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Miscellaneous - 90 SPRING HILL ROAD 4/30/2018 (2)
� � , 1 �� �9 :7 :j �'+AJ ;a 7� I :/ ;g? t,9 74: .1 r^ �1 �.. � ,�s _� f ;i ',{s+ ; f ;1 l!'�„ rte+ A North Andover Board of Assessors Public Access Page 1 of 1 M�oRT� Forth Andover Board of Assessors - - L a sACHUSE roperty Record Card Parcel ID :210/107.A-0237-0000.0 FY:2012 Community: North Andover Click on Sketch to Enlarge Click on Photo to Enlarge Location: 90 SPRING HILL ROAD Owner Name: READING, ROBERT & VALERIE Owner Address: 90 SPRING HILL ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 7 - 7 Land Area: 1.73 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3968 sqft Total Value: 696,900 696,900 Building Value: 465,700 465,700 Land Value: 231,200 231,200 Market Land Value: 231,200 Chapter Land Value: Price: 775,000 Sale Date: 08/30/2002 s Length Sale Code: Y -YES -VALID Grantor: COLEMAN, WILLIAM J Doc: Book: 07050 Page: 0002 http://csc-ma.us/PROPAPP/display.do?linkld=1896227&town=NandoverPubAcc 3/19/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATIONS qO_.__S2GL Print_ - PROPERTY OWNER JC)h Print .. 100 Year Old Structure yes no. MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no .TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p Septic ❑ Well ❑ Floodplain ❑ Wetlands 0 Watershed District El Water/.Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phon` . 9_ 5 r_tr•_I rcm a CONTRACTOR Name: Phone:- Address: Supervisor's Construction License: Exp. Date: Home ;Improvement License: _ -__ Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund F _ Signature-df-Agent%Own , Signature of contractor ; Plans -Submitted ❑ Plans=Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ •TYPE—bF: SEWERAGEDISPOSAL" Public Sewer ElTanning/Massage/Body Art ❑ .. Swimming Pools El Well ❑. -Tobacco.Sales ❑ .:Food Packaging/Sales ❑ Private:{septic tank, etc-_ . ❑. - • _ . -Permanent Dempster on-site ❑ _. -THE..:FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF'- U FORM ::..-DATE.REJECTED DATE;APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS _CONSERVATION Reviewed on Si ` nature X COMMENTS HEALTH Reviewed on �' lei Signature IVB l04 COMMENT S . _ R _ . — h %n AA n n A.. '\ 11-L rn/,\ ft *7P -Y ); LI' Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_.. Planning Board Decision: Comments Conservation Decision: :Comments Water °& Sewer Connection/Signature & Date Driveway Permit DPW 'To -,,Y.! Engineer: Signature: Located 3.84 Osgood Street FIRE DEP ARTtilifT.=�:'Terrip Dumpster on site .yes no Located at .124 Mair, Street Fire Departinerit.signature/date`_ COMMENTS f TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Issued: Date Received IMPORTANT: Applicant must complete all items on this page LOCAT Print PROPERTY OWNER JQh n G21 QaQ - Print 1 b Year Old Structure yes no MAP NO: � PARCEL��1 ZONING DISTRICT: Historic District yes no Machine Shop Village yes ( no .TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO' BE PERFORMED: 66 I/8 Identification Please Type or Print Clearly) OWNER: Name: Phon Oc 17- �/ - m Address: CONTRACTOR Name: Address: <-- Supervisor's Construction License: Home Improvement License: _Exp. Date: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Own, Signature of contractor Plans Submitted Li Plans W Certified Plot Plan ❑ Stamped Plans ❑ r r 0 ne IL 0 O_ LLI O r W CIO W W U c> Q 0 I O O on W) CL E E'' L O 'C7 (. 0 -i a) LU uj O 0 05 w ❑ ❑' ❑ Q. W LU U Cr •Y O � y„ L Z o co O css O O C9 Z O Z (1 cli Cd 0 (] `q (Ci U � i Q E ,L L (B O 4- S .v.+ �. v— O a - H H Z �••0-+ m (if � e� inr (�y' OO ® O ffiT O ! ui! Cl) U N 6 O �R O W Y Arg E CDQ F� �' n (Lp O O b CIO m M j c luj :io V a U LLJ L. O N G m O 1 Pw LU N O O u1 LL 6 z co ® CD (� O c� N� a) .� s. D P z O 1-- J ry W a-8 02 r+ J ' W LLQ 2 LL LL. LL. , Q U- W LL. ®® LL z go �a WZ Co LL, LlJ Z a o aa. :J W J L:l ®i3� L4-' W LL! 1—.. 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Before using -this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Left / Right rear of house, Left /right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address q0 � t /� City/Town �1 State Zip Code 2. System Owner. Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system- ❑ ❑ Other (describe): ACode Telephone Number co Date 2. Quantity Pumped: Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑YesE I No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition stem: 6. System Pumped By: Neil Bateson Name Bateson Entemrises Inc Company 7. Locatio here contents were disposed: G L S. Lowell Waste Water o;t F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Recons • Page 1 of 1 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 6/28/13 This is to certify that the individual subsurface disposal system has been installed in accordance with the provisions of Title 5 of the State Environmental Code: Complete Repair and Construction of an On -Site Sewage Disposal System By: Peter Breen At: 90 Sprint! Hill Rd. Map 107A Lot 0237 North Andover, MA 01845 The Issuaof this ceicate shall not be construed as a guarantee that the system will function satisfactorily. Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com H9R'Y#, 44 s.,tixe y���Q. T • "sem �_;AG US PUBLIC HEALTH DEPARTMENT Community Development Division RECEIVED TOWN OF NORTH ANDOVER JUN 2 7 2013 SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION TOWN OF NORTH ANDOVER HEALTH DEPARTMENT The undersigned hereby certify that the Sewage Disposal System constructed; ( ) repaired; By: (Print Name) r r ,/j Located at: 9 d -S 1 P, 1 k) 6— H l L �. 2 d -46 (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated LI and last revised on (p /f ll , with a design flow of 5-5-0 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. CIA Le. Bottom of Bed Inspection Date: I �j Engineer l9epresentative (Signature) And - Print Name / Final Construction Inspection Date: - t OL l-7 1 3A,�'—' Engineer Representative (Signature) Gr &L -es -_6 And- rint Name Installer: (Signature) Date: l 4 Enginer: (Signature) And - Print Name Date:_fli -7 J'�/U is 013 And - Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Thursday, June 27, 2013 12:10 PM To: Blackburn, Lisa; 'Dan Ottenheimer'; 'Pam Lally' Cc: Sawyer, Susan; 'Isaac Rowe' Subject: RE: 90 Springhill Attachments: 90 Spring Hill Rd - final inspection.doc Susan/Lisa, Attached is the final inspection form for the above referenced property. Everything looked good, Peter and Greg were ok with each other on site. Let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 90 Spring Hill Rd. INSTALLER: John Breen DESIGNER: Clayton Morin PLAN DATE: 5/24/13 BOH APPROVAL DATE ON PLAN: 6/14/13 MAP: 107A LOT: 0237 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: 6/19/2013 DATE OF FINAL CONSTRUCTION INSPECTION: 6/27/13 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: 2 -compartment septic tank used. SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ® Cleanouts per plan X Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of finish grade installed over one access port ® Hydraulic cement around inlet & outlet Comments: Tank had not been set. Peter called 6/20/13, wants to put in a compartment pump tank. Spoke to Mark at Saab Engineering and he does not want to change to single compartment tank. He will tell Peter to install 2 compartment. PUMP CHAMBER Comments: CONTROL PANEL Comments: DISTRIBUTION -BOX ❑ Bottom of tank hole has 6" stone base (did not see) ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Hydraulic cement around inlet & outlet ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement ® Installed on stable stone base ® H-20 D -Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan X Size of SAS excavated as per plan — request paperwork ® Title 5 sand installed, if specified on plan (request paperwork) ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: 46Lx20, 57Lx33. T2 needs to go 6" into the C -Layer, remove rocks. 90 degree angle, 32' from corner of house. SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = FINAL GRADE ❑ Loamed ❑ Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ❑ As -Built Plan BM = 80.00 HR = 0.40 HI = 80.40 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT 5.01 75.04 Septic Tank IN 5.23 74.82 73.70 Septic Tank OUT 5.35 74.70 73.45 Pump Chamber IN 5.37 74.68 73.43 2" Pump Chamber OUT 5.74 74.49 73.18 4" Distribution Box IN 2.88 77.17 77.17 Distribution Box OUT 3.04 77.01 77.00 Lateral 1 TOP 3.16/3.39 Lateral 1 INVERT 76.89 / 76.66 76.89 / 76.66 Lateral 2 TOP 3.16/3.39 Lateral 2 INVERT 76.89 / 76.66 76.89 / 76.66 Lateral 3 TOP 3.16/3.39 Lateral 3 INVERT 76.89 / 76.66 76.89 / 76.66 Lateral 4 TOP 316/3.39 Lateral 4 INVERT 76.89 / 76.66 76.89 / 76.66 Y CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10 (5) 20 (10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws • �° "� , Commonwealth of Massachusetts Map -Block -Lot -, • 107.A0237 BOARD OF HEALTH ----------------------- North Andover CERTIFICATE OF COMPLIANCE THIS IS TO CER Y, That the Individual Sewage Dispo System (Repair) by Peter Breen --------------------------------------------------------------------------------------------- ----------------------- ------ --------------------- Installer at No 90 SP G HILL OAD h been installed in accordance with the provisions o f the State Environmental o e as described in the pplication for Disposal Works Construction Permit No. BHP -2013-078 Dated ----------------------------------------------------------------- Printed On: Jun -17-2013 BOARD OF HEALTH • 5��'D' Commonwealth of Massachusetts Map -Block -Lot y R • 107.A0237 BOARD OF HEALTH ----_--_-- Per -mit--- No North Andover BHP -2013-0785 ----------------------- FEE $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Peter Breen to (Repair) an Individual Sewage Disposal System. at No 90 SPRING HILL ROAD - ----------------------------------------------------------- - -- -------------------- as shown on the application for Disposal Works Construction Permit No. BHP-C!F Dated Issued On: Jun -17-2013 ------------------------------------------------------ BOARD OF HEALTH t I NO eTM of .•s• .�h0 � • Town of North Andover `'•�,; ;o �:',+ HEALTH DEPARTMENT ,SSACHU`+E< CHECK #: IQ LOCATION: H/O NAME CONTRACT 6 52 1 Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) //11 $ s V ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ 71 Health Aal; t Initials White - Applicant Yellow - Health Pink - Treasurer Date... ............................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....., j{ .✓.. .. f ............ 4 ...................................... has permission to perform ..... ( . �... ............... wiring in the building of ..... IrA.e�......... at .. 1�......s/...�.. .. ...,/ -.1 .......,1�...................I North Andover, Mass Fee..�"�.................. Lic. No/Z%%`.....,�ll (............. ....................... ELECTRICAL INs OR Check # /0 2 7 11661 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ISI Application for Septic Disposal System (Construction Permit - TOWN OF TODAY'S DATE Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component - What? A. Facility Information Wo S.fTr Ad esd s 11/D l T `-f M t� City/Town 2.- *TYPE OF SEPTIC SYSTEM*: [9'Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** $ 250.00 - Full Repair $125.00 - Component JUN 17 2013 TOWN OF NORTH ANDOVER K< Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Ute. l -t- Qo ge�- T geed t tA r; Name Address (if different from above) City/Town State Zip Code Telephone Number 3. Installer Information Pe_-tr 6 mace_... (Ie -T -cr /cam, Name —7 2 0 Aok Fd SF - Name of Company Address ao sok Fv� of � A _ Jay �`L /" 0 t F City/Town State Zip Code Z.7 F ,,I 6S 23 -so Telephone Number (Cell Phone # if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 M°RTN Application for Septic Disposal System Construction Permit - TOWN OF TODAY'S DATE $ 250.00 -Full Repair �AC1W4�<l - ORTH ANDOVER, MA 01845 $125.00 - Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: ❑Residential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the constru on-site sewage disposal system in accordanc Environmental Code, as well as the Local S North Andover, and not to place the syste in been issued by this Board of Health. Name �� d maintenance of the afore -described r.•iPh he provisions of Title 5 of the Jrf, ce Disposal Regulations for the Town of ►. ration until a Certificate of Compliance has Date Applicat n Approved By: (Board of Health Representative) k� /�3 Na Date ication sapproved for the following reasons: For Office Use Only: L Fee Attached. Yes No 2. Project Manager Obligation Form AttachedP Yes No 3. Pump Svstem? Ifso, Attach copy ofElectrical Permit Yes No 4. Foundation As -Built? (new construction ronly): (Same scale as approved plan) Yes No 5. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: © s (rlddr s of septic system) For plans by (Engineer) Relative to the application of �tt%-� (Installer's name) And dated (Original ate Dated 7 ay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans PLior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed — Generally, this is the first (Vinspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdept(@townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D -Box, p pes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer_ I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: 6 (Today's Date) (Name —Print) (Name —Signed) Sawyer, Susan From: Sawyer, Susan Sent: Monday, April 22, 2013 12:49 PM To: Ireadingshome@gmail.com' Cc: Blackburn, Lisa (LBlackburn@townofnorthandover.com) Subject: F90 Spring Hill Rd Attachments: 20130422120500054.pdf, ENGINEER list 2012.doc Valerie, This email is response to your question for your as -built. There are 2 versions attached. The original and the one from the 2002 Title V inspection. Sent both just in case. Below you can access our list of installers http://www.townofnorthandover.com/Pages/NAndoverMA Health/SEPTIC INSTALLERS -2013 RENEWALS.pd We cannot recommend anyone, but this year so far I believe we have seen installation permits pulled by Soucy, Reilly, Bateson, Kellett and Sawyer. Also, I attached a short list of engineers, just in case a problem exists that needs an design. Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawyer@townofnorthandover.com Web www.TownofNorthAndover.com -----Original Message ----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Monday, April 22, 2013 12:05 PM To: Sawyer, Susan Subject: This E-mail was sent from "RNPOA428C" (Aficio MP C5000). Scan Date: 04.22.2013 12:04:59 (-0400) 1 TOANTN OF NORTH ANDOVER Office of COIN BII LAITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE ?035 NORTH ANDOVER_ MASSACHUSETTS 01845 978.658.9540 - Phone Susan Y. Salvvver, REHS✓RS 978.688.8476 -FAX Public:Heald► Director E-:MAIL:healthfttrra.to«i ofnprthando�er.con, tiVEBSI TE : Itttp:%;Ixx7%x7,,v.toNNmofnortliaudover.coiii SEPTIC PLAN SUBMITTAL FORM Date of Submission: Site Location: Engineer: New Plans? Yes review, only) NAM MAMIM N" $225/Plan Check g o? 5<-/b (includes lit submissi Re-•ised Plans?Yes S75iPlan Check, # MAY 2 9 2013 Site Evaluation Forms Included? Yes V No TOWN OF NORTH ANDOVER NCAITU r%VnAl — Local upgrade Form Included"? 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Commonwealth of Massachusetts City/Town of Percolation Test Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. 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 the local Board of Health to determine the form they use. A. Site Information G - Owner Name b s p� to L � Street Address or Lot # 1yCN 21 E-- V4'+n&QQD ' W A- 6 04S_ Cityrrown State Zip Code Contact Person (if different from Owner) B. Test Results Observation Hole # Depth of Perc Start Pre -Soak End Pre -Soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate (Min./Inch) Telephone Number Date Time 1 ' 23 i :Z3 33 12- Test Z Test Passed: [tom 51/(01(25 .9. '0C) Date Time 3 l� rJ' Test Passed: ip v &4� B Test Failed: ❑ Test Failed. ❑ Test Performed By: Witnessed By: Comments: t5form12.doc• 06/03 Perc Test • Page 1 of 1 v _--j b OF NORTy qti SACHUS� North Andover Health Department Community Development Division June 13, 2013 Clayton Morin, P.E. Engineering & Surveying Services 70 Bailey Court Haverhill, MA 01832 Re: Subsurface Sewage Disposal System Plan for 90 Spring Hill Rd (Map 107A, Lot 237) Dear Mr. Morin: The proposed wastewater system design plan for the above site dated May 24, 2013 and received on May 29, 2013 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. ye""1. Please provide the elevation/location statement as described in section 3.2 of the North Andover Board of Health regulations. 2. Please indicate the holder of all easements depicted on the design plan (3 10 CMR 15.220(4)(c)). ,,-3. Under Pump Notes, NA 12.01 regulation no longer exists. Also on the Pump Chamber detail, NA 13.03 regulation no longer exists. 4. Please indicate the orifices in the perforated pipe shall be 3/8"-5/8" (3 10 CMR 15.251(8)). 5. The profile view was missing the elevations and distances along the horizontal and vertical axis for reference. 6. The finish grade above the distribution box does not meet the 9" minimum requirement. `7. Please add a note to the plan to indicate that a riser to within 6 inches of finish grade is required above the distribution box if greater than 9 inches below grade. Please indicate the model/brands of the distribution box (NA 3.2). 9 The breakout elevation should reflect the elevation based on the high end of the leach field not the low end of the leach field. �. Please indicate the depths of the floats in the pump chamber in inches. This will eliminate the need of the installer to calculate the float depths. North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Page 1 of 2 Fax: 978.688.8476 *-.,/.. b r /1"1. Please add the pump operating point to the pump performance curve. Although not a reason for disapproval, you may wish to consider using a 2"x4" coupling with a 4' length of 4" PVC before the distribution box to reduce the velocity. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. ZSincerela r, /RS Public Health Director cc: Robert Reading File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 No. THE COMMONWEALTH OF MASSACHUSETTS FEE _ rBOARD� p OF HEALTH 1 U Cc1 At O F !V O e -r# Alybpyeg APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (X) Upgrade ( ) Abandon ( ) - X Complete System ❑ Individual Components 9th SP9irlt, )4/LL, Zaa7`�, Location „- Map/Parcel # Lot # Installer's Name Address Telephone # 4®L14- J'A?6"_Ab,AJ& O ner's Name 90 Sr>RlA)a /4i' Lc. 2Di4/> reCs�s ESS, Telephone # �Designer's Name 7—n .&A/L6�'✓ 00�1 �vtY%Z/l/LL, tM14 Address Telephone # Type of Building: /E-5117C.^1Z:• Dwelling— No. of Bedrooms IV Other — Type of Building No. of persons Other fixtures Lot Size S— 53'20 Sq. feet Garbage Grinder ( ) Showers ( ), Cafeteria ( ) Design Flow (min. required) 5'5 gpd Calculated design flow 5 gpd Design flow provided gpd Plan: Date JMA J 2q, a al 3 Number of sheets 6k R04% Date Title _4C_ Description of Soil(s) Soil Evaluator Form I 5&,N 0 Name of Soil Evaluator (nvrq S -04S Date of Eve DESCRIPTION OF REPAIRS OR ALTERATIONS A JUX9 a110nS. V00VIO U-1 The undersigned agrees to install the above described In Iiividual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issu+� Signed Inspections Date FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. , dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Date FORM 2 - DSCP FORM 1255 (REV 5/96) Board of Health DEP APPROVED FORM 5/96 H&W HOBBSB WARREN TM PUBLISHERS - BOSTON 04/29/2013 15:06 FAX 9785560284 ESS r 1 • Q [a001 TOWN OF NORTH ANDOVER Office of COMMUNITY ;DtVELOP MENT AND SERVICES HEALTH IiEPARTM, 'ENT 1600 OSGOOD S'T'REET, SUITE 2035 40 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS, RS 978.688.9540 -Phone Public Health Director 978.688.8476 —.FAX healthdent(c�townafnorthat�doyercom www.townoliiorthandover.com APPLICATION FOR SOLL TESTS DATE: �Z/01 � _- / -- MAP &c PARCEL: 1 a % A — Q3 7 LOCATION OF SOIL 'TESTS: � O PR f N G H I L - L-- P, 6 AD OWNER: R.Ae r'4 f-4aA Contact #: APPLICANT: Contact #: ADDRESS: b 1 r J :- H I L e- A.,0 ENGINEER +6 6--N_ M 0 r i V1 Contact #: 1� (RECEIVED CERTIFIED SOIL EVALUATOR: (5-rCT �-'rJ Intended Use of Land: Residential Subdivision Single Family Home Commercial MAY 06 2013 Is This: Repair Testing: V'1 Unc.eveloped Lot Testing: Upgradc for Addition; OWN OF NORTH ANDOVER HEALTH DEPARTMENT In the Lake Cochichewick Watershed? Yes No V/ TIRE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) D 8.511x 1.1" Plot plan A Location ofTestlne_lWea—u indicate test nit sites on the plan Fee of $425.00 per lot for new cor_struction. This covers the minimum two deep holes and two percolation tests required for e&ch disposal area_ Fee of35 60.00 per lot for repairs or upgrades. GENERAL INFORMA'T'ION Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only plass_ Registered Sanitarians tend Professional Engineers can dcsign septic plans. D At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep he les and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for al I additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled lPlan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approl'at Date., 3 Signature of Conservation Agent: Date Back to Health Department: (stall 9 in) Street & Trench Opening Permit.pdf 1 of 5 http://www.townofnordiandover.com/Pages/FV1-00024FEC/Street &... Town of North. Andover ' Pursuant to Policy & Town Bylaw Chapter 161-3 Street Excavation permit (as amended) With PERFORMANCE BOND AGREEMENT AND The Commonwealth of Massachusetts Jackie's Law— Trench Permit Pursuant to G.L. c. 82A §1 and 520 CMR 14.00 et seq. (as amended) PERMI I APPLIGA l ION — Street Upening Permit Wor Trench Permit Permit Number: ll Applicant: Dig Safe Number: clU/�! 7 �y� Date Issued: SITE EMERGENCY „CONTACT: , i EMERGENCY NUMBER: SECTION 1 .-SITE INFORMATION-PRINTORTYPEIN BLUE ORBLACK INK 1.1 Property Address: f1. A -M.; J 1 y 1.2 Map/Parcel Number. G� i(j`'� 39 ,^()� x Builder's Lot No: Block: 0000v GIS Property ID: Provided by the Town 1.3 Description, location and purpose of proposed street opening and trench: use back of page if needed 1 1.4 Antfcipdted Date to Begin-Operafio s- I/ Begin: End. 1.5 Anticipated Date to Conclude Operations SECTION 2 - PROPERTY OWNERSHIP AND PERMIT HOLDER INFORMATION - PRINTOR TYPE IN BLUE OR BLACK INK ma Signature 2.2 Acord tee, q� Address Permit Holder Information: 8 Permit Holder lyffofmation - continued 1 EVINMI-1 6H H 0307? J3 -d 93 - =,? Telephone ! Emergency Contacf Number 3/14/2013 1:04 PM Street & Trench Opening Permit.pdf http://www.townofnorthandover.com/Pages/FV1-00024FEC/Street &... Competent Person as defined by 520CMR 7.02 Printed Name: Massachusetts Hoisting License #: /3 L37% License Grade: License Expiration Date: all /'I/'/ I 2.3 Name and Contact Information of Insurer: In, J AnZ4 Ulf 61 -64 Lompany Name ddre s Telephone 3a / Insurance Certificate #C&,& � Policy Expiration Date: �/% ] /Z Whereas pursuant to the provisions of Chapter 161 Section 161-3 of the North Andover Town Bylaws, the grantee agrees to provide a plan and a bond in the sum of $10,000.00 bound unto the Town of North- Andover and an additional refundable amount of $ to assure proper performance and completion as defined in the general specifications and conditions below and as attached. By signing this form, the applicant/excavator and owner, acknowledge and certify that they are familiar with, or, before commencement of the work, will become familiar with, all laws and regulations applicable to work proposed, including OSHA regulations, G.L. C. 82a, 520 CMR 7.00 et seq., and any applicable municipal ordinances, by-laws and regulations and they covenant and agree that all work done under the permit issued for such work will comply therewith in all respects and with the conditions set forth below. The undersigned owner authorizes the applicant/excavator to apply for the permit and the excavator to undertake such work on the property of the owner, and also, for the duration of construction, authorizes persons duly appointed by the municipality to enter upon the property to monitor and inspect the work for conformity with the conditions attached hereto and the laws and regulations governing such work. The undersigned applicant/excavator and owner agree jointly and severally to reimburse the municipality for any and all costs and expenses incurred by the municipality in connection with this permit and the work conducted thereunder, including but not limited to enforcing the requirements of state law and conditions of this permit, inspections made to assure compliance therewith, and measures taken by the municipality to protect the public where the applicant owner or excavator has failed to comply therewith including police details and other remedial measures deemed necessary by the municipality. The undersigned applicantlexcavator and owner agree jointly and severally to defend; indemnify, and hold harmless the municipality and all of its agents and employees from any and all liability, causes or action, costs, and expenses resulting from or arising out of any injury, death, loss, or damage to any person or property during the work conducted under this permit. In witness whereof those signed below have here unto b TURE (I i For City/Towr� use Do notwrite in this section PERM ITAPPROV"EI BY PERMITTING AUTHORITY. Division of Public Works Date 2 of 5 3/14/2013 1:04 PM Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. �n Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner's Name North Andover City/Town MA 01845 State Zip Code 04/25/13 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 form. A. General Information Inspector: John Soucy Name of Inspector Soucy's Sewer Service, Inc. Company Name 78 N. Broadway Company Address Salem CityfTown 603-898-9339 Telephone Number B. Certification NH State 13397 License Number 03079 'pRECEIVED AM JUN 10 2U13 HEALTH DEPARTMENT 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: ❑ Passim ❑ Conditionally Passes ® Fails ❑ eds urther Evaluation by the Local Approvin4Date nspe a T system inspector shall submi/acopy of this inspection report to the Approving Authority (Board o ealth 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 ttm 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. t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner Owner's Name information is required for every North Andover MA 01845 04/25/13 page. 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: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health., * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner Owner's Name information is required for every North Andover MA 01845 04/25/13 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 ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ 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, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. t5ins - 11/10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner's Name North Andover City/Town B. Certification (cont.) MA 01845 State Zip Code 04/25/13 Date of Inspection 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: 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 cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/ day flow Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 ❑ ® The 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 the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts - W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /v 90 Spring Hill Road Property Address Valerie Reading Owner information is Owner's Name _ - required for every North Andover MA 01845 04/25/13 page. City/Town _ State Zip Code 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. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water 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.] ❑ ® The 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 the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner Owner's Name information is every North Andover required for eve MA 01845 page. City/Town State Zip Code C. Checklist 04/25/13 Date of Inspection 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 ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ 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) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition 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? The 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. ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner Owner's Name -- information is required for every North Andover MA 01845 04/25/13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 9 ( Y 9 (9P ))� Well Detail: See attached Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: 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 the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts UEKTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: MA 01845 State Zip Code General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Current Date Owner, pumped 2011 gallons 1500 n/a 04/25/13 Date of Inspection ❑ Yes ® No 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 (describe): t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17 Property Address Valerie Reading Owner _ Owner's Name information is required for every North Andover page. City/Town D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: MA 01845 State Zip Code General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Current Date Owner, pumped 2011 gallons 1500 n/a 04/25/13 Date of Inspection ❑ Yes ® No 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 (describe): t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 90 Spring Hill Road Property Address — Valerie Reading Owner Owner's Name information is required for every North Andover MA 01845 04/25/13 — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1986, 27 vears Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: 40' feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: n/a feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 18" feet ❑ Yes ® No ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: Sludge depth: ❑ Yes ❑ No t5ins • 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner Owner's Name information is required for every North Andover MA 01845 04/25/13 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 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 38" 2" 14" How were dimensions determined? Tape and sludge tool Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Baffel Worn, allowing solids carry over into box. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain).- Dimensions: explain): Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins • 11/10 Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments *M 90 Spring Hill Road Property Address Valerie Reading Owner Owner's Name information is required for every North Andover MA 01845 04/25/13 page. City/Town State Zip Code 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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other (explain): Dimensions Capacity: - - gallons Design Flow: gallons per day — Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: ---_ Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 15ins • 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner Owner's Name information is required for every North Andover page. City/Town D. System Information (cont.) nnA 01845 04/25/13 Zip Code Date of Inspection 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.): Box falling apart. Pump Chamber (locate on site plan).- Pumps lan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner Owner's Name required fo is North Andover MA 01845 04/25/13 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: - ❑ leaching galleries number: ® leaching trenches number, length: (2) 45' long,4' wide ❑ leaching fields number, dimensions: — - ❑ overflow cesspool number: - ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Both pipes full, and under hydraulic failure. This is due to age and outlet baffel deteriation. 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 construction Indication of groundwater inflow t5ins • 11/10 ❑ Yes ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Readinn Owner Owner's Name information is required for every North Andover page. City/Town D. System Information (cont.) R /I A 01845 Zip Code 04/25/13 Date of Inspection Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids _ Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc. ): t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading_ Owner's Name North Andover City/Town D. System Information (cont.) MA 01845 State Zip Code 04/25/13 Date of Inspection 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: ® hand -sketch in the area below ❑ drawing attached separately `- -Z 1.~r 2 zoz- _/S s ` t 1 1 i ii l L i t —t �t t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner Owner's Name information is North Andover required for every MA 01845 04/25/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 5' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record -1 ■ 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 USGS database - explain: You must describe how you established the high ground water elevation.- Dug levation:Dug hole with auger in low drop off area. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Spring Hill Road Property Address Valerie Reading Owner information is Owner's Name required for every North Andover MA _ 01845 04/25/13 page. City/Town 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 ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 11/10 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 F .. _:. .. _ . . �__ - .,_ _ .:.-:_ . _�_ �..� .�•.� V �9L12L2Q13 X58.58 -- 2100256 03/13/2013 10/30/2012-02/07/2013 04/12/2013-- " 90 SPRING HILL ROAD READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA iPREVIOUS BALANCE $54.78 01845 !PAYMENTS THROUGH 03/05/2013 $-54.78 'ADJUST. THROUGH 03/05/2013 $0.00 'INTEREST AS OF 04/12/2013 $0.00 i r?ET,=.l;l i;-;;S 'CR"tOi�!=0;� ;'OUB=' ?=CO;:DS BALANCE FORWARD $0-00 ! SEia.-.L_ R A D P.:GS USAGc i•:oCr .. j ;l J<.- YS j 1 j 136184648 232 ACTUAL 02/07/2013 13 too 1 `WATER USAGE 13 $49.40 j ADMINISTRATIVE FEE $9.18 j SE RiAL: PEADINGS USAGE 10B OF ! 1 j[D—Vi ous I;, - DAYS 136184648 219 ACTUAL10/30/2012 12 88� / `\✓� lj'� 136184648 207 ACTUAL 08/03/2012 18 93 TOTAL $58.58 36184648 189 ACTUAL 05/02/2012 15 86 i L -L E..TS S' :OULJ S= ?,L.> ;?0 ..amu•. S' =E7 C5 o I_ t TO C ..Lv.l' ?G Sc=, ,:ECF ^vRiJ, u2' c� WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 7,0" `'� u.rgw. - -r �.. SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 JV- BYPASS METER WATER RATE- ALL UNITS $5.55 ''C""'" F- gc#941 NoAndWtrSgis T4 P7 """AUTO' "5 -DIGIT 01845 READING, ROBERT & VALERIE 90 SPRING HILL RD NORTH ANDOVER MA 01845-4929 04167065322013000000000000021002560402100256000000005858000 READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 '36184648 219 ACTUAL 1013012012 12 88 PREVIOUS BALANCE $77-58 PAYMENTS THROUGH 12/06/2012 $-77-58 ADJUST. THROUGH 12/06/2012 $0.00 INTEREST AS OF 01/14/2013 $0.00 BALANCE FORWARD 1 $0.00 WATER USAGE IADMINISTRATIVE FEE Q WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9-24 BYPASS METER WATER RATE: ALL UNITS $5.55 qc#940NoAndWtrSglsT4 Pl* ..... AUTO -5 -DIGIT 01845 1 1 1111 - I I I I - I I - I I - I I I - I I I I I - - - I - I I I I I I I I I - I I I - I - I I - - I - - I I - - I I I I I I READING, ROBERT & VALERIE 90 SPRING HILL RD NORTH ANDOVER MA 01845-4929 12 $45.60 $9-18 TOTAL $54.78 0111412013 $54.78 -7- K' 04167065322013000000000000021D02560402100256000000005478000 36184648 207 ACTUAL 08/03/2012 18 93 36184648 189 ACTUAL 05/02/2012 15 86 �36184648 174 ACTUAL 02/06/2012 16 97 PREVIOUS BALANCE $77-58 PAYMENTS THROUGH 12/06/2012 $-77-58 ADJUST. THROUGH 12/06/2012 $0.00 INTEREST AS OF 01/14/2013 $0.00 BALANCE FORWARD 1 $0.00 WATER USAGE IADMINISTRATIVE FEE Q WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9-24 BYPASS METER WATER RATE: ALL UNITS $5.55 qc#940NoAndWtrSglsT4 Pl* ..... AUTO -5 -DIGIT 01845 1 1 1111 - I I I I - I I - I I - I I I - I I I I I - - - I - I I I I I I I I I - I I I - I - I I - - I - - I I - - I I I I I I READING, ROBERT & VALERIE 90 SPRING HILL RD NORTH ANDOVER MA 01845-4929 12 $45.60 $9-18 TOTAL $54.78 0111412013 $54.78 -7- K' 04167065322013000000000000021D02560402100256000000005478000 READING; ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 PREVIOUS BALANCE PAYMENTS THROUGH 09/17/2012 ADJUST. THROUGH 09/17/2012 INTEREST AS OF 10/26/2012 BALANCE FORWARD $66.18 $-66.18 $0.00 $0.00 $0-00 WATER USAGE 18 $68.40 ADMINISTRATIVE FEE $9.18 , ,A TOTAL $77.58 qc#931 NoAndWtrSgls T4 P1 •"•"AUTO••5-DIGIT 01845 11101/12 - $77.58 READ. _. ING, ROBERT & VALERIE - .._._.. 90 SPRING HILL RD NORTH ANDOVER MA 01845-4929 04167065022073000000000000021002560402100256000000007758005 �IJJ 36184648 207 ACTUAL 08/03/2012 18 93 i f 36184648 189 ACTUAL 05/02/2012 15 86 36184648 174 ACTUAL 02/06/2012 16 97 36184648 158 ACTUAL 11/01/2011 13 91 PREVIOUS BALANCE PAYMENTS THROUGH 09/17/2012 ADJUST. THROUGH 09/17/2012 INTEREST AS OF 10/26/2012 BALANCE FORWARD $66.18 $-66.18 $0.00 $0.00 $0-00 WATER USAGE 18 $68.40 ADMINISTRATIVE FEE $9.18 , ,A TOTAL $77.58 qc#931 NoAndWtrSgls T4 P1 •"•"AUTO••5-DIGIT 01845 11101/12 - $77.58 READ. _. ING, ROBERT & VALERIE - .._._.. 90 SPRING HILL RD NORTH ANDOVER MA 01845-4929 04167065022073000000000000021002560402100256000000007758005 _ NEW OFFICE HOURS nEa Town of North Andover Monday 8:00 - 4:30 _ Tues 8:00 - 6:00 120 Main Street Wed 8:00 - 4:30 North Andover, MA 01845 Thurs 8:00 - 4:30 :"(978) 688-9550 Fri 8:00 -12:00 2100256 06/20/2012 READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 Billing Information: (978)688-9550 PAYMENT ON OR BEFORE 07/20/2012 $66.18 ACCOUNT BILLING DATE 2100256 06/20/2012 SERVICE DATES DUE DATE _ 02/06/2012-05/02/2012 07/20/2012 ---- ---.. ----. ..._—_....—_.._--- Reading Information: _ SERVICE ADDRESS (978) 688-9570 - — 90 SPRING HILL ROAD TRANSACTIONS THIS PERIOD AMOUNT PREVIOUS BALANCE $69.98 PAYMENTS THROUGH 06/15/2012 ($69.98 ADJUSTMENTS THROUGH 06/15/2012 $0.00 RETAIN THIS PORTION FOR YOUR RECORDS INTEREST AS OF 07/20/2012 $0.00 MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE BALANCE FORWARD _— $0.00 SERIAL # READINGS USAGE NB OF CURRENT BILL DETAIL USAGE/UNIT_ AMOUNT ��e---_mate____...__ _.. _. _.__.._-. ___DAY..S---..:..- _.r ------_..--------=-i==-- ---- ------------- 36184648 189 Actual 05/02/2012 15 86 WATER USAGE 15 $57.00 ADMINISTRATIVE FEE $9.18 SERIAL # READINGS USAGE NB OF Previous Type Date DAYS 36184648 174 Actual 02/06/2012 16 97 Sub -Total $66.18 36184648 158 Actual 11/01/2011 13 91 TOTAL MESSAGES " NOTE * PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 Please note our office hours have SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 changed, effective 4/30. See above. BYPASS METER WATER RATE: ALL UNITS @ $5.55 Pay Online at — _ _ www.townofnorthandover.com Please return this portion with your payment by 0712012012 Town of North Andover 120 Main Street yy yy 416?06pp5 p32 North Andover, MA 01845 (978) 88-9550 Z01622-000001 If your address has changed, correct it below. READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 Any amount which is not paid by due date will be subject to interest charges of 14% Per Year Billing Information: NEW OFFICE HOURS (978) 688-9550 Monday 8:00 - 4:30 Reading Information: Tues 8:00 - 6:00 Wed 8-00 - 4:30 (978) 688-9570 Thurs 8:00 - 4:30 Fri 8:00 -12:00 ACCOUNT 1 BILLING DATE 2100256 06/20/2012 SERVICE ADDRESS 90 SPRING HILL ROAD PLEASE PAY ON • - BEFORE 07/20/2012 $66.18 JUNT PAIL 04167065322012000000000000021002560402100256000000006618000 Town of North Andover �r - 120 Main Street North Andover, MA 01845 ' (978) 688-9550 READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 OFFICE HOURS PAYMENT ON • - BEFORE •- subject to interest charges of 04/13/2012 04/13/2012 $69.98 Monday to Friday Billing Information: OFFICE HOURS SERIAL # READINGS USAGE NB OF 8:30am to 4:30pm ACCOUNT —� BILLING DATE 36184648 145 Actual 08!02/2011 24 92 2100256 i 03/14/2012 Billing Information: SERVICE DATES DUE DATE (978) 688-9550 11/01/2011-02/06/2012; 04/13/2012 Reading Information: SERVICE ADDRESS (978) 688-9570 j 90 SPRING HILL ROAD TRANSACTIONS THIS PERIODAMOUNT Pay Online at RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NB OF Current Type Date-- — DAYS 36184648 174 Actual 02106/2012 16 97 PREVIOUS BALANCE $58.58 PAYMENTS THROUGH 03/08/2012 ($58.58) ADJUSTMENTS THROUGH 03/08/2012 $0.00 INTEREST AS OF 04/13/2012 $0.00 _BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGEIUNIT AMOUNT WATER USAGE 16 $60.80 ADMINISTRATIVE FEE $9.18 v� J � subject to interest charges of 14% Per Year 120 Main Street 416706532 North Andover, MA 01845 Billing Information: OFFICE HOURS SERIAL # READINGS USAGE NB OF (978) 688-9550 _ Previous Type_ Date _ DAYS t (� 36184648 158 Actual 11/01/2011 13 91 Sub -Total $6g_gg 36184648 145 Actual 08!02/2011 24 92 TOTAL • • ; • 2100256 03/14/2012 SERVICE ADDRESS MESSAGES 90 SPRING HIL! ROAD NOTE ` PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 READING, ROBERT & VALERIE SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 Pay Online at BYPASS METER WATER RATE: ALL UNITS @ $5.55 www.townofnorthandover.com . Please return this portion with your payment by 0411312012 Any amount which is not paid by due date will be Town of North Andover subject to interest charges of 14% Per Year 120 Main Street 416706532 North Andover, MA 01845 Billing Information: OFFICE HOURS (978) 688-9550 1 18111 �10l11 fl X1111 I�BII flfl 1111 J110911118 II1I IE01 (978) 688-9550 Reading Information: Monday to Friday 201612-000001 (978) 688-9570 8:30am to 4:30pm ACCOUNT BILLING DATE 2100256 03/14/2012 SERVICE ADDRESS If your address has changed, correct it below. 90 SPRING HIL! ROAD PLEASE PAY ON •-- •- READING, ROBERT & VALERIE 04/13/2012 $69,gg 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 AMOUNT 04167065322012000000000000021002560402100256000000006998001 =:`V`. • Town of North Andover 120 Main Street North Andover, MA 01845 (978) 688-9550 READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 OFFICE HOURS PAYMENT ON • ' BEFORE •- $107.00 01/14/2012 01/14/2012 $58.58 Monday to Friday $0.00 INTEREST AS OF 01/14/2012 $0.00 BALANCE FORWARD 8:30am to 4:30pm ACCOUNT BILLING DATE WATER USAGE 13 2100256 12/15/2011 Billing Information: SERVICE DATES DUE DATE (978) 688-9550 ; 08/02/2011-11 /01 /2011 j 01/14/2012 $58.58 .� TOTAL , Reading Information:SERVICE ADDRESS (978) 688-9570 90 SPRING HILL ROAD RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NB OF Current Type _ Date DAYS_ 36184648 158 Actual 11/01/2011 13 91 SERIAL # READINGS USAGE NB OF Previous Type Date DAYS 36184648 145 Actual 08/02/2011 24 92 36184648 121 Actual 05/02/2011 15 87 j MESSAGES TRANSACTIONS THIS PERIOD AMOUNT PREVIOUS BALANCE $107.00 PAYMENTS THROUGH 12/08/2011 ($107.00) ADJUSTMENTS THROUGH 12/08/2011 $0.00 INTEREST AS OF 01/14/2012 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGE/UNIT AMOUNT WATER USAGE 13 $49.40 ADMINISTRATIVE FEE $9.18 /j lVV Sub -Total $58.58 .� TOTAL , " NOTE * PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 j SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 iBYPASS METER WATER RATE: ALL UNITS @ $5.55 Please return this portion with your payment by 0111412012 Town of North Andover 120 Main Street 416706532 North Andover, MA 01845 (978) 688-9550 119011191991 11011 111111111111111 911t1911U 111191111 If91 Z01612-000001 If your address has changed, correct it below. READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 Pay Online at www.townofnorthandover.com Any amount which is not paid by due date will be subject to interest charges of 14% Per Year Billing Information: (978)688-9550 Reading Information: (978) 688-9570 OFFICE HOURS Monday to Friday 8:30am to 4:30pm ACCOUNT BILLING DATE 2100256 12/15/2011 SERVICE ADDRESS 90 SPRING HILL ROAD PLEASE PAY ON 01/14/2012 OR BEFORE $58.58 04167065522012000000000000021002560402100256000000005858005 own of NL 120 Main Street North Andover, MA 6 (978) 688-9550 READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 ndover OFFICE HOURS PAYMENT ON • - BEFORE 10/14/2011 j $107.00 Monday to Friday 8:30am to 4:30pm ACCOUNTBILLING DATE 2100256 09/14/2011 Billing Information: SERVICE DATES DUE DATE (978)688-9550 1 05/02/2011-08/02/201111 10/14/2011 Reading Information: SERVICE ADDRESS �s7a) sss-ss7o 90 SPRING HILL ROAD TRANSACTIONS THIS PERIOD AMOUNT RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NB OF Current Type Date DAYS 36184546 145 Actual 08/02/20'i 1 24 92 SERIAL # READINGS Previous Type Date 36184648 121 Actual 05/02/2011 36184648 106 Actual 02/04/2011 MESSAGES USAGE NB OF _ DAYS 15 87 20 95 PREVIOUS BALANCE $66.18 PAYMENTS THROUGH 09/14/2011 ($66.18) ADJUSTMENTS THROUGH 09/14/2011 $0.00 INTEREST AS OF 10/14/2011 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGE/UNIT AMOUNT WATER USAGE ADMINISTRATIVE FEE I, J 24 $97.82 $9.18 V Sub -Total $107.00 `t TOTAL NOTE ' PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 Pay Online at :BYPASS METER WATER RATE: ALL UNITS @ $5.55 www•townofnorthandover.com 1 Please return this portion with your payment by 1011412011 Any amount which is not paid by due date will be .r, Town of North Andover subject to interest charges of 14% Per Year 120 Main Street 416706532 BillingInformation: '., North Andover, MA 01845 OFFICE HOURS (978) 688-9550 116IIIIVIIIIITILIIVIIIVIIIVIIIVIIIIIID111IN (978) 688-9550 Reading Information: Monday to Friday Z01612-000001 19781688-957A s�J If your address has changed, correct it below. READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 8.30am to 4:30pm ACCOUNT BILLING DATE 2100256 09/14/2011 SERVICE ADDRESS 90 SPRING HILL ROAD 'PLEASE PAY ON OR BEFORE 10/14/2011 $107.00 AMOUNT PAID 04167065322012000000000000021002560402200256000000010700001 own of North Andover 120 Main Street North Andover, MA 01845 (978) 688-9550 READING, ROBERT & VALERIE, i 90 SPRING HILL ROAD ,�� 'a�� Reading Information: NORTH ANDOVER, MA ; ; „w 1 ,1' ` �,�� (978) 688-9570 01845 V OFFICE HOURS PAYMENT ON • ' BEFORE 07/13/2011 •- 07/13/2011 $66.18 Monday to Friday 8:30afn to 4:30pm ACCOUNT BILLING DATE 2100256 06/13/2011 Billing Information: (978)688-9550 RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NB OF 11 Current Type Date DAYS 36184648 121 Actual 05/02/2011 15 87 SERIAL # READINGS USAGE NB OF Previous Type Date DAYS 36184648 106 Actual 02/04/2011 20 95 36184648 86 Actual 11/01/2010 19 90 MESSAGES SERVICE DATES DUE DATE 02/04/2011-05/02/2011 i 07/13/2011 SERVICE ADDRESS 90 SPRING HILL ROAD Sub -Total TOTAL $66.18 * NOTE * PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 BYPASS METER WATER RATE: ALL UNITS @ $5.55 Please return this portion with your payment by 0711312011 Any amount which is not paid by due date Will be subject to interest charges of w Town of North Andover 14% Per Year 120 Main Street 416706532 Billing Information: OFFICE HOURS North Andover, ; (9 8) 88-9550 MA 01845 lQlll Til IIT �IIII l��Il 11111 Til illi llll� ll�l l� Reading Infor78) mation: Monday to Friday 201591-000001 (978) 688-9570 8:30am to 4:30pm If your address has changed, correct it below READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 ACCOUNT BILLING DATE 2100256 06/13/2011 SERVICE ADDRESS 90 SPRING HILL ROAD PLEASE PAY ON OR BEFORE 07/13/2011 $66.18 JUNT PAIL 041,6?06552201,1,000000000000021,0025604021x0025600000000661,8003 TRANSACTIONS THIS PERIOD AMOUNT PREVIOUS BALANCE PAYMENTS THROUGH 06/13/2011 ADJUSTMENTS THROUGH 06/13/2011 INTEREST AS OF 07/13/2011 BALANCE FORWARD $85.18 ($85.18) $0.00 $0.00 $0.00 CURRENT BILL DETAIL USAGE/UNIT AMOUNT WATER USAGE 15 ADMINISTRATIVE FEE $57.00 $9.18 Sub -Total TOTAL $66.18 * NOTE * PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 BYPASS METER WATER RATE: ALL UNITS @ $5.55 Please return this portion with your payment by 0711312011 Any amount which is not paid by due date Will be subject to interest charges of w Town of North Andover 14% Per Year 120 Main Street 416706532 Billing Information: OFFICE HOURS North Andover, ; (9 8) 88-9550 MA 01845 lQlll Til IIT �IIII l��Il 11111 Til illi llll� ll�l l� Reading Infor78) mation: Monday to Friday 201591-000001 (978) 688-9570 8:30am to 4:30pm If your address has changed, correct it below READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 ACCOUNT BILLING DATE 2100256 06/13/2011 SERVICE ADDRESS 90 SPRING HILL ROAD PLEASE PAY ON OR BEFORE 07/13/2011 $66.18 JUNT PAIL 041,6?06552201,1,000000000000021,0025604021x0025600000000661,8003 .own of North Andover 120 Main Street i North Andover, MA 01845 A " (978) 688-9550 READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 OFFICE HOURS PAYMENT ON • - BEFORE M d 04/15/2011 $85.18 W" ay to Fnday- AMOUNT 8:30am to 4:30pm ACCOUNT BILLING DATE — PAYMENTS THROUGH 03/15/2011 2100256 03/15/2011 Billing Information: -- ------------------- --......------- S-ERVICE----DATES DUE DATE (978) 688-9550 11/01/2010-02/04/2011; 04/15/2011 Reading Information: SERVICE ADDRESS (978) 688-9570 90 SPRING HILL ROAD RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGSUSAGE NB OF Current Type Date DAYS 36184648 106 Actual 02/04/2011 20 95 SERIAL # READINGS USAGE NB OF Previous Type Date DAYS 36184648 86 Actual 11/01/2010 19 90 36184648 67 Actual 08/03/2010 31 91 MESSAGES TRANSACTIONS THIS PERIOD AMOUNT PREVIOUS BALANCE $81.38 PAYMENTS THROUGH 03/15/2011 ($81.38) ADJUSTMENTS THROUGH 03/15/2011 $0.00 INTEREST AS OF 04/15/2011 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGE/UNIT AMOUNT 'JVATER USAGE 20 $76.00 ADMINISTRATIVE FEE $9.18 Sub -Total $85.18 �; TOTAL , ; " NOTE ` PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX 184, MEDFORD• MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 ;BYPASS METER WATER RATE: ALL UNITS @ $5.55 Please return this portion with your payment by 0411512091 Any amount which is not paid by due date will be subject to interest charges of Town of North Andover 14% Per Year, 120 Main Street 4 Z 6? 0 6 532 Billing Information: OFFICE HOURS North Andover, MA 01845 pg I p g pBqg g 1j+ rt (97s) 688-9550 (978) 688-9550 I ` @III I��II f �II`) i{ IIIIC I�Q� �Y�� Reading Information: Monday to Friday ` Z01588-000001 (978) 688-9570 8:30am to 4:30pm If your address has changed, correct it below READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 ACCOUNT BILLING DATE 2100256 03/15/2011 SERVICE ADDRESS 90 SPRING HILL ROAD PLEASE PAY ON OR BEFORE 04/15/2011 $85.18 AMOUNT PAID 0416706532201,1000000000000021,002560402100256000000008518008 own of North Andover 120 Main Street North Andover, MA 01845 (978) 688-9550 READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 OFFICE HOURS PAYMENT ON • - BEFORE 01/12/2011 $81.38 Monday to Friday 8:30am to 4:30pm I ACCOUNT j BILLING DATE 2100256! 12/13/2010 7 Billing Information: j SERVICE DATES i DUE DATE (978) 688-9550 :,08/0312010-11/01/20101 01 /12/2011 Reading Information: SERVICE ADDRESS (978) 688-9570 ; 90 SPRING HILL ROAD TRANSACTIONS THIS PERIOD AMOUNT The Town is still experiencing a Water Drought. Call the Water Treatment Plant at 978-688-9574 for conservation kits information.. RETAIN THIS PORTION FOR YOUR RECORDS MOVING? PLEASE CALL (978) 688-9570 IN ADVANCE SERIAL # READINGS USAGE NB OF Current Type Date DAYS 36184648 86 Actual 11/01/2010 19 9p SERIAL # READINGS USAGE NB OF Previous Type Date DAYS 36184648 67 Actual 08/03/2010 31 91 36184648 36 Actual 05/04/2010 18 92 6AC@cA i PREVIOUS BALANCE$146.23 PAYMENTS THROUGH 12/13/2010 ($146.23) ADJUSTMENTS THROUGH 12/13/2010 $0.00 INTEREST AS OF 01/12/2011 $0.00 BALANCE FORWARD $0.00 CURRENT BILL DETAIL USAGE/UNIT AMOUNT WATER USAGE 19 $72.20 ADMINISTRATIVE FEE \ i $9.18 i J l ^i t`J� J `��)' Sub -Total $81.38 TOTAL ; NULE PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O_ BOX 184, MEDFORD, MA 02155 WATER RATE: FIRST 20 UNITS @ $3.80 OVER 20 UNITS @ $5.55 SEWER RATE: FIRST 20 UNITS @ $5.83 OVER 20 UNITS @ $8.22 ;BYPASS METER WATER RATE: ALL UNITS @ $5.55 Please return this portion with your payment by 0111212011 _ ' •gym ; ,: Town of North Andover 120 Main Street EE 1t 41L706532 ff North Andover, MA 01845 t1�II� ����� ��� ����� ���1� �I� 111111111 IN (978) 688-9550 Z01584-000001 If your address has changed, correct it below READING, ROBERT & VALERIE 90 SPRING HILL ROAD NORTH ANDOVER, MA 01845 Any amount which is not paid by due date will be subject to interest charges of 14% Per Year Billing Information: OFFICE HOURS (978)688-9550 Reading Information: Monday to Friday (978) 688-9570 8:30am to 4:30pm ACCOUNT BILLING DATE 2100256 12/13/2010 SERVICE ADDRESS 90 SPRING HILL ROAD PLETSE PAY ON OR BEFORE 01/12/2011 $81.38 JUNT PAIS 04167065322011000000000000021002560402100256000000008138008 cZ as /107 4 E/ !/V o ? �o I oiiz zoz• L�f /4 /Soo f�,y A --