HomeMy WebLinkAboutTitle V Inspection Report - 100 CANDLESTICK ROAD 6/5/2018 Commonwealth of Massachusetts
u _ u Title 5 Oficial Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1 00Candlestick Road
Property Address
Constance Montouri
Owner
bwner's Name
information is Andover MA 01810 5-17-2018
required for every ...._. _._ _.__._....__._..._ ..... —
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this farm. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When $t
fillingout forms
A. General Information
on the computer,use
vt
key to move youronthe tab
1. Inspector: � ,�� 51'e �
cursor-do not Neil J. Batesonoj
use the return __. .�
key. Name of Inspector
Bateson Enterprises Inc.
� Company Name -..--------
111 Argilla Road
Company Address
Andover MA 01810
City/Town State Zip Code
978-475-4786 SI-15
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
❑ Ne ds urther Evaluation by the focal Approving Authority
5-17-2018
Ins ct 's ignatur Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the 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.
15ins.dou-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
100 Candlestick Road
Property—Address -- I
Constance Montouri —---------
Owner Owner'sName-----
information is Andover MA 01810 5-17-2018
required for everyState Zip Code Date of Inspection
page.
B. Certification (cont.)
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:
F1 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 F] N F] ND(Explain below):
—--------------
t5lns.do4-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
100 Candlestick Road
-Property Address---
Constance Montouri ------
Owner Owner's Name
information is MA 01810 5-17-2018
required for every Andover �sta—te Dateof—Insipectlon
page. (:�1ty/fo—wn -------- —
B. Certification (cont.)
F1 Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes(cont.):
F] 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 E] Y 0 N El ND (Explain below):
F] obstruction is removed E] Y r-1 N F ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y F N F1 ND (Explain below):
F-1 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):
El broken pipe(s)are replaced 0 Y n N El ND (Explain below):
❑ obstruction is removed El Y F1 N M 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
16.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
R 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,dop-rev.6/16 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
100 Candlestick Road
isir-op—efty Address
Constance Montouri
Owner Owners Name
mm
information Is5-17-2018
required for every Andover MA 01810
page. di-ty—frown 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:
F-1 The system has a septic tank and soil absorption system (SAS) and the SAS is within
IGO feet of a surface water supply or tributary to a surface water supply.
n The system has a septic tank and SAS and the SAS is within a Zone I of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
-----------
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
El Z 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
El 0 due to an overloaded or clogged SAS or cesspool
❑ Static liquid level in the distribution box above outlet invert due to an overloaded
z
or clogged SAS or cesspool
z Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/ day flow
t5ins,doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
100 Candlestick Road
Property Address
Constance Montouri
Owner Owner's Name
information is Andover MA 01810 5-17-2018
required for every
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
El 0 obstructed pipe(s). Number of times pumped:
El 0 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
tri,butary to a surface water supply.
El E Any portion of a cesspool or privy is within a Zone I of a public well.
El 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well.
0 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
El El 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 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.
t5lns.doc•rev,6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
u Title 5 Official Inspection Form
_..m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.' 100 Candlestick Road
Property Address
Constance Montouri
Owner Owner's Name
information is Andover MA 01810 5-17-2018
required for every .__ _ _
page. City/Town State Zip Code Date of inspeakian
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
E 0 Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
M ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ® Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® Q Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4- --
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t5ins.doq•rev.6116 Title 6 Official Inspection Form;Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
V Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
100 Candlestick Road __ -------
Property Address _ _ -
Constance Montouri
Owner Owner's Name
information is
required for every Andover _MA 01810 5-17-201$
_ j
page. Cityrrown state Zip Code Date of Inspection
D. System Information {
Description:
1
Number of current residents:
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))� Yes
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Current
Date
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? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available: ---- - —
t5ins.doo•rev.06 'Dille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
.w'¢-
100 Candlestick Road
Property Address
Constance Montouri
Owner Owner's Name
information is
required for every Andover MA 01810 5-17-2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Pumped 2017, owner -—---------
Was system pumped as part of the inspection? ® 'Yes El No
If yes, volume pumped: 1500gallons
How was quantity pumped determined? Measured tank
Reason for pumping: _"s ect tank&tees_._,_"._____
Type of System:
El Septic tank, distribution box, soil absorption system
El Single cesspool
E-1 Overflow cesspool
M Privy
El 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.doo-rev.8116 Titto 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form Not for Voluntary Assessments
100., andlestick. Road
Property Address
Constance Montouri -------
Owner Owner's Name
information is Andover MA 01810 5-17-2018
every
required for eve —
page. di_tyifo_wn ------ State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
2-15-2005 on desian.,plan, no as builtplan
Were sewage odors detected when arriving at the site? El Yes 0 No
Building Sewer(locate on site plan):
2.4
Depth below grade: feet
Material of construction,
F] cast iron 40 PVC El other(explain):
Distance from private water supply well or suction line: fe-et --
Comments (on condition of joints, venting, evidence of leakage, etc.):
4" PVC through wall, 3" PVC in house , no leaks visible.
Septic Tank(locate on site plan): 1.4
Depth below grade: feet
Material of construction:
concrete El metal El fiberglass ❑ polyethylene El other(explain)
-------------
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
10'x 5'x 4'
Dimensions:
211
Sludge depth:
151ns.doq rev.6116 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
100 Candlestick Road
iProperty Address
Constance Montouri
Owner Owner's Name
information is Andover MA 01810 5-17-2018
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
31"
Distance from top of sludge to bottom of outlet tee or baffle
3'
Scum thickness
Distance from top of scum to top of outlet tee or baffle 8-1
1211
Distance from bottom of scum to bottom of outlet tee or baffle
Tape Measure
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Setic tank is Micro Fast Pretreatment system. Inlet tee ok. Outlet baffle ok. Depth of liquid at outlet
invert. No evidence of leakage. Center cover to grade. Blower is running
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
F] concrete El metal F]fiberglass ❑ polyethylene E] other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
t5ins.doc rev.6116 Titte 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
100 Candlestick Road
Property Address
Constance Montouri
Owner Owner's Name
information is
required for every Andover MA 01810 5-17-2018
page. Citylrown 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: ——----------i
Material of construction:
M concrete El metal F] fiberglass Ej polyethylene ❑ other(explain):
Dimensions: ----------- —----------
Capacity: gallons
Design Flow: -.- ___._.__-.,
galions per day
Alarm present: El Yes El No
Alarm level: Alarm in working order: n Yes El 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 n No
t5ins.doo•rev,6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
100 Candlestick Road
Property Address
Constance Montouri
Owner Owners Name
information is A 0
Andover d
noM1810 5-17-201$
required for every A - ----- M 18 _...__ �_....�
page. Cltyrrown State Zip Cade 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
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.):
Pump Chamber(locate on site plan):
Pumps in working order: ® Yes E] No*
Alarms in working order: ® Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump tank ok. Pump ok. Floats ok. Alarm has both audible &visual
* 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.doc-rev.6/16 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
z __ a_ ❑v Title 5 Official Inspection Form
— n Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4
100 Candlestick Road __ _--_---. _-----.--
Property Address
Constance Montouri
Owner Owner's Name
information is Andover MA 01810 5-17-2018
required for every An_._. _.__.
page. City[Town � State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number: - _.60
® leaching chambers number: -- -- —
❑ leaching galleries number: --—
❑ leaching trenches number, length: ----
❑ leaching fields number, dimensions: -- --
❑ overflow cesspool number: --
❑ innovative/alternative system
Type/name of technology: — -- -.--.----- _
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Soil ok. Vegetation ok. No sign of ponding to surface. Six rows of ten infiltrators per row.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration -- —
Depth—top of liquid to inlet invert —
Depth of solids layer _------__ �.—
Depth of scum layer
Dimensions of cesspool —...--. __....._.__.._._.___.-----_--._.._--
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
i151ns.doq rev.6116 Tit@e 6 Official Vnspection Farm:Subsurface Sewage Disposal System-Page 13 or 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I Ai Subsurface Sewage Disposal System Form Not for Voluntary Assessments
100 Candlestick Road
----------- j
Property Address
Constance Montouri ..........
Owner Owners Name
information is Andover MA 01810 5-17-2018
required for every -
page- cityrrown 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.dod-rev.6116 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
100 Candlestick Road
PropertyyAddress—
Constance Montouri
Owner Owner's Name
information is
required for every Andover MA 01810 5-17-2018
page. Cityfrown State Zip Code DateofIns.pection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
hand-sketch in the area below
El drawing attached separately
0 n7
J
ti -
3- :�l, if
t51ns.doq-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
100 Candlestick Road
Property Address
Constance Montouri
Owner Owners Name
information is Andover MA 01810 5-17-2018
required for every --------
page. Cilyfrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
E Check Slope
Z Surface water
Check cellar
Shallow wells
2
Estimated depth to high ground water:
t
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: 10-24-2003 --------
Date
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health -explain:
Design )Ian
❑ Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
As per test pit data on design plan.
-----------—-------
—-----------
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doq-rev.6116 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
100 Candlestick Road
Property Address
Constance Montouri
Owner Owner's Name
information is17-2018
required for every Andover MA 01810 5-
page. it own State Zip Code Date of Inspection
...........
E. Report Completeness Checklist
0 inspection Summary: A, B, C, D, or E checked
ED 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
Ilins,d,,,,*,a,,,6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
Wastewater Treatment Services, Inco
44 Commercial Sireet
Raynham,MA s
02767
i
Tel: (808)880-0233
Fax: (608)880»7232
k
i.
S
4
t
Valued Customer:
Enclosed please find the Field Inspection& Service Report for services performed at
your property.
Please review the Service � fhReport and test results if and be sure to refer to the
p r.
effluent limits set for your property by state and local approving authorities! Should you
3
have questions on the requirements for your property,please contact our office for further
information,
Any required reporting to state and local agencies will be sent out by our office.
1
Sincerely,
I
Wastewater Treatment Services
Wastewater'Treatment Services, Inc. '
Service Department
Enclosures
• _M�¢ -� 31W
n�G:a•n r r'p
8450 Calc:Parkway,Shawnee,KS 66227, Phone 913-422-0-107,Fax 913.422-0808
e-mai6:pnsite�2biatrlioroE .�?-3atnic;rob!Ps car t,800 7a3-F/13T(3278) d
D
For 13u)-]Vltc;<vUacs SAS Systems
29696 „
7ty7ST`A11 11C3N 'AUTHOAV13113SLItViCJ3 #OVtt71?1t;. ' Ii
Installation Address: 100 Candlestick road Name: Wastewater 1"reatrnent Services,lac.
North Andover,MA 01845
OwnerNaunc: Robeativlontuori
Mail Address: 100 Candlestick Road Mail Address: 44 Commercial Street
North Andover,MA 01845 Ruyubarn,MA 07.767
Phone: 978-682-9543 Fax: tJmail: Phone: (508)880-0293 Fax: (508)880-7232 e-mail
odcl r a ,4 Stnmrn 1)atc ate n ast PiLnLp oul
MlcroFAST.5 29259 8/28)2006 1019/2013
Aaprroval TO () General () Provisional () Piloting (x)Remedial () General Denite
N-0 m 0arn1 Resrtleltue ()Xe (x) No --
Mls Nll G�TwJN�.C>✓..T1:, .
,•
_ . 1�(�3�t I�A
Electrical Paitel(s) — --
Visual Alarm Operaling x ____. __.....—----•
Audio Alarm Operating x
I1In\YCC 5 ;
Air Inlet Filter Clean x
Blower Hood Vents Clear x
1;xccssive Noise x
_.Fxm"ive Vibration x
I
71'eatfueW urdl(s)
Unusual Odor x
--------------
Settleable Solids Ust Ferfornted
,Futup ou t Repli-ed x
Primary Settling Zone Sludge Depth 6"
Aerobic TYeatment 7mrrc Sludge Depth 6"
Thickatess of Scum Layer 21'
Sludge Level Distance to Outlet
_------------
Depth of Pending Within SAS
Visual Observation CornmenMS:
,
Measurement Comments:
Esthouted Doily Flow 440 gpd
pEl(Standard Units) 6 to 9 7 1
7lubidity :40 NTU 4.33 a
Dissolved Oxygen ?2 MgIL 2.2
Color Clear Clear
. ..- --..._. _ _ _ _..,..
Temperature loc
Odor Not Septic Earthy
riffluent Solids (x)None ()Some
Effluent Samples Taken: (,
Influent: OpEI ()BOD OGBOD ()TSS OTKN ()Nitrate ()Nitrite O Total Nitrogen OPhosphorvs()Spec.Cond. ()Ammonia ()Alkalinity
(}Oil/Grease ()VOC ()Fecal Coliform ;
Effluent: Opll ()BOD OCBOD ()"CSS O'rKN ()Nitrate ()Nitrite (}Total Nitrogen()Phosphorus()Spec.Cond. OArmttonio OMkalinity
()OWUreaso ()VOC ()poral Coliform — _....-_- _-_-----•-.— '
Description of any maintenance performed since previous inspection&doring this inspection: Cleaned Filter,Checked Splash Recycle,Puwp(s) r
Inspected,Float(s)Inspected
Notes and Comments:
:AAT't1VAMIs e, ��I�GA�It�N�IJMBI�R SI�R�✓ICB:J3AfEE,:.� J
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44 Commercial Street
Raynham, MA
02767
Tel: (508) 880-0233
Fax: (508)880-7232
INSPECTION AND TESTING AGREEMENT �
Agreement entered into by and between Wastewater Treatment Services,Inc. (herein called WTS)and the
FASTQ°System OWNER(hercin called OWNER)for the inspection by WTS of certain equipment of OWNER
which is described below.
t}
Upon acceptance of this agreement at WTS's office,WTS will render the following services only: I
Equipment will be inspected r t least 1 time per year that this Agreement remains in effect, with the first
inspections beginning 1-4— These inspections will include: }
1) Testing of the sludge depth in the septic tank and FAST tank;and testing of thickness of floating
grease/scum layer.
2) Inspection,power testing and clean/replace intake filter of the air blower.
3) Inspection of the alarm system.
4) Inspect overall condition of I(ASr System.
5) Visual observation or measurement of depth/presence of ponding within soil absorption system. I
6) Notification to OWNER of any problems encountered.
7) Inspection of pumps,floats,alarms; leach field lateral flushing, if accessible.
8) Service other than routine maintenance will Ere billed at ail hourly rate,plus travel and parts.
WTS shall notify the local Board of Health and Department of Environmental Protection in writing within 24
hours of a system failure or alarm event including corrective measures that have been taken.
t
OWNER will be billed standard WTS charges for any parts used in repairs or maintenance. Any additional labor
time will be.billed to the OWNER at our current labor rates.
i
Emergency service between regular inspections will be provided at standard labor rates during normal business
hours;at time and one-half after 5:00 PM and on Saturdays;and at double time on Sundays and holidays.
F.rnergency service charges will include a rninimum four(4)hours of labor, plus standard WTS charges for parts,
plus mileage and travel charges. The annual rate includes routine maintenance, but sloes not include repairs
required for damages caused by abuse,accident,theft, acts of third persons,forces ofnature, or alterations made to
the equipment. WTS shall not be responsible for failure to render the agreed services if caused by strikes,labor
disputes,non-cooperation by OWNER,or other factors beyond the control of WTS.
OWNER understands and agrees that WTS is not responsible for ecial, incidental or consequential damages,
!l�' p p q
including but not limited to loss of time, injury to person or property, or equipment failure.
OWNER agrees that WTS may enter OWNER's property and have acceptable access to all areas deetned by
WTS to be necessary or appropriate for WTS to perform its duties hereunder.
x
Current WTS practice is to send OWNER approximately 10 days before expiration of the term of the current
contract an invoice for one year of service. It is OWNER's responsibility to timely return the payment. WTS must
receive the payment before expiration of the current contract year to assure continuous contract coverage. Failure
to return payment may result in suspension of service,cancellation of the contract and/or nullification of
warranties,at the election of WTS. OWNER may not assign this contract without the prior written consent of
WTS. It will remain in force until a party cancels by written notice to the other at the address given herein.
1
MAN MAffLIRFR MODELN0. SERIAL NO. LOCATION ANNUAL RATS 'ER�1T
Dio-Microbids MicroFAST 27259 North Andover,MA $370.00 Remedial
Includes Field Testing
EQUMMENTOWNER Wastewater TreatuiciitServices,lite.
*Signed by OWNER: 111L
Robert Montouri
*Address:
100 Candlestick Road 44 Commercial Street
Raynham,MA 02767
Tole: (508)880-0233
*City: State: Zip: Fax: (508)880-7232
North Andover MA 01845
Telephone C97�') Effective Date of Agreement E-mail address: IV114
OWNER understands that(1)ANNUAL RAIL payment is for one year only commencing on the effective date set
forth above and is non-refundable;and(2) Current DEP Regulations require OWNER to maintain a service
agreement for the life of the FAST'System. I HAVE READ AND UNDERSTAND THE FOREGOING.
*Signed by OWNER:
Field Testin
Onsite testing performed 1 time per year will be used to demonstrate that the systems are operating at a secondary
treatment standard of 30 mg/L of 130155 and TSS. The following will be performed:
1) Visual examination of the effluent for color,turbidity and effluent solids.
2) Settleable solids observation/incasurement
3) Effluent pl-I to determine if the waste water is between 6 and 9 standard units,
4) Dissolved Oxygen,2nig/L or more,to•ensure that the system is operating.
5) Turbidity,'less than or equal to 40 NTU.
If the effluent does not meet effluent quality standards,a grab sample will be collected for.laboratory analysis.
Results sent to state and local Agencies as well as the OWNER. OWNER is responsible for providing acceptable
access to effluent for field testing and/or to enable a grab sample to be taken for laboratory testing performed. If
such laboratory sample is required, OWNER will be responsible for charges incurred. )F REQUIRED,THE
COST FORMIS ADDITIONAL TESTING WILL RE,$190.00NISIT.
*Approval for Additional Testing if Required
Owner's Signature
Operator assigned: Michael Moreau
Telephone: (508)289-2744
Summary Record Card generated on 511412018 2:13:01 PM by Tara Hurley Page 1
Town of North Andover
Tax Map # 210-106.A-0097-0000.0
Parcel Id 17242
100 CANDLESTICK ROAD
MONTOURI, ROBERT N Since Jan 2003
CONSTANCE H MONTOURI
100 CANDLESTICK ROAD
NORTH ANDOVER, MA
01845
Class 101 single Family Property Type 1 Residential
ZonIng2 1 Residential ZonIng3 I Residential
Size Total 1.03 Acres
FY 2018
UB Mailing Index
Name/Address Type Loan Number Active/Inact. From Until
MONTUORI, ROBERT N. Payor
100 CANDLESTICK ROAD
N,ANDOVER,MA
01845
UB Account Maint. Active/inactive
Account No Cycle Occupant Name
Bldg Id. 17688.0-100 CANDLESTICK ROAD Last Billing Date 4/10/2018 Active
3170358 03 Cycle 03
UB Services Maint.
Account No, 3170358
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.635/8 7.82
WTR WATER 01 ALL METER SIZE 45.60
UB Meter Maintenance
Account No,3170358 Brand Type Size YTD Cons
Serial No Status Location w Water 0,630.63 853
35644586 a Active ERT HH b Badger
Date Reading Code Consumption Posted Date Variance
3/7/2018 784 a Actual 12 4/23/2018 -63%
12/7/2017 772 a Actual 31 1125/2018 -4%
9/12/2017 741 a Actual 36 10/18/2017 57%
6/8/2017 705 a Actual 22 7/25/2017 42%
3/8/2017 683 a Actual 15 4/12/2017 .67%
1219/2016 668 aActual 47 1/23/2017 38%
9/912016 621 a Actual 33 10/24/2016 71%
6/1312016 588 a Actual 21 8/2/2016 16%
3/9/2016 567 a Actual 17 4/22/2016 -13%
12110/2015 550 aActual 20 1/20/2016 -10%
1/112011 530 a Actual 22 10/16/2015 .12%
6/10/2015 508 a Actual 26 7/24/2015 12%
3111/2015 483 a Actual 22 4/28/2015 -3%
12/11/2014 461 aActual 23 1/15/2015 -11%
9/11/2014 438 aActual 26 10/15/2014 30%
6/1112014 412 a Actual 20 7/16/2014 32%
3/11/2014 392 aActual 15 4/11/2014 -27%
12/10/2013 377 a Actual 20 1/17/2014 9%
9/12/2013 357 a Actual 19 10/1512013 -11%
6/1212013 338 6 Actual 21 7/24/2013 36%
1/11/2013 117 aActual 16 4/22/2013 -19%
12111/2012 301 aActual 19 1/9/2013 -10%
9113/2012 282 a Actual 22 10/15/2012 1%
6/12/2012 260 a Actual 21 7/16/2012 28%
3/14/20112 239 a Actual 17 4/14/2012 -21%
12/12/2011 222 aActual 21 1/17/2012 -7%
9/12/2011 201 a Actual 24 10/13/2011 -2%
6/7/2011 177 a Actual 23 7/20/2011 2%
Commonwealth of Massachusetts
C'V[Town of
V r
r
System Pumpino.Record
.r Form 4
DEP has provided this form for use-by local Boards of�Health. Other forms may'be'used,but the
information,must be substantially the same as that provided here. Before using.this form,check with your
local Board'of Health to determine the form they use.The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facsiit . tnforMa#ion
1. System Location: Left/Right front of Mouse, Left/Right rear of house, right �e f hou Left
Right side of building, Left/Right front of buildirig, Left/Right rear of building, Under dock
• Address • /o�,
Citylrown t state Zip Code
2, System Owner. r1OL,'1.��`c
Name'
Address(if different from location)
citylrown ' State Zip Code
Telephone Number
.B. Pumping j -ecoid -
-,�r1 w- Q;-tl /5 i
1. Date of Pumping te 2. Quantity Pumped: Gallons `
3. Type�of system: ❑ Cesspaol s ,.., 6'ptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee f=ilter present? ❑ Yes E311gQ If yes, was it cleaned? ❑ Yes ❑ Na
'5. Con ff3aof SYs
6. System Pumped By:
Neil:Bateson ' P5821
Name Vehicle License Number
Bateson Ehterprises Ina
Company
7. Lovana�
re content%were disposed:
C Lowell Waste Water
Sign a H9ule Date
t5form4.doa 08103 System pumping Record page 1 of t
Town of North Andover
o -Z..
..... HEALTH DEPARTMENT
U u
CHECK #: DATE:
LOCATION: A e.",D
H/0 NAME: -( , ")Ml'("° � ),"/
CONTRACTOR NAME:
Type of Permit or License: (Check box)
• Animal $
• Body Art Establishment $— —
• Body Art Practitioner $
0 Dumpster $
• Food Service
• Funeral Directors
• Massage Establishment $
13 Massage Practice
* Offal(Septic)Hauler
* Recreational Camp $
0 Sun tanning $
• Swimming Pool $
• Tobacco $
• Trash/Solid Waste Hauler $
El Well Construction $
SEPTIC Si stents,
• Septic-Soil Testing $
• Septic-Design Approval $
0 Septic Disposal Works Construction(DWC) $
0 Septic Disposal Works Installers(DWI) $
0 Title 5 Inspector $
Title 5 Report $
0 Other. (Indicate) $
Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer