HomeMy WebLinkAboutTitle V Inspection Report - 25 HOLLOW TREE LANE 7/31/2018 Commonwealth of Massachusetts
---------- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
26 Hollow Tree Lane
----------------- .......
Property Address
Larry�Fixler
Owner Owner's Name
information is
req i!red for every North Andover--.,--,--,.- MA 01845 7-25-2018
pa'e. City/Town 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 form.
RECEIVE,�'-D
Important:When
fill[I g out forms A. General Information 3�3 I1. 18
on use
computer, t'qjL)OVER
use only the tab NOR�
1 1 Inspector: fowsc)r- '� I ��NT
key to move your 00)ARfM,�
cur,to
-do not Neil James Bateson
use,the return
key� Name of Inspector ------------
Bateson Enterprises Inc.
——-------------
nab Company Name
111 Argilla Road
Company Address
Andover MA 01810
CityfTown State Zip Code
978-475-4786 SI-15
Telephone 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
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:
n Passes Conditionally Passes Ej Fails
[-]L Ne s Further Evaluation by the Local Approving Authority
7-25-2018
t
-----------
S1
Insp "
I t Si, 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 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 DER 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
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t6lns.doo-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
Commohwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Larry Fixler
Owoer Owner's Name
information is
req ired for every North Andover MA 01845 7-25-2018
p a e, 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:
Z 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.
n Y 0 N El ND (Explain below):
t6i4doo-rev.6/16 Title 5 Officlar Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Larry Fixier
Ow; er Owners Name
ink rmation is -25-2018
req fired
red for every North Andover MA 01845 7
'Siaie
pa a. City/Town -Zip Code Date of Inspection
B. Certification (cont.)
F] Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
F-1 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):
n broken pipe(s)are replaced n Y E N E] ND(Explain below):
n obstruction is removed E] Y E N 0 ND(Explain below):
n distribution box is leveled or replaced ❑ Y E N El 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 F
-1 Y ® N n ND (Explain below):
❑ obstruction is removed n Y Z N E] 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:
F-1 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.doc rev,6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Larry Fixler
owner Owner's Name
information is
req6ired for every North Andover MA 01845 7-25-2018
P+. CityrFown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fall unless the Boar'd 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:
F-1 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.
F] The system has a septic tank and SAS and the SAS is within 50 feet of a private water,
supply well.
F-1 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:
Outlet tee in septic tank, outlet pipe to d-box, &d-box needs to be replaced. Riser needs to be
installed on d-box..
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
El due to an overloaded or clogged SAS or cesspool'
El 0 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 %day flow
t5i rs.doc-rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
----- - -------
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
26 Hollow Tree Lane
Property Address
Larry Fixier ..................
Ow, Owner's Name
fXer,
in rm tion is
req Ire
for every North Andover MA 01845 7-25-2018
pa e. Cityrrown 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.
F1 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
El E Any portion of a cesspool or privy is within a Zone 1 of a public well.
E-1 E 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-
1 0,000g pd.
The system falls. I have determined that one or more of the above failure
E-1
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
E-1 El the system is within 400 feet of a surface drinking water supply
El El the system is within 200 feet of a tributary to a surface drinking water supply
El the system is located in a nitrogen sensitive area(Interim Wellhead Protection
El
Area-IWPA)or a mapped Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
15ins.doc-rev.6116 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
25 Hollow Tree Lane
Property Address
Larry Fixler
Ow'
0w er Owner's Name
info
ation is
req fired for every North-Andover MA 01845 7-25-2018
pa e. b7ftyrrown 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
0 FJ 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?
Z ❑ 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
F Z this inspection?
E] Z Were as built plans of the system obtained and examined? (if they were not
available note as N/A)
Z El Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
Z 0 Were all system components, excluding the SAS, located on site?
Z El 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
E El 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
Z 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):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 400
t5fi,mdoo-ray.0110 Ti0a 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Larry F�ixler
Owper Owners Name
information is
req tied for every North Andover MA 01845 7-25-2018 ---------
pa e. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? Z Yes ❑ No
Is laundry on a separate sewage system? (include laundry system inspection F] Yes 0 No
information in this report.)
Laundry system inspected? n Yes El No
Seasonal use? ❑ Yes No
Water meter readings, if available(last 2 years usage(gpd)): Yes —------
Detail:
Sump pump? F-1 Yes 0 No
Current
Last date of occupancy: Date
Commerciallindustrial 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? F1 Yes 0 No
Industrial waste holding tank present? n Yes F1 Na
Non-sanitary waste discharged to the Title 5 system? El Yes Ej No
Water meter readings, if available:
16j�r*.doo-rev.6/16 Title 5 Official Inspection Form:Subsurf`8CO Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Larry Fixier
Owner Owners Name
information is
retired for every North Andover MA 01845 7-25-2018
pa e. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: rate
Other(describe below):
----------------------
--------------
General Information
Pumping Records:
Source of information: Pumped 2017, owner—
Was system pumped as part of the inspection? Yes ❑ No
If yes, volume pumped: 1000gallons
How was quantity pumped determined? Measure tank
Reason for pumping: Inspect tank& baffles
Type of System:
Septic tank, distribution box, soil absorption system
❑ Single cesspool
F1 Overflow cesspool
❑ Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
El 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):
15Title 6 Official inspection Form:Subsurface SeWagO Disposal System-Page 6 of 17
03,doc-rev.6116
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Lar!yflxler
Ower Owner"s Name
information is North Andover MA 01845 7-25-2018
required for every
page. CityTrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
No as built plan, house built 1977, owner
Were sewage odors detected when arriving at the site? F] Yes E No
Building Sewer(locate on site plan):
Depth below grade: f1.9 eet
Material of construction:
cast iron [g 40 PVC R other(explain):
Distance from private water supply well or suction line:
Comments (on condition of joints, venting, evidence of leakage, etc.):
4" Cast Iron through wall, 3" PVC in house, no leaks visible
Septic Tank(locate on site plan):
0.9
Depth below grade: feet
Material of construction:
Z concrete El metal ❑ fiberglass ❑ polyethylene El other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) F1 Yes El No
7'x 5'x 4'
Dimensions:
211
Sludge depth:
15irls.doc-rev.6116 Title 5 Official Inspection Form:Subsurface sewage Disposal system-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
-------------
Property Address
Larry Fixier
------
Owner Nm
information is
req�lired for every North Andover MA 01845 7-25-2018
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 1411
211
Scum thickness
611
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle 1411
How were dimensions determined? Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Inlet baffle ok. Outlet baffle partially corroded, needs to be replaced. Depth of liquid at outlet invert .
No evidence of leakage.
Grease Trap(locate on site plan):
Depth below grade:
Material of construction:
El concrete n metal R fiberglass F] polyethylene E] other(e?(plain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: flats
i5ins,doc-rev,6/16 Title 5 Official Inspection Form:Subsurface Sewage 01sposat System-Page W of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
I Larry Fixler
Ow er Owners Name
inf rmation is
req !red for every North Andover --- MA 91845 7-25-2018
pa e. Cilyfrown 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:
0 concrete El metal El fiberglass El polyethylene El other(explain):
Dimensions: ------
Capacity:
gallons
Design Flow: gallons per day
Alarm present: F-1 Yes M No
Alarm level: Alarm in working order: F] Yes E] No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? El Yes ❑ No
t5l s.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Larry Fixler
Ow er Owner's Name
information is
req ired for every North AndMA 01845 7-25-2018
p a e City/Town 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 -1/2"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box badly corroded , needs to be replaced. Evidence of leakage &carryover. Replaced d-box
cover.
----------
Pump Chamber(locate on site plan):
Pumps in working order: D Yes ❑ No*
Alarms in working order: F Yes F No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
--—-------
If pumps or alarms are not in working order, system is a conditional pass.
Soll,Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
'Sins.doc rev.6116 Tit19 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
R 5
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Larry Fixi er —- —----------
Owper Owner's Name
information is
req61red for every North Andover ------------ MA 01845 7-25-2018
P+. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
El leaching pits number: -—------------
r-1 leaching chambers number: --------------
E-1 leaching galleries number:
❑ leaching trenches number, length:
z leaching fields number, dimensions: 20'x 45'
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc,):
Soil ok. Vegetaion ok. No sign of ponding to surface.
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 El Yes R No
t5ins.doo-rev.6116 Title 6 Official inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
-- --------------
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Larry Fixler
Owner Owners Name
Information
rmation is -25-2018
required for every North Andover MA 01845 7
pa�e. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
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.):
W s.doc-rev.6116 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
j
Commonwealth of Massachusetts
Title 5 Official Inspection Form
IT
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
........ 25 Hollow Tree Lane
Property Address
Larry_fixlqr -------------
Owner Owners Name
infmation is North Andover MA 01845 7-25-2018
req1trired for every
pa a. Cityrrown State Zip Code 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:
0 hand-sketch in the area below
El drawing attached separately
er
cr,
j,
15
SO
'P 314
o
JA-729
ISI
15ins,docrev. Title 5 Offirial Inspection Form:Subsurface Sewage Disposal System Page 15 of 17
-
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Larry i=ixler
..........
Owner Owners Name
inflirmation is MA 01845 7-25-2018
required for every North Andover
pa e. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
[0 Check Slope
Z Surface water
Z Check cellar
Z Shallow wells
Estimated depth to high ground water: >4
feet
Please indicate all methods used to determine the high ground water elevation:
z Obtained from system design plans on record
If checked, date of design plan reviewed. 4-2-1982
Date
❑
Observed site(abutting property/observation hole within 150 feet of SAS)
z Checked with local Board of Health -explain:
Design plan
F1 Checked with local excavators, installers-(attach documentation)
El Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Test pit data on design plan
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5iis.doo-roy.6/16
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page'16 of 17
I r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
25 Hollow Tree Lane
Property Address
Larry ffLixler ------
OY)ner Owner's Name
inf(irmation is
req,uired for every North AndMA 01845 7-25-2018
page. CityfTown State Zip Code Date of Inspection
E. Report Completeness Checklist
[I 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
t5i ps,doc-rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal system-Page 17 of 17
Town of North Andover' ----
Tax Map # 210-104.A-0084-0000.0
Parcel Id 16311
25 HOLLOW TREE LANE
FIXLER, JOAN & LARRY
25 HOLLOW TREE LANE
N. ANDOVER, MA
01845---..---.-
Class 101 Single Family Property Type 1 Residential
Zon42 1 Residential Zoning3 I Residential
Size Total I Acres
FY 2018
UB Mailinq Index
Name ddress Type Loan Number Active/Inact. From Until
FIXLER,JOAN&LARRY Payor
25 HOLLOW TREE LANE
N.ANDOVER, MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/inactive
Bldg Id. 18013.0-25 HOLLOW TREE LANE Last Billing Date 4/10/2018
3180042 03 Cycle 03 Active
i
UB IServices Maint.
Acco�nt Na. 3180042
Service Code Rate Charge Multi plier/Users
MISC14EE ADMIN FEE 0.63518 7.82 1/
WTR't,�TER 01 ALL METER SIZE 60.80 /1
UB Meter Maintenance
Accounit No. 3180042
Serial
Account
Status Location Brand Type Size YTD Cons
45505 22 a Active 00 HH b Badger w Water 0.630.63 283
D to Reading Code Consumption Posted Date Variance
12/2018 314 a Actual 23 39%
312/2018 291 a Actual 16 4/23/2018 -29%
12/13/2017 275 a Actual 23 1/25/2018 -50%
13/2017 252 a Actual 47 10/18/2017 138%
61112/2017 205 a Actual 20 7/25/2017 17%
31(10/2017 185 a Actual 16 4/1212017 -41%
12/12/2016 169 a Actual 28 1/23/2017 -70%
9/12/2016 141 a Actual 89 10/24/2016 121%
17/2016 52 a Actual 44 8/2/2016 172%
314/2016 8 a Actual 8 4/22/2016 -61%
1r,27/2016 0 n New Meter 0 4/2212016 -100%
17/2016 1205 r Replacement 9 4/2212016 -53%
91412015 1196 a Actual 41 1/20/2016 -56%
112015 1155 a Actual 92 10/16/2015 55%
6/11/2015 1063 a Actual 56 7/2412015 254%
318/2015 1008 a Actual 17 4/28/2015 -49%
11/15/2014 991 a Actual 32 1/15/2015 -69%
91,16/2014 959 a Actual 109 10115/2014 204%
61,12/2014 850 a Actual 34 7/16/2014 110%
31j13/2014 816 a Actual 16 4/11/2014 -10%
1T13/2013 800 a Actual 18 1/17/2014 -10%
-14%
9�13/2013 782 a Actual 20 10115/2013
30/2013
� 412013 762 a Actual 22 7/24/2013 38%
740 a Actual 18 4/22/2013 -7%
13/2012 722 aActual 17 1/9/2013 3%
9/2012 705 a Actual 18 10/15/2012 -3%
618/2012 687 a Actual 18 7116/2012 15%
320/2012 669 a Actual 16 4/14/2012 -26%
1 ?/19/2011 653 a Actual 22 1/17/2012 1%
s.
Commonwealth of Massachusefts
UWTowm of .
System Pumping.Record
Form 4
DEP has provided this form*foruse-by local Boards of-Health.Other forms may'be'used,but the
Information'must be substantiaffy the same as that provided here. Before using.this form,check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility. Information
1. System Location:&Rightk6nt s Left/Right rear of house, Left/right side of house, Left
Right side of building, Left/Right front of buildir g, Left/Right rear of building, Under deck
Address
Cityfrown state Zip Code
2, System Owner.
Name' ,
Address of different from location)
CitylTown � state• .� ��-•t•� "-` Zlp Code
t Telephone Number �?
.B. Pumping Record
1. Date of Pumping2. Quantity Pumped:
Date Gallons
3. Type-of s stem:
yp y• ❑ Cesspool(s) eptic Tank Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes o If yes,was it cleaned? ❑- Yes ❑ No,
' 5. Condi o of System•
6: System Pumped By:
Neil.Bateson F5821
Name Vehicle License Number
_Bateson Enterprises Inc'
Company
7. Locatiowhere cantsntsrwere disposed:
S Lowell Waste Water
sign a 4-HaularU Date
t5formCdac-06103 system Pumping Record•Page'i of 1
8 16 11)
• Town of North Andover
HEALTH DEPARTMENT
CHECK 4: DATE: -,3
LOCATION:
H/O NAME:
CONTRACTOR NAME:
Type of Permit or License: (Check box)
0 Animal $
• Body Art Establishment
• Body Art Practitioner
0 Dumpster $
0 Food Service- $
0 Funeral Directors
0 Massage Establishment
0 Massage Practice
• Offal(Septic)Hauler
• Recreational Camp
0 Sun tanning $
• Swimming Pool $_
• Tobacco $
El Trash/Solid Waste Hauler $
0 Well Construction $
SEPUCtem�,.
_5�s
• Septic-Soil Testing $
• Septic-.Design Approval $
0 Septic Disposal Works Construction(DW0 $
0 Septic Disposal Works Installers(DWI) $
0 Title 5 Inspector $
",ol)
Title 5 Report Ji4,J
13 Other. (Itidicate)-
AeaIth Agent Initials
White-Applicant Yellow-Health Pink-Treasurer ,