Loading...
HomeMy WebLinkAboutMiscellaneous - 329 REA STREET 4/30/2018 (2)Commonwealth of Massachusetts = City/Town of R1r, V, System Pumping Record Form 4 JUL 31 2014 b TOWN OF NORTH ANDOVER DEP has provided this form for use%by local Boards of Health. Oihelifomfsimay b fused, but the information must be substantially the same as that provided here. Before using.th rm, 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 1. System Locatio Ri fron of hou , Left/ Right rear of house, Left/ right side of house, Left/ Right side of buil Ing, Left / Right front of building, Left / Right rear of building, Under deck Address City/Town State Zip Code 2. System Owner. Name* Address (if different from location) City/Town State f Telephone Number f B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s)ateptic Tank El Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No, " 5. Condition of,Sys�te�s�� 6. System Pumped By: Neil. Bateson Name Bateson Enterprises Inc - Company 7. Location re contents were disposed: LS. Lowell Waste Water t5form4.doc• 06/03 F5821 Vehicle License Number Date ` System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 RECEIVED JUN U CU12 I TOWN OF NORTH ANDOVER l HEALTH DEPARTMENT 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. A. Facility Information 1. System Location/ Righ of house Left/ Right rear of house, Left/ right side of house, Left/ Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address City/Town State 2. System Owner. Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping Date P-"ko�-s 3. Type of system: ❑ Cesspool(s) ❑ Other (describe): Zip Code Staten 6`l`i` C' Telephone Number — 2. Quantity Pumped eptic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Conditio�System: � t �� 6. System Pumped By: Neil Bateson Name Bateson Entemrises Inc Company 7. Lo i . ere contents were disposed: G.L S. Lowell Waste Water 0.[ F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of w° System Pumping Record . Form 4 REI�,�` E JUL 1 12013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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. A. Facility Information 1. System Location: Left/ Right front of house, Left/ Right rear of house, Left/ right side of house, Left/ Right side of building, Left / Right front of building, Left / Right rear of building, Under deck City/Town 2. System Owner. Name Address (if different from location) State Z C'Q'j`S Zip Code Cityrrown Stt �p Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system. ❑ Date Cesspool(s) — 2. Quantity Pumped eptic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: ca� Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No � V-,- -bf'p� Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location ere contents were disposed: GLS. Lowell Waste Water Date t5form4.doc• 06103 System Pumping Recons • Page 1 of 1 Commonwealth of Massachusetts LH- �ARTMENT City/Town of System Pumping Record 2006 FOrn7 4H ANDOVER DEP has provided this form for use by local Boards of Health. The System Pumping ecord must be submitted to the local Board of Health or other approving authority. . A. Facility Information Important: When filling out 1. SyStLOC On: iC forms the T J C,(\ C' computer, r, use only the tab key Address to move your 4;k UL-z� cursor - do not V use the return Cityrrown State Zip Code key. 2. System Owner. Name Address (if different from location City/Town State Zip Code is Telephone Number B. Pumping Record 1. Date. of Pumping Pate 2. Quantity` Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes a No If yes, was it cleaned? El Yes ❑ No 5. Condition of System: (J 6. Syste[n Pumped By- Name Vehicle License Number Company -- .7. Locati n where contents were disposed: Signatu e o a r Date http://www.mass. gov/dep/water/approvalsft5forms:htm#inspect t5form4.doc• 06!03 System Pumping Record • Page 1 of 1 l Town of North Andover 21 Health Department Date: Location: (Indicate Address, if Residential, or Name of Business) Check #: � �/ �0' �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 $ ❑ Septic Disposal Works Construction (DWO $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ q OTHER (Indicate)- Indicate)1439 1439 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: _329 Rea Street _ North Andover_ Owner's Name: _Michael Diresta_ Owner's Address: _329 Rea Street —North Andover, MA 01845_ Date of Inspection: 3/29/2006_ Name of Inspector: Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, Ma. 01810_ Telephone Number: _( 978 ) 475-4786_ LRECEIVEED APR 0 3 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTVENT 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 Fails Inspector's Signature: a�-J Date: 3/29/2006_ 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. oic Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 329 Rea Street _ North Andover_ Owner: _ Diresta_ Date of Inspection: _3/29/2006 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. If "not determined" please explain . The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. 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: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _329 Rea Street_ _ North Andover — Owner: _Diresta_ Date of Inspection: 3/29/2006_ 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: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 329 Rea Street _ _ North Andover — Owner: _Diresta_ Date of Inspection: 3/29/2006 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 V2 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 I 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 II 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. Page 5 of l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _329 Rea Street _ _ North Andover _ Owner: _Diresta _ Date of Inspection: 3/29/2006_ 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 ? Yes_ _ 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. _Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _329 Rea Street_ _ North Andover— Owner: _Diresta _ Date of Inspection: 3/29/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4_ Number of bedrooms (actual): _4 DESIGN flow based on 310 CMR 15.203 _N/A_ Number of current residents: _2 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 last year, owner _ Was system pumped as part of the inspection (yes or no): Yes_ If yes, volume pumped: _1000_ gallons -- How was quantity pumped determined? _Measured tank_ Reason for pumping: _Inspect tank & baffles & tee_ 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: 30 years old, 5/1/1976, as built plan _ Were sewage odors detected when arriving at the site (yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _329 Rea Street_ _ North Andover _ Owner: _Diresta_ Date of Inspection: 3t29/2006_ BUILDING SEWER _ X _ (locate on site plan) Depth below grade: _22" 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" Cast iron thru wall. 3" PVC in house, no leaks visible SEPTIC TANKS: X Depth below grade: _10" 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: 7' x 5' x 4'— Sludge '_Sludge depth: —3- _ Distance from top of sludge to bottom of outlet tee or baffle: 24" _ Scum thickness: _3"_ Distance from top of scum to top of outlet tee or baffle: - 811 -Distance from bottom of scum to bottom of outlet tee or baffle: 18"_ How were dimensions determined: _Tape Measure _ 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 bate ok. Outlet bale ok. Outlet tee not used. Depth at outlet invert. No evidence of leakage. _ 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.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 329 Rea Street_ _ North Andover_ Owner: _Diresta_ Date of Inspection: 3/29/2006_ 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 _10"_ _ 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.):_D-box level & distribution equal. Evidence of carryover, pumped d -box to clean. No evidence of leakage. Cover broken replaced it. _ 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.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 329 Rea Street_ _ North Andover _ Owner: Diresta Date of Inspection: 3/29/2006_ SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type X leaching pits, number: 3_ leaching chambers, number: leaching galleries, number: leaching trenches, number, length: 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. Camera inside of pits thru outlets in d -box, no liquid at inverts. _ 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.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _329 Rea Street_ _ North Andover— Owner: _Diresta_ Date of Inspection: 3/29/2006_ 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. Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _329 Rea Street _ _ North Andover_ Owner: _Diresta _ Date of Inspection: 3/29/2006_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _ 6' No water found_ 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: _5/31/1975_ 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 test pit data on design plan, no water found at 6' deep _ Summary Record Card generated on 3/29/2006 10:20:33 AM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-038.0-0121-0000.0 329 REA STREET DIRESTA, MICHAEL 329 REA STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.02 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until DIRESTA, MICHAEL Payor 329 REA STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14013.0 - 329 REA STREET Last Billing Date 3/7/2006 2100522 02 Cycle 02 Active UB Services Maint. Service Code Rate MISCFEE ADMIN FEE 0.635/8 WTR WATER 01 ALL METER SIZE UB Meter Maintenance Serial No . Status Location 0022305403 a Active ENC RT Date Reading Code 2/6/2006 3585 a Actual 11/8/2005 3576 a Actual 8/10/2005 3552 a Actual 5/11/2005 3522 a Actual 2/22/2005 3511 a Actual 11/17/2004 3495 a Actual 8/12/2004 3481 a Actual 5/18/2004 3471 a Actual 2/17/2004 3457 a Actual 11/6/2003 3450 n New Meter Charge Muftiplier/Users 7.82 1/ 30.51 /1 Brand Type ? w Water Consumption Posted Date 9 3/13/2006 24 12/14/2005 30 9/12/2005 11 6/8/2005 16 3/15/2005 14 12/17/2004 10 9/20/2004 14 6/14/2004 7 4/16/2004 0 11/6/2003 Size 0.63 0.63 YTD Cons 0 Variance -63% -19% 134% -15% 14% 24% -24% 126% 0% 0% .M • 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: 329 Rea Street, North Andover Owner: DiResta Date of Inspection: 3/29/2006 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. Bateson Enterprises, Inc. TO: NORTH ANDOVER, MASS S 3 19 %r BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection ► This is to certify that I have inspected the construction of the said disposal system at L a m C E p -5 7` North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated .3 jos- 19 7c . 0 f MgSs \ /�0 7�C • je. P f. E in eg. nitaria „„n BARBAGALLO I'1 5 O uN 1� D f /y o p No. 464 C R Q �O� FG/STEP' �2� 46S ItJ F,ttOt.�sr� (L,j " -- T':::`"4SH I F' (SEA, -TY TzuST 9ro a a,f?j(. ST �- ,4F.! A R A I - f'' � dol • , MpYI I9Ty o M I-oT C 4, x197 re 911 .\ i 1 ; -- -t� L Oro( A t v PIPS 7 -=L ->M $4005M Ta " A.AK ►.IoT 14 A.S caF 5-1-76. T T Jo55rH j,tq t Lo �s NrWr vftP G Por)T�-1 �E;A►�t-� FORM - SYSTEM PU\ PL\G RECORD Commonwealth of Massachusetts , Massachusetts System Pumping Record •stem Owner h J's A o.A Date of Pumping: �? r )-iv' Cesspool: No FF System Pumped by: Contents transferred to: Quantity Pumped: (gallons Yes ❑ Septic Tank: No ❑ Yes _ License #: Date Inspector commonwealth of Massachusetts Ar, -Massachusetts stem f'u�npirrg Record em Uwner 0) f f 4, mylitel" I-,0011110" Date of humping: L" Quantity Pumped: ` � gallon's Cesspool: No H' Yes L:J Septic Tank: No IJ Yes tri' System Pumped by: Fet%4da S'Y&MAwa License # Contents tmisferrred to : Gtester Liwrenta 8tlnitary District Date: _ Inspector: Con monwe Ith of Massachusetts PIr - . Massachusetts System Pumping Record I System Owner Date of Pumping:JJ�9 Cesspool: No Yes L_) System Location Quantity Pumped: � } gallons Septic Tank: No L] Yes L4---'-' System Pumped by: Stewart Swanh tcaP,a License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: 1—TC-1W OF NORTH AN©0VER/ ' MARD OF HEALTH r AUG—910 � l System Owner I 0111111 nwealth of Massachusetts Ij- 'A �. Massachusetts System Pumping Record System Location Date of Pumping: '' Quantity Pumped: Cesspool: No Yes L) Septic Tank: No L7 System Pumped by: FRtedort Sits TAWed License # Contents transferrred to : Greater Lawrence Sanitary District Date: _ Inspector: ���llons Yes TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 1. (example: left front of house) U (5k DATE OF PUMPING:61 - I �`�C UANTITY PUMPED CESSPOOL: NO YES SEPTIC ANK: NO NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: GALLONS YES FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) LATENTS TRANSFERRED TO: rn - L--, TOWN OF fi - inlJPr SYSTEM PUMPING RECORD DATE: O- jq=vaZ SYSTEM OWNER & ADDRESS I (f jk 3�-� R'f-a- 'Co'+ SYSTEM LOCATION (example: left front of house) `4�T-CoA ai" 66-c- DATEOFPUMPING: ` 02 QUANTITY PUMPED : j 0O GALLONS CESSPOOL: NO YES S PTIC TANK: NO YES 2NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: 6 ` TOWN OF 6r SYSTEM PUMPING RECORD DATE: l� Oi SYSTEM OWNER & ADDRESS l 319 �-co' S� SYSTEM LOCATION (example: left front of house) ova ko uc('4f DATE OF PUMPING: _ I L _ QUANTITY PUMPED: oD GALLONS CESSPOOL: NO YESSEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D J Lowell Waste TOWN OF SYST: DATE: - V 6 � SYSTEM OWNER & ADD MINION �.� RECEIVED APR 13 2005 SYSTEM LOCAllfJW DEPARTMENT (example: left front of house) 1� 'J ' Ov�— V L'n - DATE OF PUMPING: `"� ' (e ` QUANTITY CESSPOOL: NO YES EPTIC NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER PUMPED: _� 0 6 GALL S TANK: NO YES EMERGENCY FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.0 V Lowell Waste Commonwealth of Massachusetts\\J HMO City/Town of System Pumping Record FMAY Form 4 3 2007DEP has provided this form for use by local Boards of Hestem P mpiin Record must be submitted to the local Board of Health or other approving authority �:'�RTMENT A. Facility Information Important: When filling out 1. System Location -, comps the computer. use only the tab key Address • "� to move your -- A % ! cursor - do not ' `' use thereturn CityfTown State Zip Code key. 2.. System Owner: Name Address (rf d'ifferent from location) CityfTown Stat Zip Code: Telephone Number B. Pumping Record - :J - .j 1. .Date. of Pumping Date 2• Quantity` Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Ei SepticTank ❑ Tight:Tank ❑ Otber(describe) 4. Effluent Tee Filter present? ❑ Yes © If yes, was it cleaned? El Yes ❑ No 5. Condition of System: ` v 6. System ,ed;BY' `�- � . Name L . F _ Vehicle License Number Company 7. Location efeC ntenfs . ere osed:. SignaturefH ul r Pate http://www.mass.gov/dep/Water/* t5form4.doc• 06/03 System Pumping Record •Page 1 of 1 Commonwealth of Massachusetts REC�IW. City/Town of MAY 2 1 2008 System Pumping Record Form 4 TOWN OF NORTH ANDOVER s° HEALTH DEPARTMENT 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. A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. law It�l 1. System Lo tion:r--,� Address Citylrown 2. System Owner: Name Address (if different from location) 7f 3�� Aj State Tp Code City/Town State t.- � IL a Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ ❑ Other (describe): Cesspool(s) eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ❑--IVo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition f System: 6. System P m -� Name �'� Vehicle License Number Company 7. Location ere cqntents were died: L1--3,� Signatu a Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of a System Pumping Record Form 4 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: eft front eft rear, left si of douse ight front, right rear, right side of house. Address City/Town State Zip Code 2. System Owner: 1 v Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: 8 Other (describe): State Telephone Number Date 2. Quantity Pumped: Gallons Cesspool(s) eptic Tank Tight Tank 4. Effluent Tee Filter present? [j Yes O If yes, was it cleaned? [ Yes Ll No 5. Condition of S) se�m�-� � tn' 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location -where contents were disposed: Q-- S.D Lowell Waste Water of F 5821 Vehicle License Number -,5---a7 Date t5form4.doc• 06!03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts -- - --- -- City/Town of RECEIVED System Pumping Record Form 4 J�� 201 I\j �M TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Oth fdd e information must be, substantially the same as that provided here. Before using this form, check with your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted Jo the local Board of Health or-other approving authority. A. Facility Information 1. System Location: Left side of house, Right side of hous Left front ght front of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address City/Town State Zip Code 2. System Owner: A , 1 Jk � `J Name �v Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Date Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No St t �� `4 {CZip Code Telephone Number 2. Qu tity Pumped Septic Tank Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System - Stahl � l System- 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio .L.S.D Signature o F t5form4.doc• 06/03 were disposed: 6)hWaste Water Date `((—/C_--, System Pumping Recons • Page 1 of 1