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HomeMy WebLinkAboutMiscellaneous - 151 CANDLESTICK ROAD 4/30/2018 210/106.A-0103-0000.0 i I i I v 1I North Andover Board of Assessors Public Access Page 1 of 1 % y NOFTI/ hl�rth Andover Board of Assessors � 41 F p SSACMUS�' ';4broperty Record Card f Parcel ID :210/106.A-0103-0000.0 FY:2012 Community: North Andover SKETCH / 1 Click on Sketch to Enlarge Click on Photo to 1n1Sr e I i y. 151 CANDLESTICK ROAD Location: 151 CANDLESTICK ROAD Owner Name: ECKLES,TIMOTHY C/O BANK OF AMERICA,N.A. Owner Address: U.S.BANCORO CENTER 800 NICOLLETT MALL j City: MINNEAPOLIS State: MN Zip: 55402 Neighborhood: 8-8 Land Area: 1.01 acres j i !Use Code: 101-SNGL-FAM-RES Total Finished Area: 2490 s ft I 9 CURRENT YEAR r � Total Value: 528,700 528,700 Building Value: 298,600 298,600 (Land Value: 230,100 230,100 Market Land Value: 230,100 iChapter Land Value: LATEST SALE Sale Price: 613,000 Sale Date: 10/24/2006 Arms Length Sale Code: Y-YES-VALID Grantor: WILLIAMS,THOMASF � !Cert Doc: Book: 10451 Page: 270 http://csc-ma.us/PROPAPP/display.do?linkId=1895413&town=NandoverPubAcc 5/2/2012 IAJUER T E LLVATAO&S 9� 4 3'19 9 A7' N6USE . . . . . . . • 1/Z. 3q TAA.JK lAl L.ET //2. /6 L0-r !3 -� Boz /ALE . . . . . . . 111. 2�5 L36X OUTLET 9q 3q7 s. EA1n n' 139b //.x.66 S • o 4 QL c T 0.2,4w 'j c5UB�SU.2F,4CE CSEW.gGE DlsPOSAZ- cSYS7-E1W W 1 lJ1./5100 `� S' zE / ZD I�,4 TE: 4�a . /37,3 hO OK//VEe: TMOAkS kl/LLl,4MS -4 SL)AJS E r AVE'.ST. 13�K ME7*1•/LA5AJ&AL.-- LQ ZOCAT/OAl LOT 13, CAA1hLEST/LX Rh. ) jUD. AAJb6V9P-' SEPTIC TAAJK j�AOF ,� andover � WI�UAM consultantsS. MACD Inc. 2 or cIsrE�E° Q` 213 Broadway , Methuen , Mass. � ,YAt SP Tel. 687- 3828 T,/-1/S IDR,4 W/Aj r7 VVI7 � ATTACKED G' ,,C7 F/CAT/DN rA7��A VO T TDQT 7-1-45 SYSTEM W IL.L FU1I/CT/O1V P�2aPE�2LY Summary Record Card generated on 5/2412012 9 26'59 AM Cy Karen Hanlon Page 1 Town of North Andover Tax Map # 210-106.A-0103-0000.0 Parcel Id 17248 151 CANDLESTICK ROAD I US BANK, N.A. TRUSTEE FOR THE CERTIICATEHOLDERS OF BANC OF AMERICA FUNDING CORP. 800 NICOLLET MALL MINNEAPOLIS MN 55402 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.01 Acres FY 2012 UB Mailing Index Name/Address Type Loan Number Activelinact. From Until US BANK,NA. Owner TRUSTEE FOR THE CERTIICATEHOLDERS OF BANC OF AMERICA FUNDING CORP. 800 NICOLLET MALL MINNEAPOLIS MN 55402 WILLIAMS,THOMAS Previous Customer Inactive 10/24/2006 151 CANDLESTICK ROAD N.ANDOVER,MA 01845 TIM ECKLES Previous Customer Inactive 11/8/2011 HEIDI JANSON 151 CANDLESTICK ROAD NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name ActivelInactive Bldg Id. 17625.0-151 CANDLESTICK ROAD Last Billing Date 4/5/2012 3170296 03 Cycle 03 Active UB Services Maint. Account No.3170296 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 60.80 /1 UB Meter Maintenance Account No.3170296 Serial No Status Location Brand Type Size YTD Cons 33132709 a Active ERT HH b Badger w Water 0.63 0.63 419 Date Reading Code Consumption Posted Date Variance 3/14/2012 581 a Actual 16 4/14/2012 -58% 12/12/2011 565 a Actual 37 1/17/2012 -10% 9/12/2011 528 a Actual 44 10/13/2011 72% 6/7/2011 484 a Actual 24 7/20/2011 56% 3/8/2011 460 a Actual 15 4/13/2011 -39% 12!912010 445 a Actual 25 1/12/2011 -2% 9/1012010 420 aActual 27 10/15/2010 16% 6f71201 393 a Actual 22 7/15/2010 39% 3/9/2010 371 a Actual 16 4/14/2010 -34% 12/8/2009 355 aActual 24 1/12/2010 -25% 9/9/2009 331 a Actual 33 10/15/2009 19% 6/8/2009 298 a Actual 25 7/20/2009 15% 3/16/2009 273 a Actual 25 4/29/2009 -5% 12/9/2008 248 a Actual 25 1/20/2009 -27% 9/8/2008 223 a Actual 35 10/10/2008 30% 6/6/2008 188 a Actual 26 7/16/2008 4% 3/7/2008 162 a Actual 24 4/11/2008 -12% 12/11/2007 138 aActual 30 1/22/2008 -19% DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, May 04, 2012 10:37 AM To: 'jenwightman@comcast.net' Subject: FW: I.R. - 151 Candlestick Road -Scanned copy of Health Dept. File (Septic) Attachments: 20120502084121835.pdf To: Jen Wig htman 978-317-8339 Dear Jen, Attached is a scanned copy of the Health Dept.file for 151 Candlestick Road,North Andover. Please feel free to call with any questions. Have a great afternoon! Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street ! Bldg.20 ! Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com 1 I r.✓ Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health.. 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. Syste Location: forms the computeto r,use only the tab key Address ��✓ -'` 1�' to move your cursor-do not use theretum Cityrrown State Zip Code .key. 2. System Owner: Name Address(if different from location Cityrrown St �- d Telephone Number j .B. Pumping Record 1. .Date.of Pumping Date 2• Quantity Pumped: Gallons I Type of system: ❑ Cesspool(s) epiic Tank ❑ Tight Tank ❑ Other(describe' ): 4. Effluent Tee Filter present? ❑ Yes U-io If yes, was it cleaned? ❑ Yes T❑ No 5. Condition of System: 6. System P pe�d 8�6 C - Name � — ��, ehicleLicense.Number Company i 7. Location ere omen ere d' .LY Signaiur o I Date http://www.mass.gov/depT ater/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•gage 7 of 1 Of NORTp 7 V� � 2 O 9 Town of North Andover `�'•�,; o:: � HEALTH DEPARTMENT ,SSGMUSE4 � CHECK#: y � AT r LOCATION: H/O NAME: c,UO CONTRACTOR NAME: Type 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 $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ I ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $� 2 Title 5 Report $ 1J� ❑ Other:(Indicate) $ V Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer /J FILE 11 TC lv, MU V INSPECTION Dean G. Luscomb H&Sons P.O.Box 135 Middleton, MA 01949 978-774-4065 Licensed Plumber#20285 SUBSURFACE SEWAGE DISPOSAL SYSTEM INPSECTION FORM J PROPERTY OWNERS NAMEJD e- e,� { Cj PROPERTY ADDRESS I co _►'N . Andover , MA rCI J ADDRESS OF OWNER(if different) J y) - - DATE OF INSPECTION M y 15 S� C) J o2 1 NAME OF I14SPECTOR D ECL Lu QUALITY IS DUMBER ONE TO US. V /7. FILE# N A h ROOT MAY ' 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT MU V INSPECTIONS r Dean G. Luscomb H& Sons P.O.Box 135 Middleton, MA 01949 978-7744065 Licensed Plumber#20285 SUBSURFACE SEWAGE DISPOSAL SYSTEM INPSECTION FORM J PROPERTY OWNERS NAME e e 1l� s PROPERTY ADDRESS 151 Co, r)d C Rd i N Ar)dovr MA ADDRESS OF OWNER(if different) hoe N M. 0 V a C) I � V� tittrr�� Y�ti# tot ti1'�e rtU�fth si P (^ � J`�h� b`a�r_��r( 11 ► b f��� �����5'tii2z3jth��s vt yy�}`t t QUALITY IS 1dUNSER ONE TO US. f ti Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May 15, 2012 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information forms on the computer, use 1. Inspector: only the tab key to move your Dean G. Luscomb II cursor-do not Name of Inspector use the return key. Dean G. Luscomb II &Sons Company Name P.O. Box 135 Company Address Middleton MA 01949 City/Town State Zip Code 978-7744065 S1848 Telephone Number License Number I I 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. 1 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 May 15, 2012 Inspect s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is required for North Andover MA May 15, 2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Checlo,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described l 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 ❑ ND (Explain below): I i t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 A � <LCommonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is required for North Andover MA May 15, 2012 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 I pass inspection if(with approval of Board of Health): v ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): I ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I 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 I ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V- 1 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May 15, 2012 required for every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 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 asses if the well water analysis, performed at a DEP certified laboratory, for fecal Y P Y � P rY 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 11 ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May 15 2012 required for Y every page. City/Town 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 de . n flow of 10,000 gpd to 15,000 gpd. F fi For large syste ou must indicate either"yes"or"no"to each of the following omits addition to the questions in Section v Yes No ❑ ❑ the system is within 4 et surface drinking water supply ❑ ❑ the system is w' 1 200 feet of a tri to a surface drinking water supply ❑ ❑ the s. is located in a nitrogen sensitive ar Interim Wellhead Protection a—IWPA) or a mapped Zone II of a public water ly well If you have a ered"yes"to any question in Section E the system is considered a i ificant threat, or answe "yes" in Section D above the large system has failed. The owner or operator any large syste considered a significant threat under Section E or failed under Section D shall upgrade the s em in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is required for North Andover MA May 15, 2012 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? i ® ❑ 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 ® El approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: i Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd a,t✓IMaI 0 {sk1 1 L e 00 L71/o b. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is required for North Andover MA May 15, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Owner and previous Title V i I Number of current residents: 0 I Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Z No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d town water 9 ( Y 9 (gP ))� Detail: J A 16 IL lea.t,4,4106,13 Sump pump? ❑ Yes ® No Last date of occupancy: April 8, 2012 Date C mercial/Industrial Flow Conditions: Type of Est i hment: Design flow(based on 31 R 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq. ., tc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to t itle 5 system? ❑ Yes ❑ No Water meter readin available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts u . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May 15, 2012 required for Y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date o upanc/use: Date Other(describe below): General Information Pumping Records: Source of information: Last pumped 2006 mg oS 6 kiglo j MTaj y G/l3f�s. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: fl gallons How was quantity pumped determined? Reason for pumping: No need at this time 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 j inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): i t5ins-11110 Title 5 Official Inspection Form: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 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May 15, 2012 required for y every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System was installed in 1979-33 years old Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20 01 feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipe and joints are in good shape with no signs of any problems. i i I i Septic Tank(locate on site plan): c� / Depth below grade: 12"feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Precast rectangular concrete 1000 gallons i I. I If tan Is mea, I7bya years Is a Certificate of Complianc�(attachaopyof certificate Dimensions: 5' D x 5'W x 8' L /UUOgm 2.. Sludge depth: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 r Commonwealth of Massachusetts - - Title 5 Oficial Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M •'y 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover required for MA May 15, 2012 every page. Clty/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 34 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? sticks and tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The septic tank and baffles are in very good condition. The solids in the tank are very light. The liquid in the tank is running at it's correct working hei th The tank does not require pumping at this time Grease Trap(locate on site plan): Depth belo rade: feet Material of construct) ❑ concrete ❑ metal ❑ fiberglass ❑ pol eth le y y ❑ other(explain): Dimensions: Scum thickness Distance from top of sc o top of outlet tee or baffle Distance from.b'ottom of scum to bottom of outlet tee or baffle — Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May 15, 2012 required for Y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments.4on umping recommendations, inlet and outlet tee or baffle condition, struc=-tea � 9 Y,WAte rit .�- � liquid levels as re a utlet invert, evidence of leakage, etc.): "mow Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): I Depth elow grade: Material of c struction: ❑ concrete metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: allons r day � Alarm present: es ❑ No Alarm level: Alarm in w ing order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of al and float switches, etc.): / _ , V '17 ' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'� 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May 15, 2012 required for y 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): "2 " / Depth of liquid level above outlet invert Zero 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.): The d-box is level with an even distribution. The liquid in the d-box is running at it's correct working heigth. The soil in this area is clean and dry with no signs of any problems. P Chamber(locate on site plan): Pumps in wor ' order: ❑ Yes ❑I No Alarms in working order: D ems ❑ No Comments(note condition of pump cha er, condition of sand appurtenances, etc.): I Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: S.A.S. was located by d-box, level area of yard, previous title v and asbuilt drawings.. t5ins•11/10 Title 5 Oficial Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May 15, 2012 required for y every page. City/Town 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: 1 -20'x45' I ❑ overflow cesspool number: I ❑ 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.): The S.A.S. is in very good condition with no signs of any problems. The soil in this area is clean with no signs of ponding or breakout. C spools (cesspool must be pumped as part of inspection) (locate on site plan): fl Number and uration — Depth to of liquid to inlet rt P p q Depth of solids layer I Depth of scum layer I Dimensions of cesspool Materials of construction Indication of ndwater inflow ❑ Yes ❑ t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 s . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May 15 2012 required for Y every page. Citylrown 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.): Pr'vy (locate on site plan): u Materia construction: Dimensions Depth of solids Comments(note condition of soil, sign hydraulic fail vel of ponding, condition of vegetation, etc.): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts D. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May 15, 2012 required for y every page. Cityrrown 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 foo� -R.V_S 71# /V, Ado",-",- MIZ, SbT A�v9=� 2'311 rt t1 Q E�Er� i n�D T O� 7 T N ` t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 " \ Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is required for North Andover MA May 15, 2012 every page. Cityrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope 6 raPW ® Surface water ® Check cellar r� ® Shallow wells Estimated depth to high round water: 6'+ below grade P g g 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. 6-4-77 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) j Checked with local Board of Health -explain: lor'sVU09 �l"G4G �ss�%�t'�rawl ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Topsfield 1 You must describe how you established the high ground water elevation: Design plan from 6-4-77 showed ground water at greater than 6'. The basement is 6' plus below grade with no sump pump. Candlestick Rd is 12 '- 15' below the grade of this yard. Previous Title V showed estimated depth to ground water at 6'+. 8-26-05. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Candlestick Rd. Property Address Delellis Owner Owner's Name information is North Andover MA May ,15 2012 required for ' every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I 'i Summary Record Card generated on 512412012 9 26.59 AM by Karen Hanlon 9" Page 1 Town of North Andover Tax Map # 210-106.A-0103-0000.0 Parcel Id 17248 151 CANDLESTICK ROAD US BANK, N.A. TRUSTEE FOR THE CERTIICATEHOLDERS OF BANC OF AMERICA FUNDING CORP. 800 NICOLLET MALL MINNEAPOLIS MN 55402 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zon1ng3 1 Residential Size Total 1.01 Acres FY 2012 UB Mailing Index NamelAddress Type Loan Number Active/Inact. From Until US BANK,NA, Owner TRUSTEE=FOR THE CERTIICATEHOLDERS OF BANC OF AMERICA FUNDING CORP. 800 NICOLLET MALL MINNEAPOLIS MN 55402 WILLIAMS,THOMAS Previous Customer Inactive 151 CANDLESTICK ROAD 10/24/2006 N.ANDOVER,MA 01845 TIM ECKLES Previous Customer Inactive 11/8/2011 HEIDI JANSON 151 CANDLESTICK ROAD NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17625,0-151 CANDLESTICK ROAD Last Billing Date 4/5/2012 3170296 03 Cycle 03 Active UB Services Maint. Account No.3170296 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 60.80 11 UB Meter Maintenance Account No.3170296 Serial No Status Location Brand Type Size YTD Cons 33132709 a Active ERT HH b Badger w Water 0.63 0.63 419 Date Reading Code Consumption Posted Date Variance 3/14/2012 581 a Actual 16 4/14/2012 -58% 12/12/2011 565 a Actual 37 1/17/2012 -10% 9/12/2011 528 a Actual 44 10/13/2011 72% 6/7/2011 484 a Actual 24 7/20/2011 56% 3/8/2011 460 a Actual 15 4/13/2011 -39% 12/9/2010 445 a Actual 25 1/12/2011 -2% 9/10/2010 420 a Actual 27 10/15/2010 160 6/7/2010 393 a Actual 22 7/15/2010 39% 3/9/2010 371 a Actual 16 4/14/2010 -34% 12/8/2009 355 aActual 24 1/12/2010 _25% 9/9/2009 331 a Actual 33 10/15/2009 19% 6/8/2009 298 a Actual 25 7/20/2009 15% 3/16/2009 273 a Actual 25 4/29/2009 .5% 12/9/2008 248 a Actual 25 1/20/2009 -27% 9/8/2008 223 a Actual 35 10/10/2008 30% 6/6/2008 188 a Actual 26 7/15/2008 4% 3/7/2008 162 a Actual 24 4/11/2008 -12% 12/11/2007 138 aActual 30 1/22/2008 -19% DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, May 02, 2012 3:04 PM To: 'sunil.k.prasad@baesystems.com' Subject: FW: I.R. - 151 Candlestick Road -Scanned copy of Health Dept. File (Septic) Attachments: 20120502084121835.pdf To: Sunil Prasad 603-885-9533 Dear Sunil: Attached is a scanned copy of the Health Dept.file for 151 Candlestick Road, North Andover. Please feel free to call with any questions. Have a great afternoon! Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street ! Bldg.20 ! Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com i i i I I i i 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, May 02, 2012 2:52 PM I To: '12plumber@live.com' Subject: FW: I.R. - 151 Candlestick Road -Scanned copy of Health Dept. File (Septic) Attachments: 20120502084121835.pdf I To: Mike Delellis j 617-794-7211 Dear Mike: Per your request for information,I have attached is a scanned copy of the Health Dept.file for 151 Candlestick Road,North Andover. Please feel free to call with any questions. Enjoy your afternoon! @ Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email gdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com i t 1 i f DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, May 02, 2012 9:36 AM To: 'medso3@comcast.net' Subject: I.R. - 151 Candlestick Road -Scanned copy of Health Dept. File(Septic) Attachments: 2012O5O2O84121835.pdf To: Maria Medrano 781-962-8676 Dear Ms. Medrano: Attached is a scanned copy of the Health Dept.file for your property at 151 Candlestick Road as you requested last evening. Please call if you have any questions. Have a great day! @ Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street ! Bldg.20 ! Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com I I 1 IA/UERT ;ELI 9+ kT 146USE TAS JK 1Al LCT -rAAJX OUTLE ,C30X DC1 -LE S . a 4 \jA vi P ci GALE I �� ZD V) 5VAJ_59T �01.3T Box I �� MET/-�U�l�� fsoo �A�. LOCA rio�! . LDT l3, CASA SEPTIL TAkK Kndover nsultonts inc. 4 Commonwealth of Massachusetts City/Town of I System Pumping Record Form 4 V DEP has provided this form for use by local Boards-of Health. 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. Syste Locati forms on the __\ �1 ��� •-�'Cy 1�..�} ' computer,use only the tab key Address (it to move your ' t � 4 r1 cursor-do not use theireturn C�tylrown State Zip Code key. 2. System Owner: - C Name Address(if different from location) -- Citylrown Stat Zip Q6de Telephone Number B. Pumping Record 1. Date.of Pumping -nate - 2. Quantity Pumped- Gallons 3. Type of system: ❑ Cesspool(s) [9—S—e-p-t—ic Tank- ❑ Tight:Tank ❑ Other(describe): --- 4. Effluent Tee Filter•present? ❑ Yes moo- If yes, was it cleaned? ❑ Yes-El No 5. Condition qf System: 6. System P tpped RT--*. Name 1 VehiGe t,icense Number Company I .7. Location erep°nipn ere d' sed:. signaltur,o u! Date http://www.mass.govidep/ ater/approvals/t5forms.htrn#inspect t5form4 - doc•06103 system.!t mping Record•Page 1 of I 5 TOWN OF �ytc- SYSTEM PUMPING RECORDS DATE: ..0 AUG 0 5 2005 i0V r4 Ii[:ALif i U_r�:gRi;�iyl SYSTEM OWNER. & ADDRESS SYSTEM LOCATION (example: Ieft front of house) r L i DATE OF PUMPING: QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NA'T'URE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: I CONTENT'S TRANSFERRED TO: G.L.S.D Lowell Waste i I TOWN OF NORTH ANDOVER � SYSTEM PUMPING RECORD DATE: (0 SYSTEM OWNER O R &ADDRESS SYSTEM LOCATION (example: left front of house) t4 -f�Kv 0� kuse I 5t COLVAJ1IN�'Cy DATE OF PUMPING: ` 5-Ot QUANTITY PUMPED t 56b GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: &-Lag=U�t COMMENTS: CONTENTS TRANSFERRED TO: I. i Conun iwealth of Massachusetts A- ,'V—!—e)UO,'rMassachusctts Sstem Pumping Record System Owner System Location Date of Pumping 'r '` Quantity Pumped: ( GoGJc'� gallons Cesspool: No H- Yes U Septic Tank: No U Yes U System Pumped by: Fetredere gaol tea License# I Contents transrerrred to : Greater Lgwrence Sanitary Qistrict Date: _ Inspector: f� I FOR 14 - SYSTEM PLIIPE�G RECORD HEA�'iH i Commonwealth of Massachusetts Massachusetts Ssty em Pumping Record SN-stem Owner Svstem Location i Date of Pumping: (�jq – ���, Quantity Pumped: gallons Cesspool: ',o p Yes 0 Septic Wank: No ® Yes iEl System Pumped b}-: l /` — License #: Contents transferred to: �--- ' Date ` _ Inspector I COMMONWEALTH OF MASSACHUSETTS N EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION I V@� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION i Property Address:_151 Candlestick Road_ I%1D"I( F, J1 North Andover_ Owner's Name:_Thomas Williams_ Owner's Address:_151 Candlestick Road_ S F_E' 6 200 j North Andover,MA 01845_ Date of Inspection:_8/1612005 10%1%1111 OF I'lln! I I I r,,It• I< IIt'At IIII;CIf,, - - Name of Inspector: Neil J.Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,Ma.01810 Telephone Number: (978)475-4786 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.Tile inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority �FaLInspector's Signature: Date: _8/26/2005_ The system inspector shall submit a copy Athis inspection report to the Approving Authority(Board of Health or DEA)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 j DEP.17ie 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. i i I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_151 Candlestick Road_ _North Andover_ Owner: Williams_ I Date of Inspection: 8/26/2005_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D I A. System Passes: X 1 have not found any information which indicates that any of the failure criteria described in 3I0 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 1 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 exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complyuig 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 ul 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 explanr: 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: I I i Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART A CERTIFICATION(continued) Property Address:_151 Candlestick Road- - North Andover_ Owner:_Williams_ Date of Inspection: 8a612005� C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ 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 I 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. i _ Tine system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance— *This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered..A copy of the analysis must be attached to this form. i I 3. Other:,— I Page 4 of i I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_151 Candlestick Road_ _North Andover_ Owner: Williams Date of Inspection: 8/26/2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections; — _No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _No Liquid depth hi cesspool is less than 6"below invert or available volume is V2 day flow. — _No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _No Any portion of the SAS,cesspool or privy is below high ground water elevation. No Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —No_ 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 duality 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.] No Yes/No The system fails.I have determined that one or more of the above failure criteria exist as described _ _( ) y 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 he considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• 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 I1 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. 'I Page 5 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 151 Candlestick Road_ _North Andover_ Owner: Williams Date of Inspection!8/26/2005 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes — Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks 7 Yes _ Has the system received normal flows in the previous two week period? _No_ Have large volumes of water been introduced to the system recently or as part of this inspection? Yes— Were as built plans of the system obtained and examined? Yes_ — Was the facility or dwelling inspected for signs of sewage back up? i _Yes_ _ Was(lie site inspected for signs of break out? i Yes_ _ Were all system components,excluding the SAS,located on site? Yes _ 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? _Yes_ _ 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 Yes _ Existing information. _Yes__ _ 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)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_151 Candlestick Road_ _North Andover Owner:_Williams_ Date of Inspection: 8/2612005_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4 Number of bedrooms(actual):_5_ DESIGN flow based on 310 CMR 15.203_600_ Number of current residents: Does residence have a garbage grinder(yes or no):_No_ Is laundry on a separate sewage system (yes or no):_No_ Laundry system inspected(yes or no): _ Seasonal use:(yes or no):^No Water meter reading: Yes,426011Ft3_ Sump pump(yes or no): No_ Last date of occupancy:- Current-COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):_gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):f Industrial waste bolding 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): GENERAL INFORMATION Pumping Records Source of information: Pumped this year,owner_ Was system pumped as part of the inspection(yes or no): No_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X_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 T Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 26 years old,8/1/1979, as built plan_ Were sewage odors detected when arriving at the site(yes or no):_No_ • Page 7 of I 1 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_151 Candlestick Road_ North Andover Owner:_Williams Date of Inspection-8/26/2005_ BMDING SOWER_X_ (locate on site plan) Depth below grade: 24" Materials of construction _cast iron _40 PVC other Distance from private water supply well or suction liner Comments(on condition of joints,venting,evidence of leakage,etc.) _Finished cellar unable to see piping_ SEPTIC TANKS: X Depth below grade:_12"'_ Material of construction: X_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: 10'x 5'x 4' Sludge depth _0"_ _ Distance from top of sludge to bottom of outlet tee or baffle:_27"^ Scum thickness:_0" Distance from top of scum to top of outlet tee or baffle:_8" Distance from bottom of scum to bottom of outlet tee or baffle: 21" How were dimensions determined:_'Pape Measure_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels ' as related to outlet invert,evidence of leakage,etc._Inlet tee ok.Outlet tee ok. Depth of liquid at outlet invert No evidence of leakage. 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 scurn 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 I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_151 Candlestick Road_ North Andover — Owner: Williams Date of Inspection:_8/26/2005_ 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,eta): DISTRIBUTION BOXES: X_ Depth of liquid level above outlet invert: _0_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):_D-Box level&distribution equal. Evidence of carryover.No evidence of leakage _ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):i Alarm in working order(yes or no): j Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):_ I i Page 9 of I 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_151 Candlestick Road— North Andover_ Owner:_Williams_ Date of Inspection 8/26/2005_ SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: p � Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: _X leaching field,number,dimensions: 1 field 20 x 45'_ overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil ok.Vegetation ok No sign of ponding to surface._ CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration:__ Depth—top of liquid to inlet invert: Depth of sludge 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.): • Page 10 of l 1 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_151 Candlestick Road_ _Nortb Andover— Owner:_Williams Date of Inspection:_8126/2005_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. House Driveway i ater Meter B A gBox ptic Tank A to Tank=22'3" A to D-Box=2515" B to Tank=40' B to D-Box=4819" i I • Page 11 of 11 I OFFICIAL INSPECTION FORM R-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_151 Candlestick Road_ _Nortb Andover_ Owner:_Williams Date of Inspection:_8/26/2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _>6'— Please 6'_Please indicate(check)all methods used to determine the high ground water elevation: _X Obtained fi-om system design plans on record-If checked,date of design plan reviewed:_6/4/1977_ 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:_ You must describe how you established the high ground water elevation: As per design plan_ or summary Record Card generated on 8125!2005 2:43:01 PM by Lisa Warren Page I Town of North Andover Tax Map # 210-106.A-0103-0000.0 151 CANDLESTICK ROAD WILLIAMS, THOMAS 151 CANDLESTICK ROAD N. ANDOVER, MA ` 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.01 Acres FY 2006 UB Mailing Index Namo/Address Type Loan Number Active/Inact. From Until WILLIAMS, THOMAS Payor 151 CANDLESTICK ROAD N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 3221.0- 151 CANDLESTICK RD Last Billing Date 7/8/2005 3170296 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 183.40 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 0025328191 a Active ENC L ? w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 6/27/2005 4209 a Actual 49 7/15/2005 32% 3/25/2005 4160 a Actual 40 4/5/2005 -8% 12/14/2004 4120 a Actual 35 1/14/2005 -18% 9/24/2.004 4085 a Actual 55 10/8/2004 -23% 6111/2004 4030 a Actual 39 7/30/2004 55% 4/15/2004 3991 a Actual 54 5/17/2004 0% 12/15/2003 3937 n New Meter 0 12/15/2003 0% f , I R-rf' tt y,et 457."P�+'j r'r t';Y 11--j. . rIV � i+;X—R 4 � I�tir F' ,t }'�' '• + i`,.� as 4talr 1 {r aR�3' i l a i? t�tSy ^ + ,, t: r• * 7 >t` t, ltU 'i(`sy,+ +i r tn'^ R bi.'' +tF_. ,r�' �S �+`Tr t i &.�'S ``n rr.; % „t y'. .� t'•.•.'..:. ,... �a,`. •:.= ti•'31 1 r t"� `...4w t1'K�>•���^t G�r frtt. �a �r�'ri1.141Y r 4 ,i y e��t� l � r FS" yt i � F= }�•t t +�t i �4'. . t irk t � •'�7�17�y�t S' Ya��.tf ! R��` �iy�t+• Y ? �`.r�t r:rJ ��d4 t).3��.!+�4 ��� h_ 9. rt' y��'�'y�; Y�9 y U f•k4r is`r ,rt. � � y `•.: �.1 l 1 - •' - It'll e r }t tt it .�y •yr ^fl•te '�} t s`i't{�.�+: Jrr tY.kC fi y*'irt�: ' ,`.L., a i ! aa� t`•�,, �'-114 ,, ,`#` it7� � P 6:yg- 4 r t !xE=,.�, Sim l5 .ttix'-w3,�,$y„, �•K1 l�. r.• ILf�1�L1 (�f� i� - .}+.t,�. vl' 3 �� {�1 � . r 1 `ti{ f � �� r �, 1!. �t( 1'ywt T s�,.r�•- t.t. +r,.+ . 'It1 r}l�istti n.,r� '��`r”f' t '`r�•..t 'ti''t R(..`f M 3 4� $,� y�3•'"'. iy' • � �� � ���`t�t� �7 +�� .�qtr �{i;' �`� u ' t r•��+"�♦♦♦ - t tat . .,;•{ �' 1 t $/ FA�. a y - a '"` ,r rh !+ .•;+rex++ t l;�t�i • t r , • 'i. r1•. •1 f1 t; g. F t r r r r`_r �� � Credit OK ` ;1 u► I i 't I d?Start GOVERN•10,1. R.,, " Ywq aM Restless-Ho.,. I��tkrdelWWAworksam.,. Service Cali•Water De,,, I �Telnet 10.1.71.55 1:49 PM u i II Thursday,Aug 25,2005 01:50 PM x 3 V + ON �t g $ r a w 4 } a i 4� "3s wS 1,�Stajtt 8'j GOVERN-103 11A Yov&-A ReAWS-W... MStAicdC*-Water De., lefoet 10171.55 Atf i YA 1 h ky �xi,4 fl I N f R 1 I I I I Thursday,Aug 25,2005 01:50 PM 6 Tel: (978)475-4786 Fax: (978)475-5451 BATESON ENTERPRISES, INC. Excavating-Water.&Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover,Mass. 01810 I Title 5 Inspection Report Property Address: 151 Candlestick Road, North Andover Owner: Williams Date of Inspection: 8/26/2005 I My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. I TOWN OF SYSTEM PUMPING RECORD R����l��� AUG 0 DATE: 3 c? S 5 2005 TOWN OF NORTH ANDOV I E R HEALTH DEPA RTMENT SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) 51 CavAr Jc'ck DATE OF PUMPING: QUANTITY PUMPED : _�cc(-, GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES i NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste 1 .1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION �;���•��� (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES r DgoUUN T d�l`i d'r boil . 1} NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY.- COMMENTS: Y COMMENTS: I CONTENTS TRANSFERRED TO: l Comm wealth ofMassachusetts Massachusetts i System Pum in Record System Owner System Location I 666tAlvt i � Date of Pumping: � �)7 l � Quai City Pumped: ( C�:�O gallons Cesspool: No Yes U Septic Tank: No LlYes L� � i System Pumped by: Fclied4rt 5it&7�ftMe4 License# i Contents transfeured to : Greater Lawrence Sanitary District Date: _ Inspector: I i 3 '•'�� � J9 FORM 4- SYSTEM PUNIPM RECORD 4��NFA�,YH X21 ' Commonwealth of Massachusetts Massachusetts System Pumping Record -stem Owner vstem Location Date of Pumping: r ( 3 Quantit., Pumped: gallons Cesspool: No P Yes ❑ Septic Tank: No ❑ Yes RCC System Pumped b} : License 4: i Contents transferred to: Date Inspector y1 ti.v r_``y--����y? '� � ., __ -`_. - 1 R" COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a d DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 Q q SVe i TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION • 151 Candlestick Road E Property Address. P North Andover_ Owner's Name: Thomas Williams_ Owner's Address:_151 Candlestick Road_ SEP 16 2005 _North Andover,MA 01845_ Date of Inspection:_8/26/2005_ TOWN OF NORTH ANDOVER HEALTH DEPAR,N.ENT Name of Inspector: Neil J.Bateson Company Name: Bateson Enterprises Inc._ j Mailing Address:_111 Argilla Road_ j _Andover,Ma.01810_ Telephone Number:_(978)475-4786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: _8/26/2005_ The system inspector shall submit a copy Athis inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_151 Candlestick Road- - North Andover— Owner:_Williams_ Date of Inspection 8/26/2005_ Inspection Snmmary: 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 exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 I ND explain: f Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_151 Candlestick Road_ _North Andover— Owner:_Williams_ Date of Inspection:8/26/2005_ 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 T 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_ I i "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: I I i i Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_151 Candlestick Road_ _North Andover_ _ Owner: Williams Date of Inspection:_8/26/2005_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ _No_ Liquid depth in cesspool is less than 6"below invert or available volume is'/z day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ _No Any portion of a cesspool or privy is within a Zone 1 of a public well. _No Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ 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 DEF 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.] No (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 gpd. 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 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 should contact the appropriate regional office of the Department. 15.304.The tem owners ppropn g Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_151 Candlestick Road_ _North Andover_ Owner: Williams Date of Inspection:_8/26/2005_ I Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes _ Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes Were as built plans of the system obtained and examined? _Yes_ ` Was the facility or dwelling inspected for signs of sewage back up? Yes _ Was the site inspected for signs of break out? Yes _ Were all system components,excluding the SAS,located on site? _Yes _ 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? i _Yes_ _ 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: j Yes no Yes_ _ Existing information. _ _Yes_ _ 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)] I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_151 Candlestick Road_ North Andover_ Owner:_Williams_ Date of Inspection: 8/26/2005_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_5_ DESIGN flow based on 310 CMR 15.203_600_ Number of currant residents: 4 Does residence have a garbage grinder(yes or no):_No I Is laundry on a separate sewage system(yes or no):_No Laundry system inspected(yes or no): _ Seasonal use:(yes or no):—No— Water oWater meter reading: Yes,426011Ft3_ Sump pump(yes or no):_No Last date of occupancy:— Current-COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based.on 310 CMR 15.203):_gpd Basis of design flow(seats/persons/sgketc.): 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): GENERAL INFORMATION Pumping Records Source of information: Pumped this year,owner_ Was system pumped as part of the inspection(yes or no):_No If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: _ TYPE OF SYSTEM X 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: 26 years old,8/1/1979, as built plan_ Were sewage odors detected when arriving at the site(yes or no): No i _ I I Page 7 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_151 Candlestick Road_ _North Andover_ Owner:_Williams_ Date of Inspection 8/26/2005_ i BUILDING SEWER_X_ (locate on site plan) Depth below grade:_24"_ Materials of construction: _cast iron _40 PVC_other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) Jinished cellar unable to see piping SEPTIC TANKS: X Depth below grade:_12"'_ Material of construction: X_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: 10'x 5'x 4'— Sludge '_Sludge depth 0"— Distance from top of sludge to bottom of outlet tee or baffle:—27"— Scum 7"_Scum thickness:_0" Distance from top of scum to top of outlet tee or baffle:_8" h Distance from bottom of scum to bottom of outlet tee or baffle: 21"— How were dimensions determined:_Tape Measure_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc._Inlet tee ok.Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. i GREASE TRAP: (locate on site plan) E 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:_151 Candlestick Road_ _North Andover_ Owner:_Williams_ Date of Inspection:8/26/2005 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): i 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 BOXES: X Depth of liquid level above outlet invert: _0_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):_D-Boz level&distribution equal.Evidence of carryover.No evidence of leakage _ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):— Alarm in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I I, I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART C SYSTEM INFORMATION(continued) Property Address:_151 Candlestick Road_ _North Andover_ Owner:_Williams_ Date of Inspection 8/26/2005_ SOIL ABSORPTION SYSTEM(SAS):_X (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: X leaching field,number,dimensions:_1 field 20 x 45'_ overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil ok.Vegetation ok. No sign of ponding to surface._ f I 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 sludge layer: Depth of scum layer:_ Dimensions of cesspool: Materials of construction: _ Indication of groundwater inflow(yes or no): C 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.): f i Page 10 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_151 Candlestick Road_ _North Andover— Owner:_Williams Date of Inspection: 8/26/2005_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. House Driveway Water Meter B Septic Tank A i D- A to Tank=22'3" Boz A to D-Boz=25'5" B to Tank=40' B to D-Boz=48'9" Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART C SYSTEM INFORMATION(continued) i Property Address:_151 Candlestick Road_ _North Andover— Owner:_Williams_ Date of Inspection:_826/2005_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _>6 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:_6/4/1977_ 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) j _ Accessed USGS database-explain:_ You must describe how you established the high ground water elevation: As per design plan_ i IIS Summary Record Card generated on 8/25/2005 2:43:01 PM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-106.A-0103-0000.0 151 CANDLESTICK ROAD WILLIAMS, THOMAS 151 CANDLESTICK ROAD N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.01 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until WILLIAMS, THOMAS Payor 151 CANDLESTICK ROAD N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 3221.0- 151 CANDLESTICK RD Last Billing Date 7/8/2005 3170296 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63 5/8 7.82 1/ WTR WATER 01 ALL METER SIZE 183.40 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 0025328191 a Active ENC L ? w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 6/27/2005 4209 a Actual 49 7/15/2005 32% 3/25/2005 4160 a Actual 40 4/5/2005 -8% 12/14/2004 4120 a Actual 35 1/14/2005 -18% 9/24/2004 4085 a Actual 55 10/8/2004 -23% 6/11/2004 4030 a Actual 39 7/30/2004 55% 4/15/2004 3991 a Actual 54 5/17/2004 0% I 12/15/2003 3937 n New Meter 0 12/15/2003 0% I i i i i i �4§ M y� oilt 3 t E CII pop , id 4 R RAW Lot aNOW � flY 3 y dt• C rfrMwwx( Thursday,Aug 25,2005 01:50 PM a m u I 3 z a � w h N 1' I Thursday,Aug 25,2005 01:50 PM i Tel: 978 475-4786 Fax: (978) 475-5451 i BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover,Mass. 01810 Title 5 Inspection Report Property Address: 151 Candlestick Road, North Andover Owner: Williams Date of Inspection: 8/26/2005 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. I Neil J. Bateson Bateson Enterprises, Inc. i Board of Health r ' North ArIO-Over':4)ias's. SEPTIC SYSTEM / l INSTALLATICK CHWK iISf LOT DAT& DI FtZCTJED / . AVATI�d OK FAIL Reas=sV FAIL OK r 1. Distance Tot { a. Wetlands i b. Drains c. Well 2. Mater Line Location { 3• No PPC Pipe 't Septic Tank------ a. Tees --Length & To Clean Out Corers. U1-5 b. Cement Pipe to Tank - Oa Both Sides of Tank _ f � 5. Distribution Box Lam` a. Covers & Box - No Cracks L/ b. All Lines Flowing Equal Amounts c. No Back Flow 6. - Leach Field or Trench r/ a. Dimensions f b. Stone Depth t� c. Capped 'Eads d. Clean Double Washed Stone r 7. Leach Pits a. Dimsnsione r b. Stone epth c. Sp 3h Pads d, .,Tess e,/ Cment Pipe to Pit - Both Sides ff. Clean Double Washed Stone 8. No Garbage Disposal 3 9. Final Grafi Inspection f10. Barricading Covered System y 1.1. As Built Sabmitted _ a. Lot Location b. Dimensions of System = c. Location with Regard-to Pere Test j d. Elevations N e: Water Table a i i py to Public Wore •- �• SUBSURFACE DISPOSAL SYSTEM CHECK LIST s� NORTH ANDOVER BOARD OF HEALTH APPROVED DATE PROVIDED DISAPPROVED DATE TIME REASON bek Title 5 Reg. 2. 5 Fail OK The submitted plan must show as a minumum: _ .=a�—the lot to be served (area,dimensions ,l,ot //,abutters) (Planning Board files) location and log of deep observation holes-distance to ties ..may (c) location and results of percolation tests-distance to ties (d) design calculations & calculations showing required leaching area a {e) location and dimensions of system (including reserve area) - existing and proposed contours -=.(g location of any wet areas within 100' of the sewage disposal system of disclaimer (check wetlands mapping) —(h) surface and subsurface drains within 100' of sewage disposal system of disclaimer location of any drainage easements within 100' of sewage disposal system or disclaimer (planning board files) - j—known sources of water supply within 200' of sewage disposal system or disclaimer location of any proposed well to serve the lot (100' from leaching facility) �:-)__ location of water lines on property (10' from leaching facilities) =­ --(w)—location of benchmark — --driveways {o)—garbage disposers no PVC is to be used in construction -)—'a profile of the system (elevations of basement, plumber.c pipe septic tank, distribution box inlets and outlets, distribution field piping and any other elevations) `(r) —maximum ground water elevation in area of sewage disposal . system „_,_(,s.)____plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Septic Tanks Reg. 6 (a) Capacities - 150% of flow, water table , tees, depth of tees , access, pumping, (b) Cleanout �� (c) 10' from cellar wall or inground swimming pool (d) 25' from subsurface drains North Andover Subsurface disposal system check list - Page 2 Fail OK Distribution Boxes Reg.10.2 .(a) Slope greater than 0.08 Reg.10.4 f, (b Sump. Leaching Pits Leaching pits are preferred where the installation is possible Reg.11 .2 (a) Calculations of leaching area (minimum 500 S.F. ) Reg.11 .4 (b) Spacing Reg.11 .1 (c) Surface drainage 2% Reg.11 .11 (d) Cover material Leaching Fields Reg.15.1 (a) RoGreater -than 20 minutes/inch Reg.15.1 '(b) Area (minimum 900 S.F.) Reg.15.4 / (c) Construction of field Reg.15.8 (d) Surface drainage 2% Reg. 3.7 �%'� (e) . 201 from- cellar wall or inground swimming pool Leaching Trenches Reg.14.1 (a) Calculations of leaching area (min. 500 S.F.) Reg.14. 3 (b) Spacing (4 ft. min. 6 ft. with reserve between) Reg.14.4 (c Dimensions 14. 5 Reg.14.6 (d) Construction Reg.14.7 (e) Stone Reg.14.1 (f) Surface drainage 2% Downhill Slope (a) Slope y/x = (to be shown) (b) y/x X 150 = (to be shown) PumpR Reg. . 9.1 (a) Approval Reg. 9.6 (b) Stand-by power r '• SOIL PROFILE & PERCOLATION TEST DATA Town,/City No.&Street �� -,��,/�L G Lot No. Loc./Subdiv. ✓ ,' i ,-, C_V1re/P1an Owner -,,_z'-/e,/ h r? \)Investigator �/-�G,/; r Observer `1 SOIL PROFILES-DATE `� 1' E ev. 2' Elev.� 3' Elev. 4'Elev. 0 p p p {fib ! 2 2 2 2 3 3 3 3 4 4 4 4 F i 5 _ 5 $ -_ �6 3 6 6 G \7 b 7 7 . 7 8 g g g .9 9 9 9 10 10 10 10 Benchmark Location Elevation Datum Percolation Tests-Date 3 Pit Number 1 2 3 4 S Start Saturation 19 Soak-Mins. /G Start Test-Time S Drop of 3"-Time ;5th Drop of 611-Time 2 .V D Mi.ns. lst 3"Dro /s Mins". 2nd 11—lDrop 0 Notes & Sketches on Back Frank C. Gelinas & Associates, *North And. r 4andcover consultants 213 BROADWAY inc. METHUEN, MASSACHUSETTS 01844 (617) 687-3828 (aD� DATE 4el6- . /, /979 TO : NORTH A14DOVER HEALTH DEPART tuiENT TOVYN HALL, NO. ANDOVER, MASS . RE : SUBSURFACE SEWAGE DISPOSAL SYSTI'M' GDi /3 6'A'"OLL377Ckl . 2D,, NO. ANDOVER, I hereby certify that I have inspected the construction of the disposal system at /3 GA'1V1J C*7-X 0-42) • North ,=ndover, iti'ass . and that the location and elevations are shown on the tis-1uilt Drawing dated 4U . /o 197-9 ANJOVEtt CONaULT,iT;T�� , Li'dC . William S . 1'4.acLeod Registered sanitarian This certification is not to be construed as a guarantee of the system.