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Home My WebLink AboutMiscellaneous - 10 CAMPBELL ROAD 4/30/2018 (2)K) Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use>by local Boards of Health. RECE o,g � 8 `2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Uther forms may be used,. but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Left / Right rear of house, Le gh a of hoho s' Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address ju Citylrown 2. System Owner. Name Address (if different from location) City/rown B. Pumping Record 1. Date of Pumping 3. Type of system- ❑ State Telephone Number Co Date 2. Quantity Pumped; Cesspools) Septic Tank cbon Gallons ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes l- NO If yes, was it cleaned? ❑ Yes ❑ No. '5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Entemrises Inc Company 7. Location where contents were disposed: Cx �,S.j1 Lowell Waste Water - - - 8 F5821 Vehicle License Number 10 --x -13 Date t5fomu4.doc• 06/03 System Pumping Record • Page 1 of 1 5460 Town of North Andover HEALTH DEPARTMENT CHECK !�- dl,-A D A - f, I-: LOCATION: H/O NAME: NAME: Type of P rmit or License: (Check box) 0 Animal $ 0 Body Art Establishment $ 0 Body Art Practitioner $ 0 Dumpster $ 0 Food Service - Type:----- $ 0 Funeral Directors $- 0 Massage Establishment $ 0 Massage Practice $ 0 Offal (Septic) Hauler $ 0 Recreational Camp $- 0 Sun tanning $ 0 Swimming Pool $ 0 Tobacco $ 0 TrashlSolid Waste Hauler 0 Well Construction $ SEPTIC Sustems: 0 Septic - Soil Testing $ 0 Septic - Design Approval 0 Septic Disposal Works Construction (DW0 0 Septic Disposal Works Installers (DWf) $ 0 Tit 9"i nspector $ it �Ttitle 5 Report 0 Other (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner's Name North Andover City/Town MA 01845 State Zip Code 4-25-11 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. A. General Information 1. Inspector: Benjamin C. Osgood, Jr. Name of Inspector none Company Name 16 Hillside Avenue, Unit 3 Company Address Amesbury Citylrown 978-834-6585 Telephone Number B. Certification MA State 870 License Number IWN OF NORTH ANDOVER HEALTH D— 01913 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 0 4-25-11 Inspector's gnature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. - e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments < 10 Campbell Rd. Property Address Judy Goodwin Owner Owner's Name information is required for North Andover MA 01845 4-25-11 every page. Cityrrown 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. ❑ Y ❑ N 0 ND (Explain below): Owner information is required for every page. s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner's Name North Andover Cityrrown B. Certification (cont.) B) System Conditionally Passes (cont.): MA 01845 State Zip Code 4-25-11 Date of Inspection ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner's Name North Andover Citylrown B. Certification (cont.) MA 01845 State Zip Code 4-25-11 Date of Inspection 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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 '/ day flow Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner Owner's Name information is required for North Andover MA 01845 4-25-11 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner's Name North Andover MA 01845 4-25-11 Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): NA Number of current residents: Commonwealth of Massachusetts 1 No Title 5 Official Inspection Form ❑ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �r 10 Campbell Rd. Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Property Address ® No Judy Goodwin ❑ Owner Owner's Name No information is required for North Andover MA 01845 4-25-11 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Yes 1 No ❑ Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No CURRENT Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner Owner's Name information is required for North Andover MA 01845 4-25-11 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Unknown gallons Date ❑ Yes ® No Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) 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. ❑ Other (describe): Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner Owner's Name information is required for North Andover MA 01845 4-25-11 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Constructed 1982 Per Owner Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): 1.5" feet Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipe ok in basement Septic Tank (locate on site plan): Depth below grade: Material of construction: 1 feet ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 1500 Gallons Sludge depth: <1 1. ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �< 10 Campbell Rd. Property Address Judy Goodwin Owner Owner's Name information is required for North Andover MA 01845 4-25-11 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 10" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Measure Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition. Concrete tee intact. Recommend the installation of PVC tee on outlet Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner Owner's Name information is required for North Andover MA 01845 4-25-11 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner Owner's Name information is required for North Andover MA 01845 4-25-11 every page. City/Town 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.): Box in good condition. Distribution equal. No evidence of soilids carryover or leakage in or out. Box 18" below grade Pump Chamber (locate on site plan): Pumps in working order: Alarms in working order: ❑ Yes ❑ No ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner Owner's Name information is required for North Andover MA 01845 4-25-11 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® 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.): Area of leach field looks normal. No evidence of ponding, damp soil, or unusual vegetation. Size of field unknown 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 ❑ Yes ❑ No Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner's Name North Andover MA 01845 4-25-11 City/Town State Zip Code Date of Inspection 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.): Owner information is required for every page. 41 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner's Name North Andover MA 01845 4-25-11 Citylrown 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: ® hand -sketch in the area below ❑ drawing attached separately "'O x ® N it IL .3 • Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Campbell Rd. Property Address Judy Goodwin Owner Owners Name information is required for North Andover MA 01845 every page. Cityfrown State Zip Code D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells 4-25-11 Date of Inspection Estimated depth to high ground water: 5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database - explain: usgs maps You must describe how you established the high ground water elevation: System elevation approximtely 3 feet above basement floor. Basement is dry with no sump pump. Flood elevation in adjacent wetland and brook area is below basement floor. Before filing this Inspection Report, please see Report Completeness Checklist on next page. • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �( 10 Campbell Rd. Owner information is required for every page. Property Address Judy Goodwin Owner's Name North Andover Cityrrown State E. Report Completeness Checklist 01845 Zip Code 4-25-11 Date of Inspection ® 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 4.- 0 I JA t HORTF, Town Of North Andover Community Development & Services William J. Scott p 27 Charles Street Director } �- �' •* North Andover, Massachusetts 01845 (978) 688-9531 CHU51 Fax 978-688-9542 June 22, 2000 Board of Judy Goodwin Appeals 10 Campbell Road (978) 688-9541 North Andover, MA 01845 Building Dear Ms. Goodwin, Department (978) 688-9545 This correspondence is a follow-up to our conversation of Tuesday, June 20, 2000, in regards to additional questions about the Health Department sewer tie-in Conservation regulations. As I recall, you mentioned that an anticipated easement to gain access to Department the sewer from your property to the sewer main may no longer be available. You (978) 688-9530 questioned how this change would affect your property's position in the requirements. I related my answer to the letter I sent to you in April. "To date, your address Health has not been placed on the list of properties that have sewer available. At such time Department that it is placed on the list, you will receive a communication from the Health (978) 688-9540 Department that will give further details on the process ". In addition, as I mentioned in the April letter, "The Campbell Street sewer is not yet active, however it will most Public Health Nurse likely be ready for connection within a few months. If at that time, you have any (978) 688-9543 concerns about this requirement, you may request in writing to appear at a regularly scheduled meeting of the Board of Health to discuss this issue ". Your second question regarded what, if anything, could the town do to gain Planning access for you to the sewer either in the resent or in the future. This office does not Department y p (978) 688-9535 handle issues of eminent domain. In my experience in general, easements are a personal property issue, best worked out between neighbors and or legal council. I believe that this communication adequately summarizes our conversation. If you have any further questions please direct them to the Board of Health after you receive your letter requiring your property to be tied in. I hope you understand that giving recommendations on hypothetical situations is very difficult. When you submit your written request to this office, you will be placed on the Board of Health Agenda for a regularly scheduled meeting to discuss your concerns and any requests for dispensation from the sewer tie-in requirements. M R.S. Health Inspector Cc: Terry Ackerman, Interim Town Manager William Scott, Director of CD&S Sandra Starr, Health Director • Town of North Andover NORTH OFFICE OF 3?0 rye,�OL COMMUNITY DEVELOPMENT AND SERVICES ° h 9 r 27 Charles Street North Andover, Massachusetts 01845 y°4•..° WILLIAM J. SCOTT 9SSACHUStit Director (978)688-9531 Fax(978)688-9542 June 22, 2000 Mrs. Judy Goodwin 10 Campbell Road North Andover, MA 01845 Dear Mrs. Goodwin: This letter is in reference to your concerns regarding the sewer line and Board of Health, see letter attached. The letter indicates that you should address these issues at the Board of Health. I would recommend that you contact the Board to meet with them as indicated in their letter. The Town is not in the position to survey private property, especially when the property owner has not sought any remedies outlined by the Town. Please review the letter and schedule a meeting with the Board. Sincerely, William J. Scott Director Cc: Terri Ackerman, Town Manager w/Encl. Sandra Starr, Director of Public Health w/Enol. William Hmurciak, Director of Public Works w/Encl. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 . PLANNING 688-9535 June 16, 2000 Mrs. Judy Goodwin 10 Campbell Road North Andover, MA 01845 Dear Mrs. Goodwin: In the event that you did not receive the enclosed correspondence, I am sure this will explain everything you need. Please note the highlighted section that may pertain to your situation. Please feel free to contact the Health Department at 688-9540 if you have any questions. Sincerely, Gf/G��CJ • . � d William ]. Sco Director Cc: Terri Ackerman, Acting Town Manager w/Encl. Sandra Starr, Director of Public Health w/Encl. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 _ Town of North Andover.ORTH OFFICE OF Ott«i° ,e1ti0 3� ` ' OL COMMUNITY DEVELOPMENT AND SERVICES A 27 Charles Street - ` North Andover, Massachusetts 01845 9�°'"'°'°•<�' SSACHUSE WILLIAM J. SCOTT Director Fax(978)688-9542 (978)688-9531 June 16, 2000 Mrs. Judy Goodwin 10 Campbell Road North Andover, MA 01845 Dear Mrs. Goodwin: In the event that you did not receive the enclosed correspondence, I am sure this will explain everything you need. Please note the highlighted section that may pertain to your situation. Please feel free to contact the Health Department at 688-9540 if you have any questions. Sincerely, Gf/G��CJ • . � d William ]. Sco Director Cc: Terri Ackerman, Acting Town Manager w/Encl. Sandra Starr, Director of Public Health w/Encl. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 r Town Of North Andover Community Development & Services William J. Scott 411 27 Charles Street Director North Andover, Massachusetts 01845 (978) 688-9531 ,SSwCNUgf'4 ax 978-688-9542 April 18, 2000 Board of Appeals Judy Goodwin (978) 688-9541 10 Campbell Road North Andover, MA 01845 Building Department Dear Ms. Goodwin, (978) 688-9545 This correspondence is in regards to your questions to the Town of North Andover offices concerning the Board of Health Regulations for Sewer Tie-in. This regulation was Conservation discussed and adopted at a Public Hearing on March 17, 1994. Since that time, the Health Department Department has been kept apprised of all properties, in North Andover, that have access to X978) 688-9530 municipal sewers. As the sewer expands through out the town, the Department of Public Works gives periodic updates to this office. Health To date, your address has not been placed on the list of properties that have sewer Department '978) 688-9540 available. At such time that it is placed on the list, you will receive a communication from the Health Department that will give further details on the process. Your property will fall under section 4. 1, which allows a maximum of six months to connect'to the municipal sewer ?urseblic Health (see attached). X978) 688-9543 '978) The Campbell Street sewer is not et active however it will most likely be read for P Y � Y y connection within a few months. If at that time, you have any concerns about this requirement, you may request in writing to appear at a regularly scheduled meeting of the ?fanning 7epartment Board of Health to discuss this issue. It is important that you bring to the meeting an P Y g g Y 'i(978) 688-9535 pertinent information to share with the Board. For example: multiple estimates for the intended sewer connection, lot specific logistical difficulties such as distance to hook-up, and or financial records that indicate hardship. Attached you will find a copy of the entire regulation as it was published in the local newspaper. "The purpose of these regulations is to safeguard North Andover's drinking water, surface waters, groundwater and surrounding environment. Sanitary sewer is believed to be the most effective form of wastewater treatment". If you have any questions regarding this correspondence, feel free to contact the Health Department at 688-9540, 8:30AM — 4:30PM. Sincerel , SusanFord Health Inspector Cc: Terry Ackerman, Interim Town Manager William Scott, Director of CD&S Sandra Starr, Health Director as moo• - s BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 BOARO OF}EALTH TOWN OF NORTH ANDOVER REGULATIONS FOR SEWER T1E4N 1.0 ALithadfy Under the authority of Chapter 111, Section 31 and Chapter 83, Section 11 of the Massachusetts General lave. the Board of Health of the Town of North Andover adopted the following reguLzions at a public meeting held on March 17, 1994. U Pu@ose The purpose of the" reguiWons Is to safeguard North Andover's drinking wxar, surface wa[ars, groundwaters and surrounding environment by requiring all residents to hook up to municipal sewer whenever possible. Sanitary sewer Is believed to be the most effective form of wastewater treatment. 3.0 r3elin ions Establishment: Includes bit not limited to all schools, nursing homes; campe. aingie and multiple dwelling units, country dubs. churches, mobile tomes, office buildings. restaurams. service sta- tions, retail stores Individual septic system: Any subsurface sewage disposal system. Including cesspools, consisting of household wastewater. Including graywatar, owned and operated by a person as dellned below. Owner. Every person wfo alone. or jo4rtry. or severally with others has legal title to any dwelling or awaiting unit or has can, charge, or control of any dwelling or dwelling unit as agent, executor, executrix, administrator, administratrtx, trustee, lessae, or guardian of the estate of the holder of legal title. Person: Every indIvidual, partnership, corpora- tion, firm, assoclatlon, or group owning property. Sewer. A pipe which curies sewage without storm, sumacs or ground watant. Watershed: The land area in North Andover which delineates all surface and groundwater which drains to lake Codhichewick. 4.0 Terms of Connection 4.1 All astao"riments that currently do not have municipal sewer available to them mus: conned to the sewer as soon as t becdnhes availads, with a maximum dme Amit of six months. 4.2 All establ(shments outside the North Andover watershed ttut are currently able to oorr nect with the municipal sewer haw a maximum of two (2) years from March 17, 199.4 to bean. 4.3 AU residences Inside the lake Cochkhawkk watershed that are currently able to to connect with the municipal sower have a mandmum of one year from March 17, 1994 to dean. 5.0 Variances 5.1 The Board of heath marvary the ap;31ira tion of the time frame during which any Individual connection must be made to the municipal sewer. 52 Variances will be based on significant financial hardship only. A property functioning Sep- tic system will not be considered a factor for a van}, ance. 52 Every request for a vartance shall be made in writing and submitted with documentary proof of the specific finarudal hardship. 6.0 P-3nahlas 6.1 Any person or owner who shall fail to comply with this regulation she! be punished by a fine not more than two hundred ($200.00) dogars and legal action. 7.0 Severablllfy it any provision, sentence, clause or phrase of this regulation is held to be uncorsttutbnaL or In violation of snare lar. the remainder of the regula- tion shag mmnue In full fora. TEL. E r-' Appeals Judy Goodwin ,f "° oT� , Town Of North Andover 0 `''' ` � ~�00 Community Development & Services William J. Scott 27 Charles Street Director ' ��• •'" North Andover, Massachusetts 01845 (978) 688-9531 ,SSAGNUS�t Dear Ms. Goodwin, Fax 978-688-9541 This correspondence is in regards to your questions to the Town of North Andover April 18, 2000 Board of Appeals Judy Goodwin (978) 688-9541 10 Campbell Road North Andover, MA 01845 Building Department Dear Ms. Goodwin, (978) 688-9545 This correspondence is in regards to your questions to the Town of North Andover offices concerning the Board of Health Regulations for Sewer Tie-in. This regulation was Conservation discussed and adopted at a Public Hearing on March 17, 1994. Since that time, the Health Department (978) 688-9530 Department has been kept apprised of all properties, in North Andover, that have access to municipal sewers. As the sewer expands through out the town, the Department of Public Works gives periodic updates to this office. Health To date, your address has not been placed on the list of properties that have sewer Department (978) 688-9540 available. At such time that it is laced on the list you will receive a communication from P , the Health Department that will give further details on the process. Your property will fall under section 4. 1, which allows a maximum of six months to connect to the municipal sewer Public Health (see attached). Nurse (978) 688-9543 The Campbell Street sewer is not et active, however it will most likely be ready for P Y connection within a few months. If at that time, you have any concerns about this Planning requirement, you may request in writing to appear at a regularly scheduled meeting of the Department Board of Health to discuss this issue. It is important that you bring to the meeting an p y g g y (978) 688-9535 pertinent information to share with the Board. For example: multiple estimates for the intended sewer connection, lot specific logistical difficulties such as distance to hook-up, and or financial records that indicate hardship. Attached you will find a copy of the entire regulation as it was published in the local newspaper. "The purpose of these regulations is to safeguard North Andover's drinking water, surface waters, groundwater and surrounding environment. Sanitary sewer is believed to be the most effective form of wastewater treatment". If you have any questions regarding this correspondence, feel free to contact the Health Department at 688-9540, 8:30AM — 4:30PM. Sincerel , Susan Ford Health Inspector Cc: Terry Ackerman, Interim Town Manager William Scott, Director of CD&S Sandra Starr, Health Director 1 BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 BOARD OFHEALTH TOWN OF NORTH ANDOVER REGULATIONS FOR SEWER TIEaN 1.0 Authcrtty Under the auhorfty of Chapter 111, Section 31 and Chapter 83. Section it of the Massachusetts General Lars. de Board of Paakh of the Town of North Andover adopted the following regulations at a public meeting held on March 17, 1994. 2.0 Purpose The purpose of these regulations Is to safeguard North Andover's drinking water, surface waters. groundwaters and surrounding environment by requiring all residents to hook up to municipal sewer whenever possible. Sanitary sewer Is believed to be the most effective form of wastewater treatment. 3.0 Definitions Establishment: Includes but not limited to all schools, numi ng homes; camps, single and multiple dwelling units, country dubs. churches, mobile homes, office buildings, restaurants, service sta- tions, retail atoms Individual septic system: Any subsurface sewage disposal system. Including cesspools. consisting of household wastewater, including graywaer, owned and operated by a person as defined below. Owner. Every person who alone, or jointly. or severally with others has legal title to any dwelling or dwelling unit or has can, charge, or control of any dwelling or dwelling unit as agent, executor, executrix, administrator, administratrlx, trustee. losses. or guardian of the estate of the holder of legal title. Person: Every individual, partnership, corpora- tion, firm, association, or group owning property. Sewer: A pipe which carries sewage without storm. surface or ground waters. Watershed: The land area In North Andover which delineates ag surface and groundwater which drains to Lake CochichewiciL 4.0 Terms of Connect 4.1 All establishments that currenty do not have municipal sewer available to them must conned to the sewer as soon as it becomes available, with a maximum time limit of six months. 4.2 All establishments outside the North Andover watershed that are currently able to con• nect with the municipal sewer have a maximum of two (2) years from March 17, 1994 to tie -In. 4.3 AN residences holds the Lake Cochirhewidc watershed that are currently able to to connect with the municipal sewer have a maximum of one year from March 17,1994 to lis -In. 5.0 Variances 5.1 The Board of Health may vary the appiira tion of the time frame during which any individual connection must be made to the municipal sewer. 52 Variances wig be based on significant financial hardship only. A property functioning sep- tic system will not be considered a factor for a var}, ante. 5.3 Every request for a varlarce shall be made in writing and submitted with documentary proof of the specific financial hardship. 6.0 Penalties 6.1 Any person or owner who shall fall to comply with this regulation shall be punished by a fire not more than two hundred ($200.170) dotam and legal action. 7.0 Severability If any provision. sentence, clacrse or phrase of this regulation Is held to be uncorstitudonal, or In violation of state lar. the remainder of the regula- tion shaft continue In tug force. NAC: 4/14/1994 TEL. Building Commissioner/Inspector of Buildings '-!?-N Od Z. /{s /Board of Health/Board of Selectmen OGAB �v� GAB Robins North America, Inc. Date /57,i 7 -cis NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the cap- tioned insured, location, policy number, date of loss, and GAB Robins file number. Insured: �% /G/t�G G (::�) _ cf V Ue:7 1 %� Property Address: Policy No. X13 3,6 Loss of O P_ - ;--18�= a�oJ GAB Robins File No. / e,,-? 03 - /c,_6V —7 (Signature) Title: - On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Form 645 (2/78) Important: When filling out forms on the computer, use only the tab key to move your. cursor - do not use the return key. Commonwealth of Massachusetts RECEIVE City/Town of JUL 2 2 2009 System Pumping Record Form 4TOFWE OFH NORTH DEPAANDOVER ENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front, left r �Ieftide of house Right front, right rear, right side of house. ------------- Address Citylrown 2. System Owner: Name Address (if different from location) State cq'�A Uj \ V-\ Zip Code City/Town State Zip Code --� '7 7 Telephone Number B. Pumping Record 1. Date of Pumping � . Quantity Pumped: Date Gallons 3. Type of system: 0 Cesspool(s) _ Septic Tank [j Tight Tank Other (describe): 4. Effluent Tee Filter present? Ll Yes No If yes, was it cleaned? [ Yes Q No 5. Condition of System:�� CA - 6. \/\ 'z' � 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati re contents were disposed: .L.S.D Lowell Waste Water of -/ 6 09 Date t5form4.doc• 06/03 System Pumping Recons • Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. vl� ISI Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 OCT 15 2007 TOWN,' N01':' H F, :DOVER ' DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. Syst m Locati n: � �lJ Address Citylrown St Zip Code 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ In State,�� f/�� Zip Code Telephone Number lz-O�-07 Date 2. Quantity Pumped; Cesspool(s) Septic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Vo 5. Condition ofSystem, Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 6. SystePum f Name eV\, Vehicle License Number Company 7. are contents were osed: ,c-.�._ Date / v --x ---c, t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 TOWN OF - ,Avvd fi N SYSTEM PUMPIN DATE: SYSTEM OWNER & ADDRESS P RECEIVED OCT 19 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: d- 6 QUANTITY PUMPED: I 00-D GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED To: G.L.S.D V Lowell Waste FORM 4 - SYSTE: Commonwealth of Massachusetts , Massachusetts Avstem Pumping Record ystem Owner Date of Pumping: P , a Cesspool: No E?-"" Yes ❑ System Pumped by: Contents transferred to It, ystem Quantity Pumped: l0�-4jgallons Septic Tank: No ❑ Yes E� X31/1 T�;�A e, License #: Date _ Inspector IMRTH .• , DOVER BOARD OF HEALTH INSTALLATION CHECK LIST i APPROVED DATE DISAPPROVED DATE EXCAVATION OK REAS S � AIL OK I 1. Distance o: We ands ains Well 2�s.hCter Line Location'` 3...... "C Pipe ' S ptic Tank Tees - Le can Out Covers Cement Pipe to Tank -- On Both Sides of Tank 5. DiyNoBack tion Box & Box - No Cracks ines Flowing Equal Amounts Flow 6. Leach field or Trench D' tensions tone Depth Capped Ends Clean Double Washed Stone 7. Leach Pits Dimensions Stone Depth Splash Pads Tees Cement Pipe to Pit - Both Sides Clean Double Washed Stone 8. o Ga�,',a?e Disposal g.'nal Grading Inspection 10. rracading Covered System 11. As - Built Submitted Lot Location Dimensions of System Location with Regard to Pere Test Elevations Water Table rt j 41Ni 4 1 V t r. I t � �.s .C -- I a M. - Ax - I a M. - Ilk.41CaztINKkIt r w a list •J t - Q ,. lot oc Q` �'' �; � �,� � a tea• -, ' ,may �` . , • " ;,,£ i' J,Q � t,.,' � t ' :� • 1 t • `Y •. _ • 1. �i, y< - V• �' �- � • �.-�. - ' t i • ....i " ' • - t LX .. >• ... 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