HomeMy WebLinkAboutTitle V Inspection Report - 1459 TURNPIKE STREET 6/25/2015 Commonwealth of Massachusetts
_ 1 r Title 5 Official r
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1459 TURNPIKE" AD
Property Address
KEVIN DUES - ---
Owner Owner's Name
information is NORTH ANDOVER MA 01845 6/26/15 --
required for every State Zip Code Date of Inspection
page. City/Town
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 General Information ��
filling out forms RECEIVED
H IE I�f�'CI6;,,',D
on the computer,
use only the tab 1. Inspector: 'a
key to move your
cursor-do not JAMES H CURRIER II
use the return Fa�T5 P ANH
Name of Ins ector
key. ll P
--
LJii'akl a[llk(L I
J'S SEPTIC & DRAIN - —
Company Name
131 FOREST ST -- -
Company Address
/ MIDDLETON MA 01949 _
City/-rown State Zip Code
978-774-6685 512327
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:
® Passes ® Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
4�
6/25/15
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Wealth or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
Title 5 official Inspection Form:Subsurface sewage Disposal system•Page 1 of 17
t5ins-3/13
Commonwealth of Massachusetts
z Title 5 Official
a
Subsurface Sewage Dis posal System Form -Not for Voluntary Assessments
'- „ 1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is NORTH ANDOVER MA 01845 6/26/15
required for every Cityrrown State Zip Code Date of Inspection
page.
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 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:
SYSTEM WORKING PROPERLY.
B) System Conditionally Passes:
❑ One or more system components as described the
of the"Conditional
p replacement or repair, need to be by
replaced or repaired. The system, up on completion ye
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
t5ins-3/13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Y
s Subsurface Sewage Disposal System Form Not for Voluntary Assessments
' . 1459 TURNPIKE ROAD
Property Address
KEVIN DUBE ----
Owner Owner's Name
information is
required for every NORTH ANDOVER MA 01845 6126115
page. City/Town State Zip Code Date of InspectiL 1
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Healti approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribuuun box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or 7 replac F1 Y El N ❑ ND (Explain below):
.
Z.
i
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is 4Requiry Board of Health:
❑ Conditions exist which luation by the Board of Health in order to determine if
the system is failing to protect/public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 3 of 17
Commonwealth of Massachusetts
Title 1 1 Inspection Form
I
a Subsurface Sewage Disposal System Form ® Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is
required for every NORTH ANDOVER MA 01845 6/26/15
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presen a of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other fai re criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above .:.-tlei nivc, ' due to an overloaded
or clogged SAS or cesspool
❑ ❑.\� Liquid depth in cesspool is less than 6" below invert or avail,,ble volume is less
than %day flow _
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Dispi•al System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBS
Owner Owner's Name
information is
required for every NORTH ANDOVER MA 01845 6/26/15
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ❑�\�'� Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ❑�� Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ❑Na Any portion of a cesspool or privy is within 50 feet of a private water supply well
❑ El\ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is wi in 2 feet of a tributary to a surface drinking water supply
❑ ❑ the system is locate n a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a ap ed Zone 11 of a public water supply well
If you have answered "yes" to any que tion in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title i i Inspection
s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBE ---
Owner Owner's Name
information is NORTH ANDOVER MA 01845 5126/15
required for every
page. City/Town State Zip Code Oate of Ins,. .,tion
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of -�e following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board o'Health
❑ ® Were any of the system components pumped out in the previous two wee :s?
® ❑ Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
❑ ® this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
330 GPD
Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 6 of 17
t5ins 3113
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Forme Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is NORTH ANDOVER MA 01845 6/26/15
required for every
page City/Town State Zip Code Date of Inspection
D. System Information
Description:
4
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? El Yes ❑ No
Seasonal use? ❑ Yes ® No
118.54 GPD
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump?
Yes ❑ No
C.'1RRENT
Last date of occupancy: Da,
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? ❑ YE ❑ No
Industrial waste holding tank present? C7 Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 7 of 17
t5ins•3/13
Commonwealth of Massachusetts
Official Title 5
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is NORTH ANDOVER MA 01845 6/26/15
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
LPD -7/30/13
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3113 Title 5 Official Inspection Form Subsurface SeWaL Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1459 TURNPIKE ROAD —
Property Address
KEVIN DUBE —
Owner Owner's Name
information is NORTH ANDOVER
page MA 01845 6/26/15
required for every City/Town State Zip Code Date of Inspection
D. System Information (coat.)
Approximate age of all components, date installed (if known) and source of information: �,�� �l•ti�`":
YJ
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
6"
Depth below grade: feet
Material of construction:
® cast iron ❑40 PVC ❑ other(explain):
22' PUBLIC H2O
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
PLUMBING IN GOOD CONDITION, NO SIGN OF LEAKAGE.
Septic Tank(locate on site plan):
6"
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
1000 GALLON -6' DIAMETER
Dimensions:
911 - 1011
Sludge depth:
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
t5ms•3/13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is NORTH ANDOVER MA 01845 6/26/15
required for every State Zip Code Date of Inspection
page Cityrrown
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle
23"
V -21'
Scum thickness
5.. _6..
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
13°
SLUDGE JUDGE
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
LIQUID LEVEL CORRECT, INLET AND OUTLET TEE'S IN PLACE, TANK DOES NOT NEED
PUMPING AT THIS TIME.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyathldene ❑ 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: Date
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
t5ins•3113
Commonwealth of Massachusetts
_ F Title 5 Official Inspection
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
� 1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is
required for every NORTH ANDOVER MA 01845 6/26/15
page. CityfTown State Zip Code Date of Inspection
D. System Information (cons.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is NORTH ANDOVER MA 01845 6/26/15
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (coat,)
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 k ridenua�,f -olids carryover, any
evidence of leakage into or out of box, etc.):
BOX REPLACED IN 6/13/07, LIQUID LEVEL CORRECT, NO EVIDENCE OF SOI_'DS
CARRYOVER. BOX IS 24" BELOW GRADE. _
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ 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:
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
t5ins•3/13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is NORTH ANDOVER MA 01845 6/26/15
required for every
page, Cityfrown State Zip Code Date of Inspection
D. System Information (coot.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions: (1) 15'X 60'
❑ 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.):
SOILS DRY, NO SIGN OF HYDRAULIC FAILURE, VEGETATION NORMAL.
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 ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
r Title 5 Official Inspection
o Subsurface Sewage Disposal System Form ®Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is
required for every NORTH ANDOVER MA 01845 6/26/15
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.):
i
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
moo= I
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form ®Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owners Name
information is NORTH ANDOVER for eve ry
MA 01845 6/26/15
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:
® hand-sketch in the area below
❑ drawing attached separately
Ar
t5 ns 11190 Title sap4w 1n5Leetlnn RIM:subsuftie Smma a symm•ptlo is of 1b
Commonwealth of Massachusetts
Title 5 Official
o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is
required for every NORTH ANDOVER MA 01845 6/26/15
I
page. CitylTown State Zip Code Date of Inspection
D. System Information (cons.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
52"
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: PREVIOUS TITLE-V
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
DATA FROM PREVIOUS TITLE-V IN WHICH JOHN SOUCY ESTABLISHED A GROUND WATER
ELEVATION AND SHOWS SEPERATION BETWEEN BOTTON OF SYSTEM AND GROUND
WATER.TITLE-V DATED 5/17/01.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
t5ins•3/13
Commonwealth of Massachusetts
w
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
'c M 1459 TURNPIKE ROAD
Property Address
KEVIN DUBE
Owner Owner's Name
information is NORTH ANDOVER MA 01845 6/26/15
required for every State Zip Code Date of Inspt ,tion
page City/Town
E. Report Completeness Checklist
• Inspection Summary: A, B, C, D, or E checked
• Inspection Summary D(System Failure Criteria Applicable to All Systems) completea
• System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attach& in :?parvte file
Title 5 official Inspection Form:Subsurface Sewage Disposal system-Page 17 of 17
t5ins-3/13
summary Record Card generated on 612212015 6:43:55 AM by Maureen McAuley Page 1
Town of North Andover
Tax Map # 210-107.B.0066-0000.0
Parcel Id 18179
1459 TURNPIKE STREET
DUBE, KEVIN
1459 TURNPIKE STREET
N. ANDOVER, MA
01845
101 Single Family Property Type 1 Residential
:lass Zoning3 1 Residential
?oning2 1 Residential
Size Total 1.06 Acres
:Y 2015
UB Mailing Index unto
flame/Address Type Loan Number Activellnact. From
RUBE,KEVIN Payor
1459 TURNPIKE STREET
N1,ANDOVER,MA
X1845
UB Account Maint. Active/Inactive
Account No Cycle Occupant Name
Bldg id. 13219.0-1459 TURNPIKE STREET Last Billing Date 6/4/2015
Active
2100007 02 Cycle 02
UB Services Maint.
Account No, 2100007
Service Code Rate Charge MultipllerlUsers
MISCFEE ADMIN FEE 0,635/8 7.82 1/
WTR WATER 01 ALL METER SIZE 49.40 /1
UB Meter Maintenance
Account No.2100007 Brand Type Size YTD Cons
Serial No Status Location NEPTUNE NEPTUNE w Water 0.63 0.63 366
16335732 a Active ERT Consumption Posted Date Variance
Date Reading Code 13 Posted D -7%
5/1/2015 704 aActual 15 3/20/2015 13%
2/4/2015 691 a Actual 13 12/15/2014 7%
11/4/2014 676 aActual 13 9/11/2014 7%
8/6/2014 663 a Actual 13 6/12/2014 14%
5/9/2014 650 a Actual 014 25%
15 3/17/2
2/3/2014 637 a Actual 11 12/20/014 4%
1111/2013 622 a Actual -1
12 9/18/2013
8/7/2013 611 a Actual 11 6/18/2013 -11%—
5/1/2013 599 aActual 13 3/1312013 4%
a c ua 12 12/13/2012 E%
10130/2012 575 a Actual 13 9/2612012 -2%
8/1/2012 563 aActual 13 6/20/2012 11%
5/1/2012 550 aActual 12 3/14/2012 17%
2/1/2012 537 aActual 10 12/15/2011 -54%
11/1/2011 525 aActual 22 9/14/2011 103%
8/3/2011 515 a Actual 10 6/13/2011 -6%
5/3/2011 493 a Actual 12 3/15/2011 3%
2/7/2011 483 a Actual 11 12/13/2010 -37%
11/2/2010 471 aActual 17 9/13/2010 60%
8/2/2010 460 a Actual 11 6/9/2010 9%
5/5/2010 443 aActual 10 3/11/2010 -18%
2/2/2010 432 aActual 12 12/11/2009 16%
11/3/2009 422 aActual 11 9/11/2009 -45%
8/5/2009 410 a Actual 19 6/16/2009 20%
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11/5/2008 365 aActual `( � �j 16 9/1202008 -11%
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