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HomeMy WebLinkAboutTitle V Inspection Report - 195 OLYMPIC LANE 6/5/2018 � Commonwealth of Massachusetts ' Title 5 Official Inspection nspec °onForm Subsurface Sewage Disposal SystemmFornm - NotforVu|untaryAssesnmente 195 Olympic Lane Property Address ------------------------- ---- K4i Crepeau Owner Owner's Name - - infvm"aUonio required for every No. Andover Mo 01845 5'31-2018 page. City/Town State Zip Code Date ofInspection Inspection results must bwsubmitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist atthe end oythe form. Important:When A m� filling out forms ~ � ����U U �m� Na�~on =~- 0 � unthe oompuVa� �\j9� w * ^- uoeun|ythetab 1� Inspector: " 5R �yunmove your -, — cursor'dnnot F. Paul Cardone 10"°" use the return key. Name of Inspector^ .Septic Compliance, Inc. Company Name 4--" 371/2BamameadmwStreet Company Address Methuen Ma. 01844 ------' Qty/Town State Zip Code 978'815'3115 or 978-681-0728 3284 --------' - ----- Te|eph000Number License Number B. Certification | martify 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. iannaDEP approved system inspector pursuant tmSection 15.34Oof Title 5 (310CMR 15.O00). The system: M Passes El Conditionally Passes El Fails �] Needs Further Evaluation bythe Local Approving Authority Inspector's Signature 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 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 mtthat time.This inspection does not address how the system will perform in the future under the same ordifferent conditions ofuse. � | Commonwealth of Massachusetts ' TN"t0 e 5 Official Inspection nspec =onF orm Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 195 Olympic Lane — �op�����aso ------------''--- P ---�� Michael Crepeau Owner Owner's Name — ---------------- mfonnauivniu required for every No. Andover Ma. O1O4� 1 poge. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A.B.C.DorE/always complete all ofSection O A) System Passes: | have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303orin 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: �l 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"yos", "nu" or"not determined" (Y. N. ND) for the following statements. If"not determined," please exog|n. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally oneoond, exhibits substantial infiltration nrex(||tnadon ortank failure is imminent System will pass inspection ifthe existing tank is replaced with a complying septic tank as approved by the Board of Health. *Ametal septic tank will pane inspection if it is structurally sound. not leaking and if Certificate of Compliance indicating that the tank ieless than 2Oyears old ieavailable. Fl Y El N 0 ND (Explain be|Vw): Commonwealth of Massachusetts Title 5 Official Inspection Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 195 Olympic Lane Property Address Michael Crepeau Owner _......_. .. Owner's Name information is required for every No. Andover Ma. 01845 5-31-2018 _. page. City/Town - _ State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i _- - 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. I 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.doe-rev.6116 'title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection nspecwonForm Subsurface Sewage Disposal System Form Not for Voluntary Assessments � 1S5Olympic Lane Property Address yWiohae| Cne Owner Owner's Name information i's required for every No. AndowerK�a __ O184� 5-31-2U18 _...... _______ page. Citw7mvm State Zip Code Date o[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 o manner that protects the public health, safety and environment: �� The (SAS) and�� ` � 1OOfeet ofosurface water supply ortributary tuasurface water supply. El The system has aseptic tank and SAS and the SAS inwithin eZone 1ofapublic water supply, F-1 The eyotgrn has a septic tank and SAS and the SAS is within 50 feet of 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 o private water supply we||^° Method used hndetermine 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 beattached tothis form. 3. Other: D> System Failure Criteria Applicable to All Systems: You must indicate "Yem" nr"Nm" boeach ofthe following for all inspections: Yes No �l �� Backup ofoevwageinto facility orsystem component due buoveduadedor �� �� clogged SAS orcesspool [A �� Discharge orponding ofeffluent hothe au�aueofthe ground orsu�aoovvab»ro �� �� due boanoverloaded orclogged SAS orcesspool Static liquid level inthe distribution box above outlet invert due toanoverloaded �� ~~ orclogged SAS orcesspool �l �� Liquid depth in cesspool in less than O" be1ovvinve�oravailable vo|unne is |gsa �� �� than 1/2day flow � Commonwealth 0fMassachusetts Title 5 Official Inspection nspecNonF orm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 195 Olympic Lane -- Property Address -----�� ---- 8iohma| Crepeau Owner owne/s-ma'me ---- -----����- infonnation is required for every No. Andover �a 01845 5-31-2018 page. ouy[T*wn State Zip Code Date ufInspection B. Certification (cont.) Yea No �� �� Required pumping more than 4 times in the last year NOT due toclogged or ^� �� obstructed pipe(s), Number of times pumped: Any portion of the SAS, cesspool or privy is below high ground water elevation. �� �� Any podionnfcesspool orphvyievvithin1OOfeet ofasurface vvabarsupply or �� �" tributary toosurface water supply. F� �U Any portion ofacesspool orprivy iswithin aZone 1ofopublic well. Any portion of a cesspool or privy is within 50 feet of a private water supply well, [� [� �� ^� Any portion nfacesspool orprivy isless than 1OOfeet but greater than 5Ofeet from a private water supply well with noacceptable water quality analysis. [This system passes ifthe well water analysis, performed atmDEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 8 ppm, provided that no other failure criteria are triggered. A copy of the mnm|Vsim and chain of custody must be attached to this form.] The system ivacesspool serving afacility with adesign flow of20O0gpd' ^~ �~ 10.000gpd. The system fails. | have determined that one or more of the above failure criteria exist msdescribed in 310 CMR 15.303. therefore the system foi|o. The system owner should contact the Board of Health to determine what will be necessary tocorrect the failure. E) LmqJo Systems: To be considered m large system the system must serve a facility with m design flow of 10,000 Spd to 15'000 gpd. For|arQeeyabanno. youmustind|omheaithar^'yes^ or"no^ toeeohu[thefo||ovving, inadd|tiontothe questions inSection D. Yes No R El the system iewithin 4UUfeet ofesurface drinking water supply El El the system is within 200 feet of a tributary to a surface drinking water supply E-1 �� the system is located inanitrogen sonsiUvearea (Interim VVe||head Protection �� nn Area- |VVPA) oramapped Zone || ofapublic water supply well If you have answered ''yes~ to any question in Section E the syeharn is considered a significant threat, oranswered "yea" inSection D above the large system has failed. The owner oroperator ofany 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, e/""u='rev.mm Title sOfficial Inspection r=m.Subsurface Sewage Disposal System'Page o"/1r Commonwealth of Massachusetts =x Title ffici l Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e`-4 w 195 Olympic Lane - _.._._...,. Property Address Michael Crepeau - . — _ ....... Owner ._ Owner's Name ... ... .. .... . . ..._.. ,..___..__ information is No. Andover Ma. 01845 5-31-2018 required for every _Y ...�.._.... p --.____ ... page, Cit /Town State Zi Code Date of Inspection — — ------------ ----------- ------------- --- -- _ C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (If they were not available note as 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? M ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ El 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)] - ...------------------------------ n D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 -- Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins.doc-rev.6116 Title 5 Official Vnspection Form:Subsurface Sewage Disposal System-page 6 of 17 Commonwealth of Massachusetts _ M Title 5 Official Inspection Form x Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 195 Olympic Lane -- Property Address MichaelCrepeau _ . . --- -.Owner Owners Jame _.. . .. .._.._ information is No. Andover Ma, 01845 5-31-2018 required for every __...._- —. ...._. page. City/Town _._. _ State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes M No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 years usage d Enclosed Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Occupied Date Commercialllndustrial Flow Conditions: Type of Establishment: .. . _...... Design flow(based on 310 CMR 15.203): — -- I Gallons per day(gpd) l Basis of design flow (seats/persons/sq.ft., etc.): _____.............. . - I 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Summery Record Card generated on W291208 9:29:59hM by Tara Hurley Page 1 Fawn Of North Andover Tax Map # 210-1063-0130-0000.0 Parcel Id 17534 195 OLYMPIC LANE CREPEAU, MICHAEL, G. Since Jan 2014 CREPEAU, KRISTINA, N. 195 OLYMPIC LANE NORTH ANDOVER, MA J 01945 Class 101 Single f=amily Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.01 Acres FY 2018 t UB Mailinei Index Name/Address Type Loan Number Active/Inact. From Until MICHAEL CREPEAU Owner 195 OLYMPIC LANE NORTH ANDOVER MA 01845 KUSEK,D&BORAX,J Previous Customer Inactive 11/15/2013 195 OLYMPIC LANE NORTH ANDOVER,MA 01846 UB Account Maint, Account No Cycle Occupant Name Active/Inactive Bldg Id. 17512.0-195 OLYMPIC LANE Last Billing Date 4/10/2018 3170182 03 Cycle 03 Active UE Services Tint. Account No.3170182 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0,636/8 7.82 1/ WTR WATER 01 ALL METER SIZE 67.00 /1 UB Meter Maintenance Account No.3170182 Serial No Status Location Brand Type Size YTD Cons 32939027 a Active ERT HH b Badger w Water 0.63 0.63 1602 Date Reading Code Consumption Posted Date Variance 3/7/2018 2095 aActual 16 4/23/2018 1% 12/6/2017 2080 aActual 14 1/25/2018 -58% 9/11/2017 2066 aActual 37 10/1812017 139% 6/8/2017 2029 a Actual 15 7/25/2017 4% 3/8/2017 2014 aActual 14 4/12/2017 -52% 12/9/2016 2000 aActual 30 1/23/2017 -69% 9/9/2016 1970 a Actual 100 10/24/2016 799% 618/2016 1870 a Actual 11 8/2/2016 -17% 3/8/2016 1859 a Actual 13 4/22/2016 -65% 12/9/2015 1846 a Actual 29 1/20/2016 -69% 9/10/2015 1817 a Actual 98 10/16/2015 317% 6/912015 1719 a Actual 23 7/24/2015 90% 3/10/2015 1696 a Actual 12 4/28/2015 -69% 12/10/2014 1684 a Actual 29 1/15/2015 -60% 9/12/2014 1655 a Actual 75 10/15/2014 634% 6/11/2014 1580 a Actual 10 7/16/2014 -8% 3/12/2014 1570 a Actual 11 4/11/2014 8% 12/10/2013 1559 aActual 3 1/17/2014 -72% 11/13/2013 1656 f Final Bill 25 11/13/2013 -58% 9/11/2013 1631 aActual 86 10/16/2013 180% 6/11/2013 .1445 aActual 30 7124/2013 70% 3/1312013 1416 a Actual 18 4122/2013 -13% 12/11/2012 1397 aActual 20 119/2013 -76% 9/13/2012 1377 a Actual 87 10/15/2012 166% summary Record Carol gone rated on 512912010 9.29.50 AM by Tara Hurley Page 2 Town of North Andover Tax Map # 210-1063-0130-0000.0 -0130-000000 Parcel ld 17534 195 OLYMPIC LANE CRRPEAU, MICHAEL, G. Sin Jan 2014 CREPEAU, KRISTINA, N. 195 OLYMPIC LANE 1 NORTH ANDOVER, MA J 01945 _� 1 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.01 Acres FY 2018 6/11/2012 1290 aActual 33 7/16/2012 81% 3112/2012 1257 a Actual 18 4/14/2012 -35% 12/13/2011 1239 a Actual 28 1/17/2012 -68% 9/13/2011 1211 a Actual 94 10/13/2011 129°fo 6/6/2011 1117 a Actual 39 7/20/2011 110% 3/8/2011 1078 a Actual 18 4/13/2011 -24°fo 12/9/2010 1060 a Actual 24 1/12/2011 -83°/n 9/10/2010 1036 a Actual 146 10/15/2010 234% 617/2010 890 a Actual 41 7/16/2010 144% 3/10/2010 849 a Actual 17 4/14/2010 -48% 12/10/2009 832 a Actual 33 1/1212010 -55% 9/10/2009 799 a Actual 76 10/15/2009 51% 6/8/2009 723 a Actual 47 7/20/2009 159% 3/12/2009 676 a Actual 20 4/29/2009 .42% 12/5/2008 656 a Actual 31 1/20/2009 -62% 9/9/2008 625 a Actual 90 10/10/2008 92% 6/512008 535 a Actual 42 7116/2008 114% 3/11/2008 493 a Actual 21 4111/2008 -47% 12/10/2007 472 aActual 42 1/22/2008 -73°/a 914/2007 430 a Actual 132 10/12/2007 338% 6/15/2007 298 a Actual 35 7/20/2007 61% 3/13/2007 263 a Actual 21 4/16/2007 -39% 12/12/2006 242 a Actual 32 1/19/2007 -74% 9/18/2006 210 a Actual 141 10/20/2006 132% Trouble Code;03 6/14/2006 69 a Actual 62 7/10/2006 216% 3/8/2006 7 a Actual 7 4/17/2006 -100% 2/1/2006 0 n New Meter 0 4/17/2006 -100% 2/1/2006 516 r Replacement 69 4/17/2006 519% 12/22/2005 447 m Manual estimate 25 1/1712006 17% MSG 9/21/2005 422 m Manual estimate 20 10/14/2005 25% MSG 6/27/2005 402 m Manual estimate 18 7/15/2005 3122/2005 384 aActual 16 4/5/2005 -29% 12/13/2004 368 m Manual estimate 20 1/14/2005 -2% i i 1 i i Commonwealth of Massachusetts p Title Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments d 195 Olympic Lane Property Address Michael Crepeau Owner Owner's Name information is No Andover Ma. 01845 5-31-2018 required for every .;. .._._.___..... ..... ..... . ...... .. ......... _—_._....__... _ ; page, City/Town State Zip Code date of Inspection D. System Information (cont.) Last date of occupancy/use: __-_- Date Other(describe below): General Information Pumping Records: Source of information: Owner and on file, pumped one year ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: - gallons How was quantity pumped determined? „ ...... Reason for pumping: _, _...._. Type of System: Septic tank, distribution box, soil absorption system Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract El Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection r F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c y, 195 Olympic Lane Property Address _ Michael Crepeau OwnerOwner's Name ... _......._ ......._._ ____.._ — information is required for every No. Andover Ma. 01845 5-31-2018 _...._. —...— ...._... _...... 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: _upgraded in 2000 Were sewage odors detected when arriving at the site? ❑ Yes 0 No Building Sewer(locate on site plan): 28" Depth below grade: ---..-_...__. feet Material of construction: El cast iron N 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 appeared to be in good condition Septic Tank (locate on site plan): Depth below grade: 8" brought up to grade with a riser ....... feet Material of construction: M concrete ❑ metal ❑ fiberglass ❑ polyethylene other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes El No Dimensions: 10'8"Lx57"Wx5'8"H Sludge depth: 3 15ins.doc•rev.6116 Title 5 Official inspection Porro;Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts -- _ Title 5 Official Inspection Form q Subsurface Sewage Disposal System Form - Not for Voluntary Assessments W° 195 Olympic Lane Property Address Michael Crepeeau Owner Owner's Name information is No. Andover Ma. 01845 5-31-2018 required for every page. CItyrTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1 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? Sludge Judge and Tape_ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): We recommend pumping on a yearly basis, inlet was original concrete, outlet was replaced with a sanitary tee, both in good condition, structural integrity appeared to be good, liquid level was good, no evidence of any leakage. Grease Trap (locate on site plan): Depth below grade: NIA feet Material of construction: © concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: -- Scum thickness Distance from top of scum to top of outlet tee or baffle _ ..,... _.. _.. _._..._.� Distance from bottom of scum to bottom of outlet tee or baffle ---- Date of last pumping: _._ . ...... _— date t5ins.doc•rev.6116 'title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 195 Olympic Lane Property Address Michael Crepeau Owner Owner's Name information is No. Andover Ma, 01845 5-31-2018 required for every - 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: N/A .......... Material of construction: ❑ concrete n metal ❑ fiberglass ❑ polyethylene ❑ other(explain): . ...................................... .............. Dimensions: ----------- Capacity: gallons ——------------------------------- Design Flow: gallons per day Alarm present: n Yes FI No Alarm level: ........ Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ............ .................. Attach copy of current pumping contract (required). Is copy attached? El Yes [:1 No t6ins doc-rev,6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts =x Title Official Inspection r ' Subsurface Sewage Disposal System Form _ Not for Voluntary Assessments 195 Olympic Lane Property Address Michael Crepeau Owner Owner's Name information is No. Andover Ma. 011184511--- `5-31-2018 t required for every --- - 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 0" Level was goad Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box was level, ran a little water through box, all 4 lines took water equally, no evidence of solids carryover, no apparent leakage in 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.): N/A * 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): i If SAS not located, explain why: j I 15ins.doc-rev.6116 'ritle 5 official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection nspecin orm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 195 Olym ic Lane Property Address yNioh� Owner Owner's Name - ------------- infonnoUunio required for every No. Andover M& 01845 5-31-3010 page. Cityrrmwn Gtoho Zip Code Date ofInspection D. System Information (cont.) Type: �1 leaching pits number: �] leaching chambers number: �l leaching galleries number: Fl leaching trenches number, length: 1-20'x4S' leaching fields number, dimensions: ------------- El overflow cesspool number � [l innova(ivo/a|ternativeayatem � � Type/name Vftechnology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): � Good None Nona No Grassy � � side yard,,area,,, Cesspools (cesspool Must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —hop of liquid to inlet invert Depth ofsolids layer Depth ofscum layer Dimensions ofcesspool Materials of construction --- Indication of groundwater inflow Fl Yes F1 No Commonwealth of Massachusetts ._ Title Official Inspection For 1 _-w Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 196 Olympic Lane Property Address Michael Crepeau Owner _ _— —. -- - ... ...... .. __— Owner's Name information is No Andover Ma. 01845 5-31-2018 required far every ......_....___— - .__....__. ..._.. ..... _._..._. __..._._ _........__....._..__� --- page, 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: N/A Dimensions - Depth of solids -_.-- -- —----------------_ Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i 1 i t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 <L\,, Commonwealth of Massachusetts A Title 5, Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 19�1 Olympic Lane Property Address Owner Jennifer Kusek win Owner's Name information is required for every North Andover MA 01845 12/18/12 page. City/Town^ State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells'within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below El drawing attached separately 7-7 2 T D.BQX Ila Tit", IT A 40' 1 fo.'H� a5.5! 2 TOA :4 1.V .2 f6-H TR"AN A I'TO U 0: TO.E WT' 2 TO W_ .52:9 2 To E] .80.0' 'BUFFER z01BE'___1 RT#1 UMlj dE.SABD. '!,W F.:, itillosiON*. 001*L Al 6 FOOT i'(INE V IN A 0 A TL rF-XISTINc CON WALL r,ALL(Yt 1,'T a6 iy: NNEW.D5"TANK:OUT." 98;05: 98A 0 A—H 'b;om DO% IN.' :9737 97-A5 Y_G 0:005 D BbX'OUT '9760 9169', 'D�•E` D'005 ��:. . Al :B 97.55 97�63 c 97,55 97,0, D 9,7:55 97;64 E 9733� 97.39, F 97.33 .97.4O`:` G 97.33 97.40 H 07,33 97.40- ---------.............. t5ins 11110 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 0 195 Olympic Lane Property Address _. Michael Crepeau Owner __._.._ Owner's Name __ .._......... -_ -_ ......._ information is No. Andover Ma. 81$45 5-31-2818 required for every – ----_--.w _—.__...._.. page. Clty/_ Town State Zip Code Date of Inspection D. System Information (cont.) - Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately t5ins.doc•rev.6/16 rifle 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 17 Commonwealth of Massachusetts -P, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 195 Olympic Lane Property Address Michael Crepeau ...... .....- Owner Owner's Name information is No. Andover Ma. 01845 5-31-2018 required for every ............... —----- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope Surface water Check cellar Shallow wells Estimated depth to high ground water: feet 71 Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record 07/22/ If checked, date of design plan reviewed: Date 99 . ......-- ....... Observed site (abutting property/observation hole within 150 feet of SAS) El Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) El Accessed USGS database -explain: ............... You must describe how you established the high ground water elevation: all liquid levels were good, basement was dry, sum pump hole was dry, soil logs on file. . ................. .............. ---—---------------------- .................. ............ ........... Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins.doc rev,6116 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Y Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19......... Property Address Michael Crepeau Owner ...... _,...... Owner's Name __.. information is No. Andover Ma. 01845 5-31-2018 required for every __. . ....... page, City/Town State Zip Cade 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 I 1 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 T Town of North Andover HEALTH DEPARTMENT �sshCK CHECK #: (n DATE: LOCATION: ,ZfL H/O NAME: CONTRACTOR NAME: Type Permit p r I Li _ense:(Check box) 0 Animal • Body Art Establishment • Body Art Practitioner • Dumpster 0 Food Serwice 0 Funeral Directors • Massage Establishment • Massage Practice • Offal(Septic)Hauler • Recreational Camp • Sun tanning • Swimming Pool 0 Tobacco 0 Trash/Solid Waste Hauler 0 Well Construction SEPTIC Systenix * Septic-Soil Testitig * Septic-Design Approval * Septic Disposal works Construction(DWC) [I Septic Disposal Works Installers(DWI) 0 Title 5 Inspector Title 5 Report $ 0 Other:(Indicate)—_—. ........... Heal't-"'Agent Initials White-Applicant Yellow-Health Pink-Treasurer