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HomeMy WebLinkAboutTitle V Inspection Report - 80 CHRISTIAN WAY 4/24/2018 Commonwealth of Massachusetts -=. Title 5 Official Inspection Form .m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 80 Christian Way Property Address Christo her Perry OwnerOwner's Name information is North Andover MA 01845 4-9-2018 required for every — _ page, It State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information U on the computer, �� r use only the tab 1. Inspector: t� key to move your �qy �i �'� cursor-do not Neil J. Bateson ' I° use the return key. Name of Inspector Bateson Enterprises Inc. rQ Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 SI-15 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes Q Conditionally Passes ❑ Fails ❑ Nee Further Evaluation by the Local Approving Authority 4-9-2018 In pct 's Signat r 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. (5ins.doc•rev.6116 'title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page t of 17 i Commonwealth of Massachusetts - ----------- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Christian Wa Property Address Christopher Perm Owner Owner's Name Information is required for every North Andover MA 01845 4-9-2018 page, City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: ----------- ----------- B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. n Y E] N ❑ ND (Explain below): ---------- t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System«Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Christian Wa Property Address Christopher Pe r rry___ Owner Owner's Name information is North Andover MA 01845 4-9-2018 required for every -- - I page. ;b—ity—/Town §j—ate 'tip Code Date of inspection B. Certification (cont.) F-1 Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.). ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced R Y F1 N F-1 ND (Explain below): F1 obstruction is removed El Y F-1 N F-1 ND (Explain below): 0 distribution box is leveled or replaced El Y 0 N n ND (Explain below): F-1 The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced 0 Y [I N n ND (Explain below): ❑ obstruction is removed R Y 0 N F-1 ND (Explain below): —..___._a.------ _. _ �_....__.__............. C) ----------- 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 15insAoc-rev.6116 Title,6 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Foran - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80C hri Property Address Christopher Perry_ Owner owner's Name information is required for every North Andover MA 01845 4-9-2018 _._ . _._. ---------.- -- page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) t 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DFP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters © ® due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less © ® than 1/2 day flow t5ins.doc^rev.6116 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts q Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t . � 80 Christian W _„ Property Address Christopher Owner Ownet's Name _.- information is North Andover MA 01845 4-9-2018 required for every ,. _.____.___ -.. --- ---page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No FJ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El ® Any portion of the SAS, cesspool or privy Is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. El 0 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd, For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ M the system is within 400 feet of a surface drinking water supply Q © the system is within 200 feet of a tributary to a surface drinking water supply E © the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone Il of a public water supply well If you have answered "yes" to any question in Section F-the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6116 'title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Christian Way Property Address Christopher Perry --------- Owner Owner's Name information is required for every North Andover MA 01845 4-9-2018 Date of Inspection page. Cityfrown State Zip Code C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No Z El Pumping information was provided by the owner, occupant, or Board of Health 0 N Were any of the system components pumped out in the previous two weeks? Z r-1 Has the system received normal flows in the previous two week period? F-1 Z Have large volumes of water been introduced to the system recently or as part of this inspection? Z El Were as built plans of the system obtained and examined? (if they were not available note as N/A) E EJ Was the facility or dwelling inspected for signs of sewage back up? 0 El Was the site inspected for signs of break out? Z 0 Were all system components, excluding the SAS, located on site? Z R 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 El 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: Z ❑ 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 M El approximation of distance.is unacceptable) [310 CMR 15,302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 600 t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Christian _W Christo her Perms Owner Owner's Name information is required for every North Andover MA 01845 4-9-2018 page. 6tvrfown —state —Z-ip Code Date of Inspection D. System Information Description: 4 Number of current residents: Does residence have a garbage grinder? El Yes 0 No Is laundry on a separate sewage system? (Include laundry system inspection El Yes 0 No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? n Yes Z No Yes Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? n Yes Z No Last date of occupancy: DCateurrent IICommercial/Industrial Flow Conditions: Type of Establishment: -------------- Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.),. Grease trap present? El Yes El No Industrial waste holding tank present? El Yes n No Non-sanitary waste discharged to the Title 5 system? 0 Yes n No Water meter readings, if available: -------------- t5ins.doe-rev.6116 Tice 6 Official inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Christian Way Property Address Christoph�er PermOwner Owner's Name information Is North Andover MA 01845 4-9-2018 required for every page. -o—wn State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): ---------- General Information Pumping Records: Source of information: Pumped 2017, owner Was system pumped as part of the inspection? 0 Yes El No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank &tees ......... Type of System: z Septic tank, distribution box, soil absorption system El Single cesspool 0 Overflow cesspool 11 Privy El Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. F1 Other(describe): 15ins.doo-rev.6116 Title 5 Oftal inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 9 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .' 80 Christian Waw_ _ Property Address Christopher Per Owner owner's Name 1 information iNorth Andover MA 01845 s N4-9-2018 required far every _ _.....-. _ _ _.. __------__.— ._----- page. Cityfrown _ State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Septic tank& d-box was replaced in 2012, leach area was installed in 7-23-1987, as built plan. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1.8 Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): --- - Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): 4" Cast iron through wall, 3" PVC in house, no leaks visible. Septic Tank(locate on site plan): 0.8 Depth below grade: feet—­­-------­ Material eet -._..._______ .-.Material of construction: fiberglasspolyethylene © other ex Iain ® concrete ❑ metal ❑ g ❑ (explain) ) I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10' x 5"x 4' i 211 Sludge depth: ___..._---------_-------- ____ t5ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts n __.___ mmR u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Chri 8 Property Address Christopher Perry Owner Owners Name information Is required for every North Andover MA 01845 4-9-2018 page. State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 31 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness ....... 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 13-1 How were dimensions determined? Tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Inlet cover has riser 1"deep. Pumped septic tank. Grease Trap (locate on site plan): Depth below grade: feet-- .......... Material of construction: El concrete El metal El fiberglass El polyethylene ❑ other(explain): ----—------ Dimensions: Scum thickness ------ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Kns.clor,-rev.6116 Date of last pumping: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Christian Property Address — Owner Owners Name information i's4-9-2018 required for every North Andover MA 01845 page. 6ft—y1—T6wn, State -tip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El concrete F metal fiberglass polyethylene El other(explain): Dimensions: Capacity: —_ _______---_--- gallons Design Flow: gallons per day Alarm present: F Yes El No Alarm level: ------ Alarm in working order: F-1 Yes El No Date of last pumping: Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? El Yes E] No t5ins.doc-rev.6t16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Christian Property Address Owner Owners Name information is required for every North Andover MA 01845 4-9-2018 page. cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert -..0..... Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal, has flow levelers. No evidence of leakage. No evidence of carryover. Pump Chamber(locate on site plan): Pumps in working order: F-1 Yes R No* Alarms in working order: R Yes E No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): ----------- -----------If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doe-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Christian Way�___ Property Address Christopher Pery Owner Owner's Name information is required for every North Andover MA 01845 4-9-2018 page. City/town State Zip Code Date of Inspection D. System Information (cont.) Type: El leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ....... ❑ leaching trenches number, length: I field 25'x 44' leaching fields number, dimensions: E-1 overflow cesspool number: ❑ innovative/alternative system Type/name of technology: ...... Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok, Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth–top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool —-------- ______---._ Materials of construction Indication of groundwater inflow El Yes ❑ No t5ins.doe-rev.6116 Titte 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ...... Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Christian Way Property—Address; Christopher tPerry Owner Owner's Name information is North Andover MA 01845 4-9-2018 every for ev page. City/Town State Zip Code Date of Inspection mm D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: ------ Dimensions Depth of solids -—---- _._---_---..___� _.-- Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): II t5ins.doc-rev.8116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Christian Way Property Address Christopher Perry ------- Owner Owner's Name------ --------- information is required for every North Andover MA _01845 �4-9-201 8 page, -6=it y�o Wn State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: 0 hand-sketch in the area below El drawing attached separately O-C',"Je-WCA B "A 'S 04 L4"z) 6,Ito t5ins.doe-rev.5116 Title 5 Official inspection Form:Subsurface Sewage Disposal System^Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Christian Wa Property Address Chrlstq_Rhe�rerms Owner Owner's Name n informati is information Andover MA 01845 4-9-2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: E Check Slope Z Surface water Z Check cellar Z Shallow wells 4 Estimated depth to high ground water: feet --------------- Please indicate all methods used to determine the high ground water elevation: z Obtained from system design plans on record If checked, date of design plan reviewed: 3-19-1984 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health -explain: Designplan Checked with local excavators, installers -(attach documentation) j ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan -------------------- — Before ----------------- Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev,6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts w Tit le 5 Official Inspection Form e- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Christian Way Property Address Owner Owner's Name -information atifo is North Andover MA 01845 4-9-2018 required for every --:-- -- _... __.._ _._...� _ page, Cityrrown State Zip Code Date of inspection ) E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked • Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I I I I t5ins.doc•rev.0116 Title 5 Oficial Inspection Form;Subsurface Sewage Disposal System Page 17 of 17 .. Commonwealth of Massachusetts Cjty/Town of r .system Pumping.Record Form 4 DEP has provided this form for useaby local Boards of Health. Other form's may be'used,but the information,must be substantially the tame as that provided here. Before using.thls form,check with your local Board of Health to determine the form they use. The;System Pumping Record must be submitted g0 the local Board of Health or other approving authority. 1 A. Facility. Informi ation 1. System Location: Left/Right front of house, Left ht rear of house, Left. right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under dck Address �� 4.w-'�1{���� �.J*��.. l/'�.I � V'J'�► °`�`" � City/Town Sta Zip Code 2', system Owner: ,��. �.... Name` Address(if different from location) Citytrown ' State• zip Code 'telephone Number 1 .B. Pum•pmgwiccord 1. Gate of Pumping Date 2. Quantity Pumped: Gallons �� Y I 3. Type-of system: ❑ Cesspool(s) 0-860—tic Tank ❑ Tight Tank i ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes if yes, was It cleaned? ❑ Yes ❑ No, 5. Condition of Systeme ,C✓vA, ' 6; System Pumped By: Neil,Bateson ' F5821 Name Vehicle License Number Bateson Ehterprises Inc- Company 7, Location where conteritawere disposed: C S Lowell Waste Water Sign a Hiul Date 15formCdoc-06/03 System Pumping Record,Page 1 of 1 Town of North Andover Tax Map # 210-104.D-0136-0000.0 Parcel Id 16822 80 CHRISTIAN WAY CHRISTOPHER PERRY 80 CHRISTIAN WAY NORTH ANDOVER MA 01845 Class 101 Single Family Property Type _ 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.02 Acres FY 2018 1 UB Mailing Index I Name/Address Type Loan Number Active/Inact„ From Until CHRISTOPHER PERRY Owner 80 CHRISTIAN WAY NORTH ANDOVER MA 01845 SHERLOCK JR.,JAMES F Previous Customer Inactive 7/12/2013 80 CHRISTIAN WAY N.ANDOVER, MA 01845 ROBERT&DEBRA DOORACK Previous Customer Inactive 4/15/2015 80 CHRISTIAN WAY NORTH ANDOVER MA 01845 t UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17764.0-80 CHRISTIAN WAY Last Billing Date 4/10/2018 3170428 03 Cycle 03 Active UB Services Maint. Account No. 3170428 Service Code Rate Charge Multi Iler/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 34.20 !1 t L UB Meter Maintenance Account No.3170428 Serial No Status Location Brand Type Size YTD Cons 36388108 a Active ERT HH b Badger w Water 0.63 0.63 1780 Date Reading Code Consumption Posted Date Variance 3/9!2018 1785 a Actual 9 4/23/201 -77% 12/8/2017 1776 aActual 38 1/25/201 -65% 9/1212017 1738 a Actual 120 10/18/20 7 216% 6/8/2017 1618 a Actual 36 7/25/2017 154% 3/9/2017 1582 a Actual 14 4/12/2017 -70% 12/9/2016 1568 aActual 49 1/23/2017 -74% 9/7/2016 1519 a Actual 177 10124/20 6 64% 6/13/2016 1342 a Actual 118 8/2/2016 862% 3/11/2016 1224 aActual 12 4/22/201 -57% 12/10/2015 1212 aActual 28 1/20/201 -69% 9/9/2015 1184 a Actual 90 10/16/2015 168% 6/10/2015 1094 aActual 21 7/24/2015 51% 4/14/2015 1073 f Final Bill 30 4/14/2015 -57% 12/12/2014 1043 aActual 53 1/15/2015 39% 9/10/2014 990 a Actual 38 10/15/2014 -22% 6/9/2014 952 a Actual 47 7/16/2014 121% 3/11/2014 905 a Actual 21 4/11/2014 -14% 12/12/2013 884 aActual 25 1/17/2014 -24% 9/12/2013 859 a Actual 23 10/15/2013 -62% 7/10/2013 836 f Final Bill 112 7/11/2013 4266% 3/14/2013 724 a Actual 2 4/22/2013 -1% 12/12/2012 722 aActual 2 1/9/2013 -98% f y10RTM W� d iib„of ti}aE„r4so,.gNap� � i Torun of North Andover HEALTH DEPARTMENT sacHus CHECK#: ena I/ �”Y DATE: H/0 NAME: CONTRACTOR NAME: Type of. Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dunzpster $ ❑ Food Service-Type:---- $ V ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $..... ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTICS stems; j ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ I ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic DisposaI Works Installers(DWI) $ N J ❑ Title 5 Inspector $. Title 5 Deports `�� ',a $ ❑ Other:(Indicate) $ i He -lth Agent Initials, White-Applicant Yellow-Health Pin -Treasurer