HomeMy WebLinkAboutTitle V Inspection Report - 543 FOREST STREET 11/20/2017 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
543 Forest Street
Property Address
Douglas & Patricia Saal
Owner Owner;s Name
information i's
North Andover MA 01845 November 4, 2017
required
page. Q�� State� �-- Z�Code Date o/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 ofthe form. �
Important:When A. ��������UU����00��~��� �
filling out«onnn ��^ General Information
~" �
onthe computer,
use only the tab 1. Inspector: �
key tomove your
cursor do not peterF ReiU �
ueeNoogum �
key. Nam—-- -'~-- |
Peter F Reilly |
�---� 130Andover Street |
' A--_-
Andover MA 01810 �
^---~�--' Ci�/Tuwn State Zip Code �
978-375-3750 HE-033221 �
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 systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(31QCMR 18.0OO). The system:
Passes �l Conditionally Passes [l Fails
F-1 Needs F luation by theLocal AingAuthorih/
November 4, 2017
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
1O'0OQ8pdnrgreater, the inspector and the system owner shall submit the report tothe 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.
^^°°ThUsreport only describes conditions mtthe time ofinspection and under the conditions mfuse
mtthat time. This inspection does not address how the system will perform |nthe future under
the same ordifferent conditions pfuse.
mmo.doc'rev.ann noaoOfficial inspection Form:Subsurface Sewage Disposal System`Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
.°' 543 Forest Street
Property Address
Douglas & Patricia Saal
Owner Owner's Name
information is
required for every North Andover MA 01845 November 4, 2017
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:
® 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 -1ND (Explain below):
ti
d
I
15ins.doc•reg.8116 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
543 Forest Street
Property Address
Douglas & Patricia Saal �.
Owner Owner's Name
information isMA 01845 November 4, 2017
North Andover
required for every
page CitylTown e StatZip 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 (cont.):
❑ 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):
i
I
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
u
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
151ns.doc•rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal system•Page 3 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
543 Forest Street
Property Address
Douglas& Patricia Saal
Owner Owner's Name
information is North Andover _MA 01845 November 4, 2017
o
required for every State Zip Code date of Inspection
page. City/Town
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
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
El El clogged
of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ElDischarge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
F1 ❑ 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
15ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 4 of 17
Commonwealth of Massachusetts
p Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
543 Forest Street
Property Address
Douglas & Patricia Saal -
Owner Owner's Name
information is North Andover MA 01845 November 4, 2017
required for every — — ..—
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.
❑ ❑ 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 falls. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ 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 Elthe system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone ll 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.
I' Title 5 Official Inspection Form:Subsurface Sewage DisposaE System•Page 5 of 17
�. t5ins.doc•rev.6/16
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
s4" 543 Forest Street
Property Address
Douglas& Patricia Saal —
Owner Owner's Name
information is
required for every North Andover MA 01845 November 4, 2017
-- -- - �-
page. City[Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ 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
E] ® 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)]
B
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): 450
i
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w, 543 Forest Street
Property Address
Douglas & Patricia Saal _.
Owner Owner's Name
information is North Andover MA 01845 November 4, 2017
required for every
own State Zip Code Date of Inspection
page, CityT
D. System Information
Description:
This is an original system that includes a 1000 gallon septic tank, with two plastic access covers at
the surface. There is a d-box and a 4 line SAS (field)that is 25' x 40' (per design plan) located in the
rear yard. According to the notes on the design plan provided by the owner, the system was installed
in 1977. The design plan is dated 1976.
2
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:
not applicable-the house has a well for domestic water. It is in the front yard >100'from the SAS.
Sump pump? ❑ Yes ® No
current
Last date of occupancy: pate
Commercial/Industrial Flow Conditions:
nla
Type of Establishment:
p
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
B
Basis of design flow(seatslpersonslsq.ft., etc.): - w.
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? El Yes [I No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins.doc•rev.6116 Title 5 Official inspection Form:Subsurface Sewage Usposal System+Page 7 o€17
Commonwealth of Massachusetts
u Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
a°t 543 Forest Street _
Property Address
Douglas & Patricia Saal -
Owner Owner's[Name
information isNorth Andover MA 01$45 November 4, 2417
required for every _ --
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: date
Other(describe below):
General Information
Pumping Records:
owner- pumped on 51$12017
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 IIA system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
a
}
t5ins.doc•rev.61111 Title 5 Official lnspect€on Farm:Subsurface Sewage Disposal System•Page 8 of V
Commonwealth of Massachusetts
a Title 5 official Inspection Form
W Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
„ 543 Forest Street —
Property Address
Douglas & Patricia Saal ... -
Owner Owner's Name
information is North Andover MA 01845 November 4, 2017
required for every
State Zip Code Date of Inspection
page. Cityrrown
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
System is about 40 years old, installed in 1977.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
2271-26FI
Depth below grade: feet
Material of construction:
® cast iron ❑ 40 PVC ❑ other(explain): —
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Watertight, no evidence of leakage.
Septic Tank(locate on site plan):
i 1811- 20°
Depth below grade: feet
Material of construction:
6'
d ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
Top of tank is 1811-20° below the surface. Two plastic covers on risers at the surface.
i .
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
rectangular approx. 6' x 12'
Dimensions:
C1„
Sludge depth:
15ins.dvc-rev.6116 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
F p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
543 Forest Street
Property Address
Douglas & Patricia Saal
Owner Owner's Name
information isMA 01845 November 4, 2017
required for every North Andover
page. Cityffown State Zip Code Date of Inspection
D. System information (cont.)
Septic Tank(cont.)
Distance from tap 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
7"
811-911
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.):
Original cross-tank baffles appear to be 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
15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w„ 543 Forest Street
Property Address
Douglas & Patricia Saal —� —
Owner Owner's Name
Information isNnrth Andover _ MA
page. City/Town 01845 _ November 4, 2017
required for every State Zip Code Date of Inspection
page
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):
NIA m
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain):
Dimensions:
1 _
a Capacity: gallons
gallons per—day
Design Flow:
Alarm present: ❑ Yes F1 No
Alarm level: -- Alarm in working order: ElYes ❑ No
Date of last pumping: Yale
i
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). is copy attached? ❑ Yes El No
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
t5ins.doc-rev.6l16
Commonwealth of Massachusetts
N W Title 5 official Inspection Form
a n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w„ 543 Forest Street
Property Address
Douglas& Patricia Saal
Owner Owner's Name
information is b
North Andover MA 01845 November 4, 2017
required for every _.... —. �_ .�
page. CitylTown State Zip Code Date of inspection
D. System Information (cont.)
Distribution Box(if present must be opened)(locate on site plan):
W
Depth of liquid level above outlet invert
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.):
Four lines, all level and accepting effluent about evenly. Minimal solids carryover evident. The box
cover was between 3 and 4 inches below the surface. Therefore no riser is needed per town regs.
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):
u
If SAS not located, explain why:
The 4 line, g00 s.f. SAS (field) is shown on the design plan provided by the owner.
l5ns.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
f
i
s
Commonwealth of Massachusetts
Title 5 Official Inspection Form
} - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
543 Forest Street
Property Address
Douglas & Patricia Saal
Owner Owner's Name
information is
required for every North Andover MA 01845 November 4, 2017
_ _
page. City/Town state Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
1 field, 4 lines,
number, dimensions:
® leaching fields 20 x 45
❑ 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 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):
i. NIA
Number and configuration
9
a Depth–top of liquid to inlet invert
u
n
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
I
45ins.dac rev.$!16
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
•
1.
Commonwealth of Massachusetts
F Title 5 official Inspection Form
} Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
543 Forest Street —
Property Address
Douglas & Patricia Saal
Owner Owners Name
information is North Andover
page. CiMA 01845 November 4, 2017
required for every m
ty/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
._
Materials of construction: NIA
Dimensions —
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
i
1
l;
3 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
I'.
0
Commonwealth of Massachusetts
w a Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
543 Forest Street
Property Address
Douglas & Patricia Saal '
Owner Owner's Name
information is
required for every North Andover MA 01845 November 4, 2017
page. CIWTown 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
W4II
�Prorn S
P-orLh
ni J �
4-o ® P .
+ _1 P
SPS
15ins.doc•rev,6116 Title 5 Offidal inspection Form:subsurface Sewage Oisposa!System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official
Inspection Form
Subsurface Sewage Disposal SymtemnFornn - NotforVn|unbaryAuauoomentn
b43Forest Street
Property Address
Dou las & Pmbioia 8om|
Owner Owner's Name
information is North Andover MA 01845 November 4, 2017
,nnu|nwm,mv��
� State �pCodn oa/au�mapecovo
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D. System Information (cont.)
Site Exam:
0 Check Slope
F] Surface water
�
�l OheckceUor �
�]
Shallow wells
>41
Estimated depth tohigh ground water:
Please indicate all methods used to determine the high ground water elevation:
Obtained from system design plans unrecord
1S78
If checked, date ��--------- --
' ' ootv
Observed site(abutting property/observation hole within 150feet ofSAS)
Checked with local Board ufHealth -explain:
plansfile
Checked with local excavators, installers -(attach documentation)
Fl
Accessed UQG8database-explain:
U8(3S data ifi to the iha Testing data more reliable.
You must describe how you established the high ground water elevation:
1976 Design plan indicated no ground water in the SAS. Dry soils and grade changes in the area
indicate that ground water elevation should be well below the SAS. No surface water observed.
--__- _----_--_���_--_----__- -���
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
Commonwealth of Massachusetts
w Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
543 Forest Street
Property Address
Douglas& Patricia Saal
Owner Owner's Name
information isNorth Andover MA 01845 November 4, 2017
required for every - —
page. City/Town 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
0
I
i
t5ins.doc-rev.8116 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 17 of 17
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.
z ?
Peter F. Reilly
Inspector
November 4, 2017
i