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Home My WebLink AboutMiscellaneous - 171 SUMMER STREET 4/30/2018 (2)N) co cr) m 0 m U Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street G Property Address AnthonyCerra Owner's Name North Andover MA 01845 7/6/2015L City(rown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may 70 e,aaltepe�d in any way. Please see completeness checklist at the end of the form. A. General Information Inspector: Anthony R Mottolo Name of Inspector John Zanni Pumpina Cc Company Name PO Box 407 Company Address North Reading City/Town (781) 944-0149 Telephone Number B. Certification MA State S15018 License Number TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 01864 Zip Code 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 8/6/15 Inspector's i ature 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. - t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner's Name North Andover City/Town B. Certification (cont.) MA 01845 7/6/2015 State Zip Code Date of Inspection Inspection Summary: Check A,B,C,D or E / 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 ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner's Name North Andover City/Town B. Certification (cont.) nnn n1Rar% 7/6/2015 State Zip Code Date of Inspection ❑ 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 obstruction is removed distribution box is leveled or replaced ❑ Y ❑ Y ❑ Y ❑ N ❑ N ❑ N ❑ ❑ ❑ ND (Explain below): ND (Explain below): 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 • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner's Name North Andover MA 01845 7/6/2015 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 4 of 17 Commonwealth of Massachusetts 4 - Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner Owner's Name nform equine fo d fotiis r every requireNorth Andover MA 01845 7/6/2015 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 fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well i ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Insp a Subsurface Sewage Disposal System For 171 Summer Street 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 ection Form ® ❑ m - Not for Voluntary Assessments 1:1 Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ❑ Property Address available note as N/A) , ® ❑ Anthony Cerra ®❑ Was the site inspected for signs of break out? Owner Owner's Name ®! ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank information is required for every North Andover MA 01845 7/6/2015 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 ❑I ® 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? 1:1 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 N/A) , ® ❑ 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: 1) Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address ❑ No current Anthony Cerra Date Owner Owner's Name Gallons per day (gpd) information is required for every North Andover MA 01845 7/6/2015 ❑ No ❑ Yes ❑ page. City/Town State Zip Code Date of Inspection ❑ Yes ❑ No D. System Information Description: Number of current residents: 1 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: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: ® Yes ❑ No current Date Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is North Andover required for every page. Cityfrown D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: General Information owner Was system pumped as part of the inspection? 700 If yes, volume pumped. How was quantity pumped determined? Reason for pumping: Date gallons gauge on truck uested by owner Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool 7/6/2015 Date of Inspection ® Yes. ❑ No ❑ 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 • 3/13 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 M ° 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) MA 01845 State Zip Code 7/6/2015 Date of Inspection Approximate age of all components, date installed (if known) and source of information: Septic tank: original. D -box and SAS: late 1990's, per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 12"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.): All ok. No leakage. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 700 aallon round concrete tank 91 feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 5' H x 7' DIA. Sludge depth: 8" ❑ Yes ❑ No t5ins • 3/13 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 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) Septic Tank (cont.) nnn 01845 Zip Code Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? 7/6/2015 Date of Inspection 28" 1" 5" 16" Sludge Judge 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 should be pumped ANNUALLY. Inlet baffle is intact and in good condition. Outlet tee is intact and in good condition. Structural integrity of tank is good. Liquid level is at outlet invert. No evidence of leakage into or out of tank. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass Dimensions: ,i 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: feet ❑ polyethylene ❑ other (explain): Date t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is required for every North Andover MA 01845 7/6/2015 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: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No 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 t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts a W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is required for every North Andover MA 01845 7/6/2015 page. City/Town State Zip Code. Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at outlet inverts 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 appears to be level and distribution to outlets is equal. No solids carryover. No leakage into or out of box. 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 • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts U W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) Type:El El leaching pits leaching chambers leaching galleries leaching trenches leaching fields overflow cesspool MA 01845 State Zip Code number: number: number: 7/6/2015 Date of Inspection number, length: number, dimensions: number: 1, 28'x 48' Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil and vegetation are normal. No signs of hydraulic failure. 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 ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 13 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner's Name North Andover MA 01845 7/6/2015 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 • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address AnthonyCerra Owner Owner's N'I information is North An required for every page. Cityrrown t5ins • 3/13 me over D. System Information (cont.) MA 01845 7/6/2015 State Zip Code Date of Inspection Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately SU MMJe: Q, PC t i�y�p / s _r' Z 16� 2' -b-28, ' i Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 wo Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner's Name North Andover MA 01845 7/6/2015 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: >7 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: reviewed Title 5 Inspection Report dated 3/14/2002. Test hole was dug that day. ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test hole dug on 3/14/02 showed no groundwater at 7'. 1 also checked the basement sump pump basin and found it to be drv. Bottom of sump basin is 6' below ground surface. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Insp Subsurface Sewage Disposal System Fo 171 Summer Street E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 ection Form rm - Not for Voluntary Assessments Property Address Anthony Cerra Owner Owner's Name information is required for every North Andover MA 01845 7/6/2015 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 t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Summary Record Card generated on 8/2512015 10:11:34 AM by Karen Hanlon Town of North Andover Tax Map # 210-038.0-0039-0000.0 Parcel Id 13040 171 SUMMER STREET ANTHONY CERRA 171 SUMMER STREET NORTH ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1 Acres FY 2016 UB Mailina Index Name/Address ANTHONY CERRA 171 SUMMER STREET NORTH ANDOVER, MA 01845 ROBERTS, M. & CHIUCHIOLO, L. 171 SUMMER STREET NORTH ANDOVER, MA 01845 MARC BOURASSA 171 SUMMER STREET NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg id. 16162.0 - 171 SUMMER STREET 3160208 03 Cycle 03 UB Services Maint. Account No. 3160208 Service Code MISCFEEADMIN FEE WTR WATER UB Meter Maintenance Account No. 3160208 Type Loan Number Owner Previous Customer Previous Customer Active/Inact. From Inactive 11/20/2009 Inactive 11/30/2010 Occupant Name Active/Inactive Last Billing Date 7/14/2015 Active Rate Charge Multiplier/Users 0.635/8 7.82 1/ 01 ALL METER SIZE 19.00 /1 Until Serial No Status Location Brand Type Size YTD Cons 29324776 a Active 00 b Badger w Water 0.63 0.63 266 Date Reading Code Consumption Posted Date Variance 6/4/2015 366 aActual 5 7/24/2015 0% 3/5/2015 361 a Actual 5 4/28/2015 -18% 12/4/2014 356 aActual 6 1/15/2015 -12% 915/2014 350 a Actual 7 10/15/2014 -1% 6/5/2014 343 aActual 7 7/16/2014 40% 3/6/2014 336 aActual 5 4/11/2014 -18% 12/5/2013 331 aActual 6 1/17/2014 -2% 9/6/2013 325 aActual 6 10/15/2013 9% 6/10/2013 319 a Actual 6 7/24/2013 -6% 3/6/2013 313 aActual 6 4/22/2013 0% 12/6/2012 307 aActual 6 1/9/2013 -12% 9/7/2012 301 aActual 7 10/15/2012 38% 617/2012 294 a Actual 5 7/16/2012 3% 3/8/2012 289 a Actual 5 4/14/2012 -7% 12/5/2011 284 aActual 5 1/17/2012 -9% 9/9/2011 279 a Actual 6 10/1312011 20% 6/6/2011 273 a Actual 5 7/20/2011 -18% 3/3/2011 268 aActual 6 4/13/2011 -75% 11/29/2010 262 f Final Bill 21 11/29/2010 -26% 9/7/2010 241 aActual 33 10/15/2010 291% 6/3/2010 208 a Actual 8 7/15/2010 -4% 3/4/2010 200 a Actual 8 4/14/2010 -45% i Arsenault, Wilfred ,,7/ Summer St. APPLICATION FOR SEWAGE DISPOSAL IMTALIATION HEALTH DEPARTMENT - NORTH ANDOVER, IHSS. I hereby make application for a permit for a sewage disposal installation at ySummgr 5t• . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 750 Lal, in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of �lao lineal (d1QDWW feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 -inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches /100 feet. No single tile'line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as. provided below, and to incorporate any additional requirements .that may be attached to the permit. Plot Plans must be submitted with application. DAT e::L) U ` Signature' of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DAA 01gnature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE N, : a Signature of nspecting Officer Percolation Test 5 mine Soil: Sandy Clay Garbage Grinder No 1. 2, BOARD OF HEALTH TCWN OF' NORTH ANDOVER, MASS. 4 2.0 SPO' C, T,4 J-4 0 1.0 o' Pita" rs aI�D Iry o — sr--�A v 4-7 . .DATE ADDRESSLOT N0. 3. NO, OF BEDROODJS DEN YES . . . . N0, `� • • 4. GARBAGE GRINDER YES • NO, �� o 5. SHOW DITPENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIIVENSIONS OF LOT r/ 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL e/ 9. 10, 11. NOTE LOCATION AND DISTANICE OF WELL - FROM SEWERAGE SYSTEM SHCK LOCATION OF BROOKSv STREAKS DITCHES p LEDGE OUTCROP S ETC SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROT4 HOUSE NOTE: LOCAL REGULAT IOALS SHOULD BE READ CAREFULLY. i Y November 4, 1961 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requestedin order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Summer Street building site of Wilfred Arsenault. The land in general is high. The subsoil in the area was of sandy clay content and a 5 -minute percolation test was conducted. It is recommended that a 750 gallon concrete septic tank be installed together with 180 lineal feet of drain pipe. Very truly yours, t'Ui iam J. D isco WJD,-); hd