HomeMy WebLinkAboutTitle V Inspection Report - 205 CAMPBELL ROAD 8/20/2018 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205 Campbell Rd.
Property Address
Daniel Palmer
Owner ...
-r'sNam6""--"'
information is
required for every North Andover MA 01845 8/2/2018
page. d4jr--rown 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
filling out forms A. General Information
ry
on the computer,
use
cursor Iydo nothe tab
key to move your 1 Inspector:
t
Anthony . Ca
use the return .........- ....... -------
Name of InsGpector
mpano
key.
Pa�mpano Engineering and Title 5 Inspections
VQ Company Name
30A Elm St.
Company Address
Pepperell MA 01463
City/Town State Zip Code
978-433-2212 3602
feiep-hone 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:
0 Passes El Conditionally Passes M Fails
El Needs Further Evaluation by the Local Approving Authority
08/03/2018
Inspect 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 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.
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
Commonwealth of Massachusetts
_=: -.m Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205 Campbell Rd.
Property Address
Daniel Palmer
Owner dwne—r"s-N-a-M—e ----
information is
required for every North Andover MA 01845 8/2/2018 ..........
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:
Z 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:
El 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.
El Y n N F1 ND (Explain below):
15ins.doo-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title ffiial Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205--Cam bell Rd.
Property Address
Daniel Palmer
Owner Owner's Name
information is
required for every North Andover MA 01845 8/2/2018
page. Cityfrown State Zip-Code- bat-e-of-Inspection
,
B. Certification (cont.)
F-1 Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
r-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):
El broken pipe(s)are replaced El Y El N 0 ND (Explain below):
F-1 obstruction is removed n Y n N n ND (Explain below):
n distribution box is leveled or replaced F] Y n N F] ND (Explain below):
-——--------------------------------------- ------
-
Ej 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):
Ej broken pipe(s) are replaced F1 Y n N F1 ND (Explain below):
❑ obstruction is removed ❑ Y n N n ND (Explain below):
—-------------------------- ............
------------------------- ..........
C) Further Evaluation is Required by the Board of Health:
n 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
16.303(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.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
205 Campbell Rd. ...........---
Property Address
Daniel Palmer
OwnerOwners Name
information is
required for every North Andover MA 01845 8/2/2018
page. citynown-- -- '-' ------- -state Zip Code Date of Inspection
B. Certification (cont.)
2. System will fall 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:
El 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.
R The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
R 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
El M Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
El 0 Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El Z Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
15ins.doo•rev.6146 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
-----------
Title 5 Offic"al Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205 Campbell Rd.
i5i-opie—r�tAddress
Daniel Palmer
Owner bt
Owner's Namte'"""
information is North Andover MA 01845 8/2/2018
required for every -----------
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
El E Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
E] 0 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.
El 0 Any portion of a cesspool or privy is within a Zone 1 of a public well.
E] E Any portion of a cesspool or privy is within 50 feet of a private water supply well.
E-1 0 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.]
El 0 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
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
El D the system is within 400 feet of a surface drinking water supply
R F the system is within 200 feet of a tributary to a surface drinking water supply
n F1 the system is located in a nitrogen sensitive area (interim Wellhead Protection
Area—IWPA)or a mapped Zone It 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
205 Campbell Rd.
Property Address
Daniel Palmer
Owner Owner's Name
information is North Andover MA 01845 8/2/2018
required for every
page. City/Town 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
M El Pumping information was provided by the owner, occupant, or Board of Health
EJ 0 Were any of the system components pumped out in the previous two weeks?
E n Has the system received normal flows in the previous two week period?
El E Have large volumes of water been introduced to the system recently or as part of
this inspection?
0 El Were as built plans of the system obtained and examined? (if they were not
available note as N/A)
* 0 Was the facility or dwelling inspected for signs of sewage back up?
* El Was the site inspected for signs of break out?
* n Were all system components, excluding the SAS, located on site?
* 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
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.
F1 E 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:
3
Number of bedrooms(design): ---- Number of bedrooms (actual): 3
3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 30
t5ins.doc-rev.6116 TiHe 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
205 Campbell Rd.
Address.
Property Address
Daniel Palmer
Owner Owner's Name
information is required for every North Andover MA 01845 8/2/2018
page. Cityfrown State Zip Code ---,--Date of Inspection
D. System Information
Description:
..........
4
Number of current residents:
Does residence have a garbage grinder? El Yes 0 No
Is laundry on a separate sewage system? (include laundry system inspection F1 Yes Z No
information in this report.)
Laundry system inspected? El Yes n No
Seasonal use? n Yes 0 No
Water meter readings, if available(last 2 years usage (gpd)): 175.7_qpd_____
Detail:
17100 cu-ft(7.48 gal/cu-ft)/728 days= 175.7 gpd, (see attached useage report)
..........
............. ------
-- ---------__
Sump pump? H Yes E] No
Last date of occupancy: occupied
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? D Yes E] No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205 Campbell Rd.
Property Address
Daniel Palmer
Owner Owner's Name
information is
required for every North Andover MA 01845 8/2/2018
page- Cit-y/Town -State 'Zjp Code Date of Inspection
D. System Information (cont.)
Last date of occupancy use: Date
Other(describe below):
----------- -------
............
General Information
Pumping Records:
Source of information: 2017 per renter......------------
Was system pumped as part of the inspection? n Yes M No
If yes, volume pumped: ......
gallons
How was quantity pumped determined?
Reason for pumping: ....... ---- ---
Type of System:
LEI Septic tank, distribution box, soil absorption system
n Single cesspool
El Overflow cesspool
F] Privy
El Shared system (yes or no) (if yes, attach previous inspection records, if any)
E] 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.
El Other(describe):
t5ins,doc rev.6/16 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
_= F . Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205 Cambell Rd,
-- --------
-P�ro-perty Address
Daniel Palmer
Owner Owner's Name
information is North Andover MA 01845 8/2/2018
required for every
page. C i t pnr o-w-n State Zip Code Date of Inspection
---------------------
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
See attached permit dated 6/15/1967.
-----------
Were sewage odors detected when arriving at the site? F1 Yes Z No
Building Sewer(locate on site plan):
1611
Depth below grade: feet
Material of construction:
0 cast iron E]40 PVC El other(explain): --------
Distance from private water supply well or suction line: Town Water
-feet''
Comments (on condition of joints, venting, evidence of leakage, etc.):
All exposed joints were in good condition with no evidence of leakage or venting problems.
. ............... ------
.............. .........................
Septic Tank (locate on site plan):
Depth below grade: 1011
feet
Material of construction:
0 concrete El metal F fiberglass El polyethylene El other(explain)
Tank was in good condition, liquid level was at the outlet pipe invert. Inlet baffle was missing and
outlet baffle was in place and composed of PVC.(See attache photos)
---
If tank is metal, list age: --......years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) F1 Yes F] No
Dimensions: 71 x 5'5"W x 5'D
2 rr
Sludge depth:
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205 Campbell Rd. —-Property AddrtessDaniel Palmer
OwnerOwner's Name
information is North Andover MA 01845 8/2/2018
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
34-1
Distance from top of sludge to bottom of outlet tee or baffle
3"
Scum thickness
711
Distance from top of scum to top of outlet tee or baffle
16"
Distance from bottom of scum to bottom of outlet tee or baffle
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.):
Tank is in good condition. Liquid level was at the outlet pipe invert. Inlet baffle was missing and outlet
baffle was in place and composed of PVC and in good condition. The tank should be pumped every
two years.(SEE ATTACHED PHOTOS)
..........
-------------
Grease Trap (locate on site plan):
Depth below grade:
Material of construction:
F1 concrete El metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness ..._-__-
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle ......
Date of last pumping: pati__..._.--"" -- "
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205 Campbell Rd. .......... ........................
Property Address
Daniel Palmer
OwnerOwner's Name
information is North Andover MA 01845 8/2/2018
required for every
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:
0 concrete F1 metal M fiberglass El polyethylene ❑other(explain):
Dimensions: --------
Capacity: I.-
gallons
Design Flow: gallons- perday'-
Alarm present: El Yes El No
Alarm level: ........ Alarm in working order: El Yes F] No
Date of last pumping: 45ate—- ------------- --
Comments (condition of alarm and float switches, etc.):
----------
Attach copy of current pumping contract(required). Is copy attached? El Yes E-1 No
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
<LN\ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205 Campbell Rd.
Property Address
Daniel Palmer
Owner Owner's Name
information is
required for every North Andover MA 01845 8/2/2018
page. 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 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.):
The D-box is level with three lines all are receiving equal flow. No evidence leakage into or out of the
box and no sign of solids carryover. The box had been replaced and is in good condition.(SEE
ATTACHED PHOTOS)
Pump Chamber(locate on site plan):
Pumps in working order: El Yes El No*
Alarms in working order: D 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.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins.doc•rev.6116 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
205 Campbell Rd. .........
Property Address
Daniel Palmer
Owner Owner's Name
information is North Andover MA 01845 8/2/2018
required for every
page. City/Town ---------- State.-..-- Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
El leaching galleries number:
leaching trenches number, length:
leaching fields number, dimensions: 180 lineal feet of
drain pipe
F] 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.):
There is no sign of hydraulic failure, ponding or damp soil. The vegetation above the field is mowed
lawn and open wooded area
- --------- --------........
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 [:1 No
15ins.doc-rev.6116 Title 5 Official tnspeclion Form:Subsurface Sewage Disposal System-Page 13 of 17
<aN\ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205 Campbell
Property Address
Daniel Palmer
Owner dw"ner's Name
information is North Andover MA 01845 8/2/2018
required for every ----------------
page. City/Town 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.):
---------- ......
t5ins.doc-rev.6116 'ride 5 official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
205 Campbell Rd.
Property Address
Daniel Palmer
OwnerOwner's Name
information is
required for every North Andover MA 01845 8/2/2018
page. City/Town 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:
n hand-sketch in the area below
Z drawing attached separately
(6ins.doc•rev,6/16 Title 5 Official 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
as
205 Campbell Rd.
Property Address
Daniel Palmer
Owner Owner's Name
information is North Andover MA 01845 8/2/2018
required for every
page. City/Town State Zip Code Date of Inspection ----------
D. System Information (cont.)
Site Exam:
r-1 Check Slope
Z Surface water
Check cellar
Shallow wells
5+
Estimated depth to high ground water: -faet— ,----------
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed:
Date
Observed site (abutting property/observation hole within 150 feet of SAS)
El Checked with local Board of Health - explain:
Allong the side of the house was a swale and it was 5+feet below the location of the
system and it was dry.
❑ Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
The closest USGS ground water monitoring well is in Andover, well number 423641071102501-MA-
AJW 462. It has an average ground water depth of 15'. On a prior Title 5 report dated 8/29/1996, a
test hole was bored to 6' and no water was encounter.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc-rev.6116 Title 5 Official frispection 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
205 CaTpbell Rd.
.Property-I-1 "Address
Daniel Palmer
OwnerOwner's Name
information is North Andover MA 01845 8/2/2018
required for every Zip Code Date of Inspection
page. cit—ylToWn State
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
15ins.doc rev.8118 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
ate-`,
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2
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Summar/Record Card ganefated on 0131201010:1&31 AM by Tam Hurley Paget i
-1r0wn of North Andover
Tax Map # 210-1063-0052-0000.0
Parcel Id 17372
206 CAMPBELL ROAD
206 CAMPBELL ROAD, LLC Since Jan 2018
746 BOYLSTON ST, STE 602
BOSTON, MA
02116
----------
Class 101 Single Family Property Type I Residential
ZonIng2 I Residential Zoning3 I Residential
Size Total 1.04 Acres
Fy 2019
...........
UB Mafflflp index
Name/Address Type Loan Number Activelinact. From Until
JOSHUA GIANOTSOS Owner Active
205 CAMPBELL ROAD
NORTH ANDOVER MA 01845
HARRISON,JOSE&LOREDANA Previous Customer Inactive 11/11/2015
206 CAMPBELL ROAD
N.ANDOVER,MA
01845
UB Account Maint.
Account No Cycle Occupant Name Activeltnactive
Bldg Id. 17489.0-206 CAMPBELL ROAD Last Billing Date 7118/2018
3170159 03 Cycle 03 Active
UB Services Maint.
Account No.3170159
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.63 618 7.62 1/
WTR WATER 01 ALL METER SIZE 76.00
UB Meter Maintenance
Account No.3170159
Serial No Status Location Brand Type Size YTD Cons
36388092 a Active ERT HH b Badger w Water 0,630.63 811
Date Reading Code Consumption Posted Date Variance
6/8/2018 790 a Actual 20 712312018 6%
31612018 770 a Actual 18 4123/2018 -11%
1216/2017 762 a Actual 20 1/26/2018 -16%
9/8/2017 732 a Actual 25 10/1812017 1%
6/6/2017 707 a Actual 24 7/25/2017 5%
3/7/2017 683 a Actual 22 411212017 -4%
1210/2016 661 a Actual 24 1/23/2017 26%
9/1/2016 �37tual 19 10/24/2016 -16%
6/8/2016 6 f a (611IM' 2$,--,81212046 -15%
3/7/2016 695 a Actual 26 4/22/2016 110%
1219/2015 669 a Actua 1 5 1/20/2016
1113/2016 564 f Final Bill 0 1116/2015
9/8/2015 664 a Actual 4 10/16/2016 -850/0
6/9/2016 560 aAGtual 26 712412015 12%
3110/2015 534 a Actual 23 412812016 3%
12/10/2014 611 a Actual 22 111612016 22%
9/1212014 489 a Actual 19 10/16/2014 -37%
6/1012014 470 a Actual 29 7116/2014 43%
3[1212014 441 a Actual 21 4111/2014 -15%
1219/2013 420 a Actual 24 1117/2014 4%
9110/2013 396 a Actual 23 10/15/2013 7%
6/1212013 373 a Actual 22 7/24/2013 -8%
3/12/2013 351 a Actual 24 4/22/2013 8%
327 a Actual 21 1/9/2013 7%
12/1012012
9/14/2012 306 a Actual 21 10/1512012 -30%
Summary Record Card generated on 0/312 01 6 10:16:31 AM by Thin Hurtoy rage 2
Town of North Andover
Tax Map # 210-1063-0062-0000.0
Parcel Id 17372
206 CAMPBELL ROAD
206 CAMPBELL ROAD, LLC Since Jan 2018
745 BOYLSTON ST, STE 602
BOSTON, MA
02116
.......... -------
Class 101 Single Family Property Type I Residential
Zonlng2 I Residential Zoning3 I Residential
Size Total 1.04 Acres
FY 2019 ...........
----------I
6/1312012 285 a Actual 29 7/16/2012
3115/2012 256 a Actual 31 4114/2012 11%
12/1312011 226 aActual 27 1/17/2012 -8%
9114J2011 198 a Actual 32 10/1312011 10%
6/8/2011 166 a Actual 27 7/20/2011 -17%
3/912011 139 a Actual 32 4113/2011 -4%
1211012010 107 aActual 33 1/1212011 10%
9/13/2010 74 aActual 33 1011512010 -13%
61812010 41 a Actual 35 7/15/2010 314/a
3/1112010 6 aActual 6 4/1412010 -100%
211912010 0 n New Meter 0 4/14/2010 100%
211912010 3012 r Replacement 27 4/1412010 -8%
1211112009 2085 aActual 38 1112/2010 35%
9/11/2009 2947 a Actual 29 10/1512009 -21%
6/9/2009 2918 a Actual 33 7/20/2009 -3%
3/1712009 2885 a Actual 40 4/29/2009 0%
1218/2008 2846 a Actual 36 1/20/2009 2%
9110/2008 2809 a Actual 38 10/10/2008 -8%
6/6/2008 2771 a Actual 37 7/16/2008 -10%
311212008 2734 aActual 43 4/11/2008 5%
1211312007 2691 aActual 44 1/22/2008 15%
9/7/2007 2647 a Actual 33 10/12/2007 -23%
6/15/2007 2614 a Actual 47 712012007 42%
3/15/2007 2567 m Manual estimate 35 4/1612007 -20%
12/8/2006 2632 a Actual 39 1/1912007 12%
9/12/2006 2493 a Actual 34 10/2012006 2%
6/1912006 2469 a Actual 41 7110/2006 -16%
3/6/2006 2418 a Actual 35 4/17/2006 0%
12/21/2005 2383 aActual 43 1/17/2006 19%
912012005 2340 a Actual 39 10114/2005 -7%
6/13/2005 2301 a Actual 35 7/15/2005 2%
3/2212005 2266 a Actual 41 415/2005 5%
12/1312004 2225 aActual 36 1/14/2005 11%
AIR Inquiry
Sub System
Account No.317059 Utility Billing j
Install Billed Adjt Bill Int/Pen Fee(s) Refunded Adjt. Abated Paid Balance
1 st $7,681.02 $57.32 ($631.04) $6,65102 $354,28
Entry Date Install Trans Type Amount Balance Due Amount Billed Posted Flag
217/2004 Billed $104.40 $104.40 $104.40 Posted
511712004 Billed $142.03 $246.43 $142.03 Posted
81312004 Interest $9.01 $266.44 Posted
8/312004 Interest $0.64 $256.08 Posted
613/2004 Payment ($251.00) $5.08 Posted
814/2004 Billed $71.37 $76.46 $71.37 Posted
8126/2004 Interest $010 $77.16 Posted
8/2612004 Payment ($330.00) ($252.85) Posted
10/18/2004 Billed $108.12 ($144.73) $108.12 Posted
1/14/2005 Billed $130,27 ($14,46) $130.27 Posted
411512006 Billed $153.98 $139.52 $153.98 Posted
6/1/2005 Interest $0.86 $140.38 Posted
6/1/2005 Payment ($139.62) $0.86 Posted
7/115/2005 Billed $130.27 $131.13 $130.27 Posted
9/21/2005 Interest $1,77 $132.90 Posted
9/21/2005 Interest $0.11 $133.01 Posted
912112005 Payment ($131.16) $1.86 Posted
Summary Record Card generated on 01312010 1 o:16:33 AM by Tara Hudoy Page 3
Town Of North Andover
Tax Map # 210-106-B-00520000.0
Parcel Id 17372
206 CAMPBELL ROAD
205 CAMPBELL ROAD, LLC Since Jan 2018
745 BOYLSTON ST, STE 602
BOSTON, MA
02116
1 Residential
Class 101 Single Family Property Type
ZonIng2 I Residential Zonin93 1 Residential
Size Total 1.04 Acres
FY -------
$172.96 $174.82 $172.96 Posted
10/1412005 Billed $0.55 $175.37 Posted
1112212005 Interest
11/2212005 Interest $0.02 $175.39 Posted
11122/2005 Payment ($174.86) $0.63 Posted
$197A0 $197.63 $197A0 Posted
1117/2006 Billed 67 Posted$1.04 $198.
313/2006 Interest
313/2006 Interest $0.04 $198.71 Posted
313/2006 Payment ($197,65) $1.06 Posted
$155.12 $156.18 $155.12 Posted
4/17/2006 Billed
6/1312006 Interest $1,57 $167.75 Posted
Posted
611312006 Interest $0.08 $167.83
Payment $1.62 Posted
6/1312006
7/10/2006 Billed $182.55 $181.04 Posted
$181.04
$182M Posted
7/26/2006 Interest $0.03
($182,70) ($0.01) Posted
7/26/2006 Payment $138,18 $138-17 $138.18 Posted
10/20/2006 Billed $138.24 Posted$0.07
12116/2006 Interest Posted
12115/2006 Interest $1.25 $139.49 Posted
12/15/2006 Payment ($138.17) $132
1/19/2007 Posted
Billed $162.38 $163.70 $162,38
Interest $0.51 $164.21 Posted
2/27/2007
2/27/2007 Interest $0.02 $164.23 Posted
($163.73) $0.50
2/27/2007 Payment
$140,77 $141.27 $140,77 Posted
4/1612007 Billed $1.76 $143.03 Posted
6/19/2007 Interest $0,10 $143.13 Posted
V19/2007 Interest ($141.29) $1.84 Posted
6/19/2007 Payment $200.72 $202.56 $200.72 Posted
7/2012007 Bitled
91412007 Interest $1.16 $203.72 Posted
$0.05 $203,77 Posted
9/4/2007 Interest
($202.60) $1,17 Posted
9/4/2007 Payment $151-51 $162M $161.51 Posted
10/1212007 Billed $0.03 $162.71 Posted
11/9/2007 Interest 0 Posted($152.71) $0.0
11/9/2007 Payment Posted
$209.78 $209.78 $209.78
112212008 Billed
212612008 Interest $0,01 $209.79 Posted
2/26/2008 Interest $0.31 $210.10 Posted
2/26/2008 Payment ($209.78) $0,32 Posted
Billed $206,81 $207.13 $206,81 Posted
4/11/2006 $0.01 $207.14 Posted
5/2812008 Interest
5/2812008 Payment ($207,14) $0.00 Posted
7/16/2008 Billed $173,63 $17163 $173.63 Posted
$0,03 $173,66 Posted
8125/2008 Interest $0.64 $174.30 Posted
8/2512008
Interest
812512008 Payment ($173,63) $0,67 Posted
Billed $163A7 $163.84 $163,17 Posted
10/1012008 $0.02 $163M Posted
11113/2008 Interest 00 Posted($163.86) $0,
11/1312008 Payment 98 $154.98 Posted$154,
1/20/2009 Billed $164.98 Posted
Payment ($164.98) $0.00
2117/2009
4/29/2009 Billed $172.06 $172,06 $172.06 Posted
5/2912009 Payment ($172.06) $0.00 Posted
$140.10 $140.10 $140.10 Posted
7/2012009 Billed $0.07 $140.17 Posted
9/1112009 Interest
9/1112009 Interest $1.17 $141.34 Posted9/11/2009
Payment ($140.10) $'1.24
$132.62 $133.86 $132,62 Posted
10/1512009 Billed
11/2412009 Interest $0,04 $133.90 Pasted
11/24/2009 Payment ($133.89) $0.01 $183.72 Posted
1/12/2010 Billed $183.72 $183.73 Posted
211/2010 Payment ($183.73) $0.00
Stirptnafy Record Card gunorated on 6131201010:16:33 AM by Tara Hurloy Page 4
Town of North Andover
Tax Map # 210-106-B-0052-0000.0
Parcel ld 17372
205 CAMPBELL ROAD
206 CAMPBELL ROAD, LLC Since Jan 2018
745 BOYLSTON ST, STE 502
BOSTON, MA
02116
-------------
Class 101 Single Family Property Type 1 Residential
Zoning2 I Residential ZonInq3 1 Residential
Size Total 1.04 Acres
FY 2019
4/14/2010 Billed $155.97 $155,97 $155.97 Posted
6/112010 Interest $0.05 $156.02 Posted
6/112010 Interest $1.02 $157.04 Posted
611)2010 Payment ($155.97) $1.07 Posted
7/1612010 Billed $167.07 $168.14 $167.07 Posted
2/112011 Interest $0.10 $168.24 Posted
9/1312010 Interest $1.76 $169.99 Posted
9/1312010 Interest $0.08 $170.07 Posted
9113/2010 Payment ($168.17) $1.90 Posted
1 0/1 51201 0 Billed $163,66 $165.56 $153.66 Posted
1 2/1 51201 0 Transferred To Tax ($1,80) $163.76 Posted
12/16/2010 Transferred To Tax(I/P) ($0.10) $153.66 Posted
12/2812010 Interest $0.13 $163,79 Posted
1 212 81201 0 Interest $2.41 $166.20 Posted
12/2812010 Payment ($155.50) $0,70 Posted
1/1212011 Billed $155.97 $156.67 $165.97 Posted
4/1312011 Billed $160.42 $307,09 $150.42 Posted
4/2612011 Interest $2,88 $309.97 Posted
4/26/2011 Interest $0.15 $310.12 posted
4/26/2011 Payment ($311.13) ($1,01) Posted
7/20/2011 Billed $122.67 $121.66 $122.67 Posted
918/2011 Interest $0.05 $121.71 Posted
9/8120111 Interest $0.88 $122.59 Posted
9/812011 Payment ($121.66) $0.93 Posted
10/13/2011 Billed $147.73 $148.66 $147.73 Posted
10114/2011 Interest $0,01 $148,67 Posted
1011412011 Payment ($148.68) ($ui) Posted
1/17/2012 Billed $122.67 $`122,66 $122.67 Posted
1120/2012 Payment ($122.66) $0.00Posted
4/14/2012 Billed $144.10 $144-10 $144,10 Posted
617/2012 Payment ($144.10) $0.00 Posted
7/16/2012 Billed $133,77 $133.77 $133.77 Posted
8/29/2012 Interest $0.04 $133.81 Posted
8/29/2012 Interest $0.68 $134.49 Posted
8/29/2012 Payment ($133,77) $0.72 Posted
1011512012 Billed $88.60 $89.32 $88,60 Posted
12/312012 Interest $0,62 $89,94 Posted
12t312012 Interest $0.06 $90.00 Posted
12/3/2012 Payment ($89.34) $0.66 Posted
119/2013 Billed $89.37 $90.03 $89,37 Posted
3/16120113 Interest $1.12 $91.16 Posted
3/1512013 Interest $0.11 $91.26 Posted
3/15/2013 Payment ($90.06) $1.21 Posted
4/22/2013 Billed $105.64 $106.86 $105.64 Posted
7/1712013 Interest $2,16 $109,01 Posted
7/17/2013 Interest $0.17 $109-18 Posted
7/17/2013 Payment ($106.88) $2.30 Posted
7/24/2013 Billed $94.54 $06.84 $94.54 Posted
713112013 Interest $0.01 $96.85 Posted
Payment ($114.53) ($17.68) Posted
7/3112013
10/26/2013 Billed $100.47 $82.79 $100.47 Posted
1/1712014 Billed $106.02 $188.81 $106.02 Posted
3/26/2014 Interest $5.17 $193.98 Posted
3126/2014 Interest $0.11 $194.09 Posted
3/25/2014 Payment ($82.79) $111.30 Posted
4/11/2014 Billed $88,60 $199.90 $88.60 Posted
6/24/2014 Interest $4.94 $204.84 Posted
6124/2014 Interest $0.40 $205.24 Posted
Payment ($268,16) ($62.92) Posted
6124/2DI4
7/16/2014 Billed $133.77 $70,85 $$80133.77 Posted
.02 Posted
10115/2014 Billed $80.02 $160.87
Summary Reoord Card genoraled on 8131201010:15:33 AM by Tara Hufloy Pape 5
Town of North Andover
Tax Map # 210-1062-0062-0000.0
Parcel Id 17372
206 CAMPBELL ROAD
206 CAMPBELL ROAD, LLC Since Jan 2018
745 BOYLSTON ST, STE 602
BOSTON, MA
02116
Class 104 Single Family Property Type 1 Residential
ZonIng2 1 Residential Zonlng3 I Residential
Size Total 1.04 Acres
Fy 209
10/29/2014 Interest $2.04 $152.91 Posted
10/29/2014 Payment ($153.23) ($0.32) Posted
1/15/2015 Billed $94.92 $94,60 $94.92 Posted
1/22/2015 Payment ($94.60) $0,00 Posted
4/28/205 Billed $100.47 $100.47 $100.47 Posted
7/24/2016 Billed $117.12 $217.59 $117.12 Posted
8/3f2015 Interest $0.20 $217.79 Posted
8/3/2015 Interest $2.38 $220,17 Posted
8/3/2015 Payment ($100.47) $119.70 Posted
10/16/2015 Billed $23.02 $142.72 $23.02 Posted
11/612015 Billed $42.82 $185.54 $42.82 Posted
11119/2015 Interest $3,77 $189.31 Posted
11119/2016 Interest $0.26 $189.67 Posted
11/19/2015 Payment ($490.57) ($1.00) Posted
1/20/2016 Billed $26.82 $25.82 $26.82 Posted
4/22/2016 Billed $117.12 $142.94 $117.12 Posted
8/212016 Billed $99.70 $242.64 $99.70 Posted
2/1/2017 Interest $2A3 $244.77 Posted
2/1/2017 Interest $18.68 $263.35 Posted
10/24/2016 Billed $80.02 $343.37 $80.02 Posted
12/16/2016 Transferred To Tax ($22.46) $320.91 Posted
12t15/2016 Transferfed To Tax ($220.18) $100.73 Posted
1 211 51201 6 Transferred To Tax(I/P) ($2,13) $98.60 Posted
12/16/2016 Transferred To Tax(I/P) ($18.68) $80.02 Posted
1/2312017 Billed $105.64 $186.66 $105.64 Posted
4/1212017 Billed $94.92 $280.58 $94.92 Posted
7/25/2017 Billed $106.02 $386.60 $106.02 Posted
21112018 Interest $3,61 $390.21 Posted
211/2018 Interest $39.87 $430.08 Posted
10/18/2017 Billed $110.42 $540,50 $110.42 Posted
1218/2017 Transferred To Tax ($31,28) $509.22 Posted
121812017 Transferred To Tax ($355.32) $153.90 Posted
1218/2017 Transferred To Tax(I/P) $160.29 Posted
12/812017 Transferred To Tax(I/P) ($39X) $110A2 Posted
1125/2018 Billed $83.82 $19424 $83.82 Posted
4/2312018 Billed $76,22 $270.46 $76,22 Posted
$83.82 Posted
712312018 Billed $83.82 $354.28
! NJ
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I hereby make application for a permit for a sewage disposal installation at
�? . I will install this system in ac -
cordance with all the laws of the Commonwealth of Massachusetts and regulations' of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2qo. I will install a con-
crete septic tank of __4_g,2.0 in size. A manhole (s) permitting easy cleaning
will be provided with removable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
or open jointed pipe and laid in a series of trenches, the bottom of which will pro- ;
vide a minimum of ""re) lineal -e) feet of effective absorption area.
The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging
in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The ,points of these
pipes will be protected from clogging and before falling the trench, 2 inches of
gravel or stone 1/$" to 1/4►, (dia.) will be placed over the course gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
the line will exceed 100 feet in length and in any case, two lines of the will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No part of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
I .further agree not to cover any portion of this installation until approved by the
infection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DATE
Signature,, f Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE ,
e) dw7VV7�L..0 rr•1Yhrfi tr.Y J fl .r ,
Signature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described. I
DATE C
Signature of specting Office
Percolation Test
Garbage Grinder
BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS
SEWAGE DISPOSAL
DATE )kpril 22,j 3-966
NAME OF APPLICANT John Don--)hoe
LOCATION® Lot #13, 0&fipbell Road
Address of lot no.
BUILDING: Dwelling Other
SYSTEM-. New x —Repair
GENERAL DESCRIPTION OF LAND Ifigh
SUBSOIL: ClayGravel- SandL_ , )r
PERCOLATION TEST 6 -minutes per inch.
- - - - - - - - - - - - - - - - -
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK 1000 —gallon capacity.
LEACH FIELD— 200 —lineal feet of drain pipe.
William J. Dscoll , EngiVeer
Board of HeaNh
BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS
SEWAGE DISPOSAL
DATE I'Vlay 27, '1967
NAME OF APPLICANT J"hilli-p S. Sulllwin
LOCATION Lot A3, Campbell I.Joad
--!M-ess oF-1`otnF.
BUILDING: Dwelling_X Other
SYSTEM: Newx-,.--® Repair -
GENERAL
x-,.--- ReDair -GENERAL DESCRIPTION OF LAND 1-1 i gx h
SUBSOIL: Clay_-x Gravel-- Sand
PERCOLATION TEST 5 -minutes per inch®
- - - - - - - - - - - - - - - - -
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK 1, 000
capacity,
LEACH FIELD 180 .--lineal feet of drain pipe.
illiam J. DrIscull , Engin ex
Board of Health
BOARD Or, HEALTH
TOWN OF NORTH ANDOVER, MASS.
y-,
1000 jo
----------
7 57--
1. NAME 'j-c) DATE 1 A/O
2. ADDRESS LOT NO TEL z
3. -NO.- OF BEDROOMS_ DEN YES- NO
4. GARBAGE GRINDER YES NO x
5- SHOW DIMENSIONS Or, HOUSE
6. SHOW DISTANCES Or, HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS OF LOT
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE, LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM
10. SHOW LOCATION Or, BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
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ORTH , E) 4
V ' 4 Town of North Andover
HEALTH DEPARTMENT
CH
CHEM #:
DATE: 8 o
LOCATION: CRI
'2 t
H/O NAME:
CONTRACTOR NAME: L�L 011), 0
Type of Permit or License: (Check box)
11 Animal
• Body Art Establishment
• Body Art Practitioner $
0 Dunipster $
qR
Food Service $
• Funera I Directors
• Massage Establishment
• Massage Practice $
• Offal(Septic)Hauler $
• Recreational Camp $
• Sun tanning $_
• Swimming Pool $
• Tobacco $
• Trash/Solid Waste Hauler $_
0 Well Construction $
SEPTIC Sustem .
0 Septic-Soilresting
0 Septic-Design Approval $
0 Septic Disposal Works Construction(DWC)
[J Septic Disposal Works Installers(DWI)
0 Title 5 Inspectol,
Title 5 Report $
0 Other. (Indicate)_-----_-- $
ii "Ith"Agent Initials
jKhiLe-Applicant Yellow-Health Pink-Treasurer