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Miscellaneous - 180 GRAY STREET 4/30/2018
1 North Andover Board of Assessors Public Access 4~ OE No oTM 7h +F �•u ,?y Y 9SSACHUSEt Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 e 4 North Andover Board of Assessors roperty Record Card Parcel ID :210/107.D-0052-0000.0 FY:2008 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e r, p®IIUip 180 GRAY STREET Location: 1.80 GRAY STREET Owner Name: STELLA, BARBARA A Owner Address: 180 GRAY STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6 - 6 Land Area: 2.34 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2048 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 455,400 487,300 Building Value: 236,600 245,700 Land Value: 21.8,800 241,600 Market Land Value: 218,800 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=1182348&town=NandoverPubAcc 8/29/2008 Commonwealth of Massachusetts _ City/Town of 2ii12 System Pumping Record �`�`' 2 .OVER Y � • �►.,y OF NORTH AN`� Form 4 CTIi CE PART 1'iEN'T - l: �EAL DEP has provided this form for use:by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, LeftRight re r of hrna he / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address a - da tri Citylrown state Zip Code 2. System Owner. Name Address Cif different from location) City/Town state Zip Code ,���-��� Telephone Number B. Pumping Record 1. Date of Pumping Date' ✓ �a � `/Septic -Quantity Pumped: Galloni' 00� 3. Type of system: ❑ Cesspool(s) Tank Ti ht Tank ❑ g ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No, 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: C Lowell Waste Water F5821 Vehicle License Number Date t5foffn4.doc• 06/03 System Pumping Record • Page 1 of 1 ✓r FC COMMONWEALTH OF MASSACHUSETTS L t L—. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ""'Y J4 � DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _180 Gray Street _ North Andover_ Owner's Name: _Michael Stella Owner's Address: _180 Gray Street _ North Andover, MA 01845 _ Date of Inspection. _9/12/2008 Name of Inspector: Neil J. Bateson_ Company Name: _Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810_ Telephone Number: _ (978) 475-4786_ LRE-CE1 0 SEP 2 2 2008 TOWN OF NORTH ANDOVER HEALTH DEPARTIAENT 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: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Eaus Inspector's Signature: Date: 9/12/2008 _ The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments: After permit from Board of Health, install new outlet tee in septic tank, inspection from Board of Health, septic system now passes Title 5 Inspection. ****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. Title 5 Inspection Form 6/15/2000 page 1 Of �ORT" a Town of North Andover '• �- + nu A 7 TU "UD A DTA i viurr SS�cwust� CHECK #: LOCATION: H/O NAME: CONTRACT( 54 k 6 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 $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ Qhle 5 Report $ J� ✓y. ❑ Other: (Indicate) $ L Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL .AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _180 Gray Street _ North Andover_ Owner's Name: _Michael Stella Owner's Address: _180 Gray Street _ North Andover, MA 01845 _ Date of Inspection: _8/19/2008 Name of Inspector: Neil J. Bateson_ Company Name: _Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810_ Telephone Number: _ (978) 475-4786 Rr a0&E I WE ® SEP 16 2008 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority a' s Inspector's Signature: Date: 8/19/2008 _ The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _180 Gray Street _ _ North Andover— Owner: _ Stella_ Date of Inspection: _8/19/2008 _ Inspection Summary: Check A, B, C, D or E / ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. 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 I4D explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _180 Gray Street _ _ North Andover— Owner: _Stella _ Date of Inspection: _8/19/2008 _ 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 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _180 Gray Street_ _ North Andover — Owner: _Stella Date of Inspection: _8/19/2008 _ 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 %2 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 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 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 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5of11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _180 Gray Street _ _ North Andover _ Owner: _Stella Date of Inspection: _8/19/2008_ 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? _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)] Title 5 Inspection Form 6/15/2000 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _180 Gray Street_ _ North Andover_ Owner: _Stella _ Date of Inspection: _8/19/2008_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4 _ Number of bedrooms (actual): 3_ DESIGN flow based on 310 CMR 15.203 _N/A _ Number of current residents: _2 _ Does residence have a garbage grinder (yes or no): _No _ Is laundry on a separate sewage system (yes or no): _Yes _ Laundry system inspected (yes or no): _Yes goes to drywell in front yard_ Seasonal use: (yes or no): No_ Water meter reading: _Yes _ Sump pump (yes or no): No_ Last date of occupancy: , Current _ COMMERCLUANDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): ___pd 'Basis of design flow (seats/persons/sgf,etc.): — Grease trap present (yes or no): Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): _ Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Pumped three ago, owner _ Was system pumped as part of the inspection (yes or no): _Yes_ If yes, volume pumped: _250_ gallons -- How was quantity pumped determined? _Measured tank Reason for pumping: _Check for infiltration TYPE OF SYSTEM X_ Septic tank, distribution box, soil absorption system Single cesspool — Overflow cesspool _ ivy _ 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 33 Years old, April 1975, owner Were sewage odors detected when arriving at the site (yes or no): No_ Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _180 Gray Street _ North Andover _ Owner: _Stella _ Date of Inspection: _8/19/2008_ BUILDING SEWER _ X _ (locate on site plan) Depth below grade: 30" Materials of construction: _X _ cast iron _X_40 PVC other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) _ 4" Cast iron thru wall to drywell. 2" PVC in house no leaks visible SEPTIC TANK: Depth below grade: _ _ Material of construction: _ _ concrete — metal _fiberglass _polyethylene _other(explain) If tank is metal list age: ` Is age confirmed by a Certificate of Compliance (yes or no): ` (attach a copy of certificate) ,Dimensions: Sludge depth: 'Distance from top of sludge to bottom of outlet tee or baffle: _ 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: _ How were dimensions determined: _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc. _ _ GREASE TRAP: _(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Title 5 Inspection Form 6/15/2000 Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _180 Gray Street _ North Andover — Owner: Stella Date of I_nspection: _8/19/2008 _ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX_ Depth below grade _ _ Depth of liquid level above outlet invert: _ Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.) _ _ PUMP CHAMBER: _ (locate on site plan) 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.): Title 5 Inspection Form 6/15/2000 Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _180 Gray Street _ North Andover— Owner: _Stella Date of Inspection: _8/19/2008_ SOIL ABSORPTION SYSTEM (SAS): _X (locate on site plan, excavation not required) If SAS not located explain why: Type X Leaching pits, number: _1_ Leaching chambers, number: _ Leaching galleries, number: _ Leaching trench, number, length: — Leaching field, number, dimensions: Overflow cesspool, number: Innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.):_ Soil ok. Vegetation ok. No sign of ponding to surface. Liquid below inlet pipe _ CESSPOOLS: 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.): Title 5 Inspection Form 6/15/2000 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _180 Gray Street _ North Andover— Owner: _Stella _ Date of Inspection: _8/19/2008_ 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 A to 1 = 55'4" Ato2=56'10" A to D -Box = 60'2" Bto1=20' Bto2=24'1" B to D -Box = 3013" C to Drywell = 35'3" D to Drywell = 4613" Drywell Title 5 Inspection Form 6/15/2000 10 Mage 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _180 Gray Street _ _ North Andover - Owner: _Stella Date of Inspection: _8/19/2008 _ SITE EXAM Slope _ No _ Surface water _ No _ Check cellar _ Yes _ Shallow wells No Estimated depth to ground water _ 4`_ 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: _5/7/1987_ 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 _ Title 5 Inspection Form 6/15/2000 11 Class Size Total FY Summary Record Card generated on 8119/20081:32:52 PM by Lisa Evans Town of North Andover 101 Single Family 2.34 Acres 2009 UB Mailina Index Name/Address: STELLA, MICHAEL 180 GRAY STREET N. ANDOVER, MA 01845 UB Account Maint. Account No ' Cycle Bldg Id. 13742.0 -180 GRAY STREET 1090420 01 Cycle 01 UB Services Maint. Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance Serial No Status 32772680 a Active Date Reading 7/22/2008 145 4/23/2008 132 1/28/2008 125 10/24/2007 112 7/20/2007 87 4/19/2007 75 1/29/2007 67 10/25/2006 52 7/28/2006 33 5/2/2006 17 1/17/2006 0 1/17/2006 2610 10/26/2005 2593 7/25/2005 2576 4/22/2005 2557 2/1/2005 2545 10/27/2004 2527 8/3/2004 2511 5/10/2004 2493 2/4/2004 2474 10/22/2003 2466 Tax Map # 210-107.D-0052-0000.0 Parcel Id 18589 180 GRAY STREET STELLA, MICHAEL 180 GRAY STREET N. ANDOVER, MA 01845 Property Type Type Loan Number Activennact. From Payor Occupant Name Activelinactive Last Billing Date 80/2008 Active Page 1 1 Residential until Rate Charge Multiplier/Users 0.63518 7.82 1/ 01 ALL METER SIZE 44.07 /1 Location Brand Type Size YTD Cons ERT HH b Badger w Water 0.63 0.63 13 Code Consumption Posted Date Variance a Actual 13 8/15/2008 77% a Actual 7 5/19/2008 -40% a Actual 13 2/19/2008 -48% a Actual 25 11/16/2007 1000/0 a Actual 12 8/15/2007 30% a Actual 8 5/21/2007 -36% a Actual 15 2/20/2007 -27% a Actual 19 11/16/2006 16% a Actual 16 8/18/2006 14% a Actual 17 5/16/2006 -1000/0 n New Meter 0 2/13/2006 -100% r Replacement 17 2/13/2006 12% a Actual 17 11/9/2005 -10% a Actual 19 8110/2005 35% a Actual 12 5/13/2005 -19% a Actual 18 2/15/2005 -1% a Actual 16 11/15/2004 -11% a Actual 18 8/25/2004 7% a Actual 19 6/8/2004 160% a Actual 8 2/24/2004 0% n New Meter 0 10/22/2003 0% Important: When filling out forms on the ' computer, use only the tab key to move your cursor - do not use the retum key. ISI Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System ?io k\ C—K-�Y �(n)E ! 2. System Owner. Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Other (describe): State Tip Code State :FSZip Code a.- Q(3 Telephone Number Date 2. Quantity Pumped: Gallons ❑ Septic Ta _ ❑TTank l�tq-'a V\�p� 4. Effluent Tee Filter present? ❑ Yes L -No If yes, was it cleaned? ❑ Yes ❑ No 5. Cond�tion�ystem:/► - J 6. Syst m Pumped Name Vehicle License Number Company 7. er contel; w re osed: Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 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 Title 5 Inspection Report Property Address: 180 Gray Street, North Andover Owner: Stella Date of Inspection: 8/19/2008 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. R, 00, ra 1- F—A j 'A 5a GA 1- I jl I -Az L_.• �34 Jl�4 L L i I 4f_ I 1 7 I 7 jkY 8, 1974 Attorncy Ylieh^cl T. Stalls, Jr. Jackson at CoT:-=a Later co, Y-acc. n--ar sir: Purcu^mt to provi.clonc of Ropal.^tion 202 :a of tho Stato Swdtarq Coo,), Comr:on- aa1•t'a of r3 hereby Lrant" tho variance-ii-4.ch :r,,u have rvuestod in pi= lct.or of :mil 26, 1974 subject: to the iolloid - conditions: 1. The aboorpUen bed es dhovn in a pl^n cilli- l ted to t'ie Bonrd of llzal•th aL p= -c -)=--d by 1!rnos �, rill be l ncrcir:- ? from Sig srunro f*_o �, W 1500 cmmm feat. 2. Thi laun( ry "n llor rill be c(,nr-raxd .."'cora tho sardtpxy uyctem by the Snconoratiou of r 1CuC Callon sccpa.To niit. 3. Fo Ca;' ba--,rinC-z --M be :W-- �.lcd c u. Li. - or after con;c4;rtto Lion o1 ►r}�e c��Lin`. �'rior to this i r ruanco of a illl mm*re revised rlrainCS incaxo: ,in �')a.,•^ :.1;:ian c� C'I' .- -.. miaj Car, 4-12mm CC sCorm of health, id.Mlonith District 4- STELLA, STELLA & STELLA ATTORNEYS AT LAW JACKSON AT COMMON LAWRENCE, MASSACHUSETTS 01840 MICHAEL T. STELLA GEORGE A_ STELLA (617) 693-2132 683-2133 MICHAEL T. STELLA, JR. April 26, 1974 Board of Health Town of North Andover 120 Main Street North Andover, Massachusetts 01845 Re: Application for Variance from the Provisions of Article 11, State Sanitary Code Gentlemen: On April 20, 1974, a perc test was done on a 2.33 acre parcel of land owned jointly by me and my wife, Barbara A. Stella. The lo' cation of said parcel of land is on Gray Street, North Andover. The result of this perc test is not within the limits of Article 11 of the State Sanitary Code, the test result being one inch in forty minutes. My wife and I are desirous of constructing our new home on this parcel of land, and we are herein applying to this Board for a var- iance from the provisions of said Article 11, and request of this Board to adopt the proposed sewerage system designed by Ernest Romano, Registered Sanitarian, predicated on the results of said perc test. I am enclosing two copies of Mr. Romano's proposed sewerage system, and respectfully request that the above matter be placed on the agenda for the May 6th meeting of the Board of Health. Very truly yours, -IT, Atwe� Michael T. Stella, Jr. / MTSjr:cav Enclosures r10R T11 16'6-r O O mca 1C.1 PUBLIC HEALTH DEPARTMENT (ommunity Development Division CER7IFICA�rE OF �O�l�l'LIA�VCYE As of: September 30, 2008 This is to cert that the individuafsu6surface disposalsystem receiveda SA`IISEWTORT INST EMON of the: Repair of the Outlet Baffle Bv• ToddBateson At: 180 Gray Street Map 10T.D; Parre[ 52 North Andover, W,4 01845 i The Issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. Sisan T Saw�fer 1t 6l�c Wealth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i` TOWN OF NORTH ANDOVER N0 TN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 * ",. •� NORTH ANDOVER, MASSACHUS 1845 �,SSqCHUS t� Susan Y. Sawyer, REHS/RS 78.688.9540 — Phone Public Health. Director / �Q 9 .688.8476 — FAX i ONSITE WASTEWATER SYSTEM GTION NOTES LOCATION INFORMATION ADDRESS: /P '.01 , MAP: LOT: INSTALLER: W v DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: i INSPECTIONS TANK INSPECTION: C���% ZAP— DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS [-]Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK MV ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500�gallon tank has been installed H-1-0 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ nlet tee installed, centered under access port Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch -cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation — Feb 2006 Page 1 of 6 1 AORTh t Commonwealth of Massachusetts Map -Block -Lot }o�t..sa 107.D -0052 - Board of Health Permit No North Andover BHP -2008-0179 w a * P.I. FEE j S�CN��gc`t F.I. $125.00 Disposal Works Construction Permit Permission is hereby granted Todd B-ateson --------------------------------------------------------------------------------------------------- to (Repair -OUTLET BAFFLE) an Individual Sewage Disposal System. at No 180 GRAY STREET as shown on the application for Disposal Works Construction Permit No. BHP -2008-017 Dated September 02, 2008 p --------------------- ---------------------- Issued On: Se -02-2008 Board of Health Commonwealth of Massachusetts Map -Block -Lot 107.D- 0052 - s Board of Health i North Andover ''�•.�4..•`4 Certificate of Compliance AcNu41 THIS IS TO CERTIFY, That the Individual Sewage Disposal System (Repair -OUTLET BAFFLE) by Todd Bateson ------------------------------------------------------------------------------------------------------------------------------------------------------ Installer ,at No 180 GRAY STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- 'has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2008-017 Dated September 02, 2008 ----------------------- ------- - - - --------------------------------------------------- Printed On: Sep -02-2008 Board of Health w 3�o +..o ,.�G oo�t N _ 9 . . Town of North Andover 4 '•e.; ... HEALTH DEPARTMENT ,sSACHustt CHECK #: DATE:'�(�� LOCATION: D 7 H/O NAME:�-c-t- CONTRACTOR NAME: odt7 �;- Type of Permit or License: (Check box) ❑ Offal (Septic) Hauler ❑ 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 Sustems: ❑ Septic - Soil Testing $ ❑"-eptic Septic- Design Approval $ �) isposal Works Construction (DWC) $ /4 � 'eu ❑ Septic Disposal orks Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ LV Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer r 1 11 M TODArS DATE $ 250.00 - Full Repair $125.00 - Component Important: 'Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the g P y computer, use only the tab key ❑ Fepair it or replace an existing on-site sewage disposal system* to move your [ or replace an existing system component - What? ©U -- cursor - do not use the return key. A. Facility Information _ _Q Address or Lot # Cityrrown 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Name 1,4 Address (if different from above) Cityrrown Stat Zip Code 5'l Y3 Telep one N ber 3:. Installer Information Name Name of Company Address 14-,Q-�--� Cityrrown State Zip Code 4. Designer Information Name Address City/Town Telephone Number (Cell Phone # if possible please) Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Pen -nit • Page 1 of 2 3 M"` i Application for Septic Disposal System *O.... AConstruction Permit -TOWN OF s •••• -� ORTH ANDOVER. MA 011345 PAGE 2OF2 TODAY'S DATE $ 250.00 - Full Repair $125.00 - Component A. Fadlity. Information continued.... 5. Type of Building:esidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issue y this Board of Health. Name Date Application proved By: (B 4 -7. of Health Representative) L Name Date AP Ica ion Disap�/oved for the following reasons: For Office Use Only: L Fee Attached. Yes No 2. Project Manager Ob4anon Form Attached. Yes No I Pump Svstem? Ifso, Attach copy ofElectrical Permit Yes No 4. Foundation As -Built. (new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans? (new construction only): Y s No Application for Disposal System Construction Permit • Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: `0 © G r A y /_j (Address of septic system) �( Relative to die application of t4 1 R-SdP� (Installer's name) Dated J.,—, - �- -d o ay s ate For plans by And dated With revisions dated I understand the following obligations for management of this project: (Engineer) ngma ate (Last revised date) 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the a_pnroved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a." Bottom of Bed — Generally, this is the first (VS inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. ` Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdept(2townofnorthandover.com) from the engineer must, be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Gracie — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons' for denial of the -system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5: As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staff or consultant. d. Installation oftaj* D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: -Fame -Print) (Today's Date) P41ffie —Sign'ed� pORTH w, 1'r 6� : �' ` 6 OL O G p ?, b O •wn■ 9 SQA COC.IIG M! WKIf `y �4 _ORATE D PUBLIC HEALTH DEPARTMENT Community Development Division ffA.-,R7I�FICA7E OFC09l�l�LIA9VC�E As of: September 30, 2008 This is to cert that the individuaCsu6surface disposal system received a SWISF,ACT0RTINSPEC7IONof the: Repair of the outlet Baffle By: ToddBateson At: 180 Gray Street Map 107.D; ('arce(52 JVorth Andover, 911A 01845 The Issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. Susan 2'. Sawfer bliicWealth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com pORT1i � 0 OL O N ti A !� e° \Za p�R�Teo P'? SAC2 PUBLIC HEALTH DEPARTMENT Community Development Division C2RTI FICA�IE O F COqVI'.GJ,/-L As of: September 30, 2008 This is to cert that the individuaCsu6surface disposafsystem received a SA7z EW ORTINSTECV0,Arof the: Repair o the Outlet Ba le p f .I By By: ToddBateson 180 Gray Street Map 107.D- Tar ceCS2 North Andover, WA 01845 The Issuance of this certificate shaff not 6e construed as a guarantee that the system u4f[ function satisfactorify. /'Slaan T Sa er (Pu6f�c Yfeafth (Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: ;TEM OWNER & ADDRESI �v l. RECEIVED NOV - 9 2005 (example: left front oTFoo m DATE OF PUMPING: I& --j 7 -45 -QUANTITY PUMPED GALLO S 7 CESSPOOL: NO YES SEPTIC TANK: NO YES " NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: � '� D'> 9 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION a t O TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _180 Gray Street _ North Andover Owner's Name: _Michael Stella_ Owner's Address: _180 Gray Street North Andover, Ma 01845_ Date of Inspection: _10/27/2005, Name of Inspector: Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, Ma. 01810_ Telephone Number: _( 978 ) 475-4786 RECEIVED NOV - 9 2005 TOWN HEEA THD DEPARTMENT CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F 'ls Inspector's Signature: Date: _10/27/2005_ The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments: ****'Phis 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: _180 Gray Street _ North Andover Owner: Stella _ Date of Inspection: _10/27/2005_ Inspection Summary: Check A,B,C,D or E /ALWAYS complete all of Section D A. System Passes: X _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or 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 ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _180 Gray Street_ _ North Andover_ Owner: Stella _ Date of inspection: _10/27/2005 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 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. T The system has a septic tank and SAS and the SAS is within SO feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: _ Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _180 Gray Street _ _ North Andover Owner: _Stella Date of Inspection: _10/27/2005 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 1/2 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 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 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 now of 10,000 gpd to 15,000 You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ — the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORINT - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 180 Gray Street _ North Andover _ Owner: _Stella _ r Date of Inspection: _10/27/2005 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 ? 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 ? N/A Were as built plans of the system obtained and examined? yea 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 ? _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. Proposed plan, no as built _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: _180 Gray Street _ North Andover Owner: _Stella _ Date of Inspection: _10/27/2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 4 Number of bedrooms (actual): 3_ DESIGN flow based on 310 CMR 15.203 N/A_ Number of current residents: _2 Does residence have a garbage grinder (yes or no): No Is laundry on a separate sewage system (yes or no): Yes_ Laundry system inspected (yes or no): Yes, goes to drywell in front yard_ Seasonal use: (yes or no): No Water meter reading: Yes_ '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): 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 two years ago, owner _ Was system pumped as part of the inspection (yes or no): Yes_ If yes, volume pumped: _1250_ gallons -- How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank & baffles_ 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: 30 years old, April 1975, owner Were sewage odors detected when arriving at the site (yes or no): No_ Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _180 Gray Street _ North Andover _ Owner: Stella Date of Inspection: _10/27/2005_ BtUDING SEWER _ X _ (locate on site plan) Depth below grade: 2' Materials of construction: _ cast iron X 40 PVC other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) _4" PVC thru wall, 3" PVC in house, no leaks visible SEPTIC TANKS: —X — ,Depth below grade: {1' _ 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: 8' x 5' x 4'— Sludge '_Sludge depth: —4- _ Distance from top of sludge to bottom of outlet tee or baffle: 23"_ Scum thickness: _6" 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: _15"` 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. Pumped septic tank. Inlet baffle ok. Outlet baffle 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 baffie: 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: _180 Gray Street _ North Andover– owner: Stella Date of Inspection: _10/27/2009 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass `polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION 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. No evidence of leakage. Evidence of carryover, pumped d -box to clean. D -Boz cover broken, replaced cover._ 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.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _180 Gray Street _ North Andover _ Owner: Stella Date of Inspection: 10/27/2005 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type _X leaching pits, number: _1, for washer machine, no liquid at invert leaching chambers, number: leaching galleries, number: _ leaching trenches, number, length: X leaching field, number, dimensions: _1 field 18' x 55'_ overflow cesspool, number: innovative/alternative system Typetname 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: 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 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _180 Gray Street North Andover_ Owner: Stella Date of Inspection: _10/27/2005 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. A to 1= 5514" Ato2=56'10" A to D -Boz = 6012" B to i = 20' Bto'2=24'1' B to D -Boz = 30'3" C to Drywell = 3513" D to Drywell = 4613" Leach pit for Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _180 Gray Street _ _ North Andover - Owner: Stella Date of Inspection: _10/27/2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _ 4' _ 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: _5/11/1974_ 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 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 Title 5 Inspection Report Property Address: 180 Gray Street, North Andover Owner: Stella Date of Inspection: 10/27/2005 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. PJ.Ba)son Bateson Enterprises, Inc. .. , u�as7 yy .x e, yY'�' a >x^ k�{-1•} i§ a i ✓ a R � �,}" '� r � k, r £ spay^� Telnet 10.1.71S5 U/S ACCOUNI HISTORY 1090420-STELLA, MICHAEL METER 41: 1090420 RX:180 GRAY ST 9 CYCLE SERVICE PP.] OR CURRENT USE VATER SEVER FEES TOTAL f- 2060-1 07/01/1999 2116 2168 52 141.96 0.00 0.00 141.96 2 2000-21 11/16/1999 2168 2197 29 79.17 0.00 0.00 79.11 3 2000-31 03/02/2000 2.19? 2220 23 62.79 0.00 0.00 62.19 p 4 2000-41 05/11/2000 2220 2236 16 43.68 0.00 0.00 43.68 S 2001-11 08/01/2000 2236 2251 15 40.95 0.00 11.00 51.95 6 2001-21 1.1/02/2000 2251 2268 17 46.41 0.00 11.00 57.41y" 7 2001-3f. 0?./12/2001 2268 228? 19 51.87 0.00 11.00 62.87 8 2001-41 05/07/2001, 2287 2300 13 3S.49 0.00 11.00 46.49 9 2002-11 07/25/2001 2300 2311 11 27.1? 0.00 S.SS 32.72 10 2002-21 11/19/2001 2311 2328 1.7 41.99 0.00 5.55 47.54;°` 11 2002.-31 03/11/2002 2328 2339 11 27.1? 0.00 5.55 32.7 12 2002-41. 05/10/2002 2339 2359 20 49.40 0.00 S.SS 54.95 13 2003-1.1 07/26/2002 2359 23?3 14 33.32 0.00 S.97 39.29 "� k 14 2003-21 10/28/2002 23?3 2387 14 33.32 0.00 5.9? 39.29 1S 2003 31 01/28!2003 2387 '1.405 18 42.84 0.00 5.97 413.81 16 2003-41 04/18/2003 2405 241.8 13 30.94 0.00 S.97 36.91 :� t 1.? 2004-11 07/21/2003 2418 2437 19 43.32 0.00 ?:42 50.14 18 2004-21 10/22/2003 243? 2466 29 ?7.24 0.00 7.42 84.66 va � REUIEW CHOICE <ENTER> MORE HISIORY: 1 ■ j ;-, Teinet 10.1.71.55 II/S ACCOUNT HISTORY ------------------- H CYCLE SERUICE 1 2004-31 02/04/2004 ----------------- 109042©-STELLA, MICHAEL Bh:180 GRAY SI PRIOR CURRENT USE 2466 24?4 8 IEUI CHOICE 11 ov <ENTEV MORE HISTORY' METER 01: 1090420 VATER SEVER FEES 18.24 0.00 ?.42 p i p � h r Summary Record Card generated on 11/4/2005 9:33:24 AM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-107.D-0052-0000.0 180 GRAY STREET STELLA, MICHAEL 180 GRAY STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 2.34 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number STELLA, MICHAEL Payor 180 GRAY STREET N. ANDOVER, MA 01845 UB Account Maint. Active/Inact. From Account No Cycle Occupant Name Bldg Id. 13742.0 - 180 GRAY STREET Last Billing Date 11/2/2005 1090420 01 Cycle 01 UB Services Mai_nt_. 1/ 57.63 Service Code Brand Rate MISCFEE`ADMIN FEE w Water 0.635/8 WTR WATER 17 01 ALL METER SIZE UB Meter Maintenance 8/10/2005 12 Serial No Status 18 Location 0021658104 a Active ENC F.L. Date Reading Code 10/26/2005 2593 a Actual 7/25/2005 2576 a Actual 4/22/2005 2557 a Actual 2/1/2005 2545 a Actual 10/27/2004 2527 a Actual 8/3/2004 2511 a Actual 5/10/2004 2493 a Actual 2/4/2004 2474 a Actual 10/22/2003 2466 n New Meter Active/Inactive Active Charge Multiplier/Users 7.82 1/ 57.63 /1 Brand Type ? w Water r Consumption Posted Date 17 11/9/2005 19 8/10/2005 12 5/13/2005 18 2/15/2005 16 11/15/2004 18 8/25/2004 19 6/8/2004 8 2/24/2004 0 10/22/2003 Size 0.63 0.63 Until YTD Cons 0 Variance -10% 35% -19% -1 -1 1 7% 160% 0% 0% 1 Nn, Ka:. O'n ti. I i I. TO: NORTH ANDOVER, MASS %I2—S 19 7 ` BOARD OF HEALTH i Re: Soil Absorption Sewage j FROM: DESIGN ENGINEER System Inspection This is to certify that I have' spected the co struction of the said disposal system at 1 y�� %�'`'°'t 412 ` ( 1�J��� North Andover, Mass. AV SITE LOCATION The grades and construction are as specified in my plans and specifications dated { 19,. I i t Reg. Prof. Engineer Reg. Sanitarian I i TOWN OF lAmirr. SYSTEM PUMPING RECORD DATE:_ I Q`�0vZ SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) l�- 0 Lct 6u:b-c- DATE OF PUMPING: I D :[0r�- QUANTITY PUlVIP'ED : 1 Ci(�� GALL NS CESSPOOL: NO YES DTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFTELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: _, (-T-, L ` -7) ' l TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD _11.oc DATE: 34 -e -,U 1� t 9-0 Gc% S� (example: left front of house) �\" S'.q DATE OF PUMPING -5-1 1 101 QUANTITY PUMPED l'� GALLONS CESSPOOL: NO � SEPTIC TANK: NO YES �— NATURE OF SERVICE: ROUTINE '- EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFI ELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: I L dig Oh , BGA r"c U. E ' iY 14 2001 CONTENTS TRANSFERRED TO:y r Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 _ C DEP has provided this form for use by local Boards of Health. Other for z I an information must be substantially the same as that provided here. Befo ilt h your local Board of Health to determine the form they use. The System Pumping Record must be su mitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front ouse, right front of house, left side of house, right side of house, Left rear of ho , . rear of use, eft side of building, right rear of building, under deck. City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town States �- Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s)eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. Locatio where contents were disposed: S.D. ,Dowell WaSt%Water F5821 Vehicle License Number &'&a _ /v Date t5form4.doc• 06/03 System Pumping Record •Page 1 of 1 Commonwealth of Massachusetts City/Town of -- Kim System Pumping Record .� Fo'rm 4 DEC 16 U11 DEP has provided this form for use by local Boards of Health. Other formF TVER T information must be substantially the same as that provided here. Before our local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/ Right front of house, Le ht rear of h Left / right side of house, Left / Right side of building, Left / Right front of buildi t rear of building, Under deck Address � <1.� � CitylTown State /�L\ 2. System Owner: Name (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date Cesspool(s) Zip Code State ip Code `- 3 Telephone Number — 2. Quantity Pumped: Septic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes [-a'No If yes, was it cleaned? ❑ Yes ❑ No 5. Condi 'on of System: � �� � t n � �l ( v 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatio wh _ contents were disposed: 11 G LL S. Lowell Waste Water L -0b.( UMA. F5821 Vehicle License Number Date �- — lQ —t t5form4.doc• 06/03 System Pumping Record •Page 1 of 1