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HomeMy WebLinkAboutMiscellaneous - 725 BOXFORD STREET 4/30/2018 (2)Lot & Street 37" Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: (Z�) NO Permit# Plan Approval: Date: /,q 8 Approved by: Designer:�/�, /6T/4i115EA) Plan Date: Z 19,01q 7 Conditions: Water Supply: Town Well Well Permit: Driller: j, T CSG 86E -j Well Tests: Chemical Date Approved Bacteria I Date Approved 111131,97 - / 13/97Bacteria BacteriaII Date Approved Plumbing Sign -Off. Wiring Sign -Off. Comments:,AND warms /441/k. _ .—te-6p 5c5DrU � Cl�Gc7. T�/%l, U Dc�P �- �`llP�fDi Form "U" Approval: Approval to Issue: Date Issued /,52IMlel 7 By: Conditions: NO Final Approval: All Permits Paid? q's NO Well Construction Approval? NO Septic System Construction Approval? YES NO Certification? YES NO Other YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: 11 SEPTIC SYSTEM INSTALLATION Is the installer licensed? (�E NO Type of Construction: REPAIR New Construction: Certified Plot Plan Review NO Floor Plan Review O K/aq%q� YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: NO DWC Permit Paid? YES NO DWC Permit !,7�,W Installer: reex-, Begin Inspection: ,YES NO Excavation Inspection: Needed: Construction Inspection: Needed: Approval of Backfill: Date: 9 By.-- Final y:Final Grading Approval: Date: Zp By: 11 61 1 Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE October 23, 1998 This is to certify that the individual subsurface disposal system constructed ( x ) or repaired ( ) by North Andover Licensed Installer Peter Breen at 725 Boxford Street, North Andover, MA 01845 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 as described in the Design Approval Site System Approval date of January 28, 1997. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. 10 � oard of Health Inspector TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (L4 constructed; ( ) repaired, by C-(er C Qy o�T t ✓) C located at X Fy 2a� 7` was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # dated with an approved design flow of _ tOgallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represente on the As -built which has been submitted to the Board of Health. Bed inspection date: Engineer Repr tative Final inspection date: %G a 15�A� ExKeer Representative Installer: ee er 60ecn k- Lic.#: Date: /a .z -£i�girceer !✓ Date: T F-44. 6A 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, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM _ LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX STAMP & SIGNATURE IMPERVIOUS AREAS -'DRIVEWAYS, ETC. l-�®f�e, V// NORTH ARROW LOCATION & ELEVATION OF BENCHMARK USED ✓ LOCUS PLAN Town of North Andover, Massachusetts Form No. a BOARD OF HEALTH c 4co4u, � DISPOSAL WORKS CONSTRUCTION PERMIT Applicant NAME Site Location a ADDRESS TELEPHONE Permission is hereby granted to Construct A, Sewage Disposal System as shown on the Design qr Ro air ( ) an Individual Soil Absorption PP al S.S. No. CHAIRMAN, BOAAFEALTH Fee D.W.C. No. 10 4 y ^f.�,/ 7,oLR—=.iLrDF`b illj _. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# f �^ LOCATION DX� 02� S fe. I t C LICENSED INSTALLER: &T­,_� 9 SIGNATURE:�TELEPHONE#, CHECK ONE: NEW CONSTRUCTION: �_/ IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. $75.00 Fee Attached? Foundation As -Built? Floor Plans? Administrative Use Only Yes No Yes Z---, Yes f No ✓ No Approval ��G Date: / NEW ENGLAND ENGINEERING SERVICES INC November 4, 2005 Ms. Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 RECEIVED NOV 2 12005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT RE: TITLE V REPORT: RE: 725 Boxford Street North Andover, MA Dear Ms. Sawyer: Enclosed is a Title 5 Report for the above referenced property. The system Passes the Title 5 inspection. If there are any questions please call me at my office, 686-1768. Sincerely, r 0� enjamin C. Osgood, Jr. Certified Title 5 Inspector 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Owner's Address: 725 Boxford Street North Andover, MA 01845 Date of Inspection: 10/31/05 Name of Inspector: (please print) Benjamin C. Osgood, Jr. Certified Title 5 Inspector Company Name: New England Engineering Services Inc. Mailing Address: 60 Beechwood Drive North Andover, MA 01845 Telephone Number: 978-686-1768 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 the on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5 (3 10 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: //.11105- The i 0S The system inspection 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. 2'of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Date of Inspection: 10/31/05 Inspection Summary: Check A, B, C, D or E/ALWAYS complete all of Section D A. System Passes: r 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: NJ 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 `Sot 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: 3 U 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Date of Inspection: 10/31/05 C. Further Evaluation is Required by the Board of Health: ALO 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 (SAS) Soil Absorption System and the (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 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 organize 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 5ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 4'of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Date of Inspection: 10/31/05 D. System 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 overload or clogged SAS or cesspool. L./ Static liquid level in the distribution box above outlet invert due to an overload or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow V 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrogen is equal to or less than 5ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) /VL (Yes/No) 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. You mulluldicate either "yes" or `no" to each of the following: (The following is apply to large systems in addition to the criteria above) / Yes No The system is within 400 f a surface drinking wat ply The system is within 200 feet of a tribu o a surface drinking water supply The system is located in ' ogen sensitive area (In ' Wellhead Protection Area — IWPA) or a mapped Zone II of a public water p y well If you answered > ' o any question in Section E the system is considered a significant or answered "yes" in Section D above the larges has failed. The owner or operator of any large system considered a significant under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should con --the appropriate regional office of the Department. 5 'of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Date of Inspection: 10/31/05 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 an 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 sign of break out? Were all system components, excluding the SAS, located on site? ✓ Were all 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 difference from owner) provided with information on the proper maintenance of the subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Y ✓es No Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] hof 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Date of Inspection: 10/31/05 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design)_ Number of bedrooms (actual): DESIGN flow based in 310 CMR 15.203 ( for example: 110 gpd x # of bedrooms): Number of current residents: Does residence have a garbage grinder (yes or no): AJQ Is laundry on a separate sewage system (yes or no): N 0 [if yes separate inspection required] Laundry system inspected ( yes or no): --- Seasonal use: (yes or no): /1l Q . Water meter readings, if available (last 2 years usage (gpd): uJ 0 i -L Sump Pump (yes or no): Last date of occupancy Go r r e - r. T COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sqft, 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 ( GENERAL INFORMATION Pumping Records Source of information: Fl j & Zoo LA G R O w N Vz- Was system pumped as part of the inspection (yes or no): Ar c> 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 Attached a copy of the DEP approval Other ( Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected wen arriving at the site (yes or no): /VO . T of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Date of Inspection: 10/31/05 BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction: cast iron_Z40 PVC other (explain) Distance from private water supply well or suction line: 30 Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: (locate on site plan) 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) Dimensions: t5 -0C, 6-p+L-Lo N S Sludge depth: 41 Distance from top of sludge to bottom of outlet tee or baffle: 35 Scum thickness: /-1 Distance from top of scum to top of outlet tee or baffle: r] Distance from bottom of scum to bottom of outlet tee or baffle .X;5' - /.l How were dimensions determined: !►-i f! Su ie E S77 cit Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): / i9/J % t N V V o 1> CZ f'f D lT7 Ai . ' S C[ t Li 0 -PU C G� r- b t 7) C) t --o c A- riF 0 v ,✓ c) Ell 0 GREASE TRAP: locate on site plan) Depth below grade: Materials 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 sludge 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. 8of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Date of Inspection: 10/31/05 TIGHT OR HOLDING TANK: N I l k (tank must be pumped at time of inspectionxlocate on site plan) Depth below grade: Materials 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) Depth of liquid level above outlet invert: 0 Comments ( note if box is level and distribution to outlets equal, any evidnence of solids carryover, any evidence of leakage into or out of box, etc.): �X [/-, &OcDD CcyN DliiZ,N V> cst Q\ $0--pov1 Eta. +t-. Juc) Q1= L. CAV -NA& -C IN 02 ov i PUMP CHAMBER: 1 . Y4 (locate on sire plan) Pumps in working order (yes or no) Alarms in working order (yes or no) Continents (note condition of pump chamber, condition of pumps and appurtenances, etc.): J 9ofII OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Date of Inspection: 10/31/05 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 in length a 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) ftc-t+ OF TR1FAj6ke- s j-oo T4s ryo .Q^A A -L_ cat IJN D(NCr- DA -M F SOIL Off- VN,s.Saj 4(, Ue-&-—1)gT)a9N. CESSPOOLS: &) 14 (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 or no) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: N��i (locate on site plan) Material of construction: Dimensions: Depth of solids Comments (note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation, etc. OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Date of Inspection: 10/31/05 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. m � 5�5'rcM f 1 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 725 Boxford Street North Andover, MA 01845 Owner's Name: Joseph Pelich Date of Inspection: 10/31/05 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: _4_ 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 excavator, installers — (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: S T E e a NSTILy C R H, A?, oy e G—az U.nJ Z,) A --Z 2- �4csre 4 r... A4zcck -j L, -c- Ll CCL9"-0 '4't,c.- o L_ -T- ccS T q T e c Town of North Andover, Massachusetts Form No.1 r1ORTH BOARD OF HEALTH r Ot Eo /646�OLJ ., (� �( b �E A APPLICATION FOR SITE TESTING/INSPECTION \QAQnicnewnPRy�J Applican Site Location— -?"f-4- ry� l �� Engineer NAME ADDRESS TFI FPHnNF Test/Inspection Date and Time �(t�l CHAIRMAN, BOARD OF HEALTH FeeJ� Test No. I.7 F S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. I - — ---------------- J7 /I -1 7-, Y. ,v ry-. GUT 174 - 6j] & pop", - — ---------------- J7 /I -1 7-, Y. ,v ry-. GUT 174 - ��'iJe✓JY�: Y � na'* ' _ 'i v t f• H �r .t I J �ckC - G ,L7 Z-0 • 'M . THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NOR THAND 0VER BOARD OFHEALTH Permit # This is to certify that Ogden Well Company of Tewksbury, Massachusetts IS HEREBY GRANTED A LICENSE To drill a well and install a pump at 725 Boxford Street, North Andover This license is granted in conformity with the statues and ordinances relating thereto, and expires DECEMBER 31, 1997 unless sooner suspended or revoked. p. Gayto <Osgood, Chairman randAn I'I _D lvinbsr;, t Jo S. zza, D.M-D., Membee Dennis L. Bedrosian Superintendent January 6, 2009 John Glasko Karrie Brenneman 725 Boxford St. North Andover, MA 01845 Dear John and Karrie, TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS WATER TREATMENT PLANT 420 GREAT POND ROAD, 01845-2909 BRUCE D. THIBODEAU, P.E. DIRECTOR NORTH Ottt�ao �01ti� 10- X70 �► o1q `�� x �9SS�IC,HuS t� Telephone (978) 688-9574 Fax (978) 688-9575 Please find below the results of general analysis conducted on the sample collected from your home at 725 Boxford St. on December 23, 2008. Total Coliform Bacteria: Negative E. coli: Negative pH: 7.58 Fluoride: 1.10 mg/L Temperature: 30 C Our analysis indicates that your water is free from any microbiological threats. We have sent out additional samples for volatile organic compound analysis and are currently waiting for results. As soon as we receive these results we will be in contact with you. If you have any further questions or concerns, please contact us at (978) 688-9574. Sincerely, Matthew O'Boyle Senior Water Analyst North Andover Water Treatment Plant MA Certification number for Bacteriological Analysis: MA 21054 :z. ;'•e,;.„:�-� BOARD OF HEALTH ,SSACNOA. NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT Permit # Date( )(3r A permit is requested to: drill a well install a pump LOCATION:_ 7 i��knvi•� '? Lot # l Owner f -%S }., :.T. Address "9, )” �,k / ofj j; �',.� %, Tel,�'� T Well Contrctr b2jfN CO Add. Tel Pump Contrctr Add. Tel WELLS (To be completed at time of pump test.) Type of well Diameter of well Depth of bed rock Use Size of casing Depth casing into bedrock Seal been tested? Yes (_) No (_) Date of test Depth of well Water -bearing rock Depth to water Delivers GPM for (how long?) Drawdown feet after pumping hours at GPM Date of completion Signature of well contractor PUMPS (To be filled in before installation.) Name & size of pump Type Size of tank Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_) Sleeve used to protect pipe? Yes (_) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health 66 LITTLETON ROAD, WESTFORD, MA 01886 Report Number: C-27446 client: Thomas Ogden 17 Catherwood Tewksbury, MA 01876 Sample Taken By: Client TEST PARAMETER: Total coliform (P) Calcium Copper (S) .Iron, :(_S,) Magnesium Manganese (S) f -sodium=- v Potassium (S) Alkalinity (S) Ammonia Chloride (S) Chlorine (total) Color .(-S)� Conductivity Hardness Nitrates(as N)(P) Nitrites(as N) Odor (S) Sulpliates %* S) ) .Tu-r-bdity,. Sediment ty". (978) 692-8395 FAX(978)692-0023 1 -800 -649 -TEST Report Date: October 24, 1997 Sample Taken At: Joe Pellech N.Andover,Mass. On: 10/23/97 CERTIFICATE OF ANALYSIS EPA Max RESULTS UNITS 0 0 Per 100ml No Limit 11.8 mg/L 1.3 <0.02 mg/L 0.3 .-#0--.7-0-- a mg/L No Limit 2.7 mg/L 0.05 0.02 mg/L -128 ,7.5.7. -� mg/L No Limit 1.4 mg/L No Limit 95.5 mg/L No Limit 0.05 mg/L 250 69 mg/L Not Spec. <0.02 mg/L 15 425, - CPU No Limit 419 umhos/cm No Limit 41 mg/L 10 <0.01 mg/L 1 <0.01 mg/L 6.5-8.5 8.5 SU 3 # 4-,Z� TON 250 18.8 mg/L 5 ,:#. , 9,. 0_ NTU pos/neg neg NT=Nat Tested, #=Value Exceeds EPA STD, TNTC=Too Numerous to Count —Background Bacteria Noted, "=EPA Advisory Limit Exceeds EPA Advisory Limit != E.coli present (P)=Primary EPA Standard, (S)=Secondary EPA Standard (may affect aesthetics of drinking water i.e. taste, color, etc.) This water sample, as submitted, is considered SAFE to drink according to EPA guidelines. However, one or more of the parameters exceeds EPA secondary standards as indicated by the (#) sign. Massachusetts State Certified Michael P. Carlson, for Testing Laboratory #MA048 Thorstensen Laboratory Inc. i TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS WATER TREATMENT PLANT 420 GREAT POND ROAD, 01845-2909 BRUCE D. THIBODEAU, P.E. DIRECTOR Dennis L. Bedrosian f Nop*a o �,,.to ,•,dao Superintendent January 26, 2009 * " CRU Ms. Karrie Brenneman Mr. John Glasko 725 Boxford Street North Andover, MA 01845 Dear Ms. Brenneman and Mr. Glasko, ji-ECEIVED JAN 3 0 2009 TOWN OF P HEALTH Telephone (978) 688-9574 Fax (978) 688-9575 Enclosed are the Volatile Organic Compound (VOC) results from the water samples collected at your home and at the hydrant outside your home on December 23, 2008 and January 13, 2009. All VOC's were negative except for the four Trihalomethanes (THM's), which are byproducts of all chlorinated water. All THM results were well below the Maximum Contaminant Level (MCL) allowable by the EPA of 80 parts per billion (ppb). There was also a very low reading of Naphthalene in the four samples. Naphthalene rarely occurs in water and when it does it is so low that it is not considered a health concern. There is an established Health Reference Level (HRL) of 140 ppb. The results of the all four samples collected were only 1 part per billion (ppb). We suspect the Naphthalene might be a byproduct of the cement lining process used in coating of the new main. I have been in contact with Tim Willet, Superintendent of the Distribution System, regarding this situation and he is willing to flush the new main again. This will probably not occur until warmer weather as not to cause unsafe icing conditions in the roads. Once we have flushed the area again, we would be more than happy to retest the water from your tap. Hopefully, regarding all the tests that we have done, this has reassured you that your water is safe to drink. If you would like to discuss these findings or would like to request further testing, please call me at 978 688 9574 or email me at watertreatment@townofnorthandover.com. Sincerely, Linda Hmurciak Assistant Superintendent/Lab Director North Andover Water Treatment Plant cc: John T. Smolak, Esq., Smolak & Vaughan Bruce Thibodeau, Director of Public Works Susan Sawyer, Director of Public Health X GROUNDWATER ANALYTICAL EPA Method 524.2 Volatile Organics by GC/MS Field ID: 725 Boxford St. House Matrix: Project: North Andover Water Treatment/3210000 Container: Client: North Andover Water Treatment Plant Preservation: Laboratory ID: 122906-1 Sampled: 01-13-09 13:10 Received: 01-14-09 17:30 Analyzed: 01-19-09 22:07 Analyst: EMC Aqueous 40 mL VOA Vial Ascorbic Acid/ Cool QC Batch ID: VM7-3103-W Instrument ID: MS -7 HP 6890 Sample Volume: 25 ml- LDilution DilutionFactor: 1 Page: 1 of 2 CAS -Number Analyte Concentration. -Notes -:- Units-- ,Reporting Limit 75-71-8 Dichlorodifluoromethane BRL ug/L 0.5 74-87-3 Chloromethane BRL ug/L 0.5 75-01-4 Vinyl Chloride BRL ug/L 0.5 74-83-9 Bromomethane BRL ug/L 0.5 75-00-3 Chloroethane BRL ug/L 0.5 75-69-4 Trichlorofluoromethane BRL ug/L 0.5 75-35-4 1,1-Dichloroethene BRL ug/L 0.5 75-09-2 Methylene Chloride BRL ug/L 0.5 156-60-5 1634-04-4 trans-1,2-Dichloroethene Methyl tert-butyl Ether (MTBE) BRL BRL ug/L ug/L 0.5 0.5 75-34-3 1,1-Dichloroethane BRL ug/L 0.5 594-20-7 2,2-Dichloropropane BRL ug/L 0.5 156-59-2 cis- 1,2-Dichloroethene BRL ug/L 0.5 74-97-5 Bromochloromethane BRL ug/L 0.5 67-66-3 Chloroform 23 ug/L 0.5 71-55-6 _ 1,1,1 -Trichloroethane BRL ug/L 0.5 56-23-5 _ Carbon Tetrachloride BRL ug/L 0.5 563-58-6 1,1-Dichloropropene BRL ug/L 0.5 7143-2 107-06-2 Benzene 1,2-Dichloroethane BRL BRL ug/L ug/L 0.5 0.5 79-01-6 Trichloroethene BRL ug/L 0.5 78-87-5 1,2-Dichloropropane BRI_ ug/L 0.5 74-95-3 Dibromomethane BRL ug/L 0.5 75-27-4 Bromodichloromethane 10 ug/L 0.5 10061-01-5 cis- 1,3-Dichloropropene BRL ug/L 0.5 108-88-3 Toluene BRL ug/L 0.5 10061-02-6 trans-1,3-Dichloropropene BRL ug/L 0.5 79-00-5 1,1,2 -Trichloroethane BRL ug/L 0.5 127-18-4 Tetrachloroethene BRL ug/L 0.5 142-28-9 1,3-Dichloropropane BRL ug/L 0.5 124-48-1 Dibromochloromethane 7 ug/L 0.5 106-93-4 1,2-Dibromoethane BRL ug/L 0.5 108-90-7 Chlorobenzene BRL ug/L 0.5 630-20-6 1,1,1,2 -Tetrachloroethane BRL ug/L 0.5 100-41-4 Ethylbenzene BRL ug/L 0.5 108-38-3/106-42-3 meta -Xylene and para -Xylene BRL ug/L 0.5 95-47-6 ortho-Xylene BRL ug/L 0.5 100-42-5 Styrene BRL ug/L 0.5 75-25-2 Bromoform 0.7 ug/L 0.5 98-82-8 Isopropylbenzene BRL ug/L 0.5 108-86-1 Bromobenzene BRL ug/L 0.5 79-34-5 1,1,2,2 -Tetrachloroethane BRL ug/L 0.5 96-18-4 1,2,3-Trichloropropane BRL ug/L 0.5 103-65-1 n-Propylbenzene BRL ug/L 0.5 9549-8 2-Chlorotoluene BRL ug/L 0.5 108-67-8 1,3,5-Trimethylbenzene BRL ug/L 0.5 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 3 of 20 GROUNDWATER ANALYTICAL Aqueous 40 mL VOA Vial Ascorbic Acid/ Cool VM7-3103-W MS -7 HP 6890 25 ml 1 Page: 2 of 2 CAS Number Analyte Concentration Notes EPA Method 524.2 (Continued) 106-43-4 4-Chlorotoluene BRL Volatile Organics by GC/MS Field ID: 725 Boxford St. House Matrix: Project: North Andover Water Treatment/3210000 Container: Client: North Andover Water Treatment Plant Preservation: Laboratory ID: 122906-1 QC Batch ID: Sampled: 01-13-09 13:10 Instrument ID: Received: 01-14-09 17:30 Sample Volume: Analyzed: 01.19-09 22:07 Dilution Factor: Analyst: EMC 104-51-8 n-Butylbenzene Aqueous 40 mL VOA Vial Ascorbic Acid/ Cool VM7-3103-W MS -7 HP 6890 25 ml 1 Page: 2 of 2 CAS Number Analyte Concentration Notes Units Reporting Limit 106-43-4 4-Chlorotoluene BRL ug/L 0.5 98-06-6 tert-Butylbenzene 95-63-6 1,2,4-Trimethylbenzene _ BRL BRL ug/L ug/L 0.5 0.5 135-98-8 sec -Butyl benzene BRL ug/L 0.5 541-73-1 1,3 -Dichlorobenzene BRL ug/L 0.5 99-87-6 4-Isopropyltoluene BRL ug/L 0.5 106-46-7 1,4 -Dichlorobenzene 95-50-1 1,2 -Dichlorobenzene BRL BRL ug/L ug/L 0.5 0.5 104-51-8 n-Butylbenzene BRL ug/L 0.5 96-12-8 1,2-Dibromo-3-chloropropane BRL ug/L 0.5 120-82-1 1,2,4-Trichlorobenzene BRL ug/L 0.5 87-68-3 Hexachlorobutadiene 91-20-3 Naphthalene BRL 1 ug/L ug/L 0.5 0.5 87-61-6 1,2,3-Trichlorobenzene BRL ug/L 0.5 QC $t_rrbgate Compound.' . ' -Spiked Measured Recovery QC.Gmitx 1,2-Dichloroben7ene-d4 10 11 106 % 80-120% 4-Bromofluorobenzene 10 10 104 % 80-120% Method Reference: Methods for the Determination of Organic Compounds in Drinking Water, Supplement III, US EPA, EPA -600/R-951131 (1995). Method Revision 4.1. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 4 of 20 GROUNDWATER ANALYTICAL CAS Number EPA Method 524.2 Concentration Notes "Units Repopieg omit' Volatile Organics by GUMS Dichlorodifluoromethane BRL ug/L 0.5 74-87-3 Field ID: -2K Boxford St. Hydrant Matrix: Aqueous Project: North Andover Water Treatment/3210000 Container: 40 mL VOA Vial Client: North Andover Water Treatment Plant Preservation: HCl/ Cool Laboratory ID: 122602-2 QC Batch ID: VM7-3090-W Sampled: 12-23-08 15:15 Instrument ID: MS -7 HP 6890 Received: 12-29-08 16:56 Sample Volume: 25 mL Analyzed: 01-06-09 16:21 Dilution Factor: 1 Analyst: TRA Methylene Chloride Page i of 2 CAS Number Analyte, Concentration Notes "Units Repopieg omit' 75-71-8 Dichlorodifluoromethane BRL ug/L 0.5 74-87-3 Chloromethane BRL ug/L 0.5 75-01-4 Vinyl Chloride BRL ug/L 0.5 74-83-9 Bromomethane BRL ug/L 0.5 75-00-3 Chloroethane BRL ug/L 0.5 75-69-4 Trichlorofluoromethane BRL ug/L 0.5 75-35-4 1,1-Dichloroethene BRL ug/L 0.5 75-09-2 Methylene Chloride BRL ug/L 0.5 156-60-5 trans- 1,2-Dichloroethene BRL ug/L 0.5 1634-04-4 Methyl tert-butyl Ether (MTBE) BRL ug/L 0.5 75-34-3 594-20-7 1,1-Dichloroethane 2,2-Dichloropropane BRL BRL ug/L ug/L 0.5 0.5 156-59-2 cis- 1,2-Dichloroethene BRL ug/L 0.5 74-97-5 Bromochloromethane BRL ug/L 0.5 67-66-3 Chloroform 22 ug/L 0.5 71-55-6 1,1,1 -Trichloroethane BRL ug/L 0.5 56-23-5 Carbon Tetrachloride BRL ug/L 0.5 563-58-6 1,1-Dichloropropene BRL ug/L 0.5 71-43-2 Benzene BRL ug/L 0.5 107-06-2 1,2-Dichloroethane BRL 0.5 79-01-6 Trichloroethene BRL __ug/L ug/L 0.5 78-87-5 1,2-Dichloropropane BRL ug/L 0.5 74-95-3 Dibromomethane BPL ug/L 0.5 75-27-4 Bromodichloromethane 9 ug/L 0.5 10061-01-5 cis- 1,3-Dichloropropene BRL ug/L 0.5 108-88-3 I Toluene BRL ug/L 0.5 10061-0_2-6 trans- 1,3-Dichloropropene BRL ug/L 0.5 79-00-5 1,1,2 -Trichloroethane BRL ug/L 0.5 127-18-4 _ Tetrachloroethene BRL ug/L 0.5 142-28-9 1,3-Dichloropropane BRL ug/L 0.5 124-48-1 Dibromochloromethane 6 ug/L 0.5 �106�93-4 1,2-Dibromoethane BRL ug/L 0.5 108-90-7----- X630-20-6 Chlorobenzene 1,1,1,2 -Tetrachloroethane BRL _ BRL ug/L ug/L 0.5 0.5 100-41-4 Ethylbenzene BRL ug/L 0.5 ioa-38-3/106-42-3 meta -Xylene and para -Xylene BRL ug/L 0.5 95-4776 ortho-Xylene BRL ug/L 0.5 100-42-5 1 -- --5- --- -- Styrene BRL ug/L 0.5 75-25-2 98-82-8 Bromoform Isopropylbenzene 0.6 BRL ug/L ug/L 0.5 0.5 _ _ 1108-86-1 Bromobenzene BRL ug/L 0.5 79-34-5 1,1,2,2 -Tetrachloroethane BRL ug/L 0.5 96-18-4 1,2,3-Trichloropropane BRL ug/I 0.5 103-65-1 9 8 � 49- n-Propylbenzene 2-Chlorotoluene BRL _ BRL ug/L ug/L 0.5 -� 0.5 108 67-8 1,3,5-Trimethylbenzene i BRL ug/L 0.5 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 5 of 18 E GROUNDWATER ANALYTICAL Aqueous 40 mL VOA Vial HCl/ Cool VM7-3090-W MS -7 HP 6890 25 mL 1 Page 2 of 2 GAS Number" Analyte Concentration Notes EPA Method 524.2 (Continued) Reporting firnit 10 Volatile Organics by GC/MS ug/L :P5 98-06-6 tert-Butylbenzene Field ID: -24-Boxford St. Hydrant Matrix: Project: North Andover Water Treatment/3210000 Container: Client: North Andover Water Treatment Plant Preservation: Laboratory ID: 122602-2 QC Batch ID: Sampled: 12-23-08 15:15 Instrument ID: Received: 12-29-08 16:56 Sample Volume: Analyzed: 01-06-09 16:21 Dilution Factor: Analyst: TRA 0.5 Aqueous 40 mL VOA Vial HCl/ Cool VM7-3090-W MS -7 HP 6890 25 mL 1 Page 2 of 2 GAS Number" Analyte Concentration Notes Units Reporting firnit 106-434 4-Chlorotoluene BRL ug/L 0.5 98-06-6 tert-Butylbenzene BRL . ug/L 0.5 95-63-6 1,2,4-Trimethylbenzene BRL ug/L 0.5 135-98-8 sec-Butylbenzene BRL ug/L 0.5 541-73-1 1,3 -Dichlorobenzene BRL ug/L 0.5 99-87-6 4-Isopropyltoluene BRL ug/L 0.5 106-46-7 1,4 -Dichlorobenzene BRL ug/L 0.5 95-50-1 1,2 -Dichlorobenzene BRL ug/L 0.5 104-51-8 n-Butylbenzene BRL ug/L 0.5 96-12-8 1,2-Dibromo-3-chloropropane BRL ug/L _ 0.5 120-82-1 1,2,4-Trichlorobenzene BRL ug/L 0.5 87-68-3 Hexachlorobutadiene BRL ug/L 0.5 91-20-3 Naphthalene 1 ug/L 0.5 87-61-6 1,2,3 -Tri chlorobenzene BRL ug/L 0.5 QC Surrogate Compound - Spiked.,' Measured Recovery Q 2 Limits ' 1,2 -Dichlorobenzene -d4 10 1 11 108 % 80-120% 4-Bromofluorobenzene 10 1 10 102 / 80 -120 % Method Reference: Methods for the Determination of Organic Compounds in Drinking Water, Supplement III, US EPA, EPA -600/R-95/131 0995). Method Revision 4.1. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. Groundwater Analytical, Inc., P.n. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 6 of 18 GROUNDWATER ANALYTICAL CAS`Nuinber EPA Method 524.2 Concentration Notes .. "Units 140 Volatile Organics by GC/MS 75-71-8 Dichlorodifluoromethane 2 BRL ug/L Field ID: T7s Boxford St. House Matrix: Aqueous Project: North Andover Water Treatment/3210000 Container: 40 mL VOA Vial Client: North Andover Water Treatment Plant Preservation: HCl/ Cool Laboratory ID: 122602-1 QC Batch ID: VM7-3090-W Sampled: 12-23-08 14:46 Instrument ID: MS -7 HP 6890 Received: 12.29-08 16:56 Sample Volume: 25 mL Analyzed: 01-06-09 15:51 Dilution Factor: 1 Analyst: TRA 0.5 Page: 1 of 2 CAS`Nuinber Analyte Concentration Notes .. "Units Reporting Lund 75-71-8 Dichlorodifluoromethane BRL ug/L 0.5 74-87-3 Chloromethane BRL ug/L 0.5 75-01-4 Vinyl Chloride _ BRL ug/L 0.5 74-83-9 Bromornethane BRL ug/L 0.5 75-00-3 Chloroethane BRL ug/L 0.5 75-69-4 Trichlorofluoromethane BRL ug/L 0.5 75-35-4 1,1-Dichloroethene BRL ug/L 0.5 75-09-2 Methylene Chloride BRL ug/L 0.5 156-60-5 trans-1,2-Dichloroethene BRL ug/L 0.5 1634-04-4 Methyl tert- butyl Ether (MTBE) BRL ug/L 0.5 75-34-3 1,1-Dichloroethane BRL ug/L 0.5 594-20-7 2,2-Dichloropropane BRL ug/L 0-5 156-59-2 cis- 1,2-Dichloroethene BRL ug/L 0.5 74-97-5 Bromochloromethane BRL ug/L 0-5 67-66-3 Chloroform 27 ug/L 0.5 71-55-6 1,1,11 -Trichloroethane BRL ug/L 0.5 56-23-5 Carbon Tetrachloride BRL ug/L 0.5 563-58-6 -1,1-Dichloropropene BRL ug/L 0.5 7143-2 Benzene BRL ug/L 0.5 107-06-2 1,2-Dichloroethane BRL ug/L 0.5 79-01-6 Trichloroethene BRL ug/L 0.5 78-87-5 1,2-Dichloropropane BRL ug/L 0.5 74-95-3 Dibromomethane BRL ug/L 0.5 75-27-4 Bromodichloromethane 9 ug/L 0.5 10061-01-5 cis-1,3-Dichloropropene BRL ug/L 0.5 108-88-3 Toluene BRL ug/L 0.5 100_61-0_2__6 trans-1,3-Dichloropropene BRL ug/L 0.5 79-00-5 1,1,2 -Trichloroethane BRL ug/L 0.5 127-18-4 Tetrachloroethene BRL ug/L 0.5 142-28-9 1,3-Dichloropropane BRL ug/L 0.5 124-48-1 Dibromochloromethane 5 ug/L 0.5 106-93-4 1,2-Dibromoethane BRL ug/L 0.5 108-90-7 Chlorobenzene BRL ug/L 0.5 j 630-20-6 1,1,1,2 -Tetrachloroethane _ _ BRL ug/L 0.5 100-41-4 Ethylbenzene BRL ug/L 0.5 108-38-3/106-42-3 meta- Xylene and para -Xylene BRL ug/L 0.5 95-47-6 100-42-5 ortho-Xylene Styrene BRL BRL ug/L ug/L 0.5 0.5 75-25-2 Bromoform 0.5 ug/L 0.5 98-82-8 Isopropylbenzene BRL ug/1_ 0.5 108-86-1 Bromobenzene _ BRL ug/L 0.5 79-34-5 _ 1,1,2,2 -Tetrachloroethane _ BRL ug/L 0.5 96-18-4 1,2,3-Trichloropropane 103-65-1 - 1 n-Propylbenzene BRL BRL ug/L ug/L 0.5 i 0.5 95-49-8 2-Chlorotoluene _ BRL ug/L 0.5 108-67-8 _L 1,3,5-Trimethylbenzene _ __- BRL ug/L 0.5 J Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 3 of 18 GROUNDWATER ANALYTICAL Aqueous 40 mL VOA Vial HCl/ Cool VM7-3090-W MS -7 HP 6890 25 mL 1 Page: 2 of 2 CAS, NumberAnalyte Concentration Notes EPA Method 524.2 (Continued) Reporting Limit 106-43A 4-Chlorotoluene Volatile Organics by GC/MS ug/L 0.5 98-06-6 tert-Butylbenzene Field ID: 2%ZS Boxford St- House Matrix: Project: North Andover Water Treatment/3210000 Container: Client: North Andover Water Treatment Plant Preservation: Laboratory ID: 122602-1 QC Batch ID: Sampled: 12-23-08 14:46 Instrument ID: Received: 12-29-08 16:56 Sample Volume: Analyzed: 01-06-09 15:51 Dilution Factor: Analyst: TRA ug/L Aqueous 40 mL VOA Vial HCl/ Cool VM7-3090-W MS -7 HP 6890 25 mL 1 Page: 2 of 2 CAS, NumberAnalyte Concentration Notes Units Reporting Limit 106-43A 4-Chlorotoluene BRL ug/L 0.5 98-06-6 tert-Butylbenzene BRL ug/L 0.5 95-63-6 1,2,4 -Tri methyl benzene BRL ug/L 0.5 135-98-8 sec-Butylbenzene BRL ug/L 0.5 54_1-73-1 1,3 -Dichlorobenzene BRL ug/L 0.5 99-87-6 4-Isopropyltoluene BRL ug/L 0.5 106-46-7 1,4 -Dichlorobenzene BRL ug/L 0.5 95-50-1 1,2 -Dichlorobenzene BRL ug/L 0.5 104-51-8 n-Butylbenzene BRL ug/L 0.5 96-12-8 1,2-Dibromo-3-chloropropane BRL ug/L 0.5 120-82-1 1,2,4-Trichlorobenzene BRL ug/L 0.5 87-68-3 Hexachlorobutadiene BRL ug/L 0.5 91-20-3 Naphthalene 1 ug/L 0.5 87-61-6 1,2,3-Trichlorobenzene BRL ug/L 0.5 QCSurrogate Compound' Spiked + Measured Recovery QC Limits'` 1,2-Dichloroben2ene-d4 10 4-Bromofluorobenzene 10 _1 1 109 % 10 104 % 80-120% 80-120 % Method Reference: Methods for the Determination of Organic Compounds in Drinking Water, Supplement III, US EPA, EPA -600/R-95/131 (1995). Method Revision 4.1. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 4 of 18 GROUNDWATER ANALYTICAL CAS Number EPA Method 524.2 Concentration .' Notes Units ReportjngLmit Volatile Organics by GCIMS Dichlorodifluoromethane Field ID: 725 Boxford St. Hydrant Matrix: Aqueous Project: North Andover Water Treatment/3210000 Container: 40 mL VOA Vial Client: North Andover Water Treatment Plant Preservation: Ascorbic Acid/ Cool Laboratory ID: 122906-2 QC Batch ID: VM7-3103-W Sampled: 01-13.09 13:16 Instrument ID: MS -7 HP 6890 Received: 01-14-09 17:30 Sample Volume: 25 mL Analyzed: 01-19-09 23:04 Dilution Factor: 1 Analyst: EMC BRL Page t or 2 CAS Number Analyte Concentration .' Notes Units ReportjngLmit 75-71-8 Dichlorodifluoromethane BRL ug/L 0.5 74-87-3 Chloromethane BRL ug/L 0.5 75-01-4 Vinyl Chloride BRL ug/L 0.5 74-83-9 _ Bromomethane BRL ug/L 0.5 75-00-3 Chloroethane BRL ug/L 0.5 75-69-4 Trichlorofluoromethane BRL ug/L 0.5 75-35-4 1,1-Dichloroethene BRL ug/L 0.5 75-09-2 _ Methylene Chloride BRL ug/L 0.5 156-60-5 trans-,1,2_Dichloroethene BRL ug/L 0.5 1634-04-4 Methyl tert- butyl Ether (MTBE) BRL ug/L 0.5 75-34-3 1,1-Dichloroethane BRL ug/L 0.5 594-20-7 2,2-Dichloropropane BRL ug/L 0.5 156759-2 cis-'1,2-Dichloroethene BRL ug/L 0.5 74-97-5 Bromochloromethane BRL ug/L 0.5 67-66-3 Chloroform 21 ug/L 0.5 71-55-6 1,1,1 -Trichloroethane _ BRL_ ug/L 0.5 56-23-5 Carbon Tetrachloride BRL ug/L 0.5 563-58-6 1,1-Dichloropropene BRL ug/L 0.5 71-43-2 Benzene BRL ug/L 0.5 107-06-2 1,2-Dichloroethane BRL ug/L 0.5 79-01-6 Trichloroethene BRL ug/L 0.5 78-87-5 1,2-Dichloropropane _ BRL ug/L 0.5 74-95-3 Dibromomethane BRL ug/L 0.5 75.274 10061-01-5 Bromodichloromethane cis- 1,3-Dichloropropene 10 BRL ug/L ug/L 0.5 0.5 108-88-3 Toluene BRL ug/L 0.5 10061-02-6 trans-1,3-Dichloropropene BRL ug/L 0.5 79-00-5 1,1,2 -Trichloroethane BRL ug/L 0.5 127-18-4 Tetrachloroethene BRL ug/L 0.5 142-28-9 1,3-Dichloropropane BRL ug/L 0.5 124-48-1 Dibromochloromethane 6 ug/L 0.5 106-93-4 1,2-Dibromoethane BRL ug/L 0.5 108-90-7 Chlorobenzene BRL ug/L 0.5 630-20-6 1,1,1,2 -Tetrachloroethane BRL ug/L 0.5 100-41-4 Ethylbenzene BRL ug/L 0.5 108-38-3110642-3 meta -Xylene and para -Xylene _ BRL ug/L 0.5 95-47-6 ortho- Xylene BRL ug/L OS 100-42-5 Styrene BRL ug/L 0.5 75-25-2 Bromoform 0.6 ug/L 0.5 98-82-8 Isopropylbenzene _ BRL ug/L 0.5 108-86-1 Bromobenzene BRL ug/L 0.5 79-34-5 1,1,2,2 -Tetrachloroethane BRL ug/L 0.5 96-18-4 1,2,3-Trichloropropane BRL ug/L 0.5 103-65-1 n -Propyl benzene BRL ug/L 0.5 9549-8 2-Chlorotoluene BRL ug/L 0.5 108-67-8 1,3,5-Trimethylbenzene BRL ug/L 0.5 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 5 of 20 GROUNDWATER ANALYTICAL Aqueous 40 mL VOA Vial Ascorbic Acid/ Cool VM7-3103-W MS -7 HP 6890 25 mL 1 Page: 2 of 2 CAS Number Analyte Concentration Notes EPA Method 524.2 (Continued) Reporting Limit 106-43-4 4-Chlorotoluene Volatile Organics by GC/MS Field ID: 725 Boxford St. Hydrant Matrix: Project: North Andover Water Treatment/3210000 Container: Client: North Andover Water Treatment Plant Preservation: Laboratory ID: 122906-2 QC Batch ID: Sampled: 01-13-09 13:16 Instrument ID: Received: 01-14-09 17:30 Sample Volume: Analyzed: 01-19-09 23:04 Dilution Factor: Analyst: EMC 0.5 Aqueous 40 mL VOA Vial Ascorbic Acid/ Cool VM7-3103-W MS -7 HP 6890 25 mL 1 Page: 2 of 2 CAS Number Analyte Concentration Notes Units Reporting Limit 106-43-4 4-Chlorotoluene BRL ug/L 0.5 98-06-6 tert- Butylbenzene BRL ug/L 0.5 95-63-6 1, 2,4-Trimethyl benzene BRL ug/L 0.5 135-98-8 sec-Butylbenzene BRL ug/L 0.5 541-73-1 1,3 -Dichlorobenzene BRL ug/L 0.5 99-87-6 4-Isopropyltoluene BRL ug/L 0.5 106-46-7 1,4 -Dichlorobenzene BRL ug/L 0.5 95-50-1 1,2 -Dichlorobenzene BRL ug/L 0.5 10451-8 n-Butylbenzene BRL ug/L 0.5 96-12-8 1,2-Dibromo-3-chloropropane BRL ug/L 0.5 120-82-1 1,2,4-Trichlorobenzene BRL ug/L 0.5 87-68-3 Hexachlorobutadiene BRLug/L 0.5 91-20-3 Naphthalene 1 ug/L 0.5 87-61-6 ( 1,2,3-Trichlorobenzene BRL ug/L 0.5 QC Surrogate Compound Spiked Measured Recovery. QC Limits j 1,2 -Dichlorobenzene -d4_ 100 12 116 % 80 - 120 4-Bromofluorobenzene 10 11 114 % 80-120% Method Reference: Methods for the Determination of Organic Compounds in Drinking Water, Supplement Ill, US EPA, EPA -600/R-95/131 (1995). Method Revision 4.1. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 6 of 20 GROUNDWATER ANALYTICAL Aqueous 40 mL VOA Vial Ascorbic Acid/ Cool VM7-3103-W MS -7 HP 6890 25 mL 1 Page: 7 of 2 CAS Number EPA Method 524.2 Concentration Notes Unit's Volatile Organics by GUMS Field ID: WTP-FW Matrix: Project: North Andover Water Treatment/3210000 Container: Client: North Andover Water Treatment Plant Preservation: Laboratory ID: 122906-3 QC Batch ID: Sampled: 01-13-09 13:40 Instrument ID: Received: 01-14-09 17:30 Sample Volume: Analyzed: 01-20-09 00:02 Dilution Factor: Analyst: EMC ug/L Aqueous 40 mL VOA Vial Ascorbic Acid/ Cool VM7-3103-W MS -7 HP 6890 25 mL 1 Page: 7 of 2 CAS Number Analyte Concentration Notes Unit's Reporting tim t 75-71-8 74-87-3 Dichlorodifluoromethane Chloromethane BRL BRL ug/L ug/L 0.5 0.5 75-01-4 Vinyl Chloride BRL ug/L 0.5 74-83-9 Bromomethane BRL ug/L 0.5 75-00-3 Chloroethane BRL ug/L 0.5 75-69-4 Trichlorofluoromethane BRL ug/L 0.5 75-35-4 1,1-Dichloroethene BRL ug/L 0.5 75-09-2 Methylene Chloride BRL ug/L 0.5 156-60-5 trans-1,2-Dichloroethene BRL ug/L 0.5 1634-044 Methyl tert- butyl Ether (MTBE) BRL ug/L 0.5 75-34-3 1,1-Dichloroethane BRL ug/L 0.5 594-20-7 2,2-Dichloropropane BRL ug/L 0.5 156-59-2 cis-1,2-Dichloroethene BRI ug/L 0.5 74-97-5 Bromochloromethane BRL ug/L 0.5 67-66-3 Chloroform _- 0.6 ug/L 0.5 71-55-6 _ 1;1,1-Trichioroethane BRL ug/L 0.5 56-23-5 _ Carbon Tetrachloride _ _ BRL ug/L 0.5 563-58-6 1,1-Dichloropropene BRL ug/L 0.5 71-43-2 Benzene_ BRL ug/L 0.5 107-06-2 1,2-Dichloroethane BRL ug/L 0.5 79-01-6 Trichloroethene BRL ug/L 0.5 78-87-5 1,2-Dichloropropane BRL ug/L 0.5 74-95-3 Dibromomethane BRL ug/L 0.5 75-27-4 Bromodichloromethane 1 ug/L 0.5 10061-01-5 cis- 1,3-Dichloropropene BRL ug/L 0.5 108-88-3 Toluene BRL ug/L 0.5 10061-02-6 trans- 1,3-Dichloropropene BRL ug/L 0.5 79-00-5 1,1,2 -Trichloroethane BRL ug/L 0.5 127-18-4 Tetrachloroethene BRL ug/L 0.5 142-28-9 1,3-Dichloropropane BRL ug/L 0.5 124-48-1 Dibromochloromethane 2 ug/L 0.5 106-93-4 1,2-Dibromoethane BRL ug/L 0.5 108-90-7 Chlorobenzene BRL ug/L 0.5 630-20-6 1,1,1,2 -Tetrachloroethane BRL ug/L 0.5 100-41-4 Ethylbenzene BRL ug/L 0.5 108-383no6-42-3 meta -Xylene and para -Xylene BRL ug/L 0.5 95-47-6 ortho-Xylene BRL ug/L 0.5 100-42-5 75-25-2 Styrene Bromoform BRL BRL ug/L ug/L 0.5 0.5 98-82-8 Isopropyl benzene BRL ug/L 0.5 108-86-1 Bromobenzene BRL ug/L 0.5 79-34-5 1,1,2,2 -Tetrachloroethane BRL ug/L 0.5 96-18-4 1,2,3-Trichloropropane BRL ug/L 0.5 103-65-1 n-Propylbenzene BRL ug/L 0.5 95-49-8 2-Chlorotoluene BRL ug/L 0.5 108 67-8 1,3,5-Trimethylbenzene BRL ug/L 0.5 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 7 of 20 V �V w GROUNDWATER ANALYTICAL Aqueous 40 mL VOA Vial Ascorbic Acid/ Cool VM7-3103-W MS -7 HP 6890 25 mL 1 Page: 2 of 2 CAs Number_ Analyte - - Concentration Notes- -. Units EPA Method 524.2 (Continued) 106-43-4 4-Chlorotoluene BRL Volatile Organics by CC/MS Field ID: WTP-FW, Matrix: Project: North Andover Water Treatment13210000 Container: Client: North Andover Water Treatment Plant Preservation: Laboratory ID: 122906-3 QC Batch ID: Sampled: 01-13-09 13:40 Instrument ID: Received: 01-14-09 17:30 Sample Volume: Analyzed: 01-20-09 00:02 Dilution Factor: Analyst: EMC 106-46-7 1,4 -Dichlorobenzene Aqueous 40 mL VOA Vial Ascorbic Acid/ Cool VM7-3103-W MS -7 HP 6890 25 mL 1 Page: 2 of 2 CAs Number_ Analyte - - Concentration Notes- -. Units Reporting Limit.`:. 106-43-4 4-Chlorotoluene BRL ug/L 0.5 98-06-6 tert-Butylbenzene BRL ug/L 0.5 95-63-6 1,2,4-Trimethylbenzene BRL ug/L 0.5 135-98-8 sec-Butylbenzene BRL ug/L 0.5 541-73-1 1,3 -Dichlorobenzene BRL ug/L 0.5 99-87-6 4-Isopropyltoluene BRL ug/L 0.5 106-46-7 1,4 -Dichlorobenzene BRL ug/L 0.5 95-50-1 1,2 -Dichlorobenzene BRL ug/L 0.5 104-51-8 n-Butylbenzene BRL ug/L 0.5 96-12-8 1,2-Dibromo-3-chloropropane BRL ug/L 0.5 120-82-1 1,2,4-Trichlorobenzene BRL ug/L 0.5 87-68-3 Hexachlorobutadiene BRL ug/L 0.5 91-20-3 Naphthalene BRL uglL 0.5 87-61-r 6 1,2,3-Tichlorobenzene BRL ug/L 0.5 QC Surrogate Compound _ S pikied Measured Recovery QC Limits 1,2 -Dichlorobenzene -d4 10 12 118 % --- 80-120% 4-Bromofluorobenzene 10 12 116 % 80-120% Method Reference: Methods for the Determination of Organic Compounds in Drinking Water, Supplement III, US EPA, EPA -600/R-95/131 (1995). Method Revision 4.1. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 8 of 20 Water Safety Services, Inc. Six 2Uaed " Jax , 2Uo&m..Ma. VISCI -372C 781-932-8787 - 1-888-932-8787 9eee f" ~ 781-932-0957 12/23/08 DENNIS BEDROSIAN NORTH ANDOVER WATER TREATMENT PLANT 420 GREAT POND ROAD NORTH ANDOVER, MA 01845 Re: 725 BOXFORD ST, POOR WATER QUALITY KARRIE BRENNEMAN & JOHN GKASKO Dear Dennis: Per your request, I performed a cross connection survey at the above named facility. The new water service seems to be all copper, at least the service entrance inside the home was appropriate copper piping. The previous well connection was completely disconnected from the town water supply, cut and capped from the home's water service. So, from a cross connection standpoint the home is in compliance. The water quality, however did seem to me to be an issue. The kitchen faucet water did seem to have excess air in the system, as noticed by the presence of excess water bubbles in a clear glass. The air bubbles dissipated, as normal within thirty seconds. Admittedly my sense of smell is probably below the average, but there was a faint odor of what may be described as petro- chemical in nature in the cold water supply ans slightly stronger in the hot water supply. Both of the above problems did not appear in a cold water supply serviced by a common cartridge charcoal filter system. It is possible, if the system was compromised prior to the public water supply being connected to the home's water supply, that there is some residual contamination in the facility' water system, especially the hot water system. I conveyed to the homeowners I would report my findings to my boss and that he may send out someone to take a current sample of the water from their system for testing and comparison. Sincerely, Robert G. Heitz, Jr. Water Safety Services, Inc. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover OEt«ec e,'ti� OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street North Andover, Massachusetts 01845 SUCHU WMLIAM J. SCOTT Director r 1� 12. January 28, 1997 i'vir. Phil Christiansen Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 Re: 729 Boxford Street This is to inform you that the proposed plans for the site referenced above have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R. S., Health Administrator SS/cjp -------- - - BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Y �6 Town of North Andover . OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director November 4, 1996 Chrisiansen & Sergi 160 Summer Street Haverhill, MA 01830 Re: 729 Boxford Street Dear Phil: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Gas deflector on tank outlet missing. 2. Only 2" of peastone instead of 4"_ (N.A. 17.07) 3. No benchmark within 75 feet of leach area. (3 10 CMR 15.220 (q) 4. Distances from foundation to tank & leach area missing from site plan; also distance to possible well. Clarify "W" with key. (N.A. 6.02) 5. Foundation drain not present. (N.A. 6.02V) 6. North arrow missing. (3 10 CMR 15.220(g) & N.A. 6.02 c) 7. Please indicate slope of SAS lines. 8. Please show slope of line from tank to D -Box. 9. Note that cellar floor must be at least 1 foot above max. groundwater level. (N.A. 4.20) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S., Health Administrator cc: Michael Howard, Conservation Admin. File William Scott, Diretor, P & C Dev. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 FTCR .............................. No.._........... _....... THE COh11AOtlWEALTFI OF i.tASSACIMSETTS BOARD OF HEALTH z� /1,�........ OF ..... .......................... ,A illfiratilltt for Ili►;fltillut Altith" (9till vit urfilltt Iferillit Application is hereby made for a PE!rnlit to Construct ( �or Repair ( ) an Individual Sewnge Disposal System at: f�) /� /Lr} 1, .................... ......... �St�. .. l./ ..:1a1:. .................................................................. i.DI•........................................--.. Loeatimt •Address 7 . .I ................. o,.•ner .................................. .....................•-- --- tnstaner GAG Type of Building � � Size 1.nt....__;.�..._.._....•...-..Sq. feet Dwelling — No. of flettroctms................".........................I?�(,ansinn Attic( ) (Jnrhage Grinder ( ) Other—Type of 1311ildittg ............................ No. of pct-sDns............................ Showers ( ) --- Cafeteria ( ) Otherfirtores............................... :...................... .............................................. Design Flow ................................. ..:..gallons per persrnt per day. •1'(1('11 daily �ow........._..................; - �'^" tll�nn , Septic •Tank -- f_iquid capacityh�L�.6;tllons f ,-ngtlt..�L._�.....__......... Ucl,th.......... �.... Disposal Trench --- No. _. t;�..... ��'i<itlt........0 ...... '1 rttal Lcngt11.rE.�.. ...... Total Icachir+g arca.._ � ��:r;.._...sq. ft. Seepage Pit No .................... Diameter.-.----............. I)el+tlt below inlet .................... Total leaching area .................. sq. ft. Other Distribution box (kl" Dosing tank �........................... i)ate..'.� '_ ........... Percolation Test Resttlts3 Perforated by.L•11lla7ylarll2r•'1..1�tj- ,�..., Test Pit No. I..........:.....ininutes per inch De)tlt of -fest Pit ............. .- Deptlt to ground ' ..•..•••••. Test Pit No. 2...... .....minntes per inch. Depth of Test, Pit.......f�- .::.. T)epth to ground water.... -t ... ............. ........... ......................................................................................... Descriptionof Soil............................................................••---•-•---"-•"•-•""................................................._.... Lc.............................................................. .......----....... ..... ................................................................................. ... . Nature of Repairs or Alteratirnts —Answer when applicable.................... ............................................................................ ....."-- •"••....------•.................................................................... •---•• Agreement The undersigned agrees to install the afnrerlescribed individual Sewage i)isposal Sy., in accordance with the provisions of TITLE 5 of the Slate Sanitary Code — The undersigned fill ther agrees not to place the system in operation until a Certificate of Compliance has been issued by the bonrd of health. Signed ........................ ..............-..... ........ nate ----•---•.............................. Application Approved i3y............................................................. ...... Date Application Disapproved lot- the fallorrdrrg reasotrs:...................................................••.........-•--• ..................................•-•• •--......... ............................................................. nate PermitNo ......................................................... issued.......................................•............---- nate THE COMMONWEALT11 OF MASSACHUSETTS 60ARD OF HEALTH OF.................................................................................... CiYurtifiritt� of (9n111fltiftitrP TIIIS LS TO Cfili'TIF}', flat the lndivid++al Sewage Disposal System constructed ( ) or Repairedby ( ) ...................................................................... ..................................................•--•--------............................. at....................................:......................... .. his been installed in accordnnce will, the provisir;ns of TITLE 5 of 'file State Sanitary Code as described in the a1+1)licatiott far Di�l+nsal Works Consl++rciit+rt Prrnit No ......................................... dated... ................. ............................ THE ISSUANCE OF T11 -111S CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT t�lE cYATFIA WILL FUNCTION SATISFACTORY. FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 Date: /I/ S _ I i&_ Commonwealth of Massachusetts N orZ 11NODULl2 , Massachusetts A c.vaccmant fnr nn -site Sewl out Date: (o� 9 �1.6.,6/Z���4 Performed B W v�..c.o. ........................... ........... .................................................. .....................I.................... . ... Witnessed By: Location Aattru= Of -7 L "I Y4 13 Q X FL S T= Lot N N00-1-1 4 vo "iz-, owner's Namc, S IM M U AaErcs=. AM Let q4 X FLWU0 5 / Telepigrc A N Q . i<1 N� vV!`c ✓t t �� New Construction R Repair ❑ Office Review Yes Published Soil Survey Available: No Y—�� Soil Map Unit Year Published �.[.. Publication Scale = S•�................ Drainage Class W ►iL� rJYU4��yly7 Soil Limitations S. IN � �./...�n'6 �.....S.bN/�................._...................... Surficial Geologic Report Available: No [31Yes ❑ Year Published Publication Scale Geologic Material (Map Unit ........... ...................................................................................................... Landform................................................. .................................................................... Flood Insurance Rate Map: ❑ Above 500 year flood boundary No 11 Yes - Within 500 year flood boundary No []Yes n F % S Within 100 year flood boundary No ❑Yes Wetland Area: maunit)..:.................................................................................................... National Wetland Inventory Map (map ................. ma unit)....................... Wetlands Conservancy Program Map (map Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Belcw Normal ❑ Other References Reviewed: DFP APPROVED FORM - 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot iJo. 7Lq 3oxF-c)nV S� On-site Review Z-1 'S y 4//7/ If _ Deep Hole Number �...:: Date:....6-�i��� Time::. _2_,'0C) Weather P .-c Location (identify u site plan) _..... Slope (%} Surface Stones. Land Use :,:..:...�'' �. ,. Vegetation :.:...::......: :..:.., .:..,..:.,.. Landform.::..::.::.:....:.:::..:,.::.:: ,,:::.:...:.::..:..:.. .............:.... Position on landscape (sketch- on the back) Distances from: Open Water Body . - feet Drainage way feet Possible Wet Area feet Property Une feet Drinking Water Well .:::.::::.. feet Other DEEP- OBSERVATIOU HOLE LOC' Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulleders, Consistency, % Grav Z� CIO^ Iz-0OIS Smolt) $'77a�Q_ Z — 7� C G►� � rf C 2¢ s-�6�� zrlo �A16 6h,�vu S 5 o4 M F IYI^I rN 'IDc_exA t Pn 114, 7' C Z C� (-S L Z s'"S� /WrIsSrVc. F I wh s,r, ��c,et�T ` MINIMUM Uh L IiULtD MtUUlntu h I cv cn , , .+, -• -• -- ^—• Parent -Material (geologic) 17 CIC DeptMoSedrock: I V L Depth to Groundwater: Standing Water in the Hole: 1 Weeping from Pit Face: Estimated. Seasonal High Ground Water: 7 M I N K �li',.•S �ry1� 'V C4'.' OMI�vw, Sv14.IC �0 P, DEP APPROVED FORM - 12/07/95 36 1` got A r•wa.IAU FORM 11 - SOIL EVALUATOR FORM Page Z of 3 Locadotr Address or Lot No. on-site Review • ,. 70 yaw,anS T T . Deep. Hole Number 1 Date:.:.:..::.,.:.:. rme::...Z •. � Weather 0 Location (identify ors site: plan) . _:.:...:... Land: Use= .....(�...: �aS0o .. Slope. (°k) �•' Surface Stones- -L46. tones ..,:. Vegetation..Lo*K1?PvG,t �ffc M._.c?6 ��,1!s p 'R :.:r,....:. :........,..,..::, Landforrrr:. ,.........,........ _.........._....... .......... ...:. .. .. Position on - landscape- (sketch on the: back) :... Distances from: Open Water Body feet Di•ainage:way:.......... feet Possible~ Wet Area .A ?Latf'eev Property l.irte ..:.....:..... feet Drinking Water Well ..:.....::.::.. feet Other _.:_... QED agSERVATTCU HALE _M!' Qeptteftntrr Soil Hocizorr. ' SoiLrextuce� (USQA), Soil Color IMunseH} . Sod- .. Motttirtgr. othew tstrucuue:stott ftw4um. Consistancv.-96 SucfaoeWttdtes4 . .. yvAjSIUAn P"A I J L LI (o iIS �s� e Codas.—S tf kL-cva ;T JaG Rf>tosncMAteriaf►Iseolo9icl 1 `��r is aepthtoSedcockx QepttrtoGroundwate... StandingWaterirrttheHole:. WeepingfromPIrFacer EsvwuK s S6asonai► High• Ground. Water. Z f" Pic Z oK Z. DE PAPPROVIMFORK-17JOW9 'f J' ;a4; r : F MT (14 i FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Distances from: Open Water Body feet Drainage way.:::......: feet Possible Wet Area feetProperty Line ....:........... feet Drinking Water Well ....:::..:..:.. feet Other .:.: ..... .>-..:..:..:.................. DEEP OBSERVATION HOLE LOW Depth from Surface (Inches) Soil Horiion Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % , Z S/(p M MS S— f144 (,orv+ Z So ,S4 ,(� P't,S �¢ kN G.oS� rad M5 M es5 ( 30`r Z olo, ,j l�J ✓!.S ...--.7-- -. Parent Material (geologic) DepthtoBedrock: Death to, Groundwater: . Standing Water in the Hole: A -1U weeping from Pit Face: %IN Estimated Seasonal High' Ground Water:_ O .-.bo DEP APPROVED FORM - 12107/95 I &� ' • � .ate, � �' ,�:�� .:,-. r z �. -,. -•' '=„ :,et:'.� �, .-;�`r y .. �x."_i a. ¢� ����. � - }�'r.M � FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 7� T Determination for Seasoble Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole ...... _ _ inches Depth to soil mottles .24_ inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date .................. Index well level ................ Adjustment factor ................ Adjusted ground water level ........... .................. ............ ......... . Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system?_ If not, what is the depth of naturally occurring pervious material? Certification I certify that on.(date) I have passed the soil evaluator examination approved by the Dep rtment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature C Date ►J �r �� iiDEP APPROVED FORM - 12/07195 FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS _ , Massachusetts Percolation Test* Date:Time:__ . . .. . . . . . ..... ............ ,err Observation Hole # Depth of Perc 7" Start Pre-soak J3 3 6 2(, End Pre-soak Time at 12" Time at 9" 3 Time at 6" Time (9"-6") Rate Min./inch 4/7 Minimum of 1 percolation test must be performied in both the primary area AND reserve area. Site Passed [a' Site Failed 0 ............. I ................................................................................................. ..................... . . ........ ........ Performed By: Witnessed By: 1/1 rel /'/7 1^i" Comments: DEP APPROVED FORM - 12/07/95 NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: 046 0 PERMIT # q7:�— DATE RECEIVED /V ! ;� f A?'c— APPLICANT X/-5' MAP 106--6 PARCEL 49 ADDRESS i e S% XV LOT # STREET # %;?? ENG. a#,el6riRV 4�;lU Q' 649.48 / STREET /�Ctb 5r. ENG. ADDRESS__ /600 5644fi4&Z Si A4U8Pfi/66- PLAN DATE / / A REV. DATE CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: OAJ' Ti4N� OUrG �r W165 bU6 , / i. o r) Jo a �v® �3H� . t v i !�/VfS MOvv D f3/D itJ rO 7-/3N4' -DI5T/9/U6C TdVcT cs�.vT. C/y.14• �,va�� /Vo2rH �� 4 N.A. (.D� C) X( / d eC,972E2 7-, AAA . O 06 Sao T,Bo aC !_.TAM J. SCOTT Director Town of Norte Andover 40RTN Ay OFFICE OF °E COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street ` .o North Andover, Massachusetts 01845 November 4, 1996 Chrisiansen & Sergi 160 Summer Street Haverhill, MA 01830' Re: 729 Boxford Street Dear Phil: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Gas deflector on tank outlet missing. 2. Only 2" of peastone instead of 4". (N.A. 17.07) 3. No benchmark within 75 feet of leach area. (3 10 CMR 15.220 (q) 4. Distances from foundation to tank & leach area missing from site plan, also distance to possible well. Clarify "W" with key. (N.A. 6.02) 5.. Foundation drain not present. (N.A. 6.02V) 6. North arrow missing. (3 10 CMR 15.220(g) & N.A. 6.02 c) 7. Please indicate slope of SAS lines. 8. Please show slope of line from tank to D -Box. 9. Note that cellar floor must be at least 1 foot above max. groundwater level. (N.A. 4.20) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. :y Sincerely, Sandra Starr, R.S., Health Administrator cc: Michael Howard, Conservation Admin. File William Sdott, Diretor, P & C Dev. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508) 373-0310 FAX: (508) 372-3960 TO: Ms. Sandra Starr. Board of Health North Andover RE: Septic System Design Plans Date: f 'Yi l9 `-,�r'�---.--•--~-w�_ --�'� Attached are plans for Z2 % &,-K& This design is : v-11 a new submittal a revision with the following changes C4 zze'14' .� 1� 0 PLAN REVIEW CHECKLIST ADDRESS '/.-2c? 60kcCe4) S% ENGINEER GENERAL 3 COPIES STAMP L� LOCUS L� NORTH ARROW SCALE - CONTOURS �� PROFILE'/ SECTION G-� BENCHMARK, SOIL & PERCS ✓ ELEVATIONS WETS. DISCLAIMER--- WELLS & WETS WATERSHED? DRIVEWAY '(Elev) WATER LINE FDN DRAIN SCH40_L::f�' TESTS CURRENT? SOIL EVAL SEPTIC TANK '/ MIN 150OG � .17 INVERT DROP GARB. GRINDER (2 comps +200) 10' TO FDN MANHOLE ELEV GW r/ ## COMPS. GBA/- D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT _ INLET? - OUTLET /1/, /la _ • 16 ( 2" OR .17 FT TEE REQ' D? TRENCHES MIN 440 gpd c,"" SLOPE (min .005 or 611/100' ) SIDEWALL DIST. 3X EFF. W OR D (MIN 6')_y RESERVE BETWEEN TRENCHES?,O IN FILL? " MUST BE 10' MIN. Z4" PEA STONE?,z VENT? (>3' COVER; LINES >501) BOT + SIDE X LDNG TOT (L x W x #) (DxLx2x#) (G/ft2) -?9G Copyright © 1996 by S_- Starr LEACHING MIN 440 GPD? �� RESERVE AREA L--�4' FROM PRIMARY?','� 20 SLOPE v?k 100' TO WETLANDS 100' TO WELLS 4' TO S.H.GW (5'>2M/IN) 20' TO FND & INTRCPTR DRAINS t� 400' TO SURFACE H2O SUPP L--- 4' PERM. SOIL BELOW FACILITY f MIN 12" COVERT FILL?"x(15') BREAKOUT MET? TRENCHES MIN 440 gpd c,"" SLOPE (min .005 or 611/100' ) SIDEWALL DIST. 3X EFF. W OR D (MIN 6')_y RESERVE BETWEEN TRENCHES?,O IN FILL? " MUST BE 10' MIN. Z4" PEA STONE?,z VENT? (>3' COVER; LINES >501) BOT + SIDE X LDNG TOT (L x W x #) (DxLx2x#) (G/ft2) -?9G Copyright © 1996 by S_- Starr CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508) 373-0310 FAX: (508) 372-3960 t UARD OF HEALTH T0: Ms. Sandra Starr Board of Health OCT 2419% North Andover RE: Septic System Design Plans Date: %® f Attached are plans for This design is a new submittal a revision with the following changes CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER SIRHT HAVERHILI, MA:75ACIiUSE7T', G]$3() Septemixr 16, 1996 North Andover Board of I lealth 120 Main Strect North Andover, MA 01$45 (508) 373.0310 FAX: (5(18) 372.3QFO Re: 729 Boxford Street Septic Symcm Design (JeffSimmor)s) Dear Board of Health Members: On behalf of illy client, Mr. Jell Sutunons, I would like to appear before the Board at the scheduled September 26, 1996 meeting to request a variance from the Town ol'North ,Andover's Minimum Requirements liar the Subsurface Disposal ol`Sanitary Sewage for a proposed septic system at the aK)ve relcrenced location The variance requested is as follows: 1 _ North Andover Regulation 4.18 Distances The variance requested is to allow for the proposed disposal system to be located at a distance of 75 feet from a welland. The ,et back distance required by the North turdover regulation is 100 feet. -]'he set hack distance required by Title V is 50 feet. Enclosed arc three copies oft.he septic system design for this lot. Please notify me when you have scheduled a hearing to consider this request tar variance. Very ulv Yours, P ti, l• instiaxlsen -5an'�)l Town of North Andover I NORTil OFFICE OF 3?0,•`"�� COMMUNITY DEVELOPMENT AND SERVICES 00 146 Main Street North Andover, Massachusetts 01845 ` WILLIAM J. SCO17 SACwus�< Director November 4., 1996 Mr. Phil Christiansen Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 RE: NOTICE OF INTENT - #729 Boxford Street. Dear Phil: This Department conducted an inspection of the above referenced property on November 4, 1996 for the purposes of revie i,nig the proposed wetland delineation; Steve D'Urso was also present. Bordering Vegetated Wetland LW_ The BVW delineation is approved with the following modifications: 1. A-4(1) was added in the field approximately 17' southeast of A-4 and placed on a large DBH white pine; 2. A-4(2) was also added in the field approximately 17' southeast of A-5 and 8' from A-4(1) and placed on a white pine sapling; 3. Please connect A-4 to A-4(1) to A-4(2) to A-5. Riverfront Area It is the opinion of this Department that this stretch of Mosquito Brook qualifies as a perennial stream (i.e. does not dry out in the summer) and is thus subject to protection under the recently created Massachusetts Rivers Protection Act. w. 'a The Act took effect on August 7, 1997, andtcreates in most instances a 200' Riverfront Area. The definition of the term "Riverfront Area" includes "that area of land situated between a river's mean annual high-water line and a parallel line located 200' away, measured outward horizontally from the river's mean annual high-water line." It is the responsibility of the Conservation Commission to begin enforcement of the Act immediately notwithstanding th absence of implemented regulations by DEP. They are required to protect the "natura,e integrity" of rivers and administer the Act consistent with the eight (8) wetland interests protected under 310 CMR 10.00. BOARD OF APPEALS 688-9541 BUII. DING 688-9545 CONSERVATION 688.9530 HEALTH 688-9540 PLANNING 688-9535 R In the interim and understanding that there is some confusion with this resource area, I have advised the Commission to simply treat the Riverfront as an extended buffer zone. However, I have also advised them to prohibit septic systems within 2.00' of any perennial stream. Please note that septic systems in existence prior to August 7, 1996 are exempt; clearly this is not the case under this Notice of Intent.. Please submit a revised plan and Notice of Intent to DEP-NERD and the North Andover Conservation Commission depicting the above mentioned modifications; proof of mailing is also warranted. If you have any questions or concerns please do not hesitate to contact me, Sincerely, )4 0000% Michael D. Howar Conservation Administrator cc: NACC BOH DEP-NERD da t 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. ****************Appl' anfills out this section***************** APPLICANT: Phone -� LOCATION: Assessor's Map Number Parcel Subdivision ,tet C' Lot (s) Street C` `�, �3T St.. Number ************************Official Use Only************************ REqPNMPDATIONS OF TOWN AGENTS: ` Date Approved Conservation Admini trator Date Rejected Comments l Date Approved Z ate_ Town P anner Date Rejected �,� Comments�I X Qn(� fA- 1.,�• •• Date Approved Food Inspeecttoor-Health Date Rejected . Date Approved / _O. �,� Septic Inspector -Health Date Rejected Comments Oxic Works - sewer/water connections - driveway permit ire Department __,:Received by Building Inspector Date t IAORTIf i? •.A. '•..'. O o P • CHUSE�� Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 n C !E - ")-4 11 9 -1L - DESIGN 9 L DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant_ ( c' t Test No. Site Location Lor —) a cl Reference Plans and Specs. ENGINEER DESIGN K DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. �r Fee SEPTIC PLAN SUBMITTALS LOCATION: sl �- ) -x I.-) CHAIRMAN, BOARD OF HEALTH Site System Permit No. NEW PLANS: S $60.00/Plan L'/ REVISED PLANS: YES $25.00/Plan I r DATE: tr �o DESIGN ENGINEER:X-A 5 �� When the submission is all in place, route to the Health Secretary