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HomeMy WebLinkAboutMiscellaneous - 1360 SALEM STREET 4/30/2018 (2) i 1360 SALEM,STREET - 210/106.A-01.64-0000.0 j I 0 I I 1 I 15 THE ' INSTALLER LICENSED? YES NO TYPE. OF CONSTRUCTION: NLW ftEhf�I.R NEW CONSTRUCTION: , CERTIFIED PLOT/i5/L1N REVIEW YLS IBJO CONDITION ( ' APPROVAL YES NU (FROM FC U ISSUANCE .OF •DWC PERMIT YES NO DWC PERMIT NO. ., . _ INSTALLER: BEGIN ..INSPECTION YE-� NO: EXCAVATION ,,INSPECTION: NEEDED:wl ,• � , PASSED /�i���02� BY _ - -- --- --- --- CONSTRUCTION INSPECTION= NEEDED: zi AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: By HY�_ FINAL GRADING APPROVAL: DATE FINAL CONSTRUCTION APPROVAL: DATE: Y___._._______.�.___ Commonwealth of Massachusetts Title 5 Official Inspection (Form - Subsurface Sewage DisposaLSystem Form-Not for Voluntary Assessments -� rty Address b Owner hd information is is me C� required for V Y - II/� c L� I J � every page. state State Zip Code Date of Inspection 0� 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. ,mp,ftnL, RECEIVE® When filring out A. General Information forms on the OCT 21 2015 computer,use only y the the tab key 1' Inspector: to move your TOWN OF NORTH ANDO `L ' cursor-do not r- HEALTH DEPARTMENT use the return Name of Inspector r key. `e ` � 1... Company Name � VQ Company Address r--- — lew� 1 �r City/Toym State - — Z 4 y q �;7 4 / Zip Code Teleph ne 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: [r Passes ❑ Conditionally Passes ❑ I Fails ❑ Needs Further Evaluation by Local Approving Authority j Ins r ature f C 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 systefn 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. i ""This report only describes conditions alt the time of inspection and under the conditions of use at that time.This inspection does not address how the system will peiform In the future under the same or different conditions of use,. I t5ins•03!73 me 5 ORdm Irupection F«trc subsixraca Sewage DWPOSEdSySts,n•pie I of n I Commonwealth of Massachusetts Title 5 Official Inspection (Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 0 Property Address Owner Information is Owner's Name required for every page. CState Zi Code P Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A)System Passes: [?fl 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. Mments: 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 replacemen r repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"br"not determined"(Y, N, ND)fo a following statyements. If"not determined, "please explain. 1 The septic tank is metal and over 20 years old'or th eptic tank(whether metal or not) is structurally unsound, exhibits substantial infiltratio r extiltration or tank failure is imminent. System will pass inspection if the existing tank is repla with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspecti if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank ' less than 20 years old is available. ❑ Y N ND (Explain below): t5ins-03/13 Title 5 Official Inspection Forth Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection (Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a b l Property Address Owner Information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ND (Explain below): ❑ The System required pumping more than imes a year due to broken or obstructed pipe(s). The system will pass inspection if(with appr al of the Board of Health): ❑ broken pipe(s)are replace ❑ 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 publi/Heal ety r the environment. I. System will pass unless Boatermines In accordance with 310 CMR 15.303(1)(b)that the system is ng in a manner which will protect public health, safety and the environment: Cesspool or privy is withinurface water Cesspool or privy is withinordering vegetated wetland or a salt march t5ins-03/13 Title 5 official Inspection Form Subsurface sewage Disposal Svstem•Paan 3 n/17 Commonwealth of Massachusetts Title 5 Official Inspection . p Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) deterimes 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 s pply. ❑ The system has a septic tank and SAS and the SAS is within one 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is wit n 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS i ess 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, pe ormed at a DEP certified laboratory, bacteria indicates absent and the presence of am onia nitrogen and nitrate for coliform g trate nitro en I Ise equal to or less than 5 ppm, provided that no other failure Iteria 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 or clogged SAS or cesspool overloaded �-IN�� ❑ Liquid depth in cesspool is less than 6"below invert or available volume is I than % day flow less [Sins-03113 Titre 5 OHldal Inspection Form Subsurface Sawnnn Commonwealth of Massachusetts Title 5 Official Inspection f=orm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 Property Address Owner Information is Owner's Name required for every page. Cityrr vn State Zip Code Date of inspection ection B. Certification (cont.) Yes No ❑ R Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 1�r 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. ❑ I 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 ss than 5m pp , provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ This system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ L✓J 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 9p design flow of 10,000 gpd to 15,000 d. For lar n large systems, you must indicate either yes or no to each of the following, in addition to the questions in Section D. Yes No / II ❑ ❑ the system ys em is within/etof ce drinkiing water supply ❑ ❑ the system is withinary to a surface drinking water supply the system islocatesitive area (Interim Wellhead Protection Area- IWPA ora pped Zone II of a public water supply well If you have answered "yes/Dove tion in Section E the system is condidered a significant threat, or answered"yes" in Sectihe large system has failed. The owner or operator of an lar e system considered a signifnder Section E or failed under Section D shall upgrade hegsystem in accordance with .304. The system owner should contact the appropriate regional office of the Department. tains-03/13 Title 5 Official Inspection Form Subsurface Sewage Disposal proal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments " Property Address Owner Information is Owner's Name required for every page. City/Town 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? This 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): � Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): kd D t5ins•03113 Tille 5 Official Inspection Form Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewa a Disposal System Form-Not for Voluntary Assessments a � d Property Address Owner Information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 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? �4 ❑ Yes ❑ No Seasonal use? ❑ Yes d No Water meter readings, if available(last 2 years usage(gpd)): �N Cat v� - --t•—C Detail: Sump pump? ❑ Yes ff No Last date of occupancy: Commercial/Industrial Flow Conditions:. Da Type of Establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sq.ft.,etc.)' Gallons per day(gpd) Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present ❑ Yes ❑ No Non-sanitary waste discharged the Title 5 system? ❑ Yes ❑ No Water meter readings, if av .able: 15ins.03/13 TIUe 6 Official MPeotlon Form Subsurface Sewape Disposal Svstem•Paae 7 m 17 ACommonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6b t roperty Address Owner Information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other(describe below): Date General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes Q No If yes,volume pumped: How wasuantit gallons q y pumped determined? Reason for pumping: Type of System: ffSeptic 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): tsins-03r13 Title s omciai Inspection Forth Subsurface Sewage Disposal System•page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - Property Address Owner Information is Owner's Name required for every page. Clty/Town State Zip Code Date of Inspection D. System Information (cont.) � Approximate age of all components, date installed (if known)9nd source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grader Material of construction: feet cast iron ❑ 40 PVC ❑ other(explain) Distance from private water supply well or suction line: A feet Comments (on condition of joints,venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: Material of construction: feet ----- concrete ❑ metal ❑ fiberglass ❑ Polyethylene ❑ other(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: S — V Sludge depth / t5ins•03113 Title 5 Official Inspection Form Subsurface Sewage Disposal 3ysterim•Pape 9 Of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments e Property Address Owner Information is Owner's Name required for every page. City/Town 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 Scum thickness t Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle . How were dimensions determined? U Qe J U dG Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i 1 �`� r r� �� r r ra ✓� �i I�v el d to -, VkUins reCO3YnYy1gj L Grease Trap(locate on site plan): Depth below grade: Material of construction: feet ❑ concrete El metal [Ell fiber ss ❑ polyethylene ❑ other(explain) Dimensions: Scum thickness Distance from top of scum to top f outlet tee or baffle Distance from bottom of scu to bottom of outlet tee or baffle Date of last pumping: t5ins-03/13 Date TWe 5 0Mdat inspecu0n Form Subsurface Sewage gsoosaf Svatam.Pena 1n N 47 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sew ge Disposal System Form -Not for Voluntary Assessments a Ur roperty Address Owner Information is Owner's Name required for every page. City/Town State Zi-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 ❑ olyethylene ❑ other(explain) Dimensions: Capacity: Design Flow: g Ions 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 fl t switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•03/13 Tete 5 Official Inspection Form Subsurface$swage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Information is Owner's Name required for every page. City/Town State Zi Code Zip ate of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert -J bT 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.): L zU ro vl "O5 P kwl yl Wt Ey ov'er Pump Chamber(locate on site plan): Pumps in working order: 13 Yes ❑ No Alarms in working order: 11 Yes ❑ No Comments (note condition of pump chamber, co ition of pumps and apburtenances, etc.): ------------- Soil Absorption System (SAS)(locate on site plan, excavatio of requ red): If SAS not located, explain why: t5ins-03/13 TIUe 5 OfUdal Ins lion Form Subsurface Sewage Disposal System. � i 8 P ys Pape 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessm nts Ao 11 Property Address Owner Information is Owner's Name required for every page. Citylfown State Zip Code ate of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: 0 leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Typelname of.technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): U � pp o� v�AratSl C, VI-68 � r. � lC urr _ � 2 -2 Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuratio/tinver,Depth -top of liquid to in Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwate ❑ es ❑ No (sins•03/13 Tule 5 OflldOl Ins Pedion Forth SubsuAa,a Sewage plsposal Systetrm•Page 13 of 17 Commonwealth of Massachusetts ` Title 5 Official Inspection p on Form Subsurface Sewage Disposal System Form - Not for V a oluntary Assessm nts 'f Property Address Owner Information Is Owner's Name required for every page. C1ty/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponc ing, condition of vegetation, etc.): i Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydr ulic failure, level of pon ing, condition of vegetation, etc.): t5 ns•03/13 Idle 5 Official Inspection Form Subsu face SewageDisposal po System•Pape 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal� 9 System Form Not for Voluntary Assessments ' a roperty Address Owner Information is Owner s Name required for every page: CityRown 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 al I 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 9 _ 4y i �r �t U _ Y t5ins•03113 Title 5 Official Inspection Forth Sutisurfa�Sewage Disposal System•page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessm nts '< Property Address Owner Information is Owner's Name .required for every page. CityfTown State Zip Code date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: ae ❑ Observed site(abutting property/observation hole within 15C feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers (attach documentation) ❑ Accessed USG$database-explain: i You must describe how you established the high ground water elevation: Lq l Before fillingthis Inspection R p sport,please see Report Completerte s Checklist on next page. � t5ins•03/1J Title 5 OfBdal InspecUan Fane subs. ae sewage Dleposal System•page is of t? I i • Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1 )2�0 5 fil Property Address Owner Owner's Name Information is required for every page. City/Town State Zip Code De to of Inspection E. Report Completeness Checklist Q� Inspection Summary:A, B, C, D, or E checked Q� Inspection Summary D (System Failure Criteria Applicable to All Sy tems)completed System Information- Estimated depth to high groundwater LJ Sketch of Sewage Disposal System either drawn on page 15 or atta hed in separate file (Sins•03113 Title 5 Official Inspection Forth Subsurfa I a Sewage Disposal systefn•Page 17 of t7 TOWN OF N ORTO ANDOVER (978)688-957(.) 120 MAIN STREET ON OR BEFORE NORTI I ANDOVER MA 01845 ReadingInformaliop 1.1/14114 �01 $76.22 BEFORE (978)688-9570 978-688-9550 NO OFFICE HOURS Mon,Wed,Th 84:30 Tue 8-6:00.Fri 8-12:00 3170085-4 16729700 10/15/2014 p WOO iETAflV TH15 PORIYON rOR YOUR RECORDS 7/1/2014 -9/30!2 014 111114/14 40VING?PLEASE CALL 978-688-9570 IN ADVANCE ML 0 "'M 0 360 SALEM STREET GAN,JOHN PIN PIN 1360 S.kLEM STREET Previous Balance 72.42 N.ANDOVER,MA Payments Through 10/03/2014 01845 Adjustments/Late Charges Interest as of: 11/14/2014 Balance Forward A N '911 ME V" Ot' E �'NONE ME 2 ,rn 09 -a' o' i WATER USAGE WATER 18 68.40 h:110:,4 9I10;14 ADMIN FEE 7.82 926 944 IS Actual 92 Sub-Total 76.22 Total MESSAGE PAYMENTS SHOULD BE MADE : TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P .O. BOX 184 , MEDFORD, MA 02155 Water rate : First 20 units (' $3 . 80 Over 20 units ' S5 . 55 3� $5 . 95 over '40 un Ca; $9 . 24 20 units IF Sewer rate : First ils Bypass Meter Water Tate : all units @ $5 . 55 IFN PLEASE RETURN THIS PORTION WITH PAYNENTS Billing Reading TOWN OF NORTH ANDOVER information Informationlip* 120 MAIN sTRE , NORFH ANDOVER MA01841 (978)688-9550 (978)688-9570 978-688-9550 416729700 11 111111 oil I 1360 SALEM STREET 3110085-416729700 ON OR GAIN,JOHN PIN PIN BEFORE 11/14/14 $76.22 1360 SALEM STREET N.AMDOVER.MA 01845 1.944 1 1,040 n4l,k?29700201500000000000000O000D00403170085000000007622009 TOWNOF NORTH ANDOVER (979)688-9570 AiA.09-111 120 NL-kTN STREET Reading Information ON OR 02/16/15 0* $49.62 NORTH ANDOVER ktA 01845 i978)688-9570 BEFORE, ---- 9118-688-9550 OFFICE HO .,'; LITK. Mott,Wed,Th 8-4:30 -.-XISP k-1-2 Tue 8-6:00,Fri 8-12:00 3170085416729700 1/15/2015 ETALIV THIS PORTION FOR YOUR RECORDS 10/112014 -12/31/2014 15 10VING? PLEASE CALL 978-688-9570 fN ADVANCL .................. 1015115-5501 � I'360 SALEM STREET . fes ()AN,JOHN PIN PIN 6 1360 SALLIM STREET PT—evious -K 1 2)- ante (76.22) N.ANDONIEK MA Payments Through 01/07/2015 01845 Adjustments/Late Charges interest as of.: 2/16/2015 Balance Forward L 110 WATER USAGE WATER 11 41.807.82 9.1'ioi" ADMIN FEE 944 955 11 Acrual 90 Sub-rotal 49.(12 Total MESSAGE PAYMENTS; SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL '1'0 OUR LOCKBOX P .O. BOX 184, MEDPORD, MA 02155 Water Tate : First20 units s ag $3 . 80 Over 20 units Q $5 . 55 -Sewer rate : First 20 units $5 .95 over 20 units g $9 . 24 Bypass Meter Water rate : all units @ $5 . 55 PLEASE RETURN THIS PORTION WITH PAYMENTS TOWN OF NORTH ANDOVER Billing Reading Information information 120?vL41N STRELT (978)688-9550 (978)688-9570 NORTH ANDOVER MA 01845 416729700 97"88-9550 q 1360 NtNWY .1 RIM- 621- kLEM STRE3170085-41672-9700 ET ON OR GAN,JOHN PIN PIN 02/1.6115 010- 549.62 1360 SALE1\4 STREET AMOLNL PAIL? N.ANDOVER,MA 01845 1,987 2 1,045 nUI.L";pq7nnpni,;nnn00000000000000000040317008500000000496200t' TO"OF NORTH ANDOVER (978)688-9570 120 MAIN STREET ON OR NORI"H ANDOVER MA 01845 Reading Information BEFORE 05/28/15 $94.92 (978)689-9570 978-688-9550 OFFICE HOURS Mon,Wed,'Th 8-430 Tuc 8-6:00,Fri 8-12:00 3170085 116729700 4,128/2015 LETAIN THIS PORTION FOR YOUR RECORDS [OVING? PL I EASE CALL 978-688-9570 IN ADVANCE 1!1/2015 -M1 1/2015 05128/1 2§1 t"I 1360 SALEM STREET GAN,JOHN PIN PIN 2.9s M 1360 SALEM STREET Previous Balance 49.62 N.ANDOVER,MA Payments Through 04/16/2015 (49.62) 01845 Adjustments/Late Charges Interest as of: 5/2$!2015 Balance Forward LJ WATER USAGE WATER 22 87.10 12;9x14 1"Y 15 I ADMIN FEE 7.82 955 977 22 Actual 90 Sub-Total 94.92 Total 4ESSAGE PAYMENT'S SHOULD BE MADE : TOWN HALL 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @) P.O. BOX 184 , NEDFORD, MA 02155 Water rate : First 20 units 6_' $3 . 80 Over 20 units $5 . 55 Sewer rate : First 20 units Id $5 . 95 Over 20 units a'1 $9 . 24 Bypass Meter Water rate : all units Lcc $5 , 55 add PLEASE RETURN T141S PORTION WITH PAYMENTS TOWN OF NORTH ANDER OVBilling Reading 120 NVLIN STREET Information Information NOR7CHANDOVER MAO 1845 (978)688-9550 (978)688-9570 W8-688-9550 416729700 IIN1111111111IN1111111IN1111oilllll T ZO AN 1360 SALEM STREET 3170085-416729700 ON,OR GAN.JOHN PIN PIN BEFORE 05/28/15 $94.92 1360 SALEM STREET N.ANDOVER,IVIA AMOUNT PA.tD 01845 3 1,047 041672970020150000001300000000000000403170085000000009492006 TOWN OF NORTH ANT)OVFR 1210 MAIN STREET (978)688-9570 0)�N OR Reading Lnformabon ( -P NORTH ANDOVER NIA 01845 978)688-9570 OH 08/24115 $76.22 978-688-9:550 OFFICE I4O1JRS Nton,lVed,Th 8-4:30 j Tae 8-6:00,Fri 8-12-00 31.110085-416729700 7/24/2015 NE1-1�V �IIWRKA 17 015 08/24/15 ETAIX THIS PORTION FOR YOUR RECORDS N IOVI19G? PLEASE CALL 978-688-9570 IN ADVANCE 4/ 4/ J �'5 -6/30/2 WWI 1360 SALEM STREET GAN.JOHN PIN PIN 1360 SALEM S'M-ITT Previous Balance 94.92 N.ANDOVER,MA Payments"Through 07/14/2015 (94.92) 01845 Adjustments/Late Charges Interest as of 9/24/2015 Balance Fomwd 1,,3 W M N ow',- ' I WATER USAGE WATER 18 68.40 5 6,1115 ADMIN FEE 7.82 971 995 18 Actual 9LJ Sub-Total 76.22 TOW ,MESSAGE PAYMENTS SHOULD BE MADE: TOWN, HALL (@ 120 MAIN STREET OR BY NIA 11, TO OUR LOCKBOX P .O. 13OX 184, MEDFORD, MA 02155 Wa t e r r a t 6 First 20 u n i t s @7 $3 . 80 Over 20 units 6�! $5 . 55 Sewer rate : First 20 units (a S5 . 95 Over 20 units §d. $9*. 24 Bypass Meter Water rate : all units $5 . 55 PLEASERFTURN THIS PORTION WITH PAYMENTS TOWN OF NORTH ANDOVER Billing Reading 120 MAIN STREET Information Infonnation NORTH ANDOVER MA 01845 (978)688-9550 1978)688-9570 978-688-9550 416729700 WL',q�g 1360 SALEM STREET 3170085-416729700 ON OR GAN,1014N PIN PIN BEFORE 08/24/15 $76.22 1360 SALEM STREET AMOUNT PAID N.ANDOVER MA 01845 1,063 4 1,051 04167297002015000000DO0000000000000403170085000000007622009 Of NORYN 1 Oftt �c °p BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 1Ss^CHNORTH ANDOVER, MASS. 01845 Ext. 32 June 26, 1992 Dr. & Mrs. John Gan 1360 Salem Street North Andover, MA 01845 Dear Dr. and Mrs. Gan: The inspection of your repaired septic system earlier today showed that all is in order. I am enclosing a brochure on preventive septic system maintenance for you to read and reference at your leisure. I most strongly advise that you have your septic tank pumped at regular intervals of approximately two to three years and that you ensure that no heavy vehicles drive over the leaching area. Sincerely, Sandra Starr Health Inspector SLS/cjp Enclosure i li MERRIMACK ENGINEERING SERVICES, INC. 49tl PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL.(508)475-3555, 373-5721 FAX(508)475-1448 June 18 , 1992 Town of North Andover Board of Health Town Hall Main Street North Andover , MA 01845 ATTN : Sandy Star RE: Septic Repair 1360 Salem Street ( Lot #1 ) Dear Ms . Star : On June 5 , 1992 , our firm and Mr. Savage of Unit Construction Company performed a site inspection in order to determine the cause of and solution to the failure of the subsurface sewage disposal system on the subject lot. Using a backhoe , components of the system were excavated. The distribution box was found to be filled with sludge approximately 2 inches deep in the outlet lines . This could possibly have been caused by lack of septic tank maintenance ( i . e . , annual pumping of the septic tank ) and/or malfunction ( or lack of) of the septic tank outlet tee . Similar sludge material was found upon excavation of the end of one of the leaching trenches . Ledge was encountered during the excavation of the end of the leaching trench approximately 1 foot below the bottom of the trench . However , ledge was not encountered at the inlet end of the trenches . Our recommendations are as follows : 1 . The septic tank should be pumped out and the outlet tee should be then inspected and , if necessary , replaced or repaired. 2 . The leaching trenches should be reconstructed in place or in the reserve area so long as any contaminated materials , soil , stone , topsoil , or subsoil , etc . is removed within ten feet of the replacement trenches . Ms . Star Page 2 June 18 , 1992 3 . The leaching trenches should be constructed approximately two feet higher in elevations then the existing trenches in order to provide additional soil depth above ledge in comparison to the existing situation . Review of the Certified Foundation Plan for this site , dated March h , 1985 , by S. L . Giles , R . L . S. , as obtained from the Town Board of Health files shows that the existing septic tank outlet is 2 . 66 feet higher than the existing distribution box inlet , therefore allowing for the trenches to be raised without having to disrupt the septic tank . 4 . All fill to used shall be sand or gravel which meets the requirements of state and local codes . 5 . All applicable construction details shall be as indicated on the original construction plan for this system as prepared by Richard F . Kaminski & Associates , Inc . , dated September 26 , 1984 , which is on file with the Town Board of Health . Please review these recommendations and feel free to contact me if you have any questions or comments or should you require any additional information . Thank you for your consideration in this matter. Very truly yours , MERRIMACK ENGINEERING SERVICES Les Godin Project Manager ca MERRIMACK ENGINEERING SERVICES,INC. 66 PARK STREET • ANDOVER,MASSACHUSETTS 01810 I ,10RT1� 3? � � °� BOARD OF HEALTH N A a 120 MAIN STREET TEL. 682-6483 "SS.�►,�5�` NORTH ANDOVER, MASS. 01845 Ext. 32 June 26, 1992 Dr. & Mrs. John Gan 1360 Salem Street North Andover, MA 01845 Dear Dr. and Mrs. Gan: The inspection of your repaired septic system earlier today showed that all is in order. I am enclosing a brochure on preventive septic system maintenance for you to read and reference at your leisure. I most strongly advise that you have your septic tank pumped at regular intervals of approximately two to three years and that you ensure that no heavy vehicles drive over the leaching area. Sincerely, f Sandra Starr Health Inspector SLS/cjp Enclosure . c CERTIFIED FOUNDATION PLAN z LOCATED /N SCALE.,,_ „ ' DATE' s -- --- — - ' S.L.G/LES R.L.S. L AWRENCE a NORTH ANDO�E"R s �a 57 t 5q258 Z r H i Ed pip�— I seow •2/.y tia _L4..120 `1 138 �' If S w I , h ` „ SEY'r'IG r4s ,T3uf� 01 � s(z3�8sr a t 4- f A A / CERT/FY THAT THE OFFSETS SHOWN ARE FOR THE .'!SE OF 'r SGOTf ti• , ' s OFFSETS SHOWN THE BU/L D/NG /NSPECTOR ONL Y, b SUCH CONFORM TO THE USE /S FOR DETERMINATION OF. SON/NG 4r IN 72o IST ZON/NG B Y L A W OF CONFORMITY OR NON CONFO."IM, TY WHEN TAKEN. i �� W�-�Cti �wG c 5 P��� G .,�v��j ���� � '►� `'��