HomeMy WebLinkAboutMiscellaneous - 30 JAY ROAD 4/30/2018--,, t,,�
North Andover Board of Assessors Public Access Page I of I
Andover Board of Assessors
MMA.,
lZroperty Record Card
Parcel ID :210/098.A-0060-0000.0 FY:2012 Community: North Andover
Click on Sketch to Enlarge
Location: !30 JAY ROAD
Owner Name: GALE, WENDY L
bw7ner Xjii�es-s: ��730- JAY ROAD
�City: NORTH ANDOVER State: MA Zip: 01845
Neighborhood: 6 - 6 Land Area: 1.03 acres
Use Coae: I0i-SNGL-FAM-RES Total Finished Area: 1872 sqft
Total Value:
361,800 361,800
Building Value:
154,700 154,700
Land Value:
207,100 207,100
Market Land Value:
207,100
Chanter La�d-Value:-
Safe Price: Sale Date: ..08/03/1990 ... - --- I I i
Arms Length Sale A -NO -FAMILY Grantor: GALE, WILLIAM L
Code: I
Cert Doc: 7 Book: -'63143 Page: '.0-14-1- 1
http://csc-ma.us/PROPAPP/display.do?linkld=1893798&town--NandoverPubAce 7/16/2012
r, Susan
From:
Sent:
To:
Subject:
Attachments:
For your information
Grant, Michele
Thursday, January 03, 2013 12:48 PM
Sawyer, Susan
FW: Complaint
Gale response 12 21 12.doc
----- Original Message -----
From: Bellavance, Curt
Sent: Thursday, January 03, 2013 11:07 AM
To: Grant, Michele
Subject: FW: Complaint
Michelle: this is a file copy of a letter that I believe was sent out. You may just want to stamp "Draft" on this until we
can verifV an actual hard copy.
----- Original Message -----
From: Maylor, Andrew
Sent: Friday, December 21, 2012 9:10 AM
To: Bellavance, Curt
Subject: RE: Complaint
Curt,
Attached is the version that will be mailed.
Regards,
Andrew W. Maylor
Town Manager
Town of North Andover
120 Main Street
North Andover, MA 01845
Phone 978.688.9510
Fax 978.688-9556
Email amaylor(@townofnorthandover.com Web www.TownofNorthAndover.com
----- Original Message -----
From: Bellavance, Curt
Sent: Friday, December 21, 2012 8:50 AM
To: Maylor, Andrew
Subject: RE: Complaint
Andrew:
1
I also wanted to mention that this site is surrounded by wetlands. Constructing a new system or repairing an existing
system would be expensive. Septic systems usually last 30-40 years if maintained properly. If a family moves in (rather
than two elderly people) the water usage will likely double, which would most likely over burden the system.
If a buyer comes in to speak with our staff we would probably advise them of this if they ask. We may advise them to do
an independent test. We would roughly be talking about $20-$30K to repair and in this case additional costs to receive
Con Com approval.
Curt
----- Original Message -----
From: Maylor, Andrew
Sent: Thursday, December 20, 2012 4:12 PM
To: Bellavance, Curt
Cc: Robertson, Karen
Subject: RE: Complaint
Curt,
Do we have some Title 5 information on GIS, but it is not complete? Is it our intention to add all of this information? If
we do not have this information for any property, I would just simply say that although it is a goal of ours to provide the
information via our website, that information does not exist today. I would avoid the reference to GIS and most of the
information in that paragraph.
Regards,
Andrew W. Maylor
Town Manager
Town of North Andover
120 Main Street
North Andover, MA 01845
Phone 978.688.9510
Fax 978.688.9556
Email amaylor@townofnorthandover.com Web www.TownofNorthAndover.com
----- Original Message -----
From: Bellavance, Curt
Sent: Thursday, December 20, 2012 4:03 PM
To: Maylor, Andrew
Cc: Robertson, Karen
Subject: RE: Complaint
Attached is a draft letter for your review.
----- Original Message -----
From: Robertson, Karen
Sent: Thursday, December 20, 2012 1:00 PM
To: Bellavance, Curt
Subject: Complaint
Please draft a written response regarding the attached letter and email to the Town Manager for his review prior to
mailing it.
Thank you.
Karen A. Robertson
Administrative Assistant
Town Manager's Office
Town of North Andover
120 Main Street
North Andover, MA 01845
Phone 978.688.9510
Fax 978.688.9556
Email krobertson@townofnorthani clover.com Web www.TownofNorthAndover.com
----- Original Message -----
From: ricohscans@townofnorthandover.com [maiIto:ricohscans@townofnorthandover.com]
Sent: Thursday, December 20, 2012 11:26 AM
To: Robertson, Karen
Subject: Message from "Town Ha 11-2 nd Fl r -Co pyRoom
This E-mail was sent from "Town Ha 11-2 nd Fl r-CopyRoom " (Aficio MP C4502).
Scan Date: 12.20.2012 11:26:12 (-0500)
Queries to: ricohscans@townofnorthandover.com
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices
and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
91
T,
leember 5, 2012
UEC 13
Andrew,, Maylor, Town Manager
120 Main Street
-10� Ur to
OFf
tu
North Andover, MA 0 1845 No
To the Town of North Andover,
My house at 30 Jay Road went on the market in late June after the title 5 was done. It
wasn't long before it was under agreement. By mid-July I had made a copy of the passed
ti tl e 5 fo rm fo r the prosp ecti ve buyer s. (Csu—ppo s e t 56y)Ai�r-Cque s ti o n -i n-'g-th- e- -vail i d ity o f it rt 6V e -
since if did f:i:o�s ow—up-on-the-town,s-weli7sitE7-W-lier-�qh�re-is a pqge to display it. It/ O,PA
app title fives are on the town website. Perhaps youi iech 44�Cr#qent -could' -2
�qars thaf NO
rda-lCe--R1Ug--e note to this effect in the middle o 'ffia-f -screen and give the proper office to
go to if a personwants-to- see -the -official. copy onfile.-
�-My buyers I'm not sure Whiali-offic-e but -my hunch is-th-e,todw-n hall) to
ask-ifAhey-had-the -title -5-Here-'s-what-l-heard-via the-tworealtors: The man behind the-]
esk saidi&—yd—idnot tiav-eit. —He k pass a 3
y di
y di not
y di not
y di not
y di not ave it. He added-that-HR-wouldNEVER year old
s stem,4nid-thatin -to-pay for,
F-- 4nd.t. y�buyqrs wo�fd certaOyj Eave:7problems they would have
y5
This person did not know the circumstances of this house or this system. It happens that
the house averaged only two people during its entire life which made for small
throughput to the system. We have always taken great care of what goes down the drain,
never allowing garbage or grease. We have done minimal laundry and taken showers at a
health club. We were snowbirds for the, last decade which left the septic dormant for half
of those 10 years. . I-re.plac.ed-parts-of-the-system- -that could have weakened over time.
Qjh:-is �-person-`representing-the -town-wasn't -looking down in the big hole 'in my lawn to see�?
the-c-lean-graveel —arowid t =1e dFain-fle-1-d-7-He-Willffo rikh-t 6--ex-press- his' ovifi ideas on
[behalf of the town. -Mi —system j�i�s�d-Mcmausea certified person looked through the
syste��and �Iiked whathe7saw. That's how this works.
The words of the town employee were enough to kill the deal.
Eventually I got some new buyers but it cost me another month of time on the market and
because of this time pressure I was forced to lower the price five thousand dollars beyond
the first buyer's offer. I would hope that Riture answers to questions about title fives
would be directed to the Board of Health and that ALL the town personnel be advised to
keep their personal opinions silent.
Thank you, Wendy Gale
100 1 North Pasadena, #41
Mesa, AZ 15201
Grant, Michele
From: Bellavance, Curt
Sent: Thursday, January 03, 2013 11:07 AM
To: Grant, Michele
Subject: FK Complaint
Attachments: Gale response 12 21 12.doc
Michelle: this is a file copy of a letter that I believe was sent out. You may just want to
stamp "Draft" on this until we can verify an actual hard copy.
----- Original Message -----
From: Maylor, Andrew
Sent: Friday, December 21, 2012 9:10 AM
To: Bellavance, Curt
Subject: RE: Complaint
Curt,
Attached is the version that will be mailed.
Regards,
Andrew W. Maylor
Town Manager
Town of North Andover
120 Main Street
North Andover, MA 01845
Phone 978.688.9510
Fax 978.688.9556
Email amaylor(@townofnorthandover.com Web
----- Original Message -----
From: Bellavance, Curt
Sent: Friday, December 21, 2012 8:50 AM
To: Maylor, Andrew
Subject: RE: Complaint
Andrew:
www.TownofNorthAndover.com
I also wanted to mention that this site is surrounded by wetlands. Constructing a new system
or repairing an existing system would be expensive. Septic systems usually last 30-40 years
if maintained properly. If a family moves in (rather than two elderly people) the water
usage will likely double, which would most likely over burden the system.
If a buyer comes in to speak with our staff we would probably advise them of this if they
ask. We may advise them to do an independent test. We would roughly be talking about $20-
$30K to repair and in this case additional costs to receive Con Com approval.
Curt
----- Original Message -----
From: Maylor, Andrew
Sent: Thursday, December 20, 2012 4:12 PM
1
To: Be-Ilavance, Curt
Cc: Robertson, Karen
Subject: RE: Complaint
Curt,
Do we have some Title 5 information on GIS, but it is not complete? Is it our intention to
add all of this information? If we do not have this information for any property, I would
just simply say that although it is a goal of ours to provide the information via our
website, that information does not exist today. I would avoid the reference to GIS and most
of the information in that paragraph.
Regards,
Andrew W. Maylor
Town Manager
Town of North Andover
120 Main Street
North Andover, MA 01845
Phone 978.688.9510
Fax 978.688.9556
Email amaylor(@townofnorthandover.com Web
----- Original Message -----
From: Bellavance, Curt
Sent: Thursday, December 20, 2012 4:03 PM
To: Maylor, Andrew
Cc: Robertson, Karen
Subject: RE: Complaint
Attached is a draft letter for your review.
----- Original Message -----
From: Robertson, Karen
Sent: Thursday, December 20, 2012 1:00 PM
To: Bellavance, Curt
Subject: Complaint
www.TownofNorthAndover.com
Please draft a written response'regarding the attached letter and email to the Town Manager
for his review prior to mailing it.
Thank you.
Karen A. Robertson
Administrative Assistant
Town Manager's office
Town of North Andover
120 Main Street
North Andover, MA 01845
Phone 978.688.9510
Fax 978.688.9556
Email krobertson(@townofnorthandover.com Web www.TownofNorthAndover.com
2
— , I J
----- Original Message -----
From: ricohscans(@townofnorthandover.com [mailto:ricohscans(@townofnorthandover.com]
Sent: Thursday, December 20, 2012 11:26 AM
To: Robertson, Karen
Subject: Message from "TownHall-2ndFlr-CopyRoom"
This E-mail was sent from "TownHall-2ndFIr-CopyRoom" (Aficio MP C4502).
Scan Date: 12.20.2012 11:26:12 (-0500)
Queries to: ricohscans0townofnorthandover.com
Please note the Massachusetts Secretary of State's office has determined that most emails to
and from municipal offices and ' officials are public records. For more information please
refer to: http://www.sec.state.ma.us/pre/``preidx.htm.
Please consider the environment before printing this email.
Andrew W. Maylor
Town Manager
Ms. Wendy Gale
1001 North Pasadena, #41
Mesa, AZ 15201
Dear Ms. Gale,
Town of North Andover
Office of the
Town Manager
North Andover Town Hall
120 Main Street
North Andover, MA 01845
e-mail:
amaylorgtownofnorthandover.com
Telephone (978)688-9510
Fax (978)688-9556
Thank you for your letter regarding the sale of your home and the septic system issues you
mentioned. As you are aware the Commonwealth of Massachusetts does have a law that requires
homeowners to test their private wastewater disposal systems when selling their property. This law is
commonly referred to as Title 5.
Because this is a State law, the Department of Environmental Protection oversees the
requirements/compliance in which septic systems are monitored, tested and constructed. The DEP
works with local communities to ensure that the requirements are met.
The Town of North Andover Health Department maintains records whenever a certified installer
or pumper does work on an old or new system. This information is kept in our central filing system
which is filed under street number and address. The file for #30 Jay Road does have a certificate
showing that the septic system was recently tested and passed. That information is public record and is
available for anyone to see.
Although the Town does provide public access through our website of certain property related
information, the status of septic systems for individual properties is not currently available
electronically.
I will let you know that I will address the fact that one of my employees provided their "opinion"
about your septic system rather than just providing facts or information we have on file. The most
important service can provide is great customer service. If in this case we acted in an unprofessional
manner then I apologize. I will investigate your realtor's situation and make sure that this type of
situation does not occur again.
Thank you for bringing this matter to my attention. If you have any further questions please contact me
at 978-688-9510.
Sincerely,
Andrew W. Maylor
Town Manager
6142
Town of North Andover
HEALTH DEPARTMENT
CHECK#: M/1 D A T E: I
LOCATION: (
U201, W
ffr-M.21=02,
FA
kRe
of Permit or License: (Check box)
0
Animal
$
0
Body Art Establishment
$
0
Body Art Practitioner
$
0
Dumpster
$
0
Food Service - Type.
$
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
TrashlSolid Waste Hauler
$_
0
* Well Construction
$
SEP77C Systems:
0
Septic - Soil Testing
$
0
Septic - Design Approval
$
0
Septic Disposal Works Construction (DWQ
$
13
Septic Disposal Works Installers (DW[)
$
0� �Title nspector
ns'
$
i itl
tle 5 Reptort
11 Other (Indicate) $
Health Agent Initials
White -Applicant Yellow -Health Pink -Treasurer
6142
Town of North Andover
...... . HEALTH DEPARTMENT
CHECK#: /3 7'� D A T E:
LOCATION: ( J��
H / 0 N A M E: _W40, 50 �'IZ Ar X! W
Tvpe of Permit or License: (Check box)
•
Animal
$
•
Body Art Establishment
$_
•
Body Art Practitioner
$
0
Dumpster
$
•
Food Service - Type.-
$
•
Funeral Directors
$
•
Massage Establishment
$
0
Massage Practice
$
•
Offal (Septic) Hauler
$
•
Recreational Camp
$
0
Sun tanning
$
•
Swimming Pool
$
•
Tobacco
$
•
TrashlSolid Waste Hauler
$
•
Well Construction
$
SEPTIC Systems
•
Septic- Soil Testing
$
•
Septic -Design Approval
$
0
Septic Disposal Works Construction (DWQ
$
0
Septic Disposal Works Installers (DW[)
$_
ZTitle 5 pector
0 $
jtl
itle 5 Report
0 Other (Indicate) $
He�lth Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
IS
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.
Commonwealth of Massachugefts �
Title 5 Offic'ial Inspection Fo
Subsurface Sewage Disposal System Form - Not for Voluntary,
30 Jay Road
Property Address
Wendy Gale
Owner's Name
North Andover
men�p,
JUN 2 '1 NQ
IrH
MA 01845 6-6-2012
Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in 4y
way. Please see completeness checklist at the end of the form.
A. General Information
Inspector:
Michael J. Wood
Name of Inspector
Service Pumpin
Company Name
5 Hallberg Park
Company Address
North Reading
City/Town
1-978-276-0217
Telephone Number
and Drain Co., Inc.
B. Certification
MA
State
5021
License Number
01864
Zip Code
b I
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:
0 Passes El Conditionally Passes El Fails
7 Needs Further Evaluation by the Local Approving Authority
6-18-2012
lnspe��6 Signatulz f Date
L/
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 DER The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins - 11 /10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page I of 17
oAll 'kim, I
wl
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Jay Road
Property Address
Wendy Gale
Owner's Name
North Andover MA 01845 6-6-2012
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E / always complete all of Section D
A) System Passes:
1 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:
El 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.
EJ Y D N 0 ND (Explain below):
t5ins - 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17
0111 L
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Jay Road
Property Address
Wendy Gale
Owner's Name
North Andover MA 01845 6-6-2012
CityrTown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
F-1 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):
El
broken pipe(s) are replaced
El Y
El
N
0
ND (Explain below):
n
obstruction is removed
El Y
0
N
0
ND (Explain below):
F-1 distribution box is leveled or replaced F-1 Y 0 N 0 ND (Explain below):
El 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):
F-1 broken pipe(s) are replaced El Y El N El ND (Explain below):
0 obstruction is removed El Y El N Ej ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
F] 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(l)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
0 Cesspool or privy is within 50 feet of a surface water
El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17
111mom
L r. j
LIN
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Jay Road
Property Address
Wendy Gale
Owner's Name
North Andover
City/Town
B. Certification (cont.)
MA 01845
State Zip Code
6-6-2012
Date of Inspection
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:
El 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 I of a public water
supply.
El 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
11
z
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
1:1
z
Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2day flow
t5ins - 11/10
Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 4 of 17
Conimonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
30 Jay Road
Property Address
Wendy Gale
)wner Owner's Name
nformation is
equired for every North Andover MA 01845 6-6-2012
age. 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.
El 1K Any portion of a cesspool or privy is within 50 feet of a private water supply well.
0 M 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.
El 0 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
El
EJ
the system is within 400 feet of a surface drinking water supply
E]
El
the system is within 200 feet of a tributary to a surface drinking water supply
0
El
the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area — IWPA) or a mapped Zone 11 of a public water supply well
i
P
The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
El 0 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
El
EJ
the system is within 400 feet of a surface drinking water supply
E]
El
the system is within 200 feet of a tributary to a surface drinking water supply
0
El
the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area — IWPA) or a mapped Zone 11 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 - 11/10 Title 5 Official inspection Form: Subsurface Sewage Disposal System - Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Jay Road
C. Checklist
MA 01845 6-6-2012
Date of Inspection
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
0 El
Property Address
El M
Wendy Gale
Owner
Owner's Name
information is
required for every
North Andover
page.
City/Town
C. Checklist
MA 01845 6-6-2012
Date of Inspection
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
0 El
Pumping information was provided by the owner, occupant, or Board of Health
El M
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?
El 0
Have large volumes of water been introduced to the system recently or as part of
this inspection?
EJ Z
Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
0 0
Was the facility or dwelling inspected for signs of sewage back up?
• El
Was the site inspected for signs of break out?
• El
Were all system components, excluding the SAS, located on site?
• El
Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
• El
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:
0 0
Existing information. For example, a plan at the Board of Health.
El 0
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): unknown Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): unknown
t5ins - 11/10 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
30 Jay Road
Property Address
Wendy Gale
Owner Owner's Name
information is
required for every North Andover
MA 01845 6-6-2012
page. CityfTown State Zip Code Date of Inspection
D. System Information
Description:
1)
Number of current residents:
Does residence have a garbage grinder? E Yes E] No
Is laundry on a separate sewage system? [if yes separate inspection required] El Yes 0 No
Laundry system inspected? El Yes Z No
Seasonaluse? El Yes E No
Water meter readings, if available (la st 2 years usage (gpd)): N/A
Detail:
Sump pump? 0 Yes E] No
Last date of occupancy: currently
occupied
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?
Industrial waste holding tank present?
Non -sanitary waste discharged to the Title 5 system?
Water meter readings, if available:
El Yes El No
F1 Yes F� No
El Yes n No
t5ins - 11/10 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
30 Jay Road
Property Address
Wendy Gale
Owner Owner's Name
information is
required for every North Andover MA 01845 6-6-2012
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use:
Other (describe below):
General Information
Pumping Records:
Source of information: owner
Was system pumped as part of the inspection?
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
Type of System:
gallons
Date
El Yes 2 No
F� Privy
El Shared system (yes or no) (if yes, attach previous inspection records, if any)
E] 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.
D Other (describe):
t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17
Septic tank, distribution box, soil absorption system
Single cesspool
El
Overflow cesspool
El Yes 2 No
F� Privy
El Shared system (yes or no) (if yes, attach previous inspection records, if any)
E] 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.
D Other (describe):
t5ins - 11/10 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
30 Jay Road
Property Address
Wendy Gale
Owner Owner's Name
information is
required for every North Andover MA 01845 6-6-2012
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:
No plans were available for this system. The homeowner says that the system is approximately 45
years old.
Were sewage odors detected when arriving at the site? EJ Yes 0 No
Building Sewer (locate on site plan):
Depth below grade: 2211
feet
Material of construction:
E cast iron [-] 40 PVC El other (explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
There are no visible sions of failure or leakaae.
Septic Tank (locate on site plan):
Depth below grade: 16"
feet
Material of construction:
0 concrete F� metal 0 fiberglass El polyethylene other (explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes [:] No
Dimensions: approximately 4'x4'x8'
Sludge depth: <21,
t5ins - 11/10 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
30 Jay Road
D. System Information (cont.)
State Zip Code
Septic Tank (cont.)
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
6-6-2012
Date of Inspection
>2'
no scum
no scum
no scum
How were dimensions determined? tape measure/ 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.):
There are no visible siqns of failure.
Grease Trap (locate on site plan):
Depth below grade:
Material of construction:
El concrete El metal El fiberglass
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
t5ins - 11/10
feet
n polyethylene El other (explain):
Date
Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17
Property Address
Wendy Gale
Owner
Owner's Name
information is
required for every
North Andover
page.
Cityrrown
D. System Information (cont.)
State Zip Code
Septic Tank (cont.)
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
6-6-2012
Date of Inspection
>2'
no scum
no scum
no scum
How were dimensions determined? tape measure/ 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.):
There are no visible siqns of failure.
Grease Trap (locate on site plan):
Depth below grade:
Material of construction:
El concrete El metal El fiberglass
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
t5ins - 11/10
feet
n polyethylene El other (explain):
Date
Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
30 Jay Road
Property Address
Wendy Gale
Owner Owner's Name
information is
required for every North Andover MA 01845 6-6-2012
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:
El concrete El. metal F1 fiberglass El polyethylene El other (explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: 0 Yes El No
Alarm level: Alarm in working order: El 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? El Yes El No
t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 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
30 Jay Road
Property Address
Wendy Gale
Owner's Name
North Andover MA 01845 6-6-2012
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
a
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.):
Distribution appears equal and there are no visible siqns of failure.
Pump Chamber (locate on site plan):
Pumps in working order:
El
Yes
F1
No
Alarms in working order:
0
Yes
R
No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins - 11 /10 Title 5 Official Inspection Form: 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
30 Jay Road
Property Address
Wendy Gale
Owner Owner's Name
information is
required for every North Andover
MA
01845 6-6-2012
page. Cityrrown
State
Zip Code Date of Inspection
D. System Information
(cont.)
Type:
leaching pits
number:
E-1
leaching chambers
number:
E]
leaching galleries
number:
0
leaching trenches
number, length:
leaching fields
number, dimensions: 1, unsure
0
overflow cesspool
number:
F�
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.):
The size of the leaching field is unknown due to a lack of plans. There are no visible signs of failure.
The distribution box has 5 outlet lines that appear to face the front of the property.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth — top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow
El Yes El No
t5ins - 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 17
L
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Jay Road
Property Address
Wendy Gale
Owner's Name
North Andover MA 01845 6-6-2012
CityrTown 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 - 11/10 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
30 Jay Road
Property Address
Wendy Gale
Owner Owner's Name
information is
required for every North Andover
page. CityfTown 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:
MA 01845 6-6-2012
hand -sketch in the area below
drawing attached separately
0 C
-0—m', r -PA.
A�
SE:F-n'cTA,q v -
AC= V7'
ZC Z- 19,(- it
27'
t5ins - 11 /10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 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
30 Jav Road
Property Address
Wendy Gale
Owner's Name
North Andover MA 01845 6-6-2012
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
Z Check Slope
F-1 Surface water
N Check cellar
F-1 Shallow wells
Estimated depth to high ground water:
6.5
feet
Please indicate all methods used to determine the high ground water elevation:
F] 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)
F1 Checked with local Board of Health - explain:
F� Checked with local excavators, installers - (attach documentation)
FJ Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
There is a sump pump in the basement that is approximately 6.5-7 feet below grade.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins - 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17
.40. 9
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
30 Jay Road
Property Address
Wendy Gale
Owner Owner's Name
information is
required for every North Andover MA 01845 6-6-2012
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 - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17