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HomeMy WebLinkAboutMiscellaneous - 30 SPRING HILL ROAD 4/30/2018 (3) h 'E P Commonwealth of.Massachusetts Zr. City/Town of No Andover [ y 4 2013 System Pumping Record ro,�Yr�:� l< T + scs Form 4 Ira-1H"DEP4 RT. E a DEP has provided this form for use by,local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, �1 �� use only the tab V aa key to move your Address cursor-do not No andover Ma use the return City/Town State Zip Code key. 00--1 2. System Owner: V� 00M Name mun Address(if different from location) City/Town t State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: talions 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Name Vehicle Lic nse Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatm nt P ant, 20 So. Mill Bradford, Ma Q1835 Signature o er Sig a ceiving Facility Date t5form4.doc•03/06 System Pumping Record-Page 1 of 1 . :`'r:::i?•r•(,'i/�"u,rCi::�Crt:r`i•,fit+r•Y)t'��;i.hLf,Y;��,..�'Ll:'l.. . • .'�'•i't vi.4't.. r`>'rY::{••:iY .GAY• rjlJ,Ct,'.�c•�.��:'!;!' IM•• DEC 0 6 200 . _ TOWNUF' AUK-I'I-t '� ! � • u^ J S Y 3 TB N1 P lJ lv1 P 1 N U RF_ `- .)HEALTH DEPARTMENT ANDOVERN OF NORTH Ys-re OWNQR (k ADouss --�- P00 L; Np y*U ......• .. ... �VpUC � uta h.• �.�'���./ rvKb oN sr✓RYlce: xvv'rIN, / Ub�tiRY.1'('IUNJ. .� � ► 0000 coNornoYvu. I'u co;K SYY 038 _..... 8A1'Yl,83 M&9$rY8 sOl,lpr3 �...., Pt,OOD�o �OLCDC�IVSYOY�X' 01�{ER•pXPL,�IN uM)*irrNcm uN I'tN I'� G ' k'•y�1��'f �`L,yN !J ,.,� r Jr�t � l 1 j ' r.. t. .. o •{i` f w:! f' fsJ �, tri sA Il ,x 41 ii. ��� r{.il.T�A {t� !+ � � t .tlt'��5 1 ! r f 1 Jt 1 t • �� �1 r_{j�gV);/tfy.i�y1� +�+S �'iir } vM p i{ , }S + � ,., l i,. Ap{•a(-y, .{� �h��! 1"7}�1 if•,kr,t��fl,.I:�t�� ,�YwX r vl� jJ,J�•,t:;Y� �i r r' } '. r , i �• t .. � t f'+f`�V•� A iL 11 q[�, + •Y .,I;1 h p';iN 1�y1, , ,j I r. - r, r ' 1 lfifrP 61 r+. .' J %i. ti' -� t �.✓C . �t'R1°: 1'' N t't 11 71 MiF' �y (,}�,. .a tr f'• ty , li ��,�,.-,..+••- J 1 TOWN OF NORTH ANDA pill SYSTEM OVER . ,'.�� P� 'ING RECORD # 4 10, � • h f T T. `T!'!, S �`t..r}vW r fY•�lA"} `t't t�. rr1.i "t t a . d , .,�f��'rJ^'n '3 �l' � �� ATE�� � �` i�r•�� '" " �` � �T't.lir'fii.��•r�y�}�fS•fiiVTsi .¢ :, _���;.��« . it-t. TJaNl,�(it `�i19r��Jxf 'r r.'., A i< 't/ `J !t t•. O• WNER&ADDRESS SYSTEVI'LOCATION ,4 i �ri!'� 't*Jl1 i .(�;} fl.'�i ~. ' Q/ /' ,/. CXS1�lp�e• kA-frout of ikQ ' ;. y;•, @ V &L. use) • '} {�{•!1 111? �I�aF fir}{''1�ta.r)R f n i t .�, � M ' 1 l ��� 5 � !F � 1 t 'rC�'�'.of.yY.rir :.,� •'t.1,4 F, v J .. .�.. . . DF P �lrL.� QUA►,NTITY PUMPED GALLONS . P r � 2tt,WW �rg4eM i`•' ?iJ{rift'� a -.`�1 IiF.: It :'. f th i. r O YES' 'SEPTIC TANK: .. NO ij3v-w,.3cfkJ�,•f1'J',r ./�r'7oS yb#1.;'r ' f.• t .t. �, t oF:SERVICE:f `RouTINE _ CMERGENCY 77 S• " • r � coD ITION FULL TO COVER ►VY GREASE. °.ROOTS BAFFLES IN PLACE EXCESSIVE SO LEACSFIELD RUNBACK SOLIDS ARRS •^--- ; �T-FLOODED C OVER OTHER ATN) ������J!(i°if Y'- ',r s�1 H'9'N•�p d t hy r t 1.. r s 41 t k�.r;ib 1 �9 7.•"d'-"a•N •�.{r+ •V.".e1r.�• t •v.. {.•;/,V A .• ' �jr M�r 9 �la�lY�y n '�t a '; � 4r@ ,tF..: ti 1 i T�• i • .-. r ca n ' v 4 � isf 7 Hit • .�;.{? n. � ,.,,s<fli,iM,i ,: �l is 7!�+S l Ir't� s i ' ' - •. .. !1��•r �' a �,.(d t� I.�_ !'t�c4��r�''p♦.t4r d�,...i } ,�,,,,ri�!R M• �.,/(J /T/���rrlff .1 f �y,{�.rt'�f.'ti�l 1�'rrSY^411 t t,!kJ•J �A( ///� ;.' . F . ,� f h L'+r � 'Vf{,r ,rti•i.':rft •}}yl�'"�!� t•.�P�/A r��J���,,. r , "" OFNORTH-ANrDUVER _ S-YSTEM PUNT ING ��p, .'I)- 4z 3 201 �M U YrYF,R $t AUt3RgSS o SYSTEM LOC'AT10N .-..__ (example: left front of bouxe)- --t V � ` y VATF OF PUMPINC:4 J QUAr+ITlTY PUMPED � ' _ ::+:aaPUUL: NO -L YESSEPTPC TANK: NO YES ATURE OF SERVICE; ROUTINE ...... EMERGENCY (P)a t R VATIONS: GOOD CONOITIOX FULL TU COYE(2 HEAVY GREASC BAFFLLS 1)Y I'L.ACI•: �— ROOTS LEACHRIELD RUMRAC)(_ EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER DRIER (EXPLA.111) PUm PrD i3 Y: u�•1•r:n'•rs TRA NSPEItRED TO: f r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS `-" DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemos SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC71ON FORM Commissioner,.' PART A CERTIFICATION Prosy Address: dame of Owner Data of Q p Address of Owner: • id, IM . Inspection: L I a N Name of Inspector:l Pring 1 am approved system inspector to Section 15.340 of Title 5(310 CMR 15.090) Company Name: utt ..;; Meting Address: 9072j Telephone Number: _ W'7 S. ELI CERTIFICATION STATEMEIff I.certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site s age disposal systems. The system: Passes Condi'ovally Passes _ Nee Further Evaluation By the Local Approving Authority Fai 4lspeetor's AhDate: L The System Inspector sh submi a c py of th inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspectio If the sys m is a. orad system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report t the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copie sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS. is i � i 1 . ; revised `:9/2/98 Page 1 of 11 Printed on Reryrled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) *apwty Address: 3 O `.Jp r i 1-H i It N. A YtAo vt.,r- MA A D t Ss q S � Owner: V1 C.toV- el Ill Dat*of kyspaction: �� l 2�C 8 INSPECTION SUMMARY:`' Checkg)B. C, or D:. SY PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: ` B. SYSTEM CONDITIONALLY PASSES: One.or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes;no,or not determined(Y,N.or ND).'Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,Is cracked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pips(s) or due to-a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times s year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed J i i; i; _ • t i *Note: THE TITLE 5 INSPECTION IS NOT A GUARANTEE/WARRANTY OF THE FUTURE FUNCTION OF THE SEPTIC SYSTEM. ri s l revised; 9/2/98 Page 2ot11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A i CERTIFICATION(continued) Prper otradaesa: 3D S,Pr►nq-I-E I�ct•. �. ncLo�-P_r i Owner: V i G`I D� b�llc� ;Pala of i"f k ,. C FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: " Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. I _ i 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 AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply wall. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) : ; OTHER L, r revised '9/2/98 Page 3ofu SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address;: 3D j, Rot N � f vLd-D U e-r� M A D l��t Z) Owner: U i 041.1,sgtb elk a i� Date of Mtspeotien. y I lZ�00. D.';' SYSTEM FABS: You must indicate either"Yes"or"No" to each of the following: . _ I have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes. No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level In the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. . Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E'f,LARGE SYSTEM FAILS: ' You must indicate either"Yes" or"No" to each of the following: The following criteria apply to large systema in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: . ' Ye'i No: the system Is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public water supply well) F The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. I'1 ;revised 9/2/98 Page aoru SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Proporty nddrese: '.3 o Spri i i lid: N. A nd00 e-4, IM R o t�L{S Owner: V I G'�DY` GJ�e-110. Da".of Inspection: - Check if the following have been done:You must indicate either"Yes" or"No" as to each of the following: Ye No is Pumping information was provided by the owner,occupant,or Board of Health. T✓ ,_, r. Nona of the system components have been pumped for at least two weeks and the system has been•receiving•normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. ;;;.. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components,excluding the Soil Absorption System,have been located on the site. The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example,Plan at B.O.H. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)) The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance.of SubSurface Disposal Systems. d j' :''revised, 9/298 Page Sof 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART C SYSTEM INFORMATION `�--Property address: 30-Spr i n -! Owner: l 1Zo� t�1. n c,D J�f, h1!� D l g y S ,. Vic+or `� Itc� Dote at Inspection: y l p� FLOW CONDITIONS RESIDENTIAL• . Design flow��g.p.d./badro m. Number of bedrooms(de n): Number of bedrooms tactual): Total DESIGN flow Z Number of current residents: Garbage grinder lyes or no): yy•�� Laundry(separate system) (yes or no):11v If yes,separate inspection required Laundry system inspected 1 s or no) Seasonal use(yes or no): Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no)- � Lest date.of occupancy:z� �. . COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: god ( based on 15.203) Basis of design flow Grease trap present:lyes or no)_ Industrial Waste Holding Tank present:(yes or no)— Non-sanitary,waste o)_Non•sanitary.waste discharged to the Title 5 system:(yes or no)_ Water meter readings,if available: Last date of occupancy:' OTHER:(Describe) '.est date of occupancy: GENERAL INFORMATION PUMPING RECO a d source of inf alio r,P/Z u System u ped as part of ins n:(y s r no) If yes,volume pumped: gallons Reason for pumping:_WKAi;,v•t r TYPE90 SYSTEM 11Septic tank/distribution box/soil absorption system Single cesspool Overflow.cesspool. Privy Shared system lyes or no) (if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other i APPROXIMATE AGE of all components,date installed lif known)and source of information: O Sewage odors detected when arriving at the site:(yes or no), .j revised ;92198 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) `--`P►ar.addresa: ori nq !i Owner: U.i Gt D rbe�t Ci _.� Dow Q! • yllalop r BUILDING SEWER (Locate on site.Plan) 4 Depth below grade: I� Material of construction: cast Iron ' 40 PVC_other(explain) Distance from private water supply well or suction line IV Diameter `/4 Comments:(condition of joints,venting, evidence of leakage,etc.) SEPTIC TANK• (locate.on site plan) Depth below grader Material of construction: oncrete_metal-Fiberglass _Polyethylene_other(explain) If tank is metal,list k10,51 agee_ Is age confirmed by Certificate of Compliance_(Yes/No) X Dimensions: /�,( !0r5"/ Amea0 Sludge depth:•--.. �_. Distance from top of pludge to bottom of outlet tae or baffle: Scum thickness.. IQ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outl to or baffle: t• Now dimensions were determined: A � L ', r<Comments. 4 (recommendation for pumping condition of inlet and outlet t as or baffles,depth of liquid level in relation to outlet inv , uctural integrity, , evidence of lea ge,etc.) �� g y GREASE TRAP• (locate on site pla . Depth below grade: Material of.construction:_concrete,_metal Fiberglass ,_Polyethylene_other(explain) Dimensions: Scum thickness: ;? Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: j Date of last pumping:T_ Comments. (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) t s7t Iii} j t• revised, 9%.2/.98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Propercydress: 30 GSpri -�-�i 11 i� N. A ncL oVt r, M7q O l z wS .!W owns►: ` ;el lc� Date of Inapectim: TIGHT OR HOLDING TANK: Tank must bepumped prior to, or at time of, inspection) (locate on plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass Polyethylene_other(axplain) Dimensions- Capacity, gallons Design flow: ; : gallons/day Alarm present Alarm level: Alarm in working order:Yes_ No - Date of previous pumping: _ Comments: . f 1. (condition,of inlet tee;condition of alarm and float switches,etc.) DISTRIBUTION BOX . (locate on site platy lepth of 111 quid level above outlet invert: Comments (note if level and istribution is equal,evidence of solids carryover,evidence of leakage into or out of box, etc.) t9L&— i2 ct� C r PUMP CHAMBER: / (locate onsite plan) _ . Pumps in working order:(Yes or Not .Alarms in,working order(Yes or No) Comments: .(note condition of pump chamber,condition of pumps and appurtenances,etc.) � I li revised) 9/2/98 Page 8of11 r� I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 6 SPri n `� l l c. ri DJ e r, hAl l D 1$LIG Owner: Vi C*orcS�t A6_ Date of : Lt1'2-100 SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) not located,explain: Type:_. leaching pits,number ;'. leaching chambers,number: leaching galleries,number: t leaching trenches,number,length: laaching fields,number,dimensions: overflow cesspool,number: a 1. Alternative system: Name of Technology: Comments: : (note condition of soil,signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.) CESSPOOLS:. (locate on site pl Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth ofscum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments :.(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) PRIVY: (locate on ite plan) ' .Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) } I 'revised 9/2/98 Pap 9of11 x -?1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM WFORMATION(continued) Addrm;. o SprV1y i�al. N . n PCov-ex, Vrt A o t sb'l 5 } 040 of Inapaqtwn• S ►CI�I OF SEWAGE DISPOSAL SYSTEM ; include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comas into house) � y _2 (wl14LO OF N - t O�Bt$RE•i�` �+—.. •u 3AN�t f f is I ; r � ; Y f vr� f � ti j ' 1I ' I 1 I ' f• I Tlif `f �X s� i'r�2I98 ni Page 10 of 11 i ,t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) e—Property Address: 3 D��pri nq '�i l l Owner. :. U i G or �l lci Date NRCS Report name Sal Type! Typical depth to groundwater USGS; Onto website visited ' Observation Walls checked Groundwater depth: Shallow Moderate Deep SITE EXAM.. Slope Surface water Check Cellar✓ Shallow wells A Estimated Depth,to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: F Obtained from Design Plans on record 4 bsofved Site(Abutting property,observation hole,basement sump etc.) Dotermined from local conditions f t Checked with local Board of health Checked FEMA.Maps '"'^- Chocked,pumping records ` Checked local excavators,installers 4 Used USGS Data 1 Describe how you established the High Groundwater Elevation. (Must be completed) , � P 1 ` revisegj9/2/98 Page ltofll Telnet - 10.1-71.55 WATER BILLING HISTORY METER #1 : 2100260 --------------------- 30 SPRINGHILL RD # CYCLE SERUICE PRIOR CURRENT USE WATER SEWER FEES TOTAL 1 2000-12 08/0371999 2302 2400 98 267.54 0.00 -_0.00 267.5 2. 2000-22 12/29/1999 2400 2470 70 191 .10 0.00 0.00 191 .1 3 2000-32 0370872000 2470 2480 10 27.30 0.00 0.00 27.3 REUIEW CHOICE # or <ENTER> MORE HISTORY: itfitx, rog�m BWS lip ru Erin ke,� .^ tdunib E3 KVS InfOFmation Systems, Inc. BE] SMUUB04A/CS/U05/L007 TOWN OF NORTH ANDOVER DATE_ 04103/00 TERMINAL NO: 000 CONSUMER METER F/M TIME: 10:17:07 Acct: 01-2491000-0 SABELLA UICTOR 30 SPRINGHILL RD Meter No: 001 Rev Mtr/#: N 000 Book: 10 Page: 24910.00000 Meter Flg: 0 [1] Connector: ] Digits: 5] Dim Cd: A] Multiplier: ] Arb #: ] Manf Cd: ] Units: Pipe Size: ] Len: ] Type: ] Req: 00/00/0000 Inst: 00/00/0000 Cnct: 00/00/0000 Disc: 00/0010000 Cd: 0] Wrk Cd: ] Mt Code: ] Met Loc: ] In/Out: ] Notes: 1" TRI-10 ] Serial #: 0032327922 1 Bgn: Cur 2302 E Prev: 2240 A 2nd Preu: 2140 E [2] From: 01/25/1999 To: 04/22/1999 Curt: Preu2: Next: 00/00/0000 Cns Cr: Mth Bill: 03 User: ] -------------------------- Consumption Information ----------------------------- --- First 12 Billing Months ------[3] 1------ Last 12 Billing Months -------[4] 06/1999 62E 12/1997 110AI 06/1996 20A 12/1994 78A 03/1999 100A 09/1997 128AJ 03/1996 20A 09/1994 BOA 12/1998 40E 06/1997 20Aj 12/1995 180A 06/1994 20A 09/1998 60A 03/1997 20AJ 09/1995 60A 03/1994 30A 06/10-08 10A�12/1996 88AI 06/1995 20A 12/1993 110A 03/1998 40A 09/1996 120AJ 03/1995 28A 09/1993 30A First 12 Total: 782 j Last 12 Total: 660 <ESC> to Enter New Meter Number <M>odify, <D>elete or <N>ext q5-o Hcr- w l Hcy = 115-0 X l qS> �� 1I0�S = 33(al 60c) 110/2S _ 5A-�� /11/a -mss N I� 2�-Ea �, "`I' F wQ CA rn N� <<o ti4 2 eJij iSTER�p'p� pNAI SANOa�` i -u a r y " 1 A� 2CARD of HF. 0--i--1 NaI�TN Atipnvel-�I MA, W,Q�Ef{ Sc��►�L7 �] �bWrJ ❑ WEc..L ,�P�ouCDl1 LC .�._... SS sEPT'ic sys��,� vEs<<� b �v�"D DArt' /PR�Ovj�v6 /urhol�,rkj ( oO/JPiTIO/J5 �i�aPPJz�v� D/�iE R�ASoNS = . • Dw� ScPT'c c SY5TE/t1 w sig u.4T►oAj C-X4V4T(o1lJ )AJSPt�-6T to,\j 94rC C1 P45S fE] F41L f=rNAL fJJ,SpE�rlon� 4 PFROOED 4WIT1oIJAL l,,jsFbz,joo5 Dt5l�PPl�ov'D DarC RV,Q L -16PPROVAL D,o ID'J-8� APP►�(�(�6 v i N o i�, BOARD OF HEALTH No.Andover, Mass . ��N'QL 67 _-5 (D sns(1RFACE DI5POSAL DEsiaN ma ;ZST » LOT APPROM - DAA "' ' 5 / DISAPPROVED DATE Provid6ds Reasonss y� r �Q Title V FAIL Ob Reg 2.5 The submitted plan must show as a minimums a) the lot to be served-area,di.mensions lot #,abutters b location and log deep observation hoes-distance to ties c location and results percolation tests-distance to ties d design calculations & calculations showing required leaching area (e) location and dimensions of system-including reserve area f) existing and proposed contours (g) location any wet areas 'Athin 1001 of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 1)01 of sewage disposal system or disclaimer (i) location any drainage easements withir 1001 of sewage disposal system or disclaimer-Planning Board fi �.es (J) knom sources of water supply within 2101 of sewage disposal e system or disclaimer (k) location of any proposed'well to serve `ot-1001 from leaching facility (1) location of water lines on property-101 ,.-om leaching facility (m) location of benchmark (n) driveways w (o) garbage disposals (p) no PVC to be used in construction (q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations (r) modmum ground water elevation in area sewage disposal system (s) plan .must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (a) capacities-150,% of flow, water table, tees, depth of tees, access, pumping (b) cleanout (c) 3.01 from cellar wall or inground swi= ng pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes (a) -Mpe greater 0.08 Reg 10.1 b) slop ,�h: y IF ,�.r • AYNDOVE�R JSSACHUS; TTS v,lrlr: ,•(.Ql'�t r ,u':,: 1' j�.r::, TOV/ ' �'f11.,,,,.,,t,_. ,',l,i 'r'�il.�,i,j:�;.�,.•.L,;YI�.�r N�l DEP.hei provided lhli form i r uao �', focal 8oarq+EoLh'oa be +::bml{{od !o the local 8oarc ar nOdi(n pr other a e SY9,al71 P_•^- L AArovin9 eu(noory. A' F1-1-1-17y -IFTQT'r�� 'a _ Sys qm LxaUon; N� Y.' ;�'..� � ..'�„'a:�� `, '%,;.•.; , , Sial+ ------- �;� Owner. .r:e (Ill dlMer+nl town/Quuon) — Ye'epnone n,n,0er - - ,fPumAlnO Rekord t� Daly o! Pum 1.TYP.a k aya(otm; (� c699Poo 1(9) op(lc Tanx _ Tf { Taro, 4^ EIIIM Ue • •C;.'� ri.�•��r• . nl.r as Fllla(Pr�•sent? r yof 19 o i t.u�, ': t:, ; '� Nr; 'i Y.•(. 1, , j y99, n'e9 c!sanav? Y on (. ..: ' .. Y . �. Sy @�1VPumped 8y; G ung !. r:,-irY„1'^�ti,'j ,1` C � 2, j - C i. r,'aye�' , on.where conlanls',y ora dl9poseo: ma-k , o /dap,`w.. /eDDrovaJs/f6(orms.rwm�in9pecl Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. a SyM �tt��M�Reco d must be submitted to the local Board of Health or other approving au ority TOWN OR NORTH ANDOVER A. Facility Information Important: When filling out 1. System Location: forms the 3-o s" -computeto r,use 1ree r only the tab key AddressAncl) V� / _ , to move your f1/ �f �(`q cursor-do not JUL use the return City/town State Zip Code key. . 2, System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 5 2• Quantity Pumped: Gallons 3. .Type of system: ❑ Cesspool(s) a Septic Tank ❑ Tight Tank � ] Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: J� 6. S stem Pumped By: meVehicle License Number ompany 7. Location where contents were dispose J AifnMre of Haulbr Dat http:/twww.mass.gov/deptwater/approvafstt5forms.htm#inspect t5fonn4.docc 06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts W City/Town of No.Andover System Pumping Record Y p 9 Form 4 �M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: �r �j 1 �� 0j, When filling out 1. System Location: forms on the �`1 l TOWN OF NORTH ANOOVE computer,use only the tab key Address RTMENT to move your No.Andover Ma 01810 cursor-do not use the return City/Town State Zip Code key. 2. System Owner: Name 'x"07 Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping lo.3 - 11 D 2. Quantity Pumped: Gallonsate 3. Type of system: ❑ Cesspool(s) © Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): /\ 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System.Pumped By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Ste rt' -treatment Plant, 20 So. Mill Bradford, Ma 01835 l i ign ture bf Hauler Date ,)�3//' Signature of VWceiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1