HomeMy WebLinkAbout- Title V Inspection Report - 70 CANDLESTICK ROAD 10/4/2018 Commonwealth of Massachusetts iU D
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ?OM
1OWN OF"NOF,�I H MOXWER
70 Candlestick Road ILALLLUMI,1'Yq11UtYU1"AL_
Property Address
Anthony Laccetti -----------I
Owner Owners Name
information is North Andover MA 01845 9-26-2018
required for every
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
ImporWnt:When
filling out forms A. Inspector Information
on the computer,
use only the tab Neil James Bateson
key to move your Name of Inspector
cursor-do not Bateson Enterprises Inc.
use the return Company Name -------------- --------------
key. 111 Argilla Road
Company Address
Andover MA 01810
City/Town State Zip Code
raNn 978-4754786 SI-16
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. Z Passes
2. r_1 Conditionally Passes
3, F1 Needs Further Evaluation by the Local Approving Authority
4. M Fails 4
9-26-2018
Ins ct 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: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.
t5inap.doo-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
70 Candlestick Road ------------
P-ro-perty Address
Anthony Laccetti
Owner Owners Name
information is North Andover MA 01845 9-26-2018
required for every
page. 67it-yrrown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
Z 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:
2) System Conditionally Passes:
F] 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.
n Y [I N El ND (Explain below):
-------------------------- -------
t5insp.doc rev.712612018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
,!A Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
iProperty Address
Anthony Laccetti ---------
Owner Owner's Name
information is
required for every North Andover ----------- MA 01845 9-26-2018
page. dt-yrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
El 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 F Y E] N 0 ND (Explain below):
❑ obstruction is removed R Y M N 0 ND (Explain below):
E] distribution box is leveled or replaced F1 Y F-1 N n ND (Explain below):
El The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
El broken pipe(s)are replaced ❑ Y El N 0 ND (Explain below):
El obstruction is removed 0 Y n N El ND (Explain below):
---------------
3) Further Evaluation is Required by the Board of Health:
El 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,
a. 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:
t5insp,doo-rev.7126/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthqqy_Laccetti ......
Owner Owner's Name
information is North Andover MA 01845 9-26-2018
required for every
page. di-ty—fTown state— -Zip—Code bate of inspection
C. Inspection Summary (cont.)
El Cesspool or privy is within 50 feet of a surface water
n Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. 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:
Ej 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.
F] 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 6 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must Indicate"Yes" or"No"to each of the following for all Inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
El 0 Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp,doo-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthony Laccetti
Owner owner's Nime�--
information is
required for every North Andover MA 01845 9-26-2018
page. diity&,own State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
F] E Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
El z Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
Any portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
El 0 Any portion of a cesspool or privy is within a Zone I of a public water supply
well.
F] E Any portion of a cesspool or privy is within 50 feet of a private water supply well.
El M Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis, [This
system passes if the well water analysis, performed at a DER 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 2000 gpd-
10,000 gpd.
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.
6) 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 C.4.
Yes No
E] R 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
El El Area—IWPA)or a mapped Zone 11 of a public water supply well
t5insp.doo-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthony Laccetti ------
Owner Owner's Name
information is North Andover MA 01845 9-26-2018
required for every
page. City/Town -State -tip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes"or"no"for each of the following for all inspections:
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?
El Has the system received normal flows in the previous two week period?
El ED- 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)
Z ❑ Was the facility or dwelling inspected for signs of sewage back up?
N ❑ Was the site inspected for signs of break out?
• El Were all system components, excluding the SAS, located on site?
• El Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
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:
N EJ Existing information. For example, a plan at the Board of Health.
N 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)]
t5insp.doc«rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
P Commonwealth of Massachusetts
..... -------
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthony --------
Owner Owner's Name
information is North Andover MA 01845 9-26-2018
required for every
page. Cityfrown State Zip Code Date of Inspection
D. System Information
1. 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
Description:
Number of current residents:
Does residence have a garbage grinder? Yes ❑ No
Does residence have a water treatment unit? ❑ Yes No
If yes, discharges to:
Is laundry on a separate sewage system? (include laundry system inspection
information in this report.) El Yes M No
Laundry system inspected? F Yes El No
Seasonaluse? El Yes 0 No
Water meter readings, if available (last 2 years usage (gpd)): Yes
Detail:
-----------
Sump pump? ❑ Yes No
Last date of occupancy: Current
Date
t5insp.doc rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthony Laccetti
Owner Owner's Name
information is
required for every North Andover MA 01845 9-26-2018
page. CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15,203): 1_10 n- per—day—(gp❑d)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? El Yes El No
Water treatment unit present? El Yes [:1 No
If yes, discharges to.,
Industrial waste holding tank present? F-1 Yes F1 No
Non-sanitary waste discharged to the Title 5 system? n Yes ❑ No
Water meter readings, if available: -—-------------------
Last date of occupancy/use: Date
Other(describe below):
---------------
3. Pumping Records:
Source of information: Pumped June 2018, owner
Was system pumped as part of the inspection? El Yes E No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doo-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthony Laccetti -------
Owner Owners Name
information is North Andover MA 01845 9-26-2018
required for every
page. City/TownState Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
0 Septic tank, distribution box, soil absorption system
El Single cesspool
n Overflow cesspool
EJ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
Tank 39 years old, 5-9-1979, old as built plan. Owner stated d-box& leach field was replaced in 1992
Permit was obtained by contactor in 5-14-199!, but permit doesn't state what for. No new as built pjan
Were sewage odors detected when arriving at the site? D Yes 0 No
5. Building Sewer(locate on site plan):
Depth below grade: 2
feet
Material of construction:
F] cast iron 40 PVC ❑ other(explain):
Distance from private water supply well or suction line:
Comments (on condition of joints, venting, evidence of leakage, etc,):
4" PVC through wall, 3" PVC in house, no leaks visible
t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthony Laccetti
Owner Owner's Name
information is North Andover MA 01845 9-26-2018
required for every —
page. -dit—yfTown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
1
Depth below grade: feet
Material of construction:
concrete F-1 metal ❑ 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) D Yes n No
Dimensions: -7' x 5'x 4'
Sludge depth: oil
Distance from top of sludge to bottom of outlet tee or baffle 3311
Scum thickness or,
Distance from top of scum to top of outlet tee or baffle 611
Distance from bottom of scum to bottom of outlet tee or baffle 1511 ------
How were dimensions determined? Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Inlet tee ok. Inlet baffle ok. Outlet tee corroded on top. Outlet baffle ok. Depth of liquid at outlet invert.
No evidence of leakage.
--------------
-—----------
"'nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthony_Laccefti
Owner Owner's Name
information is North Andover MA 01845 9-26-2018
required for every r-
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade:
Material of construction:
F-1 concrete ❑ metal ❑ fiberglass ❑ polyethylene n 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
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
El concrete n metal El fiberglass F] polyethylene El other(explain):
—---—-----
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70,Candlestick Road ---------------
Property Address
Anthony Lacceqi
Owner Owner's Name
information Is North Andover MA 01845 9-26-2018
required for every
page. 67it-yffown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: El Yes E] No
Alarm level: --- Alarm in working order: El Yes ❑ No
Date of last pumping:
Comments (condition of alarm and float switches, etc.):
-------------------
Attach copy of current pumping contract(required). Is copy attached? El Yes R No
9. Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
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.),-
D-box level &distribution equal. No evidence of leakage. No evidence carryover. D-box has plastic
riser& cover to grade.
------------- ------
tSinsp.doc-rev.7/26/201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
70 Candlestick Road —-------
Property Address
Anthony Laccetti -------
Owner Owners Name
information is North Andover MA 01845 9-26-2018
required for every
page. dkyfTown State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: D Yes F-1 No*
Alarms in working order: F-1 Yes F 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.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
El leaching trenches number, length: ------
leaching fields number, dimensions: 1 field 25'x 40'
F-1 overflow cesspool number:
0 innovative/alternative system
Type/name of technology:
t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
e Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthony Laccetti
Owner Owner's Name
information is
required for every North Andover MA 01845 9-26-2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
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.
-----------------
12. 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 R Yes 0 No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
--------------------- ------------
t5insp,doc-rev.712612018 Title 5 Officiat Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
-
Anthony_Laccetti_
Owner Owner's Name
information is
required for every North Andover MA 01845 9-26-2018
page. Cltyrrown State Zip Code Date of Inspection
D. System Information (cont.)
13. 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.):
----------
-------------
t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road ..........
Property Address
Anthony Laccetti
Owner Owners Name
information is North Andover MA 01845 9-26-2018
required for every
page. City/Town State Zip Code Date of Inspection
D. System Informa4ion (cont.)
14. 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:
Z hand-sketch in the area below
El drawing attached separately
0_Ovi,
Drzt j
2 Lf
to
t5insp.doc rev,7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthony Laccetti -------
Owner Owners Name
information is North Andover MA 01845 9-26-2018
required for every
page, ��Ktyfio�Wn— State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
Check Slope
Surface water
Check cellar
Shallow wells
4
Estimated depth to high ground water: 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: 64-1977
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
z Checked with local Board of Health-explain:
Design plan
0 Checked with local excavators, installers -(attach documentation)
El Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
As per design plan test pit data
————----------
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
tSinsp.doc rev.7/2612018 Title 5 OfficIal Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form Not for Voluntary Assessments
70 Candlestick Road
Property Address
Anthony Laccetti
Owner Owners Name
information is
North Andover MA 01845 9-26-2018
required for every
page. biijf-rown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
• A. inspector information: Complete all fields in this section.
• B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria) and 6 (Checklist) completed
D. System information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
[5insp.doc-rev,7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
Summary Record Card generated on 911812018 12:49:35 PM by Karen Hanlon Page 1
Town of North Andover
Tax Map # 210-106.A-0095-0000.0
Parcel Id 17240
70 CANDLESTICK ROAD
LACCETTI, ANTHONY
70 CANDLESTICK ROAD
N. ANDOVER, MA
01845
Class -- 101 Single Family-.- - Property Type - — 1 Residential
Zoning2 1 Residential Zoning3 1 Residential
Size Total 1.02Acres
FY 2019
LIB Mailing Index
Name/Address Type Loan Number Active/Inact. From Until
LACCETTI,ANTHONY Payor Active
70 CANDLESTICK ROAD
N.ANDOVER,MA
01845
LIB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 17689.0-70 CANDLESTICK ROAD Last Billing Date 7/18/2018
3170359 03 Cycle 03 Active
UB Services Maint.
Account No. 3170359
Service Code Rate Charge Multiplier/Users
MISCFEEADMIN FEE 0.63 5/8 7.82 1/
WTR WATER 01 ALL METER SIZE 146.23 /1
LIB Meter Maintenance
Account No. 3170359
Serial No Status Location Brand Type Size YTD Cons
36388117 a.Active ERT HH b Badger w Water 0.63 0.63 878
Date Reading Code Consumption Posted Date Variance
9/12/2018 913 a Actual 39 22%
6/11/2018 874 a Actual 33 7/23/2018 93%
3/7/2018 841 a Actual 16 4/23/2018 -20%
12/7/2017 825 aActual 19 1/26/2018 -18%
9/12/2017 806 a Actual 26 10/18/2017 -11%
6/8/2017 780 a Actual 28 7/25/2017 69%
3/8/2017 752 a Actual 16 4/12/2017 -32%
12/9/2016 736 a Actual 24 1/2312017 -47%
9/9/2016 712 a Actual 44 10/24/2016 1,18%
6/13/2016 668 a Actual 22 8/2/2016 21%
3/9/2016 646 a Actual 17 4/22/2016 -40%
12/10/2015 629 aActual 29 1/20/2016 -48%
9/9/2015 600 a Actual 55 10/16/2015 57%
6/10/2015 545 a Actual 35 7/24/2015 82%
3/11/2015 510 aActual 19 4/28/2015 -13%
12/11/2014 491 aActual 22 1/15/2015 -51%
9/11/2014 469 aActual 45 10/15/2014 73%
6/11/2014 424 a Actual 26 7/16/2014 71%
3/11/2014 398 aActual 15 4/11/2014 -36%
12/10/2013 383 aActual 23 1/17/2014 .54%
9/12/2013 360 a Actual 52 10/15/2013 263%
6/12/2013 308 a Actual 14 7/24/2013 3%
3/14/2013 294 a Actual 14 4/2212013 -46%
12/11/2012 280 aActual 25 1/9/2013 -31%
9/13/2012 255 a Actual 38 10/15/2012 23%
6/12/2012 217 a Actual 30 7/16/2012 121%
3/14/2012 187 a Actual 14 4/14/2012 -28%
12/12/2011 173 aActual 19 1/17/2012 -37%
9/12/2011 154 a Actual 32 10/13/2011 50%
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Town of North Andover
SSA HEALTH DEPAM RTENT
CHECK 4: DATE: A)
'Y
LocAmN: 7(") A 61,
H/O NAME:
CONTRACTOR NAME:
Type of Permit pr License. (Check box)
0 Animal $.......
• Body Art Establishment
• Body Art Practitioner
• Dumpster
0 Food Service
0 Funeral Directors
ri Massage Establishment
0 Massage Practice
[J Offal(Septic) Hauler
El Recreational Camp
• Sun tanning
• Swimming Pool
0 Tobacco
0 Trash/Solid Waste Hauler
0 Well Construction
SEPTIC Systems.
0 Septic-Soil Testing
[j Septic-Design Approval
Septic Disposal Works Construction(DW0
0 Septic Disposal Works Installers(DWI)
El Title 5 Inspector
$
Title 5 Report
0 Other. (Indicate)—
Hea It"Agent Initials
White Applicant Yellow.-Ilealth Fink
k-Treasurer