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HomeMy WebLinkAboutMiscellaneous - 29 GRANVILLE LANE 4/30/2018 (2)6 0 < m 0 PM 0 0�' RLE 1W JCOpy PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 10/13/2015 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair of an On -Site Sewage Disposal System By: Robert Daigle At: 29 Granville Lane Map 106.0 Lot 0050 Norl� Andover, MA 01845 Tl4A ssuan�.e of this cer(iflQrte shall not bbe co trued as a guarantee that the system will function satisfactorily. 4ichele Grant J Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ,jORTo4 0 CHO PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System [-] constructed; repaired; RECEIVED X By: Rob C6.1 c i1c OCT 1 3 2015 (Print Name) I TOWN OF NORTH ANDOVER Located at: 2 9 6irranville L—AfNe HEALTH DEPARTMENT (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated '3kily to, Z015 and last revised on BI&I j 5 —, with a design flow of . +4:0 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 3 10. CNM 15.000, Title 5 and local regulations, and the fmal grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: '3/ 1 -7 1.5 Engineer Representative (Signature) JOVIM oor;n And — Print Name 15 Final Construction Inspection Date: 91Z 0 1 Engineer Representative (Signature) Morin And — Print Name (Signature) Date: 16 1=21 Installer: A AV — - /,—' Rob .j And — Print Name Engineer:_ (Signature) Date: 101("115 .3obn Morlm And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com C�q (�O�nvi, I �e_ Lan,( L Town of North Andover — Seyfic �ystem - AS -BUILT CHECKLIST 1) VAR changes to the design plan have been reflected and noted on the as -built plan 2) \.//As -built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans) 3) V/ Street Address, Assessor's Map and Lot Number 4) Lot Lines and Location of Dwellings served by the system 5) Locations, Elevations and Dimensions of As -built system components, including reserve (if applicable) 6) Ties to all tank openings, d -box, and leach area from dwelling or Permanent Structure Setback distances are shown on the as -built plan from system components to: 4 Subsurface, interceptor & foundation drains -Catch basins Property lines Dwellings or other structures Private water supply or irrigation wells Watercourses or wetlands 8) V Locations of Wells, Drains, Wetland Resource Areas within 150 feet of system 1 4 V -/ V JIN 9) Location of water, gas, electric lines, cable, control panel (if applicable) 10) Location of Structures within 6 Inches of Finished Grade 11) Original Stamp & Signature 12) V Location and holder of any easements which could impact the system 'D"C-1, NL�-;_ i &54VLZ�t 13) /Impervious Areas; Driveways, etc 14) _��North Arrow 15) d Location & Elevation of Benchmark used 16) TSTATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, ties, cover material; exposed component covers etc., shown on this as -built substantially qpce with the approvedplan and have determined that the break out elevations, if applicable, have been met. " Signature of Designer Date b. - "If a.STUCTURAL WALL IS PPMSEAT (NA 4.9) a Letter or statement on the as -built indica the wall - was or was not, constructed in accordance with the intended design and gU manufacturer's �E�Jficatiofls. Signature of Designer Date As of: Tuesday, October 13, 2015 North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 29 Granville Lane MAP: 106C LOT: 50 INSTALLER:Ro bert Daigle DESIGNER: John Morin PLAN DATE: 07/10/2015,rev. 8/6/2015 BOH APPROVAL DATE ON PLAN: 09/01/2015 INSPECTIONS TANK INSPECTION: 9/17/15 DATE OF BED BOTTOM INSPECTION: 9/17/15 DATE OF FINAL CONSTRUCTION INSPECTION: 9/ 5/15 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK N/A Contractor reports any_changes to design plan fKis7tiqg sep ic tank properl d - ti�q -- aban- onedj Internal plumbing all to one building sewer Z Topography not appreciably altered Z Building sewer in continuous grade, on compacted firm base Z Cleanouts per plan Z Bottom of tank hole has 6" stone base Z Weep hole plugged Z 1500 gallon tank has been installed H-10 loading Z Monolithic tank construction Z Water tightness of tank has been achieved by visual testing Z Inlet tee installed, centered under access port Outlet tee installed, centered under access port (effluent filter) 24" inch cover to finish grade installed over inlet & outlet access ports Neoprene boots around inlet & outlet Comments: DISTRIBUTION -BOX Z Installed on stable stone base Z H-20 D -Box N/A Inlet tee (if pumped or >0.08'/foot) Z Hydraulic cement around inlet & outlets Z Observed even distribution Z Speed levelers provided (not required) Z Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) Z Bottom of SAS excavated down to C soil layer, as provided on plan Z Size of SAS excavated as per plan Z Title 5 sand installed, if specified on plan Z 40 Mil HIDPE barrier installed Z Laterals installed and ends connected to header (and vented if impervious material above) Z Elevations of laterals and chambers installed as on approved plan Z Retaining wall (boulder) F� Final cover as per plan Comments: 25x55 with overdig, stakes 15'4" x 43'4", Heide from ConCom spoke to John Morin about it FINAL GRADE Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As -Built Plan BM = 102.39 HR= 5.83 HI = 108.22 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT at Cleanout 2.13 105.74 106.1 Septic Tank IN 5.54 102.33 102.20 Septic Tank OUT 5.91 101.96 101.95 Distribution Box IN 6.60 101.27 101.23 Distribution Box OUT 6.80 101.07 101.06 Lateral 1 TOP 6.92/7.16 Lateral 1 INVERT 100.95 / 100.71 100.93 100.70 Lateral 2 TOP 6.92/7.15 Lateral 2 INVERT 100.95 / 100.72 100.93 100.70 Lateral 3 TOP 6.93/7.15 Lateral 3 INVERT 100.94 / 100.72 100.93 100.70 Lateral 4 TOP 6.95/7.15 Lateral 4 INVERT 100.92 / 100.72 100.93 100.70 Bottom of Bed 100.22 100.20 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback 1 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 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Tank SAS Sewer Z Property line 10 10 Z Cellar wall 10 20 Z Inground pool 10 20 Z Slab foundation 10 10 Z Deck, on footings, etc 5 10 -- Z Waterline 10 10 101 Z Private drinking well 75 1002 50 Z Irrigation well 75 100 Z Surface Water 25 50 Z Bordering Vegetated Wetland Salt Marsh, Inland / Coastal Bank 3 75 100 Z Wetlands bordering surface water supply or trib. (in Watershed) 150 150 Z Trib. to surface water supply 325 325 Z Public well 400 400 Z Interim Wellhead Prot. Area Z Reservoirs 400 400 Z Drains (wat. supply/trib.) 50 100 Z Drains (intercept g.w.) 25 50 Z Drains (Other) Foundation 10(5) 20(10) Z Drywells 20 25 1 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 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws — 01 - , Commonwealth of Massachusetts Map -Block -Lot 106.CO050 ----------------------- BOARD OF HEALTH Permit No North Andover - BHP -2015-03 - 67 ---- P.I. FEE F.I. $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Pemission is hereby granted -Robert- -Daigbe ----------------------------------------------------------------------------------------- to (Construct) an Individual Sewage Disposal System. atNo-2-9-GRANVILLE-LANE ------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. 6 Dated August 31, 2015 -co IF) IV ----------------------- --------------------------------------------- I ssued On: Aug -31 -201 5 BOARD OF HEALTH f Application for Septic Disposal System Construction Permit -TOWN OF TODAY'S 6ATE $ Q250..000) Fumil Repair NORTH ANDOVER, MA 01845 _ Co ponent Important: AgmlicatiotAis hereby made for a permit to: When filling out Construct a new on-site sewage disposal system* forms on the computer, use El Repair or replace an existing on-site sewage disposal system* only the tab key El Repair or replace an existing system component — What? to move your cursor - do not use the return A. Facility Information key. F '<'JaAA1'&Q tl,— Address or Lot # VtW --- �1 'j, "31f-vto-1 City/-rown 2.- *TYPE OF SE�ZIC SYSTEW: > El Pump [ErGravity (choose one) ***If pump system, attach copy of electrical permit to application*** > El Conventional System (pipe and stone system) > El Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.) > E] Pressure Distribution S.A.S. (No D -Box) > E] Pressure Dosed (D -Box Present) S.A.S. > El Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter?. YES = (no further info. needed) NO = (installer must specify brand of ffiter before DWC issuance) Wlha t is the Make? Wbat is the Model? RECEIVED 2. Owner Information 41 AUG 3 12015 A r- U� Name TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Address (if different from above) City/Town State Zip Code (6 Email address Telephone Number 3. Installer Information ggj.-t"" '3-, Name . Ili Name of Company izi " Alle, Address City/Town State Code Zip C1,3 3 Telephone Numrer (CeirPhone-lif possible please) 4. Designer Information AA "AZM &QUIP Name Name oLQ&mpup�- 447 Address k4e_" City/Town State Zip Code ft7 !&'ST'4 Telephone Number (Best# to Reach) Application for Disposal System Construction Permit Page 1 of 2 104 Application for Septic Disposal System Construction Permit -TOWN OF TODAY'S DA] E $ 250.00 - Full Repair NORTH ANDOVER, NU 01845 $125.00 - Component PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building: Z/Residential Dwelling or nCornmercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover. I understaqd that until a final Certificate of Compliance has been issued by this Board of H;ealth the litalled system is not approved. Name Date I VA tficm pproved a 'eait -e resentative) pid C�n 6 N,Ime Date Application Disapproved for the following reasons: For Office Use Oni L Fee Attacbed? yes__�Z_ No 2. Project Managet Obligation Fotm Attacbed? Yes 4/ No 3. Pump Sys P If so, Attach copy ofElectrical Pennit Yes No Appfican t Teceived copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewed approval letter, aLlpaparwork received? Yes No 5. Foundation As -Built? (new construction only): Yes No (same scale as approvedplan) 6. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit - Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 12 1 - &de J (Address of septic system) For plans by 2,41 Relative to the application of (Engineer) (Installer's nanl;�J And dated rigina ate Dated (I oday-s date) With revisions dated (Last revised date) I understand the f6flowing 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 al2proved 121ans 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 RegWations mgy result in a $50.00 fine being levied against me and/or my compAny. a. Bottom of Bed — Generally, d-iis is the first (V� inspection unless there is a retaining wan, 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: healthdel2t(@townofnorthandover. coin) 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 (otber 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 bv others unlicensed to install seDtic 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, siggificant fines to all 12ersons involved are also 12ossible. 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 bas been reacbed. b. Inspection of the sand and stone to be ased. c. Final inspection by Board of Healtb staff or consmItant. d. Installation of tank, D-Box,.pipes, stone, vent, pmmp cbamber, retaining xall and otber components. 6. As the installer, I understand that I am solely resl2onsible for the installation of the s)Estem as 12ef the a1212roved 121ans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) 4 it b f,col"� Ka ;, k, 1_tn. 7at-Ae — Print) V -, L) - I (Name — Signed) 41 th North Andover Board of Health Meeting Minutes Thursday — August 27,2015 ,d 7:00 p.m. 120 Main Street, 2 Floor Selectmen's Meeting Room North Andover, MA 01845 Present: Thomas Trowbridge, Larry Fixler, Frank MacMillan, Joseph McCarthy, Susan Sawyer, Michele Grant, Lisa Blackburn 1. CALL TO ORDER The meeting was called to order at 7:00 pm. II. PLEDGE OF ALLEGIANCE Ill. PUBLIC HEARINGS IV. APPROVAL OF MINUTES A. The meeting minutes from June 25,2015 will be presented for signature at the next 130H meeting. V. OLD BUSINESS V1. NEW BUSINESS A. 29 Granville Lane - John Morin representing the owners of 29 Granville Lane, requested a LUA to reduce the separation distance from the soil absorption system to the estimated seasonal high ground water table from 5' to 4' (3 10 CMR 15.405(l)(h)(2). Mr. Morin gave a detailed presentation including the background history on the current failed septic system and the location of the proposed new system. Due to an existing in -ground pool, wetlands and other issues, there wasn't a possibility to put the new septic system in the backyard. Although the back of the new system is about 4.8' above the water table which almost ineets the 5' s6t'back, the front of the system would require the LUA. The system will require a small block wall or b oulder retaining wall since the new system needs to be raised up. Dr. Trowbridge looked at the plan and asked for clarification on the lot lines. Dr. Trowbridge asked Mr. Ottenheimer, Milt River Consultant, if there were any issues as far as the abutting property or street were concerned. Mr. Ottenheimer stated there were not. Mr. Ottenheimer also stated that he thought that the design plan was well thought out and didn't see a reason for the LUA to not be granted. Dr. Trowbridge asked Mr. Morin if they needed to go before Conservation. Mr. Morin stated that they had to file with Conservation and that they were issued a permit. MOTION made by Dr. Macmillan to approve the LUA as requested and stated on the plan dated. Motionwas seconded by Mr. McCarthy. All in favor and the motion was approved. B. 700 Middleton St. - James Herrick, filling in for Jim Morin, representing the owners of 700 Middleton Street, requested: 1. A Local Upgrade Approval request to reduce the setback distance Erom the private well to the proposed leach field of 77 feet where 100 feet is required. (3 10 CMR 15.405(l)(g) 2015 North Andover Board of Health Meeting Page I of 4 Board of Health Members: Thomas Trowbridge, DDS, MD, Chairinan; Larry Fixler, Member/Clerk; Francis P. MacMillan,jr., M.D.joseph McCarthy, Member; Edvvin Pease, Member Health Department Staff: Susan Sawyer, Health Director; Debra Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector; Lisa Blackburn, Health Department Assistant Wa 2. A Local Upgrade Approval request is required to have only one test pit in the proposed leach field area where two are required. (3 10 CMR 15.405(l)(k) 3. A local Upgrade Approval request of setback distances of wetlands to a SAS of 51 feet where 100 feet is required. Mr. Herrick gave a detailed presentation regarding the failed septic system and the new proposed septic system. The new system will be generally in the same area of the existing failed system, which is the only place to put the system. Mr. Herrick stated that they filed a notice of intent with the Conservation Commission but has not met with them yet. They need the approval from Board of Health before they can go before Conservation. Mr. Herrick reviewed the proposed septic plan with the board members. Mr. McCarthy asked Mr. Herrick if the property has a well. Mr. Herrick stated that there is a well. The law requires a system to be 100 ft. from a private well to a proposed leach field area. The LUA of 77 ft. is being requested. Dan Ottenheimer, Mill River Consultant, stated that the risk of contamination of the well water is unique to each site, not the specific distance from the septic system. The state regulations list 100 ft. as an appropriate separation. Dr. Macmillan asked Mr. Ottenheimer if the board had enough information to respond to the LUA's and what would Mr. Ottenheimer suggest. Mr. Ottenheimer stated that is pursuant to the state rules, the town Board has authority to allow the distance reduction. He stated that there could be three possible answers. 1. Approve what was proposed, 2. Install a treatment system or 3. Approve what was proposed but have the well water monitored as in a sample drawn once a year. Mr. Herrick asked if there were samples drawn and the water was contaminated, how you would determine where the contamination came from. He stated that the current well is up gradient from the system. It would be difficult to prove that the new septic system is causing an impact to the well water. Mr. McCarthy asked if the new system is in the same area as the failed system. Mr. Herrick stated yes and that the failed system is 30 years old. Mr. McCarthy asked if the well water had been tested and Mr. Herrick stated he was unsure. Mr. Fixier suggested getting a water test now to get a baseline. Dr. Trowbridge looked at the plan and discussed the abutters to the property. It is very unlikely that they would have an impact the well water. A discussion ensued. regarding the impact the new septic system could have on the well. Dr. Trowbridge asked if the water tested clean now, but in 2 years came back contaminated, what would then be the Board's responsibility. A discussion ensued regarding a water treatment system. Mr. Herrick stated that the new system will be doing a betterjob than what is now there. Mr. Fixer asked what the approximate cost of a pre-treatment system would cost. Mr. Herrick replied that tanks cost around $8000 plus the electrical components and regular maintenance. Dr. Macmillan stated that he felt uncomfortable approving the LUA's without a pre-treatment system. Mr. McCarthy stated he isn't concerned and that he would feet comfortable approving the LUA's because the water flow path is away from the well. Dr. Macmillan stated that there are also wetlands on other sides of the property. Mr. McCarthy stated that it is an upgraded septic system and you can't prove that it will fail. The board then referred to Mr. Ottenheimer concerning the septic plans. Mr. Ottenheimer stated that they completed the initial review in June and didn't receive any revised plans until this week. There were two revisions that came in this week alone, There are still some technical questions that need to be considered. Dr. Trowbridge asked Mr. Herrick if there was any way of waiting until next month's BOH meeting to make a decision. Mr. Herrick was not aware of the schedule for the homeowner or others concerned. The Board will refer to Mr. Ottenheimer to work out the concerns with Mr. Herrick. A vote was made by Dr. Macmillan to table the request for the LUA's until thenext BOH meeting on the fourth Thursday of September. The vote was seconded by Mr. Fixier. All were in favor. C. 186 Ingalls St. - Vladimir Nemchenok, representing the owners of 186 Ingalls Street, requested two LUA. 1. Setback from S.A.S. to FDTN from 20'to 15' 2. Vertical offset from S.A.S. to E.S.W.T. from 41 to 3.51 Mr. Nemchenok gave a detailed presentation on the proposed new septic system and the existing well. A discussion ensued regarding the placement of the new system and the reasons for the requests. The new tank will be put in the same location but in a different angle. The septic is designed for a three bedroom house. Dr. Macmillan asked Mr. Ottenheimer what the best practices are in this situation, Mr. 2015 North Andover Board of Health Meeting Page 2 of 4 Board of Health Members: Thomas Trowbridge, DDS, MD, Chairman; Larry Fbiler, Member/Clerk; Francis P. MacMillanjr., M.D.joseph McCarthy, Member; Edwin Pease, Member Health Department Staff: Susan Sawyer, Health Director; Debra Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector, Lisa Blackburn, Health Department Assistant 0 North Andover Board of Health Meeting Minutes Thursday — August 27, 2015 7:00 p.m. 120 Main Street, 2 d Floor Selectmen's Meeting Room North Andover, MA 01845 Ottenheimerstated that he has done a thorough review of the proposed plan and what is being asked is not unreasonable. MOTION made by Dr. Macmillan to approve the LUA as requested and stated on the plan. Motion was seconded by Mr. Fixter., All in favor and th I c I motion was approved. VII. COMMUNICATIONS, ANNOUNCEMENTS, AND DISCUSSION A. A discussion regarding walk-ons to the BOH meetings. Mr. Ottenheimer stated that in the local regulation, section 8.4, it is stated that no hearing will be scheduled unless the design plan or other information submitted has been reviewed and found to be technically complete and accurate. This clearly addresses walk-ons to the BOH meetings unless considered an emergency. Michele Grant asked the board members if they would want an approved plan through Mill River pending any LUA's before having them come before the board. Dr. Trowbridge stated that in general it is the overall intent. Ms. Grant confirmed with the board that unless there is an emergency, written notice needs to be given before the meeting agenda deadline along with an approvable plan through Mill River. Dr. Macmillan stated that there is a process for a purpose which is to protect the public health. B. Susan Sawyer discussed notification of one human case with West Nile Virus in Middlesex County. The recent preventative measures of spraying the perimeters of the North Andover fields and schools were a prudent action. It was a great opportunity before school starts and the weather starts to get cool. She cautioned to wear repellents and be careftil between the dawn and dusk hours. Although mosquito activity slows down in cooler weather after Labor Day, she still urges everyone to be cautious and take preventative measures even though there are fewer mosquitos around in the cooler weather. C. Susan Sawyer reminded the Board that the new Tobacco Regulations will take place on September 1, 2015. All retailers have been notified and everything went smoothly. VIII. CORRESPONDENCE / NEWSLETTERS LK ADJOURNMENT MOTION made by Dr. Macmillan to adjourn the meeting. Mr. Fixler seconded the motion and all were in favor. The meeting was adjourned at 7:55 pm. P 1epared by., Lisa Blackburn, Health Dept. Assistant Reviewed by: 2015 North Andover Board of Health Meeting Page 3 of 4 Board of Health Members: Thomas Trowbridge, DDS, MD, Chairman; Larry Fixler, Member/Clerk; Francis P. MacMivan,jr., M.D.Joseph McCarthy, Member, Edwin Pease, Member Health Department Staff: Susan Sawyer, Health Director Debra Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector; Lisa Blackburn, Health Department Assistant XI All Board ofHealth Members & Susan Sauyer, Health Director Si-aned bi: *17erd Lariyfixler,"�enlerk ft B ar. Date Signed 2015 North Andover Board of Health Meeting Page 4 of 4 Board of Health Members: Thomas Trowbridge, DDS, MD, Chairman, Larry Fixler, Member/Ckrk; Francis P. MacMillanjr., M.D.; Joseph McCarthy, Member; Edwin Pease, Member Health Department Staff. Susan Sawyer, Health Director; Debra Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector; Lisa Blackburn, Health Department Assistant North Andover Health Department (ommunity and E(onomic Development Division August 28, 2015 Robert Lanigan 29 Granville Lane North Andover, MA 0 18 45 Re: Subsurface Sewage Disposal System Plan for 29 Granville Lane (Map 106C, Lot 50) Dear Ms. Lanigan: The proposed wastewater system design plan for the above site dated July 10, 2015 with a final revision date of August 6, 2015 and received on August 7, 2015 has been approved. The design plan has been approved for use in the construction of a new on-site septic system for a 4 -bedroom (max 9 -room) home utilizing a gravity leach field. This design plan approval is valid until August 28, 2017. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem, such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. At a regularly scheduled meeting of the Board of Health, this plan received the following approvals by the members. Local Upgrade Approvals: To reduce the separation distance from the soil absorption system to the estimated seasonal high ground water table from 5' to 4' Page I of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 0 1845 Phone: 978.688.9540 Fax: 978.688.8476 29 Granville Lane August 28, 2015 This approval is also subject to the following conditions: 1 . If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(l)) 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. /,-�Zince 'Mich Health Inspector Encl. Installers list cc: John Morin, P.E. File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 0 1845 Phone: 978.688.9540 Fax: 978.688.8476 The. M6rin-Cameron I amoup, mE:1 August 6, 2015 Ms. Michele Grant Health Inspector 1600 Osgood Street, Suite 2035 North Andover, MA 01845 RECEIVED NuG o 7 n15 10,n or- NORTH ANDOVER 'V�Rj DEPPRTMENT RE: Subsurface Sewage Disposal System Plan 29 Granville Lane (Map 106C, Lot 50) Response to Comments Dear Ms. Grant: We are in receipt of your review letter dated July 27, 2015. Please find enclosed two (2) copies of the design plan that have been revised to address your comments listed below. The following numbered responses correlate with your numbered comments from your review letter: 1. The names of direct abutters have been added to Sheet 1 of 2 on the design plan. 2. The percolation test tog has been revised to depict the correct location in the Bw horizon (at a depth of 35") on Sheet 1 of 2 of the design plan. 3. The design plan, calculations, soil absorption system and details (Sheet 1 and Sheet 2) have been modified to correlate with a Class 11 soil long term acceptance rate (LTAR) of 0.60 gpd/sq.ft.. This change slightly increased the size of the soil absorption system, caused some minor changes to grading, extended the retaining wall and shifted the septic tank and distribution box northerly by approximately 2'.. The details and system profile have been updated to reflect these changes. Although there is only a total of 47" in the C1 and C2 horizons, the test hole did not hit refusal (i.e. [edge). This can be seen in the test hole notes provided by the Board of Health representative where 107+ is noted in the Test Pit 15-1 notes. However, since the percolation test was conducted in the Bw soil horizon, this soil horizon is eligible to count towards the 4' of pervious material required. Therefore, Test Pit 15-1 has 6.1' of naturally occurring pervious material and Test Pit 15-2 has 5.8' of naturally occurring pervious material, which are both greater than the required 4'. 4. The bottom of the impervious barrier has been raised to an elevation of 97.2', creating a separation of 1' between the bottom of the barrier and the estimated seasonal high CIVIL ENGINEERS 9 LAND SURVEYORS 9 ENVIRONMENTAL CONSULTANTS a LAND USE PLANNERS 447 Boston Street (U.S. Route 1) Topsfield,MA01983 978.887.8586 FAX978.887.3480 Providing Professional Services Since 1978 www.morincameron.com Ms. Michele Grant August 6, 2015 2 water table at the front of the system and a 1.8' separation between the bottom of the barrier and the estimated seasonal high water table at the rear of the system. 5. The proposed loading for the septic tank has been labeled as "H-10" on the septic tank detail on Sheet 2 of 2 on the design plan. The materials to be used for the frames and covers have not been specified. This allows the installers to choose their preferred choice/materiat of the frames and covers to be used. We trust that these responses satisfy your questions/concerns outlined in your review letter. As you may recall, in our original application submitted to your office on July 10, 2015, we included Form 9A -Application for Local Upgrade Approval (a copy of the application is attached). We are requesting a one foot reduction in the setback from the bottom of the [each bed to the estimated seasonal high water table. Please schedule us to appear before the Board th of Health at their next regularly scheduled meeting on Thursday, August 27 If you should have any questions please do not hesitate to contact me. Sincerely, THE MORIN -CAMERON GROUP, INC. Witt Schkuta, EIT Staff Engineer WAS/kmm Enclosures cc: Mr. Robert Lanigan Mill River Consulting (via email) F:\KATHYM\Lanigan 3370\BOH\NABH Response Letter 8-6-15.docx Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts City/Town of Form 9A — Application for Local Upgrade Approval DEP has provided this form for use by local Boards J 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. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(l), is not feasible. System upgrades that cannot be performed in accordance with 310 CIVIR 15.404 and 15.405, or in full compliance with the requirements of 310 CIVIR 15.000, require a variance pursuant to 310 CIVIR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a' new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CIVIR 15.000. A. Facility Information Facility Name and Address: Robert Lanigan Name 29 Granville Lane Street Address North Andover City/Town Owner Name and Address (if different from above): Name City/Town Zip Code 3. Type of Facility (check all that apply): �1 Residential El Institutional 4. Describe Facility: Sinqle familv dwelli 5. Type of Existing System: MA 01845 State Zip Code Street Address State Telephone Number D Commercial E] Privy El Cesspool(s) 0 Conventional Septic tank, pump chamber and leach field El School El Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leach Field Local Upgrade Approval.doc - rev. 7/06 Application for Local Upgrade Approval* Page I of 4 1��\ Commonwealth of Massachusetts City/Town of Form 9A — Application for Local Upgrade Approval o DEP has provided this form for use by local Boards of Heal'�i. 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. A. Facility Information (continued)' 7. Design Flow per 310 CM R 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System gp d 44o god 444 gpd 1. Proposed upgrade is (check one): El Voluntary [_j Required by order, letter, etc. (attach copy) Z Required following inspection pursuant to 310 CMR 15.301: 2. Describe the proposed upgrade to the system: Install new two compartment septic tank, distribution box and leach field 3. Local Upgrade Approval is requested for (check all that apply): E] Reduction in setback(s) — describe reductions: El Reduction in SAS area of up to 25%: SAS size, sq. ft. Reduction in separation between the SAS -and high groundwater: +; +; Percolation rate Depth to groundwater less than 2 min./inch 4' proposed ft September 23, 2014 date of inspection % reduction Local Upgrade Approval.cloc - rev. 7/06 Application for Local Upgrade Approval, Page 2 of 4 MIII � M MIN z L itIM Commonwealth of Massachusetts City/Town of Form 9A — Application for Local Upgrade Approval DEP �las 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. B. Proposed Upgrade of System (continued) El Relocation of water supply well (explain*): El Reduction of 12 -inch separation between inlet and outlet tees and high groundwater El Use of only one deep hole in proposed disposal area F-1 use of a sieve analysis as a substitute for a perc test El Other requirements of 310 CMR 15.000 that cannot be met - describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(l)(h)(1). The soil evaluatormust be a member or agent of the local approving authority. High groundwater evaluation determined by: Isaac Rowe Evaluator's Name (type or print) Signature C. Explanation June 18, 2015 Date of evaluation Explain why full compliance, as defined in 310 CMR 15.404(l), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CIVIR 15.000 is not feasible: available area for SAS, 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: cost Local Upgrade Approval.doc - rev. 7/06 Application for Local Upgrade Approval, Page 3 of 4 . .0, 1 1 , I Commonwealth of Massachusetts City/Town,)f Form 9A — Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantiallv the same as that r)rovided here Before using this forrvi rhnt�Le with n— local Board of Health to determine the form they use. I Y C. Explanation (continued) 3. A shared system is not feasible: .Abutting septic not failed. 4. Connection to a public sewer is not feasible: Not available S. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): Z Application for Disposal System Construction Permit Z Complete plans and specifications Z Site evaluation forms 0. A list of abutters affected by reduced setbacks to pri vate water supply wells or property 11 nes. Provide proof that affected abutters have been notified pursuant to 310 CIVIR 15.405(2). El Other (List): D. Certification 1, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accura ' te, and, complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for delib te violations." Facility Owmer's Signature Date / 71 , V 4 elr 4j , IA,, I 6-A Print Name The Morin -Cameron Group, Inc. date, Name of Preparer 447 Boston Street Topsfield Preparers address C ityrTown MA 01983 978-887- 85 86 State[ZIP Code Telephone Local Upgrade Approval.doc - rev. 7/06 Application for Local Upgrade Approval, Page 4 of 4 Grant, Michele From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Friday, August 21, 2015 11:14 AM To: Grant, Michele; 'Dan Ottenheimer' Cc: Blackburn, Lisa; Isaac Rowe Subject: RE: Board Mtg I do not believe we have received a revised plan for 700 Middleton Street. That should be submitted ASAP so we have time to review prior to the meeting. Unfortunately I will only have a limited amount of time on Tuesday to review a revised plan (if submitted). My schedule is already booked with soil testing and other project deadlines and Dan is on vacation until Wednesday. I would recommend Dan and the BOH chair discuss this idea of "walk ons" in more detail soon because it appears to add unnecessary time pressure to all parties involved in a project. The BOH meeting schedule seems very clear about agenda items being requested in writing 10 days prior to the BOH meeting. I will review 186 Ingalls street either today or Tuesday. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowea.millriverconsultina.com www.millriverconsultin.g.com From: Grant, Michele [mailto:MGrant(�btownofnorthandover.com] Sent: Friday, August 21, 2015 10:54 AM To: 'Dan Ottenheimer'; 'Isaac Rowe' Cc: Blackburn, Lisa; 'Pam Lally' Subject: Board Mtg Good morning Mill River, As you know the board meeting is on Thursday August 27, 2015 at Town Hall, 7:00pm, second floor. It looks like both Vladimr of Merrimack Eng representing 186 Ingalls st. And James Morin of Northeast Classic Eng. Representing 700 Middlesex Street will be walk-ons. Also Scott Cameron of Morin and Cameron representing 29 Granville will also be there. Thankyou Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgra nt@townof northa ndove r.com Web www.Townof NorthAndove r.com All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter. com/north andover www.facebook.com/northandoverma 10, July 27, 2015 ucopy 'VT 0 North Andover Health Deportment Community and Economic Development Division Scott Cameron, P.E. The Morin -Cameron Group, Inc. 447 Boston Street Topsfield, MA 01983 Re: Subsurface Sewage Disposal System Plan for 29 Granville Lane (Map 106C, Lot 50) Dear Mr. Cameron: The proposed wastewater system design plan for the above site dated July 10, 2015 and received on July 10, 2015 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 3 10 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. On sheet 1 of 2, the names of abutters from a recent tax map are not on the design plan (NA 3.2). 2. On sheet I of 2, the percolation test log depicts the percolation test in the C 1 horizon. The percolation test was conducted in the Bw horizon. The field book notes from the Board of Health representative are enclosed for reference. 3. It appears the leach field needs to be designed on a Class 11 soil (Bw horizon in TP 15-1) instead of a Class I soil as depicted. There is a total of 47" of C 1 and C2 soil in TP 15 - 1. Although not a reason for disapproval, you may wish to consider the following: 4. Raising the bottom elevation of the impervious barrier since it is currently proposed at the same elevation as the ESHWT. 5. To better assist the installer, please clearly indicate the proposed loading for the septic tank (H- 10 or H-20) and the materials for the frame and cover. Page I of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 0 1845 Phone: 978.688.9540 Fax: 978.688.8476 Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Michele Grant Health Inspector cc: Robert Lanigan File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 0 1845 Phone: 978.688.9540 Fax: 978.688.8476 I 4�1 Q> J! V-) CL Q3 TOW'-,\'OF'-,\',ORTH AIN -DOVER 011 Office of COMNIUNITY DEVELOPNIENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDIN'G 20, SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 CHU. 97B.68&9540 - Pholie Susau Y. Saii-N.er, REHS/RS q78.688.8476- FAX Public Fle�ilth Director E.KUL: liealthdel)tl�,toiN�iiofiioilliiiicloi,,er.com �kTBSITE� SEPTIC PLAN SUBMITTAL FORM 4 RECEIVED Date of Submission: July 10, 2015 bN� JUL 1'0 2015 TOWN OF NORTH ANDOVER tiEALTH DEPARTMENT Site Location: 29 Granville Lane Engineer: Scott P. Cameron, PE - The Morin -Cameron Group, Inc. New Plans? Yes Z$225/Plan Check #60306 (includes l't submission and one re -review only) Revised Plans? Yes F�$75/Plan Check # Site Evaluation Forms Included? Yes Z No F� Local Upgrade Form Included? Yes Z No F� Telephone #:978-887-8586 Fax #:978-887-3480 E-mail: scott@morincameron.com Homeowner Name: Robert Lanigan OFFICE USE ONLY When the sub ' sion is complete (including check): 7 Date stamp plans and letter L/ Complete and attach Receipt I/ Copy File; Forward to Consultant Enter on Log Sheet and Database The Morin -Cameron Group, Inc. 447 Boston Street; Suite 12 Topsfield, MA 01983 978-887-8586 PAY Two hundred twenty-five & TO Town of North Andover LAN3370 FIB Bank America's Most Convenient BankO 53-7054-2113 CHECK DATE 7/9/15 --------------------------------- 00/100 dollars AMOUNT $225.00 AUTHORIZED SIGNATURE o The Morin -Cameron Group, Inc. 60306 Lanigan 3370 — Septic app. fee $225.00 60306 )DUCT DLT141 USE WITH 91500 ENVELOPE 9 0 G) =3 CD z CL 0 se Ul C, 2. 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C) CL 5-- Cn CD 0 a) = D 0 m 3- 0 < 0 a) CD :3 E -x, EL W CD 0 0 (n M o n 0 0 CD 3 0 0 0 "n 0 0 0 ;:w 0 o 3 0 0 z 0 0 0 cp CL A) 0 (A (D a) a Q) A: CD > 0 (0) U) (D (1) U) 3 CD —h 0 1 0 CD cn (D co (D 0 na :3 (D z 0 (D 2—q C "Ol A? -Mk ot' 5A, -S 0 pevc- -r6s-r Cl) 0 cn cn CD 3 CD D 01 7 cn CD cn (a CD &)C> 0 o P --r S-raju %OVA.L-L, _0 0 CD OD 0 co ii c (D in CL CD (n zr m (D (D CL 71111!IIIIIIIIIIIIIIII11B, Illim , me MEMONS ; M�-_, "n o o 0 0 o * 0 j 0 z 0 0 71- ::r 0 > —h Q— 2) 0 (0) < CD Cr Commonwealth of Massachusetts City/Town of North Andover Percolation Test Form 12 Percolation test res ults must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. 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 the local Board of Health to determine the form they use. Important: When fillingout forms A. Site Information on the computer, use only the tab Robert J. and Maureen M. Lanigan key to move your Owner Name cursor - do not 29 Granville Lane use the return Street Address or Lot # key. North Andover MA 01845 City/Town State Zip Code Contact Person (if different from Owner) Telephone Number B. Test Results t5form I 2.doc- 06/03 Perc Test - Page 1 of 1 06/18/15 09:53 Date Time Date Time Observation Hole # TP1 5-1 Depth of Perc 53" 09:53 Start Pre -Soak 10:08 End Pre -Soak 10:08 Time at 12" 10:12 Time at 9" 10:16 Time at 6" 4 minutes Time (9"-6") 1.33 mpi Rate (Min./Inch) Test Passed: Test Passed: Test Failed: Test Failed: Alexander F. Parker Test Performed By: Mr. Isaac Rowe Witnessed By: Comments: t5form I 2.doc- 06/03 Perc Test - Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. J0____h 4!L�l Commonwealth of Massachusetts City/Town of Form 9A — Application for Local Upgrade Approval 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. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CIVIR 15.404(l), is not feasible. System upgrades that cannot be performed in accordance with 310 CIVIR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CIVIR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a ne� esign flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CIVIR 15.000. A. Facilityinformation 1 Facility Name and Address: -Robert Lanigan Name 29 Granville Lane Street Address North Andover Cityrrown 2. Owner Name and Address (if different from above): Name City/Town Zip Code 3. Type of Facility (check all that apply): Z Residential F-1 Institutional 4. Describe Facility: Sinale familv dwelli 5. Type of Existing System: � "T W State Street Address State Telephone Number [] Commercial [I Privy Fj Cesspool(s) Z Conventional Ser)tic tank, pump chamber and leach field 01845 Zip Code El School E] Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leach Field Local Upgrade Approval.doc - rev. 7/06 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrade Approval 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System 1. Proposed upgrade is (check one): 440 gpd 440 gpd 444 gpd El Voluntary E] Required by order, letter, etc. (attach copy) Z Required following inspection pursuant to 310 CMR 15.301: September 23, 2014 date of inspection 2. Describe the proposed upgrade to the system: Install new two compartment septic tank, distribution box and leach field 3. Local Upgrade Approval is requested for (check all that apply): E] Reduction in setback(s) — describe reductions: r-1 Reduction in SAS area of up to 25%: SAS size, sq. ft. Z Reduction in separation between the SAS and high groundwater: I Separation reduction Percolation rate Depth to groundwater ft. less than 2 min./inch 4' proposed ft. % reduction Local Upgrade Approval.doc - rev. 7/06 Application for Local Upgrade Approval* Page 2 of 4 4* Commonwealth of Massachusetts City/Town of Form 9A — Application for Local Upgrade Approval 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. B. Proposed Upgrade of System (continued) [:] Relocation of water supply well (explain): R Reduction of 12 -inch separation between inlet and outlet tees and high groundwater E] Use of only one deep hole in proposed disposal area El Use of a sieve analysis as a substitute for a perc test E] Other requirements of 310 CIVIR 15.000 that cannot be met — describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CIVIR 15.405(l)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Isaac Rowe Evaluator's Name (type or print) Signature C. Explanation June 18, 2015 Date of evaluation Explain why full compliance, as defined in 310 CIVIR 15.404(l), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CIVIR 15.000 is not feasible: Topography, wetlands and existing dwelling location limit available area for SAS. 2. An alternative system approved pursuant to 310 CIVIR 15.283 to 15.288 is not feasible: cost Local Upgrade Approval.doc - rev. 7/06 Application for Local Upgrade Approval, Page 3 of 4 _.�C\ Commonwealth of Massachusetts ty/Town of Form 9A — Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the inf Ciormation 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. C. Explanation (continued) 3. A shared system is not feasible: Abutting septic not failed. 4. Connection to a public sewer is not feasible: Not available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): Z Application for Disposal System Construction Permit ED Complete plans and specifications Site evaluation forms A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). [I Other (List): D. Certification 1, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for 71elibte violations." I e Facility jb�Aees Sig�ature Date IYV.6 4j , IAv I C—A ^-1 Print Name The Morin -Cameron Group. Inc. Name of Preparer Date 447 Boston Street Top Preparer's address Cityr MA 01983 978 State1ZIP Code Tale sfield own -887-8586 phone Local Upgrade Approval.doc - rev. 7/06 Application for Local Upgrade Approval- Page 4 of 4 Tj Blackburn, Lisa From: Blackburn, Lisa Sent: Friday, July 10, 2015 9:04 AM To: Dan Ottenheimer, Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: 29 Granville Lane Septic plans are being mailed out today for 29 Granville Lane. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Ibiackburn@townofnorthandover.com Web www.TownofNorthAndover.com -[-- |--l--�-1 -| '-�- f--� Aft TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 0 1845 Susan Y. Sawyer, REHS, RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX healthdept@townofnorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: Mqy 29,2015 MAP & PARCEL: Map 106C, Parcel 50 LOCATION OF SOIL TESTS: 29 Granville Lane OWNER: — Robert Lanigan —Contact#: 617-201-3628 APPLICANT:. Robert Lanigan —Contact#: 617-201-3628 4V � ADDRESS: 29 Granville Lane, North Andover, MA 01845 RECEWED ENGINEER:— The Morin -Cameron Group, Inc. —Contact#: John Morin, PE jUN -0-12015 CERTIFIED SOIL EVALUATOR: Alex Parker -----TOWN OF NORTH ANDOVER Intended Use of Land: Residential Subdivision Commercial HEALTH DEPARTMENT Is This: Repair Testing: X Undeveloped Lot Testing:_ Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM > Proof of land ownership (Tax bill, or letter from owner permitting test) > 8.5"x 11 " Plot,21an & Location 12f Testing (please indicate test 2it sites on theplan) > Fee of $425.00 per lot for aMconstruction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION > Only Certified Soil Evaluators may perform deep hole inspections. > Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. > At least two deep holes and two percolation tests are required for each septic system disposal area. > Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. > Full payment will be required for all additional tests within two weeks of testing. > Within 45 days of testing, a scaled plan (no smaller than I"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). > Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approyal D te: Signature of Conservation Agentri 7"— Date back to Health Department: (stamp in): -J,- - D ) ls Ck"-p- r zr;o M 9 K I a 5 a PARR BETTER TIOMM INC. Commonwealth or Massachusetts rporsdaOdullemblWtdandadiels"of the sco W,15MM 1289 Salem Street. North Andover# OW baw" in Una plam of Essex EightY-SIxThOus9ndimdnO/IOOD0419vs ($86,000.00) lAnigan. husband and wife, MW U) Robert J. Lanigan and Maureau ?A - as joint tenants with Iptiflato mm"aft North Andover, Massachusetts .01 20 Granville LAnO, dinp thereon being shown an IMP luj 14 North Andover with the bull the Subdivision Of Sallm , jAng an a plan entitiod "DefinitIVO situated. on Granvilli W "r) lay, 1975" and Forest for George H. iarr by Frank C. asuriss.4 ted h North District Registry of *De:ds as Plan J7401S $0 which recorded with Essex reby made for S, More complete description of MEOWS plan reference Is hC Ming to plan. heroin Conveyed. Said Lot 12 contains 1.01, acres Saco Being the marno-pramteas conveyed to it b I y Foreclosure Dead dated Novanber 111019" and recorded with Essex North District Registry Of Deeds.. Book 1325 page 204 Lj 0 3 dw old Parr Better Homes- &ka' b" C&uud ks QwWsts sW to be lerd* Iftd OW thm Pe"I" 10 ba 504 "l`Sw#l*dV' WA ddI,t,edj&jbwm&WbdWfby G*Org*H- Farr bMW auly auth� tw 6-r% 4y.91 October in the IM om dMUUrj n6g hundail AW Iav*0ty-4IgK N LER MOMEP, J. -r, it -A AR F� IG7046rdp lip dowmanauattk at Illas"gIPMUS 73 October IV Essex a Tim pecansur am$ "MW George 11. Farr, President aad W=wWSA & WqWX jwwnenj to be the (tee od W &0d Of & Farr Better NOMAlo be* btfatem AN 21 0 AuthorizatIon Form Re: 29 Granville Lane, North Andover 1, Robert Lanigan, authorize The Morin -Cameron Group to sign any and all applications to the Town of North Andover on my behalf regarding the a bove- referenced property. Robert� nigan 'Y -a 6 - C� (// s - Date A. 0 3 4-0 11: 1?91?0 P'll. &I. 11 0 1 0 CY - A 0 K F. -r c. lie >k MA S calc 1": 46 (9 .4q CC. i -T �- !:1 1.50 f, NI -C7—S C- " �r- S m I --r �-k JO J' Lp d 00000� i.0 L Ar— Ix es. 51 tq o Eak3c Tes+ wetlan at's .. CO S2 F- �Za e— - '7 Lo -r i I.Ot Aciza-. coo............... 76- -7 17-8 70t s 0 �.D oo, + SIT TOWN OF NORTH ANDOVER NORTH AN -DOVER, MASSACHUSETTS 01845 . RTh Permit Number Date Issued �e - 11 - �5 Expiration Date APPPIOVED By BOA r -,D OF HEALTH N41' Jackie's Law — Pennit Applie'd Pursuant to G.L. c. 82A §1 and 520 CNM 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant 6E:,�r- C> rn&—1 Phone Cell Street Address &Y4Fe&cL, S 7- C� 0? a- 6 City/Town /V,� u,<r � MA � ZIP C) V Name of Excavator (if different from applicant) Phone Cell Street Address City/Town M -A I ZIP Name of Owner(s) of Property Phone Cell &A k, 6ar�- StreetA(Tdress - T7 f� Aq 4, 121,0 ta-vl��t City/Town /v- A, -d o,.j 4a- MA I ZIP r& Ll 5 - I Permit Fee Received NoFTYesFl Other Contact Description, location and purpose of proposed trench. Please describe the exact location of the proposed trench and its purpose (include a description of what is (or is intended) to be laid in proposed trench (eg; pipes/cable lines etc..) Please use reverse side if additional space is needed. Insurance Certificate Name and Contact Information of Insurer: E0601 J r6u-/v C Policy Expiration Date: Dig Safe #: ) ON S - Name of Competent Person (as define'd b�y_ 520 CMR 7.02): or) (' 60 4" - -'j L, , Massachusetts Hoisting License # -TF License Grade- tc 2, 4- q /_t Expiration Date: 7127A_ BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED, INCLUDING OSHA REGULATIONS, G.L. c, 82A, 520 CMR 7.00 et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW, THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION, AUTHORIZE, S PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH, AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLICANT SIGNATURE Pl!:;M h, ' L_ DATE EXCAVATOR SIGNATURE (IF DIFFERENT) /—(qz 'ff —k,— DATE GNATURE (IF DIFFERENT) DATE 21Page CONDITIONS AND REQUIREMENTS PURSUANT TO 1G.L.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the application, the applicant understands and agrees to comply with the following: 91 iv. vi. No trench may be excavated unless the requirements of sections 40 through 40D of chapter 82, and any accompanying regulations, have been met and this permit is invalid unless and until said requirements have been complied with by the excavator applying for the permit including, but not limited to, the establishment of a valid excavation numberwith the underground plant damage prevention system as said system is defined in section 76D of chapter 164 (DIG SAFE); Trenches may pose a significant health and safety hazard. Pursuant to Section I of Chapter 82 of the General Laws, an excavator shall not leave any open trench unattended without first making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended, Excavators should consult regulations promulgated by the Department of Public Safety in order to familiarize themselves with the recognized safety hazards associated with excavations and open trenches and the procedures required or recommended by said department in order to make every reasonable effort to eliminate said safety hazards which may include covering, barricading or otherwise protecting open trenches from accidental entry. Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CFR 1926.650 et.seq., entitled Subpart P 'Txcavations". Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; By applying for, accepting and signing this permit the applicant hereby attests to the following: (1) that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related excavations and trench safety; (2) that he has read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CMR 1926.650 etseq., entitled Subpart P "Excavations" as well as any other excavation requirements established by this municipality; and (3) that he is aware of and has, with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of the permit application, complied with the requirements of sections 40- 40D of chapter 82A. This permit shall be posted in plain view on the site of the trench. For additional information please visit the Department of Public Safety's website at vrvvw.mass.goy/dps 3 1 P a g e 10/03/2014 12:20 9786833147 I`FkUt UlfUl ,"Ilk I OATE(MKvDDNryY) 1-_ _� CERTIFICATE OF LIABILITY IMSURANCE 110/3/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAIMN ONLY AND CONFERS F40 RIGKM UPON THE CERTIFICATE HOLDER. THIS �xwrwlwm DOES moT AFFiRmATrvr:;Ly OR NECATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROM BY THE pOWES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT ISETWEEN THE ISSUING INSURE"� AUTHORIZED RFPRESMATft OR PRODUCER, AND THE CEIMFICATE HOLDER. IMPORTANT! If We cenftate boklw Is an ADDITIONAL INSURED, the p*IKXles) MuSt be gnd*meii If SUBROCATION 1$ WAIVED, BubjW to ft tsmn aM conditions of the P011CY, OmWn P011chn may reqtdre an erdmomenL A Staten"t 00 dft MURcate don not cordw tighis to the r4"Iffigm holder In Dou of such andarximumft PRODUCER M P ROBERTS INS AGCY INC :(978)683-8073 1060 Osgood Street Nor.(978) 683-.314 North Andover, MA 011945 EmpaUlaftpr WrtSinsuranco. cam MPOMM WMLWM �IMRM A; UMERWRXMW AT LWY_DS INSURED PETER RRM E=AVATING, nic. A/0 INSURER 13;P -%did" INSWUSCIR CO TRAVIS & TIM CONSTIMmoN INSIHMRCASS�IATM�Me�LOYEI�tkr. 770 ROXFORZ) STItZET - INSUF&RD!PWU&M55IW INSURANCM NORTH ANDOVER, MA 0184B INSURER E! 978-687-7774 THIS IS TO CERT" THAT THE POLICIES OF MURANCE LISTED BIELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR TKE POLICY PERIOD INDICATED. NCrTwiTHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUME14T WITH RESPECT TO WHICH THI$ CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DMRIBED MEREIN IS SUBJECT To ALL THE TEWS. EXCLUSIONS AND =11)ITIONS OF SUCH POLICIES. LIMITS SHOWN MAY 14AVE BEEN REDUCED By PAIL) CLAIMS, AWL IgUldit I - rfPE-OF INtURANCE _ INRB POLICY NUMER LIMITS L��CH OCCUR ENCE =S 14.0 0 0 c L:! -j OCCUR _lu Mfmlm) _4j 1 77 LNTSFES JF. X I 00IMMMAL MEPAL UAMIL" CLA,..,4A,,= rZ71 _.) Pi 'L AGGREGATE LIMIT APPLIES PER Foucy El J"MCT 0 Loc AUTOMOIULE LIMLM ANYAUTO ALLOWNED �X WDULED AUTOS x X X WON -OWNED KIREDA01M X AUTOS OCCUR um"E" L'A" H EXCESS LIAB IAND EMPLOYERT LIASILITY ANY PROPMMRPARWERDEMME OMCER94MMM EXCLUJ)LZ�7 (Idwag" in mg D I MWERCIAL AuTo LGL1022141 PGCOOOOIO07123 WCC500SO104372013A 04461952-4 15 L_WD E* (Arfy gM pMon) $ 5,000 NAL & A0v 10 D I I GENLRAL AGGIMIGATr, Is 2,000,000 I PRODUCTS - COMPIOP AlaG 1,000,000 c0w NT ie welden 1 1 (iAn Ano I ODILY INJURY (Par penan) $ e ODLY INJURY (Pcr sWdeM S PIV — (,p.,jlldlAllE $ E.L. I E.L DISEASE - F.A EMKOYr-9 1 500 _130f) 1 LE� _pfSEASE - cy umrr I & 500.0001 2/06/13 1 12106/14 ILI., $1,000,00*0 )ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Aftonal RDwrks S_dWule, nW be anew if rnOM Spftv Is requitcd) -'Ax: 978-1589-87,40 XM OF NORTH ANDOVER IS LISTED AS AN ADD7:TIONAL INSM= IN RESMCTS TO GENERAL ,IAB:XLITY COVMVT. TOWN OP NORTH ANDOM 384 OSC=D STREET NORTH ANDOVER MR 01845 SHOULD ANY OF THE ABOVE DESCPJ13ED pc)UCIFS BE CANCELIAD BEF)OFtE THE EXPIRATION IDATE THEREOF, NCrnCE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRC)MSIONS. AUTMORIZED XRD25(20140i) The ACORD name and lego are mgiStered marks of ACORD AjIqhtsMftrved. Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary'Assessments 29 Granville Lane Property Address Robert Lanigan Owner's Name North Andover Cityrrown MA 01845 State Zip Code 9/23/14 Date of Inspection Inspection results must be submitted on this form. Inspection forms may no way. Please see completeness checklist at the end of the form. t b ev tMd In I D 4q t A. General Information OCT 14 ZU14 1. Inspector: TOWN UF NURI'H ANDOVER I HEALTH DEPARTMENT Michael Graham Name of Inspector Wind River Environmental Company Name 163 Western Ave Company Address Gloucester MA 01930 City/Town State Zip Code 978-281-6524 S113560 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 El Conditionally Passes &—r -a i I S 0 Needs Further Evaluation by the Local Approving Authority Inspector's Signafd—re Y-4?3 -/C� Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the 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 DER 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 - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page I of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Granville Lane Property Address Robert Lanigan Owner's Name North Andover MA 01845 9/23/14 City/Town State Zip 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: 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: 13) System Conditionally Passes: El 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. F1 Y El N El ND (Explain below): t5ins - 3/13 Title 5 Official 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 29 Granville Lane Property Address Robert Lanigan Owner Owner's Name information is required for every North Andover page. City/Town B. Certification (cont.) MA 01845 9/23/14 State Zip Code Date of Inspection Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): El 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): El broken pipe(s) are replaced F1 Y El N Ej ND (Explain below): obstruction is removed 0 Y El N 0 ND (Explain below): distribution box is leveled or replaced F1 Y 0 N F] 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): El broken pipe(s) are replaced F1 Y 0 N F1 ND (Explain below): obstruction is removed F1 Y F1 N 0 ND (Explain below): C) Further Evaluation is Required by the Board of Health: El 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(l)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: 0 Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17 lj�ffll&" g L Owner information i's required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Granville Lane Property Address Robert Lanigan Owner's Name North Andover MA 01845 9/23/14 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: F-1 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. 0 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. El The system hasa septic tank and SAS and the SAS is within 50 feet of a private water supply well. El 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 E Ej Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El E 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 % day flow t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 4 of 17 ij� I L Lwmmil Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Granville Lane Property Address Robert Lanigan No Owner Owner's Name information is F� the system is within 400 feet of a surface drinking water supply required for every North Andover El MA 01845 9/23/14 page. City/Town El State Zip Code Date of Inspection B. Certification (cont.) Yes No E] E Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El 0 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. El E Any portion of a cesspool or privy is within a Zone 1 of a public well. E] E Any portion of a cesspool or privy is within 50 feet of a private water supply well. El E 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. Z El 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 16,000 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 1:1 F� the system is within 400 feet of a surface drinking water supply 11 El the system is within 200 feet of a tributary to a surface drinking water supply El El the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone 11 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 - 3/13 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 29 Granville Lane C. Checklist MA 01845 9/23/14 State Zip Code Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: E El Property Address E] E Robert Lanigan Owner Owner's Name information is required for every North Andover page. City/Town C. Checklist MA 01845 9/23/14 State Zip Code Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: E El Pumping information was provided by the owner, occupant, or Board of Health E] E Were any of the system components pumped out in the previous two weeks? 0 0 Has the system received normal flows in the previous two week period? El E Have large volumes of water been introduced to the system recently or as part of this inspection? • El Were as built plans of the system obtained and examined? (If they were not available note as N/A) • EJ Was the facility or dwelling inspected for signs of sewage back up? E E] Was the site inspected for signs of break out? • El Were all system components, excluding the SAS, located on site? • El 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? • El 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. El 0 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Granville Lane Property Address Robert Laniga Owner Owner's Name information is required for every North Andover page. City/Town D. System Information Description: Septic tank, distribution box, SAS MA 01845 State Zip Code 9/23/14 Date of Inspection Grease trap present? El Yes E-1 No Number of current residents: El 2 El No Does residence have a garbage grinder? El Yes 0 No Is laundry on a separate sewage system? (include laundry system inspection El Yes Z No information in this report.) Laundry system inspected? El Yes Z No Seasonaluse? El Yes Z No Water meter readings, if available (last 2 years usage (gpd)): attached Detail: attached Sump pump? El Yes Z No Last date of occupancy: occupied 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? El Yes E-1 No Industrial waste holding tank present? El Yes El No Non -sanitary waste discharged to the Title 5 system? El Yes El No Water meter readings, if available t5ins - 3/13 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 29 Granville Lane Property Address Robert Laniga Owner Owner's Name information is required for every North Andover page. Cityfrown D. System Information (qont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: MA 01845 State Zip Code General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: 9/23/14 Date of Inspection The home owner and Wind River Environmental are the sources of the information E Yes 0 No 1000 gallons The quantity was determined by the pump truck and it was measured. To check the structural integrity of the septic tank 0 Septic tank, distribution box, soil absorption system El Single cesspool E] Overflow cesspool El 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. El Other (describe): t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Granville Lane Property Address Robert Lanigan Owner Owner's Name information is required for every North Andover page. Cityrrown D. System Information (cont.) MA 01845 9/23/14 State Zip Code Date of Inspection Approximate age of all components, date installed (if known) and source of information: 9/15/79 Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): D Yes E No Depth below grade: 16" feet Material of construction: E cast iron E 40 PVC El other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): All joints and venting in good shape, no evidence of any leakge. Septic Tank (locate on site plan): Depth below grade: Material of construction: 0 concrete El metal H-20, 1000 aallon tank A feet El fiberglass EJ polyethylene El other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 9x5x5 Sludge depth: .3 F1 Yes F No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17 ' e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Granville Lane D. System Information (cont.) 01845 9/23/14 Zip Code Date of Inspection Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 2911 21- 6" 1411 How were dimensions determined? The dimensions were determined by sludge judge, rod and ruler. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Recommend yearly pumping, inlet and outlet baffle in good shape. Tank is structurally okay, h20. Liquid level good, no evidence of any leakage. Grease Trap (locate on site plan): Depth below grade: Material of construction: El concrete 0 metal Dimensions: feet [:1 fiberglass El polyethylene E:1 other (explain): 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 - 3/13 Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17 Property Address Robert Lanigan Owner Owner's Name information is required for every North Andover MA page. City[Town State D. System Information (cont.) 01845 9/23/14 Zip Code Date of Inspection Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 2911 21- 6" 1411 How were dimensions determined? The dimensions were determined by sludge judge, rod and ruler. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Recommend yearly pumping, inlet and outlet baffle in good shape. Tank is structurally okay, h20. Liquid level good, no evidence of any leakage. Grease Trap (locate on site plan): Depth below grade: Material of construction: El concrete 0 metal Dimensions: feet [:1 fiberglass El polyethylene E:1 other (explain): 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 - 3/13 Date 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 Voluntary Assessments 29 Granville Lane Property Address Robert Lanigan Owner Owner's Name information is required for every North Andover MA 01845 9/23/14 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: F� concrete El metal El fiberglass El polyethylene E] other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day El Yes El No Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): El Yes Ej N o * Attach copy of current pumping contract (required). Is copy attached? El Yes E] No t5ins - 3/13 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 29 Granville Lane D. System Information (cont.) MA 01845 9/23/14 State Zip Code Date of Inspection Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is not in good shape, rotten all the way down side and has orangeburg lines leading into the field, which are partially broken in spots and has some sludge build up and roots. Ran camera down and insoected. Pump Chamber (locate on site plan): Pumps in working order: El Yes El No* Alarms in working order: El Yes El 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 - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Property Address Robert Lanigan Owner Owner's Name information is required for every North Andover page. Cityrrown D. System Information (cont.) MA 01845 9/23/14 State Zip Code Date of Inspection Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is not in good shape, rotten all the way down side and has orangeburg lines leading into the field, which are partially broken in spots and has some sludge build up and roots. Ran camera down and insoected. Pump Chamber (locate on site plan): Pumps in working order: El Yes El No* Alarms in working order: El Yes El 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 - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 * <r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Granville Lane Property Address Robert Lanigan Owner Owner's Name info rmation is required for every North Andover page. City/Town State D. System Information (cont.) Type: E] leaching pits El leaching chambers El leaching galleries El leaching trenches z leaching fields El overflow cesspool D innovative/alternative system Indication of groundwater inflow E-1 Yes [:] No t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 17 01845 Zip Code number: number: number: 9/23/14 Date of Inspection number, length: number, dimensions: number: 4 Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leaching field shows signs of failure, there is no ponding, grass over field. 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 L Rawaaw-ji, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Granville Lane Property Address Robert Lanigan Owner Owner's Name information is required for every North Andover MA 01845 9/23/14 page. City/Town 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 - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 I <L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Granville Lane Property Address Robert Lanigan Owner Owner's Name information is required for every North Andover MA 01845 page. City/Town State Zip Code tl,,nc - 3/13 9/23/14 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: Z hand -sketch in the area below T-Iflo 5 OffiCial 1ncpoctjaj Fom, Subvwfaoo Sow*go D'--Posal GY�tOm - Pago IS of 17 z L ILWM-J�l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Granville Lane Property Address Robert Lanigan Owner Owner's Name information is required for every North Andover MA 01845 page. City/Town State Zip Code D. System Information (cont.) Site Exam: Check Slope Surface water Check cellar 0 Shallow wells Estimated denth to high round %A/mfinire 48"+ 9/23/14 Date of Inspection U feet Please indicate all methods used to determine the high ground water elevation: -001 I Obtained from system design plans on record If checked, date of design plan reviewed: 8/13/08 Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: Plans on file at BOH Checked with local excavators, installers - (attach documentation) Accessed USGS database - explain: You must describe how you established the high ground water elevation: Plans on file at BOH, #39 a few houses down, closest one on file. Plans dated 8/13/08 perfoemd by B Dufresne, witnessed bv Mill River Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments E. Report Completeness Checklist 0 Inspection Summary: A, B, C, D, or E checked 9/23/14 Date of Inspection E inspection Summary D (System Failure Criteria Applicable to All Systems) completed Z System Information — Estimated depth to high groundwater Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 29 Granville Lane Property Address Robert Lanigan Owner Owner's Name information is required for every North Andover MA 01845 page. Cityfrown State Zip Code E. Report Completeness Checklist 0 Inspection Summary: A, B, C, D, or E checked 9/23/14 Date of Inspection E inspection Summary D (System Failure Criteria Applicable to All Systems) completed Z System Information — Estimated depth to high groundwater Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 Town of North Andover 120 Main Street NorthAndover, MA01845 (978) 688-9550 LANIGAN, ROBERT J. 29 GRANVILLE LANE N. ANDOVER, MA 01845 NEW OFFICE HOURS DUE DATE I LW/10/2014 - 06/09/2014 Monday 8:00 - 4:30 1 0811512014 $189.27 Tues 8:00 - 6:00 ACTUAL 03/10/2014 Wed 8:00 - 4:30 ACCOUNT 482 DATE Thurs 8::00 - 4:30 L 346"388 471 Fri 8 00 - 12:00 3170023 21 92 07/16/2014 Billing information: (978) 688-9550 IS—E—R-VICE DATE_S1___ L_____ DUE DATE I LW/10/2014 - 06/09/2014 08/15/2014 Reading information� SERVICEADDRESS (978) 688-9570 29 -GPANV.I-LLE LANE TRANSACTION THIS PERIOD AMOUNT RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL# READINGS Current - ----------- - --- ­-_.____ USAGE NB OF Date DAYS 34644388 531 ACTUAL 06/09/2014 39 91 SERIAL# READING S Previous Type Date USAGE NB OF i DAYS 134644388 492 ACTUAL 03/10/2014 10 91 34644388 482 ACTUAL 12/09/2013 11 90 346"388 471 ACTUAL 09/ 10/20 1 3 21 92 BALANCE $45.82 THROUGH 07/08/2014 $-45.82 �ADJUST. THROUGH 07/08/2014 $0.00 INTEREST AS OF 08/15/2014 $0.00 iBALANCE FORWARD $0.00 -CURRENT BILL DETAIL IUSAGE/UNIT AMOUNT WATER USAGE 39 $181.45 ADMINISTRATIVE FEE $7.82 TOTAL $189.27 MESSAGES -NOTE- PAYMENTS SHOULD BE MADE. TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX Q� P 0, BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 Please note our office hours have SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 changed, effective 4/30. See above, BYPASS METER WATER RATE: ALL UNITS $5.55 Pay Online at www.townofnorthandover.com .... ..... ...... Please return this portion with your payment by Town of North Andover Z 120 Main Street NorthAndover, MA01845 (978) 688-9550 qc#405NoAndWtrSgIsT2 P1***­AUT0**6-DIGIT01840 LANIGAN, ROBERT J. 29 GRANVILLE LN NORTH ANDOVER MA 01845-4901 Any amount which is not paid by due date will be subject to interest charges of 14% Per Year NEW OFFICE HOURS Billing information: Monday 8:00 - 4:30 (978) 688-9550 Tues 8:00 - 6:00 Reading information, Wed 8:00 - 4:30 (978) 688-9570 Thurs 8:00 - 4:30 Fri 8:00 - 12:00 ACCOUNT G DATE 3170-0-2-3------ —0-77-1-6 TH-1-4 ERVI C E A D D R E S S 1_29 GRANVILLE LANE 0811512014 $189.27 MIMI 00004151712014000000000000031700230403170023000000018927005 Town of North Andov 120 Main Street North Andover, MAO 1845 (978)688-9550 1 LANIGAN, ROBERT J. 29 GRANVILLE LANE N. ANDOVER, MA 01845 NEW OFFICE HOURS DUE DATE=� M Monday 8:00 - 4:30 0511212014 $45.82 1 Tues 8:00 - 6:00 $0.00 BALANCE FORWARD Wed 8:00 - 4:30 ACCOUNT -------- ------ Bi LLING DATE I Thurs 8 : 00 - 4 30 1 subject to interest charges of -,-- Fri 8:00 - 12:00 3170023 NEW OFFICE HOURS Billing information: Monday 8:00 - 4:30 04/11/2014 (978) 688-9550 Tues 8:00 - 6:00 (9781)688-9550 �p ct-- Reading information: Wed 8:00 - 4:30 Billing information (978) 688-9550 S ERVICE DATES DUE DATE=� 27K/M3 - 03/10/2014 Ej �9_ __-- - 05/12/201 E 4 --j Reading information: SERVICEADDRESS (978) 688-9570 29 GRANVILLE LANE TRANSACTION THIS PERIOD AMOUNT RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL# READINGS USAGE NB Of: CUrrent Type Date DAYS 34644388 492 ACTUAL 03/10/2014 10 91 SERIAL # RCADINGS USAGE NB OF Previous Type Date DAYS 34644388 482 ACTUAL 12/09/2013 11 90 34644388 471 ACTUAL 09/10/2013 21 92 34644388 450 ACTUAL 06/10/2013 39 91 PREVIOUS BALANCE $49.62 PAYMENTS THROUGH 04/02/2014 $-49.62 ADJUST. THROUGH 04/02/2014 $0.00 INTEREST AS OF 05/12/2014 $0.00 BALANCE FORWARD $0.00 -------- ------ CURRENT BILL DETAIL USAGEWNIT AMOUNT WATER USAGE 10 $38.00 ADMINISTRATIVE FEE $7.82 TOTAL $45.82 MESSAGES 'NOTE' PAYMENTS SHOULD BE MADE 1OWN HALL @ )20 MAIN STREE-f OR 13Y MAIL TO OUR LOCKBOXCD 110 BOX 184, MEDFORD, MA02155 Fri 8�00 - 12:00 ------,.,-,,ACCOUNT PILLING DATE 3170023 1 SERVICEADDRESS 29 GRANVILLE LANE qc#398NoAndWtrSgIsT2 P1******AUT0**5-DlG1T01840 M 05112120 $�45.82 LANIGAN, ROBERT J. -- 29 GRANVILLE LN NORTH ANDOVER MA 01845-4901 00004151712014000000000000031700230403170023000000004582001 WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 Please note our office hours have I SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS changed, effective 4/30. See above. $9.24 BYPASS METER WATER RATE: ALL UNITS $5.55- Pay Online at www. townof northandover. coin Please return this portion with your payment by Any amount which is not paid by due date will be subject to interest charges of Town of North Andover 14% Per Year 120 Main Street NEW OFFICE HOURS Billing information: Monday 8:00 - 4:30 NorthAndover, MA01845 (978) 688-9550 Tues 8:00 - 6:00 (9781)688-9550 �p ct-- Reading information: Wed 8:00 - 4:30 (978) 688-9570 Thurs 8:00 - 4:30 Fri 8�00 - 12:00 ------,.,-,,ACCOUNT PILLING DATE 3170023 1 SERVICEADDRESS 29 GRANVILLE LANE qc#398NoAndWtrSgIsT2 P1******AUT0**5-DlG1T01840 M 05112120 $�45.82 LANIGAN, ROBERT J. -- 29 GRANVILLE LN NORTH ANDOVER MA 01845-4901 00004151712014000000000000031700230403170023000000004582001 Town of North Andover 120 Main Street NorthAndover, MA01845 (978) 688-9550 LANIGAN, ROBERT J. 29 GRANVILLE LANE N. ANDOVER, MA 01845 NEW OFFICE HOURS Monday 8:00 - 4:30 57 Tues 8:00 - 6:00 70 1712014 $49!621 Wed 8:00 - 4:30 I ACCOUNT BILLING DATE I Thurs 8:00 - 4:30 Fri 8:00 - 12:00 3170023 01/17/2014 Billing information: (978) 688-9550 -6--- SERVICE KTES DUE DATE 09/10/2013 - 12/09/2013 02/17/2014 Reading information: SERVICEADDRESS (978) 688-9570 29 GRANVILLE LANE RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL# READINGS USAGE NB OF Current Type Date DAYS 34644388 482 ACTUAL 12/09/2013 11 90 SERIAL# READINGS Previous Type Date USAGE NB OF DAYS_ 34644388 471 ACTUAL 09/10/2013 21 92 34644388 460 ACTUAL 06/10/2013 39 91 34644388 411 ACTUAL 03/11/2013 12 94 I TRANSACTION THIS PERIOD AMOUNT I PREVIOUS BALANCE $88.99 PAYMENTS THROUGH 01/07/2014 $-88.99 ADJUST. THROUGH 01/07/2014 $0.00 INTEREST AS OF 02/17/2014 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGE]UNIT AMOUNT WATER USAGE 11 $41.80 ADMINISTRATIVE FEE $7.82 TOTAL, .$49.62 MESSAGES 'NOTE' PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ RO� BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 Please note our office hours have SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 changed, effective 4/30. See above. BYPASS METER WATER RATE: ALL UNITS $5.55 Pay Online at www.townofnorthandover.com Please return this portion with your payment by Town of North Andover 120 Main Street North Andover, MA 0 1845 -9550 (978)688 qc#389NoAndWtrSgIsT2 Pl******AUTO**5-DIGIT01845 LANIGAN, ROBERT J. 29 GRANVILLE LN NORTH ANDOVER MA 01845-4901 Any amount which is not paid by due date will be subject to interest charges of 14% Per Year NEW OFFICE HOURS Billing information: Monday 8:00 - 4:30 (978) 688-9550 Tues 8:00 - 6:00 Reading information: Wed 8:00 - 4:30 (978) 688-9570 Thurs 8:00 - 4:30 Fri 8:00 - 12:00 ACCOUNT BILLING DATE 3170023 01/17/2014 PAYMENT ON OR BEFORE 0211712014 AMOUNT PAID 0000415171201400000000000003170023040317DO23000000004962001 SERVICEADDRESS 29 GRANVILLE LANE PAYMENT ON OR BEFORE 0211712014 AMOUNT PAID 0000415171201400000000000003170023040317DO23000000004962001 Town of North Andover 120 Main Street V NorthAndover, MA01845 (978) 688-9550' Sl LANIGAN, ROBERT J. 29 GRANVILLE LANE N. ANDOVER, KA 01845 NEW OFFICE HOURS READINGS $189.27 10/25Z2013 Monday 8.00 - 4:30 THROUGH 10/02/2013 CUrrent Type Tues 8:00 - 6:00 THROUGH 10/02/2013 34644388 471 Wed 8:00 - 4:30 AC B ILLIN(_-� __ DATE SERIAL# Thurs 8:00 4:30 FORWARD $0.00 USAGE N8 OF Fri 8:00 - 12: 00 3170023 10/25/2013 Date Filling infOrInatiOn: SERV�CE DATES — ----------- DUE DATE �978) 688-9550 06/10/2013 - 09/10/2013 11/25/2013 34644388 Reading information: SERVICEADDRESS 03/11/2013 (978) 688-9570 34644388 399 ACTUAL 12/07/2012 ;RANVILLE LANE THIS PERIOD AMOUNI RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL# READINGS $189.27 10/25Z2013 USAGE Nli07F THROUGH 10/02/2013 CUrrent Type Date THROUGH 10/02/2013 34644388 471 ACTUAL 09/10/2013 --DAYS 21 92 SERIAL# READINGS FORWARD $0.00 USAGE N8 OF ---- - ----- Previous Type Date DAYS 34644388 450 ACTUAL 06110/2013 39 91 34644388 411 ACTUAL 03/11/2013 12 94 34644388 399 ACTUAL 12/07/2012 16 86 PREVIOUS BALANCE $189.27 10/25Z2013 PAYMENTS THROUGH 10/02/2013 $-189.27 1112512013 ADJUST. THROUGH 10/02/2013 $0.00 INTEREST AS OF 11/25/2013 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL WATER USAGE ADMINISTRATIVE FEE USAGEILINIT AMOUNT 21 $81.17 $7.82 TOTAL $88.99 MESSAGES �NOTE' PAYME NTS SHOULD BE MADE TOWN HALL @ i 20 MAIN S FREF-3 OR BY MAIL TO OUR LOCKBOX (q� P 0 BOX 1 H4, MEDFORD MA 02155 WATER PATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 Please note our office hours have SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 changed, effective 4/30. See above. BYPASS METER WATER RATE: ALL UNITS $5.55 Pay Online at www,townofnortliaiiclover.corn Please return this portion with your payi�edfrby Town of North Andover 120 Main Street NorthAndover, MA01845 (978) 688-9550 qc#389 NoAndWtrSgIs T2 P1 ******AUTO'*G-DIGIT 01846 LANIGAN, ROBERT J. 29 GRANVILLE LN NORTH ANDOVER MA 01845-4901 Any amount which is not paid by due date will be Subject to interest charges of 14% Per Year NEWOFFICE HOURS Billing information: Monday 8:00 - 4:30 (978) 688-9550 Tues 8�00 - 6:00 Reading information: Wed 8:00 - 4 ' 30 (978) 688-9570 Thurs 8:00 - 4:30 Fri 8:00 - 12:00 ACCCUN_T___. BILLING DATE 3170023 10/25Z2013 .. SERVICEADDRESS 29 RANVILLE LANE 1112512013 88.9 9 —1 U . . . . . . . . . . 00004151712014000000000000031700230403170023000000008899008 Town of North Andover 120 Main Street North Andover, MA 0 1845 (978) 688-9550 LANIGAN, ROBERT J. 29 GRANVILLE LANE N. ANDOVER, MA 01845 NEW OFFICE HOURS READINGS Current Type Date Monday 8:00 - 4:30 34644388 460 ACTUAL Tues 8:00 - 6:00 L-R23171113A $1189.27 Wed 8:00 - 4:30 Please note our office hours have BILLING DATE Thurs 8:00 - 4:30 READINGS Previous Type Date Fri 8:00 - 12:00 3170023 07/24/2013 Billing information: S --RVICE DATES DUE DATE (978) 688-9550 L 03/11/2013 - 06/10/2013 08/23/2013 Reading information! ADDRESS (978) 688-9570 ---�ERVICE 29 GRANVILLE LANE TRANSACTION THIS PERIOD AMOUNT RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL# READINGS Current Type Date USAGE NB OF DAYS 34644388 460 ACTUAL 06/10/2013 39 91 RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 Please note our office hours have SEWER RATE: READINGS Previous Type Date USAGE N AYS D " OF] 34644388 34644388 34644388 411 ACTUAL 399 ACTUAL 383 ACTUAL 03/11/2013 12/07/2012 09/12/2012 --.- 12 94 1 16 86 37 96 I i PREVIOUS BALANCE $53.42 1PAYMENTS THROUGH 07/12/2013 $-53.42 I 'ADJUST. THROUGH 07/12/2013 $0.00 'INTEREST AS OF 08/23/2013 $0.00 IBALANCE FORWARD $0.00 I CURRENT BILL DETAIL USAGE/UNIT AMOUNT TER USAGE 39 $181.45 MINISTRATIVE FEE $7.82 TOTAL $189.27 MESSAGES *NOTE* PAYMENTS SHOULD BE MADE TOWN HALL ocx 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ RO, BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 Please note our office hours have SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 changed, effective 4/30. See above. BYPASS METER WATER RATE: ALL UNITS $5.55 Pay Online at www.townoffiorthandover,com Please return this portion with your payment by Town of North Andover 120 Main Street NorthAndover, MA01845 (978) 688-9550 Any amount which is not paid by due date will be subject to interest charges of 14% Per Year NEW OFFICE HOURS Billing information: Monday 8:00 - 4:30 (978) 688-9550 Tues 8:00 - 6:00 Reading information: Wed 8:00 - 4:30 (978) 688-9570 Thurs 8:00 - 4:30 Fri 8:00 - 12:00 ACCOUNT BILLING DATE 3110023 1 07/24/2013 SERVICEADDRESS 29 GRANVILLE LANE qc#393NoAndWtrSgIsT2 P1 'AUTO' -5-DIGIT 01845 0 ILMO M81 2 3012'0113" $1189.27� LANIGAN, ROBERT J. 29 GRANVILLE LN NORTH ANDOVER MA 01845-4901 00004151712013000000000000031700230403170023000000018927008 Town of North Andover 120 Main street North Andover, MA 0 1845 (978) 688-9550 LANIGAN, ROBERT J. 29 GRANVILLE LANE N. ANDOVER, MA 01845 NEW OFFICE HOURS READINGS Previous Type Monday 8:00 - 4:30 Tues 8:00 - 6:00 212 0 13 $53.42 Wed 8:00 - 4:30 Thurs 8:00 - 4:30 ACTUAL 12/07/2012 ACCOUNT BILLING DATE Fri 8:00 - 12:00 3170023 04/22/201 Billing information: SERV ICE DATES _��V - �1210712012 DUE DATE (978) 688-9550 ____ - 03/11/2013 __ __ 0 5 / 2 2/ 2 0 13 Reading informationi SERVICEADDRESS (978) 688-9570 GRANVILLE LANE F -TRANSACTION THIS PERIOD RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL# READINGS USAGE N11 OF Current Type Date DAYS 34644388 411 ACTUAL 03/11/2013 12 94 SERIAL# READINGS Previous Type Date USAGE NB OF DAYS 34644388 399 ACTUAL 12/07/2012 16 86 346"388 383 ACTUAL 09/12/2012 37 96 346 ACTUAL 06/011/2012 29 116 �346443811 PREVIOUS BALANCE $68.62 PAYMENTS THROUGH 04/10/2013 $-68.62 iADJUST. THROUGH 04/10/2013 $0.00 I JINTEREST AS OF 05/22/2013 $0.00 BALANCE FORWARD $0.00 —A- F&URRENT BILL DETAIL USAGE/UNIT M—OUNT WATER USAGE 12 $45.60 ADMINISTRATIVE FEE $7.82 TOTAL $53.42 MESSAGES *NOTE* PAYMENTS SHOULD BE MADE: TOWN HALL @ 12-0 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184. MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS $3.80 OVE R 20 UNITS $5.55 Please note our office hours have SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 changed, effective 4/30. See above. BYPASS METER WATER RATE: ALL UNITS $5.55 Pay Online at www.townofnorthatidover.com Please return this portion with yourpayment by Town of North Andover 120 Main Street NorthAndover, MA01845 (978)688-9550 qc#398 NoAndWtrSgls T2 P1 ...... AUTO' -5-DIGIT 01845 LANIGAN, ROBERT J. 29 GRANVILLE LN NORTH ANDOVER MA 01845-4901 Any amount which is not paid by due date will be Subject to interest charges of 14% Per Year NEW OFFICE HOURS Billing information: Monday 8:00 - 4:30 (978) 688-9550 Tues 8:00 - 6:00 Reading information: Wed 8:00 - 4:30 (978) 688-9570 Thurs 8:00 - 4:30 Fri 8:00 - 12�00 [--ACCOUNT BILLING DAT E 1 3170023 04/22/2013 L SERVICEADDRESS _CiRAU I _� 9 RANVI IIE 1��E KX�� i ��PAYMENT�ONORBFFORE -7 0512212013 $53.42 6ii 00004151712013000000000000031700230403170023000000005342001 RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978� 688-9570 IN ADVANCE ............. ___ ........ ..... . ......... . � 7 IAL# REA NEW OFFICE HOURS USAGE NB OF —346-44388-----3-99 currelit Type ToWn of North Andover Monday 8:00 - 4:30 In UAL 12/07/2012 16 86 120 Main Street Tues 8:00 - 6:00 (978) 688-9550 Tues 8:00 - 6:00 J� READINGS North Andover, MAO 1845 Wed 8:00 - 4:30 Thurs 8,00 - 4:30 USAGE NB F _-BULING DATE I Date (978) 688-9550 Fri 8:00 - 12:00 L-.____3170023--- E — ------ 01 �O 9t2 37 96 34644388 346 Billing information: (978) 688-9550 S E RVI—E _E­DiAT YES 29 86 DUE DATE 317 ACTUAL 03/14/2012 15 96 091=1 21201 12110712ol 2 02/08/2013 02108/2013 .__L_____Jf68-62 LANIGAN, ROBERT J, Reading information: ADDRESS 29 GRANVILLE LN (978) 688-9570 29 GRANVILLE—LANE LANIGAN, ROBERT J. 29 GRANVILLE LANE TRANI,$ACTION THIS PERIOD FPREVIOUS AM U N. ANDOVER, MA 01845 BALANCE $176.25 RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978� 688-9570 IN ADVANCE ............. ___ ........ ..... . ......... . � 7 IAL# REA USAGE NB OF —346-44388-----3-99 currelit Type Date DAYS 120 Main Street UAL 12/07/2012 16 86 NEW OFFICE HOURS Billing information: Monday 8:00 - 4�30 (978) 688-9550 (978) 688-9550 Tues 8:00 - 6:00 SERIAL# READINGS USAGE NB F 1111 IN Previous Type Date [DAY� S 34644388 383 ACTUAL 09112/2012 37 96 34644388 346 ACTUAL 06/08/2012 29 86 34644388 317 ACTUAL 03/14/2012 15 96 PAYMENTS THROUGH 01/03/2013 $-176.2S ADJUST. THROUGH 01/03/2013 $0.00 INTEREST AS OF 02/08/2013 $0.00 BALANCE FORWARD $0.00 . . . . .................... ......... ................. _._ ...... . ........ ... UURRENT BILL DETAIL USAGE/UNIT AMOUNT] WATER USAGE 16 $60.80 ADMINISTRATIVE FEE $7.82 TOTAL $68.62 MESSAGES *NOTE* PAYMENTS SHOULD BE MADE TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR _OCKBOX P.O. BOX 164. MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 Please note our office hours have SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 changed, effective 4/30. See above. BYPASS METER WATER RATE: ALL UNITS $5.55 Pay Online at www.towriofnorthandover.com 000041517120130000000000000317002304031700230000000OL862009 Please return this portion with your payment b'y' ny-grriount ��6 is not`7�' aid,by due ate Will be Town of North Andover subject to interest charges of 120 Main Street 14% Per Year North Andover, MA 0 1845 NEW OFFICE HOURS Billing information: Monday 8:00 - 4�30 (978) 688-9550 (978) 688-9550 Tues 8:00 - 6:00 Reading information: Wed 8:00 - 4:30 (978) 6,88-9570 Thurs 8:00 - 4:30 1111 IN Fri 8:00 - 12:00 ACCOUNT--- BILLING DATE _3170023 01F09L2013 SERVICEADDRESS 29._GRANVILLE LANE qc#398NoAndWtrSq1sT2 P1 ******AUTO' *5 -DIGIT 01845 mum 02108/2013 .__L_____Jf68-62 LANIGAN, ROBERT J, 29 GRANVILLE LN NORTH ANDOVER MA 01845-4901 000041517120130000000000000317002304031700230000000OL862009 d, Town of North Andover 120 Main Street North Andover, MA 0 1845 (978) 688-9550 LANIGAN, ROBERT J. 29 GRANVILLE LANE N. ANDOVER, MA 01845 NEW OFFICE HOURS Monday 8:00 - 4 Ulm= Tues 8:00 - 6:00 7�i im zoi 176.25 Wed 8:00 - 4:30 ---f F C COI�U IN BILLING DATE Thurs 8:00 - 4:30 L_.__3 __:�] Fri 8:00 - 12: 00 3 10/15/2012 ERVICEDATES Billing information: (978) 688-9550 06/08/2012 - 09/12/2012 11/14/2012 Reading information: �ERVICEADDRESS (978) 688-9570 RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL# READINGS 3170023 10/15/2012 —_-SERVICE ADDRESS USAGE NB OF Current Type DAYS 34644388 383 ACTUAL -Date 09/12/2012 37 96 SERIAL# READINGS USAGE NB OF Previous Type Date DAYS 346 ACTUAL 06/08/2012 29 86 134644388 34644388 34644388 317 302 ACTUAL ACTUAL 03/14/2012 12/09/2011 15 96 13 88 29 GRANVILLE LANE TRANSACTION THIS PERIOD AMOUNT PREVIOUS BALANCE $133.77 PAYMENTS THROUGH 10/02/2012 $-133.77 ADJUST. THROUGH 10/02/2012 $0.00 INTEREST AS OF 11/14/2012 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGEWINIT AMOUN7T WATER USAGE 37 $168.43 ADMINISTRATIVE FEE $7.82 TOTAL $176.25 MESSAGES *NOTE* PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR, LOCKBOX @ P 0, 84, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 Please note our office hours have SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 changed, effective 4/30. See above. BYPASS METER WATER RATE: ALL UNITS $5.55 Pay Online at www.townofnorthandover.corn Please return this portion with your payment by Town of North Andover 120 Main Street NorthAndover, MA01845 (978) 688-9550 j qc#386NoAndWtrSg]sT2 PI ***AUTO* *5 -DIGIT 01845 LANIGAN, ROBERT J. 29 GRANVILLE LN NORTH ANDOVER MA 01845-4901 Any amount which is not paid by due date will be subject to interest charges of 14% Per Year NEW OFFICE HOURS Billing information: Monday 8:00 - 4:30 (978) 688-9550 Tues 8:00 - 6:00 Reading information: Wed 8:00 - 4:30 (978) 688-9570 Thurs 8:00 - 4:30 Fri 8:00 - 12:00 PAY' MENT ON OR BEFORE 1111412012 $176.25 77 AM61LIlkTPAID 00004151712013000000000000031700230403170023000000017625000 ACCOUNT BILLING DATE 3170023 10/15/2012 —_-SERVICE ADDRESS 29 GRANVILLE-LANE PAY' MENT ON OR BEFORE 1111412012 $176.25 77 AM61LIlkTPAID 00004151712013000000000000031700230403170023000000017625000 RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE S- E DR -11 A L # $64.82 READINGS NEW OFFICE HOURS Town of North Andover Monday 8:00 - 4:30 Tues 8:00 - 6:00 120 Main Street Wed 8:00 - 4:30 Thurs 8:00 - 4:30 North Andover, MA 01845 Fri 8:00 - 12:00 (978) 688-9550 346 Actual Billing Information: 29 86 (978) 688-9550 LANIGAN, ROBERT J. _0' 12=01 29 GRANVILLE LANE Reading information: N. ANDOVER, MA (978) 688-9570 01845 PLEASE PAY ON OR BEFORE RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE S- E DR -11 A L # $64.82 READINGS ($64.82) USAGE NB OF �3464438'8 Current Type Date DAYS (978) 688-9550 Z01189-000001 346 Actual 06/08/2012 29 86 3170023 07/1612012 1 _0' 12=01 29 GRANVILLE LANE SERIAL # READINGS PLEASE PAY ON OR BEFORE USAGE NB OF 08/ . 102012 $13177�1 Previous Date WM� 34644388 317 —Type Actual 03/14/2012 15 96 1 34644388 302 Actual 12/09/2011 13 88 PAYMENT ON OR BEFORE 08/15/202 $133.77 J, �Ai 3170023 T170023M 07_11 612012 ''z;zlg�'7'.Uf�: ffiE=LT_ RTMJII� 3i� �il 4/2012-06108/20121 08/1512012 NA14-, 1, 29 GRANVILLE LANE FPREVIOUS BALANCE $64.82 I PAYMENTS THROUGH 07/09/2012 ($64.82) 1 ADJUSTMENTS THROUGH 07/09/2012 $0.00 INTEREST AS OF 08/15/2012 $0.00 BALANCE FORWARD $0.00 U.S.AG.E/UNIT AMOUNT WATER USAGE 29 $125.95 ADMINISTRATIVE FEE $7.82 Sub -Total $133.77 TOTAL �S� MESSAGES *NOTE* PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 Please note our office hours have changed, effective 4/30. See above. SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 Pay Online at BYPASS METER WATER RATE: ALL UNITS @ $5.55 www.townofnorthandover.com Any amount which is not paid by due date will be Please return this portion with your payment by 0811512012 subject to interest charges of Town of North Andover 14% Per Year NEW OFFICE HOURS 120 Main Street 41S171 Billing Information: Monday 8:00 - 4:30 North Andover, MA 01845 (978) 688-9550 Tues 8:00 - 6:00 Reading Information: Wed 8:00 - 4:30 (978) 688-9550 Z01189-000001 (978) 688-9570 Thurs 8:00 - 4:30 Fri 8:00 - 12:00 00 ITA —'C-W_U 9 6.1 3170023 07/1612012 1 _0' 12=01 29 GRANVILLE LANE if your address has changed, correct it below. 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I . . .. . .... . .......... . . ................. ... . ........ -- .............. . ............ ,35yster.-, ()perciino �ir�e VVe suggest 1�esz 4 keys to keepyour gysTem 'hullhy: 'ir,c cl service Use, VVhd` Rxve,- Rnctpr�e Additive . . . ........ 5ols P d�7e VV:rd R; Pe 6'ac,�Prij Aa6t�iv;� iv ea 5: 1. i �c-troju-,e n-aditiond ngaueri�u vi�,, Wind Riv�,r Boosl Program TeE Ak�;sin,�/,Rroken !uce Tv - C -di -rh., tffh'.-.e '-" 5oon Npot 97,8-841-1,017- ................ ............... " - -.. p2e�� —.- . 165---- ! '41�7--'-rVEd 1he if�-Jes� Locat ion Diagram wmr w4wr mwf;h In Id Payment Details Payment Type Credit Card Carol #: Security cod? Exp' Date Terms: Due on Receipt �a"f*�*'*�**er-�'*S*"*r'**'.*"e o',T * ------ ---- —healthy i 4 keys tc Ete _r!g _k. _4q� . ...... ............. . . . .......... ........ . . . ........................................... ......... ......... . . ....... D rO fl,, z r -servatons and in'f.,,nfified may requi- additional he o- Qw- �Ustom m; 5m 6eli' -,Q41 01 er 5olution , P� � s* at 976 -5 7toredditioncl information. or call I our Ctisitnier 5ervice line at 800-499-1682 with ��qM��tions. ........... . . . ............ - ..................... . ........ . .. -'Pcil ""orz� cc . ...... . o/4— kL.. c 9016 e'; .... . ... ... ........ .... . ......... rlokl�t'- '511-Adr Renit Pay.ment St Suite ....I ia-.- Customer 5iqnature WO -001 ClAh Copy Rev 2/()c