HomeMy WebLinkAboutMiscellaneous - 29 GRANVILLE LANE 4/30/2018 (2)6
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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
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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
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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
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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 $0 which
recorded with Essex reby made for S, More complete description of MEOWS
plan reference Is hC Ming to plan.
heroin Conveyed. Said Lot 12 contains 1.01, acres Saco
Being the marno-pramteas conveyed to it b I y Foreclosure Dead dated Novanber 111019"
and recorded with Essex North District Registry Of Deeds.. Book 1325
page 204
Lj
0 3
dw old Parr Better Homes- &ka'
b" C&uud ks QwWsts sW to be lerd* Iftd OW thm Pe"I" 10 ba 504 "l`Sw#l*dV' WA
ddI,t,edj&jbwm&WbdWfby G*Org*H- Farr
bMW auly auth� tw 6-r%
4y.91 October in the IM om dMUUrj n6g hundail AW Iav*0ty-4IgK
N
LER MOMEP, J. -r,
it -A
AR
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IG7046rdp
lip dowmanauattk at Illas"gIPMUS
73
October IV
Essex a
Tim pecansur am$ "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
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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.
PLEASE PAY ON OR BEFORE
LANIGAN, ROBERT J.
08/ . 102012 $13177�1
29 GRANVILLE LANE
N.ANDOVER,MA
AMOUNT PAID
01845
C"'
ck_ - d
-�1170023 "/7�� 0
3 091J3
00004151712012000000000000031700230403
I
0207053240
Work Oree�, #
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09/23/2014 Svc. 1000 gale for titio five nxAet
N'; '�n Oita HOME/cHECK (ea)
OS/23/2014 Title five customer vill be home
he ba,4 tho, plans and watez� records/ HOMI/CHECK
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0412VID SAT AM sen -rice 1-000gaig sxposed front
ya,rd TK ok'd coupon $25
Lanigan Robert
29 Granville Ln
North Andover, MA, 01845
(97'3)-685-2002 x
05,10 112000
Custot-iter S�nce
Tech Comments
4/14 dig safe 9 2014 3610496 0ept 10th, after
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SyVem Location
Primary Rome
29 Granville Ln
North Andover, MA, 01845
(978)-685-2002 x
Lanigan
Services
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-ty �ni� Pr�cp Ex� Price
D P �- C C" on Quon'! 11;
Pump�-ng 1000 1 228.7500 $228.75
Fuel Surcharge Residential 1 19.5000
$248.25
�ax $0-00
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-ty �ni� Pr�cp Ex� Price
D P �- C C" on Quon'! 11;
Pump�-ng 1000 1 228.7500 $228.75
Fuel Surcharge Residential 1 19.5000
$248.25
�ax $0-00
-76tni $248.25
Tenk Obs,7rw+ions: Potential Solutions:
............ I . . .. . .... . .......... . . ................. ... . ........ -- .............. . ............
,35yster.-, ()perciino �ir�e VVe suggest 1�esz 4 keys to keepyour gysTem 'hullhy:
'ir,c cl service
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. . . ........
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................ ............... " - -.. 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';
.... . ... ... ........ .... . .........
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