HomeMy WebLinkAboutMiscellaneous - 221 CAMPBELL ROAD 4/30/2018 (2) J 221 CAMPBELL ROAD
210/106.8-0075-0000.0
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North Andover Board of Assessors Public Access Page 1 of 1 k
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PORT" North Andover Board of Assessors
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SS"CHUB` roperty Record Card
Click Seal To Return Parcel ID:210/106.B-0075-0000.0 FY:2009 Community:North Andover
SKETCH PHOTO
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Summary
Residence
Detached Structure
Condo
221 CAMRELL ROAD
Commercial
Location: 221 CAMPBELL ROAD
Owner Name: PARKER,WALTER J
PATRICIA A PARKER
Owner Address: 221 CAMPBELL 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: 1184 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 412,700 422,500
Building Value: 186,300 196,100
Land Value: 226,400 226,400
Market Land Value: 226,400
Chapter Land Value:
LATEST SALE
Sale Price: 1 Sale 03/26/1998 -
Date:
Arms Length Sale
Code: F-NO-CONVNIENT Grantor: WALTER PARKER
Cert Doc: Book: 05003 Page: 0001
http://csc-ma.us/PROPAPP/display.do?linkld=1465283&town=NandoverPubAcc 7/22/2009
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Residential Property Record Card
PARCEL_ID:210/106.B-0075-0000.0 MAP:106.B BLOCK:0075 LOT:0000.0 PARCEL ADDRESS:221 CAMPBELL ROAD FY:2009
PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 05003 Road Type: T Inspect Date: 09/18/2003
Tax Class: T Sale Date: 03/26/98 Page: 0001 Rd Condition: P Meas Date:
Owner: Tot Fin Area: 1184 Sale Type: P Cert/Doc: Traffic: M Entrance:
PARKER,WALTER J Tot Land Area: 1.21 Sale Valid: F Water: Collect Id: RRC
PATRICIA A PARKER Grantor: WALTER PARKER Sewer: Inspect Reas: ,A.
Address:
221 CAMPBELL ROAD Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% /
NORTH ANDOVER MA 01845
{ RESIDENCE INFORMATION LAND INFORMATION
Style: RR Tot Rooms: 6 Main Fn Area: 1184 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R2
Story Height: 1.00 Bedrooms: 3 Up Fn Area: Bsmt Area: 1104 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class
Roof: G Full Baths: 1 Add Fn Area: Fn Bsmt Area: 796 1 P 101 S 43560 1.000 224,769
Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0 0.210 1,596
Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 1184 VALUATION INFORMATION
i Foundation: CN Bath Qual: T RCNLD: 186284 Current Total: 412,700 Bldg: 186,300 Land: 226,400 MktLnd: 226,400
Kitch Qual: T Eff Yr Built: 1980 Mkt Adj: Prior Total: 422,500 Bldg: 196,100 Land: 226,400 MktLnd: 226,400
Heat Type: HW Ext Kitch: Year Built: 1978 Sound Value:
Fuel Type: O Grade: AG Cost Bldg: 186,300
Fireplace: 1 Bsmt Gar Cap: Condition: A Aft Str Val 1:
Central AC: N Bsmt Gar SF: Pct Complete: Aft Str Va12:
Aft Gar SF: %Good P/F/E/R: /100/100/85
Porch Type Porch Area Porch Grade Factor
P 144
SKETCH PHOTO
12
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12 144 Sq.1122
FM
22 1184 Sq.Ft
14 308 Sq.Ft 14
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Parcel ID:210/106.B-0075-0000.0 as of 7/22/09 Page 1 of 1
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Town of North Andover
{r `ti'•�,; o::• HEALTH DEPARTMENT
CHECK#: (. D TE:
LOCATION: lie
H/O NAME:
CONTRACTOR NAME: +.�+
Type of Permit or License: (Check box)
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❑ Animal $
❑ Body Art Establishment $
❑ Body Art Practitioner $
❑ Dumpster $
❑ Food Service-Type: $
❑ Funeral Directors $
❑ Massage Establishment $
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❑ Massage Practice $
❑ Offal(Septic)Hauler $
❑ Recreational Camp $
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❑ Sun tanning $
I ❑ Swimming Pool $
❑ Tobacco $
+ ❑ TrashlSolid Waste Hauler $
F
❑ Well Construction $
SEPTIC Systems:
❑ Septic-Soil Testing $
P
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
Title{r'Report $S �>
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4 ❑ Other:(Indicate) $
Health Agent Initials
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White-Applicant Yellow-Health Pink-Treasurer
PETER F. REILLY RECEIVED
136 ANDOVER STREET C,4
ANDOVER, MA 01810 JUN 12 2009
(978) 375-3750 TOW40F NORTH ANDOVER
HEALTH DEPARTMENT
TITLE V
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART A- CERTIFICATION
Property Address: 221 Campbell Road, North Andover, MA 01845
Name of Owner: Walter and Patricia Parker
Address of Owner: same
Name of Inspector: Peter F. Reilly j
Company Name: same
Mailing Address: 136 Andover Street, Andover, MA 01810
Telephone Number: (978) 375-3750
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 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
N/A Conditionally Passes
N/A
Needs Further Evaluation By the Local Approving Authority
N/A Fails
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Inspector's Signature: Date: May 29, 2009
PEkgr F. Reilly
The system inspector shall submit a copy of this inspection reportto the Approving Authority(Board
of Health or DEP)within thirty (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
submitthe reportto the regional office of the DEP.The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority. I
NOTES AND COMMENTS
****This report only describes conditions a the time ofinspection and under 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 (See attached Disclaimer).
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART A- CERTIFICATION (continued)
Property Address: 221 Campbell Road, North Andover
Owner's Name: Parker
Date of Inspection: 5/29/2009
INSPECTION SUMMARY:
A. SYSTEM PASSES: Check A, B, C, D, or E /ALWAYS complete all of Section D
✓ I have not found any information which indicates that the system violates any of the failure criteria as
defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
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COMMENTS:
The system met the Pass Criteria of Title V. Originally, the inspection was a conditional pass, but the
septic tank and distribution box were replaced following the inspection.
B. SYSTEM CONDITIONALLY PASSES:
N/A 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). Describe basis of determination in all instances. If "not
determined", explain why not)
N The septic tank is metal, and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass
inspection if the existing septic 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 a sewage backup or breakout or high static water level in the distribution box is due to
broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will
pass inspection if(with approval of the Board of Health):
N/A broken pipe(s) are replaced
N/A obstruction is removed
N/A 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):
N/A broken pipe(s) are replaced
N/A obstruction is removed
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OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART A- CERTIFICATION (continued)
Property Address: 221 Campbell Road, North Andover
Owner's Name: Parker
Date of Inspection: 5/29/2009
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 the public health, safety and 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:
N/A Cesspool of privy is within 50 feet of a surface water
N/A Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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:
N/A The system has a septic tank and soil absorption system (SAS) and the SAS is within 100
feet to a surface water supply or tributary to a surface water supply.
N/A The system has a septic tank and SAS and the SAS is within a Zone I of a public water
supply well.
N/A The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply
well.
N/A The system has a septic tank and SAS the SAS is less than 100 feet but 50 feet or more from
a private water supply well.**Method used to determine distance N/A
This system passes if the water well water analysis, performed at a certified DEP 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. A copy of the analysis must be attached to this form.
3. Other
N/A
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART A- CERTIFICATION continued
Property Address: 221 Campbell Road, North Andover
Owner's Name: Parker
Date of Inspection: 5/29/2009
D. System Failure Criteria applicable to all systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
No Backup of sewage into facility or system component due to an 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.
N/A Liquid depth in cesspool less than 6"below invert or available volume<'/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:once
No Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
N/A Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
N/A Any portion of a cesspool or privy is within a Zone I of a private water supply well.
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well.
N/A 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 laboratory, for coliform bacteria, volatile organic compounds,
ammonia nitrogen and nitrate nitrogen is less than 5 ppm,provided that no otherfailure criteria
are triggered.A copy of the analysis must be attached to this form).
N/A The system fails. I have determined that one or more of the above failure criteria exist as defined
in 310 CMR 15.303, therefore the system fails. The property owner should contact the Board of
Health should be contacted 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 a large system in addition to the criteria above)
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N/A The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant
threat to public health and safety and the environment because one or more of the following conditions
exist:
Yes No
N/A The system is within 400 feet of a surface drinking water supply
N/A The system is within 200 feet of a tributary to a surface drinking water supply
N/A The system is located in a nitrogen sensitive area (Interim Wellhead Area - IWPA) or a mapped
Zone 11 of a public water supply well)
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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 such 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.
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OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART B - CHECKLIST
Property Address: 221 Campbell Road, North Andover
Owner's Name: Parker
Date of Inspection: 5/29/2009
Check if the following have been done. You must indicate either"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 flow 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 ? (If they were available note as
N/A)
Yes Was the facility or dwelling was inspected for signs of sewage backup ?
Yes Was the site was inspected for signs of breakout?
Yes Were all system components, excluding the SAS, located on the site?
Yes Were the septic tank manholes uncovered, opened and the interior of the septic tank
inspected for condition of baffles or tees, material of construction,dimensions, depth of liquid,
depth of sludge, depth of scum?
Yes Was the facility owner(and occupants of if different from the owner) provided information on
the proper maintenance of subsurface sewerage 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. For example, a plan at the Board of Health.
N/A Determined in the field if any of the failure criteria related to Part C is at issue(approximation
of distance is unacceptable) [15.302(3)(b)].
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OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL S OSAL INSPECTION FORM
PART C - SYSTEM INFORMATION
Property Address: 221 Campbell Road, North Andover
Owners Name: Parker
Date of Inspection: 5/29/2009
FLOW CONDITIONS
RESIDENTIAL:
Number of bedrooms(design): 4
Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203
(for example: 110 gpd x#of bedrooms: 440 gpd
Number of Current residents: 2
Does the residence have a garbage grinder(yes or no): no
Is the laundry on a separate sewerage system (yes or no): no (if yes,separate inspection required)
Laundry system inspected (yes or no): N/A
Seasonal use(yes or no): no
Water meter readings, if available(last 2 years usage[gpdj): about 100 gpd
Sump Pump(yes or no): no
Last s date of occupancy: current
COMMERCIAL/INDUSTRIAL:
Type of Establishment: N/A
Design Flow gpd (based on 15.203): N/A
Basis of Design Flow(seats/persons/sq.ft.,etc): N/A
Grease trap present(yes or no): N/A
Industrial waste holding tank present(yes or no): N/A
Non-sanitary waste discharged to the
Title 5 system (yes or no): N/A
Water meter readings, if available: N/A
Last date of occupancy/use: N/A
OTHER: (Describe) N/A
GENERAL INFORMATION
PUMPING RECORDS
Source of Information: Owner not sure BOH records: 1/2004
Was system pumped as part of inspection (yes or no): no
if yes,volume pumped(gallons): N/A
How was quantity pumped determined? N/A
Reason for pumping: N/A
TYPE OF SYSTEM
✓ Septic tank/distribution box, soil absorption system
Single cesspool
Overflow cesspool
Privy
NO 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 the 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:original system installed
in 1976. Design plan dated 6-13-1976.
Were sewerage odors detected when arriving at the site (yes of no): no
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OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C - SYSTEM INFORMATION (continued)
Property Address: 221 Campbell Road, North Andover
Owner's Name: Parker
Date of Inspection: 5/29/2009
BUILDING SEWER: (locate on site plan)
Depth below grade: about 6"-8 "
Materials of construction: cast iron ✓40 PVC other(explain)
Distance from private water supply well or suction line N/A
Diameter: 4"
Comments: Condition of joints, venting, evidence of leakage, etc.) t
Building sewer was watertight and appeared sound at foundation.
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: about 4"-6"
Material of construction: ✓ concrete metal Fiberglass Polyethylene other(explain)
If tank is metal, list age N/A Is age confirmed by Certificate of Compliance N/A(Yes/No)
Dimensions: Rectangular- 1,000 gallons
Sludge depth: <111k
Distance from top of sludge to bottom of outlet tee or baffle: 28"
Scum thickness: <11f
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: 16"
How dimensions were determined: observation
Comments:(on pumping recommendations,of inlet and outlet tees or baffle condition,structural integrity, liquid
level as related to outlet invert, evidence of leakage, etc.)
Tank was water tight and appeared to be functioning properly.
GREASE TRAP: N/A (locate on site plan) f
Depth below grade:
material of construction: concrete metal FRP other(explain)
Dimensions: N/A
Scum thickness: N/A
Distance from top of scum to top of outlet tee or baffle: N/A
Distance from bottom of scum to bottom of outlet tee or baffle: N/A
Date of Last Pumping: N/A
Comments:(on pumping recommendations,of inlet and outlet tees or baffle condition,structural integrity, liquid
level as related to outlet invert, evidence of leakage, etc.)
N/A
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C - SYSTEM INFORMATION (continued)
Property Address: 221 Campbell Road, North Andover
Owner's Name: Parker
Date of Inspection: 5/29/2009
TIGHT or HOLDING TANK: N/A(tank must beum ed at time of inspection) (locate p p p ) ( ate on site plan)
Depth below grade: N/A
material of construction: concrete metal Fiberglass Polyethylene other(explain)
Dimensions: N/A
Capacity: N/A gallons
Design Flow: N/A gallons per day
Alarm Present(yes or no): N/A
Alarm level: N/A
Alarm in working order(yes or no): N/A
Date of last pumping: N/A
Comments: (condition of alarm and float switches, etc.)
N/A
DISTRIBUTION BOX: ✓ (locate on site plan)
0" depth of liquid above outlet invert
Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out
of box, recommendation for repairs, etc.)
D-box was level. Four lines leading to SAS were accepting effluent evenly. Minimal solids carryover evident.
The d-box appeared to be recently replaced. The owner said that the box was replaced following damage
resulting from ledge blasting for the water service.
PUMP CHAMBER: N/A(locate on site plan)
Pumps in working order(yes or no) N/A
Alarms in working order(yes or no) N/A
Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.)
not applicable
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OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C - SYSTEM INFORMATION (continued)
Property Address: 221 Campbell Road, North Andover
Owner's Name: Parker
Date of Inspection: 5/29/2009
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan, if possible;excavation not required)
If SAS not located, explain why:
Type
leaching pits, number N/A
leaching chambers and number N/A I
leaching galleries and number N/A
leaching trenches, number, length N/A
✓ leaching fields, number, dimensions 1 field, 900 square feet(per design plan)
overflow cesspool, number N/A
alternative system (name of technology) N/A
Comments: (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.)
Soils in area of SAS appeared normal, no signs of breakout.
CESSPOOLS: N/A (locate on site plan)
Number and configuration N/A
Depth-top of liquid to inlet invert N/A
Depth of solids layer N/A
Depth of scum layer N/A
Dimensions of cesspool N/A
Materials of construction N/A
Indication of groundwater inflow(cesspool
must be pumped as part of inspection) N/A
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
recommendations for maintenance or repairs, etc.)
not applicable
PRIVY: N/A (locate on site plan)
Materials of construction N/A
Dimensions N/A
Depth of solids N/A
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
recommendations for maintenance or repairs, etc.)
not applicable
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
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PART C - SYSTEM INFORMATION (continued)
Property Address: 221 Campbell Road, North Andover
Owners Name: Parker
Date of Inspection: 5/29/2009
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Provide a sketch of the sewerage disposal system including ties to at least two permanent reference landmarks
or benchmarks. Locate all wells within 100'. The dwelling is not connected to town water and the domestic well
is no longer in use.
APP.
HOUSE ER
A
SEPTIC
TANK
FRONT
YARD
SAS— � �_ - d-Box
CAMPBELL ROAD
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SEPTIC TANK TIES: A to Tank 4610" B to Tank 1016"
D-BOX TIES: A to Box 7718" B to Box 37'10"
NOTE: The system is in the front yard.
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OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C - SYSTEM INFORMATION (continued)
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Property Address: 221 Campbell Road, North Andover
Owner's Name: Parker
Date of Inspection: 5/29/2009
SITE EXAM
Slope Flat to gently sloping in area of SAS
Surface water none observed
Check cellar dry
Shallow wells none observed
Estimated Depth to Groundwater >1 (below bottom of SAS)
Please indicate (check) all methods used to determine the high ground water elevation:
Y Obtained from Design Plans on record - if checked, date of design plan reviewed: 6/13/1976
Y Observed site (abutting property, observation hole within 150 feet of SAS)
Y Check with Local Board of Health - explain: information on file
Y Check local excavators, installers - (attach documentation)
N Accessed USGS Database - explain: website too complicated
You must describe how you established the high ground water elevation.*
The June 1976 design Ian indicated
that groundwater separation was
adequate. However, the
precise groundwater elevation cannot be determined for certain without a soil evaluation test.
*Inspector's Note: Soil Evaluation is the currently recognized method for determining or
establishing the high groundwater elevation. Since I am not a licensed or certified soil evaluator, I
am not qualified to determine or establish the high groundwater elevation beyond the public
information available, such as recent design plans of the site or the nearby area. My estimation of
the high groundwater elevation is based on a due diligence effortto obtain all available information
both on and off the site and my experience as a certified subsurface disposal system inspector.
(see attached Disclaimer)
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e Y
DISCLAIMER
This passing septic inspection under Massachusetts Title V is in no way a
guaranty or warranty of the inspected septic system.The inspection is a p
sna shot
in time" and does not constitute a complete assessment of the quality or potential
longevity of the septic stem.The ass/fail
g Y criteria are specific P Y p p c and outlined in detail in ,
this report. Underthe limited criteria of a Title V inspection, it is impossible to determine
how long any septic system will last. The inspector made a diligent effort to certify the
septic system based on the criteria required under Title V.
Under Massachusetts Title V, soil evaluation is the accepted method of determining the
high groundwater elevation. This inspector is not a certified soil evaluator and is
therefore not qualified under Title V to determine or establish the high groundwater i
elevation. The method used to estimate the high groundwater for this inspection was
based on the public records and methods of observation described on the previous
page. Groundwater levels can vary greatly from season to season, yearto year and soil
evaluation is considered the most reliable method of groundwater determination under
Title V.
i
Peter F. Reilly
Inspector
May 29, 2009
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Farm 4 -- System Pumping Record
Commonwealth of Massaehusetss
Massachusetts
System Pumping Record
System Owner System Location
Type: Emergency Routine
Cesspool: No Yes Septic tank: No Yes r
Date of Pumping: /tj Quantity Pumped: ��� Gallons
System Pumped By: Wind Neer E Wmmnental LLC Permit#:
Contents transferred to:
L
Contents Disposed at:
Date: Pumper Signature:
Condition of Systemkther Comments
Dep Approved Form - 12/07/95
FORM h-SYSTRM PUMPING ItE('r>ftn
CURRIER
SEPTIC & DRAIN' SERVICE
107 FOREST S1'RE17 MI,DDLETON,MA 01949
(978) 77/4-27172
COWN40NWEALTH OF NLASSACHUSETTS
�� __ ✓c'�`� �,MASSACHUSETTS
S TA TEAL PUMPING Af CORD
SYSTEM OWNER: -� �SY—_
1 STEN!.LOCATIONS:
be I(
DATE OF PU�ti1T'�'G: /l tr _ QUANTITY PUMPED: ASO GALLONS
_-
CESSPOOL: NO EYES SEPTIC.TANK: NO YES +�I�
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SYSTEM PLT'vIPED BY: CURRIER SEPTIC & DRAUN SERVICE
CONTENTS TRANTSFERRF:D T0:
DA'TF,„ _ INSPECTOR: ���t
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is
�CU ER FORM 4-SYSTEM PUMPING RECORD
SEPTIC & DRAIN SERVICE
107 FOREST STREET; MIDDLETON,MA 01949
(978) 774-2772
I
C
COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS
TS �
SYSTEM PUMPING RECORD
SYSTEM OWNER: SYSTEM LOCATION:
�3 7,`�6
67rc
DATE OF PUMPING: 1} UANTITY PUMPED: GALLONS
CESSPOOL: NO EYES SEPTIC TANK: NO YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO:__ �
DATE: INSPECTOR:
o q�pRTy
9 ��y?
TO: NORTH ANDOVER, MASS ' 19 7C
BOARD OF HEALTH
FROM: DESIGN ENGINEER Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
/)AFL L R D North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
7,.
��\NsS IVA/
69b � Od
eg. P f Afpl 6 fig. itarian ,
-
s SOIL PROFILE & PERCOLATION TEST DATA
Town/City No.&Street e- - Lot No.�
Jqq
♦ Loc./Subdiv. Plan Owner .2 GtJ •' /e.-
4
Investigator G/�D Observer
/ 761 SOIL PROFILES-DATE
�✓ 4.
1°
Elev._ ?° Elev. 3° Elev. - Elev.�
0 0 0 0
c
2 2 2 2
3 3 3 3 � � t
4 4 4 4 b
5 5 5
6 6 6 J�
47 7 >
8 8 8 8
9 9 NJ Q�
9 9 � �
1 �
10 10 10 10 N �Q
Eenchmark Location
Elevation Datum
Percolation Tests-Date
_Pit Number 1 Q 2 3 4 5
Start Saturation �
Soal':-Mins.
Start Test-Time
Drop of 3"-Time !G
Drop of 6"-Time
Mins.lst 3"Dro /r1�h
Mins.2nd 3"Dro
Notes & Sketches on Back Frank C. Gelinas & Associates, North And.
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DelleChiaie, Pamela
From: cheryl.tanguay@gmail.com on behalf of Cheryl Tanguay[cheryl@eHomesGrp.com]
Sent: Wednesday, July 22, 2009 3:08 PM
To: DelleChiaie, Pamela
Subject: 221 Campbell Ave information needed
Hi, Pamela,
Thank you for the updated information on 53 Cedar Lane.
RE: 221 Campbell Ave: Could you verify the age of the system(It's noted in MLS as being Title V approved)
and the location of the system relative to the driveway-end of the house.
Thank you, again.
Cheryl
Cheryl Tanguay
Broker-Partner, Realtor, CRS, GRI, ABR, SRES
Licensed to Practice Real Estate in MA&NH
Serving Boston's North Shore and NH Seacoast with Real Estate Solutions Nationwide!
Nothing is more precious to our business than a kind referral from a loyal friend.
Know someone behind on payments?Have them call us quickly so they know their options... we can help!
(978) 356-6300 phone/fax
(978) 233-2834 direct/fax
cheryl keHomesGrp.com
Exclusive Homes Group with Keller Williams Realty
40-42 Main Street, Topsfield, MA 01983
Our Team:
Meredith Tanguay, Realtor Partner, CRS,ABR, SRES, CNHS mergeHomesGrp.com
& Partners
ATTENTION! The information contained in this email may be CONFIDENTIAL and PRIVILEGED. It is
intended for the individual or entity named above. If you are not the intended recipient,please be notified that
any use,review, distribution or copying of this email is strictly prohibited. If you have received this email by
error,please delete it and notify the sender immediately. Thank you.
i
DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Wednesday, July 22, 2009 3:29 PM
To: 'cheryl.tang uay@gmail.com'; 'Cheryl Tanguay'
Subject: I.R. -Septic File- Health Department-221 Campbell Road
Attachments: I.R. -Septic-221 Campbell Road -Plan Design- Page 1 &3-dated 6/13/76; I.R. -Septic-
221 Campbell Road - Plan Design-Page 2-dated 6/13/1976; I.R. -Septic-221 Campbell
Road -Soil Testing Information -6/8/1976; I.R. -Septic-221 Campbell Road -Original
Design Sign-Off; I.R. -Septic-221 Campbell Road -Title 5 dated 5/29/09- 11 pages
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DelleChiaie, Pamela
From: noreply@townofnorthandover.com
i
Sent: Wednesday, July 22, 2009 4:08 PM
To: DelleChiaie, Pamela
Subject: I.R. -Septic-221 Campbell Road - Plan Design -Page 1 &3-dated 6/13/76
Attachments: SKMBT_60009072215072.pdf
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DelleChiaie, Pamela
From: noreply@townofnorthandover.com
Sent: Wednesday, July 22, 2009 4:08 PM
To: DelleChiaie, Pamela
Subject: I.R. -Septic-221 Campbell Road - Plan Design-Page 2-dated 6/13/1976
Attachments: SKMBT_60009072215080.pdf
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DelleChiaie, Pamela
From: noreply@townofnorthandover.com
Sent: Wednesday, July 22, 2009 4:09 PM
To: DelleChiaie, Pamela
Subject: I.R. -Septic-221 Campbell Road -Soil Testing Information-6/8/1976
Attachments: SKMBT_60009072215081.pdf
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DelleChiaie, Pamela
From: noreply@townofnorthandover.com
Sent: Wednesday, July 22, 2009 4:09 PM
To: DelleChiaie, Pamela
Subject: I.R. -Septic-221 Campbell Road -Original Design Sign-Off
Attachments: SKMBT_60009072215082.pdf
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DelleChiaie, Pamela
From: noreply@townofnorthandover.com
Sent: Wednesday, July 22, 2009 4:09 PM
To: DelleChiaie, Pamela
Subject: I.R. -Septic-221 Campbell Road -Title 5 dated 5/29/09- 11 pages
Attachments: SKMBT_60009072215083.pdf
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Commonwealth of Massachusetts
City/Town of REcl1f
a° System Pumping Record
Form 4 APR �Q 2011
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. Other forms mig aah&FLWWENT
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left front of ho a rig f front of house side of house, right side of house, Left
rear of house, right rear of house, left side of building, right rear of building, under deck.
';�a f P-4 klw� 4-1�
City/Town State Zip Code
2. System Owner:
Name
Address(if different from location)
City/Town ,.Zip Code
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):
I
4. Effluent Tee Filter present? ❑ Yes leo If yes, was it cleaned? ❑ Yes ❑ No
5. Conditi n of System: I
f \ �A- 47E�-
6. System Pumped By:
Neil J. Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc.
Company
7. Locatio ere contents were disposed:
.L.S.D
LqWell Wast ter
;Sig—natur of a ler Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
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