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Miscellaneous - 67 FOSTER STREET 4/30/2018
` 67 FOSTER STREET 210/104.D-0055-0000.0 - - - -- --- __---_ _--- I i t s ' ` Lot & Street 7 7-_W;-z�' ST-e&<� Map/Parcel %D X163- CONSTRUCTION ` '3`CONSTRUCTION APPROVAL Has plan review fee been paid: YE NO Permit# Plan Approval: Date: 7 at e/ Approved by:�� Designer: M P lUS &I Plan Date: -7117'1' 0 Conditions: Water Suppfyz--,Town Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? IES NO Well Construction Approval? YES NO Septic System Construction Approval? ES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARDF FjEALTH APPROVAL: DATE: U I4==i== _ APPROVED BY: t SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? YES NO Type of Construction: NEW --fZ PAIR New Construction: Certified Plot Plan Review YES O. Floor Plan Review YESO—� Conditions of Approval from Form U YES Issuance of DWC permit: NO DWC Permit Paid? 2ffi NO DWC Permit# Installer: R Begin Inspection: XE S NO Excavation Inspection: Needed: Passed: V-//o By: Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: 9117 o/ By: Final Grading Approval: Date: Q/ By: / Final Construction Approval: Date: By: Certificate of Compliance: Approval: h-�3. 1 d/ Date: J North Andover Board of Assessors Public Access Page 1 of 1 Andover Board of Assessors NORTH M o rt0 ■ry■��■ pt i�.o s1N0 F 'SswcNuset roperty Record Card Click Seat To Return Parcel ID :210/104.D-0055-0000.0 FY:2011 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e Search for Parcels Search for Sales A �' u; li Summary Residence , Detached Structure y 3 Condo 67 FOSTER STREETR° L Commercial Location: 67 FOSTER STREET Owner Name: RIVET,MATTHEW F PAMELA C RIVET Owner Address: 67 FOSTER STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:5-5 Land Area: 1.11 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2132 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 394,400 407,100 Building Value: 196,200 208,900 Land Value: 198,200 198,200 Market Land Value: 198,200 Chapter Land Value: LATESTSALE Sale Price: 430,000 Sale Date: 09/06/2001 Arms Length Sale Code: Y-YES-VALID Grantor: FRANCIS RIVET Cert Doc: Book: 06357 Page: 0327 http://csc-ma.us/PROPAPP/display.do?linkld=1707290&town=NandoverPubAcc 7/19/2011 Residential Property Record Card PARCEL ID:210/104.D-0055-0000.0 MAP:104.1) BLOCK:0055 LOT:0000.0 PARCEL ADDRESS:67 FOSTER STREET FY:2011 PARCEL INFORMATION Use-Code: 101 Sale Price: 430,000 Book: 06357_ Road Type: T Inspect Date: 05/21/2008 Owner: Tax Class: T Sale Date: 09/06/01 Page: 0327 Rd Condition: P Meas Date: 05/21/2008 RIVET,MATTHEW F Tot Fin Area: 2132 Sale Type: P Cert/Doc: Traffic: M Entrance: X PAMELA C RIVET Tot Land Area: 1.11 Sale Valid: Y Water: _Collect Id: RRC Grantor: FRANCIS RIVET - Sewer: Inspect Reas: C Address: 67 FOSTER STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 7 Main Fn Area: 1040 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R1 - - - Se6 Type- Code� Method SI-Ft' Acres Influ-YIN Value Class Story Height: 2.00 Bedrooms: 4 Up Fn Area: 1092 Bsmt Area: 1040 9 Yp p- Roof: G Full Baths: '1 Add Fn Are . Area: Fn Bsmt Area: 520 1 P 101 S 43560 1.000 197,326 Ext Wall: WS Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0 0.110 836 Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 2132 DETACHED STRUCTURE INFORMATION Foundation: CN Bath Qual: T RCNLD: 195954 - Kitch Qua_I: T Eff Yr Built: 1965 Mkt Adj: Str Unit Msr-1 Ms'r-2 E-YR-Blt Grade Cond%Good P/F/EIR Cost Class Heat Type: FA Ext Kitch: Year Built: 1961 Sound Value: SE S 80 0.00 1988 A A ///88 200 Fuel Type: O Grade: AG Cost Bldg: 196,600 VALUATION INFORMATION Fireplace: 2 Bsmt Gar Cap: Condition: A Aft Str Val 1: Current Total: 394,400 Bldg: 196,200 Land: 198,200 MktLnd: 198,200 Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Prior Total: 407,100 Bldg: 208,900 Land: 198,200 MktLnd: 198,200 Aft Gar SF: 576%Good P/F/E/R: /100/100/75 Porch Type Porch Area Porch Grade Factor P 52 S 196 E 104 SKETCH PHOTO 14 S 14 196 S24 42 14 g, 5 E3 ! �; e 576 S F 10 q Ft 24 19 FM M 1040 Sq.Ft � 1` ! 1. q.Ft 092 Sq.Ft 67 FOSTER STREET y - Parcel ID:210/104.D-0055-0000.0 as of 7/19/11 Page 1 of 1 ,�... -k h tt r MASSA CHUSETT- .: . ., m Record .•��" r.11�;l`(,)1,1.. 1.1/.Q•1•��,1 �`. ..1�• V,,''::r �O�P.hai provldad jhl, lollsto^RW'."EEJy5n', 00 �':�rr.11lod Io the IoC+I 8oerc: c'! o,ln v 0110/ IpplOrinV 1' lnprlry A. Faclllty In(orfr ,a on rl'1a'•!�� ;,; C S.9 r.� TOWN OF NORTH ANDOVER OCBLon: HEALTH DEPARTMENT �-.> .'•I ll,^ler ;,".,6)I ll.1L/� � /1 tM nl,.m•.c C17/TYn , Q� ul' — �.;/ ,)t •!li;,;lt;,lll�2.',�r'Sy3i6ff1 Gwnar,...�':,�,, _ , . - ��� .. .•1, r'•/ �� r 1 ..• �'1 . .,,1, Val. Jwl!lynl (wn IouVcn) Cq^o n c 9--70'zs�-zs� ._ ?� opnpn, n,mp„ r::; ;Pumpl�g Ra�ord �e(8 0! Puminp'' 4 .XPQ `.9 .!1. a X)(0 �m;..; . ) Sap !C Tan,, r7 'ls^.( C 3 O har (dascriba�. 4 Emuanl Tea FI)Ila(.P(g)onr? [' Yo9No II ya9. �e — '.�. v`,1 :�::r,l� �ll,l.rr/,•�J v/l; .�„F''L�' ./. �" 7 C'a8/1907 •� Yes _ ' � •. ,'�'!/:�,.brl�'l�,'rV�.11• ,.l. '.1'1',1: �! S Y Pti-mpod 8y:•'� ;a:.���,;,�:;:,I,I r,l✓ ,, � I ���; ',' ,� ,fir;�'�,1;,�, J, can ,... ..,� ! / 'l 1 '1• ,. 1 Vi�lde T� . { a S �r •�'•'','c� '�'i�"y�'I,li� (iai}?:;!a<,,4.�1,1' �r(;,�I'�?'.f,�i�;:' • � on.�rhei.9'�PPr�Ianla'•yrer.e dlyposao. �.1.'.4: lid •,N. ,1• �.. Sniku 7/ .... ., �p (PY8J V(6torm3.n m;In99aCl of NORT:,� 5568 . O Town of North Andover �+�'••;; :: �` HEALTH DEPARTMENT ,SSACN15�4 qa CHECK#: // DA E: LOCATION: H/O NAME: CONTRACTOR NAM : Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Ti 5 Inspector $ Title 5 Report $`� ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer 5568 21 ° Town of North Andover HEALTH DEPARTMENT ,SSACMU`+tt q CHECK#: /�D DATE: LOCATION: H/O NAME: CONTRACTOR NAM Gr -' Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ - SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DW() $ A 5 Inspector $ Title 5 Report $✓ ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer PLEASE ❑ LIKE ME ❑ STOP IT El CALL ❑ FINISH BE NICE ❑ ElE-M L SHUT UP El O AW Y ❑ I ME IA LY E] SO N ❑ Y AY'S END L AYS ❑ I SHOULDN'T HAVE HAD TO ASK ❑THANK YOU KNOCKKNOCKSTUFF.COM•®2009 WHO'S THERE,INC. - Commonwealth of Massachusetts REIVp w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessm is JUL 2011 TOWN OF NORTH R. 67 Foster Street _ HEALTH bEpAR Property Address Matthew& Pamela Rivet Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 page. City/Town State Zip Code Date of Inspection /n V Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not F. PaulCardone use the return -- Name of Inspector key. p Septic Compliance, Inc. Company Name 447 Boston Street Company Address �m Topsfield _ _ Ma. 01983 City/Town State Zip Code 978-407-1808 978-681-0726 3294 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 --- / " Z,,.'- Z or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Rivet 67 Foster Street No.Andover 7-20-2011•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 M0 67 Foster Street Property Address Matthew& Pamela Rivet Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This Title 5 Inspection was performed because of an addition being added to the property. 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 Rivet 67 Foster Street No.Andover 7-20-2011•08/06 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M acv 67 Foster Street Property Address Matthew& Pamela Rivet Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 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. Rivet 67 Foster Street No.Andover 7-20-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 67 Foster Street Property Address Matthew& Pamela Rivet _ Owner Owner's Name information is North Andover Ma. 01845 7-20-2011 required for 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". I Method used to determine distance: i ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or El ® tributary to a surface water supply. Rivet 67 Faster Street No.Andover 7-20-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments (° 67 Foster Street M Property Address Matthew& Pamela Rivet _ Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): I Yes No ❑ ® 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. Rivet 67 Foster Street No.Andover 7-20-2011-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 67 Foster Street Property Address Matthew& Pamela Rivet Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 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 NIA) ® ❑ 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)] Rivet 67 Foster Street No.Andover 7-20-2011•08106 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 Fora - Not for Voluntary Assessments ,^M 67 Foster Street Property Address Matthew& Pamela Rivet Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 page. City/Town State Zip Code Date of Inspection D. Systerlr>! Information Residential Flow Conditions: Number of bedrooms (design): 4 -- Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 5 i Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Rivet 67 Foster Street No.Andover 7-20-2011-08/06 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 ,C4 67 Foster Street Property Address p Y Matthew& Pamela Rivet Owner Owner's Name information is North Andover Ma. 01845 7-20-2011 required for every -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: According to the owner tank was pumped two years ago. 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: System was upgraded in 2001, complete system 5-10-01 Were sewage odors detected when arriving at the site? ❑ Yes ® No Rivet 67 Foster Street No.Andover 7-20-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 67 Foster Street Property Address Matthew& Pamela Rivet Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 27"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.): All in good condition Septic Tank (locate on site plan): 2' 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: 10' x 6' x 610" Sludge depth: 2-3 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Septic dip-stick Rivet 67 Foster Street No.Andover 7-20-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 67 Foster Street Property Address Matthew& Pamela Rivet Owner Owner's Name information is North Andover Ma. 01845 7-20-2011 required for 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.): We recommend tank be pumped on a yearly basis,inlet and outlet tees (pvc) in good condition,structural integrity of the tank appeared to be good,liquid levels were good, no apparent signs of leakage. Grease Trap (locate on site plan): Depth below grade: N/A 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.): I Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan).- Depth lan):Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Rivet 67 Foster Street No.Andover 7-20-2011•08/06 + Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 67 Foster Street Property Address Matthew& Pamela Rivet Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) N/A 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 Good and even 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 was level,ran water through box for 15 minutes distribution was equal,no solids carryover,box was solid no leaks in or out. Pump Chamber(locate on site plan): Pumps in working order: ElYes ❑ No I Alarms in working order: ❑ Yes ❑ No Rivet 67 Foster Street No.Andover 7-20-2011•06/06 Tide 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 67 Foster Street _ Property Address Matthew& Pamela Rivet Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 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.): N/A 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: Field 1 F ® leaching fields number, dimensions: 1F20'x45'=900SgFt ❑ 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.): Good No None No Grassy back yard area. Rivet 67 Foster Street No.Andover 7-20-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 67 Foster Street _ Property Address Matthew& Pamela Rivet Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 - page. Cityrrown 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 N/A Depth —top of liquid to inlet invert I 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 pian): Materials of construction: N/A Dimensions -- Depth of solids - Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Rivet 67 Foster Street No.Andover 7-20-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 /I , r t� ki, r' 11. I• I � �... � I\ 1 � ���� �\ ,) �� tai , 1 rr al A 1 't�� �Cl .J: —i I.�� yA . _ � �\ 41�. @r.Jts-., f{,,p \:• ht: iX �a �11 r p q .)..lti as Z iii a ti lr ' o. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 67 Foster Street Property Address Matthew& Pamela Rivet Owner Owner's Name information is North Andover Ma. 01845 7-20-2011 required for 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. I Rivet 67 Foster Street No.Andover 7-20-2011•08/06 rifle 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 67 Foster Street Property Address Matthew& Pamela Rivet Owner Owner's Name information is required for every North Andover Ma. 01845 7-20-2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 86 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: 4-30-01 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: p You must describe how you established the high ground water elevation: Soil Logs, all liquid were good, no sump pump,basement was dry System was replaced in 2001 There was no indication that the system was designed for a garbage grinder on the plans. There is one there, would recommend removal of the unit. Rivet 67 Foster Street No.Andover 7-20-2011•08/06 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 15 of 15 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, July 19, 2011 10:21 AM To: 'Rocko5454@gmail.com' Cc: 'Riv732@verizon.net' Subject: FW: Septic-67 Foster Street, North Andover-As Built; Plan Info. Attachments: 20110718132515493.pdf Importance: High Follow Up Flag: Follow up Flag Status: Flagged To:Paul Cardone Title 5 Inspector Re:67 Foster Street,North Andover 978.407.1808 Cc:Matt Rivet Homeowner 978.258.2580 Hi Paul, Attached is the information you need to conduct a Title 5 Inspection for Matt Rivet at 67 Foster Street. Please call me if you have any questions. Best Regards, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street Bldg 20 1 Suite 2-36 North Andover,MA 01845 N Office-978-688-9540 9 Fax-978-688-8476 9 Email-pdellechiaie@townofnorthandover.com ; Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet." -AnonYous If you are happy with the customer service you have received from town departments,please let us know...feel free to complete the general Comment Form(link below): ht!p://www.townofnordiandover.com/Pages/NAndoverMA WebDocs/contact 1 3 Aokim � Q g I.� 'K � t t � t - i � d dYf � t � AS BUILT PLAN OF S .ft �E nISPOSAL SYSTEM LUCATEDIN M PREPARED MR Lvl- �- _.�_.: .. DATE: al AK .. . +� M E SCAL rel �" Pi Pe Iib �� It Z0,7 Ar— . t f I - 1 d " � 1 3 PLAN SCALE: I" = 20' 40 . vC rift f L F ;< S 0.005 (MIN.) 1. SCH. 4 PV � ' + - ZX 0.02 FT.IFT. ( PIPE MIN. — ---;. —I2p MIN. COVER 4 DIA. PERF. SCH. 40 PVC .005 .�. S-0 R C.. • w.� a.a•b 1 IV. PRO 0 a - _ . -v rEE - r. - N _ 1 INTERCO IN �_ ._ — PIPE ENDS S& - -�—��- == �=' f p OF 3 4 E.TIE:r; iiNK.w I. 2 STONE w w I _ O 9 / v l d G _ FT. - C 4 ABw - f ?s` - - PROFILE - P x - r SCA LE: t 4 HORIZONTAL rA1 1"= 2 ' VERTICAL �eajGrL1" 17s11.�Mr�1+i' �I �. Gave' 0 0 0(\ WITH HYDRAULIC CEMENT. � ) D --BOX DETAILS DESIGN CALCULATIONS NOT TO SCALE DESIGN FLOW = AL— BEDROOMS x I GAL./DAY mac, +,�� DESIGN PERC RATE: M.P.I. ' SOIL CLASS: PERC TEST RESULTS! DESIGN FOR LEACH FIELD (SEE DETAIL) LEACHING AREA REQUIRED = =! ," GAL. x 1/. GPD, r �• r! 4 LEACHING AREA PROVIDED: �— WIDE x LON DEPTH DEPTH #— Z SOAK TIME i SOAK TIME E �— eg R"o 12"-9" DROP 2 �— 12"-9" DROP " 2 9"-6" DROP I CERTIFY THAT ON MAY 3, 1996, 1 PASSED THE EXAMI 9 -6 DROP BY THE DEPARTMENT OF ENVIRONMENTAL PROTECTION A PERC RATE �M.P.I. PERC RATE M.P.I. ANALYSIS WAS PERFORMED BY ME CONSISTENT WITH TH EXPERTISE AND EXPERIENCE DESCRIBED IN 310 CMR 15 C Z TEST DATE: ] t SIGNATURE D ENGINEER: (/� rLli /N/ 2 INSPECTOR: r2, ,4 . ` U PLAN OF SUBSURFACE SE WA GE DISPO>< IN } AS PREPARED FOR t. SCALE: AS SHOWN ,�- ,! DATE: LOT SUBDP ►< I<c7E3^,tr ASSESSORS MAP # •t {' Gill;.. �(ri� REVISIONS: A� 1kIERRIMACK ENGINEERING � .: 11 � 1 �cr { A � + l J racy otl _ I 4" DIA, SCH. 40 PVC PIPE 5 = 0.005 (MJN.) SCH. 4 PV PIPE (Ma) 2x 02 FT,/FT- �M1N.) TEES 12" MIN. COVER >. 4" DIA. PERF'. SCH. 40 PVC S=0.005 F rNv.= � ° PROP.TEE INV.=Gf�L�% INTERCONNEC 1500 GAL. CONC. 10" OF 3/4"_ PIPE ENDS INV.=SEPTIC TANK i a 1 112" STONE int1 yoU 0 pi FT. 77 i` Not, PROFILE SCALE: 1"= 4' HORIZONTAL 1"= 2' VERTICAL `may ,• �. LCF'1r1� �,•!I- iii �� ` � '` ` fc Gave►-r t o 1J sA L.L. Ar6PJr ,,� FWT TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 8/30/01 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by Peter Breen at 67 Foster Street 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 ealth Inspector jr i i 5 '✓ s i I v IS °f Y'- - J • North Andover Health Department Community Development Division Date: July 12,2011 Matt and Pam Rinet 67 Foster Street North Andover,MA 01845 Re: Application for 2 story addition at 67 Foster Street Dear: Mr. and Mrs. Rinet, Your application for a deck submitted on July 11,2011 at has been reviewer, )y thL,Healt Department. Unfortunately,the application cannot be approved by the Health Department for the following reasons found in red: 1. x Miss, g.informat;� - only a partial floor plan was submitted. Also note that the septic plan used in the application was not the actual As-Built of the septic system. This can be found in the Health Dept. file. 2. x Passing Title 5 inspection of septi . vs m r ,giured. 3. ❑ Location of structure not acceptable 4. ❑ Undersized septic system ***need more information before determination To address the problem(s): If#1 is checked,please supply: a. _A_flel all rooms b. Draw in the project on the As-built at the Health Dept. showing house, se tp ic; system and proposed project in scale (this can be done in the Health Dept) If#2 is checked: a. Once the Health Director reviews the room count and gives the approval,have the septic system inspected by a certified Title 5 inspector to determine whether it is operating properly: A list of licensedinspectors can be at http://www.tnwnofnorthandover.com/Pages/NAndoverNlA Health/permitsandreg_s 67 Foster Street 1 July 11,2011 operating properly: A list of licensed inspectors can be found at http://www.townofnorthandover.com/Pages/NAndoverMA Health/permitsandregs b. Tie-in to municipal sewer If#3 is checked: NO a. Relocate the project • If#4 is checked: Please be aware that this cannot be determined until further information is received Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, u Sawy Public Health Director Cc: Building Department File 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fox 978.688.8476 Web www.townofnorthandover.com tf ps� w � � s TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The ycldersigned hereby certify that the Sewage Disposal System( ) constructed; (,repaired: by 41crL�Er.� located at was installed in conformance with the Nort4 Andover Board of Health approved plan, System Design Permit #��5 dated dao with an approved design flow of 400 gallons per day. The materfals used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Rep esentative Final inspection date: C6— �3-01 Engineer Rtylpresentative D Installer: I Lie.#: /63"79, Date: Y-130 A/ Design Engineer: Date: cvoAR # -By, 1 AS-BUILT CHECKLIST LOTNUMBER, STREET NAME ✓ ASSESSORS MAP& PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING FXSERVE tw., Nd TIES TO LOT LINES &DWELLING, WELLS d. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES& PERC / TESTS y ELEVATIONS OF DISPOSAL SYSTEM TOP OF EDN ELEVATION /V,4. LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS,ELECTRIC LINES, CABLE i DISTANCE F E T CENTER S FROM CORNERS OF HOUSE O C TER OF TANK&D-BOX ORIGINAL STAMP & SIGNATURE J IMPERVIOUS AREAS - DRIVEWAYS, ETC. y NORTH ARROW LOCATION&ELEVATIONS OF BENCHMARK USED UILD1 ES JLIHjAY PARTS I,la�� uc'f ftp; R A a G ►21 ED . ly E 33.o Z .5 -- lz Et-i . 0�'t e ti e o S�1 o 4 LaAjvt,Y,TEN . TT is �, eEco�a OF f�+& tLY/�TbJJ — q A WV ELEVAeflod OF TiaE �' `�TtNt� �i(5'fa►-i Pwr. mc ,3&Z op Loco i PT Ta'Jc f�yT?Wl ' � �tN•`Fb�'� =1 3 M �� I I i E 4 k t f 1✓ I AS -- I LT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN 0.v 2T 1� A�,4POV E 12- , �--� ��/ G-7 FSE t2_ �r7-2 5E AS PREPARED FOR TF� Y-- BOARC; . DATE: -23- 9 /� SCALE: 1"'_ 4f� ' T1'1 I "IAUG2 30 001 �� AU MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS " PARK STREET • ANDOVER. MASSACHUSETTS 01910 TEL (617) 473-3533, 373-5721 �I s Town of North Andover, Massachusetts Form No.2 ' NORTh BOARD OF HEALTH y o � F ' • •. -moi DESIGN APPROVAL FOR ` : HUS SOIL SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No.— Site o.Site Location —L x Jv-- Reference Plans and Specs. ENGINEER SIGN DATE Permission is granted for an individual soil absorption sewage disposal sy em to be installed in accordance with regulations of Board of Health. • CHAIRMAN,BOARD OF HEALTH Fee ` Site System Permit No. /%J INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at C_ I `S TCS i relative to the application Frc,,n. U_ Qi,)e-- of dated /p D (_for plans by /1'IGfr ►�it dated ?1)17 2Y with revisions dated 1-7 2 F :7-0 c' I I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade-Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. .I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer 6 ke Date: hJ 6 b i 'to ( Disposal Works Construction Permit# 6 i i APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT 1 DATE: ® d CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER: SIGNATURE: V1, TELEPHONE# 6T? CHECK ONE: REPAIR:—U/ NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only 7e Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval Date: f0 J� I Town of North Andover, Massachusetts Form No.a Olt NORT1{ BOARD OF HEALTH ' tt�►° °,ti DISPOSAL WORKS CONSTRUCTION PERMIT SAGMUSE Applicant NAME ADDRESS • TELEPHONE Site Location__ Permission is hereby granted to Construct ( ) or Repair ( ndividual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. ,r CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. I i I Town of North Andover NORTF� Oat«<o ,,qao Office of the Health Department 1O p Community Development and Services Division 27 Charles Street "` •� ��- North Andover, Massachusetts 01845 Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 July 24, 2001 Bill Dufresne Merrimack Engineering 66 Park Street Andover, MA 01810 Re: 67 Foster Street Dear Bill: This is to notify you that the revised plans dated 7/17/01 for 67 Foster Street have been approved. The following variances have been granted: 1. Separation to ground water from 4 feet to 3.3 feet. If you have any questions, please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, Sandra Starr, R.S., C.H.O. Health Director SS/smc cc: Rivet File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 r } CpMMOpk � y ` O s9y�e-o j I TgR1AN SL1�S i 0 1 h f r' l X1S I I t D _ Town of North Andover, Massachusetts Form No. 1 � pj`•ED ORTN •o BOARD OF HEALTH . y� (J� '09.. Q � ib�'Y 2nL Q 3 ye e L APPLICATION FOR SITE TESTING/INSPECTION ADRATED �SSACHU5�� Applicant Az!2.1'-0 �" pp AME ADDRESS TELEPHONE Site Location �o Engineer �a ME ADDRESS TELEPHONE Test/Inspection Date and Time �f� ��� CHAIRMAN,BOARD OF HEALTH Fee Test No. 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 3�0� 16 0 APPLIL51TE TESTING INSPECTJON Applicant NAME / ADDRESS TELEPHONE Site Location Engineer � �!/i..��-C/off ;L. I.LY_ NAME ADDRESS, TEL�!EPHONE Test/Inspection Date and Time r CHAIRMAN,BOARD OF HEALTH '1 Fee h Test No. j S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. _. 7 }.., ` -:�. -...,..::: s ,. ,;: r. r .a. 'eu:. �a .::z 'ts',, %"s �° � s�"�� 9''xs z S �k x at ..✓r,{kt°1 ;;.�-� ::'s x � _ _ .: r ..-=. .r' + '&' ','r✓, Na�t ktBr� r *p '..', i ,ve+aw^,� k>, `*t /Y.q�"y� d f"M" '. + ,+.,F.:.. r ,,w t«p .. `.:,; •r,; e^e' .C, y"uSI'^"k"'•''G :'' s .c'.7p 4 'eh't"p ry., '*+f�snbs ""`�s,,, YAu'w " r- y,- . tet + }.,.5 �c iw.s�.Ips: ,,ya .x;. _. r a* ,'e.,d•6�a x`u � a � ,,Y'a x� -� a t'E.: r t �„ I.q ,..T.s' r:;. I Ira- x;r0' ax .r "r'... ;. '� w,.� .•,;- .,. R ra aq� r p} • >' �i ""` ,, r i':'t r a°x,� 4 xs.t.i:: .:.". r.•-s. J A w::',.tw f -s '+� :.'+ k X. Y n`• tea ,+ q '"„�h,- : '�.F:. ' .. Ai4 .,, "' ?r r.,•:.a+�7a xa.* drtr~:;>�A "&q� "� u'�"EtY•:r;. � t' �* c ''? �.n "° s c - t r„.: `^{ s;>,u.. ^^6 ` r ,yA y:� r w;:�TM � wa .,}i„` � .xr^. •�t*� V+.�: �' ���". 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Tell—�52� New tsi;ol �epai Date: 4f� 10"t7� Wetlands Zone II Soil.Symbol —Soil 1Qame t1/ZC. oil Class/ Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Tenure Soil Color Soil AiottlinQ . /o Gravel,Stones,etc i Ar Cole-WNu LA-r- V. F11Itvg�.... • �1.� f•to-rTl,a�i�SCv� �lZleb�t� .. t� Patent Material TI L—L, Depth to Bedrock Standing Water in the Hole: Keeping from Pit Face ESHG«':� Parent Material De � •• th to Bedroc{: e P Standing Water in the Hole: �Yeeping from Pit Face ESfiGtiY- Date Percolation Tests Observation Hole r P Depth of Perc Z' Start Pre-soak 1 !!9 Time at 12" Zj-7 Time at 9" Time at 6' Time(9"-6") Rate MimUch Performed BrY - Ll nVA0 Witnessed B.- - ,- p. f2cr�r_cc� NErTIC PLAN SUBMITAL AL FORM LOCATION: �af;�ek' —5m NEW PLANS: - -25-A0/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: S NO DATE: DESIGN ENGINEER: r rjfel DATE TO CONSULTANT: 6 *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 a f G i � w{ - , f e 71 65 A l000 .10 i 3 I I k y ri II� u l j •yam ,p k� f Location: `7 -tGr� G owner's Name: F 12,��Jly Vt V/C� Map/Parcel:"1 1••'l. I O � � Address:_ /11 F0.C.,- r_ �T►ZG l=r Installer. Tel R:-6$Z--q 528 New tsisol epai Date: 4�ZZo'�� Wetlands '— Zone U Soil Svmbol�_Soil Raine A/ oil Classy Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Te=ture Soil Color Soil Mottling % Gravel,Stones,etc: Ar5L 2-10 rr7 L, F'(I�c`1Gi1 V V� �f1I�✓�:� 10-0c, C , FSIsiyl 1�I�i►v � f el. Parent Material Tl L—V Depth to Bedrock Standing Nater in the Hole: Weeping from Pit Face �FSHGjy; T Q t f it Parent Material Depth to Bedrock: Standing Water in the Hole: Weepkng from Pit Face ESHGIv: Date Percolation Tests Observation Hole r P Depth of Pere Z" Start Pre-soak- Time re-soakTime at 12" -1�7 Time at 9" s Time at 6" Time(9"-6") -Rate M udnch- - Performed Bv: Y7_ �u F �� Witnessed By: MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com TO: North Andover Board of Health FROM: Bill Dufresne/Merrimack Engineering DATE: �i ' 4� RE: (v? 05TC'(i t TM: I�� TL: OWNER(NAME& ADDRESS) 9T. Members of the Board: An upgrade sewage disposal system plan dated: has been submitted for the above referenced site. Pursuant to Title 5, and the North Andover Board of Health Regulations, Local upgrade approval and/or variances are being sought from the following sections. 1) �� ?�c�-{ \/F�2�-tc:al� ©F�S�'T l%►zrx� �.E.S. 'To ��z��' 2) FRCP-1 14' -77, 3) Please consider these requests for approval on your earliest available meeting agenda. We respectfully request your consideration of these matters. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne cd 71 1 N � '`_ � `.J_' ` ��NIi +7 - INC) I O� 77 - I- N OI ! .Q - Q � - - BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 1 APPLICATION FOR SOIL TES TS RCS 4 � DATE: WAN 2 2 2001 1—Ig_©( LOCATION OF SOIL TESTS: &_7 �S7 r re— Sr - , ten:, Assessor's map & parcel number._ �inn / off'- T� �� CO NS E���+�, � _. OWNER: rrw, cs CZ— ue_+ TEL. NO.: - z� ADDRESS:_ A ENGINEER: fM &I i hbTEL. NO.: CERTIFIED SOIL EVALUATOR: Intended use of land: residential subdivision, single family home commercial R air testin g Y A e p 9 Undeveloped lot testing N. A. Conservation Commission Approval: S THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permittings tests) 2. Plot plan 3. Fee of 1275.OQ per lot forepow construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or uagrades. GENERAL:INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two-percolation tests are required for each septic system j FRANCIS•E RIVET 2951 IOn test, at the MARY -=RIVET 67 FOSTER ST' '_ =DATE---4 / 'e') NORTH ANDOVER,MA 01845-2203 _ s3-esso/2113 _ x _ �j*s of testing. shall.be submitted to PAY TO THE a ORDER-QFL Doped tests). l uva DOLLARS B TOWN OF NORTH ANDOV:._.t/ r&` `° BOARD OF HEALTH NORTH N: AS5ACHU$ETTS ACH.R/T:211383901 ACHACCT:11815 TEL'EPHON'E WORKERS' ! C.U. CRED1T UNION ` _- LOWELL,MASSACHUSETTS 01851JAN ' 2 001 $ MEMO 1 2 L 13 8 3 9 0-L�: _--_ i-187SO 9118 295 x ®LIBERTY MAY Wn, _Y.�5 Q4 b, 0 -tw 4F."IT, H 11, hY-I1l4m_,`l�,l. IVA- *P M er VIM zet; 01, NO 6" US �,V lz"Ir Air W-WO Z, 'A 13", '01 K? "P, of m V", fit Mip-11,Ail MU l."gRguw, Me Mac 00% 110 MIE. mel. w R_ 2Er R, "a RM kM ,let wq Z W -T , ��sw , N P� KIM, T, 'J _0 -4W_ll`RlMNW4;� Wfl WPM"E�l_ M'" �p R 5tp. ZRI, &,P�*Mg g 5 wjz 4,WOR v ip 4M. 410.4rIN4 WIA yq� VoW I�f 1,Mmlvli� K41A k I r_�4,q %pow No u 0:11,1E, Ul Min---u "Will, wtg' g F.. _,_F�f 1p mall IK"I, Av; R" ggvgm 21N I R 2r, I Mil SERUM Mail 1121 R,V MR IT BIR11-11 I f;1P g, X;iw n, wm V fi GN .11 I-R R ME a M .O�w V., , Pgy 'U."M WE A g k RUIA �,S R ` M M 'AMO wv1%, Mil A� MN Ato MH "t-z' �t 5, Ell a� Q0 MCI, OF atm I �n W ml�,,,,,, a Fag t'A"ftl. ME R2 kpg Fon MW pq Mill�WI DO �A A to- Ell CZX�_". J g 6.r .......... BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: LOCATION OF SOIL TESTS: &7 srI S� Assessor's map & parcel number. 7rx., / 2<,, OWNER: ccs i Z-t u r _ TEL. NO.:_____6,F7 z� ADDRESS:_ ENGINEER: HE121Z1"ALr-fM61 U } :,TEL. NO.: 475'7?75 �;15 CERTIFIED SOIL EVALUATOR: [24 IZ-e E Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting, tests) 2. Plot plan 3. Fee of J275.00 per lot forep_w construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75,00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. 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'. �x tr �'�1-Y r k i4 i�i'.: ,, r'�" _ '.`� > .t Y., t i . r .. 3..,.�. .:,a. p,;,: b. ♦�+=:es.•.. r : .:o' .5_, ::a t'.,e7. ..ttx t .rr:., �, >; .3- ,c R+r - # - ,n .',_. �..;.� ., ,. ..,...- t i.e..F., -;r I�J:•.. : Address 6 Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health-- Planning Board — Conservation Commission — Buildin- g Department (, FosterSSt�°et DISPOSAL II�6TALIATION APPLICATION FOR SE"�AGENORTH ANDOVBR, SSS. HEALTH DKX RTP�NT - a sewage disposal installationia t t for this system I hereby make application for a Pew I will install and regIllations of the laws of the CommonweSt. alth of Ivyssachusetts cordance with all of North Andover* d spigot pipe, the minimum the Board of Health of the Town the house Sealer of bell an until 10 feet pre- -4- will will construct um rade of 11- Further, I will install a con- ter being 4 inches, and will made shall not ext ed 2°�• easy cleaning diameter where the g emnw thi inches of the septic tank, in size A manhole (s) P within l2 erforated ceding of iron or concrete inch n trete septic tank of disposal field witho which will pro- will be provided with will brovideesu surface trenches) the bottom or tion area. I P a series of abs P the ground surface. and laid in (square) feet of effective or open jointedoPipe 200 linea l (sq ravel or crushed stone rangilar vide a minim a 6 inch layer of washed gravel be surrounded by these es will be laid on and the Pines The joints of The pipe to 1-1/2 inches (dia.) of the Pine• 2 inches of in size from She ht of 2 inches above the crown the trench, and before filling ravel or stone• material to a height laced over the course g No single pipes will be protected from clogg Will be P to 6 inches/100 feet. $11 to 1/4 (dia-) rade of 4 be gravel or stone 1/ case, two lines of tile will e The disposal field will.-be installed a thea d in any t center lines of the tile line will exceed 100 feet in ll depth of trench shall not exceed 36 inches• minim"u 6 feet will be d intained between he rivets water supply9 installed, Ami d the average P ro erty line. installation will be less than 100 feet from any P disposal field trenches an dwelling or l0 feet frlii a property by the No part of the lnstream, 20 feet from any ui.rements 2� feet from any cover an ortion of this installation additional req I further agree nota provided below, and to incorporate any application* 'ns ection officer, a rmit. plot Plans must be submitted with aPP i that may be attached to th e 61 DATE Applicant 1 4Signature of pp •t for the Board of Health of the Town of North I hereby issue the above perm Andover, Massachusetts. AUS. 14,1961 DATE ._. h,Agent i nature of H I have inspected the uncovered system indicated above and find everything done as described. DATE Officer Signature o nspecting t Percolation Tes _ Sandy Cla Qom•----- Garbage Grinder . . r August 12, 1961 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Foster Street building site of Francis E. Rivet. The land in general is high. The subsoil in the area was of sandy clay content., and a 3-minute test was .conducted. It is recommended that a 1,000 gallon concrete septic tank be installed together with 200 lineal feet of drain pipe. Very truly yours, A Wi 'am J. rii&� WU, G` WJD:hd BOARD OF HEALTH TOWN OF NORTH ANDOVERV hMSS. i� ®�3 38 ia��i�iGue . ..enrlcTRu� { 9-Q� � Q, �„�'.�.•P�.� "Lid � •$ - tab_ `� 13 Eob (o 1 NAPdE � .JI; g.6 . �f-�� OX�r .�. DATE .O. .� • � _ �" , LOT NO. 43 /tea 'ef?:4EL.ol? 2. ADDRESS .. . 3, NO. OF BEDROOMS DEN YES . . . . . NO.. 4. GARBAGE GRINDER YES NO.. . 5. SHOW DIL EMIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7, SHOW DIPJI VSIONS OF LOT S. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTAIME OF WELL FROIJ SEWERAGE SYSTEPA 10. SHOW LOCATION OF DROOKSV STREX61 DITCHES,. LEDGE CUTCROP, ETC, 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NO�tEa LOCAL REGULATIONS SHOULD HE READ CAREFULLY. WLC��.{,�> a �- � {•w-1 I`�+LG. �QLs�'t�-a ��-tt:(tJ•-��� � c1ru, . 1 i � I I �- �i Ct►ntuutlltr�allil I,t �MaRrnritusells . . , IVlossacltust3tts i j�lalmv�rno r p5� � V � V �� q(p ,_ , . Qtltltllil}' ihUlti��dl +• /��� l)aie nr Itultti►inll . � ' +� . -------------- ff firnllr� 'l'dt�t•t ti'•► � � Yes � ' C"eseltuull r Lit:t±l►se a: sysleltl Pumi►ed h.': �, S Cu1Nenls.IrattsletreJ Ir: �' --"— DateIllspetlut r • / ` �� L,���u�u,t�t�tal�b wl' AMaRr�trb�iselu . � IVlnsst�cltu��tl� i —`5j't1��Lnciit'o� • gsllettrt�trno 1 1 . t z V'14 Iq \J ' 1 ; , 1 �.• C161 + t1UA���1�}► huwlqitJl i 1000 Uete of Lj- fiNhllrt� 'l pHt t.�rl Ye! Gl, s n i Llee�ise at Sysleil1 i'MmieJ CumetNs.IrailsleileJ is+t ' l)a i t - , r t Ic��,Ji�q�t ;• ,✓! r,~ i4 l��c1' s ". .: r, t t � r n ..,r J, rn;�,y ,.. Hyl!, •hf S { .o-• �� r ,+� 4 .r.. TOWN�F`NO$TH ANDOR,.or o `1' S:YS'TEM PtJIi2P := INO RECORD • p DATE •. .� SYSTEM OWNER&ADDRESS SYSTEM LOCATION /e/ ve-7 Fl,v 6 75 os-�e s T. -� N ei2 lUD Q •,�oV l q . DATE OF PUMPING:�'/ ^C�y QUANTITYTUMPED CESSPOOL NO_12YES, SEPTIC TANK NO YES t NATURE OF SERVICE; RQClI' 'EMERGENCY •, - ., CJI'••. • .. , OBSERVATIONS:•. : GOOD CONDITION' FULL-TO CQVER H$AVY GREASE BAFFLES IN LACE ROOTS ', •_ LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED 30LIp CARRyOVB OTHER EXPLAIN SYSTEM PUMPED BY h COMMENTS; CONTENTS TRANSFERRED TO 1 Commonwealth of Massachusetts City/Town of NORTH ANDOVER MASSACH SE System Pumping Record 1 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. The S t be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use only the tab key Address to move your /Vo 4 a v., 2 61#s s cursor-do not Cityrrown State Zip Code use the return key. 2. System Owner: Name Y-lwc-/v Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of PumpingDate 0 2. Quantity Pumped: canons 3. Type of system: ❑ Cesspool(s) [[Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes [5No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition o System: CL 6. System Pumped By: 1 f J�fl✓J C-- Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of NORTH ANDOVER MASSACHU System Pumping Record Form 4 " 17 �� DEP has provided this form for use by local Boards of Health. The Sys eTQV0tl!L jQ � be submitted to the local Board of Health or other approving authority. HEAL M D PAR A. Facility Information Important: When filling out 1. System Location: forms on the �� computer,use ��� t /L" only the tab key Address to move your IN)11 cursor-do not City/Town State Zip Code use the return key. 2. System Owner: L f4,—ca l i4- Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. _ Date of Pumping VJ� 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): — 4. Effluent Tee Filter present? ❑ Yes 2/No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: o cL 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Siga ure of Hauler Date http://www,mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Q\ Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record RECOVED Form 4 DEP has provided this form for use by local Boards of Health. The Syste Purn R �cTi>3"ust be submitted to the local Board of Health or other approving authority. TOWN OF NORTH ANDOVER A. Facility Information Important: When filling out 1. System Location: forms on the ,�t7`7 'T 1 f computer,use ., only the tab key Address / to move your A-) • A,, cursor-do not City/Town State Zip Code use the return key. 2. System Owner: ZI M -/11-(k— Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping of`� 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) 2---S"eptic Tank ❑ Tight Tank ❑ Other(describe): — 4. Effluent Tee Filter present? ❑ Yes B--No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: G-L'-� a 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: C�-�5z-op A Signature of Hauler Date http://www.mass.gov/dep/water/approvals 5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1