The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 326 CANDLESTICK ROAD 4/30/2018 (5)Commonwealth of Massachusetts gKW City/Town of OCT - 9 2008 d System Pumping Record ��• I^TH Pn+pCVER Form 4 TOS 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. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. A. Facility Information 1. System Location: ry ,, 01�—' h 0 v's� Address CJ (Jcx- Vv. Cityrrown State 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State17 Telephone Number Zip Code 9_IC- fs� Date 2. Quantity Pumped: Gallons Cesspool(s) E3--Te—ptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes B- lro If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Syste(n�P, u�mped _ Namen'�?� Vehicle License Number Company 7. Lo ca ' n where conte were disposed: _c .I Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 8B —Certificate of Compliance 242-970 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP A. Project Information Important: When filling out 1. This Certificate of Compliance is issued to: forms on the Scott &Marlene Bowman computer, use Name only the tab key to move 326 Candlestick Road your Cursor - Mailing Address do not use the North Andover MA. 01845 return key. City/Town State Zip Code 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: Scott &Marlene Name 7/21 /99 242-97 0 Dated DEP File Number 3. The project site is located at: 326 Candlestick Road North Andover Street Address City/Tow n Map 106A Parcel 249 Assessors Map/Plat Number Parcel/Lo t Number the final Order of Condition was recorded at the Registry of Deeds fo r: Property Owner (if different) Essex North Instrument # 30 521 County Book Page N/A Cert applicant's agent, on: ificate 4. A site inspection was made in the presence of the applicant, or the 9/9/03 Date B. Certification Check all that apply: wpaform 8b.doc • rev. 12/15/00 ® Complete Certification: It is hereby certified that the work regulated by the above -referenced Order of Conditions has been satisfactorily completed. ❑ Partial Certification: It is hereby certified that only the following portions of work regulated by the above -referenced Order of Conditions have been satisfactorily completed. The project areas or work subject to this partial certification that have been completed and are released from this Order are: Page 1 of 3 Massachusetts Department of Environmental Protection LkiBureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-970 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Certification (cont.) ❑ Invalid Order of Conditions: It is hereby certified that the work regulated by the above - referenced Order of Conditions never commenced. The Order of Conditions has lapsed and is therefore no longer valid. No future work subject to regulation under the Wetlands Protection Act may commence without filing a new Notice of Intent and receiving a new Order of Conditions. ® Ongoing Conditions: The following conditions of the Order shall continue: (Include any conditions contained in the Final Order, such as maintenance or monitoring, that should continue for a longer period). Condition Numbers: 63 C. Authorization Issued by: North Andover Conservation Commission This Certificate must be signed by a m jority of the Conservation Commiss applicant and appropriate DEP Regio al Office (See Appendix A). On Of Day Month and Year before me personally appeared of I suance copy sent to the. to me known to be the person described in and who executed the foregoing instrument and. acknowledged that he/she executed the same as his/her free act and deed. 04-yrn'�'�'ewv' Z L-� � - / 7 Notary Pubic My commissi n e fres wpaform 8b.doc • rev. 12/15/00 Page 2 of 3 i Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B - Certificate of Compliance 242-970 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP D. Recording Confirmation The applicant is responsible for ensuring that this Certificate of Compliance is recorded in the Registry of Deeds or the Land Court for the district in which the land is located. Detach on dotted line and submit to the Conservation Commission. -------------------------------------------------------------------------------------------------------------------------- To: North Andover Conservation Commission Please be advised that the Certificate of Compliance for the project at: 242-970 Project Location DEP File Number Has been recorded at the Registry of Deeds of: County for: Property Owner and has been noted in the chain of title of the affected property on: Date Book Page If recorded land, the instrument number which identifies this transaction is: If registered land, the document number which identifies this transaction is: Document Number Signature of Applicant wpaform 8b.doc • rev. 12/15/00 Page 3 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands L� i WPA Appendix A — DEP Regional Addresses Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments, payable to: Commonwealth of Massachusetts Department of Environmental Protection Box 4062 Boston, MA 02211 DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham 436 Dwight Street Agawam Conway Hancock Montague Plainfield Wales g Alford Cummington Hatfield Monterey Richmond Ware Suite 402 Amherst Dalton Hawley Montgomery Rowe Warwick Springfield, MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone: 413-784-1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell Belchertown East Longmeadow Holland New Ashford Savoy Westfield Fax: 413-784-1149 Bernardston Egremont Holyoke New Marlborough Sheffield Westhampton Blandford Erving Huntington New Salem Shelburne West Springfield Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge Buckland Gill Lee Northampton Southampton Whately Charlemonl Goshen Lenox Northfield South Hadley Wilbraham Cheshire Granby Leverett Orange Southwick Williamsburg Chester Granville Leyden Otis Springfield Williamstown Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor Chicopee Greenfield Ludlow Pelham Sunderland Worthington Clarksburg Hadley Middlefield Peru Tolland DEP Central Region Acton Charlton Hopkinton Millbury Rutland Uxbridge 627 Main Street Ashburnham Clinton Hubbardston Millville Shirley Warren Ashby Douglas Hudson New Braintree Shrewsbury Webster Worcester, MA 01605 Athol Dudley Holliston Northborough Southborough Westborough Phone: 508-792-7650 Auburn Dunstable Lancater Northbridge Southbridge West Boylston Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield Fax: 508-792-7621 Barre Fitchburg Leominster Oakham Sterling Westford TDD: 508-767-2788 Bellingham Gardner Littleton Oxford Stow Westminster Berlin Grafton Lunenburg Paxton Sturbridge Winchendon Blackstone Groton Marlborough Pepperell Sutton Worcester Bolton Harvard Maynard Petersham Templeton Boxborough Hardwick Medway Phillipston Townsend Boylston Holden Mendon Princeton Tyngsborough Brookfield Hopedale Milford Royalston Upton DEP Southeast Region Abington Dartmouth Freetown Mattapoisett Provincetown Tisbury 20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro Attleboro Dighton Gosnold Nantucket Rehoboth Wareham Lakeville, MA 02347 Avon Duxbury Halifax NewBedford Rochester Wellfieet Phone: 508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater Fax: 508-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport Bourne Easton Harwich Norwell Scituate West Tisbury TDD: 508-946-2795 Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham Brockton Fall River Mansfield Pembroke Somerset Yarmouth Carver Falmouth Marion Plainville Stoughton Chatham Foxborough Marshfield Plymouth Swansea Chilmark Franklin Mashpee Plymplon Taunton DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield 205 Lowell Street Andover Chelsea Holbrook Methuen Randolph Walpole Arlington Cohasset Hull Middleton Reading Waltham Wilmington, MA 01887 Ashland Concord Ipswich Millis Revere Watertown Phone: 978-661-7600 Bedford Danvers Lawrence Milton Rockport Wayland Fax: 978-661-7615 Belmont Dedham Lexington Nahant Rowley Wellesley Beverly Dover Lincoln Natick Salem Wenham TDD: 978-661-7679 Billerica Dracut Lowell Needham Salisbury West Newbury Boston Essex Lynn Newbury Saugus Weston Boxford Everett Lynnfield Newburyport Sherbom Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester -By -The -Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Winthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield wpaform8b.doc • Appendix A • rev. 9/9/03 Page 1 of 1 f NORTH 1 3463 Town of North Andover ` 50 �'•�;, o HEALTH DEPARTMENT ,sScNust CHECK #: -_ DATE: LOCATION: 1-1/0 NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal ❑ Body Art Establishment ❑ Body Art Practitioner ❑ Dumpster ❑ Food Service - Type: ❑ Funeral Directors ❑ Massage Establishment ❑ Massage Practice ❑ Offal (Septic) Hauler ❑ Recreational Camp ❑ Sun tanning ❑ Swimming Pool ❑ Tobacco ❑ TrasWSolid Waste Hauler ❑ Well Construction SEPTIC Systems: ❑ Septic - Soil Testing ❑ Septic - Design Approval ❑ Septic Disposal Works Construction (DWC) ❑ Septic Disposal Works Installers (DWI) ❑ TitlZtl�e -Inspector Report ❑ Other: (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 326 Candlestick Road _ _ North Andover_ Owner's Name: _Marlene Bowman Owner's Address: _326 Candlestick Road _ North Andover, MA 01845 _ Date of Inspection: _9/19/2008 Name of Inspector: _Neil J. Bateson_ Company Name: _Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810 Telephone Number: _ (978) 475-4786_ 6& CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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: _X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F 's r Inspector's Signature: Date: 9/19/2008 _ 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 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 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 326 Candlestick Road _ _ North Andover Owner: _ Bowman_ Date of Inspection: _9/19/2008 _ Inspection Summary: Check A, B, C, D or E / ALWAYS complete all of Section D A. System Passes: X 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: 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. 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. ND explain: 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): broken pipe(s) are replaced obstruction 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 will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _326 Candlestick Road _ _ North Andover— Owner: _Bowman _ Date of Inspection: _9/19/2008 _ 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 public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is 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 and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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 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: Title 5 Inspection Form 6/15/2000 Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _326 Candlestick Road- - North Andover— Owner: _Bowman_ Date of Inspection: _9/19/2008 _ D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: _No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool __ No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No_ Liquid depth in cesspool is less than 6" below invert or available volume is %2 day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped — _No_ Any portion of the SAS, cesspool or privy is below high ground water elevation. No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ 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 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.] No_ (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 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 criteria above) yes 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 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. Title 5 Inspection Form 6/15/2000 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _326 Candlestick Road _ _ North Andover _ Owner: _Bowman_ Date of Inspection: _9/19/2008_ Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Yes_ Pumping information was provided by the owner, occupant, or Board of Health _No_ Were any of the system components pumped out in the previous two weeks? Yes_ Has the system received normal flows in the previous two week period? No_ Have large volumes of water been introduced to the system recently or as part of this inspection? N/A Were as built plans of the system obtained and examined? Yes_ _ Was the facility or dwelling inspected for signs of sewage back up ? Yes_ _ Was the site inspected for signs of break out ? Yes_ _ Were all system components, excluding the SAS, located on site ? _Yes_ _ 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? _Yes_ _ 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: Yes No _Yes_ _ Existing information. Design plan no as built plan _Yes_ _ 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(3)(b)] Title 5 Inspection Form 6/15/2000 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 326 Candlestick Road- - North Andover– Owner: _Bowman _ Date of Inspection: _9/19/2008_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4 _ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CMR 15.203 _600 _ Number of current residents: _1 Does residence have a garbage grinder (yes or no): _Yes _ Is laundry on a separate sewage system (yes or no): _No _ Laundry system inspected (yes or no): Seasonal use: (yes or no): _No_ Water meter reading: _Yes _ Sump pump (yes or no): _No_ Last date of occupancy: _ Current _ COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): _gpd Basis of design flow (seats/persons/sgft,etc.): _ Grease trap 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: Pumped three ago, owner _ Was system pumped as part of the inspection (yes or no): Yes_ If yes, volume pumped: _1500_ gallons -- How was quantity pumped determined? _Measured tank_ Reason for pumping: Inspect tank & tees_ TYPE OF SYSTEM _X_ 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 tank _ Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information _19 Years old, Info at Board of Health_ Were sewage odors detected when arriving at the site (yes or no): _No Title 5 Inspection Form 6/15/2000 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: _326 Candlestick Road _ North Andover _ Owner: _Bowman _ Date of Inspection: _9/19/2008_ BUILDING SEWER _ X _ (locate on site plan) Depth below grade: 36" Materials of construction: _X _ cast iron —X-40 PVC _other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) _ 4" PVC thru wall to tank. 3" PVC in house no leaks visible SEPTIC TANK: X Depth below grade: _24" _ Material of construction: X 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: _10' x 5' x 4' Sludge depth: _ 6" _ Distance from top of sludge to bottom of outlet tee or baffle: 21" _ Scum thickness: _6"_ Distance from top of scum to top of outlet tee or baffle: - 8" -Distance from bottom of scum to bottom of outlet tee or baffle: 15"_ How were dimensions determined: _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc. _ Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert_ 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 to top of outlet tee or baffle: Distance from bottom of 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.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _326 Candlestick Road _ North Andover— Owner: _Bowman_ Date of Inspection: _9/19/2008 _ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX X_ Depth below grade ,24" _ Depth of liquid level above outlet invert: _0 _ 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.) _P -box level & distribution equal. No evidence of leakage. Evidence of light carryover._ PUMP CHAMBER: _ (locate on site plan) Pump in working order (yes or no): Alarm in working order (yes or no): _ Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Title 5 Inspection Form 6/15/2000 Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _326 Candlestick Road _ North Andover— Owner: _Bowman_ Date of Inspection: _9/19/2008_ SOIL ABSORPTION SYSTEM (SAS): _X_ (locate on site plan, excavation not required) If SAS not located explain why: Type Leaching pits, number: _ Leaching chambers, number: — Leaching galleries, number: _X_ Leaching trench, number, length: _3 trenches 43' long _ _ Leaching field, 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.):_ Soil ok. Vegetation ok. No sign of ponding to surface _ CESSPOOLS: Number and configuration: _ Depth — top of liquid to inlet invert: — Depth of sludge layer: Depth of scum layer: _ Dimensions of cesspool: _ Materials of construction: 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.): Title 5 Inspection Form 6/15/2000 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _326 Candlestick Road _ North Andover— Owner: _Bowman _ Date of Inspection: _9/19/2008_ 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 enters the building Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 326 Candlestick Road _ _ North Andover— Owner: _Bowman_ Date of Inspection: _9/19/2008 _ SITE EXAM Slope _ No _ Surface water _ No _ Check cellar _ Yes _ Shallow wells No Estimated depth to ground water _ 4 Please indicate (check) all methods used to determine the high ground water elevation: _X Obtained from system design plans on record - If checked, date of design plan reviewed: _4/18/1989_ Observed site (abutting property/observation hole within 150 feet of SAS) 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: As per design plan _ Title 5 Inspection Form 6/15/2000 11 Q, Commonwealth of Massachusetts ITCity/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the infomhation must be substantially the sae as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important fWhenorms. filling out 1. System Location: _ c `. y 0 \-)-s' e, forms on the � � V l computer, use only the tab key Address tomoveyour C�� Jbc-A-kk.cvig� �� cayrrown �T zQ code use the key. 2. System Owner: r� ate)'dam q Name rern Address (if dfferent from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date state 0 i7 Telephone Number 2. Quantity Pumped: Gallons Cesspool(s) p''T�ptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes B-lq If yes, was it deaned? ❑ Yes ❑ No 5. Condition of System: � o0 C-�a .L �-�l, d `-inn k� -�� 6. PumpedpA Fla t Marne � Vehicle License Number 1 Company 7. where conter4 were disposed: Date t5l`WTAACo- 06/03 System Pumping Record • Page 1 of 1 Suffrwy Record Card generated on 9/26/2008 2:58:18 PM by Karen HaMon Page 1 Town of North Andover Tax Map # 210-106.A-0249-0000.0 Parcel Id 17397 326 CANDLESTICK ROAD BOWMAN MARLENE EVOS 326 CANDLESTICK ROAD NO. ANDOVER, MA 01846 Class 101 Single Family Property Type 1 Residentiai Size Total 1.04 Acres FY 2009 UB Mailina Index Name/Address Type Loan Number Active/lnact. From Until BOWMAN MARLENE EVOS Payor 326 CANDLESTICK ROAD NO. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17645.0 - 326 CANDLESTICK ROAD Last Billing Date 7/8/2008 3170315 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 71.80 /1 UB Meter Maintenance Serial No Status Brand 36832393 a Active YTD Cons Date Reading 9/8/2008 2532 6/6/2008 2474 MSG Posted Date 3/7/2008 2454 12/11/2007 2438 9/5/2007 2416 6/18/2007 2346 3/15/2007 2308 12/8/2006 2288 Trouble Code:03 a Actual 9/12/2006 2274 Trouble Code:03 a Actual 6/14/2006 2209 3/8/2006 2188 Trouble Code:03 7/20/2007 12/21/2005 2173 Trouble Code:03 4/16/2007 9/20/2005 2156 Trouble Code:03 1/19/2007 6/13/2005 2055 3/25/2005 2029 12/14/2004 2009 Trouble Code:03 7/10/2006 9/24/2004 1993 6/11/2004 1900 4/15/2004 1880 Trouble Code:03 1/17/2006 Location Brand Type Size YTD Cons ENC L w Water 0.63 0.63 20 Code Consumption Posted Date Variance a Actual 58 181% m Manual estimate 20 7/16/2008 20% a Actual 16 4/11/2008 -19% a Actual 22 1/22/2008 -74% a Actual 70 10/12/2007 122% a Actual 38 7/20/2007 94% m Manual estimate 20 4/16/2007 28% a Actual 14 1/19/2007 -78% a Actual 65 10/20/2006 237% a Actual 21 7/10/2006 10% a Actual 15 4/17/2006 5% a Actual 17 1/17/2006 -82% a Actual 101 10/14/2005 214% a Actual 26 7/15/2005 64% a Actual 20 4/5/2005 0% a Actual 16 1/14/2005 -78% a Actual 93 10/8/2004 152% a Actual 20 7/30/2004 59% a Actual 27 5/17/2004 0% • Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 326 Candlestick Road, North Andover Owner: Bowman Date of Inspection: 9/19/2008 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Reil J. Bateson Bateson Enterprises, Inc.