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HomeMy WebLinkAboutTitle V Inspection Report - 337 PLEASANT STREET 8/15/2018 Commonwealth of Massachusetts RECEIVED Title 5 Official Inspection Form tqJ(1 1 �J ?0 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1'oo OF 337 Pleasant StreetJAEALM Property Address Alan Freedman Owner Owners Name information Is North Andover MA 01845 7-27-2018 required for every page. 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. Important:When A. Inspector Information filling out forms on the computer, use only the tab Neil James Bateson ------—-------- key to move your Name of Inspector cursor-do not Bateson_���nc. ------- ...... use the return Company Name key. 111 Arc 00---h jilla Road vs—t-A Company Address AndoverMA 01810 City[rown State Zip Code rerun 978-475-4786 SI-15 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 6 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1 F] Passes 2. E Conditionally Passes 3. El Needs Further Evaluation by the Local Approving Authority 4. El a 7-27-2018 Inspec or ature 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 DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: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. t5insp,doe-rev,712612018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 1 of 16 Commonwealth of Massachusetts ; 0- Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 337 Pleasant Street ------- Property Address Alan Freedman Owner Owners Name information is North Andover MA 01845 7-27-2018 every required for eve page. cityrrown State Zip Code [�a—te—of­Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: El 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: ---------- 2) 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 cl� Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate o Compliance indicating that the tank is less than 20 years old is available. 1 D Y Z N F] ND (Explain below): t5lnsp.doe-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman Owner Owner's Name information is required for every North Andover MA 01845 7-27-2018----------- page, CityfFown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational, System will pass with Board of Health approva I if pumps/alarms are repaired. ❑ 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 n Y E N F-1 ND (Explain below): El obstruction is removed F1 Y 0 N F ND (Explain below): ❑ distribution box is leveled or replaced El Y 0 N 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 El Y [A N Ej ND (Explain below): obstruction is removed nY 0 N n ND (Explain below): —------------ ------------ —-—-------- 3) Further Evaluation is Required by the Board of Health: [I 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. a. 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 hea,ith, safety and the environment: t5insp.doc-rev.7/26/2018 Tulle 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman Owner Owner's-Name information is North Andover MA 01845 7-27-2018 required for every CI&yifo­wn - State Zip Code Date of Inspection page. C. Inspection Summary (cont.) El Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. 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. n 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. c. Other: Outlet tee in septic tank&d-box needs to be replaced. Riser needs to be installed on d-box. ----------- 4) 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 El 2 clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface watel rs due to an overloaded or clogged SAS or cesspool 15insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 I 1^ Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman -- Owner Owner's Name information is North Andover MA 01845 7-27-2018 required for every State Zip Code Date of Inspection page. CityTrown C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded El 0 or clogged SAS or cesspool 0 Liquid depth in cesspool is less than 6" below invert or available volume is less F1 than Y2 day flow Required pumping more than 4 times in the last year NOT due to clogged or El 0 obstructed pipe(s). Number of times pumped: El 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. E] ID 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 water supply) F1 E well. ❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. El Z 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 6 pprr, provided that no other failure criteria are triggered.A copy of the analy 3is and chain of custody must be attached to this form.] M The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. EJ 0 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. 6) 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 CA. Yes No El 0 the system is within 400 feet of a surface drinking water supply El D 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 Protqctl 'on Area—IWPA) or a mapped Zone 11 of a public water supply well 15insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street -———-----------Property Address Alan Freedman Owner Owner's Name information is North Andover MA 01845 7727-2018 required for every State Zip Code Date of Inspection page. Cityrrown C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No Pumping information was provided by the owner, occupant, or Board of Health El 0 Were any of the system components pumped out in the previous two weeks? E El Has the system received normal flows in the previous two week period? El Z Have large volumes of water been introduced to the system recently or as part of this inspection? El 2 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 tan 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 system,s? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: E E] 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)] t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 16 � Commonwealth of Massachusetts ------- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman Owner Owners Name information is 01845 7-27-2018 mquimd�xevery North Andover —� page. City '~~' State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): -- Number of bedrooms (actual): DESIGN flow based on31OCMR 15,2D3 (for example: 11OQodx#ofbed[oomn): ���----�-- ueecnpnmn: i ------------- Number of current residents: Does residence have a garbage grinderl n Yes No Does residence have a water treatment unit? n Yes No If yes, discharges to: Is laundry on a separate sewage system? (include laundry system inspection F] Yes Z No information in this report.) Laundry system inspected? Yes n No Seasonaluse? Yes 0 No Yes Water meter readings, if available (last 2 years usage(gpd)): � Sump pump? n 'e" Z No | / Last date mfoccupancy: Current Date| t5lnsp.doG rev.712612018 Title 6 Official Inspection Form�Subsurface Sewage Disposal System-Page 7 of 18 | Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address rt Alan Freedman Owner Owner's Name information is North Andover MA 01845 7-27-2018 required for every state Zip Code Date of Inspection page. D. System Information (cont.) 2. 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? F1 Yes F1 No Water treatment unit present? F1 Yes El No If yes, discharges to: Industrial waste holding tank present? n Yes El No Non-sanitary waste discharged to the Title 5 system? El Yes El No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Pumped three years ago, owner Source of information: Was system pumped as part of the inspection? Yes ❑ No If yes, volume pumped: 1500gallons Now was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees t51nsp.doo-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman Owner Owner's Name information is required for every North Andover MA 01845 7-27-2018 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 37 years old, 6-9-1981, as built plan Were sewage odors detected when arriving at the site? El Yes 0 No 5. Building Sewer(locate on site plan): 1.6 Depth below grade: feet Material of construction: cast iron [g 40 PVC n other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" Cast Iron through wall to septic tank, 3" PVC in house, no leaks visible. ------------- ----------- t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman Owner Owner's Name information is North Andover MA 01845 7-27-2018 required for every page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 0.6 Depth below grade: feet——------- Material of construction: concrete El metal El fiberglass El Polyethylene El other(expla in) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) El Yes ❑ No 10'x 5'x 4' Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3011 ....... 311 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 12 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 tee ok. Outlet tee corroded at liquid level. Needs to be replaced. Depth of liquid at outlet invert. No evidence of leakage. Pumped septic tank. ------------ t5insp.doe rev.7/2612018 Title 5 Offictal Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street ------------ Oropey Address Alan Freedman Owner Owners Name information is North Andover MA 01845 7-27-2018 _ required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: Te-et Material of construction: concrete ❑ metal El fiberglass ❑ polyethylene E]other(explain): Dimensions: -------- Scum thickness Distance from top of scum to top of outlet tee or baffle ------ Distance -------- Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: -da-te ­---------­ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): ...... Depth below grade: ...... Material of construction: F] concrete F1 metal El fiberglass El polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp,doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts 711 lrTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman ........... Owner Owners Name information is North AndMA 01845 7-27-2018 required for every . rt over page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: El Yes F] No Alarm level: Alarm in working order: El Yes ❑ No Date of last pumping: Comments (condition of alarm and float switches, etc.): ... —---------- ............ ----------- Attach copy of current pumping contract(required). Is copy attached? R Yes El No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box has bad corrosion, needs to be replaced. Evidence of carryover. Evidence of leakage. .....------ ------------ t5insp,doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachuseft Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman .._......._—r Owner Owner's Name information i's7-27-2018 North Andover MA 01845 required for every --- page. City/Town '--­ State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: 0 Yes El No* Alarms in working order: E-1 Yes El 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: El leaching pits number: El leaching chambers number: M leaching galleries number: El leaching trenches number, length: leaching fields number, dimensions: 1 field 32'x El overflow cesspool number: El innovative/alternative system Type/name of technology: t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ams, 7 337 Pleasant Street —----- Property Address— Alan Freedman Owner Owner's Name information is North Andover MA 01845 7-27-2018 required for every ------------ _ page. ----------- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition �f vegetation, etc.): Soil ok, Vegetation ok. No sign of ponding to surface. ------------ 12. 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 E] No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.dor•rev.7/2.6/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman Owner Owner's Name information is North Andover MA 01845 7-27-2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): ------------ t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman Owner Owners Name information is North Andover MA 01845 7-27-2018 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 I tc /12 t5insp.doc-rev.7126/2018 Titte 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman —----------- Owner Owner's Name information is required for every North Andover MA 01845 7-27-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope Surface water Check cellar Shallow wells Estimated depth to high ground water: >4feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: ❑ 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: Essex County Soil Map. You must describe how you established the high ground water elevation: Essex County Soil Map, Sheet#30, Paxton Soil,Water>6' deep ----------- Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 337 Pleasant Street Property Address Alan Freedman Owner Owner's Name information is North Andover MA 01845 7-27-2018 required for every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: • A. Inspector Information: Complete all fields in this section. • B. Certification: Signed & Dated and 1, 2, 3, or 4 checked C. inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed D. System information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t6insp.doc-rev.712612018 We 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 18 of 18 Summary Record Card generated on 7/1112018 3:09:16 PM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-095.0-0070-0000.0 Parcel Id 13665 337 PLEASANT STREET ALAN FREEDMAN 337 PLEASANT STREET NORTH ANDOVER, MA 01846 Class 101 Single Family Property Type 1 Resiential S Zoning2 1 Residential ZonIng3 I Resil ential Size Total 0.81 Acres FY 2018 UB Mailing Index Name/Address Type Loan Number ActivelInact. From until ALAN FREEDMAN Owner 337 PLEASANT STREET NORTH ANDOVER,MA 01845 STRATTON,WILLIAM B, Previous Customer Inactive 1 1/1 212004 337 PLEASANT STREET N.ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name ActivelInactive Bldg Id. 16257.0-337 PLEASANT STREET Last Billing Date 4/10/2018 3150264 03 Cycle 03 Active UB Services Maint. Account No. 3150264 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 22.80 /1 UB Meter Maintenance Account No.3150264 Serial No Status Location Brand Type Size YTP Cons 35644530 a Active ERT HH b Badger w Water 0.630.63 ' 325 Date Reading Code Consumption Posted Date Valiance 6/4/2018 324 a Actual 7 11% 3/112018 317 a Actual 6 4/23/2018 43% 12/1/2017 311 a Actual 4 1/25/2018 1 25% 9/6/2017 307 a Actual 6 10/18/2017 i -37% 6/1/2017 301 a Actual 9 7/25/2017 45% 3/1/2017 292 a Actual 6 4/12/2017 3% 12/212016 286 a Actual 6 1/23/2017 -1% 9/1/2016 280 a Actual 6 10/24/2016 1 -26% 6/2/2016 274 a Actual 8 8/2/2016 -38% 3/4/2016 266 a Actual 6 4/22/2016 1 26% 12/212015 260 a Actual 8 1/20/2016 -12% 9/112015 252 a Actual 9 10/16/2015 -9% 6/2/2015 243 a Actual 10 7/24/2015 40% 3/2/2015 233 a Actual 7 4/28/2015 -46% 1212/2014 226 a Actual 13 1/15/2015 33% 9/3/2014 213 a Actual 10 10/15/2014 25% 6/3/2014 203 a Actual 8 7/16/2014 -2% 3/3/2014 195 a Actual 8 4/11/2014 -1% 12/3/2013 187 a Actual 8 1/17/2014 -8% 9/5/2013 179 a Actual 9 10/16/2013 12% 6i5/2013 170 a Actual 8 7/24/2013 -11% 3/612013 162 a Actual 9 4/22/2013 -3% 1213/2012 153 a Actual 9 1/9/2013 4% 9/5/2012 144 a Actual 9 10/15/2012 -9% 6/412012 135 a Actual 10 7/16/2012 -12% 3/2/2012 125 a Actual 11 4/14/2012 17% Commonwealth of Massachusetts City/Town of . System Pumpin§.Record Form DEP has provided this form*for use-by local Boards of Health. Other form's maybe'used,but the information,must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitteO>0 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, eft lght f house L6ft/ Right side of building, Left/Rigl`it front of building, Left/Right rear of bulfd'm , Un e g j Address Cityfrown State Zip Code 2. System Owner. Name' Address Of different from location) Cityfrown State- Z rAft— Telephone Number `1 S B. Pumping Record 1. Date of PumpingDate 2. Gtubnfity Pumped: Gallons • r 3. Type,of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank r. ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes if yes,was it cleaned? D Yes Q No, ' S. Condition of System: A 6: System Pumped By: Neil,Bateson F5821 Name Vehicle License Number _Bateson Enterprises Inc Company i 7. Lo re content&were disposed: S Lowell Waste water Sign a Nul Date t5formCdoc-08/03 System Pumping Record•page 1 of 11, Town of North Andover HEALTH DEPARTMENT CHECK #: j DATE: LOCATION: H/(NAME: CONTRACTOR NAME: )Z I Type of Permit or License: (Check box) 0 Animal $ • Body Art Establishment • Body Art Practitioner 0 Dumpster $ 0 Food Service,- • Funeral Directors • Massage.Establishment • Massage Practice • Offal(Septic)Hauler $ • Recreational Camp • Sun tanning • Swimming Pool [J Tobacco • Trash/Solid Waste Hauler • Well Construction SEPTIC Systems: • Septic-Soilresting • Septic-Design Approval $ El Septic Disposal Works Construction(DWC) $-- * Septic Disposal Works firstallers, (DWI) $ * Title 5 Inspector Title 5 Report $ D Other. (Indicate)--.---.-- $ ............. He t ,Agent Initials White-Applicant Yellow--Health Pink-Treasurer