for inspection on 1/4/00. • January 3, 2000—Installer confirmed appointment,but then consultant cancelled. Received fax from UTS stating that they did take the sample from the trenches at Lot C Salem Street. • January 3 &4, 2000—Many phone calls resulted trying to set up another appointment • January 5, 2000—Received inspection report from Port Engineering that system was approved. Home Health Care News from VNA of Central Massachusetts VNA Care Network Headquarters: 120 Thomas Street, Worcester, MA 01608 Headquarters: 245 Winter Street, Waltham, MA 02451-8792 Jan. 7,2000 Dear Director: VNA Care Network and Visiting Nurse Association of Central Massachusetts have been committed to providing compassion- ate home health care and hospice to eastern and central Massachusetts residents for more than 100 years.We've seen a lot of changes in the health care system in those years,but we've always put patients and our nonprofit mission first. To ensure the availability of nonprofit home health care in the coming decades,VNA Care Network and VNA of Central Massachusetts merged effective Jan. 1,2000. This merger is based on a shared vision to strengthen community-based health care that makes patients the focus of our work. The combined agency will be called VNA Care Network to reflect the individual agencies that have come together to serve more than 200 communities in eastern and central Massachusetts. The merger also creates three other agencies.Hospice of Central Massachusetts and VNA Care Network's hospice programs for the terminally ill(Hospice of Cambridge and Visiting Nurse Associates Hospice)will join under the name VNA Care Hospice.This new company will care for the terminally ill in their own homes and operate three of the four alternative residences for the terminally in Massachusetts(Coes Pond in Worcester,Chilton House in Cambridge and Stanley R. Tippett Home in Needham). Diversified services will be administered by VNA Care Advantage.This includes adult day health centers and child care centers.VNA Care Network Foundation will act as the parent company for VNA Care Network,VNA Care Hospice and VNA Care Advantage. Although our names are changing,our mission of community service and delivery of patient-focused care will remain the same.The same clinical staff will continue serving patients with no disruptions in care.We will continue working from our offices and program sites in the Cambridge,Danvers,Dedham,Gloucester,Haverhill,Leominster,Needham,Spencer, Watertown,West Roxbury,Westboro and Worcester areas. The ability to provide comprehensive home health care,hospice and diversified programs together instead of separately has many benefits for clients,including: • Ensuring the continuation of our work in caring for patients and families in your community • Sharing clinical expertise of nurses,therapists and other staff to improve patient care • Increasing access to specialized health care programs in areas such as oncology,palliative care,hospice and cardiac disease management • Creating a cost effective network with more efficient business and management operations • Coordinating services over a large geographic area • Continuing our nonprofit mission Karen Green, the current president and CEO of VNA of Central Massachusetts,will serve as the president and CEO of this new organization.Our senior management team will include Pete Henry,chief financial officer and vice president of finance; Barbara Brooks,vice president of clinical services;Jane Woodbury,vice president of business and fund development;Sandra Lynch, vice president of diversified services;Rosalie Lawless,vice president of human resources;Mary Whalen,director of hospice;and Mary Farnsworth,executive liaison. We look forward to continuing our relationship with you and serving all who need care in eastern and central Massachusetts. If you have any questions about the merger,please call me at(781)890-4440,ext.5561 or Deborah Corkum at ext.5560. Sincerely, o UG Jane Woodbury Vice President of Business and Fund Development 12/07/1999 11:40 5085362672 CYRUS CONSTRUCTION C PAGE 01 i Cyrus Construction Corporation Post Office 583 North Andover,Massachusetts 01845 Phone(978)683-3605 Fax(978)683-2913 Date: 12/7/99 To: Sandy Starr From:Joseph Pelich Regarding:Conl:umation of failure of septic system at Lot C(formerly 492 Salem St.) Pages.fax only Message: Please let this letter stand as confirmation of our discussion.. The licensed installer())ean Chongris),you,Susan Ford,and I met on site.You and Ms.Ford do not believe that the 1.5"stone meets the requirements of title V.You both stated that the stone was and 4 dam' you specifically stated you believed that the stone was not double washed.You stated the stone needs to be removed and replaced with double washed stone. I asked if I could have an independent lab do an analysis.You stated Haat would be fine and if needed you or Susan would be present for collection of the stone samples. I believe this is an accurate reflection of our discussion.If it is not,please put to writing any discrepancies. Sincerely, Joseph Pelich 12/08/1999 02:59 5085362672 CYRUS CONSTRUCTION C PAGE 01 Cyrus Construction Corporation Post Office 583 North Andover,Massachusetts 01845 Phone(978)683-3605 Fax(978)683-2913 Date: 12/8/99 To: Sandy Starr From:Joseph Pelich Regarding:Confirmation of statement at site visit on 1217. Pages:fax only Message: Please let this letter stand as confirmation of our discussion. You stated if the lab analysis comes back"acceptable"I would not have to remove and re-install the trenches.You also stated that the system could be completed this year. Sincerely, Joseph Pelich I 12/08/1999 02:53 5085362672 CYRUS CONSTRUCTION C PAGE 01 Cyrus Construction Corporation Post Office 583 North Andover,Massachusetts 01845 Phone(978)683-3605 Fax(978)683-2913 Date: 12/8/99 To: Sandy Starr From:Joseph Pelich Regarding:Confirmation of phone conversation on 12/5/99. Pages:fax only Message: Please let this letter stand as confirmation of our discussion. You called my office on Monday the So. You stated that I could not Continue with the installation of the septic system.You stated that I could finish the system in the spring. I asked what was the reason for stopping the completion of the system.You stated I did not start the stem Y system until after the"cut off date"of 12/1/99.You did state that the system was permitted prior to the 12/1 cut off. I stated it was started prior to 12/1 and you stated,1 will not argue with you".I then informed you all the trenches were installed. You asked who installed the system on the weekend,and I stated Myself,Peter Murphy,and Dean Chongris. I described who did what aspects of the work.I stated I was an"observer"and assisted with labor,Mr.Murphy ran the equipment and Dean Chongris did the install,he was"on site".You stated that it was"O.K.for Dean to do work but not you and Peter Murphy".I took exception with what you stated. You said have the installer and engineer call me for the inspection. I believe this is an accurate reflection of our discussion,especially since it's recorded in my daily planner. If you disagree,please put to writing any discrepancies. Sincerely, Q f t-10✓ b Joseph pelich 1Jl/b3/2000 06:24 508536267`2 CVKUS Wr4b1HUC1iur4 C PAGE 05 Of1111_1111%111141�hMft I -'The Conwucfwn Tas�ng people' January 3, 2000 Mr. Joseph Pelich Cyrus Construction Corp. P. 0. Box 583 North Andover, Massachusetts 01845 RE: Lot C, 492 Salem..Street . North Andover, MA Dear Mr. Pelich: U T S of Massachusetts, Inc. obtained a stone sample from the leaching field of Lot C, 492 Salem Street, North Andover, MA on December 10, 1999, under the direction of Mr. Joseph Pelich: The stone sample was then transported to the UTS laboratory, logged in.as Sample#7895, Torremeo.Pit, 1"crushed stone. A washed grain size distribution test was performed on.December 17, 1999. The results are attached. UTS certifies the onsite sampling and laboratory testing was completed in accordance with ASTM C136, and ASTM C117 "Sieve Analysis for Fine and Coarse Aggregates, Material Finer than No. 200 Sieve by Washing" Sincerely, U T S OF MASSACHUSETTS,'INC. William P. Crabtree President �l �ND. Notary P lic S Richa'dsou bane, Stoneham, MaWaotiusette 02180 (781) 438-7755 F" (781) 43"216 This letter is in reference to your letter dated December 22, 1999, which was received by fax December 28th, 1999. Please insure in the future that correspondence dating is reasonably close to the date sent. In reference to your testing it is my understanding that UTS appeared at the site and collected the samples. If this is true please provide a letter,to the Health Department,from UTS indicating that the material tested was as a result of their site visit and collection of the material from the site. In reference to the back filling of the system, I do not have the authority to approve such action. As indicated in prior correspondence from the Health Department(December 9th)you should contact the department so that they can call the consulting engineer and schedule an inspection. The UTS testing occurred on December 10th, your letter requesting an inspection (dated December 22"d)was faxed to my office 18 days later on December 28th. Further it appears that your plan was approved on May 12, 1999 and your application for construction occurred on November 12, 1999, 5 months later.To expedite this process the Health Department needs a more prompt submittal of information. I have reviewed the files to determine what.has"transpired" it appears that the letters you have forwarded are recapitulations of discussions, and letters, with the Health Department. The Health Department has been clear that the soil testing and the process for such testing should be followed. That includes meeting Title 5 for soilAypes and insuring that there is no possibility of contamination of the material to be tested. I would recommend that you close the process by obtaining a letter from UTS to certify that they tested the material on site. The UTS form and -information refers to the Torremeo Pit and does not clearly indicate that the i! tested was the "soil currently on site. Call the Health Department to schedule an inspection by the outside consulting engineer. In reference to the installer performing the work(your letter of 12/08/99, received 12/09/99 by f t fax),the Health Department has been clear to all applicants that the installer is responsible for all aspects of the installation. Please understand that there is a past circumstance where the Health Department has discovered work by persons other than the licensed installer and that installers' licen asbeen-suspended for two months.The importance of the installer conducting the C allation and the necessary approvals is clearly an issue that has been and continues to be important for all applicants. A request that the installer performs the work should not be considered as an insult, it should be considered as a reminder that the installer legally has responsibility for the installation. It appears that the Health Department in every case has responded quickly(within the same day of your letters)and professionally.The Health Department is taking the additional step of placing the matter in the hands of the consulting engineer to provide an expeditious inspection. Further it appears that you have a solution to the situation which can be easily achieved with your actions. v � lG n 12/28/1999 05:39 5085362672 CYRUS CONSTRUCTION C PAGE 01 Q 2 81999 Cyrus Construction Corporation Post Office 583 North Andover,Massachusetts 01845 - Phone(978)683-3605 Fax(978)683-2913 Date: 12/22/99 To: William Scott From:Joseph Pelich Regarding: Septic stone test results—Lot C Salem Street Pages:fax only Message: The testing company told me that the results of the double wash test meet with title five requirements.I had to pay additional to re-test and have the company come to my site to collect the sample. Could you please contact me as soon as possible?I intend to back fill the system and need to make sure that is satisfactory with you.I would like to meet with you to discuss events that have transpired.I suspect you are not aware of exactly what has transpired and should be aware. Sincerely, /� •/� <;�� �t,(G✓ f Joseph Pelich 12/28/1999 05:39 5085362672 CYRUS CONSTRUCTION C PAGE 03 Of hKe .nn CrOm rucftn Yes wwwgp�� December 10, 1999 Project: 492 Salem Street Lot C North Andover, MA Transportation of one (1) soil sample (source: offsite, stone from Torremeo Pit) to the laboratory for analysis. William P. Crabtree 5 Richardson Lane, Stoneham, Massachusetts 02180 (781) 436-77SS Fax (781) 438-6316 12/28/1999 05:39 5085362672 CYRUS CONSTRUCTION C PAGE 02 GRAIN SIZE DISTRIBUTION TEST REPORT G _ r r- r C G \ C Hm 01 p P N O D OK w "i w Vc 4 a I 90 80 70 W 60 LA— Z 50 w W 40 30 20 10 0 200, 100 10.0 1 .0 0. 1 0.01 0.001 GRAIN SIZE — mm % +3" % GRAVEL 7 SAND % SILT % CLAY USCS LL PI 0 .0 100 .0 0 .0 SIEVE PERCENT FINER SIEVE PERCENT FINER Location; inches number *STONE FROM TORREMEO size 0 size 1 .5 100.0 1 73.0 0.75 17.5 Description: 0.5 t 6 61" CRUSHED STONE GRAIN SIZE D60 23.7 Ui r I'vlA":SACiii6"f S J 030 15.7 REVI 10 Remarks.: • •„ 0.20 % SY WEIGHT OF THE COEFFICIENTS SAMPLE FINER THAN No_200 Cc 1 . 11 SIEVE BY WASHING Cu 1 .5 UTS OF MASSACHUSETTS, INC. Project No. : Project : 492 SALEM ST. . LOT C. NORTH ANDOVER 5 Richardson Lane Stoneham, MA 02180 11Date: 12/17/99 Somple No. 7895 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 12/11/98 LOCATION IN AREA NEXT TIME 08:00 PERK# P-Cl LOCATION IN AREA NEXT TIME 15:30 PERK# P-C2 TO THE SEPERATE GARAGE TO THE SEPERATE GARAGE OBSERVATION HOLE TP-Cl OBSERVATION HOLE TP-C2 DEPTH of SHELF 27" DEPTH of SHELF 44" DEPTH of HOLE 18" DEPTH of HOLE i8" START PRE-SOAK 08:15 START PRE-SOAK 09:15 END PRE-SOAK 08:30 END PRE-SOAK 09:30 TIME at 12" 08:30 TIME at 12" 09:30 TIME at 9" 08:51 TIME at 9" 09:50 TIME at 6" 09:20 TIME at 6" 10:25 TIME 9"to 6" 29 MIN. TIME 9"to 6" 35 MIN RATE 10 MPI RATE 12 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-C1 DATE 12/11/98 TIME AM WEATHER CLOUDY, 38 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+ 50'+ 301+ DEPTH HORIZON TEXTURE COLOR MOTTLES STRUCTURE, STONE, ETC. 0-9 Ap FINE SANDY 10YR 3/2 NONE SEEN FRIABLE, GRANULAR, WEAK, LOAM MOIST 9-19 Bw FINE SANDY 10YR 5/6 NONE SEEN FRIABLE, GRANULAR, WEAK, LOAM MOIST 19-96 C1 FINE/MEDIUM 2.5Y 7/9 AT 33" 7.5YR 6/8 LOOSE, SINGLE GRAIN, SAND 2.5Y 8/1 STRUCTi3RELESS, MOIST NO REFUSAL PARENT MATERIALGLACIAL OUTWASH DEPTH BEDROCK 96"+ STAND WATER ND WEEPING ND ESTIMATED SEASONAL HIGH GROUNDWATER AT 33" SKETCH PROVIDED YES FLAGGING YES DEEP OBSERVATION HOLE LOG for TEST PIT # TP-C2 DATE 12/11/98 TIME AM WEATHER CLOUDY, 38 F ADDRESS and LOCATION SALEM ST., NORTH ANDOVER MA. LAND USE SLOPE LANDFORM VEGETATION SURFACE STONE UNDEVELOPED OUTWASH PLAIN VARIOUS NONE DISTANCES from in FEET: DRINKING WELL OPEN WATER POSS. WET AREA DRAIN WAY PROP. LINE 1001+ 200'+ 1001+ 501+ 30'+ DEPTH HORIZON TEXTURE COLOR MOTTLES STRUCTURE, STONE, ETC. 0-10 Ap FINE SANDY 10YR 3/2 NONE SEEN FRIABLE, GRANULAR, WEAK, LOAM MOIST 10-20 Bw FINE SANDY 10YR 5/6 NONE SEEN FRIABLE, GRANULAR, WEAK, LOAM MOIST 20-101 C1 FINE/MEDIUM 2.5Y 7/4 AT 32" 7.5YR 6/8 LOOSE, SINGLE GRAIN, SAND 2.5Y 8/1 STRUCTURELESS, MOIST NO REFUSAL PARENT MATERIALGLACIAL OUTWASH DEPTH BEDROCK 101"+ STAND WATER ND WEEPING ND ESTIMATED SEASONAL HIGH GROUNDWATER AT 32" SKETCH PROVIDED YES FLAGGING YES . SEPTIC PLAN SUBMITTAL FORM LOCATION: C_)/13,.c- _7 gletri NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: DESIGN ENGINEER.Ct`&.!nau.j /J iMca�;� F s, l�.�e,�� Sv`2:R•-�� VSs DATE TO CONSULTANT: *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 Professional Land Surveyors&Civil Engineers I TOWN OF NORTH ANDOVER/ ESSEX SURVEY SERVICE 1958- 1986 BOARD OF HEALTH OSBORN PALMER 1911 - 1970 BRADFORD&WEED 1885- 1972 APR 2 21999 April 21, 1999 Ms. Sandra Starr, R.S., Health Administrator Office of Community Development and Services 27 Charles Street North Andover, Massachusetts 01845 RE: F 11074 Lot C 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). The distance to the property line from the reserve area has been revised; as well as the proposed regrading on the front of the lot. The Profile of the septic system has been revised. Trenches are now proposed. 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 1 r� 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. 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, 0-r" IV, James H. MacDowell JHM/tlm Enclosures cc: Cyrus Construction 2no49W 16A Ll pwvw LDOWL 9aa 2W& I FORM U - LOT iEL ASE FORM l INSTRUCTIONS: This form is used to veri that all necessary approvals/permits from Boards and Departments having jurisdiction ha e been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT CY U CO1�l,Ci( ll, ?�l L)PPOI✓;-ANY) PHONE0 LOCATION: Assessor's Map Number 3" PARCEL c� SUBDIVISION Nfl LOT (S) STREET r slri2d /-Olt ST. NUMBER ILI-9 **************** ** *********************OFFICIAL USE ONLY******************* ************** RECQ.N�MENDATIONS OF TOWN AGENTS:. V/ CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS r T PLANNER DATE APPROVED `I DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED 4 -__L DATE REJECTED �/ SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED 7 COMMENTS PUBLIC WORKS -�6WATER CONNECTIO - - 05 1 DRIVEWAY PER LA/- FIRE DEPARTMENT �#1�1/F RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm Ak z , . a APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT IINSTALLER'S LICENSE# '9 LOCATION: L00). &&, S� LICENSED INS TA LER: bta4 & r`S 6(.)A C0�1�►. SIGNATURE: XTELEPHONE# C/ 7S S CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only 575.00 Fee Attached? Yes L1 No Foundation As-Built? Yes ✓ No Floor Plans? Yes_,- No Approval Date: l//� :r _, :,,rs�:.xsar:, ra:et.$ :i:' rj: ;iFt }}_r �', t :x6 ..s.'- dF f,t.. -moi r}�; xe..e'- '+'' i=, '.t s t' i �Gs,t F t 1 .i 5...,r. _Y'�.._i _i�::.utE:.FSrxk''�u.t+. teis':L�':4, sll tc_.t• 'i, a .Ectl! k 1 gyp^ i t k :}�i ! i c +yi �{ f�. i ' ___ ._..._........,Wsrci:.ax r:'A4.4,,1a4,su�..,..., .: f r : prlF -�; E Yt Town of North Andover, Massachusetts Form No.3 r , ' - BOARD OF HEALTH e1. '' , . �""w r"•e O r t ' -7 3? e.A _� O0 /a / E c xt t - F _ 'A 19 . � 3 -^ i t t: 1. . �, b,, - ;,�" Yi j ,SSAGHUSEt� DISPOSAL WORKS CONSTRUCTION PERMIT r x , N . # Applicant NAME A DRESS TELEPHONE Site Location 11 . 7a j ) �. > , . Permission is hereby granted to Construct or Re air ( p (Individual Soil Absorption `} Sewage Disposal System as shown on the Design Approval S.S. No. /l� k { :' � , `�` f 1G%c` � '7 Y j ¢ Y - CHAIRMAN,BOARD OF HEALTH `S1 ° o- _ i �, t, i - ' r�k " f'' r _...--1 f ,,; .Fee D.W.C. 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L a t F3 t:..r, k , Y r - ,11 Y �E iit i3.. s *, ; 8 j r- It .::�Y� gt Y sib .3 r t 4::. i s , S i 5 F 3 k ft 1 Y.kf L " F... ti ); I S 4.zN 1�(t#t 6 ,•t 1 tt t Z 9t i x k. r Y. ,h xy ..j,* R t: (.11�Y r. .,tlt£i t s Y f. i , N is t4. , 14'.. 1 - Town of North Andover, Massachusetts Form No.2 e NORTH BOARD OF HEALTH o � 19 F w " °•b°-='��'s�` DESIGN APPROVAL FOR ' ;,SSACNUS t� • SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant Test No. Site Location Reference Plans and Specs. /6 ENGINEER DESIGN DAT Permission /- is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. J CHAIRMAN,BOARD OF HEALTH ' Fee—__�L_. � Site System Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH�r/�' C?19ps r AR 0OCX1CXPW14N�" APPLICATION FOR SITE TESTING/INSPECTION 7 Q�RATED �SSACHUS�� Applicant NAME ADDRESS TELEPHONE Site Location Engineer '"`"VIN V\ NAMEt ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH ee Test No. L S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH ? � <6 °0 J ' 19fI y m A APPLICATION FOR SITE TESTING/INSPECTION ��SSACHU5���5 r '� + Applicant I _.. -� ` = + -✓`-- NAME ADDRESS r1 TELEPHONE Site Location { �' . , + t ' 1-v) Engineer �1.� I ;V I t 1,� Nk� NAME ADDRESS TELEPHONE Test/Inspection Date and Time +� CHAIRMAN,BOARD OF HEALTH l Fee Test No. %� '- S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. i NORTH ANDOVER BOARD OF HEALTH AUTHORIZATION FOR SOIL TESTS LOCATION ENGINEER TEL# PAID DATE TO PORT 492 Salem St.,Lots A,B,C,D Clayton Morin 978-531-8121 Yes 11/18/98 P,N-FAXED ,Z/4 YOU Y mQXAO 14 6 R . NORTH ANDOVER BOARD OF HEALTH AUTHORIZATION FOR SOIL TESTS LOCATION ENGINEER TEL# PAID DATE TO PORT 492 Salem St.,Lots A,B,C,D Clayton Morin 978-531-8121 Yes 11/18/98 AXE !Z14 pe . 7-� Y Meg�� y �c ��� Influenza - r HMO Medicare Risk (Senior) Reimbursement,Project. Adult Vaccine Administration Record (Influenza) The doctor or clinic may use this form for the written documentation required for every dose of.vaccine, or they may record it in your medical record. They will record what vaccine was given, when the vaccine was given, the address where the vaccine was given, the name of the company that made the vaccine the vaccine's specialecial lot num- ber, ber, the name and title of the person who gave the vaccine, and the document number._ Information about the person to receive vaccine /ease nil Name: (Last, First,. MI) Birth date: Age:- Street address: C' -- -- — State: — - - zi . Phone: Check the source of your healthcare from the.following: Medicare #: Blue Care 65 Fallon Senior Plan ; #: First Seniority (Harvard Pilgrim) #: Secure Horizons (Tufts Health Plan for Seniors) #: United HealthCare/Medicare Complete #: Other #: Signature of person to receive vaccine, or thatper-son's uardian X Date: For Clinic/Office Use - Vaccine name: Date vaccine administered: Injection site: Date VIS given: Date on VIS: Vaccine manufacturer: Vaccine lot number: Name and title of vaccine administrator: Clinic/office address: (824/99) j 1174 F - JP d-;Spotr A- W,-P.. G1,1v-t toos i"-y b7 4 .x . 9t- h�,�tk�t ,,jo De— GCr•� s a JGr 5 e.aa CJ�DS `, / J fit' �G�'' } �T�C✓� �--� �G'✓� ��,/As` � ;✓+..-tom' r:� 4�..5` *? ie rT� "� ✓L�X %v►-S�C t rl i Cs f'+ L�-�-��G / S�I i �C�1.� 00 101- vTs I /"Ia ss � � c. , - Ga f 1���� S /,• �•-�e � �a7�- C ��7r. l�/rte '�'�/� S c.�-�� ��r .• ,S ta•°�-�� s f� �.z e.e.�a-s c.��'1�t.-....�.�.,c.� r'b �-�...,�`� v-t� J-n !;s-;�-, Y=,.,s/-,, �fz �- L..+�'�r r..,..�.,.�_ �.� � �a+'7R �+.�.t�". ,4,�x►" S u /71" t.iq...�.Y �/e..' �/y-r l ,/Y)m•..�y �L,.,rs-� L a!/,s r�5 s..+ /�'` �'y r"`� �'jy .S�-7� ..�� aZ.-�a��,�..,,,•.. `a� (ZC 4.t;v e_.�l.� =x TS .57`a_7� J_ -�` �.a,7` `�L, a!�'d►,, -7Ga��� 7-L,.� r�S � ,4/t �:a*,cL u..+o r/�C c�pv4G �7r r��,0 a.a"�"a�► �t� G Sa�:,t� �trv,saTG.�-�%��+'S i•�.:5"�a�Ccr.� o v �..,.a„ GX�.a✓�'xa«- ��pe*'a>�eav Gq.us@..s�,� '>R'r� �s=. G..�''-`�'2-�.....i.1.t-'�'�,�. a� .z���� Commonwealth of Massachusetts City/Town of I � � System Pumping Record \\j EIVe Form 4 SUN — 5 2006 DEP. has provided this form for use by local Boards of Health. hT� PrP in Record must be submitted to the local Board of Health or other approving au A�zH�S Noo\r. A. Facility Information Important: When tilling out 1. System Location: forms to the t .� j - �L computer,use ,D�'�. only the tab key Address , r� to move your 1`-`-f'`-`/Cs— cursor-do not i use the�retum City/Town State Zip Code key. 2. System Owner:' 1, -�J n � q Name Address(if different from•focation) Cityfrown State Code JJ C. 1 Telephone Namber 13. Pum in R p g ecoid �✓��� 1. Date.of In Pum p g Date 2. Quantity Pumped: canons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight.Tank ❑ Other(describe)` 4. Effluent Tee Filter present? ❑ Yes yes, was it cleaned? F1 Yes ❑ No 5. Condition f System: r, 6. System urnp d By Name Vehicle License Number Company �- — P Y 7. Lo ratio here contents stents were-disposed: C_ : - Si nat e o Hauler Date hftp://www.mass.gov/dep/­water/approvals/t5forms.:htm#inspect t5forrn4.doc•06/03 System Pumping Record•Page 1 of 1 North Andover Board of Assessors Public Access Page 1 of 1 NORTH North Andover Board of Assessors Ott«•n •�ti0 3i e�;a. • *. • of # F 'ss,C»uikps�� roperty Record Card Click Seal To Return Parcel ID :210/038.0-0321-0000.0 FY:2009 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels Search for Sales O l Summary Residence Detached Structure , Condo 496 SALEM STREET Commercial Location: 498 SALEM STREET Owner Name: PAPADOPULOS,STERGIOS Owner Address: 498 SALEM STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5-5 Land Area: 1.57 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2470 sgft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 518,700 568,000 Building Value: 317,000 366,300 Land Value: 201,700 201,700 Market Land Value: 201,700 Chapter Land Value: LATEST SALE Sale Price: 437,500 Sale Date: 12/13/2007 Arms Length Sale Code: S Grantor: DEUTSCHE BANK Cert Doc: Book: 11000 Page: 219 http://csc-ma.us/PROPAPP/display.do?linkld=1459672&town=NandoverPubAcc 7/14/2009 4200 Of BORT" F 9 Town of North Andover .yst� HEALTH DEPARTMENT 3 CHU§ F CHECK#: _V DAT -7 LOCATION: H/O NAME: Com CONTRACTOR NAME: 40� Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ j ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning ❑ Swimming Pool `' $ i ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic.Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ 1 Title 5 Report ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-.Health Pink-Treasurer Commonwealth of'Massachusetts Title 5 Official Inspection Form RECEIVED Subsurface Sewage Disposal System Form-Not for Voluntary Asse sments 498 Salem Street JUL 0 8 2009 Property Address TOWN DEPTNTER Ster ios Pa ado ulos HEALTH DEPARTMENT Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Benjamin C. Osgood, Jr cursor-do not Name of Inspector use the return key. Company Name 224 High Street, Apt 1 Company Address Newburyport MA 01950 F City/Town State Zip Code 508-328-4633 870 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 Co ` 6/27/09 Inspector' ignature Date The system inspector shallubmit 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every page. Cityrrown 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: 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. ❑ Y ❑ N ❑ NDEx Iain below): ( P I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every 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 Commonwealth of Massachusetts - e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'w 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every page. Cityrrown 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, j safety and environment: I ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 %day flow 4. Commonwealth of Massachusetts lug, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every page. City/Town 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 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. l 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. Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 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? ® ❑ 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): 4 440 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Commonwealth of'Massachusetts fD Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every 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: pumped 4/14/05 per BOH records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Built in 2000 per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5' 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.): Pipe looks new in basement Septic Tank(locate on site plan): Depth below grade: .5'5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ 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: 1000 gallons Sludge depth: 2" Commonwealth of Massachusetts rA Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every page. Cityrrown 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 30" 2'f Scum thickness Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measure stick 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 in good condition. Sch 40 PVC tee in good 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner'sName information is required for North Andover MA 01845 6/27/09 every page. Cityrrown 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 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0" 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.): Box in OK condition. Distribution equal. No evidence of solids carryover or leakage in or out. 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: Commonwealth of'Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every 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: 3-75' ❑ 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.): Area of trenches very dry 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 0 Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every page. Cityrrown 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.): Commonwealth of'Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every 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 D�STl�CC f I-T ts�` �-va�� 2L•v z -o3�x So,s ' Z Ocma SC I T y/�LSM STCZ E�'T- Commonwealth of Massachusetts lvTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 498 Salem Street Property Address Stergios Papadopulos Owner Owners Name information is required for Northover AndMA 01845 6/27/09 � every page. Citylrown 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: 5 feet 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: Test pits 12/10/99 by Alex Parker 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: System designed 4 feet above ground water Before filing this Inspection Report, please see Report Completeness Checklist on next page. 1 r Commonwealth df Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 498 Salem Street Property Address Stergios Papadopulos Owner Owner's Name information is required for North Andover MA 01845 6/27/09 every page. Cityrrown 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