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HomeMy WebLinkAboutTitle V Inspection Report - 209 VEST WAY 4/18/2018 Commonwealth of Massall;husett�. --- Title 5 Official Inspection Form — a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Vest Way ...._-. Property Address Pawel Zakowicz Owner Owner's Name information is North Andover Ma 01$45 3/20/2018 required far -- ...._..__�.. _ ._...._..- j every 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: A. General Information When filling out forms on the � computer, use 1. Inspector: onlythe tab ke y y to move our Dean Dynan _......._.......... use the return �°�lV��•�"� cursor- not Name of Inspector key. Company Name 2 SuntaugStreet Company Address Lynnfield Ma 01940 City/Town State Zip Code 508-726-9935 S112837 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 ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority n actor's Signa ." g ture 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 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. l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 or 17 ` . Commonwealth of Massachusetts � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 209 Vest Property Address Pawe|Zakovvicz Owner 0wnor'sNamo information is North Ma 01845 3/20/2018 required for -��--- -------- nvorypage. City/Town State Zip Code Date ofInspection B. Certification /DOOt.\ Inspection Summary: Check A.B.C,O or E/always complete all of Section O A) System Passes: | have not found any information which indicates that any ofthe failure criteria described in 310 CMR 15.303orin 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated be|mw. Comments: 4 bedroom single family dwelling with pipe in stone trenches in working order 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 nfHealth, will pass. Check the box for°yes". "no" or"not determined" (Y. N. ND)for the following statements. If"not determined,"' p|aeae 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 orexfi|trodon ortank failure is imminent. System will pass inspection ifthe existing tank |ereplaced with a complying septic tank asapproved bvthe � � Board of Health, *A metal septic tank will pass inspection if it is structurally sound' not leaking and if Certificate of Compliance indicating that the tank is less than 20 years old is available. El y F1 N El ND (Explain below): mm*om"���emmnpmma�,mm�u�mo omp�mo�wm'p�"cmn ��.�� Commonwealth of Massachusetts - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Vest Wim,. Property Address Pawel Owner Owner's Name information is North Andover Ma 01845 3/20/2018 required far u__..._ .._. _..._..,_..._._._ �._......__ _ ...._.___.._._.. n____.. every page. CityfTown State Zip Code Date of Inspection B. Certification (cont,) j ❑ 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Farm ; - Subsurface Sewage disposal System Form - Not for Voluntary Assessments m w` 209 Vest Way Property Address _—.-- Pawel Zakowicz Owner Owner's Name information is North Andover Ma 01816 3/20/2018 requiredfor _....___. _a__.....__.. ._.....__ -..._...___-- every page. City/Town State Zip Code Date of Inspection B. Certification (cant.) 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: F-1 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 ❑ ® 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 El or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow thins•3113 Title 5 Official Inspection Form:subsurface Sewage Disposal System-nage 4 of 17 ^ Commonwealth of Massachusetts Wh °�����0�� �� ��`����w°��0 0����������������� ����U���� Title �� ��y� � ������� Inspection N-��mmmm Subsu�momSmvxmge [3isposa| SystmmmFmrmo - No�forVn|unt�ryA��eaam�nte 2O8Vest VVa ------- Property Addema Powe| Zakovvioz Owner Owner's Name information is North Andover W1e 01846 3/20/2018 required for ----- ------ -------------- every page. QtyfTmwn State Zip Code Date of|nopaction B. Certification (cont.) Yee No �l �� Required pumping more than 4Unoeminthe last year NOT due bzclogged or �� �� obskuohadpipe(a). Number nftimes pumped: ____. El N Any portion ofthe SAS, cesspool orprivy iebelow high ground water elevation. �� �� 8nypo�|onofcesspool orprivy ievvithin1OOfeet ofoeu�ocewater supply ur � �� �� tributary tomsurface water supply. � El N Any portion ofGcesspool orprivy |swithin a Zone 1mfapublic well. El N Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion nfa cesspool orprivy isless than 1OOfeet but greater than 5Ufeet from a private water supply well with no acceptable water quality analysis. [This system passes ifthe well water analysis, performed atmDEP certified iabonatmry,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm, provided that mwother failure criteria are triggered. A copy mfthe analysis and chain ofcustody must be attached inthis fnrrmJ The system ioacesspool serving ofacility with a design flow nf2DOOgpd- 10'000gpd. �l �� The symtmrnfaUs. | have determined that one or more of the above failure �� �� criteria exist andescribed in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary tncorrect the failure. E) Large Systems: To be considered m large system the system must serve afacility with m design flow of10,W0U Upd to 15,000 gpd. For large eystnms, you must indicate either"yes" or"no" to each of the following, in addition to the questions inSection D. Yes No El F] the system iswithin 4OOfeet Vfasurface drinking water supply 0 [l the myetonn is within 200 feet ofa tributary to a surface drinking water supply �� �� the system is located in a nitrogen sensitive area (interim Wellhead Protection �� �� Area-|VVPA) or a mapped Zona || of public water supply well If you have answered "yes" to any question in Section E the system is considered e significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator ofany large system considered e 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. .n*" mm rm�oom*°/m°*0000"rmm:u"� xm " ^ mom�ou/"v"�/a��m'p"owom,r ' / . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2O9Vest VVm Pmpe�yAd-dmso Pomm| Zakovvioz Owner Owner's Name information is North Andover Ma 01845 3/20/2018 required for ---- ------ oworypag*. QtyrTmmn State Zip Code Date orInspection C. Checklist Check ifthe following have been done. You must indicate^yen" Vr^nn" ustoeach ofthe following: Yes No F] E] Pumping information was provided by the owner, occupant, or Board of Health Fl H Were any ofthe system components pumped out inthe previous two weeks? Z El Has the system received normal flows inthe previous two week period? �� �� Have large volumes ofwater been introduced tothe syehernrecently oraspa�of �� �� this inspection? �� VVereaabuilt plans ofthe eyohennobtained and examined? (If they were not �� �� available note aeN/A\ M [| Was the facility Vrdwelling inspected for signs ofsewage back up? E Fl Was the site inspected for signs ofbreak out? * n Were all system components, excluding the SAS, located Onsite? * Fl 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? �� F� ` ' VV�ath�f�ci||tyo�ner(end000upon�e |�di�enyntfromV�n�r\ providedwith �� �� information onthe proper maintenance of subsurface sewage disposal systems? The size and location pfthe Soil Absorption System (GAS) onthe site has been determined based on: Z El Existing information. For example, a plan at the Board of Health. �� �l ` Determined in the field (if any of the failure criteria na|obyd to Part(� is at issue �� �� approximation ofdistance iVunacceptable) [310CMR 15.302(5)l D. System Information Residential Flow Conditions: 4 * Number ufbedrooms (daai n): --------' Number ofbedrooms (achuo|): —'-------- 440 DESIGN flow based on310CMR 15.203 (for example: 11Ogpdx#nfbodromms): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 209 Vest Way 'Property Address Pawel Zakowicz.___1---------- Owner Owner's Name information is required for North Andover Ma 01845 3/20/2018 ------------------- every page. City/Town State Zip Code Date of Inspection ........... D. System Information Description: 4 bedroom single family dwelling ___.,_.__ -——-------- Number of current residents: 3­­11...........— Does residence have a garbage grinder? 9 Yes D No Is laundry on a separate sewage system? (Include laundry system inspection n Yes Z No information in this report.) Laundry system inspected? ❑ Yes R No Seasonal use? F] Yes M No Water meter readings, if available (last 2 years usage (gpd)): < 250 GPD Detail: Sump pump? El Yes M No Last date of occupancy: Datecurrent 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/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? El Yes No Non-sanitary waste discharged to the Title 5 system? El Yes F1 No Water meter readings, if available: .......... 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Vest Way Property Address Pawel Zakowicz Owner Owner`s Name information is North Andover Ma 01845 3/20/2018 required for — ___.._..._... .....m�.._ .__..... _.. w._._.......__..__._._ 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: Source of information: Homeowner/ Board of Health 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 I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 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 209Vest Way Property Address Pawel Zakowicz Owner "Owner's_Name information is required for North Andover Ma 01845 3/20/2018 every 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: _§�em installed 1994 as per plan on file ------------- per sewage odors detected when arriving at the site? El Yes Z No Building Sewer(locate on site plan): 811 Depth below grade: feet Material of construction: El cast iron Z 40 PVC F1 other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): _building sewer in good condition no evidence of leaks ---------- Septic Tank(locate on site plan): 1011 Depth below grade: feet Material of construction: E concrete EJ metal n fiberglass F-1 polyethylene El other(explain) 1500 concrete tank in good condition center cover is 10"from grade for service access If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) F-1 Yes 0 No 111X5110"X5110 Dimensions: 611 Sludge depth: 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form -- — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Vest Way _ _.__ _. _ _ _ _.._.__._...---..__----_ Property Address Pawel Zakowicz Owner Owner's Name information is North Andover IVIG 01845 3/20/2018 required for w _ .__._.__.___....._._....._.._._..._ every page. City/Town 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" - — " 411 Scum thickness 5 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? infield with measure stick and tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 gallon concrete septic tank with concrete inlet and PVC outlet T / Tank in working order with separation from inlet to outlet / no evidence of leakeage recommend pumping every two to four years depending on usage and number of occupants Grease Trap (locate on site plan): Depth below grade: feet _.__.----_ w.. .._._.----- 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 t5ins•3113 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Farm =„ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 209 Vest Way -- .. _. Property Address Pawel Zakowicz Owner Owner's Name information is North Andover Ma 01845 3/20/2018 required for ..-.___..__._. _._. ..__. every page. Cityfrown State Zip Code Date of Inspection D. System Information (cant.) 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; _. .- _------. _,_.__ gal4ons per day Alarm present; ❑ Yes ❑ No Alarm level; -- -- Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No j l5ins•3113 "title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts -- k Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments W_v, 209 Vest Way Property Address Pawel Zakowicz ___--- Owner Owner's Name information is North Andover Ma 01845 3120/2018 required far _____..........__-- _.... — _....._ _� every page. CitytTown 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" above 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.): 16"x16" Concrete box level with two outlet pipes /little evidence of solids carryover / no evidence of leakage into or out of box D box in working order D Box is 28° below grade 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 Form:Subsurface Sewage Disposal System•Page 12 of 17 I . Commonwealth of Massachusetts �����0�� �� �°����~�����N 0������������°���� �����"��N � ����� �� ��o� � �����m� Inspection �-�.mmm � Subsurface Sewage Disposal System Form Not for Voluntary Assessments 209Vest Way �mpnnNy���mss Pewe| Zakuvvicz Owner Owner's Name information is required for North Andover Ma 01845 3/20/2018 every page. City/Town State Zip Code Date ofInspection D. System Information (cont.) Type: � E] leaching pits number yl leaching chambers number: || leaching galleries number: X VV leaching trenches number, length: - El leaching fields number, dimensions: E-1 overflow cesspool number: EJ innnveUvu/a|ternotiveoystem Type/name Vftechnology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): trenches found |ngreen lawn area/soils |ngood condition / nosigns ofhydraulic tsi|ume/ no ponding/ nndamp soi|cK grass inuniform |ngood condition Drain field is a pvm pipe in stone conventional system in working order sew plan on file/ 2tVV Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth -topof|iquid to inlet invert Depth ofsolids layer Depth ofscum layer Dimensions mfcesspool Materials of construction Indication ofgroundwater inflow Fl Yee No Commonwealth of Massachusetts Tule 5 official Inspection Farm ._ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .•4 209 Vest Way .. Property Address Pawel Zakowicz Owner owner's Name information is North Andover Ma 01845 3/20/2018 required for __a...._.. _..._ _....__..... — every page. City/Town State Zip Code Date of Inspection D. System Information (cant) 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 ____ _.._..____ m_-__..._-. Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 209 Vest Way Property Address Pawel Zakowicz _.__.m..____,,._....----------------.-_ Owner Owner's Name information is North Andover Ma 01845 3/20/2018 required for every 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: F-1 hand-sketch in the area below Z drawing attached separately t5ins-3113 Title 5 Official tnspeclion Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form W Subsurface Sewage Disposal System Form Not for Voluntary Assessments 209 Vest Way Property Address Pawel Zakowicz Owner Owner's Name information is required for North Andover Ma 01845 3/20/2 018 every 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: 60" + as per plan on filefeet 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: 1994 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) El Accessed USGS database -explain: You must describe how you established the high ground water elevation: soil data obtained at Board of Health as per plans on file dated 1994 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-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 209 Vest Way ........ ------ Property Address Pawel Zakowicz Owner Owner's Name information is North Andover Ma 01845 3/20/2018 required for every page. CityrTown 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 l5ins-3113 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 .,S-v A �A v v\v v`` env ..2 MON \\ v \; 4 WIN yon P, 091 Ron cm SRI z �t \ VE 7,7 yvv�� y vv I �f'i �f3EET tv�Ati � `\`` f� ed V �c YIa� iF IPA— r ' t r -slf .Y ) h 1 r p i Summary Record Card generaled on 4/1012018 9:52:12 AM by Karen Hanlon Page I Town of North Andover Tax Map # 210-104.D-0093-0000.0 Parcel Id 16780 209 VEST WAY SILVIA ZAWADZKI 209 VEST WAY NORTH ANDOVER MA 01845 Class 101 Single Family Property Type I Residential ZonIng2 I Residential ZonIng3 I Residential Size Total 1.22 Acres FY 2018 ................. —----- UB Malling Index Name/Address Type Loan Number Activelinact. From Until SILVIAZAWADZKI Owner 209 VEST WAY NORTH ANDOVER MA 01845 URRY,CARA Previous Customer Inactive 8/2912005 209 VEST WAY NO.ANDOVER,MA 01845 KEITH&DEENA TAYLOR Previous Customer Inactive 3/22/2010 209 VEST WAY NORTH ANDOVER,MA 0 184 5 GONE TO RELOCATION COMPANY HEARTH N HOME Previous Customer Inactive 2/11212009 ATTN: BRENT JONES 210 BOSTON ROAD CHELMSFORD,MA 01824 RYAN&NICOLE NELSON Previous Customer Inactive 6/28/2013 209 VEST WAY tt NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17826.0-209 VEST WAY Last Billing Date 1/1 81201 8 3170491 03 Cycle 03 Active UB Services Maint. Account No.3170491 Service Code Rate Charge Multiplier/Users MISCFEEADMIN FEE 0.635/8 7.82 1/ VVTR WATER 01 ALL METER SIZE 11 UB Meter Maintenance Account No.3170491 Serial No Status Location Brand Type. Size YTD Cons 36388109 s Active ERT HH b Badger w Water 0.630.63 1119 Date Reading Code Consumption Posted Date Variance 3/912018 1128 a Actual 13 -41% 121812017 1115 a Actual 21 1/2512018 -66% 9/12/2017 1094 a Actual 68 10/18/2017 279% 6/8/2017 1026 a Actual 17 7/25/2017 40% 3/9/2017 1009 a Actual 12 4/1212017 3% 12/9/2016 997 a Actual 12 1/23/2017 -85% 9/712016 985 a Actual 75 10/24/2016 204% 6/13/2016 910 a Actual 27 8/2/2016 103% 3111/2016 883 a Actual 13 412212016 .52% 12/10/2015 870 a Actual 27 1/20/2016 -63% 91912015 843 a Actual 72 10/1612015 98% 6t1012015 771 a Actual 36 7/24/2015 177% 0-4 too Town of North Andover .o HEALTH DEPARTMENT ASSACK ,HECK.##; DATE: LOCATION: ,1221 H/O NAME: CONTRACTOR NAME: 4-1 A e Type of Permit or License: (Check box) 0 Animal 0 Body Art Establishment 0 Body Art Practitioner 0 Dempster D Food Service- Fype.,-,- $ 0 Funeral Directors 0 Massage Establishment 0 Massage Practice $ 0 Offal(Septic)Hauler 0 Recreational Camp, 0 Sun tanning 0 Swimming Pool 0 Tobacco 0 Trash/Solid Waste Hauler 0 Well Construction SEP77CUl stems: 0 Septic-Soil Testing 0 Septic-Design Approval $ 0 Septic Disposal Works Construction(DWO $ 0 Septic Disposal Works Installers(DWI) $ 0 Title 5 Inspector $- Title 5 Report $ 0 Other. (Indicate) &41th,Agent Initials White-Applicant Yellow-Health Pink- 'Freasurer ................