Loading...
HomeMy WebLinkAboutTitle V Inspection Report - 25 ORCHARD HILL ROAD 6/24/2017 (2) Commonwealth of Massachusetts � °�=�N�� � ����°���0 N������������ ������ � Title �� �w�� � ������� �mm���������0��mm Form | Subsurface Sewage Disposal System Form ~ Not for Voluntary Assessments 25Orchard Hill Road ,�;r�perty Address Genr e R Barker Jr Owner Owner's Name information is required for every North Andover MA O184� June 24, 2017 ���-- � Date of|un»ooUun page. City/Town -- -- Inspection results must be submitted omthis form. Inspection forms may not be altered inany way, Please see completeness checklist mtthe end mfthe form. --------- Important:vvo"n A filling out form* ~"^ G`°^^~"^~~^ ^^~~~~ ~^~~^~^~^^ §������- onmeoompuu,� ��~- �m�V use only the tab 1� Inspector: �� kaytomnveynur ' ��� cursor do riot Peter F. Reilly use the return Name of Inspector key. Peter F. Reilly Q138Andover Street -6o m parry Address AndovarMA 01810 «--��--� Stam Zip Code 978'375-3750 HE-033221 Tefelpli"8ne N-u—mber License Number B. Certification | certify that | have personally inspected the sewage disposal system otthis 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. | arnoDEP approved system inspector pursuant toSection 16.24Oof Title 5 (J1DCMR 15.8DG). The system: E Passes El Conditionally Passes Fl Fails [l Needs Further Evaluation bythe Local Approving Authority June �01� -- ��v����� lnsp�e/ts gnatu)re�� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days ofcompleting 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, ifapplicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use mtthat time. This inspection does not address how the system will perform in the future under the same prdifferent conditions ofuse. m/ns.doo'rev.w`v Title nomciaiInspection Form:Subsurface Sewage Disposal ayste='Page 1u1, Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Orchard Hill Road -- Property Address George R. Barker Jr. Owner Owners Name information is North Andover MA 01845 June 24, 2017 required for every — — page. Cityfi'own 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: ® 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: ❑ 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): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 25 Orchard Hill Road Property Address _George R. Barker Jr. Owner Owner's Name information Is required for every North Andover MA 01845 Jure 24, 2017 __.� - -.— - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cant.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ 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 ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ 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 l5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title�����N�� �� �����N ���������=������� ����U���� �� N��� � ������N Nmm���������N��� p 0-�.� mmm Subsurface Sewage Disposal System Form ~ Not for Voluntary Assessments 25Orchard Hill Road GeqrqieR Bork*rJr. Owner Owner's Name information is North Andover MA 01845 June 24 2017 required for every page. ~^''~`~' p Code Date of Inspection B. Certification (cont.) 2. System will fail Health Sup9|ier, if any) determines that the system |mfunctioning |namanner that protects the public health, safety and environment: [l ThenyetemhaeenepticLankondsoi| abaorpUnnaystenm (SAS)andtheSASinvvithin 1OOfeet ofasurface water supply ortributary tnasurface water supply. n The system has o septic tank and SAS and the SAS is within a Zone 1 of public water supply. n The system has mseptic tank and SAS and the SAS iswithin 50feet Vfoprivate water supply well, �l The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or � more from aprivate water supply vve||°° i Method used hodetermine distance: / ** This system ponome ifthe well water analysis, performed eta 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 tVthis 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 Fl Backup ofsewage into fmuiUtyorsystem component due toovedoadador �� �� �� clogged SAS orcesspool ,=l Discharge nrponding ofeffluent hothe su�oouofthe ground orau�ooevvahero [l 2g� due tnanoverloaded orclogged SAS or cesspool Static liquid level inthe distribution box above outlet invert due tnanoverloaded orclogged SAS orcesspool Fl [l Liquid depth in cesspool is less than 8" below invert oravailable volume is less ', � �� /� �� than Y2daY 0ovv . Commonwealth of Massachusetts �����0�� �� ��^��������0 N����������4������ ����U���� � ��@�r �� ���� � ���N��N Nmmw��������N��m � Form Subsurface SmvvaBe �}impmsa| SystenmForrm ~ NotforVo|untnryAaeooam�nts 2bOrchard Hill Road Property Address Georcie R Barker Jr. OwnorOwn��aNamo information is North Andover MA 01845 June 24, 2017 required for every PoO*. —Owrl- -State— Zip Code Date of Inspection B. Certification (cont.) Yes No Required pumping more than 4times |nthe last year NOT due toclogged or obstructed pipe(e). Number oftimes pumped: _____. Any portion of the SAS, cesspool or privy is below high ground water elevation, �l [l '�� Any portion within^^�� tributary toasurface water supply. Fl [l Any portion ofacesspool orprivy iswithin oZone 1 ofapublic well. � ' E] Any portion of a cesspool or privy is within 50 feet of a private water supply well. [l 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 noacceptable water quality analysis. [This system passes 1fthe well water analysis, performed mtuDEP certified laboratory,for fecal moUformmbacteria indicates absent and the presence #fammonia nitrogen and nitrate nitrogen |eequal tomrless than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain ofcustody must hmattached tmthis Yormm.] �l F� Theoyatemimaoeuspoo| men/ingmfaoi|ityvvithmdeaignf|ovvnf2O0OQpd- �� �� 10.000gpd. The system fails. ihave determined that one ormore ofthe above failure criteria exist aadescribed in310CMR 15.3U3, therefore the system fails. The system owner should contact the Board ufHealth todetermine what will be necessary tncorrect the failure. E\ Large Systems: To be considered mlarge system the system must serve afacility with a design flow wf10'OU&gpdto16'OOWgpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions inSection D. Yes No [l n the system is within 4OOfeet ofn surface drinking vvahar supply Fl [l the system is within 200 feet of a tributary to a surface drinking water supply �� Fl the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— |VVPA) oramapped Zone || ofepublic 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 ofthe Department. ����N0�����Uth �f ������chuse�s = �� ���4�N�� �� ��'���������N N����������^�N���� ����W~��� mm���~ �� ��� wm��m��m �� m����~=~���_-� " �~~ ~ . ~ Subsurface Sewage Disposal System Form ~ Not for Voluntary Assessments 25Orchard Hill Road Property Address George R Barker Jr. Owner Owner's Name information is North MA 01845 June State Zip Code Date of I I24, 2017 required hrevery spection page. ~^r'~`'~ C. Checklist Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yen No E [l Pumping information was provided by the owner, occupant, or Board of Health E Were any ofthe system components pumped out inthe previous two weeks? [] Has the system received normal flows |nthe previous two week period? Fl 1 � Novo|arge volumes of water been introduced to the system recently orae part of �� �� this inspection? �U Fl ` were�� �� available note oo N/4\ E El Was the facility ordwelling inspected for signs ofsewage back up? Was the site inspected for signs ofbreak out? Were all system components, excluding the SAS, located onsite? �� Fl VVorethe septic tank manholes uncovered, opened, and the interior nfthe tank -- -� inspected for the condition of the baffles ortees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? VVoethe facility owner/andoccupants ifdifferent fnomnuwner) providedv�th E �l informotiononthepro `ermaintenonoeofmubsu�ooeaewmg' disposal systems? The size and location ofthe Soil Absorption System (SAS) onthe site has been determined based on: Z Fl Existing information. For example, a plan at the Board of Health. Determined in the field <ifany ofthe failure criteria related to Part<� is at issue E] F7 opproximohonnfdistance imunacceptable) [310CMR 15382/5\] D. System Information Residential Flow Conditions: N/4m/* Number ofbedrooms (design): -------- Number nfbedrooms (aobua|): ----��----- 660 DESIGN flow based on310CMR 15.203(for example: 11Ogpdx#ofbedroonnn>: -------��- Commonwealth of Massachusetts u Title 5 official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Orchard Hill Road Property Address George R. Barker.Jr. Owner Owner's Name information is North Andover MA 01845 June 24, 2017 required for every —_ --- — page. City/Town State Zip Code Date of Inspection D. System Information Description: The property is a commercial use. The system includes a 1500 gallon septic tank, with two iron access covers at the surface of the parking lot along the left side of the building. There is a d-box and a 6 line SAS (field)that is 30'x 35'(per design plan) located in the front yard. Design flow based on 66 people at 10 gpd =660 gallons. According to the"as-built" plan, the system was installed in December of 1997. The design plan is dated March of 1997. NIA 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? ❑ Yes No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: see below Sump pump? ❑ Yes ® No current Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: gymnastics school Design flow(based on 310 CMR 15.203): Gallons per day(gpd) 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: 13,100 cu.ft. 1730 days = 17.945 cu.ftlday x 7.5 = 1,35 gpd _ 15ins.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 25 Orchard Hill Road Property Address George R. Barker Jr. Owner Owner's Name information is North Andover MA 01845 _ ,lune 24, 2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) Last date of occupancy/use: current Date Other(describe below): General Information Pumping Records; Source of information: owner- pumped by Stewarts on 5131117 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 IIA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins.doc•rev.6118 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts s Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Orchard Hill Road Property Address George R. Barker Jr. Owner Owner's Name information is North Andover MA 01845 June 24, 2017 required for every _ — - . page. CItylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System is nearly 20 years old, "as built" plan dated December 1997. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 14"-16" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet m Comments (on condition of joints, venting, evidence of leakage, etc.): Watertight, no evidence of leakage. Septic Tank(locate on site plan): 10"- 12" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Top of tank is 10"-12" below the pavement. Iron cover and short riser to surface. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes 0 No rectangular approx. U x 12' Dimensions: <1, Sludge depth: t5ins.doc•rev.6116 Title 5 Ofridal Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'' 25 Orchard Hill Road Property Address George R. Barker Jr. Owner Owner's Name information is North Andover MA 01845 June 24, 2017 required for every -. — – page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 21 -22 <1„ Scum thickness Distance from top of scum to top of outlet tee or baffle 6' - 7 Distance from bottom of scum to bottom of outlet tee or baffle - m_ How were dimensions determined? design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is entirely below the paved parking lot.Two iron access covers at the surface. PVC Tees in good condition. Tank was observed to be water tight and functioning property. Tank was pumped more than two weeks prior to the inspection. Grease Trap(locate on site plan): NIA Depth below grade: feet 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 l5ins.doc•rev.6116 Title 5 Official tnspeclion Form:Subsurface Sewage Usposal System•Page 10 of 17 Commonwealth of Massachusetts F W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'� 25 Orchard Hill Road Property Address George R. Barker Jr. Owner Owner's Name information is required for every North Andover MA 01545 June 24, 2017 --.. . .— .. . 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: NIA 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.doc•rev.6/16 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I Commonwealth of Massachusetts u W Title 5 official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments „ ..' 25 Orchard Hill Road Property Address George R. Barker Jr. Owner Owner's Name information is required for every North Andover MA 01845 June 24, 2017 ... _.— —. _. page. City/Town State Zip Code Date of Inspection D. System Information (cant.) Distribution Box(if present must be opened)(locate on site plan): 11 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.): Six lines, all level and accepting effluent evenly. Minimal solids carryover evident. The box cover was slightly less than 3' below the surface. Therefore no riser is needed per town regs. Soils are sandy, easy digging. 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.): NIA * 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: The 6 line SAS (field) is shown on the"as-built" plan. t5ins.clac•rev.6116 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Orchard Hill Road Property Address George R. Barker Jr. Owner Owner's Name information is North Andover MA 01845 June 24, 2017 required for every State ate Zip Code Date of Inspection page City/Town D. System Information (cont.) Type: ❑ leaching pits number: -- ❑ leaching chambers number: ❑ leaching galleries number: — ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 field, 6 lines,30'x 35' ❑ overflow cesspool number: J ❑ innovativelalternative system Type/name of technology: — W Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils in the area of the SAS appeared normal, no evidence of breakout. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NIA Number and configuration Depth–top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool — Materials of construction – i Indication of groundwater inflow ❑ Yes ❑ No i i l t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Orchard Hill Road Property Address George R. Barker Jr. Owner Owner's Name information is North Andover MA 01845 June 24, 2017 required for every page. CitylTown 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: NIA _ Dimensions Depth of solids - _— Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5lns.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 25 Orchard Hill Road Property Address George R. Barker Jr. Owner Owner's Name information Is North Andover MA 0'1845 June 24, 2017 required for eery page. CitylTown State Zip Cade 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 oQ 4 -.-.... � C/i t— Co 4? U T168i 0 4� TANKS CORERS AT.SURFACE U D-BOXII LOY 1 2A B to Boxi 98.6'(corner of bldg.) 8©1000 5Q'. F7. _ C to Boxtt 69.9'(hydrant] i i i t5lns.doc•rov.6116 Title 5 Official inspect on Form:Subsurface Sewage Disposal System•Page 15 of 17 !i I I Commonwealth of Massachusetts w Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Orchard Hill Road Property Address George R. Barker Jr. Owner Owner's Name w. m information is North Andover MA 01845 _ June 24, 2017 required for every —._ page CkylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells >4' 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 n Ian reviewed: 3/2/1997 (revised) If checked, date of design P Date ..... .._ ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: plans on file ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: USGS data non-specific to the site. Testing data more reliable. You must describe how you established the high ground water elevation: 1997 Design plan indicated no ground water in the SAS. Dry soils and grade changes in the area indicate that ground water elevation should below the SAS. No surface water observed. The building is on slab, so there is no basement. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposaf System•Page 16 of 17 Commonwealth of Massachusetts u u Title 5 official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 25 Orchard Hill Road Property Address George R. Barker Jr. Own er Owner's Name information is North Andover MA 01845 June 24, 2017 required for every - page. Cityfrown 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 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 d: y; u i1 9 DISCLAIMER This passing septic inspection under Massachusetts Title V is in no way a guaranty or warranty of the inspected septic system. The inspection is a "snapshot in time" and does not constitute a complete assessment of the quality or potential longevity of the septic system. The pass/fail criteria are specific and outlined in detail in this report. Under the limited criteria of a Title V inspection, it is impossible to determine how long any septic system will last. The inspector made a diligent effort to certify the septic system based on the criteria required under Title V. Under Massachusetts Title V, soil evaluation is the accepted method of determining the high groundwater elevation. This inspector is not a certified soil evaluator and is therefore not qualified under Title V to determine or establish the high groundwater elevation. The method used to estimate the high groundwater for this inspection was based on the public records and methods of observation described on the previous page. Groundwater levels can vary greatly from season to season, year to year and soil evaluation is considered the most reliable method of groundwater determination under Title V. Peter F. Reilly Inspector June 24, 2017 is Summary Record Card generated on 71111201712:01:32 PM by Karen Hanlon page 1 Town of Noah Andover � Tax Map # 210-034.0-0052-0000.0 Parcel Id 10066 i 25 ORCHARD HILA, ROAD i 9 GEORGE BARKER 1267 OSGOOD STREET NORTH ANDOVER, MA 01846 Class 376 Gymnasiumslathletic Clubs _ Property Type 3 Commercial Zoning2 3 Commercial Zoning3 3 Commercial Size Total 1.84 Acres FY 2017 UB Mailing Index I — Name/Address ress Type Loan Number Activellnact, From Until GEORGE � R Payor l 1267 OSGOOD STREET NORTH ANDOVER,MA 01845 s a UB Account Maint. t Account No Cycle Occupant Name Activelinactive Bidg Id. 15288,0-25 ORCHARD HILL ROAD Last Billing Date 611912017 2120130 02 Cycle 02 Active t i UB Services Maint. .1 Account No.2120130 Service Code Rate Charge MultipiieriUsers MISCFEE ADMIN FEE 1 1 9,18 11 WTR WATER 01 ALL METER SIZE 98.20 11 UB Meter Maintenance Account No,2120130 Serial No Status Location Brand Type Size YTD Cons 13240283 a Active ERT HH METE METE w Water 1 1 987 Date Reading Code Consumption Posted Date Variance 5/8/2017 1577 aActual 24 6/2612017 53% 211012017 1553 a Actual 17 3/14/2017 7% 11/8/2016 1536 a Actual 15 12/19/2016 29% 8/11/2016 1521 a Actual 12 9/2112016 -320 i 5111/2016 1509 a Actual 17 6/21/2016 10% 2/12/2016 1492 a Actual 17 3/28/2016 7% 1116/2015 1475 a Actual14 0 1% 8/1212015 1461 a Actual 15 9114/2015 15 f -i8°10 � 5/13/2015 1446 a Actual 18 6/22/2015 -230o 2/13/2015 1428 a Actual 26 3/2012015 16% 11/6/2014 1402 a Actual 19 12/15/2014 -13% t 8114/2014 1383 a Actual 24 9/11/2014 .5% 5/14/2014 1359 a Actual 25 6/12/2014 -44% 2/12/2014 1334 a Actual 48 3/17/2014 108% 11/612013 1286 a Actual 20 12120/2013 35% 8/13/2013 1266 a Actual 16 9/18/2013 -54% 5/13/2013 1250 aActua1 34 6/18/2013 1% 2/1312013 1216 a Actual 38 3/13/2013 13% 11/5/2012 1178 a Actual 28 12113/2012 89% 8/14/2012 1150 a Actual 17 9/26/2012 -50% 5/11/2012 1133 a Actual 31 6/20/2012 -50% 2/14/2012 1102 a Actual 70 3/14/2012 58% 11/7/2011 1032 a Actual 39 12/15/2011 15% 8/12/2011 993 aActual 36 9/1412011 -59% 5/12/2011 957 a Actual 86 6/13/2011 78% 2/11/2011 871 a Actual 51 3/15/2011 89% 11/8/2010 820 aActual 25 12/13/2010 19% a 8/12/2010 795 a Actual 22 9/13/2010 11% 5/1212010 773 a Actual 20 619/2010 -32% 1 t i i t