The URL can be used to link to this page

Home My WebLink AboutTitle V Inspection Report - 300 RALEIGH TAVERN LANE 12/7/2017 Commonwealth of Massachusetts 47 it 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments '300 Ra Tavern Lane iaIgp ............. Or-o—pe–rty,Address Arvind Ramani Owner Owner's Name information is required for every North Andover MA 01845 November 29, 2017 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 James R. Kellett use the return key. Name of Inspector ........... Kellett Excavating LLC VQ Company Name 400 Salem Street ................. Company Address Lynnfield .......... MA 01940 City/Town State Zip Code 781-599-7934 5113463 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 16.340 of Title 5 (310 CMR 15.000). The system: Passes, ❑ Conditionally Passes El Fails eeds Further Evaluation L the by I Approving Authority by the L December 2 2017 t Yspecor's Sign re 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 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 | � ' ^ Commonwealth of Massachusetts Tit0 e 5 Official Inspection nspec °onForm Subsurface Sewage Disposal Bysbmnn Form - Not for Voluntary Assessments 300 Ra|ai h Tavern Lane Property Address Arvind Ramemi Owner Owner's Name information is required for every North Andover MA 01845 November 29, 2017 page. Cityrrown State Zip Code Date ofInspection B. Certification (cont.) Inspection Summary: Check A'B,C,Q or E/always complete all of Section D A> System Passes: | have not found any information which indicates that any of the failure criteria described in31OCMR 16.303orin310CMR 15.304exist. Any failure criteria not evaluated are indicated below. Comments: Everything | �i | 13> System Conditionally Passes: F] One ormore system components asdescribed inthe "Conditional Pass" section need tnbe replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board ufHealth, will pass. Check the box for"yea''. "no" ur"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 isless than 2Oyears old ioavailable. EJ Y N R ND (Explain below): mm^ooc'rev.axo Title nOfficial Inspection Form Subsurface Sewage Disposal System'Page,of,r / Commonwealth of Massachusetts xTitle 5 Official ) i -- m' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Ko 300 Ralaigh Tavern Lane Property Address Arvind Ramani Owner Owner's Name information is required for every North Andover MA 01845 November 29 2017 � page. City1Town 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 (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 its 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts =�'=.�0 �� Official 0 0 ��= Form � Title N��0�� 0�� 0=0�� N �� /� � � � � D—��m � � m m �� m�� m�� w��mu Subsurface Sewage Disposal SystermForrn - NotforVo|untaryAeneeannents 300Ra|oi hTevernLgo ------ Property Add*eeo Arvind Ramoni Owner Owner's Name information i's required for every North Andover MA 01845 November 29, 2017 ----- page. City/Town State Zip Code Date nfInspection B~ Certification (cOOt.) 2- System will fall 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: El The system has a septic tank and soil absorption system (SAS) and the SAS is within 1OOfeet ofasurface water supply ortributary toosurface water supply. �lThe system has a septic tank and SAS and the SAS iewithin oZone 1ofapublic water supply. The system has a septic tank and SAS and the SAS igwithin 5Ofeet Vfaprivate water supply well. �] The system has oseptic tank and SAS and the SAS inless than 1OOfeet but 5Ofeet or more from a private water supply vve||^* Method used todetermine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence ofammonia 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 baattached huthis form. 3. Other: 0) System Failure Cr|bmr|m Applicable to AN Systems: You must indicate '"Yas" pr"No''tmeach ofthe following for all inspections: Yen No �l �� Backup Pfeewvagainto facility orsystem uornponentdue tomvedoodedor �� clogged SAS urcesspool �� Discharge nrponding ofeffluent bothe au�aoeofthe ground oruu�aoem/utero �� due tVaOoverloaded Vrclogged SAS orcesspool �� Static liquid level inthe disthbubonbox above ouUatinvo�due toanovedooded �� orclogged SAS urcesspool �l �� Liquid depth incesspool ieless than 6^ be|ovvinvm�oravailable vo|urne |oless �� than }6day flow wm"»oc^rev.om Title xOfficial inspection Form:Subsurface Sewage Disposal System'Page*un | � Commonwealth 0fMassachusetts =�"��0�� =��°��0 N��"�� N"H�� N ��N�� /� � ��*0�*N Inspection �-�~mmmn Subsu�acmSeuuageDisposal SymtmmmFwvmn -N��forVo|unt�ryA��ee�m�ntn 300Ho|ai h TavernLanm PmpmrtyAddress ArvindRamoni Owner Owner's Name information is required for every North Andover MA 01845 November 29, 2017 page. C|tyfTmwn State Zip Code Date ofInspection B. Certification (cont.) Yea No �� times�� obstructed pipe(a). Number oftimes pumped: ____. [l 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. �l �� Any podiunofcesspool orprivy isvvithin1QOfeet ofaou�acevvetersupply or �� = tributary toa surface water supply. F-1 Any portion ofacesspool orprivy iawithin aZone 1 ofapublic well. El N Any portion of a cesspool or privy is within 50 feet of a private water supply well. �� Any � ^~ �~ � from a private water supply well with no acceptable water quality analysis. [This � system passes ifthe well water analysis, performed mtmDEP certified laboratory,for fecal coliform bacteria indicates absent and the presence ofammonia nitrogen and nitrate nitrogen |sequal tmonless than 5ppm, provided that noother failure criteria are triggered. Acopy wfthe analysis and chain mfcustody must be attached hmthis fnrmn'] �l �� The syebmm |oenasspou| aarvingahaoi|ityvvithadeeign �owof2OOOgpd- �� 10.000gpd. Fl �� The eVstenmYa�s. | have determined that one ormore ofthe above failure �� criteria exist amdescribed in 310 CMR 15.302. therefore the system fails, The system owner should contact the Board ofHealth hodetermine what will be necessary to correct the failure. E) Large Systems: Tobeconsidered mlarge system the system must serve mfacility with a design flow mf1U,O00 gpdtoiS,0UMgpd. For large systems, you must indicate either"yee^ or''no" toeach ofthe following, |naddition tnthe questions inSection D. Yes No El 0 the system iawithin 40Ofeet ofmsurface drinking water supply El N the system is within 200 feet ofatributary too surface drinking water supply �l �� the system islocated inanitrogen senaiUvearea (|nhahnnVVe||headProtection �� Area- |VVPA) oramapped Zone || ofapublic water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, oranswered "yes" inSection D above the large system has failed. The owner oroperator ofany large system considered asignificant threat under Section E orfailed under Section [}shall upgrade the system inaccordance with 81OCMR 15.3O4. The system owner should contact the appropriate regional office ofthe Department. mmao""'rev.m1s Title oOfficial Inspection Form:Subsurface Sewage Disposal System^Page nm1, � Commonwealth of Massachusetts =�""��R�� .��*"��Q 0��°��"�� W�� Title �� »� � �� Inspection �-��m � mw Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 300Re|ai hTavern Lana PmpohyAddress AmindRamani Owner Owner's Name information i's naqu|�dforove� North Andover �A O1845 November 29, �O17 page. CitylTlxwm 8moe Zip Code Date ofInspection C. Checklist Check if the following have been dune. You must indicate"yea" or"no" as to each of the following: Yes No R 0 Pumping information was provided bythe owner, occupant, or Board of Health El H Were any ofthe system components pumped out inthe previous two weeks? Has the system received normal flows inthe previous two week period? Have large volumes ufwater been introduced bothe system recently oras part of this inspection? Were asbuilt plans nfthe system obtained and examined? (if they were not available note aeNA\) Z 1:1 Was the facility ordwelling inspected for signs ofsewage back up? Z El Was the site inspected for signs ofbreak out? Z F1 Were all oyebam cnmponenta, excluding the SAS. located on site? Z El 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 ofliquid, depth ofsludge and depth ofscum? �� VVasthe facility owner(and occupants ifdifferent hnmovvnehprovided vvith �� information on the proper maintenance of subsurface sewage disposal systems? The size and location o7the Soil Absorption System (SAS) onthe site has been determined based on: Z El Existing information. For example, o plan at the Board of Health. �l �� Determined inthe field (if any ofthe faUurecriteria related tuPa�Cisatissue �� approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: 44 Number ofbedrooms (design): ----- Number ofbedrooms (actual): 440 DESIGN flow based on 310 CMR 15.203 /foraxannp|a�. 11O gp�x#ofbedronmo)�� . Commonwealth of Massachusetts Title 5 Official Inspection Subsurface Sewage disposal System Form - Not for Voluntary Assessments ,�, / 300 Ralaigh Tavern Lane Property Address Arvind Ramani Owner Owner's Name information is required North Andover MA .01„845 November 29 2017 . ._ page, Cityffown State Zip Code Date of Inspection .—_..... D. System Information 1 Description: Number of current residents: 22nd of Nov. 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 records attached Water meter readings, if available (last 2 years usage gp : ............. - Detail: Sump pump? ❑ Yes ® No 11/22/2017 Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: _......._ _ ........................ �._._.... ......... Design flow(based on 310 M 5. . .._.................Gallons per day(gpd) Basis of design flow(seats/persons/sq,ft., etc.): - Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No j Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: _........_.._._ _...___._...... t5lns.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 ge,\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 300 Ralaigh Tavern Lane Property Address Arvind Ramani Owner Owner's Name information is required for every North Andover MA 01845 November 29, 2017 .......... page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date .......... Other(describe below): . ........... .................. ........... General Information Pumping Records: Source of information: none available Was system pumped as part of the inspection? El Yes Z No If yes, volume pumped: ............ galions How was quantity pumped determined? Reason for pumping: Type of System: 0 Septic tank, distribution box, soil absorption system El Single cesspool El Overflow cesspool El Privy El Shared system (yes or no) (if yes, attach previous inspection records, if any) El 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 El Tight tank. Attach a copy of the DEP approval. El Other(describe): .......... t5ins.cloc-rev.6116 Title 5 Official Inspection Form:subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts .................. Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .300R�Iai h'Tavern Lane ...... Property Address Arvind Ramani Owner Owner's Name information is required for every North Andover MA 01845 November 29, 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed in 12/2010 Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): 2 Depth below grade: feet Material of construction: cast iron E 40 PVC El other(explain): Distance from private water supply well or suction line: 30+ feetfeet Comments (on condition of joints, venting, evidence of leakage, etc.): Building sewer outside and inside for plumbing is completely constructed with sch 40 4, Septic Tank(locate on site plan): 1211 Depth below grade: Material of construction: E concrete f-1 metal ❑ fiberglass polyethylene ❑ other(explain) tanks still in great shape ................ If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Yes ❑ No 10'-10" x6-8"x6tall __(1500 gal Dimensions: 411 Sludge depth: t5ins.doe-rev,6116 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts �71 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments .309..Ftalaigh Tavern Lane ............. -------------- Property Address Arvind Ramani ------- Owner Owner's Name information is required for every North Andover MA 01845 November 29, 2017 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) 32" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1311 201 Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? by measuring stick (the shitty-stick patten pendin 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's 1St compartment has a really thick scum layer with tons of wipes or maybe paper towels not sure but the tank should be pumped out so those don't clog filter or get in leachfield. The 2"d compartment was much better due to tee and gas baffle. This is where outlet filter is located. I cleaned filter due to build up of scum layer. Tank had no evidence of leakage or structual damage in any way. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: El concrete El metal El fiberglass ❑ polyethylene El 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: t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 300..Ralaigh Tavern Lane ....................... ......... ........ Property Address Arvind Ramani Owner Owner's Name information is required for every North Andover MA 01845 November 29, 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: Material of construction: R concrete F-1 metal F-1 fiberglass ❑ polyethylene F] other(explain): ..........--....... ............ Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: El Yes ❑ No Alarm level: Alarm in working order: F Yes E-1 No Date of as pumping: Date Comments (condition of alarm and float switches, etc.): ...........- ------------- ................ Attach copy of current pumping contract(required). Is copy attached? El Yes E-1 No t5ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 340 Ralaigh Tavern Lane Property Address Arvind Ramani Owner Owner's Name information is North Andover MA 01845 November 29 2017 required for every ................ _� _ ......_... _—...�._.._. ....... -- s"�._...._._..._._ I page. Cit yI7o`nrn State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): a° 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.): This Dbox is a 6 outlet baffle box with 6 outlet pipe laterals. As you can see in pictures, dbox in great shape. Didn't see much if any carry overs just some tiny roots as usual. Dbox was down deep due to slope that's over it so we installed a 2' dbox riser to bring top within 9"of grade. Box still level and laterals staking effluent_very evenly Very good shape.w 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 chamer is in great shape. all 3 floats are working properly and pump is as usual too. Control panel is mounted in basement next to Electrical panel on same side as tanks. My only j recommendation in a perfect world I would love to see a remote light and or alarm wired upstairs in house in a central location for better visual and hearing location. * 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: i t5ins.doc-rev.6/16 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 300 Ralaigh Tavern Lane Property Address Arvind Ramani Owner Owner's Name information is required for every North Andover MA 01845 November 29, 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ----------- leaching chambers number: 60 infiltrators El leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: El 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.): Conditions all good. Leachfield is in front yard. All grass over it and all dry. ........... ........... .......... ............. 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 El Yes El No t5ins.doc-rev,6116 Title 5 Official Inspection Form: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 300 Ralaicih Tavern Lane Property Address Arvind Ramani ....................... Owner Owner's Name information is required for every North Andover MA 01845 November 29, 2017 ........... .......... page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ............ ............... .......... —---------- 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,doc•rev,6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systern-Page 14 of 17 Commonwealth of Massachusetts .............. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 300 Ra,l,a,iq,hT, avern Lane Property Address Arvind Ramani Owner Owner's Name information is MA 01845 November 29, 2017 required for every North Andover page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: R hand-sketch in the area below Z drawing attached separately 151ns.cloc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts _ r Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �Y .4' 300 Ralai h Tavern Lane _._...._ .__g.... .. Property Address Arvind Ramani . ....�............. . .._.___... .. . .......... Owner � Owner's Name information is required for every North Andover MA 01845 November 29, 2017 _......... _..............— page. City/Town State Zip Code Date of Inspection D. System Information (coat.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: m 74°frotop grade of_test pits in 2003 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: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Soil testing logs from 2003 which were used on the 2010 proposed replacement plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 300RaTavern Lane �..__. _ _ Property Address Arvind Ramani Owner ...........____.._____Y.._. _......__ ...__............._ —___..._�.. Owners Name information is required fo ed far every North Andover MA 01845 November 29, 2017 requir _w. _.___..........__ _. ..__._. ._....._.._...... page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Z 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 1 t5ins.doo-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ING AR ` sync TAM T-3 Y SOOp dAL l' � COST.<baa f*f PUMP IA"W t' pyj "�' ''� ice. 1 ii t7tY! VfPh� CKAMBERS 4OW'i RAWGH TAVERN ' 8 NAI- ASBUMI PLAN OF SUBSURFACE 'ISPOS S LOCATED IN NORTH ANDOVER, 3. 300 RAIZIGH TAVERN LANE AS PREPARED FOR TM: 107A DATE: 12-2-10 TL: 128 3 SCALE: 1"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810