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HomeMy WebLinkAboutTitle V Inspection Report - 707 TURNPIKE STREET 3/15/2018 Commonwealth of Massachusetts RECEIVED Title 5 Official Inspection Farm : 15 ?018 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments TOWN OF NORTH ANDOVER 707 Turnpike St. North Andover Ma. 01845 HEALTH DEPARTMENT Vropie–�y�A —----- —------ Ms. CherVI A. Fitzpatrick (Trustee of the L.J. Kmiec, Jr. Nominee Realty Trust) 6 Independence Dr. Owner Owner's Name information is required for every N.H. 03848 2/5/18 page. City/Town State it�—Co d-e -da-ti-of-1n`Spe-c-t—ion-­­ 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 Company Name 58 Pleasant Street Company Address —------- Rqw1ey -&Ity/Town Ma. 01969 978-314-0503 sia't—e —Zi p_6—od-e—"-" - -- 514268 Telephone Number LicenS—eN"u-mbe—r "'---"-- ----— . 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 ❑ Conditionally Passes Fails ❑ Needs Further Evaluation by the Local Approving Authority 2/5/18 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 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.doc-rev.6/16 Tiffs 5 Official 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 Y h 707 Turnpike St. North Andover Ma. 01845 property Address Ms. Che I A. Fitz atrick Trustee of the L.J. Kmiec,Jr. Nominee Realty Trust) B Independence Dr. Owner Owner's!Name - — information is Kin Ston required for every N.H. 03848 215118 page. CityFrown 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: 13) 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 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts = Title 5 official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w=, 707 Turnpike St. North Andover Ma. 01845 Property Address Ms. Cheryl A. Fitzpatrick (Trustee of the L.J. Kmiec, Jr. Nominee Realty Trust) 6 Independence Dr. Owner Owner's Name _ information is required for every Kingston _ N.H. 03848 215118 page. CitylTown 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 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.doc-rev.6116 'fide 5 official Inspection t=orm: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 707 Turnpike St. North Andover Ma. 01845 Property Address Ms. Cheryl A- Fitz atrick Trustee of the L.J. Kmiec, Jr_ Nominee Reait Trust 6 Inde endence Dr. Owner Owner's Name a information is required for every Kingston N.H. 0384$ 21511$ page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal 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 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool F1 ® 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts 03. r Title 5 Official Inspection Form ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 Turn p ike St. North Andover Ma. 01845 Property Address i Ms. Cheryl A. Fitzpatrick(Trustee of the L.J. Kmiec, Jr_ Nominee Realty Trust) 6 Independence Dr. Owner Owners Name information is Kingston N.H. 03848 215!18 required for every _._ _. page. Citylrown State Zip Code Dale of Inspection B. Certification (cont) Yes No El ® Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: ® ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® 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 forma ❑ ® 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 El ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El Area system is located in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA) or a mapped Zone I I 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. Mns.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •~'� 707 Turn p ike St. North Andover Ma. 01845 Property Address Ms. Cheryl A. Fitzpatrick Trustee of the L.J. Kmiec, Jr. Nominee Realty Trust)6 Independence Dr. Owner Owner's Name information is required for every Kin stogy n N.H. 03$48 _ 215/18 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 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): Na Number of bedrooms (actual): n/a DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 707 Turnpike St. North Andover Ma. 01845 Property Address — — Ms. Cheryl A. Fitz atrick Trustee of the L.J. Kmiec, Jr. Nominee Realt Trust 6 Inde endence Dr. Owner Owner's Name information is required for every Kingston N.H. 03848 21511$ page. City/Town State dip Code Date 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 information in this report.) ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: office 2,844 s , ft. Design flow(based on 310 CMR 95203): nla Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft-, etc.): nla Grease trap present? El Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? (__1 Yes ® No 9 Water meter readings, if available: 47,872 total ga1.1730= 65.5 g.p.d. 1 15ins.doc•rev.6116 "title 5 official Inspection Forrn:Subsurface Sewage Disposal System-Page 7 of 17 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 Turnpike St. North Andover Ma. 01845 Property Address _ Ms. Cheryl A. Fitzpatrick Trustee of the L.J. Kmiec, Jr. Nominee Real! Trust 6 Independence Dr. Owner Owner's Name - information is required for every Kingston N.H. 03848 215118 page. Cityfrown State Zip Code Date of inspection I D. System Information (cont.) Last date of occupancy/use: occupied Date Other(describe below): General Information Pumping Records: ed 917114 pump Source of information: last - 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 DIP approval. ❑ Other(describe): 3 I: �', l5ins.doc•rev.6116 Title 5 Official inspection 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 707 Turnpike St. North Andover Ma. 01845 Property Address Ms. Cheryl A. Fitzpatrick Trustee of the LJ. Kmiec, Jr. Nominee Realty Trust 6 Independence Dr. Owner Owner's Name information is required for every Kingston N.N. 03848 215118 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: 40 years old, installed in 1978, info. from real estate aertt Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30.1Leet 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 of mints good, ro er venting, no evidence of Eeakage Septic Tank(locate on site plan): Depth below grade: 24"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8`x5'x5'dp. 311 Sludge depth: 15ins.doc•rev.13116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 t. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 707 Turnpike St. North Andover Ma. 01845 Property Address Ms. Cher I A. E=itz a#rick_(Trustee of the U. Kmiec, Jr. Nominee Realty Trust 6 Independence Dr. s Owner Owner's Name information is required for every Kingston _ N.H. 03848 215118 page. cityrrown 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 31 0" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measurin stick& 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 will be pumped when replaced, inlet and outlet baffles in fair condition,structural integrity was good, liquid was level to bottom of outlet invert, no evidence of leakage Grease Trap (locate on site plan): Depth below grade: Leet Material of construction: 9 a ❑ concrete ❑ metal El fiberglass El 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 I5ins.tloc-rev.6116 Ttile 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 �., ,•• 707 Turnpike St. North Andover Ma. 01846 _ Property Address A Ms. Cheryl A. Fitzpatrick (Trustee of the L.J. Kmiec, Jr. Nominee Realty Trust) 6 Independence Dr. Owner Owner's Name information is Kin Ston N.H. 03848 215118 required for every _ . page, Cityfrown 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 3 o Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date 0 Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage nisposat System•Page 11 of 17 Commonwealth of Massachusetts ®R f Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,..'' 707 Turnpike St. North Andover Ma. 01845 Property Address Ms. Cher I A. Fitz rick(Trustee of the L.J. Kmiec, Jr. Nominee Realt Trust�6 Independence Dr. Owner Owner's Name W information is required for every Kingston N.H. 03848 215/18 page. Cityr�rown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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 in fair condition, distribution was not equal,evidence of solids carryover,no evidence of leakage, Box was 48" below grade, size of box was 30"x21"x13"dp. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ Noy` 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: 15ins.rioc•rev.6116 Tide 5 Official Inspedion f=orm: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 707 Turnpike St. North Andover Ma. 01845 Property Address Ms. Cher !A. Fitz atrick Trustee of the L.J. Kmiec, Jr. Nominee Realty Trust) 6 Independence Dr. Owner Owner's Name information is Kin stars required for everY N.H. 03848 215118 page. City/Town State Zip Cade Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: — - ❑ leaching galleries number: ® leaching trenches number, length: 4 @various lengths ❑ leaching fields number, dimensions: -- ❑ 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.): soil was dry layered fill, loam on top, sand then more loam over D- Box,no ponding,3 out of 4 lines were partially clogged, leach system located in front of building under mowed grass 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 r t5ins.doc•rev.W16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 17 �d. f Commonweal Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s° 707 Turnpike St. North Andover Ma. 01845 Property Address Ms. Cheryl A_ Fitzpatrick{Trustee of the L.J. Kmiec, Jr. Nominee Realty Trust) 6 Independence Dr. W Owner Owner's Name @ information is required for every Kingston N.H, 03848 215118 page. CitylTown 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 r 2. f 1 �F tj 41 l5ins.doc•rev.6116 Title 5 Official inspection Forrry Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts b Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y 707 Turnpike St. North Andover Ma. 01845 Property Address Ms. Cheryl A. Fitzatrick Trustee of the L.J. Kmiec, Jr_ Nominee Realty Trust 6 Inde endertce Dr. Owner Owner's Name information is required for every Kingston _ N.H. 03848 215118 page. CitylTown State Zip Code Date of Inspection a D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ® Shallow wells 12" 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: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: monitoring wells located behind building in crush stone driveway (grade), standing water 24" below grade and water marks 12" below grade. monitoring well#1 is 83'from end of leach trench#3.end of Leach trench#3 was 2'6" below hi h water mark 0 Before filing this Inspection Report, please see Report Completeness Checklist on next page. 151ns.doc•rev.6116 Tille 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts v. u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y 'r 707 Turnipike St. North Andover Ma. 01845 Property Address Ms. Cheryl A. Fitzpatrick (Trustee of the L.J. Kmiec, Jr. Nominee Realty Trust 8 Independence Dr. Owner Owner's Name information is required for every Kingston N.H. 03848 215118 _ 9 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed E System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file B t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 DEP FILE#24-2-1510 ,\ `z4;'` � � ASSESSORS REFERENCE � MAP 98.0 LOT 47 NOTES: �f 1. TME LOCATION OF ALL UNDERGROUND UTILITIES SHOWN HEREON ARE APPROXIMATE AND ARE BASED ON A COMBINATION OF FIELD LOCATIONS AND COMPILED INFORMATION FROM PLANS \ \ , LO CL SUPPLIED BY VARIOUS DTLIT'[COMPANIES AND o, GOVERNMENT AGENCIES,!N ACCORDANCE WITH \ & .� .G L.L.CHAPTER 82 SECTION 4C.INCLUDING \ \ 1 AMENDMENTS,ALL CONTRACTORS SHOULD \ AS-BUILT PLAN NOTIFY IN WR171NG ALL UT€LITY COMPANIES ANp A 2Q Q'P' \ 2rp \\\ GCVERNMENTAGENCIES PRIORTC ANY 20 0 20 EXCAVATION WORK AND CALL DIG SAFE AT \ , 40 FT 0 a t-88&0IGSAFE. - »1"VVttt 1. SCALE1 -26 2_ THIS PLAN REPRESENTS THE CONDI TIONS OF THE SITE ON APRIL 18,2012.TWE DATE CF 7HE AG-BUILT o 1 } \ `� S \ LOCUS MAP URVEY. 1.. N0770 SCALE 411 I SUDARSHAti CHATTERJEE V1 q .Al 25 PARCEL 167 _ i LOT AREA vvp A 1 MONITORING vd0:.!j.rP I �y\N OF Mq� \ M1CHAE-L c II , LIMI70F FEMA IDD YEAR `'\ PAEll \ \ $-RGI FLOOD HAZARD ZONE W, Y S WALK \�� �♦ (}^�NCHMARK No 3597 I I V MAOv NAi1.SET q < ExI5T1NG LIMIT OF1Dp' \� BUILDING 1\ UMIT1� \ ELEV 23955 DUFFER ZONE{TVP.) EDGE OF BORDERING-- \,,, x707 \ DISTURBED LAW VEGETATED WE71AND r \ I -N='�ll � RDOF CRAW l 1 t f_ C\ 1 / � t i FILTRATION 1 : OF,In I too' tw ;tLa - � SYSTEM{BOTTOM OF` T v rti P ?d'FEND OF FENCE YO EDGE(3F'NETLANDS) I I N w ao �-� HAMBERS=239-1'7) l _ �I tnea GAR,F�,R zbuZ' ? ronnL EH A-6 S S28 �1:jv .\ EDGE OF 314 BLUESTONE it r $ ` x'240-��\ry : DRIVEWAY N I & DOWNSPOUT CONSERVATION AS-BUILT PLAN '. SIS sDT Q1P} a . �s f 4IMl7o s NO-SUILO ZON}E \ FOR 7Q7 TURNPIKE STREET LINK TE AIN =r LINK FENC �� ��� _ -� NORTH ANDOVER, MASS A-9 `237_ _._ PREPARED FORS A10 A-11A LOU KMIEC Q" r� 767 TURNPIKE STREETA-12 A-'7 OCK - - - NORTH ANDOVER.MA 91SILT S `23 8;5 J 6_-_ -238 -- 12'IFENCE TO EDGE OF WFTIANDS) - S LIMITCF A-13 DATE:APRIL 24.2012 ...._ WORK `?� 779,85• PR�OgFp�E)5�S?i'p©''?gdAL�EgNGIN�EpERS&LANE)�`SgURpV$EpYORS --_ LIMIT DE 25'Np-0ESTll R6 NiF _ 4805UMMER ST.1tAVERHILL,VA 01330 VNNW.C$!-ENGR.COM ZONE(TYP.) JOHN WA-16 A-17 -�- — CS1 TEL.97B-373 20 OG10 FAX.978-372-SS60 COPYRIGHT 71 ERCVL-LL MAP 58QPAARCEL 3S - DW13.NO.1OC25004 Summary Record Card genaraled on 211212016 2:16.40 PM by Karen Hanlon pa96 I Town of North Andover Tax Map # 210-098.D-0047-0000.0 Parcel Id 16023 707 TURNPIKE STREET KMIEC, LOUIS 1001 TURNPIKE STREET NORTH ANDOVER, MA 01845 Class 340 General Off3 Commercialice Building Property Type 3 Commercial ZonIng2 3 Commercial Zonlng3 Size Total 0-63Acres FY 2018 UB Mailing Index NamelAddressFrom Until Type Loan Number Activefinart. KMIEC,LOUIS Payor 1001 TURNPIKE STREET NORTH ANDOVER,MA 01845 UB Account Maint, ctivelInactive Account No Cycle Occupant Name A Bldg Id. 13475.0-707 TURNPIKE STREET Last Billing Date 21912018 1090226 01 Cycle 01 Active II UB Services Maint. Account No. 1090226 Service Code Rate Charge multiplierfusers MISCFEE ADMIN FEE 0.63518 7,82 WTR WATER 01 ALL METER SIZE UB Meter Maintenance Account No. 1090226 Serial No Status Location Brand Type Size YTD Cons 16802348 a Active 00 METE METE wwater 0.630.63 351 Date Reading Code Consumption Posted Date Variance 111712018 954 a Actual 0 212012018 -100% -63% 10117/2017 954 a Actual 2 1111312017 15% 7/1812017 952 a Actual 5 8/1150017 412512017 947 a Actual 5 511712017 137% 1/1812017 942 a Actual 2 211612017 -79% 10118120116 940 a Actual 9 11/1612016 -74% 7121/2016 931 a Actual 35 811612016 1079% 412112016 896 a Actual 3 512512016 0% 112012016 893 aActual 3 211912016 -71% 1012012015 890 a Actual 10 11/2012016 -52% 7/2212016 880 a Actual 21 8/1412015 938% 4122/2015 859 a Actual 2 5/19/2015 -49% 1122/2016 857 a Actual 4 2/2012015 -43% 10/2212014 853 a Actual 7 11114/2014 11/0 712312014 846 a Actual 7 811312014 36% 412212014 839 aActual 5 5/1612014 3% 112312014 834 aActual 6 2114/2014 -64% 10/2312013 829 a Actual 14 11/18/2013 174% 7122/2013 815 aActual 5 81115/2013 63% 412212013 810 aActual 3 5120/2013 3% 112312013 807 aActual 3 2113/2013 -81% 10/2312012 804 a Actual 16 1119/2012 712412012 783 a Actual 24 8/14/2012 187% 4/2012012 764 a Actual 8 5/912012 102% 112012012 766 a Actual 4 211312012 -84% 10/2012011 762 a Actual 24 11114/2011 41% 7/2112011 728 a Actual 17 811612011 713% 412112011 711 aActual 2 511612011 -26% 3 2111/2011 -91% 112412011 709 a Actual