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HomeMy WebLinkAboutMiscellaneous - 56 CANDLESTICK ROAD 4/30/2018 (2) J 0/CANDLESTICK ROAD id 210/106._=0.0 �I l U� i I l FILE North Andover Health Department [ommunity and Economic Development Division 11/28/16 Address: 56 Candlestick Rd. All North Andover Residents with Septic Systems and Garbage Disposals Please note that due to a recent review of a Title 5 Report,your property has been identified as maintaining a working garbage disposal that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage disposals are never recommended where septic systems are used, but if they are installed,the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this disposal could quickly cause a pre-mature failure of your septic system,resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdept@northandoverma.goy. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dis os _ � 9 p aLSystem Form Not for Voluntary Assessments `� nd e S C- Pro Address _ Gr i Owner ow7f'sn information is requiredfor ! dpv er every page. Cky/Town State Trp Code Date of Inspectionb�-- i Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: WhenfilGng out A. General Information - fomis on the computer,use 1. Inspector. NOV 2 8 201b only the tab key to move.your >r I-e d TOWN OF NORTH ANDOVER useUte rrettum Name of Inspector r' _ key- X L j,, L /`-- Company Name _ Ia13-Pa At A Id Company Address _ cityrroyltrr _ 9" L I , O �. State �^ ' Trp Code `-r ! Telephone Number Lice- ___ilk nce Number B. Certification - I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: [� Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority In o Si nature I 9 Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. This report only describes conditions at the time of inspection and under the conditions of use j at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. i i t5ins-03/13 THM 5 offidel InaPocron F-M SLftwfaos Sewage Disposal system•papa 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection f=orm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5� �vIes� 1 c Property Address Owner Information is Owner's Name required for everypage. City/Town State Zip Code Date of Inspection _ B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 1A 1A tJ t Uyvt I y) e L o I I 13)System Conditionally Passes: I ❑ 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. I Check the box for"yes", "no"br"not determined"(Y, N, ND)for he following statyements. If"not determined, "please explain. The septic tank is metal and over 20 years old'or the septi tank(whether metal or not)is I structurally unsound, exhibits substantial infiltration or exf ration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is st cturally sound, not leaking and if a Certificate of Compliance indicating that the tank is less tha 0 years old is available. Y ❑ N ❑ ND(Ex in below): I i i i (Sins 0311.3Trlie 5 Official Inspection Form Subsurface Sewage Disposal System•Page 2 of 17 � ' Commonwealth of Massachusetts Title 5 Official Inspection pect�on I-orm a - - Subsurface Sewage Disposal System Form Not for Voluntary Assessments 04 Salle 5I' C - •'• Property Address _ Owner Information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.); ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑/Kb (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ND (Explain below): ❑ The System required pumping more t n 4 times a year due to broken or obstructed pipe(s). The system will pass inspection ifof t roval with ( p he Board of Health ❑ brokenpipe(s)are re la d ) P ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is rem o d ❑ Y ❑ N ❑ ND (Explain below): 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 the system is failing to protect public health, ety or the environment. if 1. System will pass unless Board of ilth determines in accordance with 310 CMR 15.303(1)(b)that the system is not f ctioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is ithin 50 feet of a surface water ❑ Cesspool or pri is within 50 feet of a bordering vegetated wetland or a salt march 15ins-0311:7 Tine 5 Official Inspection Form Subsurface Sewage Disposal System.Paye 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection p Fora aSubsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address _ i Owner Information is j Owner's Name — required for every page. I, Cityfrown State I--ip Code Date of Inspection B. Certification (cont.) I 2. System will fail unless the Board of Health (and Public Water Supplier, if any) deterimes 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) the SAS is within 100 feet of a surface water supply or tributary to/rfacesupply. ! ❑ The system has a septic tank and SAS and the one 1 of a public water supply• ❑ The system hasa septic tank and SAS and thefeet of a private water supply well. The system has a septic tank and SAS and th 100 feet but 50 feet or more from a private water supply well** Method used to determine distance: i **This system passes if the well water an sis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the pres ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no of r failure criteria are triggered. A copy of the analysis must be attached to this form. 1 3. Other: I I i i; D) System Failure Criteria Applicable to All Systems: I You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Backup 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 99 cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged ed SAS or cesspool 00l i r p ❑NIA ❑ Liquid depth in cesspool is less than 6"below invert or available volume isless than% day flow 1�1 Title 5 Official Inspection Forth Subsurface S owage Disposal System•Paye 4 of 17 Commonwealth of Massachusetts Title . 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i � Property Address P rtY _. Owner Information is Owner's Name required for every page. City/Town� State Zi Code, P Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, Cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0 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 i system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ 12� This system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ 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. For large systems, you must indicate either"yes"or"no"to each of following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of,�p urface drinkiing water supply ❑ ❑ the system is within 200 f of a tributary to a surface drinking water supply ❑ ❑ the system is locate ' a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA or a apped Zone II of a public water supply well If you have answered "yes"to a question in Section E the system is condidered a significant threat, or answered"yes"in Section above the large system has failed. The owner or operator of any large system considered a si cant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•03/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � Property�y i Address -- Owner — Information is Owner's Name required for every page. i CityfTown State Zip Code Date of Inspection I C Checklist — i Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ❑ Pumping information was provided by the owner, occupant, or Board of Health I ❑ Were any of the system components pumped out in the previous two weeks? I 0 ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) I ❑ Was the facility or dwelling inspected for signs of sewage back up? i Er ❑ Was the site inspected for signs of break out? I ,-,/ ❑ Were all system components, excluding the SAS, located on site? LTJ ❑ 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? ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? This size and location of the Soil Absorption System (SAS) on the site has been determined based on: R/ ❑ Existing information. For example, a plan at the Board of Health. i 0 ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] i i� D. System Information Residential Flow Conditions: _ Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): i Title 5 Official Inspection Form Subsurface Sewage Disposal System•Pape s of 17 t5ins-03113 ii Commonwealth of Massachusetts D. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �Gyl� !S l C 1 Property Address — Owner Information is Owner's Name required for every page. Cityfrown State Zip Code Date of Inspection D. System Information — Description: Number of current residents: Does residence have a garbage grinder? WO f "-C(D y� �e rtij QLJ Yes ❑ Na Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes No Laundry system inspected? / ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, If available(last 2 years usage(gpd)): Detail: IJ 1 10l c, 1z. Sump pump? ❑ Yes No Last date of : �l occupancy:P Y -� — — td Commercial/industrial Flow Conditions:. Da Type of Establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sq.ft.,etc.): Gallons per day(gpd) Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? � ❑ Yes ❑ No Non-sanitarywaste discharged to the'Titl 9 , e 5 system? ❑ Yes ❑ No Water meter readings, if available/ t5ins•03113 Title 5 Official InSPOCUOn Form Subsurface Sewage Disposal System•Page 7 at 47 ,\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments cla V)& '41 Property Address — Owner Information is Owner's Name — required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: [)ate "— Other(describe below): General Information Pumping Records: Source of information: ��-r>_` � Was system pumped as part of the inspection? ❑ Yes d No If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: Type 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval, ❑ Other e (describe): t5ins-03,1:3 Title s official Inspection Form Subsurface Sewage Disposal System-Page 8 of 17 ! I Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ! Owner Information is i Owner's Name required for t every page. City/Town State Zip Code Date of Inspection I D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information- Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): i _ Depth below grade: f Material of construction: feet i ❑ cast iron In 40 PVC ❑ other(explain) AJ Distance from private water supply well or suction line: _ A A feet ---Tom Comments (on condition of joints,venting, evidence of leakage, etc.): j I Septic Tank(locate on (locateon site plan): a Depth below grade: ; S feet Material of construction: I concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain) i i -- I I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: i i, Sludge depth lids 5 official Inspection Form Subsurface Sewage Disposal System•page 9 of 17 t5ins-03113 j Commonwealth of Massachusetts Title 5 Official Inspection Form ®rm Subsurface Sewage Di, osal System Form- Not Y for Voluntary Assessments �G Vt le c Property Address "— o p Owner Information is Owner's Name 'required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle i Scum thickness Distance from top of scum to top of outlet tee or baffle _ i Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? ( J I Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I G L rl-e e '` V Pew► , G t �lylh c,+ — A i Grease Trap(locate on site plan): j I I Depth below grade: feet Material of construction: IEl concrete ❑ metalfiberglass ❑ polyethylene ❑ other(explain) Dimensions: Scum thickness Distance from top of s m to top of outlet tee or baffle Distance from bo m of scum to bottom of outlet tee or baffle i h Date of last pumping: Date Tlge 6 Oftidal Inspection Fpm Subsurface Sewage Dlsposel System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection • Farm j Subsurface Sewage Disposal System Form-Not for Voluntary Assessments !� (?a yid 1 e Rroperty Address - Owner Information is Owner's Name _ required for every page. City/Town State Zip Code Date of Inspectlon I D. System Information (cont.) _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i I _ i I Tight or Holding Tank(tank must be mped at time of inspection)(locate on site plan): Depth below grade: Material of construction: I ❑ concrete ❑ metal ❑ fiberglass ❑ polyet�Oeene ❑ other(explain) Dimensions: I _ Capacity: gallon Design Flow: Ilon,per day Alarm present: --/Alarm ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm d float switches, etc.): i I "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins••oui:1 Title 5 official inspection Form Subsurface Sewage Disposai system•page 1 I of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form orm ? Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address _ • I Owner Information is Owner's Name required for _ every page. CltylTown State Zip Code Date of Inspection D. System Information (cont.) — Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): - � - j I v W- ���y� oW I r ver_ V r c k1 c> Pump Chamber(locate on site plan): Z Pumps in working order: ,� El Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber,conditionpumps and appurtenances, etc.); I I II i i Soil Absorption System (SAS)(locate on site plan, excavation not required): l If SAS not located, explain why: I I °11,3 Title 5 Official Inspection Form Subsurface Sewage Disposal sPosal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e��'l C Property Address — — Owner Information is Owner's Name — required for every page. Cityfrovrn State Zip Code Date of Inspection D. System Information (cont.) — Type: i ❑ leaching pits number: I ❑ leaching chambers number: _ ❑ leaching galleries number: _ ❑ leaching trenches number, length: LJ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of itechnology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, : � g etc.): i i 0 15 Sq,� r — o d l vi _ Loa o� ` ra �� Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration / Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of constru ion Indication of grou dwater inflow ❑ Yes ❑ No I �I tSins•0311:1 Title 5 Official Inspection Form Subsurface Sewage Disposal system-Page 13 of 17 1 I i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments j r G N-VI Property Address — Owner Information Is Owner's Name — required for I _ every page. City/Town State Zip Code Date of Inspection I i D. System Information (cont.) — I j Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I — i I I Privy(locate on site plan): i Materials of construction: i I I Dimensions Depth of solids r — I — Comments (note condition of soil, signs of hydraulic Ilure, level of ponding, condition of vegetation, etc.): i i -- i r ! i i I I I I I I I l I t5ins-03113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 14 of 17 i I i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Dis al System Form- Not for Voluntary Assessments Property Address — Owner N 's ame _ I Information is i Owneri required for every page: I Cit)r/Town State zip Code Date of Inspection ` I D. System Information (cont.) — I Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: 0 hand-sketch in the area below ❑ drawing attached separately i i i i, �i i I \� t5 i i i I i Title 5 Official Inspection Form Subs t5ins-03/13 UlreCe Sewage Dis sal Po system•Page 15of 17 Commonwealth of Massachusetts Title 5 Official Inspection on dorm Subsurface Sewage Dispos I System Form -Not for Voluntary Assessments 'r Property Address — Owner _ Information is Owner's Name required for ` every page. ICityfrownf! StateT-ip Cade Date of Inspection _ D. System Information (cont.) — Site Exam: ❑ Check Slope ❑ Surface water / ❑ Check cellar ✓ i ❑ Shallow wells Estimated depth to high ground water: -f' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date — 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 USG$database-explain: You must describe how you established the high ground water elevation: Cj l Before filling this Inspection Report, please see Report Completeness Checklist on next page. Title 50fnd,jj Inspedlon Form Subsurface Sewage MgXMal System•page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �r Property Address —� — — Otroner Owner's Name — Information is required for every page. Cityj7 vn State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked Inspection Summary D(System Failure Criteria Applicable to All Systems)completed System Information- Estimated depth to high groundwater L✓1 Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I i i t5ins•03/13 Title 5 Official Inspection Form Subsurface Sewage Disposal Systertt•Page 17 of 17 i Sep 03 1q,18 08; 2. 3a David Lu 578 68.7-7435 p. 2 I Cais�� '� ', •�t //903 1�`�" �'-��.�.- �✓�s��Wit+ 2611 4 l i I � idy l r 10 1 �` deli t 41 .a, - ---Town of --....__..... .Andover....,,....,...,,,,, Page t North Tax Map # 210-106.A-0094-0000.0 Parcel Id 17239 56 CANDLESTICK ROAD MARTIN, JAMES 56 CANDLESTICK ROAD NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.13 Acres FY 2017 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until MARTIN. JAMES Payor 56 CANDLESTICK ROAD NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 1'7691.0-56 CANDLESTICK ROAD Last Billing Date 10/13/2016 3170361 03 Cycle 03 Active UB Services Maint. Account No. 3170361 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 53.20 /1 UB Meter Maintenance Account No. 3170361 Serial No Status Location Brand Type Size YTD Cons 33132710 a Active ERT HH b Badger w Water 0.63 0.63 643 Date Reading Code Consumption Posted Date Variance 9/9/2016 740 a Actual 14 10/24/2016 -41% 6/13/2016 726 a Actual 26 8/2/2016 6% 3/9/2016 700 a Actual 23 4/22/2016 7% 12/10/2015 677 aActual 22 1/20/2016 67% 9/9!2015 655 a Actual 13 10/16/2015 -35% 6/10/2015 642 a Actual 20 7/24/2015 -6% 3/11/2.015 622 aActual 21 4/28/2015 gala 12/11/2014 601 aActual 22 1/15/2015 85% 9/11/2.014 579 aActual 12 10/15/2014 -33% 6/11/2014 567 aActual 18 7/16/2014 _15% 3/11/2014 549 a Actual 21 4/11/2014 -27% 12/10/2013 528 aActual 28 1/17/2014 81% 9/12/2013 500 a Actual 16 10/15/2013 -13% 6/12/2013 484 aActual 18 7/24/2013 -15% 3/14/2013 466 a Actual 22 4/22/2013 17% 12/11/2012 444 a Actual 18 1/9/2013 57% 9/13/2012 426 a Actual 12 10/15/2012 3200 6/12/2012 414 a Actual 17 7/16!2012 300 3/14/2012 397 a Actual 17 4/14/2012 o 12/12/2011 380 a Actual 18 1/17/2012 20% 9/12/2011 362 a Actual 16 10/13/2011 -17% 6/7/2011 346 a Actual 18 7/20/2011 -16% 3/8/2011 328 a Actual 21 4/13/2011 33% 12/9/2010 307 a Actual 16 1/12/2011 -20% 9/10/2010 291 a Actual 21 10/15/2010 -1% 6./7/2010 270 a Actual 20 7/15/2010 -19% 3/9/2010 250 a Actual 25 4/14/2010 24% 12/8/2009 225 aActual 20 1/12/2010 29% 9/9/2009 205 a Actual 16 10/15/2009 -21% I Commonwealth of Massachusetts M _ City/Town of NORTH ANDOVER, MASSACHUSETTS = - _ System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The System Pumping Record m t be submitted to the local Board of Health or other approving auth DECEIVED A. Facility Information Important: APR 14 Z014 When filling out 1. System Location. forms on thea f� 'TOWN OF NUKf H ANUOVER computer, use (.,�0W �r r-k iZC� IIFALTH DEPARTMENT only the tab key Address to move your cursor-do not �/ ,�`/L(, d(/ - use the return City /`town (� C1 �-p/ � State Zip Code ey 2 System Owner: �'S" ''ice --- Name Address(if different from location) CityfTown _._... .. _. _... State Zip Code Telephone Number B. Pumping Record 1 Date of Pumping .3"' 3 f__ L. 2. Quantity Pumped: Date Gallons 3 Type of system ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): -- - 4 Effluent Tee Filter present? ❑ Yes �lo If yes, was it cleaned? ❑ Yes I` No 5 Condition of System: d � I 6. System Pumped By: Name Vehicle License Number Company 7 Location where contents were disposed: Signature of Hauler Date r)ttp.//www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4 coc•06/03 System Pumping Record • Page Commonwealth of Massachusetts —rCity/Town of Tewksbury 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: TQ forms on the /D [WAcomputer, useI TH DEP_AH4JlJlFm- only the tab key Address ,- move your '57' cursor-donot use the return City/Town v State•v Zip Code key. 2. System Owner: Address(if different from location) Cityrfown State Zip Code Telephone Number B. Pumping Record c� 1. Date of Pumping Da`�e 2. Quantity Pumped: Glo�do 3. Type of system: ❑ Cesspool(s) peptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): --- --------- - -- - 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By.- Name y:Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record •Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: GB -- Cl/ SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) e, DATE R 9 1 DATE OF PUMPING: —0QUANTITY PUMPED 1096 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO E NATURE OF SERVICE: ROUTINE I/ EMERGENCY OBSERVATIONS: / GOOD CONDITION t, FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: En Q , COMMENTS: CONTENTS TRANSFERRED TO: C9 Sin n 12 700 Commonwealth of Massachusetts Title 5 Official Inspection f=orm Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments -- ' PromAddress r+Iy1 ownerONme s e hrfnmeis I required ( ydoV-er 1" `1 1 every page. Cityfrown state Zip Code Date of Inspection Inspection results must be submitted on this form.inspection forms may not be altered In any way.Please see completeness checklist at the end of the fort. 'mp° "'c A. General Information When filling out , forms on the j cornpuW,use ' 1. Inspector: 1 to ly the mom ��j to move ur ! ( / cursor-do not use the return Name.of Inspector key. ti Company Name Company Address u '► MOO" 19-1440- a Teleph neNumber B. Certification 1 r� I certify that I have personally inspected these information reported below is true,accurate ari pection j was performed based on my training and expo i site i sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Passes ❑ Conditionally Passes ❑ Fails i ❑ Needs Further Evaluation by the Local Approving Authority InWdtoff Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or j 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. i """"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. i T1%6 0Mdal hspoe5en%nc 8i6eurre0e 3ssepe Dtaposd System•Pape 1 or 17 t5ins•03113 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage DisposaMptem Form-Not for Voluntary Assessments Pro ` Addy-) ress Owner s NAMe — infomrd lisM required fbor ! y1�OV'e'(' every page. i CRY/To" state Zap Code Date of Inspection Inspection results must be submitted on this form.inspection forms may not be altered In any l way.Please see completeness checklist at the end of the form. Important: t A. General Information When filling out forms on the } C°n°pute`.is I 1. Inspector only the tab key to move your r i�5 'DU X cursor-do not Name of Inspector y t the return l' `Q t _ key- Company a o F... {.. - Name a� 3Ta-F�.p In �1 L ICompanyAddess Cityn'"n state l e--94 O f q � 4 �' rode Teleph ne Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the Inspection.The inspection M 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 i the 5(310 CMR 15.000).The system: Passes (] Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority i In cto Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board j 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. I *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. I 1 tSins 03l1� T'%5 OfficW b"P-5-Fomc 8tbau ibw Sswgpe Imposm symen,•Page 1 or 17 • i Commonwealth of Massachusetts - Title 5 Official Inspection Formi p Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner I Information is Owner's Name required for every page. I City/Town State Zip Code Date of Inspection t B. Certification (cont.) Inspection Summary: Check A,B,C,D or E!always complete all of Section D ' A)System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 orin 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: i f LA 1 LJ m MYl e(--D MVR-eIn pc� q5 Y-C, ( 2 ;.Lj rte C tai fi-(- i j I�I B)System Conditionally Passes: I ❑ 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 i the Board of Health,will pass. i Check the box for"yes", "no"br"not determined"(Y, N, ND)for a following statyements. If"not determined,"please explain. I The septic tank is metal and over 20 years old'or the septi tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfi ration or tank failure is imminent. System ( will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is st cturally sound,not leaking and if a Certificate of Compliance indicating that the tank is less tha 0 years old is available. Y ❑ N ❑ ND(Ex in below): 4 l — I i i I i Tale 5 official Insneceon Form isp Subsurface Sewage Dosal System Pape 2 of 17 'Sins-03113 4 1 Commonwealth of Massachusetts Title 5 Official Inspection f=orm a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments = Property Address Owner Information is Owner's Name required for every page. Chyli own state Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.); ❑ 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 ❑ Y ❑ N ❑ ND :(Explain below): ) ❑ obstruction is removed ❑ Y ❑ N ❑ (Explain below): ❑ - distribution box is leveled or replaced ❑ Y ❑ N ND(Explain below): ❑ The System required pumping moret 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with proval of the Board of Health): ❑ broken pipe(s)a/repla ❑ Y ElN 13ND(Explain below): obstruction is re ❑ Y ❑ N ❑ ND (Explain below): 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, ety or the environment. I. System will pass unless Board of Hdialth determines in accordance with 310 CMR 15.303(1)(b)that the system is not f ctioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is ithin 50 feet of a surface water ❑ Cesspool or pri is within 50 feet of a bordering vegetated wetland or a salt march 15ins.03,13 Tnle 5 orfdel Inspmftn Form sub6urrace Sewage otsposm system•Paas 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' b 0aN 1e 1 CI�/� Property Address i Owner Information Is Owner's Name required for every page. I Cityrrown State Zip Code Date of inspection B. Certification (cont.) I 2. System will fail unless the Board of Health(and Public Water Supplier,if any) deterimes 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)8,06 the SAS Is within 100 feet of a surface water supply or tributary to a surface wat supply. ❑ The system has aseptic tank and SAS and the SAS is wit ' a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS' 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: i *'This system passes if the well water an ysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the pres ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no of r failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: � r , D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ In Backup of sewage into facility or system component due to overloaded or i clogged SAS or cesspool ❑ 0' 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 1AE1 Liquid depth in cesspool is less than 6"below invert or available volume is less than% day flow i Me 5 Official Inspection Forth Subsurface Sampe D400 System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection p� coon F-orm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Information is i Owner's Name _ i required for every page. CitylTown State Zip Code Date of Inspection j B. Certification (cont.) Yes No ❑ © Required pumping more.than 4 times in the last year NOT due to clogged or s obstructed pipe(s). Number of times pumped: ❑ d Any portion of the SAS, Cesspool or privy is below high ground water elevation. ❑ 1� Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. I ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. I ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] 3 E ❑ 12f This system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. f ❑ The system fails.I have determined that one or more of the above failure i criteria exist as described in'310 CMR 15.303 therefore the ails. system falls. 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. For large systems,you must indicate either"yes"or"no"to each of the following, in addition toe } questions in Section D. / Yes No I i ❑ ❑ the system is within 400 feet ofa-�urface drinkiing water supply ❑ ❑ the system is within 200 f of a tributary to a surface drinking water supply ❑ ❑ the system is locate a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA or a apped Zone II of a public water supply well If you have answered"yes"to a question in Section E the system is condid " Y ered a significant threat or answered es l y n Stctlon above the large system has failed. The owner or operator of any large system considered a si cant 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. i (Sins•03113 Titre s Offidal tnspec0on Form subsurface Sewn . 9e Disposal System•Page 5 or 17 i Commonwealth of Massachusetts Title 5 Official inspection Form — 'i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments m Property Address Owner j Owner's Name Information is I required for every page. ! Cityfrown State Zip Code Date of Inspection C Checklist _ Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ Ef Were any of the system components pumped out in the previous two weeks? i 0 1 ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? 9 ❑ Were 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? LTJ ❑ 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? ❑ Was the facility owner(and occupants if different from owner)provided with Information on the proper maintenance of subsurface sewage disposal systems? This size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ Existing information. For example,a plan at the Board of Health. i { ❑ Determined in the field(if any of the failure criteria related to Part C is atissue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design)` Number of bedrooms(actual): __ i, DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 41 41 a,/, r I i 4 i tSins•0True 5 omcial Inspection Form Subsurface sewage Disptmai System•Paye 6 of 17 3113 Commonwealth of Massachusetts Title 5 Official Inspecti®n Farm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Information IS Owner's Name — required for every page. Citylrown State Tp Code Date of Inspection D. System Information — Description: Number of current residents: Does residence have a garbagegrinder? rLC "J � Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes EJ No Laundry system inspected? iJ ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): { i Ow Pi P Detail: —j (Xi ALA.. 1(7 G �- � C Sump pump? ❑ Yes© No Last date of occupancy: �l i Commercial/industrial Flow Conditions:. , DaW Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? �' ❑ Yes ❑ No Non-sanitary waste discharged to thp"Fitle 5 system? ❑ Yes ❑ No i" Water meter readings,if available: Wpm.03!13 title 5OMc4d Ulspfttton Form Subsurface S&*aOa Dl3ponal System•Papa 70147 I Commonwealth of Massachusetts Tale 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments vig'l L Property Address I Owner ! Owner's Name Information is i required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): i General Information Pumping Records: Source of information: �� Was system pumped as part of the inspection? ❑ Yes d No I If yes,volume pumped: gallons How was quantity pumped determined? W TU i Reason for pumping: Type of System: I d 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DFP approval. I ❑ Other(describe): Title s ofidal Inspection Foan Subsuft*Sewage Disposal System•page a or 17 tsins-03113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Information is ; Owner's Name required for every page. C1ty/1 own State Zip Code Date of inspection I D. System Information (cont.) _ i Approximate age of all components,date installed(if known)and source of information _ Were sewage odors detected when arriving at the site? ❑ Yes No i Building Sewer(locate on site plan): r Depth below grade: .5 feet Material of construction: ❑ cast iron In 40 PVC ❑ other(explain) Distance from private water supply well or suction line: Ai i r i feet — d ' I Comments(on condition of joints,venting,evidence of leakage, etc.): I� k I t I Septic Tank(locate on site plan): Depth below grade: Material of construction: feet 0/concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I i I E 1 If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: �� 'k �-•— t/�`� i Sludge depth t5ins-03113 lttle 5 Official Inspect on form Subsurface sp pql Syltsrn, ge 9 d17 Commonwealth of Massachusetts Title 5 Official Inspection Form Tj pSubsurface Sewage Dis osal System Form-Not for Voluntary Assessments E Property Address Owner Information is j Owner's Name required for every page. !City)rows State Tip Code Date of Inspection System Information (cont.) i Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle f' I 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 i --II How were dimensions determined? 1 U t P Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): i I-erA6gQ 'Alo bc) l /Jv 1>1 qqYAC` dub Grease Trap(locate on site plan): ( Depth below grade: feet Material of construction: ❑ concrete ❑ metal fiberglass [� polyethylene ❑ other(explain) t Dimensions: Scum thickness Distance from top of s m to top of outlet tee or baffle Distance from bo m of scum to bottom of outlet tee or baffle Date of last pumping: Date iTitle 5 Oft5f tMecUM Fam Subsurface sewage Dlspasal System•Pape 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a �cv►d�esI c�<�I sf Property Address Owner Owner's Name Information is required for every page. City/Town state Zip Cade Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): i Tight or Holding Tank(tank must be pfimped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyet ene ❑ other(explain) i Dimensions: ,r/ Capacity: / s - gallon Design Flow: lions per day Alarm present: ❑ Yes El No Alarm level: Alarm in working order: C1 Yes El No Date of last pumping: 7 Date Comments(condition of ala;" dfloat switches,etc.): i i l i "Attach copy of current pumping contract(required). is copy attached? ❑ Yes ❑ No tSins•a3i19 Title 5 OHkaal Inspection Form Subsurface Sewage Disposal System•page 17 of 17 ' Commonwealth of Massachusetts Title 5 official Inspection Form j Subsurface Sewage Disposal System Form-Not for Voluntary Assessments QA vid it? Property Address Owner Information is Owner's Name required for i every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invertt �-TJ] 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.): 7-0—,160 1 U 9---J r r> e (A tK V of ' 1) AloU r,c r-, t- 0 11 c,�0 Pump Chamber(locate on site plan): Pumps in working order: 0, Yes ❑ No Alarms in working order: El Yes ❑ No Comments(note condition of pump chamber,condition ofpumps and appurtenances,etc.): A Soil Absorption tion SYstem(SAS)(locate on site plan ,excavation not required): If SAS not located,explain why: t5ins•03M 3 Title 5 Of lUal lnspeCtlan Form Subsurface_ dace Sewn a Dis 1 System Page 12 a» Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner ; Owner's Name Information is required for every page. CityNown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: leaching fields number,dimensions: SLC—> — ❑ overflow cesspool number: r ❑ 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 site plan): i Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of constru ion Indication of gro dwater inflow ❑ Yes ❑ No t5in s-03113 mile 5 Of0Ua1 InspeUlon.F—suturraw sewage Dlsomi System-page 13 ar w i • t i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rYPro r I party Address i i Owner ! owner's Name Information Is 1 requtred for every page. i City/Town State Zip Code Data of Inspection r D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): I i i s _ 4 I I Privy(locate on site plan): Materials of construction: Dimensions Depth of solids i Comments(note condition of soil,signs of hydraulic (lure,level of ponding,condition-of vegetation, etc.): i y i i r i t5ins-03113 Title 5 0MCial Inspectlan Form S`bw face Sewage DlspOeal System•Pape or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Dis al System Form-Not for Voluntary Assessments Property Address 1 Owner I Information is i Owner's Name required for i every page: City/TDwn State Zi Code Zip Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: i 0 hand-sketch in the area below t E] drawing attached separately i i )s t I i Bins-03113 Tdle 5 OH1dat Ingpecllon Form SubSurraee Sewage Disposal System.page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form orm Subsurface Sewage Dispos 1 System Form-Not for Voluntary Assessments lei) Property Address Owner Information Is Owner's Name .required for every page. City/Town state Zip Code Date of Inspection _ D. System Information 'Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. �— feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked,date of design plan reviewed: Date 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 USG$database-explain: You must describe how you established the high ground water elevation: Before filling this Inspection Report,please see Report Completeness Checklist on next page. __ ,,., Me 5 otFlmd 1nsPOdlon Fwm Subaurtace Serape DISP 81 SYU@m.Pape 16 of 17 Commonwealth of Massachusetts � Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name Information is requi,ed for every page. Citylrown State rip Code Date of Inspection E. Report Completeness Checklist Inspection Summary:A,B,C,D,or E checked Inspection Summary D(System f=ailure Criteria Applicable to All Systems)completed System Information- Estimated depth to high groundwater L✓1 Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•a311] Tise 5 Ofwai h+spection Forth Subsurface Sewage Dispose!System•Paye 17 of 17 Sep 03 5B OB: 03a tDavid Lu 578 68.7-7435 p. 2 10 Iql 11 �I h�1 j �`�•� y b �� ♦ti} S 1. O. /C �� t 1 4 1 X5.08 Qo'NJ n / 1 . �% _._..__......__.._,... .,.. .,. ., Nage t Town of North Andover Tax Map # 210-106.A-0094-0000.0 Parcel Id 17239 56 CANDLESTICK ROAD MARTIN, JAMES 56 CANDLESTICK ROAD NORTH ANDOVER, MA 01845 .Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.13 Acres FY 2017 UB Mailing Index Name/Address Type Loan Number Active/inact. From Until MARTIN.JAMES Payor 56 CANDLESTICK ROAD NORTH ANDOVER,MA 01845 Ula Account Maint, Account No Cycle Occupant Name Active/Inactive Bldg Id. 17691.0-56 CANDLESTICK ROAD Last Billing Date 10/13/2016 3170361 03 Cycle 03 Active UB Services Maint. Account No.3170361 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 . 7.82 1/ WTR WATER 01 ALL METER SIZE 53.2.0 !1 UB Meter Maintenance Account No.3170361 Serial No Status Location Brand Type Size YTO Cons 33132710a Active ERT HH b Badger w Water 0.63 0.63 643 Date Reading Code Consumption Posted Date Variance 9/9/2016 740 aActual 14 10/24/2016 -41% 6/13/2016 726 a Actual 26 8/2/2016 6% 3/9/2016 700 a Actual 23 4/22/2016 7% 12/10/2015 677 aActual 22 1/20/2016 67% 9/9/2015 655 a Actual 13 10/16/2015 -35% 6/10/2015 642 a Actual 20 7/24/2015 6% /11/2015 622 a Actual 21 4/28/2015 -3% 12/11/2014 601 aActual 22 1/15/2015 85% 9/11/2014 579 aActual: 12 10/15/2014 33% 6I1v2014 567 aActual 18 7/16/2014 -15% 3/11/2014 549 aActual 21 4/11/2014 _27% 12/10/2013 528 aActua1 28 1/17/2014 81% 9/12!2013 500 a Actual 16 10/15/2013 -13% 6/12/2013 484 a Actual 18 7/24/2013 -15% 3/14/2013 466 a Actual 22 4/22/2013 17% 12/11/2012 444 aActual 18 1/9/2013 57% 9/13/2012 426 a Actual 12 10/15/2012 -32% 6/12/2012 414 a Actual 17 7/16/2012 3% 3/14/2012 397 a Actual 17 4/1412012 _8% 12/12/2011 380 a Actual 18 1117/20'12 20% 9/12/2011 362 aActual 16 10/13/2011 17% 6/7/2011 346 a Actual 18 7120/2011 -16% 3/8/2011 328 a Actual 21 4/13/2011 12/9/2010 307 a Actual 16 1/12/2011 33%33% 9/10/2010 291 a Actual 21 10/15/2010 0% 6/7/2010 270 a Actual 20 7/15/2010 19% 3.9/2010 250 a Actual 25 4/14/2010 24% 12/8/2009 225 a Actual. 20 1/1212010 29% 9/9/2009 205 a Actual 16 10/15/2009 -21% C ONWEALTH OF MASSACHUSETTS CUTIV-E OFFICE OF ENVIRONMENTAL AFFAIRS ARTMENT OF ENVIRONMEN 1AIJ PROTECTION i RECEIVED AUG 16 2005 TITLE 5 F NORTH ANDOVER OFFICIAL INSPEC ON FORM—NOT FOR VOLUNTARY ASS i9W�y'i O PARTMENT SUBS RFACE SEWAGE DISPOSAL SYSTEM FORM j PART A CERTIFICATION Property Address: Owner's Name: ct r 1 Owner's Address: Date of Inspection: ka --Name of Inspector:(please prin C'hrtrle5 J: Rowc Company Name: ' e Mailing Address: ale. T k Telephone Number: 7 CERTIFICATION STATI MENT I certify that I have personally insl ected the sewage disposal system at this address and that the information.reported below is true.accurate and compl a as of the time of the.inspection.The inspection was performed based on my training and experience in the pro r function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pun 'ant to Section 15340 of Title 5(310 CMR 15.00014 The system: VV Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails ..Inspector's Signature: Date: The system inspector shall:submit copy of this inspection report to the Approving.Authority(Board of Health or DEP)within 30 days of completin this inspection.If the systdm is;a'shared system or has a design flow of 10,000 gpd or greater,the inspector,and system owner shall submit the report to the appropriate regional office of the DEP.The original should be sentt' the system owner and copies sent to the buyer;if applicable,and the approving authority. i 1 Notes and Commentsr ****This report only describes c aditions at the time of inspection and under.the conditions of use at that time.This inspection does apt ad cess how the system will perform in the future under the same or different conditions of use. Title 5 Inspection form 611Sn0 page I Page 2 of I I i 1. OFFICIAL INSPECT N FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'S WAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) t . Property Address: l c n of Q 014 E Owner. Date of Inspection: Inspection Summary: Check D or E I ALWAYS complete all of Section D } A. Svstem Passes: I have not found any informs ion which indicates that anv of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. kny.failure criteria not evaluated'are indicated below. Commen KU IL) vl 'tr fSt VA10404 5 ,eYw q + A(%1A(_C _B. .System.Conditionally Passes: One or more system compon nts as described in the"Conditional Pass"section need to b replacedor repaired.The system,upon comp letii n of.the replacement or repair,as approved by the Boar f Health,will pass. Answer yes,no or not determined( N,ND)in the for the following statement f"not determined"please explain. The septic tank is metal'and er 20 years old*or the septic tank(wh er metal or not)is structurally unsound,exhibit substantial infiltra on or exfiltration or tank failure is' inent.System will pass inspection if the existing tank is replaced with a com ging septic tank as.approved by Board of Health. .*A metal septic tank will pass inspe ion if it is structurally sound,n leaking and if a Certificate of Compliance indicating that the tank is less than 2 vicars old is available. ND explain: Observation of sewage bac or break out or h' static water level in the distribution box due to broken or obstructed pipe(s)or due to a broke settled.or unev distribution box.System will pass inspection if(with. approval of Board of Health)`. Token pip )are replaced bstrucd is removed istri ion box is leveled or replaced ND explain: The system required pum more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approv. of a Board of Health): oken pipe(s)are replaced struction.is removed ND explain: 2 Page 3 of 11 OFFICL41 INSPE ON FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE WAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: . Date of Inspection: C. Further Evaluation is.Requi ed by the.Board of Health: Conditions exist which req ire further evaluation by the Board f Health in order to determine if the s�stem is failing to protect public health, fety or the environment. i 1. System will pass unless B rd of Health determines i accordance with 310 CMR 15.3U3(1)(b)that the system is not function' g, a manner which will p tett public health,safely and the environment: _ Cesspool of pries is thin 50 feet of a surfa water _.Cesspool or privy is thin 50 feet of a bor ting vegetated wetland or a salt marsh 2. System will fail unless th Board of Health(and Public WaterS pplier,if any)determines that the system is functioning in a ma ' er that protects the public health, fety and environment: _ The system has a sept tank and soil absorption.system AS)and the SAS is within 100 feet of a surface water supply or tri , to a surface water supply. _ The system has a se ti tank and SAS and the SAS s within a Zone 1 of a.public water supply. _ The system has a septi tank and SAS and the S is within 50 feet of a private water supply well. _ The system has a septi tank and SAS and a SAS is less than 100 feet but 50 feet or more from a private water supply well' Method used to d ermine distance "This system passes if the ell water anal is,performed ata DEP certified laboratory,for coliform bacteria and volatile ortani compounds' dicates that the well is free from pollution from that facility and m the presence of amonia ni rogen and ' to nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy the analysis must be attached to this form. 3. Other: 3 { Page 4 of l l OFFICIAL INSPE07ION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE EWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) r t A -- Property Address:S >1 (e J14,� Owner: Date of Inspection: D. Svstem Failure Criteria!ap ,icable to all systems: You must indicate`yes"or"'no" each of thefollowing for all inspections: j' Yes 0 _ d Backup of sewage int facility or system component due.to overloaded or clogged SAS or cesspool ` 7 Discharge or ponding f effluent to the surface of the ground or surface waters due to an overloaded or / clogged SAS or cess 1 _ Static liquid level in a distribution box above outlet invert due to an overloaded or clogged SAS or /� cesspool 1 R Liquid depth in cess 1 is less than 6"below invert or available volume is less than'/:day flow 7 Required pumping m e than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ Any portion of the SA cesspool or privy is below high ground water elevation. 7 Any portion of cesspo I or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cessp 1 or privy is within a Zone I of a public well. _ 7 Any portion of a ces l orprivy is within 50 feet of!private water supply well. Any portion of a cess of or privy is less than 100 feet but greater than 50 feet from a private water supply well with no a eptable water quality analysis. (This system passes if the well water analysis, performed at a DEP ertified laboratory,for.coliform bacteria and volatile organic compounds indicates that the we is free from pollution from.that facility and the presence of ammonia nitrogen and nitra i itrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A co _ of the analysis must be attached to this form.] 1—J-0 0 (Yes/No)The system fail 1 have determined that one or more'of the above failure criteria exist as described in 310 C 15303,therefore the system fails.The system owner should contact-the Board of Health to determine at will be necessary to correct the failure. F .Large Systems: To be considered a large system a system must serve a facility with a design flo of 10,000 gpd to 15,000 gpd• . You must indicate either"yes"or o"to each of the following: (The following criteria apply to I e systems in addition to the criteria abov yes no _ the system is within 400 et of a surface drinking water s ply the system is within 200 eet of a tributary to a surfs drinking water supply the system is located in itrogen sensitive (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of public wate upply well If you.have answered"yes"to any uesnon.m S 'on E the system is considered a significant threat,or answered ."yes"in Section D above the lame stem 'led The owner or operator of any large system considered a significant threat under Section-P fail . der Section D shall upgrade the system in accordance with 310 CMR 15:304.The system owner should n the appropriate regional office of the Department. 4 Page 5 of 1 l OFFICIAL.IN3 Ec rION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE EWAGE DISPOSAL, SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the followine have been done.You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information Vas provided by the owner,occupant,or Board of Health j V, Were any of the s tel components pumped out in the previous two weeks -Has the system receivi normal.flows in the previous two week period? ✓ Have large volumes o water been introduced to the system recently or as part of this i-ispection? — Were as built plans of a system obtained and examined?(If they were not available note as N/A) _ Was the facility Lor dw Ming inspected for signs of sewage back up? Was the site inspectedor signs of break out? Were all system comp nents,excluding the SAS, located on site? _ Were the septic tank nholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of nstruction,dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owne (mid occupants if different from owner)provided with information on the proper maintenance of subsurface sewag disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Y. qs no ✓ I Existing information. or example,a plan at the Board of.Health. 7 - - _ Determined in the firrl (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR I15JO (3)(b)] i 5 i f Page 6 Of 11 . OFFICIAL INSPE ON FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFAC WAGE DISPOSAL SYSTEM INSPECTION FORM PART C t SYSTEM INFORMATION - Property Address: Of 4f)b I I I Owner: Date of Inspection: I FLOW CONDITIONS RESIDENTIAL Number of bedroomsdesi f (I ! �� r ( �): Number of bedrooms(actual) : DESIGN'flow based on 310 CivR 15203(for example: 110 gpd x#of bedrooms)t_ VYA Number of current residents: ' Does residence have a earbage der(yes or no):YC 5y 64'e`'" Is laundry on a separate sewage sy tem(.yes or no): 1/ [if separate T yes es P inspection required] i Laundry system inspected wesor• Seasonal use:(yes or no):A II Water meter readings,if a ilable ast 2 years usage(gpd)): 5 e Q q'�I Ct( 12 d -5 U l I -VA A CC Sump pump(yes or no):, Last date of occupancy: Y Y 2 COMMERCIAIANDUSTRIAL Type of establishment: Design flow(based on 310 C +1 203): . d Basis of design flow(seats/perso gft,etc.): Grease trap present(yes or no): Industrial waste holding tank pres t(yes or no)-_ Non-sanitary waste discharged to ta Title 5 s tem(yes or.no): Water meter readings,if available: Last date of occupancyiuse: OTHER(describe): 'GENERAL INFORMATION Pumping Records Source of information: ` Was system pumped as part f the. pection(yes or no):_ If yes,volume pumped: al its_H was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM JJ Septic tank,distribution box,s I absorption system _Single cesspool _Overflow cesspool _Privy -Shared system(yes or no)(if, attach previous inspection records,if any) _Innovative/Alternative techn�l y.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)i _Tight tank _Attach a cop of the DEP approval Other(describe): Approximate age of all components date installed(if known)and source of information �e�,r r Were sewage odors detected when ving at the site(yes or no):01-j 6 Page 7 of 1 I OFFICIAL INSPE ON FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE S WAGE DISPOSAL SYSTEM INSPECTION FORM PART C IYSTEM INFORMATION(continued) Property Address: �Ryl J1(L Owner: Date of Inspection: BUILDING SEWER(locate on'i pian) Depth below grade: I Materials of construction: cast on v/ 40 FVC other(explain): Distance from private water ppl, .ell or suction line: Comments(on co dition of jo• -.., ming, vidence of leakage,em): eQ< v v e SEPTIC TANK: ✓ (locate on sit plan) ..Depth.below grade: D Material of construction: ✓concr a metal_fiberglass_polyethylene other(explain) If tank is metal list-age:_ Is ag 'confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Y,W— X — j'o 0:�Q Sludge depth: Distance from top of sludge to bon of outlet tee or baffle: Scum thickness: Distance from top of scum to top o outlet tee or baffle: Distance from bottom of scum to b om of outlet tee or b Elle How were dimensions determined: t)l Comments(on pumping reco nme tions.inlet and outlet tee or baf c condition,structural integrity;liquid levels as related to outlet' vert,eviden a leakage,etc.): I 1z h eu Ir ,r 6 TZ>-er- d e � )yl r, 1,ev-d,—F(2,e5 1 A qce- h �r c bvy� 2 GREASE TRAP:_(locate on si , plan) Depth below grade:_ Material of construction-_concrete_metal_fiberglass lyethykne_other (explain): L i Dimensions: Scum thickness: Distance from top of scum to top 01 outlet tee ;an : Distance from bottom of scum to om of ouor tile: Date of last pumping: Comments(on pumping recommen ions;inlutlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence f leakage, j' 7 j Page 8 of l I i . • OFFICIAL INSPE ,TION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:sly F 1 Owner: , Date of Inspection: i TIGHT or HOLDING TANK: (tank must be pumped at time of ins ctionxlocate on site plan) 't - Depth below grade: Material of construction: o: Crete metal fiberglass_polyethylene other(explain): LJ Dimensions: _ 1. Capacityj:,,:;:;;. allons Design Flow: eallonslday Alarm present Lyes or no): Alarm level: Alarm in orking order s or no): Date of last pumping: Comments(condition of alarm ark' float s tches,etc.): DISTRIBUTION BOX:y (i 'present must be opened)(locate on site plan) Depth of liquid level above outleirlvert` ,Iq Comments(note if box is level ar distribution to outlets equal;any evidence of solids carryover.any evidence of leaks a into or out of box, tc.): 11 1 l ev-, 4- Y�V���S �eVe� �iow a vsJ�� el ylQ —vvllYllmW� PUMP CHAMBER '(loc on site plan) Pumps in working order(yes'or n ): Alarms in working order(yes o ): Comments(note condition of p chamber,conditio of pumps and appurtenances,etc.): i 8 i Page V of 11 OFFICIAL INSPE ION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE EWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1 Property Address: �� j L e-,l I Owner: Date of Inspection: SOIL ABSORPTION SYSTE (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number leaching galleries,number: leaching trenches,number, 1 ngth: leaching fields,number,d' nsions: overflow cesspool,number: innovative/alternative IIsyste Typeiname of technology: Comments(note condition of s it signs of hydraulic failure, level of ponding damp soil,condition of vegetation, etc.): r' A-v fG� 'j _,? CESSPOOLS: (cesspool in st be pumped as.part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet inve Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater Inflow es or no Comments(note condition of soil igns of hydrauli failure, level of ponding,condition of vegetation,etc.): E PRIVY: (locate on site plan Materials of construction. Dimensions: Depth of solids: Comments(note condition'oPisa, igns of hydra is failure, level of ponding,condition of vegetation,etc.): i 9 FRON :MEL I SSR 11RRT I N l'1RDCO FAY NO. :9782580152 Jul. 28 2005 08:-ZR"I P4 S11SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner., Date of Inspection: I Ii � SKETCH OF SEWAGE DISPOSAL.SYSTEI h include ties to at least two perti anent references landmarks or benchmarks locate all wells within loo' (Lot tte where public water supply comes into houses 50k x"e- �IrC?atJ� . rs' . I (l c{O10 i { ii I i I � 1 I I Page 11 of 11 OFFICIAL INSPECTI N FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SE KAGE DISPOSAL SYSTEM INSPECTION FORM PART C s, S INFORMATION FORMATION(continued) Property Address: y GQK6 LReD Owner: Date of Inspection: SITE EXAM Slope ,/ Surface water v Check cellar Shallow wells i Estimated depth to ground water� feet Please indicate(check)all methods u ed to determine the high ground water elevation: '.Obtained from system design p ins on record-If checked, date of design plan reviewed: x/ Observed site(abutting grope /observation hole within 150 feet of SAS) V Checked with local Board of H aith-explain: Checked with local excavators, ;nstallers-(attach documentation) Accessed USGS database-expl : You must describe how you eshigh ground water elevation: _ f i i � ' 11 i. FROM :MELISSA MARTIN MADCO , FAX NO. :9752580152 Jul. 28 2005 08:34AM P6 Sep -03 N 08: 03x! David Lu 578 68.7-7439 p. 2 A; ��! //9x3' t►r' � � - �ra� �: 10 1 , 0,,p� ' 47 inlr- FROM :MELISSA MARTIN MADCO FAX NO. :9782580152 Jul. 22 2005 03: WPI P7 Town of North Andover OFFICE OF �:a•z� ea` • COM UY DEVELOPMENT AND SERVICES 10 27 Charles Street 104 ' i VVI7-T.T4M J.SCOTTNorth Andover,Massachusetts 01845 Direclor sS�cHuStt (979)688-9531 Fax (978)688-9542 January 19, 1999 New England Engineeti Benjamin Osgood,jr 3 3 Walker Road North Andover,MA 01 5 RE: 56 Candlestick oad Dear Iv1s-Osgood: I am in receipt 0'your letter dated January 8, 1999 concerning the septic system at 56 Candlestick Road and your request ftp: a determination about its capacity, You state that th current home has three bedrooms. The existing plans state that the original septic system was design d for 4 bedrooms with a flow of 800 gallons per day under the 1978 Sanitary Code. This appears to tr 14te to an appropriate size system under the 1995 Code to accorrunodate four bedrooms. Please be ad that although you state the system has passed a Title 5 inspection,the Health Department has no rotor of any such inspection,and would surely want to review same before any final word on this matter. In dition,there appears to have been no soil testing in the area of the reserve. Before a final determinat' n on this could be made,at;east one deep hole test to locate ground water would be required- As you are,this could affect the current elevation of the system if groundwater under current regulations is f to be higher than before. Before a£nal nnination is made, and before any expansion of the home is allowed, an inspection of the home o scertain the actual number of rooms must be performed;existing and proposed floor plans stamped by stered Architect must be submitted for review,an inspection report must be on file. and a deep hole to must be performed. The request must also be reviewed by a number of other local approving authoritie If you have any estions about the contents of this letter,please call the Health Department at thE1 number below. Sincerely, Sandra Starr,.R,S. Health Administrator Co. File BOARD OF APPEALS 688-9541 ING 688-9343 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 639-9535 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS L DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. MA 02108 617-292.5500 f E WILLIAM F.WELDTRUDY COa1 Govemor ' Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissiorxr PART A CERTIFICATION Property Address: -{` �j!V _ �'' o MFS Address of Owner: %0 Date of Inspection: /9 (If different) Name of Inspector: C, IR OW X C.? by0-9Q8 \'7 ) 79- —'r8a0 am a DEP approved system inspector pursuant to Section 15.340 of Title S (310 CMR 15.000) Company Name:7P_Ltl (bru-u Seu�erS'QtrvicQ Mailing Address: -GK.1CSy Telephone Number: e9,7 / CERTIFICATION STATEMENT I certify that (..have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: v1Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: G Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluolted are indicated below. COMMENTS: rJ v 4 BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (lf, N,or ND). Describe basis of Bete tion in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or ope r has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tan as installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is , structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will s inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Heal (revised 04/2S/97) Paye 1 of 10 DEP on the World Wide Web: httpJ/www.rmgnet.state.rns.u3/dep Printed on Recyded Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: C� Date of Inspection: 81 SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level obse in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribu' box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s)are repla obstruction is remo distribution bo levelled or replaced The system required pump' more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with appy al of the Board of Health): ken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to d mine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND ENVIRONMENT: Cesspool or priv,..- is within 50 feet of a surface water Cesspool or privy is within 50 feet of a borderin egetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEA (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNE HAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank d soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water upply. The system has a septic nk and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a se c tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a ptic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water s ply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Dago 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: �+ Owner: SG (.. /r• Date of Inspection: D] SYSTEM FAILS: You must indicate ew-er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overlo ed or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground r surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above o et invert due to an overloaded or clogged SAS or cesspool. I Liquid depth in cesspool is less than.6" w invert or available volume is less than V2 day flow. _ Required pumping more than 4 ti in the last year NOT due to clogged or obstructed Pi Pe(s) Number of times pumped_. Any portion of the Soil A rption System, cesspool or privy is below the high groundwater elevation. Any portion of a ces ool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of cesspool or privy is within a Zone I of a public well. Any port n of a cesspool or privy is within 50 feet of a private water supply well. i Any ortion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd r greater (Large System) and the system is a significant threat to public health and safety and the environment because o or more of the following conditions exist: Yes No the system is within 400 feet a surface drinking water supply the system is within feet of a tributary to a surface drinking water supply the system is ted in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public wat r supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Pape 3 of 10 i I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST j Property Address: Owner: Date of Inspection: Check if the following have been done: You.must indicate either "Yes" or"No"as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal I flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built planshave n obtained and examined. Note :i they are not available with N/A. loro(JoSS Owly _ The facility or dwelling wasinspectedfor signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. i The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)] (revised 04/1S/97) Paps 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION Property Address: / Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: //[7 g.p.d./bedroom for S.A.S/A-sst w- ,Q Number of bedrooms:_ Number of current residents:, Garbage grinder (yes or no)��$�r-SJLz &20* �,�� "'Lot Laundry connected to syste (ye or no):� / Seasonal use (yes or no):h/ n Water meter readings, if available (last two (2)year usage (gpd): Sump Pump (yes or no): 'Last date of occupancy: Cc.UAM COMMERCIAL/I N D USTRIAL: Type of establishment: Design flow: galIons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: s or no)— Non-sanitary waste discharged to t itle S system: (yes or no)_ Water meter readings, if avail Last date of occupan OTHER: (De 1 e) Last date occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: v System pumped as part of inspection: (yes or no)�[ If yes, volume pumped: /4040P0_gallons Reason for pumping: /",ao.v�. TYPE 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) I/A Technology etc. Copy of up to date contract? Other i APPROXIMATE AGE of all components, date installed (if known)and source of information: 111 0!2�.c�, Uvio Sewage odors detected when arriving at the site: (yes or no) I (rovioad 0{/25/97) Pago 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: „j G C Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron ✓40 PVC_other(explain) Distance from private water supply well or suction line Diameter 1_ Comments: (condition of joints, venting, evidence of leakage, etc.) Na crtt c3 �.ery SEPTIC TANK: (locate on site plan) y Depth below grade0 Material of construction: ,,✓concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: /6_R--Vw- dt -et.#'1.K.I►•i-f� Sludge depth: Distance from top of sludge to bottom-of outlet tee ei be e:J 0 Scum thickness:_ 4 Distance from top of scum to top of outlet tee o#66a4le: _ Distance from bottom of scum to bottom of outlet tee er-!%a#ilo:� How dimensions were determined: Agd*&MML-,V-QF �. Comments: (recommendation for pumping, conditi of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) p. .v • _ 1 cn. 1 GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass Pol ene _other(explain) Dimensions: Scum thickness: r Distance from top of scum to top of outlet tee file: Distance from bottom of scum to bottom utlet tee or baffle: Date of last pumping: Comments: (recommendation for pum ' g, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of I age, etc.) (revised 04/25/97) Page 6 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: ,rt: Cia11 Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, o t time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fibe ass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallon ' ay Alarm level: Ala in working order_Yes; _ No Date of previous pumpin ., Comments: (condition of inlet t , condition of alarm and float switches, etc.) DISTRIBUTION BOX: woe' (locate on site plan) L � Depth of liquid level above outlet invert:�� Comments: (note if level and distribution equal, evidence solids�r, gvidence of leakage into or out of box, etc.)_ f� 4-fl (yJ iG�Le c —!ys r'Zt�f1-►1 w�r'vtv vv n(.t(.- n i2;�L4�: r y D 4a o uv PUMP CHAMBER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ' Property Address: Owner: .rG Coo Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): / (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimension-. / w /i eta �• <�� y O .Gc� overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic f •lure level of ponding, condition of vegetation, etc.) — t y I CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be roped as pan of inspection) Comments: (note conditiono oil, 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 ure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page a of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: .Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Frow>F IT 3a' � A`• yoi0.. II (raviaad 04/25/97) Page 9 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of.Inspection: Depth to Groundwater "Feet Please indicate all the methods used to determine High Groundwater Elevation: N� Obtained frorp Design Plans on record Observation of Site (Abutting property;observation hole, basement sump etc.) / Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) 6 —�u,,� -A44. 3O pow. "►��-d� (revised 04/IS/97) Page 10 of 10 Sep 03 918 08: 03a David Lu 978 68.7-7439 p. 2 1 1 A517 4 v� c\ w C41 1 _ tj t ge 110ql t1y ^ ion 01, 41 Town of North Andover NoRTM OFFICE OF Of e COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street North Andover, Massachusetts 01845 + �9cNus�s�y WILLIAM J. SCOTT FILE SS Director (978)688-9531 Fax(978)688-9542 January 19, 1999 New England Engineering Benjamin Osgood,Jr 33 Walker Road North Andover,MA 01845 RE: 56 Candlestick Road Dear Mr. Osgood: I am in receipt of your letter dated January 8, 1999 concerning the septic system at 56 Candlestick Road and your request for a determination about its capacity. You state that the current home has three bedrooms. The existing plans state that the original septic system was designed for 4 bedrooms with a flow of 800 gallons per day under the 1978 Sanitary Code. This appears to translate to an appropriate size system under the 1995 Code to accommodate four bedrooms. Please be advised that although you state the system has passed a Title 5 inspection,the Health Department has no record of any such inspection, and would surely want to review same before any final word on this matter. In addition,there appears to have been no soil testing in the area of the reserve. Before a final determination on this could be made,at least one deep hole test to locate ground water would be required. As you are aware,this could affect the current elevation of the system if groundwater under current regulations is found to be higher than before. Before a final determination is made,and before any expansion of the home is allowed,an inspection of the home to ascertain the actual number of rooms must be performed;existing and proposed floor plans stamped by a Registered Architect must be submitted for review;an inspection report must be on file, and a deep hole test must be performed. The request must also be reviewed by a number of other local approving authorities. If you have any questions about the contents of this letter,please call the Health Department at the number below. Sincerely, Sandra Starr,R.S. Health Administrator Cc: File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 FROM :MELISSA MARTIN MADCO FAX NO. :9782580152 Oct. 07 2003 08:08AM P1 _ 1 { Cover Page/Fax Transmif#al From: Melissa Martin 56 Candlestick Road North Andover,MA 01845 978-681.9862 melissasl.8@hotmail.com TO:Town of North Andover,Dept.of Health FAX: 978-688-9542 DATE: 10/8/03- PAGES:3 including cover Attn: Brian COMMENTS: Hello Brian, It was a pleasure speaking to you last week about the addition we would like to put onto our home. Here are the rough diagrams of our house as it is now. If you could let me know if we would likely get approval for our addition. If not,if you could let me know what we would need to do that would be great. Thank you, Melissa 07, N—Ld FROM :MELISSA MARTIN MARCO FAX NO. :97825BO152 Oct. 07 2003 08:09AM P2 1 Co I rU� CD o � S LP Q u► M b" FROM :MELISSA MARTIN MADCO FAX NO. :9782580152 Oct. 07 2003 08:09AM P3 ^Q °0 Ti T1 n o t � . S q) 1 o . Home Energy, Inc. 14 Edgehill Rd. Haverhill, MA 01830 8/27/03 Melissa Martin 56 Candlestick drive No. Andover, MA 01845 Dear Melissa, Here is a preliminary plan and contract for your additional second floor rooms. Please review: We can make any changes required. You m,ay want to add kneewall storage space in the room closest the driveway. when the plans are complete, ( can get my subcontractors to submit final bids. You may want to check with the Board of Health to see if there are any issues regarding the septic system for added bedrooms. if you have any questions call my cell during the day at 978-407-4895 or home in the evening, 978-372-4071. Thanks. Sincerely, John J. Call i I r Home Energy, Inc. Building Contract This contract, dated August 19 ,2003 , is by and between the following owner and contractor. Owner: Melissa Martin Telephone: Days978-681-9862 Eves Mailing Address: 56 Candlestick Dr., No. Andover, MA 01845 Contractor: Home Energy, Inc., 14 Edgehill Rd., Haverhill, MA 01830 MA Home Improvement Contractor license certificate #127191 Fed. I.D. #04-3355584 Telephone:978-374-6256 1. GENERAL This contract is for the following work and materials to be performed by the contractor (or new construction) on the property address above. The project is generally described as follows: Build two new rooms in 12' x 28' vaulted ceiling area of main house according to attached estimate. Rooms will mirror existing bedrooms in rear of house. Install two new skylights in main roof and two new Andersen casement windows for room egress. The contract consists of this document, any plans or specifications or exhibits referenced herein, and the General Conditions following the signature page. Change orders and modifications shall be in writing and shall become part of this contract. 2. PRICE The total price for the work agreed upon is$33,180.67. Payment terms are set out below, in Paragraph 6. 3. STARTING AND COMPLETION PROVISIONS The work will begin on February 12th, 2004 , and will be completed, absent unusual circumstances, on April 28, 2004. 4. PERMITS AND APPLICABLE CODES; COMPLIANCE WITH LOCAL LAW a. All work to be done under this contract will be in accordance with the building codes presently in force in the Town of No. Andover, MA. The contractor shall obtain all necessary permits and pay all required permit and plan fees. b. The contractor shall at all times comply with the laws of this state regarding mechanic's liens. i 5. SPECIFIC REQUIREMENTS FOR MATERIALS AND WORKMANSHIP This contract will be completed by the contractor in a good and workmanlike manner, using good quality materials. The parties agree upon the following materials specifications and work description, together with any plans or specifications incorporated herein. 6. PAYMENT a. Timely payment by the owner of all sums due under this contract is of the essence to thi contract. The parties agree to the following schedule of payments: PAYMENT SCHEDULE DATE EXPECTED AMOUNT Initial deposit 9/29/03 $1000.00 windows& doom ordered 2/01/04 $3000.00 lumber delivery 2/12/04 $5000.00 frame complete 2/28/04 $3000.00 windows installed 3/06/04 $3000.00 rough electrical 3/13/04 $3000.00 insulation installed 3/20/04 $3000.00 blueboard delivered 3/27/04 $3000.00 plaster finished 4/04/04 $2000.00 trim&doors installed 4/11/04 $2000.00 flooring installed 4/15/04 $1000.00 finish electrical 4/21/04 $2000.00 occupancy permit 4/28/04 $2180.67 $33180.67 The contractor shall provide the owner with his own waiver or cumulative subcontractor's waivers equal to the amount paid for any progress payment. b. The contractor may cease operations if any progress payment is not made by the owner as required herein, and proceed to collect any balance due with any legal remedy. Alternatively, the contractor may continue operations, as set forth in the attached General Conditions. 7. SIGNATURE Attached hereto are General Conditions governing the rights and obligations of the parties to thi contract. The parties are further subject to the laws of this state governing contracts and mechanics' liens. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of , 2003 . owner contractor { GENERAL CONDITI These General Conditions are part of the contract betweerMelissa Martin and Home Energy, Inc. for work at 56 Candlestick Drive, No. Andover MA 01845 1. CONTRACTOR'S DUTIES-GENERAL a. To direct and control the work contracted for in accordance with the terms of this contrac and all applicable codes, laws, and regulations, and as the building permits, if any, issued for this project require. b. To inspect the site, examine the plans and specifications, if any, and supervise all of contractor's employees, and to direct the work of all subcontractors selected by contractor. c. To maintain the work site in a safe and clean condition, to the extent consistent with the contract. d. To advise the owner promptly if concealed conditions are ascertained which require additional or different work, and to proceed in such event in accordance with this agreement. 2. OWNER'S DUTIES-GENERAL a. To provide adequate utilities for the work agreed upon. b. To advise the contractor of any condition of the property which affects contractor's ability tc perform. c. To provide secure storage areas for materials delivered to the work site. d. To execute in a timely manner all permit applications and other documents necessary for the work to proceed. e. To perform no work on the project without a written agreement with the contractor'f. Tc avoid interfering with workers. g. To make no agreements with any tradesperson, subcontractor, or contractor's employee outside the scope of this contract without the written consent of the contractor. h. Owner shall be entitled to make periodic inspections of the work site when accompanied by representative of the contractor, provided such inspections do not interfere with the work and can, in the sole judgment of the contractor, be made safely. Any other entry onto the construction site shall be at owner's risk. i. Owner shall notify his insurance agent of the execution of this Agreement and obtain any necessary Riders to his current coverage or any locally customary forms of coverage, such as Builder's Risk, to cover owner's interests and liabilities during the construction process. 6. MATERIAL SUBSTITUTION Contractor reserves the right to substitute other materials, products and/or labor, of similar, equal or superior quality, utility, or color. The Contractor reserves the right to make alterations to the heating and/or cooling system, provided any such substitution or alteration has comparable durability and performance characteristics. In the event of the substitution of any appliance or heating equipment, the warranty terms of the substituted materials shall be equal to those originally specified unless the owner otherwise agrees in writing. 7. DELAY Contractor shall not be responsible for delays caused by events beyond the control of th( contractor, including but not limited to: strikes, war, acts of God, riots, governmental regulations aned restrictions. Delays caused by owner's failure to make allowance materials' selections or caused by the performance by contractor of extras or necessary work (as described in Paragraph 9) shall likewise be excusable delays. 3. 4 8. INSURANCE Contractor agrees to maintain all necessary forms of insurance to protect the owner from liability for any occurence arising from the performance of this contract. Contractor agrees that he shall cover his own employees for worker's compensation and carry general liability, and that all forms of insurance carried hereunder shall be with reputable companies licensed to do business in this state. Owner agrees to carry full coverage on the subject property covering owner's risk of loss during the construction period, together with all special forms required by reason of the performance of this contract. Specifically, owner shall contact owner's insurance agent and secure any necessary Builder's risk coverage prior to the commencement of the work. 9. HIDDEN, CONCEALED and UNFORESEEABLE CONDITIONS The parties agree that in the event contractor discovers a condition requiring an extra cost that they shall proceed as follows: The contractor shall notify the owner verbally at once to expedite agreement as to the charge to correct or cure such condition, and provide a written estimate as soon as practicable. The parties must agree to such extra charges, or agree to a resolution method, or this contract may be canceled by either of them. For purposes of this section, a "hidden, concealed and unforeseeable condition" shall mean 4 condition not readily observable to a prudent contractor inspecting the subject property for the purpose of performing this contract. 10. EXTRAS Any extra work or materials desired by the owner shall be agreed upon in writing and such extras shall become a part of this contract. Unless otherwise agreed, extras shall be paid for as performed. Failure of the owner to sign an extras order shall not preclude recovery for same by contractor, and acceptance of said extra work or materials shall be presumed, unless there is written notice to the contrary. Contractor shall advise owner at the time of agreement on an extra as to any additional tim required to perform this contract. 11. SUBCONTRACTORS a. Contractor shall select subcontractors as required to complete this contract. Owner acknowledges that various portions of the work will be done by subcontractors. Any subcontractor selected by the contractor shall have all requisite licenses for the work to be done by such subcontractor, and the contractor shall issue subcontracts in writing whose specifications are consistent with this agreement. b. It shall be the duty of the contractor to use reasonable care in the selection of subcontractors Absent objectionable performance by any subcontractor, the selection of subcontractors shall be with the contractor exclusively. The contractor shall require all subcontractors to have such types of insurance in force as are required to hold harmless and indemnify the owner from any claim for injuries of property damage by any agent or employee of any subcontractor. c. Contractor shall pay subcontractors on a timely basis and obtain from subcontractors any necessary documentation required to release their lien rights, if any, as the work proceeds. d. Contractor shall exercise reasonable care in the selection of materials used by subcontractors, but shall not be responsible for later discovered materials' defects or damages from installation methods, not reasonably ascertainable at the time of installation. e. All home improvement contractors and subcontractors shall be registered: Any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA 02108, Tel. (617)727-8598. i I 12. TERMINATION and CANCELLATION The contractor may terminate and cancel this contract if any payment called for hereunder is not received as scheduled, provided that notice is given to the owner as provided below. Upo such termination, the contractor shall have all remedies provided by law, including such lien rights as then apply. The owner may terminate this contract upon the following conditions: a. Failure of the contractor, or his subcontractors, to pursue the work contracted for, absent excusable delay, as provided in Paragraph 7 above, for a continuous period of seven days, without a written agreement permitting same, which may be satisfied by a simple notation to this agreement. b. Failure of the contractor to rectify any condition regarding which building code enforcement authority has issued a citation or violation notice, within seven days' notice of such violation, unless owner and contractor otherwise agree. c. Any other failure to perform this contract required by the terms of this contract. d. No termination shall be effective unless 10 days notice of owner's intent are given as provided below, during which time the default may be cured by the contractor. 13. WARRANTIES a. The work of the contractor including materials and labor, shall be guaranteed for a period of five years, during which period contractor shall at its own expense correct any defect arising from its work unless Paragraph 11 (d) of these General Conditions applies. This provision is in lieu of all other warranties, express or implied, and owner has no action at law or in equity against the contractor after said date . b. Any and all warranties for appliances or mechanical systems shall be delivered to owner when contractor's final payment is received. c. Notwithstanding any manufacturer's warranty of any component, appliance, or system, no action may be brought against the contractor on this contract, for the performance of this work, except as provided above. 14. NOTICES Notices may be sent to either party at the addresses shown above, or mailed by certified or registered mail. Any mailed notice shall be deemed given as of the date of mailing. 9 15. SEVERABILITY If any portion of this agreement is found invalid or unenforceable by any court, the remaining provisions shall remain in force between the parties. 16. ARBITRATION The contractor-and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to E private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in MGL. c. 142A. Owner___ ___ _—Contractor------________— NOTICE: The signature of the parties above apply only to the agreement of the parties to j alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. 16. ENTIRE AGREEMENT This contract consists of the documents defined above, and constitutes the entire agreement the parties. It can be modified only by a written document. IN WITNESS HEREOF, we have hereunto set our hands and seals this day of 2003 , at Owner___ -----—Contractor I i NEW ENGLAND ENGINEERING SERVICES lk INC 'I T��IVBOOF NORTH ARD OF HEALTHVER/ a January 8, 1999 Sandra Starr, Administrator North Andover Board of Health 27 Charles Street North Andover, MA 01845 Re: 56 Candlestick Rd septic system capacity Dear Sandra: I am writing this letter to request that you evaluate the capacity of an existing septic system at 56 Candlestick Road in North Andover. This letter replaces the letter delivered to you earlier today. I was confused as to how many bedrooms exist in the home now. I have enclosed copies of the original design plans and the certified as built plan for your use. The plans show the following; 1. The perc. Rate of the soil is 5 min/inch 2. The existing system is 38' x 20'or 760 Sq. Ft. Using this information a loading rate under current Title 5 regulations would be 0.74 gallons per square foot. This would translate into a capacity of 562 gallons. That capacity would support a 5 bedroom house under the current regulations. Currently the home has 3 bedrooms. A potential buyer would like to add a fourth bedroom after purchasing the home. With this letter I am specifically requesting that you determine if the septic system as constructed can handle flow from a 4 bedroom house. I feel that you can make a determination in writing that the buyer could rely on for purchasing the home and obtaining financing for the expansion and will not release you of any authority to determine at a later date if the proposed expansion meets the Title 5 regulations. 33 WALKER ROAD—SUITE 23—NORTH ANDOVER, MA 01845—(978)686-1768—(888)359-7645—FAX(978)685-1099 A sample of the wording I feel would be appropriate and would protect your position is as follows: "I am in receipt of your request concerning the capacity of the septic system at 56 Candlestick Road in North Andover. Based upon the following facts I have determined that the system can handle flow from a dwelling with 4 bedrooms. 1. The system size based upon as built plans of record is 760 sq. ft. 2. The percolation rate according to existing plans of record for this lot and other lots in the area is 5 min/inch. 3. The system has passed a Title 5 inspection. 4. The required system size for a 4 bedroom home is 595 sq. ft. This office however will not allow any expansion of the home until plans of the existing home and any proposed additions are submitted to this office for approval. Plans must be stamped by a registered architect. Plans must show that the proposed footprint will have no more than 4 bedrooms or 9 total rooms. Further, at this time I am not determining how many bedroom exist or how many rooms the house has. Also, no determination of feasibility of an addition as it relates to anything other than septic system capacity is being made. A request to add an addition will require full review by all appropriate town approving authorities." If you have any questions about what I have requested you to do, please do not hesitate to contact this office. Sincerely, Benjamin C. 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Septic Tank ,flees - Length & To Clean Out Covers - moment Pipe to Tank - On Both Sides of Tank �. Distribution Box Cover & Box - No Cracks All Lines Flowing Equal Amounts i Ho Back Flow _ F. Leach Field or re chi M0one �ensions �Depth aoped Ends mean Double Washed Stone - Pits lmensions_ S e Deti Spl Pads T,e e's - ement Pi to Pit - Both Sides Clean Double Washed Stone R. No Gar_ ,_:age Disposar� r 9. Final G;'adi ng Inspection 10. Barracading Covered System 11 . As - Built Submitted Lot Location Dimensions of System Location with Regard to Perc Test Elevations ',later Table I I I ,ropy•t;o Public �ti,orks SUBSURFACE DISPOSAL SYSTEM CHECK LIST NORTH ANDOVER BOARD OF HEALTH APPRaVED DATE PROVIDED DISAPPROVED DATE TIME REASON _(Af' '5 ac-J�- 4. 3 � 6. Title 5 T- 13-7 6 Z 0.��` Reg. 2. 5 Fail OK The submitted plan must show as a minumumi"'�'r a) the lot to be served (area,dimensions ,�ot_ utters) (Planning Board files) b) location and log of deep observation holes-distance to ties 00—location and results of percolation tests-distance to ties (d) design calculations & calculations showing required leaching area Wt7 (e) location and dimensions of system (including reserve area) existing and proposed contours location of any wet areas within 100' of the sewage disposal system ot- disclaimer (check wetlands mapping) (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location of any drainage easements within 100' of sewage disposal system or disclaimer (planning board files) known sources of water supply within 200' of sewage disposal system or disclaimer location of any proposed well to serve the lot (100' from leaching facility) M (1) location of water lines on property (10' from leaching facilities) location of benchmark driveways garbage disposers no PVC is"to be used in .coristruction a profile *'of the system (elevations of basement , plumber; pipe septic tank, distribution box inlets and outlets , distribution field piping and any other elevations) maximum ground water elevation in area of sewage disposal . system (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Se t ' c Tanks Reg. 6 (A) Capacities - 150% of flow, water table , tees , depth of tees , access, pumping, b) Cleanout ( K(c) 10' from cellar wall or inground swimming pool (d) 25' from subsurface drains North, Andover Subsurface disposal system check list — Page 2 Fail 0K D' stribution Boxes Reg.`10.2 (a) Slope greater than 9.08 Reg.10."� (b Sump Leaching Pits � Leaching pits are preferred where the installation is possible Reg.11 .2 (a) Calculations of leaching area (minimum 500 S.F. ) Reg.11 .4 (b Spacing Reg.11 .1 (c Surface drainage 2% Reg.11 .11 (d Cover material Leaching Fields ' Reg.15.1 tb) RoGreater than 20 minutes/inch _ Reg.15.1 Area (minimum 900 S.F. ) Reg.15. Construction of field Reg.15.8 Surface drainage 2% Reg. 3.7 20' from" cellar wall or inground swimming pool Leaching Trenches Reg.14.1 (a) Calculations of leaching area (min. 500 S.F. ) Reg.14.3 (b) Spacing (4 ft. min. 6 ft. with reserve between) Reg.14.4 (c Dimensions 14.5 Reg.14.6 (d) Construction Reg.14.7 (e) Stone Reg.14.1 (f) Surface drainage 2% Downhill Sloe a) Slope y/x = (to be shown) (b) y/x X 150 = (to be shown) Pumps Reg. 9.1 (a) Approval Reg. 9.6 (b) Stand-by power SOIL PROFILE & PERCOLATION TEST DATA flown/City No.&Street ,/�C G Lot No. Loc:/Subdiv. ✓ �' �'„c (.t�hce�plan Owner �,�y h Investigator ,/; ,,r Observer SOIL PROFILES-DATE 1' E ev. 2' Elev. 3' Elev. 4'Elev. 401 77 0 4/1 0 0 I 1 1 I 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 6 6 6 6 7. 7 . 7 7 8 _ 8- 8 8 9 9 9 10 10 10 10 Benchmark - Location Elevation Datum Percolation Tests-Date 2/ Pit Number 1 2 3 4 5 Start Saturation Soak-Mins. 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DSS TRiBu r/o/v Box C.S'yEEr 2 o,=3 FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section*****************APPLICANT: zl_ Phone 6 6 73 LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street "'�,CG St. Number '. ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: _ Date Approved Conservation Administrator Date Rejected Comments — - _ Date Approved TownPlanner Date Rejected Comments - - --. Date Approved-.-- Fond pprovecl�-Fond Insnector-Heal.th- P?t e Rcj ected Date Approved o2�/ ep is Inspector-Health Date Rejected CommentsZ�6G Public Works - sewer/water connections driveway permit Fire Department Received by Building Inspector Date OF NORi�1 " Town of OFF�'ES OF: 03` "' °°m 120 Main Street AF3PEALS « NORTH ANDOVER North Andover, BUILDINGMassachusetts O 1845 CONSERVATION ss,�""gas DIVISION OF (617)685-4775 HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR North Andover Board of Health INSPECTION REPORT July 8, 1988 At the telephonic request of Dr. John Lu I inspected a home at 56 Candlestick Rd. in North Andover today. Although the interior was disorderly - presence of rubbish, overturned or broken furniture, soiled carpets, bare plywood floors (carpeting missing) , dirty kitchen appliances (oven and refrigerator)- the major concern of the Health Department is the presence of dog and cat feces. Multiple cat feces were found on the second floor foyer by the stairway. It appeared that some attempt was made to clean this area yet the carpet remains soiled. The presence of animal waste is the sole violation of the State Sanitary Code (105 CMR 410.602 B) at 56 Candlestick Road. It is my opinion that an extensive cleaning of the house should be done to ensure the health and safety of anyone who should live there. The North Andover Board of Health members have not yet been notified of this inspection and subsequent report. Step en F. us r Assistant H a thh�AA�eg��aaen _ A99- O,p t A NOR ri F OFFIC'(---S 01=: p0 Town of 120 Miiin SIrCcl 4%4'1'EAI-S off; -, NORTH ANDOVER No)rlh Andovcr. BUILDING Nlilssilch�iscllst)I�4 CONSERVATION SS4cMU5ES DIVISION ON ((i 1 7)G85 4775 HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, UIREChOR North Andover Board of Health INSPECTION REPORT July 8, 1988 At the telephonic request of Dr. John Lu I inspected a home at 56 Candlestick Rd. in North Andover today. Although the interior was disorderly - presence of rubbish, overturned or broken furniture, soiled carpets, bare plywood floors (carpeting missing) , dirty kitchen appliances (oven and refrigerator)- the major concern of the Health Department is the presence of dog and cat feces. Multiple cat feces were found on the second floor foyer by the stairway. It appeared that some attempt was made to clean this area yet the carpet remains soiled. The presence of animal waste is the sole violation of the State Sanitary Code (105 CMR 410.602 B) at 56 Candlestick Road. It is my opinion that an extensive cleaning of the house should be done to ensure the health and safety of anyone who should live there. The North Andover Board of Health members have not yet been notified of this inspection and oubsequent report. Stephen F.SAN Assistant