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HomeMy WebLinkAboutMiscellaneous - 687 SALEM STREET 4/30/2018 1� 687 SALEM STREET 1 ® 210/065.0-0169-0000.0 1 l Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: S' 44� s �(102T7-/ l�/UQ�id� Owner: Date of Inspection: L SITE EXAM Slope a 3 Surface water 7 Wa# Check cellar iV 0_ py2y Shallow wells Estimated depth to ground water feet Pleaseindicate(check)all methods used to determine the high groundwater elevation: V 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) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 11 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION(continued) Property Address: S% AV12-4"75�-/9rc/Od1/ Owner: R5_47o� Date of Inspection: 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. HSE.Co¢A HSE Gee E S.Y hAu oLE H9.6 14A, D-BOX 52.2' Z3.6' =�;,�`• AS E'>`ntY ElEVAT10LlS� G7 IUV Fauturlotil E1=160.25 •:e'^.:_., '.� G•' E1r IGo,03 r IW.114 S.T. SC4 40 P.V.C.IUV.CVr C.Y El•Ism.94 1 I uv. W D Bbr EJ `159.13 R #y �,•"'G IUV.ouTDBok(TYP) E1=159 (07 �.` IUV cEUD cr-'blies Tv r) EJ=159.32 ; HSE.AaoPLSS ° .4-7-7 CE Or r l THAT'W£ T aoa`f I N1; IuVe_-rEDTHE ILIZALVnW OFTNE N aaswacp_: DISPOSAL S115tV-J-1 a LOr FA SALGH ST MO.A AIDP,E'2,MA. THE AS-6uir.T C,'LrxS f!-0kjS'Q'-e-710i' ucE.W�T H PLAA uS ' III A' •„ I,r•% 'V Co�Fo4:N= HAy -z I,1967 COT rIj Sau2 S��M Sr'?EET 3AS BUILT PLANOF SUBSURFACE DISPOSAL SYSTEM L• RT}4 AQ)\/f (P, MASS. A` WILD kM X5LL0WAY as V_A": C.L+o' b ? IMERRIMACK ENGINEERING SERVICES, INC. r ru=1�Mx1 • MoO.'Y r�iMC,•MRf 01.1• : VOL"171 0"N"0"M s s 10 t Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 592 £ri-r Sl— Owner: jOwner: y L (-V,4 Date of Inspection: lan TIGHT or HOLDING TANK: tank must be pumped at time of inspection)(locate on site p ) 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: " (if present must be opened)(locate on site plan) r+ 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.): Xe k tnayFa/- - AeL tv.4 y A7- WV QTS" GGLuw,57 O, tA44-W-,,Z_ Ar)z9l�F Q — /?I/1-,< dc' fGot4J f,yTTy12S ©/VF D/PF PUMP CHAMBER: locate on site plan) Pumps in working orde (yes or no): Alarms in working order(yes or no)- Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 R; o Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 697 514L-9,44 S/ — Owner: Date of Inspection:�/z3 16 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: i/1•eaching 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.): FG o cy S TOPS A 7 CESSPOOLS: (cesspool must be pumped as part of inspect ion)(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 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.): 9 \ COMMONWEALTH OF MASSACHUSETTS { f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t TITLE 5 �QFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:Xr�'7 S'/¢'Gz✓rYI .Sr �Q2.rrf Aau vF Owner's Name: RECEIVED Owner's Address: Date of Inspection: Al � /o s— MAR 1 1 2005 Name of Inspector: (please print) .&4—mtA/ TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Company Name: /GtI/L�7"/�ig$T f/ L41 Mailing Address: ,124A14411IS01923 Telephone Number: Z7dr- 74-/ - sz!z S-c� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: -,/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 9 �.--- Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 .' -,,age 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Ad ess: 107 .5,44r,4i S7 Owner k`GG crud¢ Date oflnsp�ection: 4S 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. Anv failure criteria not evaluated are indicated below. Comments: G 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 orexfiltration 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 breakout 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: 2 •,.t Page 3 of 11 OFFICIAL INSPECTION•FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A f CERTIFICATI.ON(continued) Property Address: Owner: -- Date�of Inspection: C. Further Evaluation is Required by the Board of Health: �f 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 �F 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 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: . . 3 Page 4 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) f Property Address: dS 7 5;*L944 SI— Owner: KGowi9Y Date of Inspection: 2= T— 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 ischarge 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 �1 squid depth in cesspool is less than 6"below invert or available volume is less than ''/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number /of times pumped _V 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. _)h 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and.nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO(Ye4 he system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: FS7 SAL£ S� WOM T i74 Owner: Date of Inspection: /off Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes o _ Pumping information was provided by the owner, occupant, or Board of Health 1/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? Y Have large volumes of water been introduced to the system recently or as part of this inspection? 1_ 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: Yes no L,-"- Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] 5 'w Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION Property Address: 5�e,,5,0 f7- Owner: TOwner: LE 1—,vWAy Date of Inspection: Id 2 /z? Si FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual):_I DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): �{ Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): Al •[if yes separate inspection required] Laundry system:inspected(yes or no): LVA Seasonal use: (yes or no): N Water meter readings,if available(last 2 years usage(gpd)): / Sump pump(yes or no): l� f Last date of occupancy:e a g/t a'v% COMMERCIALANDUSTRIAL JU/� Type of establishment: Design.flow(based on 310 CMR 15:203):_ gpd 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: Was system pumped as part of the inspection(yes or no): }!' If yes, volume pumped: I_S'W gallons--How was quantity pumped determined? Reason for pumping: iwrF_, N,1 e- /1'/E <2,>10 tl TYPE OF SYSTEM 4,L�eptic 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/Alternativetechnology. 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: Were sewage odors detected when arriving at the site(yes or no): D'V 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: %S Ir6C,'" S 7- Owner: AECWL.-W Date of Inspection: - 3_/ BUILDING SEWER(locate on site plan) Depth below grade: /Z� Materials of construction:_cast iron 2' PVC other(explain): Distance from private water supply well or suction line: Continents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) r, Depth below grade: Material of construction: concrete— metal_fiberglass polyethylene - other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of; certificate) r. . Dimensions: x 6 Sludge depth: y Distance from top of sludge to bottom of outlet tee or baffle:. Z 2- Scum Scum thickness: r� 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: FIEe-p ©45.54V* L:> Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): G o c4/) c 0ti0 1-76N GREASE TRAP:/u ocate on site plan) Depth below grade: 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.): 7 _ AS- 8vit,T I�SE• Coil A� H SE cop-`b I Ll D-BoX 5;r �w`n'4` C t N AS `rt d� r•x _1 r •� ti , !$s,F. C:T- IKIV.. rMUAA`("l01� -= ,.t'vD•2� ice. t X67 1t © !, 1 ice. Sao JqV P.wc'. 1 V� Q(' l 1uVf i p-BaX, x.:=159,73 7�� t H y 5 "f i/„LH”t L k r v !!•/. f uv, D v ✓_�'-r r)—EW( 1 J , t ' +Y ii r . 41 K��5W,11 Yv' y "1 `� i;:x} . ;p - ��� NSE. /l•DpY�SS , a 677 1�J SPC�i~D `I N '!iLG STAT- D 51, T1 5UWAC Y fcs 1 11,f- �a4r-i �" fi4,a �. o� M1i 7tS9 { 77 AS-"Euu, ' G- p�S P. gT1Z tic of W iTA ` Itli 'p ' I C �'_P P� EW �� 1=1 Def _� ,+v''r'r. ...-• ,.� `,tr x._. �&,� !�k A f y � s� ,-' .•5 �, +ri 1: fi`. f.s�',. �.-/�!•:d.°'-i x r vi Aq HJ 5A LE71-i a a� 4 C.� Gc dee ` ~ E {H4C-- Y * tT W 14D $sJi$j y h 1� r �•:�� )��l,�ty'�.rs R�'Ft ler yi�,���.a 4t x:.-� - t + �-`! ����"�wN'`�. �, � ?�,Y r�.#1�t-dY� ..�'!.��rr�_�' ,�-r'LJ'J+•� I rA _ (!'l/C.i�V � ��`�G!lf I� 'C/� SwiOt,C r =t AS BUILT PLAN � 5<< f Y OF 5 °., S�IM�/�IURMCE DlSMwrVwwwSYSTEM zt . LOCATED IN �t 0T AkDWf�R, .MASS. AS PREPARED FOR s'�r - t •� j OF Al _W ILLI AM . X _ Yrs ,a01. DATE: AuGuST, 't ., '1.987 R a+ y ROBERT CDALEY . G fVLE..' '.�. D 8 CIVIL rS�ONAI EN MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LANO SURVEYORS • PLANNERS v ab PARK STREW • ANDOVER. "WACHUSETTS 01010 TEL (617)413�iSSs. R?�-S17t1� TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD C APR T 2Q �1 STEM wNER & ADDRESS SYSTEM L-OC-ATION (example, left front of house) L)a-\TE OF PUMPING: �' � QUANTITY PUMPCD�C'ALLU� ) ,. I:S.S1 00L. NO YES SEPTIC TANK. NO YES l/ �.ATURE OF SERVICE: ROUTINE EMERGENCY 1J 13.>FRVAT10NS: COOD CONDITION.. FULL TO COVER HFAVY GREASE BAFFLES IN 1'L,ACL,' ROOTS LEACHFIELD RUNBACK , K . EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER ;Oj�HER (EXPLAIN) >1'>'I' 'm PUMPED BY; Y. CU M NI FNTS: lQ U.N,..I tiZANSFEIZRED TO: . j ...S k: ' 'i> :44+ d '=�wfirr r i K. x '• y #Y Y it� � R� t � y � Y�� s k X55- � ° r x 4V 11V FORM U - IAT RELEASE FORM " INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant f' lls out this section***************** pLICANT: Phone q 1 CATION: Assessor's Map Number Parcel Subdivision Lot(s) CjS"treet St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected _ Date Approved _ ptic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit ire Department Received by Building Inspector Date VON KO NMOHS /1 7 t I , 61 a fj s'o£ ". I ti £•os 1'Y'N/77�rYt 0 W Y �N/11j x� ' 40 A v *man s otib. , o�a31s/o�b >- . 94 '0O/ pr„ Z504Z'ON 1, , -r— :as 1 o d o1 � NOSGUMOM m ; M s , �y 39HO30 -:7 -7 `s�blV jO\�w;.�` � + -ss& 44 0/l ^.• �C d en 0 -7 -7 b d � AA7A W K x 4.. ,- � _� �- G..,F � r, -.. -� {,+.�_ � a,,,., ��..�e=-^� �'x�`T ,ft' �,,�i �S "�� i� �'xw r� " _� ,�..''�,,�..e��`-�-k,s� �a�s:,���r �t int„ ar _. ",� -n a,��t�y,e';��• ��. ..+"�'a.?' ° ,tORTJI Town Of North Andover p Community Development & Services William J. Scott 27 Charles Street Director (978)688-9531 North Andover, Massachusetts 01845 �SSACHUS�� Fax 978-688-9542 June 30, 2000 Mr. &Mrs. Albert Greene Board of 687 Salem Street Appeals No. Andover, MA 01845 (978) 688-9541 Re: Sewer Tie-in Building Department Dear Mr. &Mrs. Greene: (978) 688-9545 The Health Department has been supplied with a list of all residences, currently on Conservation septic, which have access to the municipal sewer system. As previously published Department at a Public Hearin on March 17, 1994, the Board of Health has adopted (978)688-9530 g p regulations concerning the required sewer tie-in. The following timetable Health concerning your property status was adopted: Department (978)688-9540 4.1 All establishments that currently do not have municipal sewer available to them must connect to the sewer as soon as it becomes available, with a Public Health maximum time limit of six months. Nurse (978)688.9543 The purpose of these regulations is to safeguard North Andover's drinking water, surface waters, groundwater and surrounding environment. Sanitary sewer is Planning believed to be the most effective form of wastewater treatment. A copy of the Department entire regulation can be obtained at our office. (978) 688-9535 Any questions concerning this regulation should be directed to the Board of Health at (978) 688-9540. Additional inquiries regarding the physical tie-in and permitting process should be directed to the Department of Public Works at (978) 685-0950. Please be advised this Board intends to persevere in this regulation. Yours truly, or Gayton sgood, Chairman J Francis P. MacMillan, M.D., Member John SF/smc IF 6Vc f-IDA13D Op HEALTH IA (,-06R SOPPL7 fl,-F5wt i 0 UJEU- ,�P oucD1YJTC �- 56PI-IC Sy S SEM vES16A �J-2 3197 �PPi�cav��D PATr�- -22 /JPR�OUiNG AUrho1'�)ry �fONPITio,JS_ REMO Poo rAT&Y s-,7-(-?7 7�r 5HOL4,15 sw�� D►SAPPRvv�p IN TE R�4SoNS . Dw� �� SrPrf C SYSTE�1, I�S�iO l.l,�'r►o�1 CYZA^ UAT(cO ),A-A ;— — �wAl. I tiSpE�i low 4 PPROOEP UU( , � 3o f APPMDvjivG AUrHOr�i i y Gwn/E� �4�D(T�D�v,4L I n15P�z.j IOtis �11-�Y) D�IN r SU�� Kl�vr /-� DA T vi kT-ki FVAL /JPPt�)VAL APp)�Ovr, G .� ��.: �� --.1 :, - � �tr. �A i �; '� 4► .e. ,�,.�,�.,, ,.-� s .� �' YR;.-1s�� ... �"; R - .� x=. * 4 ++ �.. '�' .�s �_ air=:2�;,,. f^ ~ 2 Jy. . . \: & \ : Al �RM7� -NIS, I ( AIMF— -Tl�l T IT -77t V tot 2 + it LOT-- W.�6 ROQ2W iTH log 2-f-4mr5—tIL� jP A.10 r 10 r )SA TO VNU-, 1/6W ZOrtl Al- ltll�— ?Oss 13 5R 11th7 70 52 ... ............ 777 ------------- ��,��, � '�' ra ftcx��r A�^"fua .aft ••'� '�� 'Ykfk� '�"QY^-ta l.... 5.,. � t::z. �. yak s"� '� c�, �' �} tf � - `h.3 '�., xY M�y'k'�'F%il�rMei•�.*#�� •� a'ys, 'Y,(.y a '`6 C k". � c zt``iiw#,X „a - fi. �Y✓<, :# �, `,�} xi��. i k N-ivy, 1" �" t"! � r' ��y.,�� 4 '1' �'3 '�.r H 4, at �.Y'„t- � s,.�, '+a�e�,.;� �•. �' rD rs � .K +� "h -��'ar, qa<V�� ^ '3'-�''�Ss 'ak 'S". FORM U - LOT RELEASE 'FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant f' lls out .this section***************** ._4PPLICANT: LAPhone CATION: Assessor's Map Number Parcel Subdivision Lot(s) C,,-Street St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administratorr Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected __ Date Approved 7 Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit ire Department Received by Building Inspector Date .......... RECEIVED TOWN OF NORTH AN4DOVEkMAR -. 2 2005 c?:3 j SYSTEM PUMPINQ RECORD TOWN OF NORTH ANDOVER HEALTH DEPARTMENT .SYSTEM 0 WNS)Uf ADDRJESS I SYSTEM LOCATION DATE OF PUWNQ; 3 D, _QUANTITY PUMPED; rte`"j}Q ` t 4S POOL: NO_ ... YES .. Snpuc Tank: NU YES NA rURE ON SERVICE, ROUTINE,. t:MERUENG'1' ObSHRVA*11ON9. OOOD.CONDITION FULL'T`U COVER HRAVY.ORWB 8APP1,83 IN PLACE. ..._ s C6SS7VE -• LEACKFIELD RUNBACK .,FLOODED # " _ SOLID CARRYOVER OTHER EXPLAIN 3 Jylt•m Pwn*bx . o 1Y1�'. .. . CMZ`;•. ..,Qra ,- �-ra tUMMHNTS. C`3 127E' l_ 2 11 � "WN PEN'I'S fKANSt'ERjwj) fG