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HomeMy WebLinkAboutMiscellaneous - 22 FULLER ROAD 4/30/2018 22 FULLER ROAD : (R R p 210/065.0-0073-0000.0 poet r! North Andover Board of Assessors Public Access Page 1 of 1 d Parcel ID: 210/065.0-0073-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge — '«dpi IIS •-u i i 1 22 L-33 FULLER ROAD i Location: 22 FULLER ROAD Owner Name: MASTERSON, KATHLEEN A WILLIAM P MASTERSON Owner Address: 22 FULLER ROAD City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 7 - 7 Land Area: 1.21 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2692 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 627,800 587,800 Building Value: 411,600 387,700 Land Value: 216,200 200,100 Market Land Value: 216,200 Chapter Land Value: LATEST SALE Sale Price: 1 Sale Date: 03/30/1999 Arms Length Sale Code: F-NO- Grantor: WILLIAM CONVNIENT MASTERSON Cert Doc: DOC 69955 Book: 00102 Page: 0057 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=805588 10/12/2006 � ' North Andover Health Department (ommunity and Economic Development Division November 20, 2017 Address: 22 Fuller Road All North Andover Residents with Septic Systems and Garbage Disposals Please note that due to a recent review of a Title 5 Report, your property has been identified as maintaining a working garbage disposal that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage disposals are never recommended where septic systems are used, but if they are installed, the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this disposal could quickly cause a pre-mature failure of your septic system, resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdeptgnorthandoverma.gov. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. Sincerely, rian LaGrasse, CEHT irector of Public Health 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov rA RECEI V EM Commonwealth of Massachusetts Title 5 Official Inspection Form NOV 2 0 2011 r a Subsurface Sewage Disposal System Form-Not for Voluntary Assessme is TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 22 Fuller Road Property Address Bill Masterson D Owner Owner's Name (1 information is North Andover MA 01845 11/13/2017 4 require]for every page. City/Town State Zip Code Date of Inspecti 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 A. General Information : filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Neil J. Bateson use the return Name of Inspector key. Bateson Enterprises Inc. ry Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 SI-15 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Nee Further Evaluation by the Local Approving Authority /jj/ ) _ -`� 11-13-2017 Ins ec rs Signatu 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 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.doc-rev.6116 1 Title 5 05cial Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is North Andover MA 01845 11/13/2017 requireq for every ate page. Cityrrown StZip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 C ficial Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is North Andover MA 01845 11/13/2017 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 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 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is North Andover MA 01845 11/13/2017 required for every page. City/Town SatetZip 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 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 must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts a - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is North Andover MA 01845 11/13/2017 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6116 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 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): N/A Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): N/A t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gp ))� Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •''� 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is North Andover MA 01845 11/13/2017 required for every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2014, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is North Andover MA 01845 11/13/2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Original system, owner, Outlet tee&d-box was replaced in 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.7 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.): 4"cast iron through wall, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: 0.7feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x5' x4' Sludge depth: 2" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. Cityrrown 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 31" Scum thickness 2" 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 13" 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. Pumped septic tank. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Vo`untary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and obtlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6116 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 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. City1rown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal, has flow levelers. No evidence of leakage. Evidence of carryover, pumped d-box to clean Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts ti Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 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 filed 18'x 40' ❑ 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 solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "r 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. City/Town 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 60-9--kri 0 o - D=(_6©f z-5bt t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >4 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Essex County Soil Map. You must describe how you established the high ground water elevation: Essex County Soil Map, Sheet#36, Hinckley Soil, Water>6 ' Deep Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °y 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. City/Town 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 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 : Commonwealth of Massachusetts , . _ Citk/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. Inforri�ation 1. System LocatioryWRigh .ou Left 1 Right rear of house, Left/right side of house, Left/ Right side of buil i g", Left/Right front of building, Left/Right rear of building, Under deck Address .�--> -,4 i--A city/rown State Zip Code 2. System Owner. Name' Address(if different from location) cityrrown Stater . —lip Code Telephone Number Y f; .B. Pumping R-9cord -- 1-7 1. Date of Pumping Date 2. Quantity Pumped: Gallons ; .3. Type-of system: ❑ Cesspool(s) eptic Tank F1 Tight Tank i. ❑ Other(describe): 4. Effluent Tee Filter present? E] Ye o If yes, was it cleaned? ❑ Yes ❑ No, 5. Condition of System: 6. System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Lo w e contents-were disposed: Lowell Waste Water g���� 4SJj9neWH Date f 5form4.doc•06/03 System Pumping Record•Page 1 of 1 Summary Record Card generated on 10/30/2017 2:43:19 PM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-065.0-0073-0000.0 Parcel Id 9931 22 FULLER ROAD MASTERSON, WILLIAM 22 FULLER ROAD N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.21 Acres FY 2018 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until MASTERSON,WILLIAM Payor 22 FULLER ROAD N.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17215.0-22 FULLER ROAD Last Billing Date 10/10/2017 3160293 03 Cycle 03 Active UB Services Maint. Account No.3160293 Service Code Rate Charge Multiplier/Users MISCFEEADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 563.25 /1 UB Meter Maintenance Account No. 3160293 Serial No Status Location Brand Type Size YTD Cons 32707569 a Active 00 b Badger w Water 0.63 0.63 2091 Date Reading Code Consumption Posted Date Variance 9/7/2017 2659 a Actual 108 10/18/2017 168% 6/5/2017 2551 a Actual 39 7/25/2017 324% 3/6/2017 2512 a Actual 9 4/12/2017 -66% 12/7/2016 2503 aActual 27 1/23/2017 -89% 9/6/2016 2476 a Actual 260 10/24/2016 799% 6/3/2016 2216 a Actual 28 8/2/2016 274% 3/3/2016 2188 a Actual 7 4/22/2016 -88% 12/8/2015 2181 a Actual 63 1/20/2016 -43% 9/4/2015 2118 a Actual 105 10/16/2015 102% 6/5/2015 2013 a Actual 52 7/24/2015 378% 3/6/2015 1961 a Actual 11 4/28/2015 -81% 12/4/2014 1950 aActual 53 1/15/2015 -56% 9/9/2014 1897 a Actual 133 10/15/2014 454% 6/6/2014 1764 a Actual 23 7/16/2014 22% 3/7/2014 1741 aActual 19 4/11/2014 -48% 12/5/2013 1722 aActual 36 1/17/2014 -32% 9/6/2013 1686 a Actual 52 10/15/2013 72% 6/10/2013 1634 a Actual 33 7/24/2013 70% 3/6/2013 1601 a Actual 18 4/22/2013 -35% 12/7/2012 1583 a Actual 29 1/9/2013 -71% 9/5/2012 1554 a Actual 99 10/15/2012 308% 6/6/2012 1455 a Actual 24 7/16/2012 39% 3/8/2012 1431 a Actual 18 4/14/2012 42% 12/5/2011 1413 aActual 12 1/17/2012 -86% 9/7/2011 1401 a Actual 89 10/13/2011 250% 6/6/2011 1312 a Actual 26 7/20/2011 83% 3/3/2011 1286 a Actual 13 4/13/2011 -76% 12/6/2010 1273 aActual 56 1/12/2011 -73% 9/7/2010 1217 a Actual 219 10/15/2010 237% rr nn l UU of NORTH 1a Town of North Andover �` HEALTH DEPARTMENT CHECK#: DATE://070 LOCATION: ola v�/ems H/O NAME: AL 5 4rSOI] CONTRACTOR NAME: Ag,,&570 � 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 $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ xTitle 5 Report Q 0.55 $ 50- 0 5d—❑ Other:(Indicate) $ N Healt Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 APR 2 2 2014 DEP has provided this form for use-,by local Boards of Health OMW „spay�be'use , but the information must be substantially the same as that provided e ' wdT€;rrsig; ',check with your local Board of Health to determine the form they use.The System Pumping be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Locatione /Rig ont of h , Left/Right rear of house, Left/right side of house, Left/ Right side of buil Id•ng, Left/Right front of building, Left/Right rear of building, Under deck Address a �Fu U-e✓1 City/rown State Trp Code 2. System Owner. Name Address(if different from location) City/rown ' State de Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes; No If yes, was it cleaned? ❑ Yes ❑ No: ' 5. Condition o Sys cj V\ I ` 6. System Pumped By.- Nell y:Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company 7. L here contents were disposed: a�.S. Lowell Waste Water Sign Haul Date t5form4.doc•06/03 System Pumping Recons•Page 1 of 1 RECD ED Commonwealth of Massachusetts City/Town of APR 2 3 2009 System Pumping Record TO EALOTH DEPA ANDOVER T ENT 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 Important: When filling out 1. System Locatio - Lefffront, eft rear, left sid of house.'Right front, right rear, right side of house. forms on the computer,use only the tab key Address &� to move your cursor-do not Citylrown State Zip Code use the return key. 2. System Owner: Name Address(if different from location) City/Town Stat � ` Zi Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: Cesspool(s) Septic Tank [j Tight Tank Other(describe): 4. Effluent Tee Filter present? [j Yes No If yes,was it cleaned? [] Yes No 5. Conditi717Z�� System: Y V\- q—e" Z 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati contents were disposed: L.S.D Lowell Waste Water igna ure of H u r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1. t10RTi4 q O tt�eo $6� �O 6 0 �0 A �► ?, �b O ,wrI .�. •�q tOtwKpwRw �9SSACHUS PUBLIC HEALTH DEPARTMENT Community Development Division C21' RIT FICArrE OF CO9Yr9GIAgCE As of: October 27, 2006 This is to cert that the individual subsurface disposal system received a SMIS-AC2ORT IMTEMON of the: Outlet Tee in Septic Tank Q� Distfibution Bo., By. Todd Bateson At: 22 Fuller Road YorthAndover, W,4 01845 The Issuance of this cert f cate shall not 6e construed as a guarantee that the system will function satisfactorily. 1 , Michele E. Grant Tu6CcYlealth Inspector 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com V40RT14 OFtt�ec �6Ati0 O LCo' couuc.KuwKw`y1• ��SSACHAT US PUBLIC HEALTH DEPARTMENT Community Development Division C'ER2I FIC.AT2 Off' CO_1V1-1'�-t'/-L 2 As of: October 27, 2006 ,This is to certify that the individual subsurface disposal system received a SATIS FACTORT IM(P MOW of the: Outlet Tee in Septic Tank 6� Distfibution Oo.- Oy: Toddw(Bateson At: 22 Fuller Road North Andover, WA 01845 Tfie Issuance of this certiftate shall not 6e construed as a guarantee that the system will function satisfactorily. Michele E. Grant , (Pu6licYfealth Inspector 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 4 y TOWN OF NORTH ANDOVER NORTh Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 �''ITS';C Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: `eD MAP: LOT: INSTALLER: �� �� ti� DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: 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 ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Watertightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet 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 TOWN OF NORTH ANDOVER t NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES o HEALTH DEPARTMENT p 1.600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 +cMus Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: Wastewater System Documentation—Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES o? HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ► NORTH ANDOVER, MASSACHUSETTS 01845 �'SS„CHU Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX [� Installed on stable stone base [� Inlet tee (if pumped or >0.08'/foot) [[� Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retainii g wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: Wastewater System Documentation—Feb 2006 Page 3 of 6 r TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p i 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 • �, .-;��:..,,> NORTH ANDOVER, MASSACHUSETTS 01845 �'SS.;cH�s�`�' Susan Y. Sawyer, REHSIRS 978.688.9540—Phone Public Health Director 978.688.8476—FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: Wastewater System Documentation—Feb 2006 Page 4 of 6 r TOWN OF NORTH ANDOVER of NORTa Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ` 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 ACHUS S Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck,on footings, etc 5 10 -- ❑ Waterline 10 10 10' ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains(wat. supply/trib.) 50 100 ❑ Drains(intercept g.w.) 25 50 ❑ Drains (Other)Foundation 10(5) 20(10) ❑ Drywells 20 25 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.21 l(3),also by NA wetland bylaws Wastewater System Documentation—Feb 2006 Page 5 of 6 r TOWN OF NORTH ANDOVER a NORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 �►", . NORTH ANDOVER, MASSACHUSETTS 01845 �'SS;;�H„st� Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Wastewater System Documentation—Feb 2006 Page 6 of 6 DrivingDirections from 1600 Osgood St,North Andover, MA to 22 Fuller Rd, North An... Page 1 of 2 1 � f mWell%Ts 17 Start: 1600 Osgood St North Andover, MA 01845-1048, US End: 22 Fuller Rd North Andover, MA 01845-3114, ""` US t gg Notes: �► l M u Directions Distance Total Est. Time: 13 minutes Total Est. Distance: 6.04 miles _ 1: Start out going SOUTH on OSGOOD ST/ MA-125 toward ORCHARD HILL 3.1 miles RD. Continue to follow MA-125. 2: Turn LEFT onto MASSACHUSETTS AVE. 0.5 miles 4 3: MASSACHUSETTS AVE becomes SALEM ST. 2.3 miles 4: Turn LEFT onto FULLER RD. <0.1 miles Q 5: End at 22 Fuller Rd North Andover, MA 01845-3114, US Total Est. Time: 13 minutes Total Est. Distance: 6.04 miles Map out great hotel rates on Orbitz http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt&1 gi=0&un=... 10/27/2006 Driving Directions from 1600 Osgood St,North Andover, MA to 22 Fuller Rd,North An... Page 2 of 2 Li csarrs, �F�—�1mi - fit ' 11 ` ono W ow Rd Andr 0 . b .r -I-- ---- ove DIY Boxford _wr High Plaid,Rd y� �r �; • �. f�p�-- -�/ L 0 20H MapQuest,inc. � r_ffi2006 Start: End: 1600 Osgood St 22 Fuller Rd North Andover, MA 01845-1048, US North Andover, MA 01845-3114, US O. tmi �^aAPCi1d :. 1 1mi ' NN - 1km %/�' 0 1 m j 12 Ward"ill �'I _k �Wx 'K+a 3. MIN 'se - -47 ' f - 1 A GcdaLpond Rd Poi 5� N bb .� 0 2006 MapQuest,inr. 02006MA VTEQ 0 2006 MapQuest,hoc. 02006 All rights reser\-ed. Use Subject to License/Copyright These directions are informational only. No representation is made or warranty given as to their content, road conditions or route usability or expeditiousness. User assumes all risk of use. MapQuest and its suppliers assume no responsibility for any loss or delay resulting from such use. http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt&1 gi=0&un=... 10/27/2006 KORTM Commonwealth of Massachusetts Map-Block-Lot ot,•,�° 065.0-0073- P a Board of Health Permit No BHP-2006-0271 North Andover ---- - ' °* - • ' P.I. FEE �$SAC,HUS� F.I. $125.00 Disposal Works Construction Permit Permission is hereby granted Todd Bateson to(Repair-OUTLET TEE IN SEPTIC TANK&D-BOX)an Individual Sewage Disposal S at No 22 FULLER ROAD --------- as ------as shown on the application for Disposal Works Construction Permit No. BHP-2006-027 Dated October 12,200.6 ------------------- --------- Issued On: Oct-12-2006 Board of Health f pO Commonwealth of Massachusetts Map-Block-Lot ~�o •"`°0 '•.�ooD 065.0-00737. Board 073- Board of Health • North Andover s •r�� Certificate of Compliance SAC Muse THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair-OUTLET TEE IN SEP by Todd Bateson Installer at No 22FULLER ROAD 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-2006-027 Dated October 12,-2006 ---------- - - - --------- -------- Printed On: Oct-12-2006 Board of Health OPT" • 1 D� Town of North Andover - 'y ;•4,' HEALTH DEPARTMENT/ oL/l ------ 'SSAcNus6 � ' u��(Zepa��t CHECK#: f► /� J S St6 00,F °nen , a� ��250• ,compo 1� �•�i(/G�/� /f-l%�-� S O�`/ ,125.00 ` LOCATION. ✓f _ ,„/ g45 006 H O NAME: 4�-- R ti CONTRACTOR NAME: Stem* ' Stem* T e of Permit or License:(Check box) o; sal sy /Sa%0 ❑ Animal $---- 9e atsP° tie disp° \ Se* ElBody Art Establishment $� 00-SN" component $ 9 stem ❑ Body Art Practitioner sy ❑ Dumpster $ �_ p Food Service-Type: a $ / 1 ❑ Funeral Directors --" ❑ Massage Establishment ❑ Massage Practice $ / to app��CattO� \5 type 0191 ❑ offal(Septic)Hauler $ c�ca`pevm� ❑ Recreational Camp Oe)oje\ectemst fc at`Oo toP9rtseta e�tmthe om ,pydtoreSysG°py 011 0\11 ❑ Sun tanning sPtaGha vatMakn p Swimming Pool $--- gave.LO BoXI lPtte0o ` r. F . [3 Tobacco Tobacco $ S. �No $ ❑ Trash/Solid Waste Hauler �'. ❑ Well Construction _ �VN ❑ Septic-Soil Testing $ _ � _ Stat i ❑ Septic-Design Approval $ �, t)oje) n NUtr� U/ bec El, Disposal Works Construction(DWC) $--- / d\(\ ❑ Septic Disposal Works Installers(DWI) $---- / ❑ Title 5 Inspector ❑ Title 5 ReportO � /ode $ at1 n � Zip Sy`�/ sd pleas �j fes / $�— �`(^ / State 'Ig, ❑ other. (Indicate) % � Umber/ phone =fe\ePh°ne N (J" i Health Agent Initials Name of GomPany =" / White-Applicant Yellow-Health Pink-TreasurerC jon e yp coa .. .� _ -- - 4• Dg5� �� `" - ,/�/ �(each/a• ame " g<at/o Nor bei(B Ctonst��&OV\Peet P N P aatess .1,0011"r\ PP`°at�o ' /, n fot 0�sP°Sa\SysteR` �.- _ &;ty[� ------------- i i� Y Z!0 Z'9 d•lJWje C'uo/10nJjsuo3 uo�1e�/jdab 0 �. 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SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: as k_j (Address of septic system) For plans by (Engineer) Relative to the application of - (Installer's name) And dated ngina ate Dated (� I©rate OCT 1 ZOO6With revisions dated T0,v%cr r I (Last revised date) HEALTr t. d I understand the following obligations for management of this project: 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 approved 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 Tide 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�(V) 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: healthdeptntownofnorthandover.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 Grade—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 of Health staff or consultant. d. Installation of tank,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 der the approved plans. No instructions by the homeowner eneral contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) /0— car=0,�. (Name— not (Nathe—Signed) SCALE-71"40' DATE.-10/19/2006 10/23%2006 10/27/2006 THE ZONING DIST. IS R1. Scott L. Giles R.P.L.S. 87,120 S.F.AREA Frank. S. Giles R.P.L.S. 175'FRONTAGE 50 Deer Meadow Road 30'SETBACKS ALL AROUND. North Andover, Mass. L•C PLAN #36903 D. LOT 32 i 302.59' APPROX.SHAPE I I AND LOCATION IZ W OF EXIST.POOL I I C-)rn01 i � I I I DZ II I '< r, DECK RUN o OOM N PROP. a ADO. EXIST. HSE. FND. II o I t O 12' I I I Zm OVER 155'TO 2 #22 Lu , I I i I j SALEM ST. 53' 1_ + I ' d � i O O I iD j I LEACH N Z I I I AREA I On I DRAIN EASEMENT I I I L.C PLAN#36903 D. I i i I LOT 33 EASEMENT I l 290.00' Z FULLER W ROAD Q f.. THE PROPERTY LINES SHOWN ARE THE LINES DIVIDING EXISTING OWNERSHIPS,AND THE LINES OF STREETS AND WAYS SHOWN ARE THOSE OF PUBLIC OR PRIVATE STREETS OR WAYS ALREADY ESTABLISHED,AND NO NEW LINES FOR DIVISION OF EXISTING OWNERSHIP OR NEW WAYS ARE SHOWN. �a , OF I CERTIFY THAT OFFSETS SHOWN AREFOR THE USE THE OFFSETS �o �L y SHOWN COMPLY OF THE BUILDING INSPECTOR ONLY WITH THE ZONING AND SUCH USE IS FOR THE BY LAWS OF DETERMINATION OF ZONING �L «IM NORTHANDOVER CONFORMITY OR NON-CONFORMITY (012oG� WHEN BUILT WHEN CONSTRUCTED. NORTM O��t`eo 161 NO s 'Y' O� COCMI[Mlw[M V 'tl 404A7119) �SSACHU PUBLIC HEALTH DEPARTMENT Community Development Division Date: September 19,2006 Address: 22 Fuller Road Re: Application garage, master closet, bathroom renovations Dear:Mr. And Mrs. Masterson, Your application for a deck at has been reviewed by the Health Department. The application was denied on, September 19, 2006, for the following reasons: 1. x Missing information 2. x Passing Title 5 inspection of septic system required per local N. Andover regulations � 3. ❑ Location of structure not acceptable 4. ❑ Undersized septic system To address the problem(s). H#1 is checked, please supply: a. Floor plan of existing and proposed addition— all rooms b. Certified plot plan showing house, septic system and proposed project. in scale If#2 is checked: a. Have the septic system inspected by a. certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If#3 is checked: a. Relocate the project H#4 is checked: a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult an engineer to determine the flow capacity of the septic system. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.towoofnorthandover.com Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely an Sawyer, publi alth Dir for Cc: Building Department File 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com &y, 611_ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION rc71°f �Ql IA VO TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 22 Fuller Road —North Andover_ Owner's Name:_William Masterson Owner's Address: 22 Fuller Road —North Andover,MA 01845_ Date of Inspection: 926/2006 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.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 _X_ Conditionally Passes Needs Further Evaluation by the Local Approving Authority ils Inspector's Signature: ate: 9/26/2006_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 22 Fuller Road_ _North Andover_ Owner:_Masterson Date of Inspection: 9/26/2006_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: X One or more system components as described in the "ConditionalPass"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 .Outlet Tee&D-boa needs replaced N 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: N 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: N 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:_22 Fuller Road_ _North Andover— Owner:_Masterson_ Date of Inspection: 9/26/2006_ 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 su_rface 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's*.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:_22 Fuller Road_ _North Andover Owner:_Masterson_ Date of Inspection: 9/26/2006_ 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. _No7 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 T 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 i 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_22 Fuller Road_ _North Andover_ Owner:_Masterson_ Date of Inspection:_9/26/2006_ 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? _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 Was 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 _N/A_ 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: 22 Fuller Road_ _North Andover– Owner:_Masterson_ Date of Inspection:_9/26/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): N/A Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203_N/A_ Number of current residents:_3 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no):_No Laundry system inspected(yes or no): _ –No– Laundry use:(yes or no):_No Water meter reading: Yes_ Sump pump(yes or no): Yes_ Last date of occupancy:_Current COMMERCIALIMUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):igpd 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:_1500_gallons--How was quantity pumped determined?_Measured tank Reason for pumping: _Inspect tank&tees_ 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 T Other(describe):_ Approximate age of all components,date installed(if known)and source of information:_Original,no plan at B.O.H._ 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: 22 Fuller Road— _North Andover_ Owner:_Masterson_ Date of Inspection:_9/26/2006 BUILDING SEWER_X_ (locate on site plan) Depth below grade:_22"_ Materials of construction: _Xcast 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 wall,3"PVC in house,no leaks. SEPTIC TANKS: X Depth below grade:_10" 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:—2"— epthT2"_ Distance from top of sludge to bottom of outlet tee or baffle:_N/A_ Scum thickness:_4" Distance from top of scum to top of outlet tee or baffle: N/A N/A=Outlet tee corroded off. Distance from bottom of scum to bottom of outlet tee or baffle:_N/A_ 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 tee ok.Outlet tee corroded off. Depth of liquid at outlet invert.No evidence of septic tank leaking._ GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 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: 22 Fuller Road, North Andover Owner: Masterson Date of Inspection: 9/26/2006 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. RNeil . Ba son Bateson Enterprises, Inc. Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 22 Fuller Road_ _North Andover_ Owner:_Masterson_ Date of Inspection: 9/26/2006_ 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:—18'x 40'field_ 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 oL Vegetation oL 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 infl_ow(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 ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 22 Fuller Road_ _North Andover Owner•_Masterson_ Date of Inspection:_9/26/2006_ 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 Garage House A B Water Meter Driveway Septic Tank D- Box A to Tank=3113" A to D-Box=4113" B to Tank=42' B to D-Box=36' Page 11 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 22 Fuller Road_ _North Andover Owner•_Masterson_ Date of Inspection: 9/26/2006_ 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: Obtained from system design plans on record-If checked,date of design plan reviewed:— 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) X Accessed USGS database-explain: Essex County Soil Map_ You must describe how you established the high ground water elevation:_Essex County Soil Map,Sheet#36, Hinckley Soil,Water>6'Deep_ Summary Record Card generated on 9/2512006 2:28:46 PM by Lisa Warren Page t Town of North Andover Tax Map # 210-065.0-0073-0000.0 22 FULLER ROAD MASTERSON, WILLIAM 22 FULLER ROAD N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.21 Acres FY 2007 US Mailing Index Name/Address Type Loan Number Active/Inact. From Until MASTERSON,WILLIAM Payor 22 FULLER ROAD N. ANDOVER, MA 01845 US Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17215.0-22 FULLER ROAD Last Billing Date 7/5/2006 3160293 03 Cycle 03 Active US Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 210.90 /1 US Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 32707569 a Active ERT HH b Badger w Water 0.63 0.63 Date Reading Code Consumption Posted Date Variance 9/6/2006 134 a Actual "79 70% 6/12/2006 55 a Actual 47 7/10/2006 136% 3/17/2006 8 a Actual 8 4/17/2006 -100% 2/10/2006 0 n New Meter 0 4/17/2006 -100% 2/10/2006 6206 r Replacement `173 4/17/2006x- 458% 12/15/2005 6033 m Manual estimate 50 1/17/2006 8% MSG 9/14/2005 5983 m Manual estimate 50 10/14/2005 -5% MSG 6/7/2005 5933 m Manual estimate 50 7/15/2005 3% MSG 3/5/2005 5883 m Manual estimate 45 4/5/2005 -13% MSG 12/8/2004 5838 m Manual estimate 50 1/14/2005 17% 9/15/2004 5788 m Manual estimate 50 10/8/2004 -39% 6/9/2004 5738 a Actual 46 7/30/2004 135% Trouble Code:03 4/15/2004 5692 a Actual 47 5/17/2004 0% CERAMIC T1Lr HALF WALL EXISTING WF--r WALL NEW "DROP-IN'' TUI3 UNIT TILT CURC3 FXT'G• �XT'G• - - - - - -- - - - -- - - -- - - - -- - - - - -- - - - - - -_ - - _ _ - - - --- - AT�NTIZI WINDOW WINDOW 26" X 6$CLAWI%OOT (1113 = I I - - _-_-_-_- -_ _—_-_-_- -_- -_-_ —_ _- _ -_- -_ -__-__ :I:I II - - - - - - - -- - - - - - - ---- - - - - - - - - - - -- - - - - - --- :I: Cl II _-_- - - --_ -_-- - - - - -- -- _ -_-- -- - - -_-_- - -_- - - - - I I - - - - -- --- - il /,---NFW5Ut2lN4�- - - - -- --- - - -- _ - - - = N�W�XHAU5TF5— - - - - - _ _ _ _ SHOWEI?P p HARP PUCTr;PTOF-XT MOR - - - - --- - - -- - -- - -- - --- - - - - -- - - - - - - - - - - - -- - - - -- -- - - - -- - -- - - - - - - - - - - - - - -- - - - (9 13ATH == - - _= = = _ ______ _ ____=__ _= = = = == 4' VANITY- - - - - 13ATH G ________________-_ _______ 5UMP t21.5GHAP.GE PIPING ° CAMS � REMOVE EXISTING WALL • N N 30" X 30"X 12"sTcoLunn 2 r N _ — — — — — — — — 1 FOLY2EI2 CONCteTE FOOTING { I I 3 " 171A.0TF FlCOL-U — r � 1/2 - - - - - - - - - ll�n ��l � � $ _ _ _ _ _ _ __— — MASONRY CHIMNEY ` l I I r - - - - - -L - J i ,M I I I I I I 9' X 7' OH DOOR I N I I ( I CEJ i 2 -2 X12HEAPEEK I I I I QV 9X 7' OH DOOR 9' X 7' OH DOOR Oak + + (� 2 - 2X12HEAPF-R 2 - 2X 12HEAMR 12'-O" O IST�LI ���5� ����� ��� OCT4:2 6 TOWN Fr N. i SUMP 1215CHAP6F PIPING 2 REMOVE EXISTING WALE �FA ` N \'� //oo / N U� (,69 f�Gt BOJ 30" X30" X 12" ^ - - r FOOW CONCRETe F0011NG 1 — Uv '5112" IIIA.CONCMTT; FILL P 5TEEL GOLWMN� MASONRY CHIMNEY r- - - - - - - - � _J- - - - - - - - - o I to 9' X 7' OH 1200P 2 — 2 X 12 HEADER 9' X 7' OH 1200P 9' X 7' OH POOR + + 2,- 2X 12 HEADER 2 - 2X 12 HEADER O 15TPL1 'ef OCT - 4 2006 TO VN OF N'•.j-1I/,N )O`t R HEALTF4 a :,�KT`.'c N i _ TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: L4—,29—UP— SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) 04-ccso V�,- �,4 �,A- 0-� FLI�er 2) DATE OF PUMPING: -Q;LOUANTITY PUMPED t,SQ 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: ts�—� COMMENTS: CONTENTS TRANSFERRED TO: Commonwealth of Massachusetts Massachusetts System Pumping Record System Owner System Location Date of Pumping: �,� ^ ��� � Quantity Pumped: �'�gallons Cesspool: No ]� Yes [] Septic Tank: No [] Yes [-- System Pumped by: 64&4" License# Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from. Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ********************APPLICANT FILLS OUT THIS ;APPLICANT W;LL( coM145t&-j050AJ PHONE C1-78-5r7 -;75Z::) LOCATION: Assessor's Map Number 065— PARCEL 00 7, SUBDIVISION LOT (S) STREET 22- FZt L L e72- eo X4-7 ST. NUMBER 2Z * * �* ******OFFICIAL USE R MMENDATIO OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED 1( �� �1 S cP-�-�� S�57c►� / DATE REJECTED ✓ COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED I COMMENTS FOOD INSP TOR-HEALTH DATE APPROVED DATE REJECTED E. C SPECTO - EAL - DATE APPROVED DATE REJECTED i COMMENTS /4/l ��✓� � ��_ �� Zdr�� Src. PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED EY EUILDING i�ISPECTOR DATE Revised 419;jm 11/'_'9/99Ftj ]9:a6 FAA 001 TEC, (508) 475-1474 FAX; (508) 4/75-5451 BATESON ENTERPRISES, INC. Excavating-Water& Sewer!.!rtes-Septic Systems &Pumping Sef%'Ice 111 Argi Ila Road Andover, Mass. 01810 � SSiON FAX #: (ql-g) I (U l(a PAGES: 1 ,INCLUDING cowit sHM FRONT TODD BATESON SUBJECT: r tci S't-P��cv� c ce �ar i3 t t i �,uc:- t l vl� TOWN OF I� SYSTEM PUMP G RECORD DATE:_ SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) fU�a��-eC SUS. J te-4 -f0'- W Pj DATE OF PUMPING: -D-Q-DA QUANTITY PUMPED : _ G LONS 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: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D1 Lowell Waste FG�c L E.e Rn• 6.yrsE�y,�Nr _t ar 33 �, � 1� 71 3A) im dS C1 r 1 � ��xglo Vare 30Z- OF ' o v, • C2 VND This plan,was.rigt.pre�are-frot .an Instrument survey, Offsets and distances shown should not LOCATION: 2A be=used to establish-property lines. V. AA1jQhC WF-,e This plan is intended for mortgage.purposes only... SCALE: =¢a ' DATE; 46-6-87 :1-C ertify.tha t.the structure shown on this REGISTRY-- Plan-.A`. in conformance with the zoning TITLE REFERENCE: aza-1,o vy PGax setbacks.In-effect at the time.of construction. PLAN REFERENCE: - �•�G7v3 certify.that.the parcel shown is .yim- located.within'a flood hazard area'as depicted COREY & DONAHUE, INC. -on FEMA.Flood.Insurance Rate Maps for nelneers t Survtynr, Community No: Asea 9R In8 Cambridge Rnad,«ahnm,MA Of 901 Conn lonweallb of htassachusetls �assaclitisel(s liyst@L Pu!nging Record System Owner System Location - - -- r3 Date of Pumping: t-7 Qllaiklity I'unII)Cd: Cesspool. No �N'es l � � � Septic Iauk Nu ( � ties Syslem Pumped by: L arwate gitrve 61ije j Conlenls Uanslei�red lu : Greater a4nlre�lce 8a�lt4SY 1�I_sylcl, .._._- -._. _._______—__ Date: ------- ------------------- lnspeclur: -- ---- - - -- --------- Commonwealth of Massachusetts City/Town of System Pumping Record �� 15 C011 w Form 4 L02 N OF NORTH ANDOVEjh DEP has provided this form for use by local Boards of Health. Other Information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Locati : Left Rig ront of hou eft/Right rear of house, Left/right side of house, Left/ Right side of bu- g, Left/Right front of building, Left/Right rear of building, Under deck Address \ y (�� City/Town state Zip Code 2. System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record Cv -�jl - �( �S✓'Gv 1. Date of Pumping 2. Quantity Pumped: Date _ Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes D-1 If yes, was it cleaned? ❑ Yes ❑ No 5. Conditign qfo System: p 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location _ . e contents were disposed: 'G L S.P Q Lowell Waste Water L4JIT &)QZ - I - ( Signitufe I Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1