HomeMy WebLinkAboutTitle V Inspection Report - 855 WINTER STREET 10/12/2016 Vt D.I,-,. 4
CLARK
DJF". CLARK INC,
YFFLE V
SEPYIC SYSUM PROFESSIONALS
INC. �
�a
RECEIVED
oc'r Y. of k,
TOWN OF N(A AN uOVER
V7 hrA�z�rM NT
October 21, 2016 V 4 M
Mr. & Mrs. Patrick Spain
855 Winter Street
North.Andover, MA 01845
RE: Title 5 Inspection
855 Winter Street, North Andover
Dear Patrick & Anna:
Please find enclosed the Subsurface Sewage Disposal System. Inspection Report for the
above referenced property. As noted on Part B (Certification) of the report, the system.
Passes the inspection criteria. This inspection is good for the next two (2) years; you may
extend the life of the inspection to three (3) years by having the septic tank pumped
annually (before anniversary date of inspection).
Thank you for allowing us to be of service to you on this project. Please contact us if you
have any questions regarding this matter.
Sincerely,
D.F. Clark, Inc.
George F. Norris
Title 5 Inspector
Enclosure
cc: V<orth Andover Board of Health
D.F. Clark, Inc.
ii4
PO Box 265 21A X/fitchel'l Rwd Ipswich, MA 0103£3
978-356-5638 Fax 978-356-5500 1-011 Fiec 888-t7F-CLARK
^
Commonwealth of Massachusetts
RECEIVED= N tl 5 OffaciaQ Q pec °on Form
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�
Subsurface Sewage Disposal System Form Not for Voluntary Assessments OCT w(3
855 Winter Street OF NORTH ANDOVER
Property Address HEALTH DEPARTMENT
Patrick &Anna S i
Owner Owner's Name
information is
required for every North Andover MA 0 1 845 October 12, 2016
page. City/Town Gieto Zip Code Date ufInspection
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 �������2�K U�����00�t~��n
MUinguu 0omm ^ ~~ General Information
~^
on the computer,
use only the tab 1. Inspector:
key m move your
oumnr-duoot George F Norris
use the return
key. of Inspecto
D.F. Clark, Inc.
Company Name
«�---� 22 Mitchell Road, P(} Box 265
Company Address
| swich MA 01938
^---~---^
City/Town State Zip Code
S78 S|4O51
Telephone Number License Number
B. Certification
| certify that | 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 mysb*nne. 1 mrn a DEP approved system inspector pursuant to Section 15.340 of
Title 5 /310CK8RL1S.0OD\.The system:
E Passes E] Conditionally Passes El Fails
Needs Further Evaluation by the Local Approving Authority
InspeN- v 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 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 mag|ono| 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 ofuse
at that time. This inspection does not address how the system will perform in the future under
the same wr different conditions of use.
t5ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page I of 17
Commonwealth of Massachusetts
Title 5 Official Inspects ®r
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick&Anna Spain
Owner owner's Name
information is every Andover MA 01845 October 12, 2016
required for every - ---
page. CityfTown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E 1 always complete all of Section D
A) System Passes:
a ® 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.
d
Comments:
Cleaned effluent filter in the septic tank at time of inspection. Manufacturer recommends filter be
cleaned on a yearly basis to prevent filter from clogging and possibly backing sewerage into
residence.
i -
i
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
l5ins•3113 Title 5 Official lnspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick&Anna Spain
Owner Owner's Name
information is North Andover MA 01845 October 12, 2016
required for every State Zip Code Date of Inspection
page Cityfrown
B. Certification (cunt.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
i
❑ 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
j pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y E] N E] ND {Explain below}:
❑ obstruction is removed E] Y ❑ N E] ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below}:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y El [I ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
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
Title 5 Dtfi6al Inspection Form:Subsurface Sewage Disposal system•Page 3 of 17
15ins•3113
Commonwealth of Massachusetts
Title 5 Official Inspection rm
Subsurface Sewage Disposal System form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick & Anna Spain
Owner
Owner's Name
information is
required for every North Andover MA 01845 October 12, 2016
-
page. City/Town 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 presence of ammonia nitrogen and nitrate nitrogen is equal
I' 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 f=ailure 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
El ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than f/2 day flow
t5ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick & Anna Spain
Owner Owner's Name
information is North Andover MA 01845 October 12, 2018
required for every
page. Cityrrown State Zip Code Date of Inspection
B. Certification (coat.)
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.
El Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
a ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
u
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
cesspool or privy is less than 100 feet but greater than 50 feet
❑ ® An portion of a c p y g
Any p
ll with no acceptable water quality analysis. This
from a private water supply we p q Y Y
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 forma
I
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" In Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
15ins•3113 Title 5 Official inspection Form,Subsurface Sewage disposal System•Page 6 of 17
Commonwealth of Massachusetts
x
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick &Anna Spain
Owner Owner's Name
information is North Andover MA 01845 October 12, 2016
required for every
page. CiEylTown 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
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
❑ ® this inspection?
® El Were as built plans of the system obtained and examined? (if they were not
available note as NIA)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® El Was the site inspected for signs of break out?
l
® ❑ Were all system components, excluding the SAS, located on site?
i
® ❑ 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) 1310 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
l5in5 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w 855 Winter Street
Property Address
Patrick & Anna Spain
Owner Owner's Name
information is
required for every North Andover MA 01845 October 12, 2016
page. Cityfrown State Zip Code Date of Inspection
D. System Information
Description:
Asper desi in plan
Number of current residents: 3
Does residence have a garbage grinder? ❑ Yes ® No
uIs laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
o information in this report.)
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 187 gpd
9 ( Y 9 (9p ))�
Detail:
'
September 17, 2014- September 12, 2016 = 136,000 gallons divided by 726 days = 187 gallons per
day
Sump pump? ❑ Yes ® No
Last date of occupancy: Currently
occupied
Commerciallindustrial Flow Conditions.
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day tgpdt
Basis of design flow(seatslpersonslsq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
15ins•3113 Title 5 Official Inspection Form:Subsuriace Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
t Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick&Anna Spain
Owner Owner's Name
information is North Andover MA 01845 October 12, 2016
required for every
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other (describe below):
General Information
Pumping Records:
According to owner, system was last pumped one
Source of information: year ago
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
Mow 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):
Septic tank, pump chamber, distribution box, soil absorption system
(sins•3113 Title 5 Olficiat Inspection Form;Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick&Anna 5 ain
Owner owner's Name
information is North Andover MA 01845 October 12, 2016
required for every
page. Cityfrown State Zip Code Date of Inspection
D. System Information (coat.)
Approximate age of all components, date installed (if known) and source of information:
System as-built is dated October 21, 2010 per Board of Health file,
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
1.42
Depth below grade: feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other (explain):
Distance from private water supply well or suction line. NIA
feet
d
Comments (on condition of joints, venting, evidence of leakage, etc.):
Building sewer pipe is in the slab floor. Unable to inspect
pipe.
I
Y
d
Septic Tank (locate on site plan):
.75
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
5'Wx10,5' Lx4' D
Dimensions:
Stud e de the 1$' Compartment= 2", 2"¢
g p Compartment= 1"
t5ins•3113 Title 5 Orfciat Inspection Form:Subsurface Sewage D;sposal System•Page 9 of 17
Commonwealth of Massachusetts
x
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick&Anna Spain
Owner Owner's Name
information is North Andover MA 01845 October 12, 2016
required for every
page. City[Town State Zip Code Date of Inspection
D. System Information (cant.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle
33"
Scum thickness 0" in both compartments
Distance from top of scum to top of outlet tee or baffle NIA
Distance from bottom of scum to bottom of outlet tee or baffle NIA
How were dimensions determined? Tape measure and Sludge Judge
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 and outlet tees are in place. Liquid level is normal. Pumping is not required at this time. Cleaned
effluent filter in second compartment at time of inspection. Septic tank is in good condition.
I
i
i
0
i� Grease Trap (locate on site plan):
Depth below grade: feet
u
Material of construction:
❑ concrete ❑ 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: Date
15ins•3113 Title 5 Official Inspection Form:Subsurface Sawage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Fran
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick&Anna Spain
Owner Owner's Name
information is North Andover MA 01845 October 12, 2016
required for every
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cunt.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
g Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
9
g Depth below grade:
0
i
i Material of construction:
u
El ❑ metal ❑ fiberglass ❑ polyethylene El other(explain):
Dimensions:
i.
Capacity:
iI gallons
3
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 Dtficiat 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
855 Winter Street
Property Address
Patrick&Anna Spain
Owner Owner's Name
information is
required for every North Andover MA 01845 October 12, 2016
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 0-1 —
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.):
Distribution box "d-box" is 5" below rade. Distribution is equal. There are no signs of leaks a or
solids carryover. Ran pump and observed good flow into the d-box. D-box is in good condition.
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.):
Pump and all three (3)floats are working properly. Pump chamber is in good condition.
0
n
* 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 3113 Title 5 Official Inspection Form:Subsurface Sewage Msposat System•Page 12 of 17
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick&Anna Spain
Owner Owner's Name
information is
required for every North Andover MA 01845 October 12, 2016
page, City/Town State Zip Code Date of Inspection
D. System Information (cant.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
9 ❑ leaching trenches number, length:
1 leach field -
® leaching fields number, dimensions: 12.82'W x 32' L
0
❑ overflow cesspool number:
❑ innovativelalternative system
i.
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Soil absorption system ("SAS") is under the front yard. There are no signs of ponding or hydraulic
failure. Inspected leach field with inspection camera and found it working properly.
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
15ins 3113 Title 5 Official Inspection Ferm.Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w 855 Winter Street
Property Address
Patrick&Anna Spain
Owner owner's Name
information is North Andover MA 01845 October 12, 2016
required for every
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
1
V
j
Privy (locate on site plan):
Materials of construction:
Dimensions
i`
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
[Sins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•age 14 of 17
Commonwealth of Massachusetts
u _ 'Tide 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 855 Winter Street
Property Address
Patrick &Anna Spain
Owner Owner's Name
information is
required for every North Andover MA 01845 October 12, 2016
page. CityrFown State Zip Code Date of Inspection
D. System Information (cunt.)
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
A-1 = 16'6" #1, #2 &43 have covers to grade
B-1 = 31'3"
A-2 = 15'6"
B-2 = 39'3"
A-3 = 19'5"
B-3 =495"
A-4 = 27'2"
B-4 = 359"
I
B
9
Garage
Water Sewer
o ' A
#2— Septic Tank (Outlet) #1 - Septic Tank (Inlet)
# - Pump Chamber B=4" vent
Paved 4" Vent line 32 Infiltrator
Driveway #4 Leach Field
Distribution
is
Box
�4swti_c1�, �
CAL
INC
Winter Street
t5ins•3733 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
+
Title 5 Official inspection Form
aSubsurface Sewage Disposal: System Form - Not for Voluntary Assessments
855 Winter Street
Property Address
Patrick&Anna Spain
Owner Owner's Name
information is
required For every North Andover MA 01845 October 12, 2016
page. City/Town State Zip Code Date of Inspection
D. System information (cunt.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
5
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
July 7 2010
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health - explain:
El Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database -explain:
j You must describe how you established the high ground water elevation:
is
Greg Saab performed soil testing on June 24, 2010 and observed ESHGW in both holes @ 60".
According to design plan the bottom of SAS is 4` above the E=SHGW in hole DH1. At time of
of inspection a site exam was made, site was level, no surface water was observed, house is on a
slab, and no shallow wells were located.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15ins•3l13 Title 5 Official€nspecucn 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
855 Winter Street
Property Address
Patrick&Anna Spain
Owner Owner's Name
information is North Andover MA 01845 October 12, 2016
required for every
page, Cityffown State Zip Code Date of Inspection
E. Report Completeness Checklist
® inspection Summary: A, B, C, D, or E checked
• Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
• System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
i
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i
s
3
i
3
I
S5ins•3113 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 17 of 17
V t L• I f IV I U I V v l I r �• J L J
osureunry Rovurd Card pnoreled an 1M V2016 12:59:54 PM by Tefd Hurley page 1
Town of North Andover
Tax Map # 210-104.8-0041-0000.0
Parcel Id 16366
855 WINTER STREET
SPAIN, PATRICK Since Jan 2012
NGUYEN,ANNA
855 WINTER STREET
NORTH ANDOVER, MA
01845
Class 101 Single Falnlly Property Type 1 Residential
Zoning2 1 Residential 2waning3 1 Residential
Slz*Total 2 Acres
FY 2017 u
UB Mailinq Index
Norne/Address 'type Loan Number Activeltnact, From Until
PATRICK SPAIN Owner
855 WINTER STREET
NORTH ANDOVER,MA 01$45
GREEN,HENRY Prevlou5 Customer Inaclive 9/812009
855 WINTER STREET
N.ANDOVER,MA
01645
BANK UNITED,)=SB Previous Customer Inactive 2/28/2011
7916 N.W. 148 STREET
MIAMI LAKES,FL 33016
U6 Account Maint_.
Account No T Cyclo Occupant Name Activelinactivs
Bldg Id.18034.0-855 WINTER STREET Last 13111111g Date 10/13/2010
3180063 03 Cycle W Active
UB Services Maintr
Account No.3180003
Service Code Rate Charge MultiplierlUsers
MISCFEE ADMIN FEE 0.03510 7.82 11
WTR WATER 01 ALL MATER SIZE 60.80 11
LIB Meter Maintenance
Account No,3100083
8arlal No Status Location Brand Type Size YTD Gone
13242152 a Active 00 METE METE w Water 0.63 0.63 498
Date Reading Cede Consomptlon Posted Date varlance
9/12/2016 054 a Actual 16 10/24/2016 -BOA
6/17/2015 939 a Actual 19 81212016 21%
3/14/2016 919 oActual 15 4/22/2018 •9%
12/14/2015 904 a Actual 17 1/20/2016 -2%
9/11/2015 $87 S Actual 17 10/16/2018 5%.
6111/2015 070 aActual 15 7/24/2015 .9%
3118/2015 955 a Actual 18 4/28/2015 -15%c
12/15/2014 831 aActual 19 1/1512015 13%
9/16/2014 81B a Actual 18 10/15/2014 -29%
5/1212014 800 a Actual 24 7116/2014 70%
3/13/2014 776 a Actual 14 4/11/2014 -6%a
12113/2013 702 a Actual 15 1/17/2014 7%
0/13/2013 747 a Actual 14 10/15/2013 20%
6114/2013 733 a Actual 11 7/24/2013 3%
3/20/2013 722 a Actual 12 4/22/2013 -12%
12/13/2012 710 a Actual 12 1/9/2013 -12%
0/10/2012 698 a Actual 15 10/15/2012 32%
6118/2012 693 a Actual 11 711012012 12%
3/2012012 672 a Actual 10 4114/2012 -211%
12/19/2011 662 a Actual 13 111712012 1%