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j 307 CAMPBELL ROAD JS-2006-0004
Project Detail Report
Printed On:Wed Jul 20,2005
1 Project Name: - - - -- - — --
GIS#: 7303 Project No: JS-2006-0004 Owner of Record 307 CAMPBELL ROAD NORTH
t 14ORT11 .9 Map: 106.13 Date Submitted: Jul-12-2005 307 CAMPBELL ROAD
3� •' �� Block: 0062 u Status: Open NORTH ANDOVER, MA 01845
Lot: Work Category: Work Location: 307 CAMPBELL ROAD
• Zoning: Proposed Use: District: -__`
�SswcMustt land Use: 101 Proposed Use Detail Subdivision
Description Septic D-sox Comments:
of Work:
Department Status
GeoTMS Module: Status File No. Comments: LCDate:
Board of Health GREEN FLAG BHJ-2005-0031 7/20/05-Gerri from RJ inspections calling for James Wright who did the Title 5 on this
property on 7/5/05 and noted a conditional pass based on D-Box replacement. Looking for
COC. This has not been inspected yet. Todd Bateson called back,and box will be ready for
inspection tomorrow after 12:00. Scheduled inspection for 3:00 p.m. Tried calling RJ
Inspectional Services twice to let them know,but line was busy.--p.d.
Permit History
Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work:
DWC Component Repair - BHP-2005-0234 Jul-12-2005 SIGNED OFF JS-2006-0004
- i
GeoTMSm 2005 Des Lauriers Municipal Solutions,Inc. Page 1 of 1
Driving Directions from 400 C--good St,North Andover, MA to 307 C-�' bell Rd,North ... Page 1 of 3
Start: 400 Osgood St
North Andover, MA 01845-2909,
us
End: 307 Campbell Rd
North Andover, MA 01845-5726,
us
Rent tV isek
Directions Distance
1: Start out going SOUTHWEST on OSGOOD ST toward 0.3 miles
MILL POND.
2: Turn RIGHT onto BEACON HILL BLVD. _ 0.1 miles
3: Turn LEFT onto MA-133 / CHICKERING RD / MA-125. 1.2 miles
Continue to follow MA-133 / MA-125.
4: Turn LEFT onto MA-114 / MA-125 / TURNPIKE ST / 3.6 miles
SALEM TURNPIKE. Continue to follow MA-114 /
TURNPIKE ST / SALEM TURNPIKE.
5: Turn SLIGHT LEFT onto BERRY ST 0.3 miles
6: Stay STRAIGHT to go onto ASH ST. Y 0.1 miles
7: ASH ST becomes CAMPBELL ^RD. T 0.2 miles
8: End at 307 Campbell Rd
North Andover, MA 01845-5726, US
Total Est. Time: 13 minutes Total Est. Distance: 6.03 miles
http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt&1 gi=0&un=m... 7/12/2005
Driving Directions from 4000,sgood St,North Andover, MA to 307 Q bell Rd,North ... Page 2 of 3
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400 Osgood St 307 Campbell Rd
North Andover, MA 01845-2909, US North Andover, MA 01845-5726, US
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All-rights reserved. Use Subiect to
License/Copyright
These directions are informational only. No
representation is made or warranty given as to
their content, road conditions or route usability
or expeditiousness. User assumes all risk of
use. MapQuest and its suppliers assume no
responsibility for any loss or delay resulting
from such use.
http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt&1 gi=0&un=m... 7/12/2005
North Andover Board of Ass(,-.q--,,Ors Public Access Page 1 of 1
Parcel ID: 210/106.D-0062-0000.0 Community: North Andover
SKETCH PHOTO
Click on Sketch to Enlarge
No Picture
II
Available
Location: 307L-5 CAMPBELL ROAD
Owner Name: 307 CAMPBELL ROAD NORTH ANDOVER
REALTY TRUST-CHERYL C WALKER, TR
Owner Address: 307 CAMPBELL ROAD
City: NORTH ANDOVER State: MA ZIP: 01845
Neighborhood: 7 - 7 Land Area: 3 acres
Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2464 sqft
i
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ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 477,700 456,800
I
Building Value: 269,200 258,300
Land Value: 208,500 198,500
Market Land Value: 208,500
Chapter Land Value:
LATEST SALE
Sale Price: 1 Sale Date: 12/16/1993
Arms Length Sale Code: F-NO-CONVNIENT Grantor: WALKER, CHERYL C
Cert Doc: Book: 03935 Page: 0030
j
http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=468039 7/12/2005
Residential Property Record Card
PARCEL_ID:210/106.D-0062-0000.0 MAP:106.D BLOCK:0062 LOT:0000.0 PARCEL ADDRESS:307L-5 CAMPBELL ROAD
PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 03935 Road Type: T Inspect Date: 09/18/2003
Tax Class: T Sale Date: 12/16/1993 Page: 0030 Rd Condition: P Meas Date:
Owner: Tot Fin Area: 2464 Sale Type: P Cert/Doc: Traffic: M Entrance:
307 CAMPBELL ROAD NORTH ANDOVER Tot Land Area: 3 Sale Valid: F Water: Collect Id: RRC
REALTY TRUST-CHERYL C WALKER,TR Grantor: WALKER,CHERYL C Sewer: Inspect Reas:
Address:
307 CAMPBELL ROAD Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LOW Indust-B/L% 0/0 Open Sp-B/L% 0/0
NORTH ANDOVER MA 01845
RESIDENCE INFORMATION LAND INFORMATION
Style: CL Tot Rooms: 7 Main Fn Area: 1232 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R2
Story Height: 2 Bedrooms: 4 Up Fn Area: 1232 Bsmt Area: 1232 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class
Roof: H Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1 199,069
Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 2 9,400
Masonry Trim: Ext Bath Fix: Tot Fin Area: 2464 VALUATION INFORMATION
Foundation: CN Bath Qual: T RCNLD: 244702 Current Total: 477,700 Bldg: 269,200 Land: 208,500 MktLnd: 208,500
Kitch Qual: T Eff Yr Built: 1987 Mkt Adj: 1.1 Prior Total: 456,800 Bldg: 258,300 Land: 198,500 MktLnd: 198,500
Heat Type: HW Ext Kitch: Year Built: 1985 Sound Value:
Fuel Type: O Grade: G Cost Bldg: 269,200
Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Val 1:
Central AC: N Bsmt Gar SF: Pct Complete: Att Str Va12:
Aft Gar SF: %Good P/F/E/R: /100/100/91
Porch Type Porch Area Porch Grade Factor
W 360
SKETCH PHOTO
20
12360 Sq.R.
16 No icPture
4 Available 3430 44 1 n
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1232 Sq.R.
28 28
44
Parcel ID:210/106.D-0062-0000.0 as of 7/12/05 Page 1 of 1
--
Town of North Andover ' J pORrit
Office of the Health Department
Community Development and Services Division a
400 OSGOOD STREET
North Andover,Massachusetts 01845 �s'
sACMus
Susan Y. Sawyer,REHS/RS 978.688.9540-Phone
Public Health Director 978.688.8476-Fax
I
CE�'N��'ICA2�E OFCogytDr LA-PA.AXCE
As of:
of 20 2005
I
This is to cert that
the indi'vidual su6su ace di osaf stem
Constructed( or
W,paired- 1D-Bo,� Onfy - (-4 By
Todd Bateson
I
.A
t
307 Campbeff Road
Xorth Andover, gy q 01845
9fas been instaffed in accordance with the provisions of Titfe V of the State Sanitary Code and
with the North Andover Board of Yfeafth regufations.
The Issuance of this certfcate shall not 6e construed as a guarantee that the system wiff
function satisfactorily.
f.
-Susan . Sawyer, 1REAS19S
1Pu6fic.Ifeafth Director
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
DelleChiaie, Pamela
Subject: Susan & Michele-D-Box Inspection
Location: 307 Campbell Road
Start: Thu 7/21/2005 3:00 PM
End: Thu 7/21/2005 3:30 PM
Show Time As: Tentative
Recurrence: (none)
Meeting Status: Not yet responded
Required Attendees: Grant, Michele; Sawyer, Susan
Todd Bateson called for a D-Box inspection which will be ready noon or after. Based on the calendar. I booked you for
this time. Call Todd at 978.815.2703 if you need to Reschedule (and let me know!) Thanks.--P
. D
D
V /
1
` TOWN OF NORTH ANDOVER t MO DTh
' Office of COMMUNITY DEVELOPMENT AND SERVICES F? p
HEALTH DEPARTMENT
400 OSGOOD STREET `"+ • '�
NORTH ANDOVER, MASSACHUSETTS 01845
Susan Y. Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
i
SEPTIC SYSTEM CONSTRUCTION NOTES
ADDRESS: MAP:_ LOT:
INSTALLER: `
DESIGNER:
PLAN DATE:
BOH APPROVAL DATE ON PLAN:
DATE OF BED BOTTOM INSPECTION: 021 OSS
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:
SELECT SYSTEM TYPE
GRAVITY DISTRIBUTION
PRESSURE DISTRIBUTION
PRESSURE DOSING
HOLDING TANK
ADVANCED TREATMENT
OTHER
COMPONENT SUMMARY FROM PLAN
GALLON TANK =
LOADING OF SEPTIC TANK =
GALLON PUMP CHAMBER =
LOADING OF PUMP CHAMBER =
TYPE OF SAS =
DIMENSIONS AND DETAILS OF SAS:
SITE CONDITIONS
❑ Existing septic tank properly abandoned
❑ Internal plumbing all to one building sewer
❑ Topography not appreciably altered
Comments:
Page 1 of 4
r
TOWN OF NORTH ANDOVER °<p°RT11 ,
Office of COMMUNITY DEVELOPMENT AND SERVICES
r. .r •_••. . p
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Susan Y. Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
SEPTIC TANK
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ gallon tank has been installed
(H-10 or H-20) (monolithic or 2 piece)
❑ Water tightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
❑ Inlet tee installed, under access port
❑ Outlet tee (gas baffle or effluent filter) installed, under
access port
❑ inch cover to within 6" of final grade installed over
one access port, must be over outlet of tank if effluent
filter is present
❑ Hydraulic cement around inlet & outlet
Comments:
PUMP CHAMBER
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ gallon Pump Chamber installed
(H-10 or H-20) (monolithic or 2 piece)
❑ Inlet tee installed, under access port
❑ Pump(s) installed on stable base
❑ Alarm float working
❑ Pump On/Off float working
❑ Drain hole in pressure line
❑ inch cover to within 6" of final grade installed over
one access port
❑ Water tightness of tank has been achieved
Visual or Vacuum Test or Water held for 24 hrs
❑ Hydraulic cement around inlet & outlet
Comments:
Page 2 of 4
r
: TOWN OF NORTH ANDOVER ct N0T 7
Office of COMMUNITY DEVELOPMENT AND SERVICES 3 '`t0.
H y p
HEALTH DEPARTMENT
x F#
400 OSGOOD STREET • , ...�:.. .
NORTH ANDOVER MASSACHUSETTS 0 184 �sSATtD ���
ACNUS
Susan Y. Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
D-BOX 1V#
O
�I Installed on stable stone base / `,
—/
Inlet tee (if pumped or >0.08'/foot)
/
Hydraulic cement around inlet & outlets
Observed even distribution
p ed levelers provided (not require
Comments: 0 L) r 2
SOIL ABSORPTION SYSTEM
❑ Bottom of SAS excavated down to soil layer, as
provided on plan
❑ Size of SAS excavated as per plan
❑ Title 5 sand installed, if specified on plan
❑ 3/4-1 Y2" double washed stone installed
❑ 1/8-1/2" (peastone) double washed stone installed
❑ laterals installed and ends connected to header (and
vented if impervious material above)
❑ Orifices @ 5 & 7 o'clock positions
❑ Gravelless disposal systems: type, number and
location as per plan
❑ Elevations of laterals installed as on approved plan
❑ 40 Mil HDPE barrier installed
❑ Retaining wall (boulder/ concrete /timber/ block)
❑ Final cover as per plan
Comments:
PRESSURE DISTRIBUTION
❑ inch manifold
❑ laterals installed with end sweeps
size:
material:
❑ Squirt test ft in height
❑ Equal distribution to all laterals
❑ orifice size inch as per plan
Comments:
Page 3 of 4
f
TOWN OF NORTH ANDOVER of NORT1
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET 14 � "
NORTH ANDOVER, MASSACHUSETTS 01845
SACHUg�
Susan Y. Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.9542—FAX
CONTROL PANEL
❑ Alarm & Pump are on separate circuits
❑ Alarm sounds when float is tripped
❑ Location of control panel:
El for exterior if placed outside
Comments:
SYSTEM ELEVATIONS
Benchmark:
Rod at Benchmark:
Height of Instrument:
INVERT ON DESIGN PLAN ELEV TOP OF PIPE INVERT ELEVATION
Building Sewer OUT
Septic Tank IN
Septic Tank OUT
Pump Chamber IN
Pump Chamber OUT
Distribution Box IN
D-Box OUT Manifold
Lateral 1 HIGH
Lateral 1 LOW
Lateral 2 HIGH
Lateral 2 LOW
Lateral 3 HIGH
Lateral 3 LOW
Lateral 4 HIGH
Lateral 4 LOW
Lateral 5 HIGH
Lateral 5 LOW
Page 4 of 4
. i
I
i
Tgwn of North Andover
Health Department Date:
Location: -161 /
(Indicate Address,if Residential,o ame of Business)
Check#: 17,5 1
Type of Permit or License:(Circle)
➢ Animal $
➢ Dumpster $
➢ Food Service-Type: $
➢ Funeral Directors $
➢ Massage Establishment $
➢ Massage Practice $
➢ Offal(Septic)Hauler $
➢ Recreational Camp $
➢ SEPTIC PERMITS:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
0 eptic Disposal Works Construction(DWC)$
❑ Septic Disposal Works Installers(DWI) $
➢ Sun tanning $
➢ Swimming Pool $
➢ Tobacco $
➢ Trash/Solid Waste Hauler $
➢ Well Construction $
➢ OTHER:(Indicate)
90 Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
TOWN OF NORTH ANDOVER "O:T,4
Office of COMMUNITY DEVELOPMENT AND SERVICES o
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845
a•►cHub�
978.688.9540—Phone
Susan Y.Sawyer, REHS/RS 978.688.9542—FAX
Public Health Director healthdeptOtownofnorthandover.com-e-mail
www.townofnorthandover.com-website
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE:
LOCATION: 36
LICENSED INSTALLER NAME.
PLEASE PRINT
SIGNATURE: ±2�!t�_TELEP' HON'E#
72 -
4 CHECK ONE:
FULL SYSTEM REPAIR: ($250)
dOMPONENT REPAIR(indicate what parts): ��x ($125)
* NEW CONSTRUCTION:
* If NEW CONSTRUCTION,please attach the Foundation As-Built Plan.
$250.00 or$125 Fee Attached? Yes No
Project Manager Obligation From Attached? Yes No 400 Foundation As-Built? Yes No
Floor Plans? Yes No
Date:
Approval of Health Agent / ��
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the
--�
property at G'v� �2r_ __relative to the application
� �C� �
r l� ,ds for plans by and
0C__
f ts,N dated 9--
dated with revisions dated
I understand the following obligations for management of this project:
1. As the installer 1 am obligated to obtain all permits and Board of Health approved plans prior
to performing any work on a site. I must have the approved plans and the permit on site
I
when any work is being done.
2. As the installer I must call for any and all inspections. If homeowner, contractor, project
manger, s 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 necgssary work completed prior to the applicable
inspections as indicated below. I understand that requesting an inspection, without
completion of the items in accordance with Tile 5 and the Board of Health Regulations may
result in a-$50.00 fine being levied against my company.
a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done
first. Installer must request the inspection but does not have to be present.
b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or
s for
verbal OK from engineer must be submitted to Board of time. Installer must be present or this inspection.Health,With
tafterump'system ch all electricaler
work
inspection
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. Does not have to be
on site.
4. As the installer I understand that only I_may perform the work(other than simple excavation)
required to complete the installation of the system identified in the attached application for
�tlicensed to install septic systems in
installation. I further understand that work by others u
North Andover can constitute reasons for denial of the system, and/or revocation or
operate in the Town of North Andover; significant fines to all
suspension of my license to
persons involved are also possible.
5. As the Installer I understand that I must be on site during the performance of the following
construction.steps:
a) Determination that the proper elevation of the excavation has been reached.
b) Inspection of the sand and stone to be used.
c) Final inspection by Board of Health staff or consultant.
d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other
components.
6. As the installer I understand that I am solely responsible for the installation of the system as
per the approved plans. No instructions by the homeowner, general contractor, or any other
persons shall absolve me of this obligation.
Undersign t nsed Septic Installer _
Date:
Disposal Works Construction Permit#
'\ UMMONWEALTH OF MASSACH �I
USL�.�I S
r (EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
f DEPARTMENT OF ENVIRONMENTAL PROTECTION
, t
JUL 2 S 2005
TITLE S T0vu1, y OVER
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSE �DE�PAIQMI�EW
SUBSURFACE SEWAGE DISPOSAL SYSTEM FO -�
PART A
CERTIFICATION _
Property Address:
N 21nr�nc ar NA j}
Owner's Name: CV/
Owner's Address: 307 Rd
— t �Av 141!
Date of inspection:-. 7 5 05
Nanic of Inspector: (please print) ,Tam W i ah t
Company Name: R T TNGpecf_ s, Inc.
Mailing Address: One OsgoodSt
M thu n MA 01844
Telephone Number:_g jZ 6Z_ _23_59_
CERTIFICATION STATEMENT
1 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 DPP
approved system inspector pursuant to ction 15:340 of Title 5(310 CMR 15.000). The system:
t basses
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: "� Date:
Tire system inspectors ' submit a copy of this inspection report to the Approving N(ithonty(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
gild or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DF.P.'File original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Continents
****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.
Title 5 Inspection Form 611512000 page 1
(� Town of North Andover 0 , MORTk
Office of the Health Department
Community Development and Services Division
400 OSGOOD STREET
North Andover,Massachusetts 01845
s�CHU
Susan Y. Sawyer,RENS/RS 978.688.9540-Phone
Public Health Director 978.688.8476-Fax
I
C- rrErCA2p o� Co�r��.r"A5rCE
As of
,duly 20, 2005
This is to cert that
the individuafsu6surface d4osafsystem
Constructed(---� or
Repaired- 1D-Bo.-� Only -- (IC) By
ToddBateson
At
307 CaMpfieff Road
North-Andover, gb1A 01845
9fas been instafred in accordance with the provisions of Title v of the State Sanitary Code and
with the NorthAndover Board of yfeafth regulatwns.
rhe Issuance of this certfiCcate shaff not 6e construed as a guarantee that the system wiff
function satisfactorify.
T
s:Sicsan Sawyer, RIS/Rh
ftic.9feafth(Director
1
1
1
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Ii
-\ COMMONWEALTH OF NASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL.AFFAIRS
U
Y
M o DEPARTMENT OF ENVIRONMENTAL PROTECTION
p�� SJe i
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 307 Camp hPl 1 Rd
N AndnyPr MA - �����
Owner's Name: George Walker RZ.`+#�
Owner's Address: -397 F-ampbeii Rr
N d�17er- MA JUL 1-2 2005
Date of Inspection: 775/05
5
TO'vVtN,, ..:t-17TH ANDOVER
Name of Inspector: (please print) James Wright . HEAL FH DEPARTMENT
Company Name: R_.T_ TNqpPrt-i nn g, Inc.
Mailing Address: One Osgood St
Methuen MA 01844
Telephone Number: 978-681 -8759
CERTIFICATION STATEMENTf
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:
� sses
Conditionally Passes
- -�_ Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: �. `"ice-`�� --�--' _ Date:
The system inspector sV/ submit a copy of this inspection report to the Approving A thority(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
d or greater, the inspector and the system owner shall submit the report to theappropriate re ional office of the
ZP g� � P Y Pg
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving
authority'.
Notes and Comments
"***This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 307 Campbell Rd
N. Andover-MA
Owner: George walker
Date of Inspection:-Zi is/6"
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
1.have not found any information which indicates that any of the failure criteria described in 310 CMR
15.=03 or in_10 CNIR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
_ One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the 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. j
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tattle is less than 20 years old is available.
ND explain:
✓ Observation of sewage backup or break out or high static water level in the distribution box due to broken oz
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
_,045,struction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s), The system wilt
pass.inspection if(with approval of the Board of Health): I
I
broken pipe(s)are replaced
obstruction is removed
i
ND explain:
2
Page of 1 I D
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 307 Campbell Rd
N. Andover MA
Owner: _ George Walker
Date of Inspection: .... 7/5/05
C. Further Evaluation is Required by the Board of Health:
_ Conditions exist which require further evaluation by the.B-and of Health in order to determine if the system
is failing to protect public health, safety or the environment:'
o�
1. System will pass unless Board of HeajW&termines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a mairfier which will protect public health,safety and the environment:
— Cesspool or privy isthin 50 feet of a surface water
Cesspool or pri s within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank andSAS an e S is within a Zone 1 of a public water supply.
"The system has a septic tank SAS and the SAS is within 50 feet of a private water supply well.
The system has a s tc tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supplell**.Method used to determine distance
**This sy,�Y[m passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
3
I'ac e 4 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A j
CERTIFICATION(continued)
Property Address: 307 Campbell Rd
N Andover MA
Owner: George Walker
Date of Inspection: 7/r /0e;
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no" to each of the following for all inspections:
Yes No
cp of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
squid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructedi e s .Number
erf.times pumped P p ( )
dny P high or cesspool f t
porion othe SAS,cess privy is below
P h ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply tributary
water supply. PP Y or D to a surface
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 .feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analvsis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
4T(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
i
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the c
yes no
the system is within 400 f a surface drinking water supply
the system is i. in 200 feet of a tributary to a surface drinking water supply
_-_ — the tem is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone.11 of a public water supply well
]f you have answered"yes"to any question in Section E the system is considered a significant threat, oranswered
vcs" 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
1.5.304.The system owner should contact the appropriate regional office of the Department.
4
� t
Page 5 of I l CD
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 307 Campbell Rd
N And'ouer 4A
Owner: GPnrcrP Walker
Date of Inspection:
Check if the following have been done. You must indicate `yes"or"no"as to each of the following
Yes o
Pumping information was provided by the owner,occupant, or Board of Health
-Were any of the system components pumped out in the previous two weeks?
Has the system received norma:flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of this inspection'?
' ere as built plans of the system obtained and examined? (If they were not available note as N/A)
_ Was the facility or dwelling inspected for signs of sewage back up
Was the site inspected for signs of break out'.)
Were all system components, excluding the SAS,located on site?
Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition
Ot the ieffles or tees, material of construction,dimensions, depth of liquid, depth of sludge and depth of scum
I
Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems'?
i
I
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes n°
<xj--t—ing information.For example, a plan at the Board of Health.
i
Determined in the field(if any of the failure criteria related to Part C is at issue approximation.of distance I
is unacceptable) [310 CMR 15.302(3)(b)J
i
5
i
i
Pace 6 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
FART C
SYSTEM INFORMATION
Property Address:- 307 Campbell Rd
N. Andover MA
Owner: orae Walker
Date of inspection:. IS;//0 r,
' I
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of edrooms):
Number of current residents:
Does residence have a garbage—gr—finder(yes or no):
Is lau-ndry on a separate sewage system(yes or no): , f yes separate inspection required)
Laundry system inspected(yes or no):
Seasonal use: (yes or no):_,!!�Cl —
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no):e'yC�'
:Last date of occupancy:
COMMERCIAL/INDUSTRIAL
T}pe of establishment:
Design flow(base 0 CMP. 15.203): gpd
Basis of des ` ow(seats/persons/sgft,etc.):
Grease ap present(yes or no):_
Industrial waste holding tank present(yes or no —
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records ----
Source of information:
Was system pumped as part of the i on(yes or no):ell_(f
If ves, volume pumped: gallons--How was quantity pumped determined?
Reason for pumping.-
Tl'P OF SYSTEM
Septic tank, distribution box, soil absorption system
Single cesspool
_—Overflow cesspool
Privy
—Shared system (yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_ Tight tar l: _Attach a copy of the DEP approval
- r
Other(describe):
Approximate age o omponents, date installed(if kn�) d source of information:
Were sewage odors detected�when arriving at the site(yes or no): A
6
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
307 Campbell Rd
N. Andover MA
Owner: George Walker
Date of Inspection: 7/5/05
BUILDING SEWER(locate on site plan)
i(
Depth below grade:
Materials of construction: ./cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments (on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
f
Depth below grade:
Material of construction: ? concrete_metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: K
Sludge depth:
Distance fi•om top of sludge to bottom of outlet tee or baffle:
Scum thickness: '
Distance from top X scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or ba fle: —
How were dimensions determined: ��- G
Continents(on pumping recommendations, inlet and outlet tee or ba fle condition,structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.): R
GREASE TRAP: _(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum op of outlet tee or baffle:
Distance from bottom o scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
7
Page 8 of 11 CD
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 307 Campbell Rd
N_ Andover MA
Owner: George Walker
Date of Inspection: 7
TIGHT or HOLDING TANK: tank
( must be pumped at tune of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete met fiberglass_polyethylene other(explain):
D imensions:
Capacity: gallons
Design Floe':_ gallons/day
.Alarm present(yes no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DIST.RI.BUTION BOX: (if present must be opened)(locate on sitelan
P )
Depth of liquid level above outlet invert:
Comments(note if box is level and distri ution to outlets equal, any evidence of solids carryover, any evidence of
leaka into or out of box,etc.):
PUMP CHAMBER: (locate on site an)
Pumps in workingorder(yes : I
(Y no)
Alarms in working ordees or no):
Comments(note cond tion of pump chamber,condition of pumps and appurtenances, etc.):
I
I
8
Page 9 of 1 l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 307 Campbell Rd
N, n aver
Owner: George Wa er
Date of Inspection: 7/5/05
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
_leaching pits,number:
leaching chambers,numb_er:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool, number:
_ innovative/alternative system Type/name of technology:
Comments (note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on siteIan
P )
Number and configuration:
Depth—top of liquid to inlet invert: I
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspoo
Materials of construefion:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
f
9
c �
Page 10 of I 1
OFFICIAL INSPECTION FORM—
NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 307 Campbell Rd
N, n over
Owner: George Wa e-—r
Date of inspection: 7 F5705
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet. Locate where public
water supply P
� enters the building.
fee
- � 1
41711
-/o
10
i
DelleChiaie, Pamela `
From: Sawyer, Susan
Sent: Tuesday, October 12, 2010 10:29 AM
To: alison@redapplerenovations.com; chris@redapplerenovations.com
Cc: DelleChiaie, Pamela; Grant, Michele
Subject: Maureen Magauran &Patrick Hanks-258 Bridges Lane- Proposed Deck Replacement
Good Morning,
Please be advised that as of I OAM this morningthe North Andover Health Department has signed off on the
p g
permit for 258 Bridges, and the permit application/form U has been returned to the Building Department.
Thank you for your cooperation in this matter.
Susan Sawyer
Health Director
-----Original Message-----
From: DelleChiaie, Pamela
Sent: Friday, October 01, 2010 4:11 PM
To: alison@redapplerenovations.com; chris@redapplerenovations.com
Cc: Sawyer, Susan
Subject: FW: Letter to Maureen Magauran&Patrick Hanks - 258 Bridges Lane - Proposed Deck Replacement
Importance: High
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal
offices and officials are public records. For more information please refer to:
http://www.sec.state.ma.us/pre/`i)reidx.htm.
Please consider the environment before printing this email.
i
( C �
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 307 Campbell Rd
N, n over
Owner:_ George a er
Date of Inspection: __77_5T6_5
SITE EXAM
Slope
Suac
rfe
cell
S la ow wetls
Estimated depth to ground water�feet
Please indicate(check)all methods used to determine the high ground water elevation:
gamed from system design plans on record-If checked,date of design plan reviewed:
Observed site(abuttingproperty/observation hole within 150 feet of SASAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
11
SUMMARY OF GROUND-Wf-'\a LEVELS JUNE 2005 VISIONAL
(NOTE: Wells with * als �vailable in real-time atto o
Data round-Water
-
page; OWc P d Water
P 9 , monthl�measured value used in hi -
high ground water level
estimation report, USGS Open-File Report 80-1205. )
WELL L START NET CHANGE
DEPARTURE WATER LEVEL
T I YEAR IN MONTH IN ONE FROM BELOW LAND-
0 T OF YEAR MONTHLY SURFACE
P H RECORD
0 0 MEDIAN DATUM
(OWc)
(FEET) (FEET) (FEET) (FEET) DAY
MASSACHUSETTS
ACTON i58 * TS 1965 0.67 + 1.24 + 1.46 16.59 30
ANDOVER 462 VS 1968 - 0.01 + 0.77 + 0.74 14.00 22
ATTLEBORO 83 VS 1964 - 0.96 + 0.06 - 0.23 4 .28
BARNSTABLE 230 _ 30
FS 1
957 0.51 + 1.28 + 1.27 22. 10 2.8
BARNSTABLE 247 FS 1962 0.08 + 1.94 + 1.94 22.00 28
BECKET 12 TS 1986 + 0.46 + 1.06 + 1.43 2.48 27
BLANDFORD 9 VS 1986 - 0.47 + 0.08 + 0.49 2.13 27
BOURNE 198 FS 1962 ----- _ __ ___ _
BREWSTER 21 FS 1962 + 0.05 + 1.75 + 1.
55 8.23
BREWSTER 22 * FS 1962 - 28
0.27 + 2.05 + 1.58 28.75 30
CHATHAM 138 FS 1962 - 0.06 + 1. 67 + 2.28 21.21 28
CHESHIRE 2 HT 1951 - 2.20 - 3.00 - 2. 91 8.48 28
CHICOPEE 95 TS 1984 - 0.58 - 0.20 - 0.26 21. 40 27
COLRAIN 8 VS 1965 - 1.48 + 0.71 + 0.52 18.06 28
CONCORD 165 TS 1965 + 0.35 + 1.75 + 0.80 39.87 21
CONCORD 167 TS 1965 0.87 + 1. 47 + 0.45 6.80 21
CUMMINGTON 13 VS 1986 - 1.15 + 0.00 - 0.39 5. 63 28
DEDHAM 231 ST 1965 - 1.18 + 2.16 + 1.13 6. 69 21
DEERFIELD 44 VS 1965 - 0.88 - 0.18 - 0.28 3. 19 28
DOVER 10 TS 1965 - 0.08 + 0. 66 + 0. 67 31.81 21
DUXBURY 79 * VS 1965 - 1.16 + 0.24 + 0.31 8.34 30
DUXBURY 80 VR 1965 - 0.66 + 0.27 + 0.55 21.56 29
EAST BRIDGEWATER 30 HT 1958 2. 64 + 0.15 + 0. 17 8.75 29
EDGARTOWN 52 VS 1976 + 0.56 + 2.28 + 2.49 14.71 7/1
FOXBOROUGH 3 TS 1965 - 0.19 + 0.08 + 0.13 18.82 27
FREETOWN 23 TS 1964 - 0.57 + 1.15 + 0.73 12.36 30
GEORGETOWN 168 VS 1965 - 1.90 + 0. 67 + 0. 67 4.15 22
GRANBY 68 VS 1954 - 1.25 - 0.07 + 0.12 7.56 27
GRANVILLE 5 TS 1965 - 0.60 + 0.21 + 0.14 31.85 27
GRANVILLE 6 SS 1965 - 2.42 - 0.24 - 0.82 6.54 27
GREAT BARRINGTON 2 VT 1951 - 1.82 - 1. 15 0.57 12.10 27
HANSON 76 VS 1964 - 0.77 + 0.01 + 0.07 4 .82 29
HARDWICK 1 TS 1965 - 1.29 - 0.45 - 0.48 15.19 30
HAVERHILL 23 TS 1960 - 0. 92 + 1. 67 + 2.01 9.44 22
HAWLEY 8 ST 1986 - 0.84 + 0. 17 + 0.29 3.75 28
LAKEVILLE 14 * TS 1964 - 2.52 + 2.07 + 2.05 12. 19 30
LEXINGTON 104 VS 1965 - 1.20 + 0. 64 + 0.76 2.23 21
MASHPEE 29 FS 1976 - 0. 48 + 1.45 + 1.14 6.86 22
MIDDLEBOROUGH 82 VT 1965 - 2.36 + 2.45 + 2.15 8. 12 29
MONTGOMERY 19 SS 1986 - 0. 96 + 0.03 - 0. 11 1.71 28
NANTUCKET 228 FS 1976 + 0.46 + 2.20 + 2.46 21.19 29
NEW BEDFORD 116 VS 1964 - 0.63 + 0.15 - 0.08 4.35 30
NEWBURY 27 VT 1965 - 2.08 + 2.34 + 3.20 4.20 22
NORFOLK 27 * VS 1965 - 0.98 + 0.48 - 0.01 6.38 30
NORTHBRIDGE 54 VS 1984 0.32 , + 0.09 + 0.30 3. 95 21
NORTON 37 FS 1964 - 2.09 + 0.37 + 0.44 7.86 27
ORANGE 63 TS 1985 - 0. 65 + 0.36 + 0.30 6. 68 29
OTIS 7 VS 1965 - 1.20 - 0.25 - 0.57 9.23 27
PELHAM 23 * SR 1984 - 0.36 + 1.03 - 1.42 15.35 30
PELHAM 24 SS 1984 - 0.25 + 1.11 + 0.58 4 .02 30
PETERSHAM 16 ST 1984 - 1.29 - 0.10 - 0.50 14.34 29
1 of 3
7/8/2005 1:50 PM
PITTSFIELD 51 * VS 1963 1.66 - 1.40 - 2.08 17. 47 30
PLYMOUTH 22 TS 1956 + 0.29 + 2.31 + 1.73 21.51 29
PLYMOUTH 494 SS 1985 + 0.51 + 1.78 + 1. 64 28.06 29
SANDWICH 252 FS 1962 - 0.37 +
1.0
SANDWICH 253 FS 1962 - 0.04 + 1.75 + 0.88 48. 80 22
SEEKONI< 275 VS 1964 - 0. 95 - 0.04 + 0.50 6.27 29
SHEFFIELD 58 FS 1987 - 0.64 - 0.13 + 0.37 12.58 27
SOUTHBOROUGH 12 HT 1990 - 1.07 + 1.17 + 0. 66 6.89 21
SOUTHWICK 95 TS 1986 - 1.20 + 0.17 - 0.81 3.60 28
STERLING 1 ST 1947 2.37 + 2.36 + 1.46 3.41 21
STERLING 177 SS 1995 - 0.10 + 0.48 + 0.25 14 .23 21
SUNDERLAND 7 SS 1957 - 1.23 ----- - 1.43 12.52 28
SUNDERLAND 68 VS 1983 - 0. 91 - 0.18 - 0.18 3.42 28
TAUNTON 337 TS 1964 - 0. 98 + 0.40 + 0.44 8.76 30
TEMPLETON 3 VS 1957 1.10 - 0. 68 - 0.81 4 . 69 < 29
TOPSFIELD 1 HT 1936 - 4.86 + 1.53 + 1.00 10. 92 22
TOWNSEND 13 TS 1965 - 0.27 + 0.59 + 1.30 11.13 21
TRURO 1 TS 1950 - 0.46 + 0.54 + 0.76 10.04 28
TRURO 89 TS 1962 - 0.39 + 0.85 + 0. 66 11.29 28
WAKEFIELD 38 * FS 1965 - 1.14 + 0.43 + 0.82 6.35 30
WARE 43 VS 1965 - 1.03 + 0.87 + 1.43 7. 60 30
WAREHAM 51 TS 1959 - 0.37 + 1.86 + 0.45 6.55 23
WAYLAND 2 TS 1965 - 0.27 + 0.39 + 0.19 15.63 21
WEBSTER 1 HS 1958 - 0.70 + 0.17 - 0.95 14 . 60 21
WELLFLEET 17 VS 1962 - 0.30 + 1.53 + 0.55 9.24 28
WENHAM 76 VS 1965 - 1.49 + 0.55 + 0. 69 2.28 22
WEST BOYLSTON 26 SS 1995 - 1.10 + 1.04 + 0.48 6.09 21
WEST BROOKFIELD 2 TS 1959 0.64 + 0.55 + 0.68 17.73 30
WESTHAMPTON 20 SS 1986 - 3. 65 - 0.17 - 0.94 10.33 28
WESTFIELD 62 SS 1957 - 1.31 - 0.22 - 0.55 7. 65 28
WESTFIELD 152 TS 1986 - 0.46 + 0.08 + 0.74 3.03 28
WESTFORD 160 VS 2001 - 0.73 + 0.3311.11 30
WEYMOUTH 2 FT 1965 - 0. 67 + 2.31 + 2.10 9.24 20
WEYMOUTH 3 VS 1965 - 0.16 + 0.66 + 0. 62 4 .80 20
WEYMOUTH 4 TS 1965 - 0.33 + 0.57 + 0.43 6.85 20
WILBRAHAM 55 TS 1965 - 3.11 - 1.24 - 0.46 38.86 27
WILMINGTON 78 * FS 1951 - 1.36 + 0.64 + 0.13 7. 94 30
WINCHENDON 13 ST 1939 - 0.84 + 2.34 + 1.15 5.08 29
WINCHESTER 14 ST 1940 - 3.37 + 0.48 + 0.02 11.44 22
RHODE ISLAND
BURRILLVILLE 187 TS 1968 - 0.73 - 0.15 - 0.45 15.37 27
BURRILLVILLE 395 UT 1992 - 1.39 + 1.11 + 1.01 7.79 30
BURRILLVILLE 396 VT 1992 + 0.52 + 0.52 + 1.23 4.49 > 30
BURRILLVILLE 397 HT 1992 - 2.93 + 0.85 + 0.82 17.20 28
BURRILLVILLE 398 HT 1992 - 1.71 - 0.46 + 0.11 9.31 28
CHARLESTOWN 18 FS 1946 - 1.76 + 0.41 + 0.41 16.98 27
CHARLESTOWN 586 VT 1992 - 0.53 - 0.11 - 0.08 4.07 27
CHARLESTOWN 587 ST 1992 - 1.86 + 0.12 - 0. 93 10.22 27
COVENTRY 342 VS 1991 - 1.72 - 0.23 - 0.25 10.04 27
COVENTRY 411 SS 1961 - 1.00 + 0.19 + 0.03 21.41 27
COVENTRY 466 VT 1992 - 1.40 - 0.58 - 0.79 4.15 < 28
CRANSTON CITY 439 ST 1992 - 4 .13 + 0. 96 - 0.08 15.51 28
CUMBERLAND 265 SS 1946 - 1.08 + 0.78 + 0.48 13.04 27
EXETER 6 VS 1948 - 1.23 - 0.15 - 0.02 6.05 27
EXETER 158 ST 1991 - 4.88 - 0.49 - 0.48 12.00 27
EXETER 238 FT 1991 - 0.65 - 0. 10 - 0.11 12.54 27
EXETER 278 HT 1991 - 3.17 + 0.34 - 1.03 13.30 27
EXETER 475 VS 1981 - 1.18 , - 0.05 + 0.01 14 .10 27'
EXETER 554 SS 1988 - 0.59 + 0.11 - 0.01 10. 13 27
FOSTER 40 HT 1991 - 3.46 - 0.84 - 0.87 7.77 27
FOSTER 290 HT 1992 - 3.35 + 0.37 - 0.21 8.71 28
HOPKINTON 67 ST 1991 - 3.23 + 0.04 + 0.04 16.58 27
LINCOLN 84 VS 1946 1.48 + 0.42 + 0.42 4.91 27
LITTLE COMPTON 142 ST 1992 - 2.09 + 0.48 - 0.20 15. 94 29
i
2of3
7/8/2005 1:50 PIS
Jul 08 05 01 : 50P ( � P. 1
I Summary Record Card generated on 7/6/2005 2:47:70 PM by Cisa Warren
Page i
Town of North Andover
Tax Map # 210-106.D-0062-0000.0
307 CAMPBELL ROAD
WALKER, CHERYL
307 CAMPBELL ROAD
N. ANDOVER, MA
_ 01845
Class 101 Single Family Property Type 1 Residential
Size Total 3 Acres
FY 2005
UB Mailing Index
Name/Address Type Loan Number Active/Inact. From Until
WALKER,CHERYL Payor
307 CAMPBELL ROAD
N. ANDOVER, MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/inactive
Bldg Id. 3398.0-307 CAMPBELL RD Last Billing Date 7/8/2005
3170153 03 Cycle 03 Active
UB Services Maint.
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.635/8 7,82 1/
WTR WATER 01 ALL METER SIZE 30,80 /1
UB Meter Maintenance
Serial No Status Location Brand Type Size YTD Cons
0030397558 a Active ENC F.L. ? w Water 0.63 0.63 0
Date Reading Code Consumption Posted Date Variance
6/1312005 1497 a Actual
11 7/15/2005 13%
3/22/2005 1486 a Actual 15 4/5/2005 23%
12/13/2004 1471 a Actual 11 1
/14/2005 110%
9/15/2004 1460 a Actual 5 10/8/2004 -54%
6/22/2004 1455 a Actual 9 7/30/2004 -11%
4/13/2004 1446 a Actual 18 5/17/2004 0%
12/11/2003 1428 n New Meter 0 12/11/2003 0%
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Commonwealth of Massachusetts
ILA City/Town of --
System Pumping Record
Form 4 ���� �. ����
DEP has provided this form for use by local Boards of * fA AR%M used, but the
information must be,substantially the same as that pr i 94DSB� is form, check with your
local Board of Health tQ determine the form they use. ys em umping Record must be submitted to
the local Board of Health or�otber approving authority.
A. Facility Information
1. System Location: Leftdsi a of house Right side of house, Left front of house, Right front of house,
Left rear 00ous , Right rear of hous eft rear of uilding. Right rear o building.
Address
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Cityrrown State Zip Code
2. System Owner: -
r--
�-ed
Name
Address(if different from location)
Cityrrown State Zip Code
QD FS fQ Oa
Telephone Number
B. Pumping Record
1. Date of Pumping Dai ^C 2. Quantity Pumped: Gallons C57b
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3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ YesNo If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6 4z_
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
umber
Bateson Enterprises Inc
Company
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7. LocatiorlwMre contents were disposed:
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G. Lowell Wase Water
Signature of Ha r
9 Date
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t5form4.doc-06/03 System Pumping Record-Page 1 of 1
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
7
DATE OF PUMPING: C C QUANTITY PUMPED l - /GALLONS
CESSPOOL: NO
YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO: " ` 0 ,
r
10 FORM 4 SYSTEM I UNIPM RECORD
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OF 140 \A
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Commonwealth of Massachusetts y�V
Massachusetts
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Syslern Pumping Record
ystem Owner System Location
wq�
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Date of Pumping C(7 ^� � Quantity Pumped:
Cesspool: No ,�y'es ❑ Srntir Tnnt•• kip Yes
System Pumped bx-: License
Contents transferred to:
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Date Inspector
0
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TOWN OF
SYSTEM PUMPING RECORD
71 12 '(
DATE:�Q3
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example:left front of house)
CC �(
DATE OF PUMPING: QUANTITY PUMPED : G LONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
L
�'n -selts
V.�i( assaclruse s
r.
8yste f plea �te00
x l9Y IQ11!I�t�+ller system vocation
Oj vto_4- 3a 1-7 CaAAAP
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�at►tQNf1'4ltlipitl�3: Qt!ailtityPui»ped: �5� gallons
'esspc�c�l:
No I+ Yes L_1 SeptiTank: No L� Yes
YAlelt! ptttt�p�d by: a�"�4Q�fK License
tttttrttl tr��lsferrre�l !N �.,, �a.`�, � su.` nwn 840114/11 nilSic
Palo: Inspector:
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