Loading...
HomeMy WebLinkAboutMiscellaneous - 100 SAW MILL ROAD 4/30/2018 (2)3 0 Commonwealth of Massachusetts City/Town ofRECEI!!ED System Pumping Record Form 4U9 JUN 2 3 2014 . F DEP has provided this form for use, by local Boards of Health. Other formllJF l•.e 'TmalN T y . us Riei information must be substantially the same as that provided here. Before 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, Le Right rear of hous. Left / right side of house, Left / Right side of building, Left / Right front of building, I_e Ight rear of building, Under deck Address City/Town u 2. System Owner. Name Address Cd different from location) State Lke-co (/\ Trp Code City/Town . State���� Telephone Number B. Pumping Record 1. Date of Pumping gate 2. Quantity Pumped: Gallons —? 3. Type of system: ❑ Cesspool(s) Septic Tank ❑Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No, '5. Condition of 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. L ere contents were disposed: �GLLS. _ Lowell Waste Water t5f6rm4.doe- 06/03 1 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of W' System Pumping Record u;i .l .i 2013 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use -by local Boards of Health. Other forms may a 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, Le re f , Left/ right side of house, Left/ Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address l� Citylrown 2. System Owner. Name Address (if different from location) Citylrown 11 State Zip Code Stat - Zi Cod Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) Septic Tank I �J Gallons ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition f ystem: 6. System Pumped By: 7. Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company contents were disposed: _ Lowell Waste Water Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record y Form 4 RE ujULItoiuMz 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 / Right front of house, Left i h iss? Left / right side of house, Left / Right side of build' , e ig n -buildin , Left / Right rear of building, Under deck Address Q� r City/Town 2. System Owner: L�Ae,-<Wn Zip Code Name 1 Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Date Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Lam' No State _ ,/ZipCodeL 7 Telephone Number — 2. Quantity Pumped eptic Tank Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 5. Conditi n of System: � 't, �! 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. e G.Sign t5form4.doc• 06/03 contents were disposed: Lowell Waste Water Date System Pumping Record • Page 1 of 1 O V. O � cr. J g � till CO) cf) 2 � .q\ \ � a 2 2 � § § § 0 t 2 CL � � e k a k_ 0 2 2 2 D§ « � : k £ £ a � U � � c Q ■ S D o 2 k ■ � 3 a � ® 2 � \ 4@ � t � . Cc)- 0 2 o A 0- o � E 2 m t a w ° 0 7 0 2 k 2 } 2 cc § � c d - � ■g � aE / Ecc a u ® ƒ j CD ) 2 k a q I L ] \ 42 2 B 6 / $ § ■ $ c k \ m k k ° ® 3 ) 0/ ° § 2 ° do-. ° ~ a ) / ® � B % 2 _o f % « ■ c a ■ ■ § R § e � $ F T t Town of North Andover HEALTH DEPARTMENT ,SS4CHUSt� CHECK #: A> � DATE: 7 -lB /,"V LOCATION: H/O NAME: _ CONTRACTOR NAME:u,i �T Gtr/moi Tyne of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ (O,,.Title 5 Report $ ❑ Other: (Indicate) $ 2378 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 100 Saw Mill Road North Andover, MA 01845 Owner's Name: _ James & Linda V. Calvert Owner's Address: 3/30/2007 Date of Inspection: _ Name of Inspector: Richard C. Tangard Company Name: _ g Mailing Address: 33 Pillin s Pond Road _ Lynnfield, MA 01940 Telephone Number; 781334-5049 APR - 5 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 15340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails �--� Inspector's Signature: 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 I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 100 Saw Mill Road mued) Property Address:. North Andover, MA 01845 James & Linda V. Calvert Owner. 3/30/2007 Date of Inspection: Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: X 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. 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 exhltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3, of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ��.w.wrrt—♦ r 1117i._--ruedLL14G4) 100 Saw Mill Road Property Address:, North Andover, MA 01845 Owner. James & Linda V. Calvert Date of Inspection: 3/30/2007 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 to a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance • •This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A popy of the analysis must be attached to this form. 3. Other. Title 5 Inspection Form 6/15/2000 Page 4.of 11 sw- OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 100 Saw Mill Road Property Address: North Andover, MA 01845 Owner: James & Linda V. Calvert Date of Inspection: 3/30/2007 D. System Failure Criteria applicable to all systems: , You must indicate "yes" or `no" to each of the following for all inspections: Yes No X 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 _ K4 Liquid depth in cesspool is less than 6" below invert or available volume is less than ''/z day flow -X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped 0 . Any portion of the SAS, cesspool or privy is below high ground water elevation. N 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. tjA 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.] %! (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 You must indicate either "yes" or `no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ _ the system is within 400 feet of a surface drinking water supply — _ the system is within 200 feet of a tributary to a surface drinking water supply _ — the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone R 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. Page 5,of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:. 100 Saw Mill Road North Andover, MA 01845 Owner: James & Linda V. Calvert Date of Inspection: 3/30/2007 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No . _. , 4 _ Pumping information was provided by the owner, occupant, or Board of Health k 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 ? k _ Was the site inspected for signs of break out ? _ Were all system components, excludilig the SAS, located on site ? X _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no -�_ _ Existing information. For example, a plan at the Board of Health. — k 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)] Poge 6 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 100 Saw Mill Road IATION Property Addres North Andover, MA 01845 James & Linda V. Calvert Owner: 3/30/2007 Date of Inspectio, FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 4440 Number of current residents: Z_ Does residence have a garbage grinder (yes or no): ill C, Is laundry on a separate sewage system (yes or no):Na [if yes separate inspection required] Laundry system inspected (yes or no): — Seasonal use: (yes or no): N6 Water meter readings, if available (last 2 years usage (gpd)): <Sa"— ;,41z__ Sump pump (yes or no): NO Last date of occupancy: Z!F<i•C_e2ft — COMNIERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): and Basis of design flow (seats/persons/sg8,etc.): Grease trap present (yes or no): — Industrial waste holding tank present (yes or no): — Non -sanitary waste discharged to the Title 5 system (yes or no): — Water meter readings, if available: Last date of occupancy/use: OTHER (describe): Pumping Records GENERAL INFORMATION Source of information: /W �.-A--ale'D 5 Was system pumped as part of the inspection (yes or no): Ae If yes, volume pumped:gallons — How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box, soil absorption system _ Single cesspool _ Overflow cesspool _ Privy — Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank _ Attach a copy of the DEP approval _ Other (describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site (yes or no): NC's Page'? of 11 OFFICIAL INSPECTION FORM:—SNOT FOR VOLUNTARY ASSESSMENTS 4, SUBSURFACE;SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 Saw Mill Road North Andover, MA 01845 Owner: James & Linda V. Calvert Date of Inspection 3/30/2007 BUILDING SEWER (locate on site plan) Depth below grade: �'O '/ Materials of construction:'_cest iron . Y , .40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: % (locate on site plan) Depth below grade: 8 a Material of construction: concrete _metal _fiberglass _polyethylene —other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: Sludge depth: A,10,V —A -- Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: /V(VN& /A! ® V'"Cv�f Distance from top of scum to top of outlet tee or baffle: A/® �LuTa� Distance from bottom of scum to bottoti of outlet tee or baffle: ;E3 How were dimensions determined: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Ale GREASE TRAP: _(locate on site plan) . Depth below grade: _ Material of construction: _concrete _metal _fiberglass polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8. of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:, 100 Saw Mill Road North Andover, MA 01845 Owner: James & Linda V. Calvert Date of Inspection: 3/30/2007 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/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: Y (if present must be openned)(locate on site plan) Depth of liquid level above outlet invert: 4:V— IXJI'& - j5ee' �/ ! 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.): PUMP CHAMBER: (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C cvemvs,r ri►r��nwr.'vr )N (continued) 100 Saw Mill Road Property Address: North Andover, MA 01845 Owner: James & Linda V. Calvert Date of Inspection: 3/30/2007 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why. Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: innovativetalternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): / /Vep CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ..Wage 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 Saw Mill Road Owner: North Andover, MA 01845\ Date of Inspection: James & Linda V. Calvert 3/30/2007 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 1Q0 feet . z�, 4- (/V L 0 • ;. , Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. Date of Inspection: SITE EXAM ✓ Slope Surface water X10 Check cellar O/-' Shallow wells 140 100 Saw Mill Road North Andover, MA 01845 James & Linda V. Calvert 3/30/2007 Estimated depth to ground water -4 feet Please indicate (check) all methods used to determine the high ground water elevation: X Obtained from system design plans on record - If checked, date of design plan reviewed: Y Observed site (abutting property/observation hole y4thin 150 fe of SAS X Checked with local Board of Health -explain: _OiOCAO�? ,COFD.5 Checked with local excavators, installers- (attach documentation) Accessed USES database -explain: You must describe how you established the high ground water elevation: m o z�/ 7` CCK l �+�2l�I GSE i"vi c� ✓ii_ri�/2 M A/ - .'iA 9d 7 .� I M lov Cm�fiS ric�� mr /2 T�r��loc�s iN Title 5 Inspection Form 6/15/2000 Mar :30 07 01:30p' Location • Symmary Record Card generated at MO/200712:06:60 PM by Lisa Warren 00 Date Town of North Andover iTr(1 ita 0� Tax Map # 210-104. B-0061-0000.0 a Actual 12/13/2006 100 SAW MILL ROAD G 9/19/2006 CALVERT, JAMES 100 SAW MILL ROAD a Actual 6120/2006 N. ANDOVER, MA a Actual 3/20/2006 01845 Class Size Total 101 Single Family 1 Acres Property Type FY 2007 213 UB Mailing Index 135 NametAddress Type Loan Number Active/Inact. CALVERT, JAMES Payor 100 SAW MILL ROAD N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 18139.0 -100 SAW MILL ROAD 3180167 03 Cycle 03 UB Services Maint. Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance From Occupant Name Active/Inactive Last Billing Date 1/11/2007 Active Rate Charge Multiplier/Users 0.63 518 7.82 1/ 01 ALL METER SIZE 43.82 11 Serial No Status Location 13242182 a Active 00 Date Reading Code 3/16/2007 345 a Actual 12/13/2006 325 a Actual 9/19/2006 311 a Actual 6120/2006 257 a Actual 3/20/2006 243 a Actual 12/2712005 229 a Actual 9/21/2005 213 a Actual 6/14/2005 135 a Actual 3/10/2005 113 a Actual 12/15/2004 94 a Actual 9/28/2004 81 a Actual P.1 Page 1 1 Residential Until Brand Type Size YTD Cons METE METE w Water 0.63 0.63 0 Consumption Posted Date Variance 20 31% 14 1119/2007 -72% 54 10/2012006 290% 14 7/10/2006 -10% 14 4/17/2006 2% 16 1/17/2006 -79% 78 10/14/2005 244% 22 7/15/2005 3% 19 4/5/2005 34% 13 1/14/2005 -84% 49 10/8/2004 147% l� la TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD�U DATE: f b 1'r:M OWNER & ADDRESS (fz "A; l DATE OF PUMPING CESSPOOL: NO YES SYSTEM LOCATION (example: left front of house) ANTITY PUMPEDY-, - GALLONS SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY. COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: v ` ' cl° 1. Commonwealth of Massachusetts JAfIVOL &ndover , Massachusetts Svstem Pumping Record System Owner System Location GGl Ue r �- Zc o S�,tiJ M ill P, ' Date of Pumping: Wg0rc)0 Quantity Pumped: i SUO gallons Cesspool: No [V Yes (...) Septic Tank: No [] Yes System Pumped by: elre44a License # Contents transferrred to : Qreater Lawrence 3anitary 9lstrict Date: __ Inspectors • 4 Commonwealth of Massachusetts Massachusetts astern Purnping Record System Owner Ccs Iuc r.1. Date of Pumping: r ] C 49. Cesspool: No Yes L System Location Quantity Pumped: 1,00 gallons Septic 'Tank: No [.1 Yes Ft System Pumped by: 5erre4ore sive taa License # Contents transferrred to: Greater Lawrence t3anitary District Date: _--- `—_ Inspectors FOILNI 4 - S1 SILAI 1'L A11'LM; KL• CUIIU Conuuolm-ealth of Massachusetts , Massachusetts S'Xst�rrt Pumping ec r Date of PumpingL '91 Quantity humped: t Cesspool: No , i'e Sentir 'i nr+k� n�., �] Yes es S% -stent Pumped lig•:V� License #: Contents Transferred to:. C' Date Inspector ,4orloA - "rA 4K. TA 4H - /p, n- ?q 4j, r q TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD OCT 2 4 2045 L OF, 4UR1HANDOVERLTH DEPARTNIENT DATE: cAe,A1c"'v 'S�� DATE OF PUMPING: CESSPOOL: NO YES (example: left front of house) PUMPED GALLONS SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: . L, , S� Or, Con unonweal th of Massachusetts Massachusetts System Pumping Record System Owner GCAl ve.r+ Date of Pumping: cg1g0ro0 Cesspool: No I.v System Location 760 SGLJ Ml)) V Quantity Pumped: I Soo gallons Yes Septic 'Tank: No Ll Yes System Pumped by: Fetredoo Sre& ftiw License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector- Ivi ` Commonwealth of Massachusetts _ &d&u , Massachusetts System Pumping Record System Owner �Oducr� Date of Pumping: A 49 Cesspool: No W` Yes LJ System Location 10 , atzdAi�� Quantity Pumped: /,50-0 gallons Septic Tank: No Yes System Pumped by: verre40a6 SitA+7�ftaa License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector F0101 A • S1•STEM 1,011'L\G RECUIW commonwealth of Massachusetts , Massachusetts System pumjj- a lecor i U�Mncr - 5)'stent 1.ocan0n \110" Uate of Pumping L (^ --� j Quantity Pumped! Cesspool: No ,�' 1'e Sentir Tnnl•l X'n Yes System Pumped by: `. License Contents transferred to: Date Inspector North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax healthdept(pD-townofnorthandover com .. E-mail www.townofnorthandover.com - Website Letter of Transmittal Page of tAORTF► q p �t420 A ti ,6*4 O fA R - Y TO: DATE: (OMPANY: D FROM: Pamela DelleChiaie, Health Department Assistant RE: Phone: Fax: G We are sending you: O Copy of Letter O Plans P&Ae—r mll in below) These are transmitted as checked below: ➢ O�,gawealasNofad ➢ S CAmigvtow ➢ L7*A t&w ➢ Oforraurl4e REMARKS: tej COPY (OPY TO: PY T0: SIGNED: 1 6004VI ➢ OIPesu(r,Nt c�uiesfbw 5 A qpvmi ➢ OSurirt w iesfbra&t f TO: NORTH ANDOVER, MASS NO V 9 19 P3 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System I nspection This is to certify that I have inspected the construction of the said disposal system at L.o-p- 616 A SA U) IW! L/ P GA North Andover, Mass. SITE LOCATION The grades and construction are as specified in plans and specifications dated S ,E P i" 3 cl 19 �2 Z. 6y NE 1/E ,ossa BOARD OF HEALTH DESIGN APPROVAL Lot # 40 A STREET '5�&W �A % ( Septic Tank Permit # Proposed Construction .01 Approx Building Size 4x0 le S Garage /Under Attached None Min elevation of top of slab Min elevation of top of foundation 155.0 Height of foundation wall Footing in fill yes ✓ no Further Comments 4 4, 4 4 SOIL PROFILE * PERCOLATION TEST DATA Start Saturation �}p A North Andover, Mass. Street No `JAW M I k k Lot No TiMir 5 Loa/Subdiv. Pland Owner 5\A C,.eA+J 6 Investigator iJsVE Observer Drop of 3" -Time 7 7, SOIL PROFILE DATES Drop of 6" -Time 1."Elev 2.Elev 3.Elev 4.Elev 8 3c� ► AN. -T5 9 0 0 101 0 , 0 1 1 Elevation 1 1 S Ti S Ties ptcest 2 2 2 2 31 3. 3 3 4 4, 4 4 Till Start Saturation { 5 ► :.� ► : �� 5 c c�pN�S ar e C,.eA+J 6 6 -ng Drop of 3" -Time 7 7, Drop of 6" -Time _f 8 8 3c� ► 9 9 3p 101 to , Benebmark Elevation DATES 4 5 6 7 8 9 10 Location Datum PERCOj,ATION TESTS GI1p19) IN C,1z3 101. 4 5 6 7 8 9 10 Pit Number 4, 3 4 Start Saturation Soak -Minutes ► :.� ► : �� ar e �S tS Drop of 3" -Time Drop of 6" -Time Z: 2$ '2'• 3Z M©ms-lst 3" drop 3c� ► Mins.2nd " Dro 3p Percolation ►3 a Zw a� 0 a L 00(1) ( 00Lo JW (rJ w C� > (.000 J OD co Q co r� Q (D .. 0 Z In U N C J o Q Zw a� 0 a L O� ( z JW (rJ 66 Q Uor Board of Health ggp�C SISTEli North Ano -O erIHaaa. INSTALLATICK-CHBOK LIST LOT' Reaminst Distance To: a. Wetlands b. Drains c.. - Well 0. Water Line Location V rTIPIle-S 3. No PVC Pipe 4. Septic Tank a. Tees -_Length k To Clean 0at Covers. b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flow �6. - Leach Field or Trench a. Dimensions . Stone Depth c. Capped Inds / d. Clean Double Washed Stone - 7. Leach Pits a. Dimeas ns b. Ston epth c. Spl sh Pads A . T s e. ment Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted _ a. Lot Location b. - Dimensions - of System c. Location with Regard -to Perc Test d. Elevations e. Water Table Board of Eealth SUBSURFACE DISPOSAL DESIGN CHOCK DIST r LOT 1S.0 V Y L�++ DATE/V DI SAPPROM UTE Provided Reasons: J -� B �' •�! ms's . i Title V FAIL (ffi :. Reg, 2.5 a submitted plan roust show as a Amin=: e lot to be served -area, dimensions lot #,abutters ocation and log deep observation holes -distance to ties location results and percolation tests -distance to ties d sign calculations k calculations showing required leaching area location and dimensions of system -including reserve area existing and proposed contours location any vot areas Athin 100' of sewage disposal system or disclaimer -check wetlands mapping face and subsurface drzins within 100' of sewage disposal system or disclaim' i) "cation any drainage easements 14thin 100' of stege disposal system or disclair—er-P a„ning Board files 3) sources of cater supply within 200' of selp._ge disposal e _ stem or disclaim a ion --of -any-proposed -,,-e11 to serve lot -1001 from leaching facili' cation of water lines on property -10' from lezching facili location of benchmark 1 (n) i-re-,-ays age disposals PVC to be used in construction profile of system -elevations of basement, plunb, pipe, septic fianY., stribution box inlets and outlets, distribution field piping and Ober elevations r) groimd cater elevation in area se -..-age disposal system j plan amst be prepared by a Professional Eagineer or other professional autborized by Iaw to prepare such plans Reg 6Septic Tanks r(a)czpacities-150,%,of flow, wester table, tees, depth of tees, access, pumping cleanout 10' from cellar gall or inground sem.-�---ng P001 d) 251 Brom subsurface drains Reg 10.2 I ! Distribution Foxes I eb) s ope greater than 0.08 Reg 10.4 Commonwealth of Massachusetts RECEIVED City/Town of a' w System Pumping Record FEB 10 2009 Form 4 TOWN DEPARTMENTF NORTHNDOVER DEP has provided this form for use by local Boards of Health. a use , 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 Important: When filling out 1. System Location: Left front, left rear, left side of house. Right froK, right 'rear, ight si a of house forms on the computer, use only the tab key Address Saw4/v\-��, to move your cursor - do not use the return City/Town State Zip Code key. 2 System Owner: 1 �� x/112 J I �--�' 1 � �� Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record _ 1. Date of Pumping Date 012. Quantity Pumped: Gallons 3. Type of system: Cesspool(s) 0-56-pttic Tank [] Tight Tank Other (describe): 4. Effluent Tee Filter resent? �- p � Yes [g -No If yes, was it cleaned? 0 Yes L] No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Lowell Waste Water F 5821 Vehicle License Number of 1-14ur Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 -C-\ Commonwealth of Massachusetts City/Town of I RE E�� v System Pumping Record JUN � 2010 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other for KNOW information must be substantially the same as that provided here. Before using this form, check wit your local Board of Health tQ 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 side of house, Right side of house, Left front of house, Right front of house, Left rear of ho e, Right re r of house..Left rear of building. Right rear of building. ------------------ Address ,(L Cityrrown 2. System Owner: Name State ✓lP Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ 4 5. Date Cesspool(s) ❑ Other (describe): Effluent Tee Filter present? ❑ Yes No Condition,of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Loc F contents were disposed: II W ste Water �— Zip Code stat _ : � � Lr Telephone Number 2. Quantity Pumped eptic Tank Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts � City/Town of W� System Pumping Record i� 147 Form 4 ,M ,•°'� TOWN OR NdR'f'�I+AN6QNgR HEALTH p p DEP has provided this form for use by local Boards of Health. Other e 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 Locati front of house, left side of house, right side of house, Left of hitilrlinn rink+ ro-r of k,.;1,4;-- -r1.... --I, Cod S�51� H L( Cityrrown State Zip Code 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ �Jp,t;oae Telel/phhoonne Number C�Jj Date 2. Quantity Pumped: Gallons Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System:` 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. Loc 'e f ere contents were disposed: L.S.D Wwell Was "r c F5821 Vehicle License Number Date Ca --?_/v t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts _ W City/Town of a System Pumping Record Form 4 RECEIVED uUL' 18 ZU11 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 of house, right front of house, left side of house, right side of house, Left rear of ho , rlgh ear of use, left side of building, right rear of building, under deck. City/Town State Zip Code 2. System Owner: UA ex -v-\ Name Address (if different from location) City/Town Statry Zip Cqde l Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s)eptic Tank ❑ Other (describe): Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No 5. ConditioN4 is -jtj A 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. Loc i n where contents were disposed: G. L. S. D. F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1