HomeMy WebLinkAboutTitle V Inspection Report - 851 FOREST STREET 11/14/2017 Commonwealth of Massachusetts RECEIVED
1
Title 5 Official Inspection Form N( V4
8 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments TOWN OF NORTH ANDOVL,,R
HEALTH DEPARTMENT'
851 Forest Street
Property Address
Christopher De Resende (508 Essex St. §�Mqs Ma. 019
Owner Owner'sName
information is
required for every North Andover Ma, 01845 11/1/17
page. City/Town State Zip Code Date of inspection—"---------
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When —--------
filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Ron Jenkins
use the return
key. Name of Inspector
R. Jenkins & Sons
ray 6om_panyName
58 Pleasant St.
GOAddress
M�a"ny,
fir
Rowle Ma. 01969
City/Town State Zip Code
978-3 1 4-0503 S14268
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 Q Conditionally Passes Fails
❑ Needs Further Evaluation by the Local Approving Authority
_45�_ -4, 11/1/17
-Fnspector's Signature Date
The system inspect ir 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 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systern-Page 1 of 17
Commonwealth of Massachusetts
F Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
851 Forest Street
Property Address
Christopher De Resende 508 Essex St. Sau us Ma. 0190-6)
Owner Owner's Name
information is North Andover Ma. 01845 1111117
required for every _
page. City/Town 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:
❑ 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:
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 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
i
Commonwealth of Massachusetts
v, Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
851 Forest Street
Property Address _.
Christopher De Resende 508 Essex St. Sau us Ma. x1906
Owner Owner's Name
information is North Andover Ma. 01845 11/1117
required for every _
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
t5ins•3113 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
9 ' 851 Forest Street
Property Address
Christopher De Resende 508 Essex St. Sau us Ma. 01906
Owner Owner's Name
information is
required for every North Andover Ma. 01845 1111117 _
_
page. Cityrrown State Zip Code Date of inspection
B. Certification (cant.)
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 60 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 DI=P 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
® ❑ 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 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 %day flow
t5ins-3113 Title 6 Official Inspection Fonn:Subsurface Sewage Disposa$System•Page 4 of 17
Commonwealth of Massachusetts
y Title 5 official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
. 851 Forest Street
Property Address
Christopher De Resende 508 Essex St. Sauclus Ma. 01908
Owner owner's Name
information is North Andover Ma. 01845 1111117
required for every _
page. Cityrrown 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.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® 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 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
❑ ❑ 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
j regional office of the Department.
i t51ns•3113 Title 5 Drfirial Inspection Farm;Subsurface Sewage Disposal System•Page 5 of 17
i
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,v 851 Forest Street
Property Address
Christa her be Resende 508 Essex St. Saugus Ma. 01906
Owner Owner's Name T
information is
required for every North Andover Ma. 01845 1111/17
page. CityfTown 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?
❑ ® 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?
® ❑ 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): N/A Number of bedrooms (actual): 4
DESIGN flaw based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A
t5ins•3113 Tille 6 Official fnspeclion 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
„ 851 Forest Street
Property Address W
Christopher De Resende (508 Essex St. Saugus Ma. 01906)
Owner Owner's Name
information is North Andover Ma. 01845 1111117
required far every .�.
page. CitylTown State Zip Code [late of Inspection
D. System Information
Description:
Number of current residents: 0
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
Seasonaluse? ❑ Yes ® No
Water meter readings, if available(last 2 years usage (gpd))= 136,500 total
Detail:
136,500 1 730= 186.9 gallons per day _
Sump pump? ® Yes ❑ No
Last date of occupancy: vacant 6-12
months ?
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/sci t., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ Na
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-3113 Title 5 O€ficia$Inspection Form:Subsurface Sewage Disposal System•Page 7 o€17
I
Commonwealth of Massachusetts
rD
Title 5 official Inspection Form
a _ _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
851 Forest Street
Property Address _
Christopher De Resende (508 Essex St. Saugus Ma. 01906 ._ .____
Owner Owner's Name _
information is _North Andover Ma. 01845 1111117
required for every _ _W._
page. CityfFown State Zip Code [late of Inspection
D. System information (cont.)
Last date of occupancy/use: pate
Other(describe below):
General Information
Pumping Records:
Source of information: Last pumped unknown
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 flank, 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):
15ins•3113 TiRe 6 Official Inspecfion Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
851 Forest Street
Property Address —
Christopher De Resende 508 Essex St. Saugus Ma. 01906
Owner Owner's Name
information is North Andover Ma. 01845 11/1117
required for every
page. Cityrrown _ State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
original system installed in 1970, the system I inspected appears to be newer but no info. at health
dept.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 36"feet
Material of construction.,
® cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: n/a
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
condition ofloints good, proper venting, no evidence of leakage
Septic Tank(locate on site plan):
Depth below grade: 2611
feet
Material of construction:
® concrete ❑ metal E)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 ❑ Na
8'x5'x5'dp.
u
Dimensions: —
a
Sludge depth: 6"
t5ins-3113 Tifle 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 9 of 17
4
1
Commonwealth of Massachusetts
Tine 5 Official Inspection Form
E Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Y
851 Forest Street
Prgpedy Address
Christopher De Resende (508 Essex St. Saugus Ma. 01966) ..
Owner owner's Name
information is north Andover Ma. 01845 1111117
required for every - —
page. Cityrrown 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
28"
V"
Scum thickness --
611
Distance from top of scum to top of outlet tee or baffle _.
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? Measuring stick and ruler
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 appears to be leaking, 1" below outlet invert. no inlet baffle or tee, outlet tee is good, structural
irate rit is fair. tank will be um ed when s stem is re laced
Grease Trap (locate on site plan):
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 —
u
9 Date of last pumping: Date
i
¢g t5ins•3113 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 10 o€17
t
i
Commonwealth of Massachusetts
x Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
851 Forest Street
Property Address
Christopher De Resende X08 Essex St. Saugus Ma. 01906)
Owner owner's Name
information is
required for every North Andover Ma. 01845 1111117
- -- �
page. Cityrrown 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:
❑ 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: mate
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins-3113 Title 6 official Inspection Fonn:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
851_Forest Street
Property Address
Christopher De Resende (508 Essex St. Saugus Ma. 01906)
Owner Owner's Name
information is
required for every North Andover Ma. 01845 1111117
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 01
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.):
box was level and distribution was equal, some carryover, no evidence of leakage into or out of box
Box is 36" below grade, size of box 16"x96"x13"dp.
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:
t5ins-3113 Title 5 Official Inspection Farm: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
- 851 Forest Street
Property Address
Christopher be Resende (508 Essex St. Sauqus Ma. 01906)
Owner owner's Name
information is
required for every North Andover Ma. 01845 _ 1111117
page. Cityfrown State Zip Code Date of Inspection 1
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
® leaching trenches number, length: 37'
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovativelalternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
gravely soil, signs of hydraulic failure, no ponding, leach trenchs are located in back of house under
mowed grass. Ran snake with locater on end to determine trench length is 37'. 1 ran camera down
other trench and found there was 1.5"of solids in pipe, could not qo more than 5' into pipe
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-SM Title 5 Official Inspection f=orm:Subsurface Sewage Disposal System Page 13 of 11
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
851 Forest Street
Property Address _
Christopher De Resende (508 Essex St. Saugus Ma. 01906) _
Owner Owner's Name
information is North Ma. 01845 1111117 Andover
required for every w _._
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:
Dimensions
Depth of solids -
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•$113 Title 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
y'r 851 Forest Street
Property Address
Christopher De Resende 508 Essex St_ Saugus Ma. 01905)
Owner
Owner's Name
information is North Andover
required for every _ Ma, 01845 1111117
page, Citylrown 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
SU
7,-14/4" ®� ice ✓*��f'
A —43
) c s ,
D
ill 2. f �
15ins-3113 Title 5 Official Inspection 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
„ 851 Forest Street
Property Address
Christopher De Resende (508 Essex St. Saugus Ma. 01906)
Owner owner's Name
information is North Andover
required for every _ Ma. 01845 11/1117
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
® Check cellar
❑ Shallow wells
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: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health-explain:
Info. from next door 150 Laconia Circle)
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
seasonal high water at 93.80 = 6.7' below grade
test date 4122188 test Conducted by Joseph Barbagallo witnessed by M.Graf
Note: within 30' of system basement has 2 sump pumps both approx. 64" below grade
Leach trenchs are 46" below grade.
Also Note: Washing machine was empting into one of the sump pumps
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
I
t5ins•3113 Tito 5 Official Inspection Form:Subsurface Sewage Msposa$System•Page 16 of 17
s
1
Commonwealth of Massachusetts
p Title 5 official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
851 Forest Street
Property Address
Christopher De Resende (508 Essex St. Saugus Ma. 01906)
Owner Owner's Name
information is North Andover Ma. 01845 1111117
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•3113 Title 5 Otfioiel Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Summary Record Card generated on 11!712017 1:34:21 PM by Karen Hanlon Page 1
Town of North Andover
Tax Map # 210-105.D-0162-0000.0
Parcel Id 17123
851 FOREST STREET
LINUENBERG OLIVERA
851 FOREST STREET
NORTH ANDOVER MA 01845
Class 101 Single Family ~W - Property Type 1 Residential
Zoning2 1 Residential Zoning3 1 Residential
Size Total 1.14 Acres
FY 2018
UB Mailing Index
Name/Address Type Loan Number Activelinact. From Until
LINDENBERG OL(VERA Owner i
851 FOREST STREET
NORTH ANDOVER NIA 01845
WYSOCKI,LISA Payor Inactive 6121/2017
851 FOREST STREET
NORTH ANDOVER,LMA
01845
ALTISOURCE SINGLE FAMILY INC. Previous Customer Inactive 1011812017
PO BOX 905265
ATLANTA GA 30348
E
I
UB Account Maint. ,
Account No Cycle Occupant Name ActivelInactive
Bldg Id, 17548.0.851 FOREST STREET Last Billing Date 10/10/2017 t
3170218 03 Cycle 03 Active
t
UB Services Maint. E
Account No.3170218
Service Code Rate Charge MultiplierlUsers
MISCFEE ADMIN FEE 0.635/8 7.82 1/
WTR WATER 01 ALL METER SIZE /1
UB Meter Maintenance
i
I
Account No.3170218 l
Serial No Status Location Brand Type Size YTD Cons s
36153063 a Active ERT HH b Badger w Water 0.63 0.63 651
Date Reading Code Consumption Posted Date Variance
10/10/2017 635 f Final Bill 0 10/10/2017 -100% g
6/8/2017 635 a Actual 3 7/25/2017 -85%
3/8/2017 632 a Actual 19 4112/2017 -41%
12/9/2016 613 a Actual 33 112312017 87%
9/9/2016 580 a Actual 18 10124/2016 -46%
61812016 562 a Actual 33 8/2/2016 -28%4
318/2016 529 a Actual 45 4/22/2016 45%
12/9/2015 484 aActual 31 1/20/2016 14% a
9/10/2015 453 a Actual 28 10/16/2015 -23%
6/9/2015 425 a Actual 35 7/24/2015
3/11/2015 390 aActual 39 4/28/2016 33%
12110/2014 351 aActual 29 1/15!2015 2%4
9/11/2014 322 a Actual 29 10/15/2014 30%
6/11/2014 293 a Actual 22 7/16/2014 -18%
3/12/2014 271 a Actual 27 4/1112014 -20%
12/10/2013 244 a Actual 33 1117/2014 15% t
9111/2013 211 a Actual 29 10/15/2013 -22%
6112/2013 182 a Actual 37 7/24/2013 50%4
3/13/2013 145 a Actual 25 4/22/2013 0%4
12/11/2012 120 a Actual 24 11912013 62%
9/14/2012 96 a Actual 16 10/1512012 •4%0
6/11/2012 80 aActual 16 7/16/2012 3%
I
C
2F
i
t
t