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HomeMy WebLinkAboutTitle V Inspection Report - 66 SUNSET ROCK ROAD 6/25/2018 a ` Commonwealth of Massachusetts Title 5 Official Inspection Form 21 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .... : vv.: I 66 Sunset Rock Road Property Address Steve Marshall OwnerOwner's Name _...._...._._..__...__._....._____ _......_._�__._.__......__...._..___ information is North Andover MA 01845 06/06/2018 required for every __.._w.___..._. page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be alter in any way. Please see completeness checklist at the end of the form. fmngoutf rens A. General Information JL) �"5 filling out farms on the computer, use only the tab 1. Inspector: ) N or f kTH ANDOVER key to move your HEAL i!� f i1 cursor-do not Robert Herrick use the return - _ _.._........ _____ key. Name of Inspector Wind River Environmental a8 Company Name 46 Lizotte Drive Company Address am Marlborough MA 01752 City/Town State Zip Code X978)833-7924 5113759 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority I I v 06106/2018 1;�Oector 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 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. t i i 15ins.doc•rev.6116 Title 5 Ofrictal Inspection Form:Subsurface Sewage Disposal System•Wage 1 of 17 Commonwealth of Massachusetts u =- aTitle ffi i l Inspection Form 'f Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 66 Sunset Rock Road Property Address Steve Marshall j Owner Owner's Name information is North Andover MA 01845 06/06/2018 required for every �w.. __.._,_..._.._ _ ___....._.__._. page. 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. j Comments: B) System Conditionally Passes; ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 o€17 Commonwealth of Massachusetts wTitle fi i I Inspection r nI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 4_. 66 Sunset Rock Road e Property Address Steve Marshall i Owner Ownor"s Name information is MA 01845 06/06/2018ve North Andover required for every ...__ _._ ....... _......._ .---. 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 (cant.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): © distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health; ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-rev.6116 Title 5 Official Pnspection Form;Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts =-w Title ffi i l Inspection r Subsurface Sewage Disposal System Form Not for Voluntary Assessments �u 66 Sunset Rock Road Property Address Steve Marshall _...... _ _..__._ _.._ ___....._-- _ _-. _....._. Owner Owner's Name information is North Andover MA 01845 06/06/2018 required for every -.- _ _,_- _ ...__ __...__ - -- page, City/Town State Zip code date of Inspection B. Certification (cant.) 2. System will fail unless the Board of Health (and Public water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: I i 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 ❑ 0 clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool E] ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/day flow t5ins.doc-rev.5115 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 � � .' »�^ Commonwealth of Massachusetts �����0�� �� �w���°��"��0 ���������^������� ����U�H�� N ��Q�� �� �=�DNN�����N �mm���������B��xw B—��nmou Subsurface Sewage Disposal System Form - Not for Voluntary Assessments OOSunset Rock Road Property Address Steve Marshall Owner Owner's Name information is A 01845 06/06/2018 �nvimdmro,ory '`°'"'"''°°`e' ��' page. °.""."=. State _'Code_ Date of Inspection B. Certification (cont.) Yes No �� Required pumping more than 4bnneointhe last year NOT due toclogged or �� �~ obstructed pipe(s). Number oftimes pumped: Any portion of the SAS, cesspool or privy is below high ground water elevation. 0 [� Any po�|onofcesspool orprivy invvithin100feet ofmmu�acewater supply or �� �� tributary to msurface water supply. Fl M Any portion ofacesspool nrprivy iawithin aZone 1 nfapublic well. El Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. El 0 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from e private water supply well with no acceptable water quality analysis. [This system passes ifthe well water analysis, performed mtaDEP certified laboratory,for fecal coliform bacteria indicates absent and the presence ofammonia nitrogen and nitrate nitrogen isequal toorless than 5ppm, provided that noother failure criteria are triggered.A copy ofthe analysis and chain ofcustody must heattached tothis form.] �� Thmoystamimacaoopoo| aen/ingefeci|itywithodoo|gnOovvof2008gpd- �� ~~ 10.000Qpd. � El �� The system faUs. [ have determined that one mrmore ofthe 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: Tobeconsidered olarge system the system must serve mfacility with a design flow of1O'OOOgpdto15,¢UOgpd. � For large systems, you must indicate either^yem" or"no^(oeach ofthe following, inaddition tothe questions inSection D. Yes No Fl the nyoham is within 4UOfeet ofe surface drinking water supply F1 [l the system is within 200feet ofa tributary to a surface drinking water supply F1 �l the system imlocated inanihogennensiUvearea (Interim VVe||headProtnodon ^~ �� Area—|VVPA)oramapped Zone || ofapublic 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 esignificant threat under Section Eorfailed under Section Dshall upgrade the system in accordance with �10 CMR 15.304. The system owner should contact the appropriate regional office ufthe Department. Commonwealth of Massachusetts Title 5 Official Inspection For "= Subsurface Sewage Disposal System Form Not for Voluntary Assessments 66 Sunset Rock Road Property Address Steve Marshall Owner Owner's Name information is North Andover MA 01845 06/06/2018 required for every _.,,....._ _.._..._ _....._._ __. ..._ _,_ .._ _..._...�......__.._. r page, City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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? ® ❑ 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)] i 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 gpd 15ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I I Commonwealth of Massachusetts Title (fi i l Inspection For ry Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Sunset Rock Road Property Address Steve Marshall Owner Owner's Name information is required for every over North AndMA 01845 06/06/2018 fo - � page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is made up of a septic tank, a distribution box and a soil absorption systema 2 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 E No Seasonaluse? ❑ Yes No Water meter readings, if available last 2 years usage d 346`33 Detail: 338x748=252,824/730=346.33 Sump pump? ❑ Yes ® No Last date of occupancy: Current mC7ate _.. Commercial/Industrial Flow Conditions: Type of Establishment: __w..._...____.....____...__..........-------_._.—_-- Design flow(based on 310 CMR 15.203): Gallons per day tgpd> 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts x = Title Off Inspection For -" 5 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • 66 Sunset Rock Road Property Address Steve Marshall ' Owner Owner's Name information is North Andover MA 01845 06/06/2018 required for every _ page. City/Town State Zip Code Date of Inspection s D. System Information (cont.) 1 Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Wind River Environmental - Last pumped on 09/06/2017. See attached record. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: I ------ ...... _.w....._..._.._ 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) 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. ❑ Other(describe): I t5lns,doc rev.6/96 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 ti 2 66 Sunset Rock Road Property Address Steve Marshall Owner Owner's Name information is Nrth Andover MA 01845 06/06/2018 required for every o .,..._..__ ..._ _.....,_.____.. ._ 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: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® Na Building Sewer(locate on site plan): 56” Depth below grade: i Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance fromwater rivate supply well or suction line: Town Water p PP Yeet Comments(on condition of joints, venting, evidence of leakage, etc.): All the)oints look to be solid. There are no signs of leakage. Vented through building sewer. Septic Tank(locate on site plan): 4- Depth below grade: feet -- Material of construction: ® 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 ❑ No 10'6"x 5'8"x 5'8" Dimensions: ---..._..__._-- Sludge depth: 8 t5ins.cloc•rev.6116 Title 6 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 �-5 66 Sunset Rock Road Property Address Steve Marshall Owner Owner's Name required on is North Andover MA 01845 06/06/2018 required for every __..._ ..__ page. City/Town 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 31"--- ---- - 1 Scum thickness �..._ Distance from top of scum to top of outlet tee or baffle 6 --- ,,,_-------- — Distance from bottom of scum to bottom of outlet tee or baffle 14"— --- 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.): Recommend yearly pumping. The inlet and outlet are solid. There are no signs of leakage. The liquid level is OK in relation to the inverts. Grease Trap(locate on site plan): Depth below grade: 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 - I Date of last pumping: Date _.._.___ f5ins.doc-rev.6116 Title 5 Officiat Inspection Farm:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts j� Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 66 Sunset Rock Road_._.. _ ._.....m,.._...._ Property Address Steve Marshall _, ..Marshall --,,,---._... Owner's. Owner _game information is North Andover MA 01845 06/06/2018 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,): 'Fight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: ___.-------__ Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: g gallons per day Alarm present: ❑ Yes ❑ No Alarm level; - Alarm in working order: ❑ Yes ❑ No Date of last pumping: _..._._ _....,.._ Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/'16 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts _ Tule 5 Official Inspection Farr Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 66 Sunset Rock Road Property Address Steve Marshall Owner Owner's Name information is required for every North Andover MA 01845 06/06/2018 _ __...... __.. _ page, City/Town 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 01 ..._.... ......._._ _.._..__.� 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.): The distribution box is solid but starting to show signs of decay. There is no carryover and there are no signs_of leakage. The li uid level is OK in relation to the inverts. wap Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: ------...._.. _......._ t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of'17 Commonwealth of Massachusetts Title 5 Official Inspection Form x — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 66 Sunset Rock Road Property Address I Steve _Marshall_..._ ne_ Owner Owr's Nam.e------------- .. information is North Andover MA 01845 06/06/2018 required for every _._ __._._ _..... ........__._-- ..._.._ page. CltylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: leaching galleries number: leaching trenches number, length: 4x54' (❑ leaching fields number, dimensions: ❑ overflow cesspool number: ---- d 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 soil is dry with no signs of hydraulic failure and no ponding. The vecgetation is normal for the area. 1 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 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Sunset Rock Road Property Address Steve Marshall Owner Owner's Name information is North Andover MA 01845 06/06/2018 required for every _...,_..-...__ w...__ ---.-_.--- _.___-.-.- 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: Dimensions _..._.._,,,_....-..---_.._._ Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title Official Inspection For , r { o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y 66 Sunset Rock Road Property Address Steve Marshall Owner Owner's Name _. information is North Andover MA 01845 06/06/2018 required far every 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: E hand-sketch in the area below F-1 drawing attached separately � r / ` 7 l Mns.doc-ray.6116 T11e 5 Offal klspecuon Fomc Subsurface sewage DYspoaal system-Page is of 17 Commonwealth of Massachusetts Title 5 official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3a 66 Sunset Rock Road Property Address Steve Marshall Owner Owner's Name information is North Andover MA 01845 06/06/2018 required for every _..._ _,-----_--_-- _.__...__._.-- �._.w _.,.----__ _--.._-- page_ City/Town State Zip Code date of Inspection D. System Information (cont.) i Site Exam: Check Slope Surface water ® Check cellar ® Shallow wells Estimated depth to high round water: 10 -- P 9 9 �feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Title V from 60 Sunset Rock Road ❑ Checked with local excavators, installers -(attach documentation) ❑ . Accessed USGS database -explain: You must describe how you established the high ground water elevation: Pulled information from the Title V performed on 60 Sunset Rock Road showing estimated high water to be 10', recorded in 1993. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6116 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts iN- Title 5 OfficialIn i n Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 66 Sunset Rock Road _.— Property Address Steve Marshall Owner Owner's Name information is North Andover MA 01845 06/06/2018 required for every No _..._. ...,.___..__�.... _..,__...__ ..___ ...._.. __... _......_m__.___ page. CCtylTawn State Zip Cade Date of Inspection E. Deport Completeness Checklist M Inspection Summary: A, B, C, D, or E checked M 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 l t5ins.dor,-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Summary Record Card generated on 6/1912018 1:32:37 PM by Karen Hanlon Page i t Town of North Andover Test Tax Map # 210-106.A-0267-0000.0 Parcel Id 17412 66 SUNSET ROCK ROAD 11 STEVE & LISA MARSHALL 66 SUNSET ROCK ROAD NORTH ANDOVER, MA 01845 .......... Class 101 Single Family Property Type I Residential Zonlng2 1 Residential Zoning3 1 Residential Size Total 0.92 Acres FY 2018 UB Mailing Index Name/Address Type Loan Number ActivelInact, From Until STEVE&LISA MARSHALL Owner 66 SUNSET ROCK ROAD NORTH ANDOVER,MA 01845 SERRAO,GREGORY A. Previous Customer Inactive 9/1/2005 66 SUNSET ROCK ROAD NORTH ANDOVER,MA 01846 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17677.0-66 SUNSET ROCK ROAD Last Billing Date 4/10/2018 3170347 03 Cycle 03 Active UB Services Maint. Account No.3170347 Service Code Rate Charge Multiplior/Users MISCFEEADMIN FEE 1 1 9,18 11 WTR WATER 01 AL1-METER SIZE 76.00 UB Meter Maintenance Account No.3170347 Serial No Status Location Brand Type Size YTD Cons 35077354 a Active ERT HH b Badger w Water 1 1 1080 k Date Reading Code Consumption Posted Date Variance 6/11/2018 1134 aActual 26 22% 317/2018 1108 a Actual 20 4/23/2018 1% 12/712017 1088 a Actual 19 1/25/2018 -68% 9/1212017 1069 a Actual 66 10/18/2017 164% 6/8/2017 1003 a Actual 24 7125/2017 16% -3% 3/8/2017 979 aActual 20 4/12/2017 -78% 1219/2016 969 aActual 21 1/23/2017 9/9/2016 938 a Actual 92 10/2412016 101% 6/13/2016 846 aActual 50 8/2/2016 3/9/2016 796 aActual 23 4/22/2016 -2% 12/10/2015 773 aActual 24 1/20/2016 -42% 9/912015 749 a Actual 41 10/1612015 -7% 6/10/2015 708 aActual 44 7/24/2015 98% 3/11/2015 664 a Actual 22 4/2812015 -11% t 12/11/2014 642 aActual 25 1/1512015 -40% 9/11/2014 617 aActual 42 10/15/2014 62% 6111/2014 576 a Actual 26 711612014 35% 311112014 549 aActual 19 4/11/2014 -12% 12/1012013 530 aActual 21 1/17/2014 -13% s 9112/2013 509 a Actual 25 10/15/2013 55% 6/12/2013 484 a Actual 16 7/24/2013 -16% 3/1312013 468 a Actual 19 4/2212013 -3% 12111/2012 449 aActual 19 1/9/2013 -62% 9/13/2012 430 a Actual 52 10/1512012 119% 6/1212012 378 a Actual 23 7116/2012 25% 3/1412012 355 a Actual 19 4/14/2012 -16% Work Order# 0207086223 Cust# 1023830 Customer Since: 2 0 0 0 Tax: 6 . 2500 Job Comments Tech Comments 09/6/2017 SVC 1500gals, cover in front yard , little digging 9/1/16 Serviced septic. Removed all light solids & Out front left side of steps 22'out 5'to left , no alt# HOME bottom sludge. System operating fine. (JD)ds OR GONE/cc in office 09/01/2016 THU AM - [Online] ; *-* 7/27/2,5 Serviced system, pumped 1500 gallons, liquid level service 1500gals, cover in front yard, little digging, no is good. (BS)ds alt4 HOME OR GONE/cc in office (mp) 7/23/14 serviced septic; removed all mod -solids and 90§ mod Service 1500, cover in the front some digging, alt home, sludge, recommend combo, yearly service, digging fees will check (Jo) apply at next service. (DV) .mb 07/23/2014 REQUEST I ST STOP CALL ALT# ENROUTEk* SERVTRC 1500GALS,cover in front yard, little digging, HOME/PAYMENT TO TECH (mp) (ea) customer moved from 7/21/2014 07/22/2013 "CALL RN ROUTE 978-360-7452 ** service 1500 gals; frnt yrd little digging; HOME.CHECK (nj) 7/2/12 MON AM service service / 1.500 gallons / customer to expose / no alt / Home check / bd 7/9/10 PRT AM! qPrvi(,P i,,nn aqi.q: r,,mrpr Pyno-iod in frnnt- System Owner System Location Steve Marshall Primary Home 66 Sunset Rock Road 66 Sunset Rock Road North Andover, MA 01845 North Andover, MA 01845 (978) 685-3031 Marshall Steve (978) 685-1011 Service Date: WED 09/06/2017 10:00 Am Frequency: Call to Confirm: Service Type: Standard Previous Service: 09/01/2016 Approx. Gals: 1,500 CCLS: Location Details: Depth Below Grade:4 Custom Clean: **OFF CANDLESTICK ROAD** Cust Home: NO Filter: Out front left side of steps 221out 51to Township: Inspection/T5: left;pls.draw diagram County: Essex Build Up: -Ul e -Descriptio — 01 Pumping 1001 1500 1,00 $ 298,;6567 $ 298.66 Environmental Compliance Residential 1.00;' $ 19,5000 $ 19.50 Coupon or Discount 1,Ob' $ -20.0000 $ -20.00 Subtotal: $ 298.16 We suggest these 3 keys steps to keep your system healthy: Tax $ 0.00 - Regular servicing o Use CCLS bacteria additive Total $ 298.1.6 - Use a filter Disposal Site: HWWTP Disposal Volume: Payment Detail: Waste Code PumpSeptic 1500.0000 Master xxxxxxxxxx1461 09/2020 Sates Rep : CSR Robert Blackstock Due on Receipt Truck : Technician Rodiny Moise On Site : 11:12 AM P 0 Number Tech Notes Normal water level. Moderate top solids. Moderate bottom sludge. Both baffles are intact. Main line Clear. Filter condition not applicable. Recommended Boost additive, CCLS additive. Cover(s) secured. X Customer Signature ENVIRONMENTAL it TAL Remit payment to 45 Lizotte Dr Suite 1000,Marlborough,MA 01752 [ � ~~~'^~ ~x ~--'-'------ ' HEALTH DEPARTMENT CONTRACTOR NAME: ` (Check box) 0 Animal • Body Art Establishment • Body Art Practitioner 13 Food Service- 0 Funeral Directors • Massage Establishment • Massage Practice • Offal(Septic)Hauler � ^~ -__---__- _m' • Sun tanning • Swimming Pool 13 Tobacco 0 Trash/Solid Waste Hauler 0 Well Construction 0 Septic-Soil Testing 0 Septic-Design Approval 0 Septic Disposal Works Installers,~,,° _