Loading...
HomeMy WebLinkAboutMiscellaneous - 846 CHESTNUT STREET 4/30/2018 (2)4 'M x North Andover Board of Assessors Public Access Parcel ID: 210/107.C-0019-0000.0 SKETCH Click on Sketch to Enlarge Community: North Andover PHOTO No Picture Available Location: 846 CHESTNUT STREET Owner Name: SKELTON, TIMOTHY P SANDRA L SKELTON Owner Address: 846 CHESTNUT STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6 - 6 Land Area: 1.22 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 1838 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 403,400 378,000 Building Value: 192,400 182,700 Land Value: 211,000 195,300 Land Value: 211,000 Land Value: LATEST SALE Sale Price: 155,000 Sale Date: 12/14/1993 Arms Length Sale Code: F-NO-CONVNIENT Grantor: FIORI FAMILY TRUST Cert Doc: 11806 Book: 00089 Page: 0029 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3 &LinkId=809681 Page 1 of 1 NORTH w 3:. '• pc F A SACH 5E� Permit NO: d Date Issued: _ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 1 Date Received: . L. j I�IPORT;kNT: ;\ppliCant must complete all items un this i'ST,LUC:\TION_y Io CV��S�d�v ,P'rint PROPERTY OWNER SP,n4Pa e- VQ I Print MAP NO.: 10' C� PARCEL: :� � - ZONING DISTRICT: ■rra rnni!' rVICTDICIr VFC n TYAPIU U»L Ur Dult.vu4" ••• �......v �-- ----- - TYPE OF IMPROVEMENT ' PROPOSED USE -- Residential Non- Residential ----� New Building = One tatnily SAddition - Two or more family I Industrial Alteration No. of units: — --__-_ _ — –' ----� _ Rehair, replacement : ;\ssessury Bldg _ I ,:. Commercial Demolition _ Moving (relocation) -.Other _. Others: Foundation only i DESCRIP"17UN M �vuKlt t V tsr. rKt,,rk_)Kmry -ala Idyntification Please 'ryne or Print Clearly) — OWNER: Name:_ ,�L�IUL��� Phone G aG +_ tii!, ture I Address: l�I CjIi3 �-� �as �Tv� / CONTRl\CTOR Name: u, Phone: Address: - Supervisor's Construction License: 1 G'R _Exp. Date: %s/o ri, Io/l�, 10.7 Home Imprmcnicnt Lic::nse:. 10 Oct _ E:rh. Date:,_ Phone: y75 Address: � I. * Vt[t��� . —�V_I ti��,�c r- Rei. No. F'EE S('HEDULE: 13LLDL\G PER=►IIT. Sit). 00 PER $1000.00 OF THE TOT IL ESTLIL-t TED COST 8, ISL•D O=ff S 12.5. 00 PER S. F. 'rota) Pro jvetCost :S_ `_^_— xl().00 FEES Check No.: -----------Receipt —__ ---Receipt No.:_ TYPE OF SE\X ARGE DISPOSAL Public Sewer Well Private (septic tank, etc. Tanning; Massage Bod} Ail i Tobacco Sales Permanent Dunlpster on Site i Swinlnlim" Pools i I Food Packaoing. Sales NOTE: Perlotry contructi.ng with unregistered contructon th; not htive uccess to the /J Signature of Agent, Owner ,f>Lle-L i C� =:� Signature of Conttacto Plans Submitted ! Plans Waived Certified Plot Plan Stamped THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM PLANNING & DEVELOPMENT COMMENTS DATE REJECTED i Water Shed Special Permit U Site Plan Special Permit ❑ Other DATE APPROVED TE REJECTED DATE APPROVED CONSERVATION � / � ���� 2QD COMMENTS / HEALTH COMMENT i� DATE REJECTED �,�,� / I/c�>��l-t � /onin! Board of ,Appeals: Variance. Petition No: Lon in, Decision. receipt submitted yes —__ Phnnim! Board D(-- inion: Conlnlents C_tinsci-vation DCclsion: l*o11l11lellts DATE APPROVED ',dater & Scb\cr connection SkMatffc ,.', date Tcnlp Dunlp:,ter on site ;e no__ Fire Department 131.111din� Permit ,approved and Issued b-: ` BUilding Setback (ft.) Front Yard DINIENSION NUmber o[Stories: Total land area, sq. ft.: Side Yard Rear Yard � Total square feet o[floor area, hxord mn Exterior di|oumionn`_________ � ! � / �-----_-_-_-__----__---___-__—_�-_-__--__--_- ! | / {JCQll %7.. lJb{p\l--.AIW P.O. Box 135 age.JO of 11 Middleton, MA 01949 1-978-774=4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ' Owner: Date of Inspection:IQ D4 10 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. Carai-e- ) J-oTZ= g, g�v D = 17 1-0 PUBLIC HEALTH DEPARTMENT Community Development Division Sandra Skelton 846 Chestnut Street North Andover, MA 01845 June 30, 2006 Re: Variance request Dear Ms. Skelton, This correspondence is in response to your request to the Health Department to appear at the May 25, 2006 meeting of the Board of Health. At that meeting the members of the Board of Health approved a variance to the North Andover Subsurface Disposal Regulations 1.07 "Cesspools are failed systems and shall be replaced with a system meeting these regulations and 310 CMR 15.000" a cesspool is a failed system". With this variance the board allows the property, known as 846 Chestnut Street, to maintain the drywell for the purpose of the laundry water only. This variance approval is granted for the home as was approved for a recent addition. It does not include any future additions to the total number of rooms such as the garage and pool house. Any further addition of flow to this system would require the installation of a fully compliant wastewater disposal system or the connection of the home to a municipal sewer and the proper abandonment of the existing system. Sinc , usan Sawyer, RENS S Public Health Director Cc: Building Dept. File 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web wwwjownofnorthandover.com TOWN OF NORTH ANDOVER Ot NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 3 '*°� r .�,0 0 HEALTH DEPARTMENTNOW 400 OSGOOD STREET ► ^, ?" r NORTH ANDOVER, MASSACHUSETTS 01845 'SSACHUS Susan Y. Sawyer, REHS/RS Public Health Director Sandra Skelton 846 Chestnut Street North Andover, MA 01845 Re : Variance request April 25, 2006 Dear Ms. Skelton, 978.688.9540 — Phone 978.688.9542 — FAX healthdept(cvtownofnorthandover.coin www.townofnorthandover.coni The Health Department has received your request to be on the next available Board of Health meeting agenda. The next regularly scheduled meeting will be held on May 25, 2006 at the North Andover Town Hall, 120 Main Street, in the 2nd floor Selectmen's meeting room. Your request will be provided to the board members prior to the meeting. At the meeting, however, you will be able to address them personally with any additional information you may wish to present. Sincerer r u9 Sawyer, REHS/RS Public Health Director Cc: file r April 20, 2006 North Andover Board of Health c/o Susan Sawyer, REHS/RS Public Health Director Town of North Andover 400 Osgood Street North Andover, MA 01845 APR 2 0 2006 :OVER .ENT Timothy Skelton MD PhD Sandra Skelton 846 Chestnut St. North Andover, MA 01845 978-685-9926 Re: Variance to North Andover Septic Regulation 1.07 for laundry -only subsurface disposal system (grey water) Board of Health Members, We are currently undergoing renovations and an addition to our home that involves no change in the number of bedrooms (four). There are two subsurface sewage disposal systems in place. The primary (blackwater) system consists of a septic tank, distribution box, and leaching field, which are functioning properly, appropriately sized, and in compliance with Title V regulations (3 10 CMR 15.303) as demonstrated by a passed Title V inspection (Dean Luscomb II and sons, 10/24/2005) and review by a licensed professional engineer (Norse Engineering, 3/25/2006). A secondary (greywater) system is in use for laundry discharge only and consists of a subsurface dry well pit of stone that is functioning properly and has passed a Title V inspection (Dean Luscomb II and sons, 3/17/2006). Steven Eriksen, a registered sanitarian and certified soil scientist has reviewed the relevant documents and state and local regulations and has rendered the opinion that the current greywater system should be allowed to remain in place (Norse Engineering, 3/25/2006). He notes that Mass DEP state regulations do not require tie in of a separate discharge as long as it passes a Title V inspection. However, as indicated in a 4/4/2006 letter from Susan Sawyer, North Andover Public Health Director, maintaining our current greywater system appears to be in conflict with North Andover Septic Regulation 1.07 which states that "Cesspools are failed systems and shall be replaced with a system meeting these regulations and 310 CMR 15.000". It is our desire to do the right thing to ensure public health and protect the environment. Greywater discharge is primarily an environmental concern and blackwater is primarily a public health concern. In our situation, there are no wetlands, rivers or streams, open water, or wells within a distance much greater than the required 100 feet from our greywater system. Therefore, there is no environmental risk in continuing to use this system. Furthermore, there is benefit in improving the efficiency and lifespan of our primary blackwater system by not tying in the laundry effluent (Norse Engineering, 3/25/2006). For these reasons, we are requesting that the Board of Health grant a variance to the North Andover Septic Regulation 1.07 and allow us to maintain our current laundry -only subsurface disposal system. Sincerely, Timothy kelton MD PhD Sandra Skelton 4Z FILE # Wnd I02405A TITLE V INSPECTIONS Dean G. Luscomb H & Sons P.O. Box 135 Middleton, MA 01949 978-774-4065 t Licensed Plumber #20285 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INPSECTION FORM r k PROPERTY OWNERS NAME S a n d C PROPERTY ADDRESS ?L4 (6 Ck e S+h i 1 J +. N A n d c)ue- r "M A ADDRESS OF OWNER (if different) qJDMP DATE OF INSPECTION Q C+d h e r a 4 aDO5 NAME OF INSPECTOR F) EQ h (3L� s CO m h QUALITY IS NUMBER ONE TO US COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENviRONMENTAL PROTECTION DEAN G. LUSCOMB II & SONS P.O. BOX 135 MIDDLtTON , MA 01949 1-978-774-4065 TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PARTA, CERTIFICATION Property Addr+ess:'RU, Ches-f hLLi 8f N. A r,dave r MA Owner's Name: Gar)d; S16e_14Dn Owner's Address: SO r nC Date of Inspection: DEE b t' r a y dOZ. Name of Inspector: (please print) Dean G. Luscomb II Company Name: Dean G, Luscomb II & Sons Mailing Address: p _ 0 _ Box 135 Mi ddl Ptgn, MA 01949 Telephone Number. 9 7 8-7 7 4— 4 0 6 5 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. l am a DEP approved system inspector pursuant to Section 15340 of Title 5 (310 CMR 15.000). The system: asses Conditionally Passes Needs Further.Evaluation by the Local Approving Authority Fails Inspector's Signature: 4AL _Iy, Date: &kd r 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 wits perform in the future under the same or different conditions of use. FILE --E-.V INSPECTIONS "bean G.- Luscomb If & 5ons V.0. Box 135 WitId I eton, MA' 01949 1-978-774-4065 ,.::LICENSED PLUMBER #2-0 2 8 5 nlx _4z m1a; '5USSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNERS NAME; SQndl' qk2140r, PROPERTY -ADDRESS.: -'9_q CL41)U-11 si% ivk- A DRESS OF OWNER: RL (if -different) DATE OF. INSPECTION: NAME OF INSPECTOR: QUALI-TY I.S. N.U.M.B.E.R, ON -E TO. U.S. ¢X. COMMONWEALTH OF MASSACHUSETTS fa EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS oA DEPARTMENT OF ENVIRONMENTAL PRO'T'ECTION DEALT G. LUSCOMB II & SONS P.O. BOX 135 MIDDLETON, MA 01949 1-978-774-4065 TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: g q G C k e S h U --f- S4 til.Ar,douer M Owner's Name: Sclia i S1f21+bn Owner's Address: Slit M 2 Date of Inspection: lV) Q rC-k 17, a UCS Name of Inspector: (please print) Dean Q. Luscomb II Company Name: Dean Q. Luscomb II & Sons Mailing Address: P- 0- Box 135 Middleton, MA 01949 Telephone Number. 9 7 8-274-4065 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: _ 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. MAR -27-2006 01:08 PM NORSE_ENVIRONMENTAL 9786497582 March 25, 2006 NORSE ENVIRONMENTAL SERVICES, INC. 130 Middlefox Rood, Sulta 15 7yngoboro, MA 01879 TEL. (978) 849-9932 • FAX (978) 849.7582 Susan Sawyer, Director Board of Health 400 Osgood Street North Andover, Ma. 01845 Re: 846 Chestnut Street Ms. Sawyer; 1 was contacted by Sandra Skelton to review the material regarding her Title 5 Inspection. I inspected the property and reviewed the Title 5 inspection documents by Dean Luscomb for the leaching facility and the dry well. l also received a copy of your letter of March 22, 2006 to Ms. Skelton. No original documents of the design or as built plans were available. I also reviewed the proposed addition and note that it is a four bedroom dwelling and no additional bedrooms are proposed. It appears that the inspection was thorough and in compliance with Title 5 standards and policies. I have no reason to suspect that the inspection is inaccurate or flawed in any way, and assume that it is accurate. There is no evidence of system failure and the inspector noted none of the Title 5 failure criteria were observed. The inspection shows one 90' long trench, probably three feet in width and likely one foot in depth below the perforated pipe with a dry well for laundry wastewater. This was a fairly conventional design for the time period. It appears that both systems are above the water table. We have no percolation rate data and do not know the exact size of the trenches to calculate if it would meet current standards, but it appears that it was installed in compliance with all applicable regulations at the time of construction. Given the circumstances, the system is functioning adequately and I would see no reason to require any upgrades or repairs to the system. In my opinion, the system is adequately sized for the existing dwelling and the proposed addition. Furthermore, though I believe that the system would be capable of taking the greywater, I do not think that this would be beneficial. As you are aware, greywater has a far lower bacterial level than blackwater. In, the past, many towns required separation of the laundry waste. This can substantially reduce the effluent loading rate of the. trenches and could increase the life span of the system.. I understand that DEP is currently considering regulations for greywater systems, but currently Title 5 does not regulate greywater systems. P. 02 01:08 PM NORSE.ENVIRONMENTAL 9786497582 i The Mass DEP website does provide some guidance (attached) noting that "Title S does not require the tie in of a separate discharge as long as that discharge is inspected and passes a Title 5 inspection. Given the circumstances, it is my professional opinion that the system is adequate to service the dwelling as is, and no additional work is necessary to upgrade the facility. Furthermore, the greywater system appears to be in compliance with State and Local regulations and should be allowed to remain in place. Should conditions change and failure of the greywater system occur, tie in to the leaching facility would be appropriate. Please contact me if you have any questions or if I can provide any additional information that would be of assistance to you. Thank you. Sincerely, Steven Erikson Registered Sanitarian #866 Certified Soil Scientist Cc Sandra Skelton P.03 TOWN OF NORTH ANDOVERof poRT Office of COMMUNITY DEVELOPMENT AND SERVICES � t4 F A HEALTH DEPARTMENT 400 OSGOOD STREET w NORTH ANDOVER, MASSACHUSETTS 01845 ,ssA�►�St, Susan Y. Sawyer, RENS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX healthdept'ar?toitmofnortliandover.c,mm w«,iv.to«mofnorthandovcr.com Sandra Skelton 846 Chestnut Street North Andover, MA 01845 Re : Building permit for addition April 4, 2006 Dear Ms. Skelton, Thank you for responding to the March 22nd request for additional information in regard to your building application. The information submitted on March 27te has been reviewed and the health depamnent has the following comments in relation to the previous letter. 1) The Title V report for the second subsurface disposal system has been properly submitted. 2) A professional engineer, Steven Enksen, of Norse Environmental Services, Inc. has submitted a written opinion as requested and a supplemental opinion on April 4,2006. Mr. Eriksen was contacted to confirm the size of the existing home. The drawing submitted by you on March 13a; identified the current home as a 34xxk om, however Mr. Eriksen has personally confirmed that this home is currently a 4 -bedroom home therefore the sketch drawing is not precisely accurate. The North Andover Subsurface Disposal Regulations state that by definition 1.07 "Cesspools are fair systems and shall be replaced with a system meeting these regulations and 310 CMR 15.000" a cesspool is a failed system". This letter is to inform you that the cesspool/ laundry drywell system must be abandoned and the internal plumbing be rerouted to the piping to the subsurface disposal system. In addition Part F 17.06 states that if the leaching area has not received usual effluent it shall require a second inspection conducted 6 months later by a MA and N. Andover licensed system inspector and a report must be submitted to the Health Department. In regard to tying the laundry into the subsurface disposal system, the report submitted by Norse Environmental states that he does "not think that this would be beneficial" in this case. Therefore, if you wish to request a variance to the Board of Health regulations, allowing you to continue the usage of your laundry system, you may do so by submitting a written request addressed to the Board of Health, to be heard at the next regularly scheduled Board of Health meeting. PIease refer to the regulation section listed above in your request. At the meeting, the board members will review Mr. Enksen's findings and, if you wish to do so, you may present any additional evidence to the three board members as to why this variance should be granted. ffyou choose this option, please submit your request in writing at least seven (7) days prior to the board meeting. The next scheduled meeting is on April 27, 2006 at 7:00 PM, in the Town Hall 2nd floor selectmen's meeting room. This letter will be forwarded to the Building Department. It is common practice that this office approves a building permit for an addition to a structure, while concurrently, the corrections to septic system is being done. Failure to comply with these stipulations could result in further action. Therefore, in good faith, this office has signed off on the building permit with the stipulation that the septic system issues will be corrected prior to issuing any Building Department final ocarpancy permit, for the completed addition. Thank you for you cooperation. Sincere ' , 'cam `S Sawyer, REHS/RS blic Health Director Cc: Building Department SEW ELEGANT 97e6872804 02/18/06 05:36pm P. 001 f NORSE ENVIRONMENTAL SERVICES, INC. 130 Middlesex Road, Suite 15 '' Tyngsboro, MA 01879 TEL. (978) 649-9932 C1� 400 (s!306d S+re e: I o- AnlmI , AAAa/F4s WE ARE SENDING YOU O Attached O Under separate cover via ❑ Shop drawings ❑ Copy of letter MEET M ofUMRS UCTM oArS � 100Mo • A1T NTIOtt '1.l.SA DESCRIPTION l�• �ncio�^ert. ❑ Prints ❑ Plans ❑ Samples ❑ Change order O the following items: ❑ Specifications THESE ARE TRANSMITTED as checked below: ❑ For approval O For your use ❑ As requested ❑ For review and comment ❑ FOR BIOS DUE REMARKS ❑ Approved as submitted O Resubmit copies for approval ❑ Approved as noted O Submit copies for distribution O Returned for corrections O Return corrected prints 0 19 O PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: DESCRIPTION Kew ee - THESE ARE TRANSMITTED as checked below: ❑ For approval O For your use ❑ As requested ❑ For review and comment ❑ FOR BIOS DUE REMARKS ❑ Approved as submitted O Resubmit copies for approval ❑ Approved as noted O Submit copies for distribution O Returned for corrections O Return corrected prints 0 19 O PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: NEI April 4, 2006 NORSE ENVIRONMENTAL SERVICES, INC. 130 Middlesex Road, Suite 15 Tyngsboro, MA 01879 TEL. (978) 649-9932 • FAX (978) 649-7582 Susan Sawyer, Director Board of Health 400 Osgood Street North Andover, Ma. 01845 Re: 846 Chestnut Street Ms. Sa'�vy.2r. APR 0 6 2006 TDHEALTH DEPARTMENT DER Further research on the above site, including a site inspection of the building, shows that it is currently used as a four bedroom dwelling. However, it was assessed by the Town of North Andover as a five bedroom unit, and could be used for five bedrooms. In my opinion, the system does not meet any of the failure criteria of 310 CMR 15.303, Systems Failing to Protect Public Health and Safety and the Environment. Therefore, the application for a permit for up to a five bedroom addition would be appropriate and reasonable. If you have any questions, please feel free to contact me. Thank you.. Sincerely Steven Eriksen, RS 866 :FR,rt 04=2206 11:59 From: North Andover ;Board of /Assessors Public Access hiluhi �c,dtr: fi:,���r• iT°t��•:::h.k ort eae. New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Saps To:9786497582 P. 2/3 Page 1 of 1 ht.1p://csc-ma.us/NandoverPubAcc/jsp/Home.,i.gp?Pzge=4&Liiikid=809681 4/4/2006 4 Map/Block/Lot: 210/107.0;-0019- Parcel Address: 846 0000.0 R1K:S1:D.tlNCE DAJ kik. Style: CONVENTIONAL ToW Rooms: 9 Story Height: 2 Bedrooms: 5 Ext.Wall: AI,tiMNM-VINYL Full Bath, 1 Foundation: CONCRETE lialf Bath: 1 Year Built: 1923 Heat Type: HO7' Overall Grade: AVERAGE Heat Fuel: OIL Overall Condition: AVERAGE Central Air: NO Living Area: 1838 sgft. Fireplace: t Basement Area: 1055 sgfl. 1~dnlshed Base=nf: Basement Garage: Capacity: Square Foot: Attached Garage: Capacity: Square Foot: CaLrport: Trailer: Width: Length: ht.1p://csc-ma.us/NandoverPubAcc/jsp/Home.,i.gp?Pzge=4&Liiikid=809681 4/4/2006 gl jcmx 2/2,d 28sl6t79BL6: 01 :WOJA GS:TT 9002_rM_8a_b_ )> nm X Z> C) X= 0A > am) _j 2 16 4 Ir z V) m < MO M ;z �..e r- -4 r 0. >M IM 2 .g7 7— .n 0 6 i71 �f A -4 co rn sp oa -< 6n -, c P. 0,A a - E j a -IJ-13 C). 0< 5' z 0 M T, C,> Li 7 r. 0 3p p 0 z 0 m -n. rp r. ab M lu co ca ch 0 in;,w CD M -n r- > 3:00 0 G) G) (n (D 'U'V K3 -1 Z 0 R 0 0 O NE- z Ow CALc I a CL!s m z 0 M -4 > Cn.'* 0 99 8 C-0 —0 —0 83 1 2 P. Rn, 00-D 0 r OD co 0 >>>>>H Pa g NO 0 m m OZEE W (41 M M> ;j PER CYR.60 0 - z ANN z Rr 0 Z 345 8 P 9� K3 N co Cp 8!2 98 gl jcmx 2/2,d 28sl6t79BL6: 01 :WOJA GS:TT 9002_rM_8a_b_ )> OP Z> X= Qr -4 > am) _j 2 16 .0 > Ir z V) m < MO M m (a r- -4 r 0. >M 0 Z4 7— .n 0 6 i71 �f Z Li 7 r. 0 0 m m U) co ca ch 0 CD M -n r- > z CALc I a CL!s m o 0 M gl jcmx 2/2,d 28sl6t79BL6: 01 :WOJA GS:TT 9002_rM_8a_b_ s. TOWN OF NORTH ANDOVER ,10RtH Office of COMMUNITY DEVELOPMENT AND SERVICES �W.I0 HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01.445 �'S- yaw Susan Y. Sawyer, REBS/RS Public Health Director Sandra Skelton 846 Chestnut Street North Andover, MA 01845 Re : Building permit for addition April 4, 2006 Dear Ms. Skelton, 978.688.9540 — Phone 978.688.9542 — FAX healtUdept a;townofnorthandover.com w tviv. townofnortliandover. com Thank you for responding to the March 22nd request for additional information in regard to your building application. The information submitted on March 27th has been reviewed and the health department has the following comments in relation to the previous letter. 1) The Title V report for the second subsurface disposal system has been properly submitted. 2) A professional engineer, Steven Eriksen, of Norse Environmental Services, Inc. has submitted a written opinion as requested and a supplemental opinion on April 4,2006. Mr: Eriksen was contacted to confirm the size of the existing home. The drawing submitted by you on March 13th, identified the current home as a 3 -bedroom, however Mr. Eriksen has personally confirmed that this home is currently a 4 -bedroom home therefore the sketch drawing is not precisely accurate. , The North Andover Subsurface Disposal Regulations state that by definition 1.07 "Cesspools are failed systems and shall be replaced with a system meeting these regulations and 310 CMR 15.000" a cesspool is a failed system". This letter is to inform you that the cesspool/ laundry drywell system must be abandoned and the internal plumbing be rerouted to the piping to the subsurface disposal system. In addition Part F 17.06 states that if the leaching area has not received usual effluent it shall require a second inspection conducted 6 months later by a MA and N. Andover licensed system inspector and a report must be submitted to the Health Department. In regard to tying the laundry into the subsurface disposal system, the report submitted by Norse Environmental states that he does "not think that this would be beneficial" in this case. Therefore, if you wish to request a variance to the Board of Health regulations, allowing you to continue the usage of your laundry system, you may do so by submitting a written request addressed to the Board of Health, to be heard at the next regularly scheduled Board of Health meeting. Please refer to the regulation section listed above in your request. At the meeting, the board members will review Mr. Eriksen's findings and, if you wish to do so, you may present any additional evidence to the three board members as to why this variance should be granted. If you choose this option, please submit your request in writing at least seven (7) days prior to the board meeting. The next scheduled meeting is on April 27, 2006 at 7:00 PM, in the Town Hall 2`hd floor selectmen's meeting room. This letter will be forwarded to the Building Department. It is common practice that this office approves a building permit for an addition to a structure, while concurrently, the corrections to septic system is being done. Failure to comply with these stipulations could result in further action. Therefore, in good faith, this office has signed off on the building permit with the stipulation that the septic system issues will be corrected prior to issuing any Building Department final occupancy permit, for the completed addition. Thank you for you cooperation. Sine , S Sawyer, REHS/RS S/ Saw Director Cc: Building Department NORSE ENVIRONMENTAL SERVICES, INC. 130 Middlesex Road, Suite 15 Tyngsboro, MA 01879 TEL. (978) 649-9932 TO t_r t� cA2 t1 �a &k 4ne4 LLA- U 1 Y y S WE ARE SENDING YOU ❑ Attached O Under separate cover via EUETTIEM oF I —HEALTH DEPARTMENT ❑ Shop drawings ❑ Prints O Plans ❑ Samples ❑ Copy of letter ❑ Change order O the following items: O Specifications THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ OESCRIPTION ©AL As requested SEEI FINE FOR BIDS DUE 1100i Y - FINE 1100 _ .J MAL � L -.-_ 1000001 FINE ME FINE THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested O For review and comment 0 FOR BIDS DUE REMARKS ❑ Approved as submitted ❑ Approved as noted O Returned for corrections ❑ ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints 19 O PRINTS RETURNED AFTER LOAN TO US 0 6N COPY TO SIGNED: J�1 March 25, 2006 NORSE ENVIRONMENTAL SERVICES, INC. 130 Middlesex Road, Suite 15 Tyngsboro, MA 01879 TEL. (978) 649-9932 • FAX (978) 649-7582 Susan Sawyer, Director Board of Health 400 Osgood Street North Andover, Ma. 01845 Re: 846 Chestnut Street Ms. Sawyer; RECEIVED MAR 2 8 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT I was contacted by Sandra Skelton to review the material regarding her Title 5 Inspection. I inspected the property and reviewed the Title 5 inspection documents by Dean Luscomb for the leaching facility and the dry well. I also received a copy of your letter of March 22, 2006 to Ms. Skelton. No original documents of the design or as built plans were available. I also reviewed the proposed addition and note that it is a four bedroom dwelling and no additional bedrooms are proposed. It appears that the inspection was thorough and in compliance with Title 5 standards and policies. I have no reason to suspect that the inspection is inaccurate or flawed in any way, and assume that it is accurate. There is no evidence of system failure and the inspector noted none of the Title 5 failure criteria were observed. The inspection shows one 90' long trench, probably three feet in width and likely one foot. in. depth below the perforated pipe with a dry well for laundry wastewater. This was a fairly conventional design for the time period. It appears that both systems are above the water table. We have no percolation rate data and do not know the exact size of the trenches to calculate if it would meet current standards, but it appears that it was installed :n com„liMce'v;th all 7ip_c �ler gu1...yye »t th t_P_ f n n struction. Given the circumstances, the system is functioning adequately and I would see no reason to require any upgrades or repairs to the system. In my opinion, the system is adequately sized for the existing dwelling and the proposed addition. Furthermore, though I believe that the system would be capable of taking the greywater, I do not think that this would be beneficial. As you are aware, greywater has a far lower bacterial level than blackwater. In the past, many towns required separation of the laundry waste. This can substantially reduce the effluent loading rate of the trenches and could increase the life span of the system. I understand that DEP is currently considering regulations for greywater systems, but currently Title 5 does not regulate greywater systems. The Mass DEP website does provide some guidance (attached) noting that "Title 5 does not require the tie in of a separate discharge as long as that discharge is inspected and passes a Title 5 inspection. Given the circumstances, it is my professional opinion that the system is adequate to service the dwelling as is, and no additional work is necessary to upgrade the facility. Furthermore, the greywater system appears to be in compliance with State and Local regulations and should be allowed to remain in place. Should conditions change and failure of the greywater system occur, tie in to the leaching facility would be appropriate. Please contact me if you have any questions or if I can provide any additional information that would be of assistance to you. Thank- Certified hank Certified Soil Scientist Cc Sandra Skelton TOWN OF NORTH ANDOVER of NORTH � Office of COMMUNITY DEVELOPMENT AND SERVICES �? •`;_ ' `'• HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 'SSAC14 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX healthdept(a?toivnofnorthandover. coin w«Nv. townofnorthandover. com Sandra Skelton 846 Chestnut Street North Andover, MA 01845 Re: Building permit March 22, 2006 Dear Ms. Skelton, This letter is to follow-up and to document our conversation held this afternoon at the Health Department regarding your proposed addition. In short, the following items remain at issue. 1) The Title V Inspector must submit proper documentation to make his submission comply with the Title V state inspection requirements. 2) A licensed professional engineer must review and consider all of the documents, the property itself and all available information necessary to reach their conclusion. If you have any original documents, please provide them for this process, as the Health Dept. has no records available. A letter is to be submitted to this office by the engineer. It must indicate whether or not, in their professional opinion, the existing septic system is properly sized for the home with the proposed addition. They should also indicate whether or not the introduction of the laundry and the abandonment of the gray water system are recommended 3) Once submitted, all of the information will be reviewed by the Health Department personnel for its completeness and a written response will be given as to any further action needed As you are likely aware, Title V has certain requirements that are to be met if there is an increase in flow. 310 CMR 15.352 "No person shall increase the actual or design flow to any system above the existing approved capacity, unless the system is upgraded". It is important that you provide the engineer with the pre and post plans to assist them in determining whether or not the existing size of the subsurface disposal system can handle any proposed increases in flow as is required by state regulation. If it is not sufficient and replacement is identified, we will assist you through that process. Also, please submit the pre and post floor plan design to be added to your submission packet. Lastly, the certified plot plan submitted with your permit application shows that there will be no work done to the rear of the home near the septic. If this is incorrect, the septic system components must be shown on the certified plot plan to ensure the integrity of the system and compliance to the setbacks set in the state regulation. It is encouraged that you provide a copy of this correspondence to the engineer so they may have a guide to assist them in providing you the service necessary to move this process forward. If they have any questions, the engineer may contact us at any time. Michele Grant or I will be happy to assist them or you if you have any questions regarding this correspondence. t ,f Sincere r S Sawyer, REHS/RS , Public Health Director v ' ro n in c 'D rNy a fU ri 'C7 a rt 3• � to . 4 C01 Oic obi , t;QrD A ro $ Ct1 n, n r� 47 �" iJi Ol 7 r 20 kv rD s t P,• 3 n � .. vi T i Uf $ d. 'O `L N w a O fl. n` O tan rat O O � O nj 3 c 'ID a C (D r' a a a a< wul c Ro t�rtD ('rtD tft @ 0vi M iSa rt rt i m (Di p n _ (n a t (D (n ...., (DLA y LA S. a(D ro n m LnO N to rev 7 a to f Cce G cr 3 C r m rTci 1 "57 W .. 0 3 v v v v v v v v v vv p v v v v v v v v$ v v v v ,=Dr(D O _„ D D `c' .rte` N `c' `<' O fD Q. Q rt s-•� �r� Sc = p N ` `L n fD . �a M m ea o- s o ° p 3 70 �o �s�tD '3r O �= 'ai• O rar D N a QJ ° ray, Sn a a to � `2 N I ° a• N v (n 0 (D (D (D rt N a O v S n• O 0 ° j M to (CD O S S S 7 7 7 t0 (D (D 7 O N O. to O to rw 0) r rD m" (n a (D (p � -, a n -, � � a n � a -, vi '�O 3 O 3 t0 c_ a (D 3 O � •� a "C (D N N a N 01 .roD ro< ,<a(DLO 0ti0=?rtK"a3a�<'-'K p• n N jt�c =r O 0)t99 lro11 OO mMa v�O m =rN *0•ro((ooa in�a�yv°m�a0m(D ro ° tan (p iy a 7 < Ll to �- fD o (D N 3 C? (p CL rt '* S N A 3 a (D N ti. rar d tpi( to n c a ro '0? O O =ri rt° - to rt O ro ro rr '� N 3 6 O• a p s ro ro •.N< ma °nOlio 3 "Oo roa° man=r�p� s aroroa3 a �v ca^a3�ontcna�,'ufDv'm mM rN-r �3 .Nr 01 N N a rt rr 3 Q n O n r�-r. to to =r rN_•e• 3 W O S_'00 ro O' O 7 pD(D m -.0M o_ `o rt rom=���=�y�@� 'nrn-*•3 N0 roc N a O . rt ^_t to • .Q rt (D ._j 3 rt tp �rt O (D -r' CL `� (D O 7 "a < (A (D (f) o.ca < o°rtN���< Woo=��°�°Q�3I.�,a n° �`�' O Ln n n ro p N C7` (D ,G in to a v a n •� (D N 3 ,..,. a •p (D n (J °- ,a n O M rt O a .D O CL ro (D a r'f' �, O to n• N rop_ N 5 y rt rD m O Q -t M OJ ? O C O rrt 0. 0=) C N N •gyp d i 3 rt N O a oxo a (D 00 moo 3 �m r�-3'aiam?�po°a (�D 3 n > tJ _rD n rD a N � O _. p nn aceto ° a a v° < p •� * ° O top -n p (D - v Q in n CL (n Oj v? rfDDoM <vc (D° 3to0) via `A° �ro 3na ro op' <��rna `'•v m tD K o to p ((DD CL an N 3 r -r rr O ro N O O. aa i ori C 3 (D as �� (Dro v 'a n' 3 -1 3 u°i V V n (n y cu 3nn•F to W to •v h' ((DD 0 9 ^- r" rD n n to 0. < or A 7 (u ? 3 N O O O `C. c rr -iii LA O rr O •p O (D ��� �^. N T3 3 O CDF � C n n (t° �� 0 3 n rD d in a ro 7 C o. a: a in CL nC7 rD C N a O O 6 tett N O ; ro tin '< (DD L (D3 Q• < ro o ro T I Ct a S a0 0 t 0 0 O Fp S rt (D O vai 1° �< N' a' v; O =� :�o a 7`t O O (n•p pc Zvi n n m O 1 �n Da D�,C, � (-_'� ° G1_. ° S 'n om, � � � a o � m =a m �*0 stn° � m j �N ararm a •O 777 n 7 m(D S O(D m !/�m ° c:D� j n W rtC p O• C a rr n as a (n (D 3 <�m o m c ,o a0) a v ^ n° as m Qo v °'.� m rto m rta m o a n in V) o n a a o°° < m °' ��a c rtm on (Dm ^ fD mam m cn O.o n\•o'm rtm.pcm—m -„Om m na 7aj vi rt'_' mam • 0. W�m �•*u3,O� OaNCjN In K(n m'00 `°� m-007 m 7m <ON:3 mrt(rt—DCan ((DD ��N�O.n Onam X n ° n c O < d m C O m t0 S `�. an d �'ND � N ya, umi o a° -o o m mrtm ort ° rta < u� 3 ava o 4- m o o g c So ° (D a c( =*n- `<4 a°(A a'�.o m a iu m 3aoaa 3mm=no <a_C'o M a0 m Tsm Srt Sm p U� aC On °'�? rtm m aof �* rt O m rt n > to m ton .7n0O.m 3 -+3 (n O :r rtO ? O v)ao O O rta O 3 n'a 7 p o+Vf 7 7 m 7v�m� m '+(Jf m �•��a�3a�-atnc� 7 °7N Ln �m =On foN3O V1r=r�7'_.7 7''Y n 0)0 aO r)=wm a� 0 � � °'n , r � o � 3 3 a ° m � �� ° 3'a 3 °mac on, a u7i ° o tn may m SQ3 rta ^ (D m' O n •,, a rtc p o n `° rt�•v c a a -„ -0;���sm OO(� O mN7 `<a mN`� laDvi��rt•< IA amrtto�n 7 O rt O. c a O X p 7 � rTi m= rt° to m O rNt '9 3 3 y m m O mrr m a3 mfg as �o �crt°rtm o.a°aa� mi m0,C(A _1 °ao yam 3 �� ort ID 0) r, �. 3 mairt'o ^th m �� vo arty 01•�o'm v:n rn, '^ °' S m, 3 a m-`"*`" <n`oc mm f ��°x`_��oo� �n� n'Do m c no' 00���3 - crmu+ m Y m 3ma�-•<c Y d?� Yo> > N -n(D a i,om=om 0°imi� a� m '7Ourtim=S n7- <.Q a ,� 3o ma���o ° m��>> c.� 3 n Qoaa a °rt' `Da mo 3 cpu n:) a o 3�m ° u, p3, 0 V1 S -• N m m 7 a Q N m— S d m a to an v°_,.o a� a � �Yvo �� a rtrt m ,n ° � n o� a0 (n (DD =m d `n C o> -1 a= n (D .. O a N O S i d = O C c m (n to r° p a rt O (D ��O = d a rtp Ln �a m gL m m -o Ort O �.N� �. < a a a m a rt S(D c mt m01'n O 7�p,nv�m a(n '<=7 aa' (D m' 3 �'-„�•uai� (D varta3 m a'n p �tn U� a' T o va °1 7� �� o o° a m of u o mm ° c -o rt o Mm >`�a a m v moao v 3 x m 3 m S a to a ” w m tn o, s o a �Ln m 0 o —01 o, 43 0) O <_ o a 3 n a@ .< a° m < a °ort o a 3 3 oCfD i a o D p �< Krt3� a �poiAd O d C, a m o m m p a m a m 0 m n(D rt >> z 7 n C y; K d s cr S m '" cr ry ,0 t° cr '^ O' (D n Q' O• u�i - m m d O rt m CD tnrt O c0 (D C 7(D 0) n* n o z c(n m nx < o0. to �o ma M � a� �� o N 3 ort O m , a _o to Oi n O ((DD m O �• O a =r M O� p m n� m c 3 m O 7 0 4 S O d m O 7 m tn m p p n (D O rt W N Cn N O O O N C4 C C� w b It to ►. :EO Om m M (n � —to -t - m r a _. Ot D -< m a ..{ m -< '•r r•r -„ -• m to n -• -I O1 X 30 (D n crtn ttnn � c � K`—'opo M ( c U.A <r�o oni �1A M oQ.� o �' m = � M oxi F th � � c cacrtu a .07-< °° °; _�� � �° 0 m n *o (D °�3—rtmn�,< 0: r*o,03 in Ln mmO �.M nvv ac 0 (nOrt ? K O N ,�-* Ln < `O N O O uC3i N" n 3 2 0 <� , a -rt o,3 nrt oaa�m me ° -'rn .0 rt °rt`"ao �a°0 z aim ° �m�-3 m3 °!nma 0wc nmv my OtnrttnN 3to<�0 tai pt0 =N.O Ol to O. 0n n n C On. to mO p an 3m V mO0, w C N N m d '_?rr '*° m_ti d T° O O O O O C tA "+ O m o.ao. °'aa o 0 0,0 noxi ^ ° (n ° °< m o "n ^� n u°i ° „rn, �, ° �tn0.0Qtn 30 m30� 3�m �(na oo,oin '0 �+ 0 m o 0 0J ° _ 0'r 2nt0 a 'O.? N N.0 ° �. v j N t0 wT rOr - ° m o, to or — v m m to n m o o .� o m 7 d LOM N n 7 `T 0 7 7 d rt '0 UI m 6 rt ° o K �� �� o to n rt� m 0 0> j o �^.m < 03a 3 mom° ofDs �K�tn rr(A mtn �tnTO rtatn 0trto,nr m �'a CA,°*03 < m nn3 c,�.i.M°m oQ a�a mo fD >> o, m�=N �3°: q-< o 0, 0 0 3 -� F� ori 0 0 0 n a T 0 � m ofDi Q rte ° 6 �' '�' M' N 3 of rt 01 7 C> c: 0 'a 01 � 'r m N to m (Nn3o3 �tn -m QOM*0 a�T N°3 0 CL Mto n rtdtn rt� F�-� n mtn3 �� Sal Orttn mrt fD 0. 0) am�0�c a >>° a0 �� ium(�oP; M,@@ m W tn r" C c O rt S rr O O m N N rnr r�r W ° a 0 rn-P p O to .r OJ 0 0� G� Ory =r -O m 0 3 (A n O N 0 N N 07 rmt (rtp 0 m 0 Q !n _ of A N O Z tn m °3 3� ° to M to -i a 7 0 E to .. O O N m 0 ° S ° a O ,* mm3 ,n m 0 (A 30�-+� <- �01 03, 3 n a0 cn n0 nN �rnpV m N 7 h G� O cS� CD E z m -�n m m Q orrOm to �S a0m 0f) p� p°0a atn(D 'aa 0 m C� KN N � m �.y N K 0 ? m n� tn� p3j � O C1 7 �p '•r rt C rnr. ° W M n 7 C 7 to rt m n O O �* m O X rr O d mc? Omtn �a 0 m m 0 �m * tv� 3 f m <� =r d a o 0 0 T Ln to o, s n o. a mon m°c � Ln �c ai 0 pr" cQto rt -* 01 O! 3 N -n 7° n to stn m rt Q Q 0 °- a0 a 0' 3 Q �n 0 c O h m O Q (aD N N 7 °' a SL O o tv N N •.( O m to tv m t0 -f m 0cu n C n ti+ rt n {n n n r •O a n '1 tn� ?Om n x O0) <dd � =c x O 7c F c?(D0(D F amu, m" c 0 o� (D��' o om, tn. o 0 0 '`" y Y o �3 • ' ' ' r N O =r 'O O O O 3 rt� '>a N rt 9 Ct 4 0 ►n o` S J Q O d0 o, rt (� o a m in a oa <arn O_ (n <(n r30)0)0� d a 7 4 nN0 --1 --1 O to �+ (D O S '•r S S r -Drt In O of N 0) n rt C 0)a�(<n -� m S rt W-Zn�,� p j p rt 0 (D CU C Ln (D 7 00 1n m a ri 0 0 C d. g 0 ,ti � (D (D T (D v W-0 a 7 01 0) -0 rr al m re fD � 1 U3 O W N y Ln y; O 3 N c oo fm1 a N c S� rt S O (D °' S < �* • (n m O v 0 O n n m N _3 m O rt CL O m '" O 01 n O S Cl 0J 0 ,'* (n _ Z•m 0 m o) Om 0 3 m m 0) M 0) r�r O� vasoi m 7 9 O 0) _. 17n aO ,ny 7 3 =, � 7 m m o< r* (D CL O S7tn obi �^ ton o � at Z � c�a or � n rt �� 3 drDiO o � � j ac °i It oroi' 0 man a�,a fD rt (D O n �N mrD m °' n �'�° (n,� a O rt 3 O. (n (D �+ m0 03= �; n (n - ,-' v,3 O -{a S r0°'a0 O0) O 7 /D' Q .n �*�,Y O' vi (D S(p p 01 ::r r, ..m ? Ina 01 0) ,Y O. n °w°`"03,3 000m <-•rDCOa 0th10)) N^ O' o��'a "muni �'0O. d LO n C O. O. ul ado m N N C 3' cr 7 o° m a N d r�r a t0 it O (D v 7 a 7 O p O,J i 00 (D m N Q c 7 rt 3 N 3 O (�D 0 m m n p 3 (n 0 0 a (n m N n r•r m '0 p 3 7 fD n � (<p 0�j j a a to 0) Urti (D 7 3 3 S o n N Q =_ o (D p+� to C O n (D f1 m N d 0 c O O fD Ola 0mw to X (n j r. (D : O tnfDm Ln cr°r(np m 0) ry. M <a•c. (D wK° (mnK W�.n O N o05 -•a 3 o N 3:3 rnv a a j o= m tC ��� v�i?Ln m N 0 p a v m .' c 0 n 3 (p n N n (n C 0 m V) vOi 'D C p °.�(D m 0)• n co, a m L umi o a c ac 0 N 0 nv o fD.0 n C pnj ow ul m m a c a am 0.ca 1n Cr n VOf m (y, (Tn (i ,-, O< (n O 3 a '''• 3>> m O c m 77 N m N d a cS,G w a O o j m OS C.m M d 0 Q. �' - (A:3d� n m 'v in C O 00 O 3 � 3 in =r m ((D 0 a) n as fD FD' (A 3 (n 0) m SO ..m_ �� C m uci o�i��'-?(' c °�? �. O 7�3 c a �= an ° ? m v0i� m 0) 7 N Srn aN -3 `"� a O.�*N c mmfD (Drt(D303)"0 7 (<D.� m7 o os ° rt tn (A un o Q (D In - (D m n to C (D (n 0) 0) N •< w a (D a rt a m S Cr v ' S O (D C (X'1 (n 0) 'Y n 0 m � (n S 7 rt (D m �d < �p m 0"m o.O w n a ° O o m M ry 'O n < O (!1 (D 0 w� m 3.� ma �,a(D g 0 o� m =' rnm V) rt °' a3 mm s � a m G�i.000 0 0 0 0 v, In 'a Qo Ka o q "O'D v,� m on O S ama O (O 7- n C..-.�O n 7 n• 3tn 0)i (D � ,� rt a n° (D o rt (DNdOnX 3 0� K a m 3 mom' m0 O. O m O � pj <. ',* 0) (m() (D rt O A rt 'ny. Q N i. O Q r;' n• K ? 0 0) p m (D n O f N 7 S 0) 7 rt 7C c (O in m 7 in C O o m a p ,t a c m e 7 0 m S O r 7 Cu m a p y, 0 0 °c . an d mi i o 3 m to n C N p N M @ 7 f 7 j 7 C d 01 C Stn rt '+ O 7 c "z 0 rt> c Ol rt 3 �o M 3X01 m `i a (n {n fD `< nY(n n (n In `' - Q 'c 0 d (D (n O. y 0 m rt °C-YZ n ^onto°o cmc&, c v O X atn Q(n a n =�3 0 3'rn°,r' m 3 rtOSj 0� o m �°:m°m3 m o 0 3 c om)w n 3 o n o 0 °''J'�*; 0' n m 0 Y T` rt r7 rt- °' S S d, a m S< 0) 0) -, M m (D m rt 7 7C rt N o o n i rt M 7" 01 F ? c 7C S J= S 77 O (D y 0 Q M „, rt"- ;:v rt or (n o n et N C_ O' O O ^' O O (p < O 0 a 3to MIn moa_ 0 p a O m dam 0 n 4 a N O a o)m �y -� O a m a 0 7 m 0 0 0 0) m (D m rD 0 S 01 0. m Ln 0 3 w D D v CD w rD m 7 — r=°r -Imo wp�0) oc� rmr -��� ocna na�oD rwr =*oa�ODN ��v0 ° m�'a mmu0iN �v. *tom man wO�N Nrd° -<�ioa (D W �a3 a3 m030���� 7rr•rt� 7mo+�n �rt rtrt w cm�0 a° mn (n 0.0 moan i�otn m ��(D 33°? ��n°� 3cm`°5,. M c `rn(D ; (D0.�0 rr3am n :r. o ��„ m Zvi 3�ma (D �N Ln 0 ° � 3p of o �� 0) — Sm ° 0 to (A �'d 0 7 a m m.QN 7 7S N Q N a s 'O n : 7. O C - O O a O m 0 m 7 n c O rt 01 n n° X n (SD m �a 00 , rwr 7�3 vOi m�OC N Er Ln N �nm�3 O�rwrwCw60 rt�WN �• CD �' 01 -• p �•'n w to 3 n O' o 3 -+ m ° w r=r r�r m ? C o O.(� O 7 O (D m> O °� a rr d° m (rtD O m rr �• N Vwi w N to O IOn cc d- to m w -. m 'mp w O c (n a O ^. O m =r mrt to (SD co O O M. 7 N C >' (D n 0 O 7 =?NW pSr S. m (D ew•t Oc•=R� 3m- N nrt0°7 (Dnw.DV N Z3 m UI' N 3o '•r 7 N ? 7 OOof (D C 'O 'O tan m m u=1 C• rt C S 3 w n0 rtCL mn roar rZP r m 3� ti` 3 rt3 m SN3 m n 3 aim =.<N 0) 0W(DM mS OO 3 to Yn >>w "3n!On 00mrt 3 �+.� ° S Ut-, a p K N rt tn'tnrD m to rmr m rt 0' to waa --I -< w wmmrtc `�' 3< d wSSmOt0O Cr m w X to I to 3'�vi C p to n -mc 'n ° <rt own ° �� aL .1 O mo �'� cQ(D rt m.� rt �0) 0 mrt„C O' mrta O w cp�tpw0 <m o. C•7-0 n rr c 'D -0 (D (Sp 01 0) EP t'0d NO -.n Ir Ln wm �t0 3m0w N O atom.0m-„ noc •� rt S aSC > n a =r to I O a 'O w in t0 j "in C O C r+; � •0 to m d m o m3 n 0 - C;<'a - d 7..C° (D -*(� OtamMrDN ((D '+ n w 7r�''3 w NM to �in .. tin 7 tmn ((D w C O 3 �* N tcn 3 art m (7- a (mj C t0 rrtD m 0 rr m n 0 C O `G C w 0 7 n y 0 a C a m Q N N O d w 3 �'* m 3m w to m m < m c m� 3 ; r m a (n •� n - �°1 f m c to - v �o w S.m 0 w3 aa0 as min vi a `' o nm c0 0tn �tn to J 3-< cLn -'^ (n 0mC7a-•1 m 3m CL 0 rnr a w mm n Ym(A to ono° -<��•totO� m IIDD° j m tna rmDrnr mN caQ•Ln M=(°Dwm3 umi urtiot0 7 rcr `tmn= LnO3 m �O vOi(D 3NOn OO tn r*�0?Ym CL rt (D rt(n t03 <� ai w° -0 min'= 0 SO�OO7 w_m �N� ? m tn (Spw a �� (nM ^� ms rOr<�7 3a0. narr3o0 �L< CA rn 0 m 7 fn (7O 0m 0< am 0) S a l rt n to w w �^do to O' r�D rnr, = 4 to LL �� � 3 N a N(n d vm K(rt° m rt -0 r'D ° a w a rt= rt =r „a3 i w 0 OSl Q. '< 3 to orD n ° n w 3n m n m to n O E 0 3 ,(D 000 w c< n x -sem o t0 n � m c (D rr -n tn rt c 0. '"' m O rr <= r�r w -n 7 < m t0 'r w- 4D, f M rt O r"r m l< rt r�r 3 O O O to 3 O O :3 w ° O •� O O O 7 G `� 3 W rt w 0 3� p rt `'* m (D O w j ° to .a to �, 0 iy m n 3 Ts (rtD \ w N U N O O O N Ci N _n -• N w 10 TI 0 - ai � - rD , @ N d -'O= N� > O C1 7 3 D= 3 (D pI .CN Cl. N 0) O "„ X 3a CL o(D omm3 W O. 0 •O rt ;:;,o "D N O O O O C O < N 'O N GJ 01 d2 rt n N C N M �• 3 — rt (A a m a ?•+ < < N M E (mD `^(:3,o c t N Ln N d a C n n w w O (D N �i O d IVV��\�'Fr 1\Vl\l la'`k. Ivy• —. APPLIC,\-F10N FOR PLAN EXAMINATION F \SSACHUS�4 Permit NO: Date Received: -s2- 4 7, 4 R,itc Issued: j I�IPORT:kNT: Applicant trust Complete all items un this page i _ I LOCATION PROPERTY WkNER . c G'A, 'runt PARCEL: --k - ' 1 _ _ _. ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF lNNlPROV E\vIENT PROPOSED USE -- Residential New Building i _. One family /kddition - Two or more family %Iteration I No. of units: _. Repair, replacement Demolition 'Moving ( relocation) Assessory Bldg Other = Foundation only DESCRIPTION OF WORK TO BE PREFORNMED Non- Residential -- Industrial _. Commercial Others: "filar ter; e4AA1°n Q\A1� � ) Fc,m,i(gym, V-Jy�Ar, "V\ Identification PleasS "I'vr)t or Print Clearly) OWNER: Name: -��t� Phone:�e 1 Si -3F6X :address:— �ri8 CONTRI�CTOR Name: �'�� �j�•��a"S�� Phone: (�`i�i-� 300 �0 � 'a �iS � SM of A :address: oY. n�kkw Supervisor's Construction License: _—Exp. Date: I{alltl Inl�)1'+)Vl:nllnt LiCCII;S�:_ ,��� ► tct -7 Exp. Datc. � Exp. .�.I�.C'I II'1►=C'7. [:�c il_�L.I fl � F�a�i:-- ''ante: [?lu>�le: yZs�'�'S'3 ` � �d.lecss:--�� FEE.SCHEDULE: N LDI:\G PERMIT 510.110 PER S11100.0OF'THE TOT IL ES'TLILATED COST 8, l:i'ED OWN S1?S.00PER S.F. Total Project Cost :S_.--- —--_---_– x10.00 FEF:S Chcck No.: �__–Rcceipt No. _ T,ry PE OF SE\k ARGE DISPOSAL Public Sewer Well Private (septic tank, etc. Tanning 'Massage Body Ail I Tobacco Sales I Permanent Dempster on Site I I Sevimmim, Pools Food Packa-ing. Sales ` i MOTE: Penoin contracting with nnre,(4viere(I contmelr►n rlu not Itnve uccecs lu the g 1 Sillnaturr of rent;(hvnerc�,lw-=�� Signature of Contractor - Plans Submitted ❑ Plans Waived lJ Certified Plot Plan Stamped THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS DATE REJECTED 1—;Water Shed Special Permit Lj Site Plan Special Permit ❑ Other DATE APPROVED TE REJECTED DATE APPROVED CONSERVATIOt J 2��� �?Q" COMMENTS DATE REJECTED DATE APPROVED, VIIE.kLTH �- �% /lC � � {��( I x'43 `1//// /440 C G �/� `. CO,MN1ENTS��(-/Sy//�"i�--�5 G ��( 5�� /,S cZ�J �� %onin'L� Board ofAppeals: Variance. Petition No: /oiling Decision. receipt submitted yes Nianninc Board Decision: Comments t C:;nscry ation Decision: Comments `,eater a SCkNCI• connection sivnatere & date Tenlp Dunlp�ter on site ; e no__ Fire Department signnture'date . - Building, Permit .Approved and Issued hy- f 1 D. Robert Nicetta Building Commissioner Town of North Andover Town Clerk Time Stamp Community Development and Services Division RL.(-ii'VL- Office of the Zoning oning Board of Appeals ''�' �'� � E-Sk' ADSH'AW 400 -I U'L/pJ C E^ Osgood Street + � r tv� c �� � }( North Andover, Massachusetts 01845 Any appeal shall be filed within (20) days after the date of filing of this notice in the office of the Town Clerk, per Mass. Gen. L. ch. Telephone (978) 688-9541 Fax (978)688-9542 Notice of Decision Year 2005 1uu5 V.Y 2b P 4: 11 40A, § 17 Pro at: 846 Chestnut Street NAME: Sandra Skelton HEARING(S): May 12, 2005 ADDRESS: 846 Chestnut Street PETITION: 2005-010 North Andover, MA 01845 TYPING DATE: May 23, 2005 The North Andover Board of Appeals held a public hearing at its regular meeting in the Town Hall top floor meeting room, 120 Main Street, North Andover, MA on Tuesday, May 12, 2005 at 7:30 PM upon the application of Sandra Skelton, 846 Chestnut Street, North Andover requesting a dimensional Variance from the requirements of Section 7, Paragraph 7.3 and Table 2 of the Zoning Bylaw for relief of the rear setback of the existing structure and the right side setback of the proposed front addition, and a Special Permit for a pre-existing, non -conforming structure, lot & use from Section 9, Paragraph 9.2 of the Zoning Bylaw for an addition to a residential structure. Said premises affected is Party with frontage on the Southeast side of Chestnut Street within the I-1 zoning district. The legal notice was mailed to all abutters and published in the Eagle -Tribune on April 25 & May 2, 2005. The following members were present: John M. Pallone, Ellen P. McIntyre, Joseph D. LaGrasse, Richard J: Byers, and Albert P. Manzi, III The following non-voting members were present: Thomas D. Ippolito, Richard M. Vaillaneourt, and David R. Webster. Upon a motion by Albert P. Manzi, III and 2"d by Richard J. Byers, the Board voted to GRANT a dimensional Variance from Section 7, Paragraph 7.3 and Table 2 of the Zoning Bylaw for relief of 24.1' from the right side setback for the proposed two-story front addition and 20.2' from the rear setback of the existing dwelling, and upon a motion by Albert P. Manzi, III and 2°' by Richard J. Byers, the Board voted to GRANT a Special Permit from Section 9, Paragraph 9.2 of the Zoning Bylaw in order to allow a pre-existing, non -conforming structure, lot, &use to be extended by a two front addition attached garage and breezeway on a pre-existing, non -conforming lot per Variance Plan, 846 Chestnut Street, North Andover, MA Assessors Map 107C, Parcel 19, prepared for Sandy Skelton, 846 Chestnut Street, North Andover, MA 01845, April 13, 2005 [by] David Alves #45454, New England Engineering Services, Inc., 60 Beechwood Drive, North Andover, MA 01845 and Residence for Sandra Skelton, 846 Chestnut St, N Andover MA 01845, Date 8-25-04, [by] G. J. Bruno Associates, Residential Designers, 28 Berkeley Road, N. Andover MA 01845. With the following condition: 1. The ground to roof peak elevation of the proposed addition shall be no greater than 291. Voting in favor: John M. Pallone, Joseph D. LaGrasse, Richard J. Byers, and Albert P. Manzi, III. Voting against: Ellen P. McIntyre. The Board finds that the lot and pre -1941 dwelling existed before the I-1 zoning district and the lot cannot be used for I-1 unless other residential lots along the access are redistricted to I-2, and that the applicant has satisfied the Provisions of Section 10, paragraph 10.4 of the Zoning Bylaw in that the granting of this Variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Also, the Board finds that the applicant has satisfied the provisions of Section 9, Paragraph 9.2 of the zoning bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Pagel of 2 Board of Appeals 978- 688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 M.G.L - Chapter 40, Section 10 Page 1 of 1 GENERAL LAWS OF MASSACHUSETTS PART PARTIzMV-RP. ADMINISTRATION OF THE GOVERNMENT TITLE VII. CITIES, TOWNS AND DISTRICTS CHAPTER 40A. ZONING Chapter 40A: Section 10 Variances Section 10. The permit granting authority shall have the power after public hearing for which notice has been given by publication and posting as provided in section eleven and by mailing to all parties in interest to grant upon appeal or upon petition with respect to particular land or structures a variance from the terms of the applicable zoning ordinance or by-law where such permit granting authority specifically finds that owing to circumstances relating to the soil conditions, shape, or topography of such land or structures and especially affecting such land or structures but not affecting generally the zoning district in which it is located, a literal enforcement of the provisions of the ordinance or by-law would involve substantial hardship, financial or otherwise, to the petitioner or appellant, and that desirable relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of such ordinance or by-law. Except where local ordinances or by-laws shall expressly permit variances for use, no variance may authorize a use or activity not otherwise permitted in the district in which the land or structure is located; provided however, that such variances properly granted prior to January first, nineteen hundred and seventy-six but limited in time, may be extended on the same terms and conditions that were in effect for such variance upon said effective date. The permit Pty may impose conditions, safeguards and limitations both of time and of use, includ ,ed existence of any particular structures but excluding any condition, safeguards or li .d upon the continued ownership of the land or structures to which the variance pertains�\icant, petitioner or any owner. If the rights authorized"Sk Viance are not exercised within one year of the date of grant of such variance such rights shall la , provided, however, that the permit granting authority in its discretion and upon written application by the grantee of such rights may extend the time for exercise of such rights for a period not to exceed six months; and provided, further, that the application for such extension is filed with such permit granting authority prior to the expiration of such one year period. If e permit granting authority does not grant such extension within thirty days of the date of apf ...i therefor, and upon the expiration of the original one year period, such rights maybe ree ' my after notice and a new hearing pursuant to the provisions of this section. Return to: ** Next Section ** Previous Section ** Chapter Table of Contents ** Legislative Home Page http://www.state.ma.us/legis/laws/mgl/40A-10.htm 10/9/03 V INSPECTIONS -tDean G. Luscomb 11 & Sons F.Q. Box 13 5 Middleton, MA- 01949 1-978-774-4065 SED PLUMBER #20285 za,11Y7d # RECEIVED MAR 2 7 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 0j)Iq 3117_IjC_, UBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 3' PROPERTY OWNERS NAME: 2ndl PROPERTY-ADDRESS:.-Fqtl S+. And ADDRESS OF OWNER: LQ_A()C_ (if -different) DATE OF INSPECTION: M 0 rCk NAME OF INSPECTOR: QU-ALITY I.S. NU.M.B-E.R. ON.E TO. U.S. COMMONWEALTH OF MASSACHUSETTS EXECUTwE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENvIRONMENTAL PROTECTION DEAN G. LUSCOMB II & SONS P.O. BOX 135 MIDDLETON, MA 01949 1-978-774-4065 TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 9q G l.. k e -s (,t.f &i Ardt P.r Owner's Name: SO h d. i Owner's Address: 0 ren 2 Date of Inspection: M Q rCj 17.Q00(, Name of Inspector: (please print) Dean G. Luscomb II Company Name: Dean G. Luscomb II & Sons Mailing Address: p_ O_ Box 135 Mi drll Pt -on, MA 01949 Telephone Number: 978-774-4065 CERTIFICATION STATEMENT I certify that 1 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 71 Al Inspector's Signature: YS&Date: i6�/c / ?, za06 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. Page 2 of 11 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: M� C h e s4 h xf . N r,doUP-r MA Owner. Date of Inspection:.) - 1 -7, (o Inspection Summary: Checl&B,C,D or E /ALWAYS complete all of Section D A. S stem 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 15304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. NThe 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: fj 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: >i The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ND explain: broken pipe(s) are replaced obstruction is removed 2 rage.) ul i i Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: �C r Ue_M Owner: 3 k p-14 () h� _�� Date of Inspection: -;- I I - U C. Further Evaluation is Required by the Board of Health: _. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(6) that the system is not functioning in a manner which will protect public health, safety and the environment: .i Cesspool or privy is within 50 feet of a surface water TJ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone t 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.. Page 4 of I I Middleton, MA 0.1949 1-978-774-4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: $ G� 6 C kEs4n uJ of l .hd o U e -r, M A Owner. +D- r) Date of inspection: 3 `7 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ,) Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool PJ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool AT Liquid depth in cesspool is less than 6" below invert or available volume is less than _ day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ Any portion of the SAS, cesspool or privy is below high ground water elevation. J Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface G , water supply. _ W Any portion of a cesspool or privy is within a Zone I of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _1 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis most be attached to this form.] )6 (Yes Jo The system fails. l have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered- a. Large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd• --� You must indicate either "yes" o " o" to each of the following: (The following criteria apply to large ems; in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking wat upply — ` the system is within 200 feet of a tributary water supply the system is located in a nitroge nsilive area (Interim Wellhead Protection Area - I WPA) or a mapped Zone 11 of a public water s y well If you have answered "yes; td any question in Section E the system is considered a significa6t�threat, or answered "yes" in Section D aboydthe 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. Page S of 1 I Mict Teton, MA U1949 1-978-774-4065 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ?q(=.CA eS4hLgj 5t N. ov?r 0A Owner: jCe 1 4� h Date of Inspection: 3-17-66 Check if the following have been done You must indicate "yes" or "no" as to each of the following: Y 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) V"- _/ Has the system received normal flows in the previous two week period Have large volumes of water been introduced to the system recently or as part of this inspection? 9//—AWere 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 ? V'_ Was the site inspected for signs of break out ? V 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 ? _V 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 I" _ 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) 1310 CMR 15.302(3)(b)] P4ge 6 of I 1 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: {1 q (� C h e 94t,, %E"4 S� ".Ar- _ p o Y /Y's Owner: Gke.I-16n Date of Inspection: .3 -17 - D.re FLOW CONDITIONS RESIDENTIAL . Number of bedrooms (design): �/ Number of bedrooms (actual): DESIGN flow based on 3 10 CMR t .203 (for example: l 10 gpd x # of bedrooms): �1/p Number of current residents: -T Does residence have a garbage grinder r no): Yes Is laundry on a separate sewage systemc(Sig>or no): Ye -r, [if yes separate inspection required] Laundry system inspected4)6es)or no): �&J , Seasonal use: (yes or (Loy. &:f> Water meter readings, if available ( ,last 2 years usagru )): —0Z , H t,Jcz f Sump pump�Ys Fir r no): r SC—cr� .ncQa �G�1 Last date of occupancy: C u rt - Design flow on 310 CMR 15.203): gpd Basis of design flows rsons/sgftete.) Grease trap present (yes or no): — Industrial waste holding tank present (y Non -sanitary waste discharged to the Title 5 Water meter readings, if avail e:------ Last date of occup use: OTHER (describe): no): — GENERAL INFORMATION Pumping Records Source of information: Was system pumped as;jof the inspection (yes or� -00If yes, volume pumped: allons — How was quantity pumped determined?�Reason for pumping: a C5 o'er• V TYPE OF SYSTEM _ Septic tank, distribution b , soil absorption system L/ Single cesspool PitL4-1-1-act`c- o`Al! _ Overflow cesspool — Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank — Attach a copy of the DEP approval _ Other (describe): Approximate age of all compgnents, date installed (if known) and source of information: i r o ro(S E S k n" cz ter.( Were sewage odors detected when arriving at the site (yes no Nz I Page 7 of I 1 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:9q `1 ra C k es -4 h ulf -5-f N . A hdQuer, MA Owner. Owne S k �.14-Di Date of Inspection: 3 -1 -7 -Ne, BUILDING SEWER (locate on site plans Depth below grade: 10 Materials of construction: _cast iron Z0 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): P IV C rAw } atK C.'LM GJ�No 5 i9/l S o � SEPTIC TANK:P6,(locate on site plan) Depth below grade: Material of constru tion: concrete metal fiberglass _polyethylene If tank is metal list age: — Is age- Iiirmed by a Certificate of Compliance -(yes or no): _ (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom=t:or5baffle: Tiaffle: Scum thickness: Distance from top of scum to top of Distance from bottom of scum ttom of outlet tee or baffle: How were dimensions d fined: Comments (on pu3qi1fig recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related too et invert, evidence of leakage, etc.): GREASE TRAP:11-9ocate on site plan) Depth below grade: _ Material of construction: _concrete metal _fiberglass _poJyet6ylene other lexnlainl: _ Dimensions: Scum thickness: Distance from top of scum to top of outle�eorbaffle: Distance from bottom of scum tofiott6m of outlet tee or baffle: Date of last pu:pPum g: Comments (on -recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to ou invert, evidence of leakage, etc.): 7 Page 8 of I I Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: v11 rC X1 v� Pr MA Owner --G K e 46 Date of Inspection: 3 - 17 � TIGHT or HOLDING TANK: - (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: .'' Material of construction: concrete metal fiberglass _.•Po1yethylene other(explain): 1� iy Dimensions: .y Capacity: -gallons Design Flow: gallons/days. Alarm present (yes or no): Alarm level: Alarm in worl(Q order (yes or no): Date of last pumping: Comments (condition ofala'rm and float switches, etc.): DISTRIBUTION BOX: Pd (if present must be opened)(locate on site plan) Depth of liquid level above outla invert, Comments (note if box is level and distributidri to outlets. equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): ---- PUMP CHAMBER: /L)U(locate on site plan) . Pumps in working order (yes or no): Alarms in working order (yes or no): " Comments (note condition ofpump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of 11 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS = SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Zg (r, C%C's h t f fi—t ±j-- A rNd oyf> Owner. S ke 1+0 h Date of Inspection: 3 -17 - (� 6 SOIL ABSORPTIpN SYSTEM (SAS): pd(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: leaching fields, number, dimensioi overflow cesspool, number. innovativelalternative sy m Typetname of technology: Comments (note condt�n�6f soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): l44lw4r-' !./ 5e Gil j� T) rI e� CESSPOOLS: d6'' (cesspool must be pumped as part of inspectiioon)(locate on site plan) Pi-� J g--Or--e i Number and configuration: 19yir--' Depth - top of liquid to inlet vn inlet Depth of solids layer_ Depth of scum layer: Dimensions of cesspool: Materials of construction: Eve. Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): J ,: i�+r�i..�c ntga.o� �� tf %�'–rt•c O�uS ��- PRIVY:" (locate on site plan) Materials of construction: _ Dimensions: Depth of solids: Comments (note condition of I f "r'> ' /j/t3e4�/Gpl tf�t+ �s ir�•�C i GVG�lf�" CI7 Ze u/0rLYk W lh01 raulic failure, level of ponding, condition of vegetation, etc.): 6 M Page 10 of 11 iVltuulCwur 111M 12Y� 1-978-774=4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM FART C SYSTEM INFORMATION (continued) Property Address: 67q C�� P �� I ; �! T S -f M. A t- _ P t- owner. Owner: �Ka 1-4,- or) 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. d Eel 10 `m C =17 v s o -f- u � l `J Y t•LLUU-L=W11" sua V l iz� 1-978-774-4065 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ELI C' h e-s4N L i ST N.An o�}fir M.14, Owner:sk 14-6n Date of Inspection• 3 - ! i b SITE EXAM Slope S#-ea-PCit Surface water Check cellar �-&(,;sp Pm te.rl7-`,� �=1 :. kV�l4F..� +L':;.1.�C'•kCLrl/J Il Shallow wells Estimated depth depth to ground water !` f feet Please indicate (check) all methods used to determine the high ground water elevation: VObtained from system design plans on record - If checked, date of design plan reviewed: NU Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: NG ZA4., Un A; Checked with local excavators, installers- (attach documentation) c7 Accessed USGS database -explain: You most describe how you established the high ground water elevation: 27, �ez-S-�dYt�i77'" i� � t >��dc.�.`.� 1t'CeG�,. E.�,•�''�3i�t,t�r� f=._:E��3� ill � f•� �-i/::i � �t'-- /a (JG1G�� - ([ l� V "OPS G!f J� c:< c (;� I C6--7 vt� qjjjLD FILE# NAndouer►o2go5A TITLE V INSPECTIONS Dean G. Luscomb II & Sons P.O. Box 135 Middleton, MA 01949 978-774-4065 Licensed Plumber #20285 SUBSURFACE SEWAGE DISPOSAL SYSTEM INPSECTION FORM PROPERTY OWNERS NAME S a r7 d C- S k e- 1 +o r) PROPERTY ADDRESS 9 H G C he -S+ n u i S-� N A hdoucr M A ADDRESS OF OWNER (if different) 6 Q M e DATE OF INSPECTION o c -+ o b e r a g a o o 5 NAME OF INSPECTOR e a n5. L L c.. C o rn QUALITY IS NUMBER ONE TO US i OCT 2 7 2005 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION DEAN G. LUSCOMB II & SONS P.O. BOX 135 MIDDLETON, MA 01949 1-978-774-4065 TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENT_ S SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:g4� Che5- t -i Sf N. A r,davFr M� Owner's Name: S' ar>d i S KP, i- D n .Owner's Address: So r -n yy I Date of Inspection: Oc.`i c) b e - r QEc-bn---s p CI 2 7 2005 Name of Inspector: (please print) Dean G. Luscomb II DVER Company Name: Dean Q. Luscomb II & Sons t VT Mailing Address: p_ O_ Box 135 Middleton, MA 01949 Telephone Number: 978-774-4065 CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I• am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: asses Conditionally Passes Needs Further.Evaluation by the Local Approving Authority Fails Inspector's Signature: 4e , „A. (fg r J 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. Ueda u. UU5CUu10 11 & bVr15 P.O. Box 135 Page 2 of I 1 ' Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 H ( Ches+n uj 3+_ N Andaver, Mfr Owner: 'S V -e- I +on Date of Inspection: 10 JA 4 105. Inspection Summary: ChecoB,C,D or E / ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined" please explain. NThe 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: AThe 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): ND explain: broken pipe(s) are replaced obstruction is removed K Dean G. Luscomb II & Sons Page 3 of 1 I P.O. Box. 135 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property. Address: 8'y (� C k e -ef h u4 S+ N, Ahcf o Up_r, M A Owner: 1 Date of Inspection: ! Q a1 y O C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: A) The system has aseptic 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. N 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 LktUl l7. UUbULAIW 11 a .7vttb P.O. Box 135 Page 4 of 11 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM = NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Address:'EH G � !S f W . ArAn uP Owner. k2d Date of Inspection: 101aL4 115S D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No fJ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than _ day flow J Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped . /J 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. _ A) 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.] /V6 (Yes&cl 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. Large Systems: considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd. You must in�criten es" or "no" to each of the following: (The followily to large systems in addition to the criteria above) yes no _ _ the system is within 400 feet _ _ the system is within 200 feet of a _ the system is located in a Zone II of a public waw drinking water drinking water supply I— i sensitive area (Interim We d Protection Area — IWPA) or a mapped well If you have answere " es".to any question in Section E the system is considered a significan eat, oor answered "yes" in Sectio above the large system has failed. The owner or operator of any large system co red a significa eat under Section E or failed under Section D shall upgrade the system in accordance with 310 -CMR 15� . The system owner should contact the appropriate regional office of the Department. 4 Ly--Wl u. r,uscxnlw 11 a .x11.5 P.O. 8oic 135 Page 5 of l 1 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: gy ip Ck e- ` r, $ r tm >q Owner: I Date of Inspection: I Doi y b 5 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Y ,^o 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 ? V/ Have large volumes of water been introduced to the system recently or as part of this inspection ? 114- 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 ? I//'— Were al 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 ? -Z— 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 — 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)J 5 Page 6 of I I UUML v. L I-la-kllw F.O. Box 135 Middleton, MA 1-978-774-4065 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address• Ch es h 15+' Owner: K I+ Date of Inspection: I Q I A L4 105 FLOW CONDITIONS 11 KOUL >, 01949 RESIDENTIAL , / Number of bedrooms (design): 7 Number of bedrooms (actual): DESIGN flow based on 310 CISA 5.203 (for example: 110 gpd x # of bedrooms): Number of current residents: . Does residence have a garbage grinder g or no): Is laundry on.a separate sewage systembr no): � [if yes separate inspection required] Laundry system inspectedgy ;)br no): Seasonal use: (yes or ro Water meter readings, if available (last 2 years usage (gpd)): Town t-�� Sump pumpd j!RsZr no): J! S F e..GA 1 tome- cn �ci�(Sa n Last date of occupancy: Z Type tablishment: Design flow on 310 CMR 15.203): gpd Basis of design flow(k-atVpersons/sgft,etc.): Grease trap present (yes or no . Industrial waste holding tank presen Non -sanitary waste disch o the Title Water meter rea ' , if available: Last date ut)ancv/use: (describe): ,m (yes or no): GENERAL INFORMATION Pumping Records Source of information: /U- Pzw-e4r Was system pumped as part of the rnsp tion (yes or no): Ycs If yes, volume pumped-/OLlJgallons —How was quantity pumped determined? Reason for pumping:_ -5a j, 7--j>�E"F'O �"ff1a t" TYP OF SYSTEM V/ Septic tank, distribution box, soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) _ Tight tank _ Attach a copy of the DEP approval Other (describe): _ Approximate age of all components, date installed (if known) and source of information: n . • I Were sewage odors detected when arriving at the site (yes ogz> /UG 0 1 t1. LjLL5L JntU P.O. Box 135 Page 7 of 11 Middleton MA 1-978-774-4065 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address:g4 (o i,hPS4h N.Ar,doue TMA Owner: w-( I Date of Inspection: BUILDING SEWER (locate on site plan) rt Depth below grade: —�S Materials of construction: Zcas t iron _40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting,evidence of leakage, etc.): e,-4e, ­4 7.'t a y% IT. -Ill 4L, Wa. Fpl /V o :� i VV O r SEPTIC TANK:l90 (locate on site plan) 01949 Depth below grade: gy Material of construction: _concrete. metal fiberglass __polyethylene _other(explain) ` r� sca -� lzoo If tank is metal list age:A0 Is age confirmed by a Certificate of Compliance yes oqoo Lli (attach a copy of certificate) Dimensions: S If S �GcJi c12 J� �a f4�G�2- Sludge depth: �A i � A/ Distance from top of sludge to bottom of outlet tee or baffle: /1!9r — 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: How were dimensions determined: �' A66 QK Tve /%'er6J�l Comments (on pumping recommend Oons, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 G S4lC TI.k zG2^.4+(,-5 zr-P ih Vo6v e-Y06A O/'l a I//ar k tk 00 1-S S'/i s &', � iS"F� FIs c�rr�cf �'4011� AZci ZI , GREASE TRAP. )(locate on site plan) Depth be o de: _ Material of construe i . (explain): Dimensions: Scum thickness: Distance from top of scum to Distance from bottom of Date of last pumpi . concrete _metal _fiberglass _polyethylene _other ofodflet tee or baffle: bottom of outlet tee or baffle: Comments umping recommendations, inlet and outlet tee or baffle as relat o outlet invert, evidence of leakage, etc.): 7 rc7a 1 rE i� integrity, liquid levels . LO --M1 V. LiUk-AAA lV 11 0[ AlJ1L7 Page 8 of 11 P.O. Box 135 P ag Middleton, NIA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: gy C_ h " �i ¢j' Owner: Date of Inspection: ) 0 HT or HOLDING TANK:/U1 (tank must be pumped at time of inspection)(locate on site plan) Depth below Material of construct ion. concrete metal fiberglass,, ' Polyethylene other(explain): Dimensions: Capacity: Ballo Design Flow: Ions/day Alarm present (yes or no Alarm level: Alarm in working order (yes or no): Date of lam mping: Comfits (condition of alarm and float switches, etc.): DISTRIBUTION BOX: Ya (if present must be opened)(locate on site plan) 7> _gds c S �` Depth of liquid level above outlet invert: �'� J °�'u �O J��-2 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 .)• ` �e�,erc_- ( cr nd%iion , Z li id 'n -� D -13et i S iRnnGr�F CHAMBER: /`'locate on site plan) Pumps in working orZeT(yes_or no): Alarms in working order (yes or no Comments (note condition of pump cham s and appurtenances, etc.): 91 Page 9 of 11 ueati b. Liuticxeiw P.O. Box 135 Middleton; MA 1-978-774-4065 OFFICIAL INSPECTION FORM -'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: (, ui ' t Owner: Gk,2i4n h Date of Inspection: _I DIQTO,5 SOIL ABSORPTION SYSTEM (SAS): Y69 (locate on site plan, excavation not required) If SAS not located explain why: S 11 at. ouLD 01949 Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: f / leaching trenches, number, length: �r 'aG ?l Ut AgPrOX. ^�T� 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. 1 K, S &,S , is i h q��enerj cond i6nr, wz No St);/)S 0�' x�o^of`,7 Sod !h iS areo— is Glnan aA4 DrNT o Sic, r W /ince 42' ?lP._.rn. CESSPOOLS: Yd'g (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: — pi-� 04VAI <- �. �ct.k n0!rx 411,15- Depth — top of liquid to inlet invert: Q Depth of solids layer: Depth of scum layer: 7 Dimensions of cesspool: Materials of construction: I Indication of groundwater inflow (yes onjo o Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): zr _ 1 lz-, �,r-e no Sirs As 0-r a -,i T pro/�h -Ulf area- ® % g, 5,00 i'l L 1 C kAn ,an Ca( PRIVY:` (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note conditioj of hydraulic failure, level 9 condition of vegetation, etc.): ' - _ -VGQll V. U40\r\.AtW 11 Ut' VWJJIJ 1 t P.O. Box 135 Page.10 of 1 l Middleton, MA 01949 1-978-774=4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:'FW ChP-�;,"-' Owner: e K.e14cnr\ h Date of Inspection: i a y 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. wZ {- T-1= zo,�, ti 73¢v D 17 r0 ` l/�.I..ILa V • L'JUJ\r�AllN 11 la WLLJ P.O. B= 135 • ; l Page 11 of 11 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �q C Owner:T Date of Inspection: I D Do SITE EXAM dope �S+caaG4 ✓gurface water Nan c- n i V heck cellar 2 S �kp� l��w � 5 Ft*,, (A S(4)VXy__ cunA4�%Ori ri'Shallow wells Advm-z. Estimated depth to ground water t feet Please indicate (check) all methods used to determine the high ground water elevation: tr Obtained from system design plans on record - If checked, date of design plan reviewed: AJ -d rz�/s Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: 1Uo Z4 o" Ai S Checked with local excavators, installers- (attach documentation) %^ Accessed USGS database -explain: Talos� PC.(� 'E You must describe how you established the high ground water elevation: SrOla-� iGlf Ft �Gc �tG /^� �O / S /y '� l G [ ✓ ^�' A/ S Ct/4u/G��(%C�I Z Gt[ .fJG'fC �lrt Gl 11 LML M FILE #N_6d 0,3) 70 ISTA X�V_. v Ii v _j 1. E-%- I IN -1.1 *4 CDean G. Luscomb 11 & Sons K-0. Box 135 Widdleton, MA- 01949 1-978-774-4065 V� f, - ;i.-..-l..-Ll'CENSED PLUMBER #2.0285 1 za s�zfo_x J// -7 "ll ao,/tU C--, SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNERS NAME: SO n 14 (p TY -AD e s4 f� u r ADDRESS:? _` -1(, e, Cli PROPER DRESS: -J. S, \j. ADDRESS OF OWNER: 15 ln� (if -different) _ DATE OF INSPECTION: 21Ck NAME OF INSPECTOR: _�C)L_L_ QU.ALITY I.S. N.U.M.B.E.R. ON.E. TO- U.S .1,1CQ11 l7� U4J�,.1./lW 11 ti' fJ\JaaJ P.O. Box 135 /age.10 of 11 Middleton, MA 01949 1-978-774=4065 OFFICIAL INSPECTION FORM —'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: W G�1h i t4 Owner: W t\ Date of Inspection: 1QIQ L4 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. AOT 1-0 ( n i fa ^ 14 jn .y w `1 --Z-0 a `'C,sf F — r1 T) LD —!,0A' AOT 1-0