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Home My WebLink About- Title V Inspection Report - 1542 SALEM STREET 4/16/2019 Commonwealth of Massachusetts Titl e 5 Official Inspection Form RECI,',, PUI[ED - -- ------ - Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1542 Salem St Property Address Alexander Grant 1pk:AL kt U-1YR1 MUlf Owner Owner's Name information is required for every North Andover Ma 01845 3/14/19 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. Important:When filling out forms A. Inspector Information on the computer, use only the tab Dean Dynan key to move your Name of Inspector cursor-do not Dean Dynan use the return ___-------------w-------------- key, Company Name 2 Suntaug Street ------------- VQ Company Address _Lypnfield Ma 01940 City/Town State Zip Code 508-726-9935 S112837 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. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. F-1 Fails (Spector'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 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. t5insp.doc rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts ....... Title 5 Official Inspection Farm <i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1542 Salem St__.__. Property Address Alexander Grant Owner Owner's Name information is North Andover Ma 01845 3/14/19 required for every _�_.....___-- page. City/Town 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 4 Bedroom septic system in working order 2) 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): t5insp.doc•rev.7126/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1542 Salem St Property Address Alexander Grant Owner Owner's Name information is required for every North Andover Ma 01845 3/14/19 page. City/Town 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): F-1 broken pipe(s) are replaced F-1 Y F-1 N El ND (Explain below): 0 obstruction is removed ❑ Y n N ❑ ND (Explain below): Fj distribution box is leveled or replaced El Y n N F-1 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): R broken pipe(s) are replaced F] Y ❑ N F-1 ND (Explain below): ❑ obstruction is removed F-1 Y El N 0 ND (Explain below): 3) Further Evaluation is Required by the Board of Health: F1 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 16.303(1)(b)that the system is not functioning In a manner which will protect public health, safety and the environment: t6insp,doc-rev,712612018 Title 5 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 1542 Salem St Property Address Alexander Grant Owner Owners Name information is required for every North Andover Ma 01845 3/14/19 ---------- page, CityfTown State Zip Code Date of Inspection C. Inspection Summary (cont.) El Cesspool or privy is within 60 feet of a surface water. ❑ 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: F-1 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. F-1 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply, F-1 The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. F-1 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. 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 0 0 clogged SAS or cesspool E-1 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.doc rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Form Not for Voluntary Assessments Subsurface Sewage Disposal System 1542 Salem St Property Address Alexander Grant Owner Owner's Name information is required for every North Andover Ma 01845 3/14/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No 0 Z Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El Z Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ri z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: EJ Z Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public water supply El Z well. El 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ z The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ z 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 CA. Yes No ❑ the system is within 400 feet of a surface drinking water supply F1 E the system is within 200 feet of a tributary to a surface drinking water supply El the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone 11 of a public water supply well t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 ' Commonwealth of Massachusetts �0��0�� ~��°��N N��^�� 1�N � N��~ �� y� � �� N� m��N�� m 0—�rw � � m Subsurface SmxvmgmDispmmoUSystmnnFormn -NutforVo|untaryAasesomente 1542 Salem St Property Address Alexander Grant Owner Owner's Name information is required for every North Andover Ma 01845 3V14/19 page. ~'^''``~' State '� p 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 nr operator mf any large system considered a significant threat under Section C.5orfailed under Section CA shall upgrade the system in accordance with 310 GMR 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 0 F1 Pumping information was provided by the owner, occupant, or Board of Health El Z Were any mf the system components pumped out|n the previous two weeks? �� Hae�he�y��omre:eiv�dn0rmo|f|�wmin �h� previouehwovv�mhpariod? � �_ __ � El �� Have large volumes ofvvab*r been introduced tu the uysternnacenU � recently � �� this inspection? � Were ao built p|anaof the system obtained and exmrn|ned? (If they were not ` available note aeN/4) Was the facility Or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Z [l Were all system components, excluding the SAS, located onsite? �l VVerethe nepUctank manholes uncovered, opened, and the interior of the tank -- -- inspected for the condition ofthe baffles or tees, material ofconstruction, dimensions, depth of liquid, depth of sludge and depth ofscum? Was the facility owner(and occupants if different from owner) provided with � �� [l information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (�� on �h� e|teh�� (SAS) � been determined based on: �� Fl 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 �l �l approximation of distance im unacceptable) [31OCK0R 15.302(6)] 15insp.dv ^re°rmeoom Title o official Inspection Form:Subsurface Sewage Disposal System'Page om1" Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1542 Salem St Property Address Alexander Grant -——----------- Owner Owner's Name information is North Andover Ma 01845 3/14/19 required for every -_------- page. CityfTown State Zip Code Date of Inspection D. System Information 1. 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 Description: 4 bedroom pipe in stone leachfield Number of current residents: Does residence have a garbage grinder? F-1 Yes H No Does residence have a water treatment unit? ❑ Yes N No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes N No information in this report.) Laundry system inspected? El Yes n No Seasonaluse? El Yes N No < 100 GPD ave Water meter readings, if available (last 2 years usage(gpd)): Detail: see attached Sump pump? ® Yes El No current Last date of occupancy: Date t5insp.doe•rev.7)26/2018 Title 5 Official Inspection Form:Subsurface sewage Disposal System-Page 7 of 16 Commonwealth of Massachusetts �x Title 5 official Inspection Farm -LL Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1542 Salem St Property Address Alexander Grant Owner Owner's Name information is North Andover Ma 01845 3/14/19 required for every ...-- page. Cltyfrown State Zip Code Date of Inspection D. System Information (cunt.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) _ Basis of design flow(seats/persons/sq.ft., etc.): - - -- Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ Na If yes, discharges to: ------- Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: -- - - Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Homeowner/Board of Health Source of information: Tank pumped last year Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: i t5insp.doc-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 1542 Salem St -Property Address Alexander Grant Owner Owner's Name Information is required for every North Andover Ma 01845 3/14/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool Overflow cesspool F1 Privy El Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. Other(describe): Approximate age of all components, date installed (if known) and source of information: 11 / 1989 as per permit on file Were sewage odors detected when arriving at the site? F-1 Yes 0 No 5. Building Sewer(locate on site plan): 1411 Depth below grade: feet Material of construction: F] cast iron 40 PVC El other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): sewer pipe in good condition no evidence of leakage t6insp,doc-rev.7/26/2018 TWO 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 1542 Salem St Property Address Alexander Grant... ....................— Owner Owner's Name information is required for every North Andover Ma 01845 3/14/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 7" Depth below grade: feet Material of construction: 0 concrete R metal El fiberglass ❑ polyethylene ❑ other(explain) 1500 gallon septic tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) F] Yes n No Dimensions: 1 OX5' X 68" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3011 0-211 Scum thickness 610 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 1311 in field with measure stick and tape How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 gallon concrete septic tank with PVC inlet and outlet T / Tank in working order with separation from inlet to outlet / no evidence of leakeage recommend pumping every two to three years depending on usage and number of occupants Media filter in outlet t / filter needs annual service for proper operation and to avoid back up filter was cleaned during inspection t5insp.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 yy: 1542 Salem St Property Address Alexander Grant Owner Owner's Name information is North Andover Ma 01845 3/14/19 required for every ...............__.._-.- page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal F] fiberglass ❑ polyethylene El 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: ❑ concrete ❑ metal ❑ fiberglass El polyethylene F-1 other(explain): Dimensions: Capacity: gallons Design Flow: gallons-per day----------- 15insp.doc-rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts 6-1A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1542 Salem St Property Address-- I Alexander Grant Owner Owner's Name information is North Andover Ma 01845 3/14/19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: E3 Yes E] No Alarm level: Alarm in working order: R Yes E-1 No Date of last pumping: Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? R Yes E] No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert liquid at 0" above invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 6 Outlet concrete D box level with four outlet pipes /little evidence of solids carryover / no evidence of leakage into or out of box/d box in good conditoin D box in working order D Box has diffuser T D Box is 10" below grade 15insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1542 Salem St Property Address Alexander Grant .......... Owner Owner's Name information is North Andover Ma 01845 3/14/19 required for every .--....— page, Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: Yes ❑ No* Alarms in working order: 0 Yes El No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): concrete pump chamber 8"from grade , pump chamber in good condition 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: 0 leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: leaching trenches number, length: ❑ leaching fields number, dimensions: D overflow cesspool number: D innovative/alternative system Type/name of technology: 15insp.doc,-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 2 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1542 Salem St —Property Address Alexander Grant Owner Owner's Name information is required for every North Andover Ma 01845 3/14/19 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.): leach trenches found in lawn area / soils in good condition / no signs of hydraulic failure no ponding/ no damp soil/ leach trenches constucted of pipe in stone in working order Mound system with vent located on side of slope at rear of property no breakout 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 0 Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15insp.doc•rev.7126/2018 Title 5 Official 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 1542 Salem St Property Address Alexander Grant Owner Owner's Name information is North Andover Ma 01845 3/14/19 required for every page, City/Town 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.7126/2018 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 1542 Salem St Property Address Alexander Grant Owner Owner's Name information is required for every North Andover Ma 018_4, 5__ 3/14/19 page. cityfrown State Zip Code Date of Inspection D. System Information (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: [D hand-sketch in the area below ❑ drawing attached separately 30/ 0 /9 L 0/p, 1:3 ... .� d- Iq / 7 / V t5insp.doc rev.7126/2018 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 1542 Salem St Property Address Alexander Grant Owner Owner's Name information is North Andover Ma 01845 3/14/19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15, Site Exam: Z Check Slope Surface water Check cellar Z Shallow wells 481'+ Estimated depth to high ground water: Teiec------ Please indicate all methods used to determine the high ground water elevation: z Obtained from system design plans on record If checked, date of design plan reviewed: 1989 / abutter 1997 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) EJ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plans on file at BOH dated 1988 Also checked with abutter dated 1997 at with eshgw el 137.00 System is mound located on side of slope well above el 137.00 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1542 Salem St Property Address Alexander Grant Owner Owner's Name — information is North Andover Ma 01845 3/14/19 required for every page. CltylTown State Zip Code Date of Inspection E. Report Completeness Checklist 1 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 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 t5insp.doc•rev.7/2 612 0 1 8 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 18 of 18 I rLYNN Zap M to r t , t Y t' r,w /"'.'r �• r.�'^'" "�it�S if �Y•+,,f„� � 9 e� , 1' '�+M� .. 01 to .h rf try �� r }r2D� S"�^s 8 a �+ .'Y•',f 1` 7Nr�� C. L1a '� tP ... s �n+y<'�' }}��' �t��,,,t^2 g, �s9.✓ P+7"e' �!1�rc?. i � 1 7 ,�'� �� '!'dk:" � � .- E 1 NA f AJ 6 , $E- ' `C`EO I t,1 U" F r r'y+,/ k^ �7Q ii74r1 �� #w(..)Y, '� ' ` y. ,9{';'S V. •.1"'"'w+i"+"�"" wJl ��ri� G: ..) �'��yl 4Fttfli`'I.i. "c y I � I i u r 9'� iAf a u -"k�� ✓f/ ��elf ��u�' �g� 044, r f Viol w x/ a w1 � 9 t 6` 4 P N M � j X M1 P x l r 1 Summary Record Card generated on 312112019 1:30.52 PM by Joanna Sallb Page 1 Town of North Andover Tax Map # 210-1063-0053-0000.0 Parcel Id 17373 1542 SALEM STREET GRANT, ALEXANDER Since Jan 2016 GRANT, TRICIA 1542 SALEM STREET NORTH ANDOVER MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential ZonIng3 1 Residential Size Total 1.02 Acres FY 2019 U13 Mailing Index Name/Address Type Loan Number Active/Inact. From Until ALEX GRANT Owner Active 1542 SALEM STREET NORTH ANDOVER MA 01845 PRYOR,KEITH Previous Customer Inactive 7/3/2015 1542 SALEM STREET N.ANDOVER, MA 01845 U13 Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17431.0-1542 SALEM STREET Last Billing Date 1/16/2019 3170101 03 Cycle 03 Active UB Services Maint. Account No, 3170101 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 49.40 U13 Meter Maintenance Account No. 3170101 Serial No Status Location Brand Type Size YTD Cons 36388182 a Active ERT HH b Badger w Water 0.630.63 540 Date Reading Code Consumption Posted Date Variance 3/7/2019 554 a Actual 16 19% 12/7/2018 538 a Actual 13 1/22/2019 -32% 9/11/2018 525 a Actual 21 10/1512018 13% 6/7/2018 504 a Actual 18 7/23/2018 34% 3/6/2018 486 a Actual 13 4/23/2018 -27% 12/6/2017 473 a Actual 17 1/25/2018 7% 9/11/2017 456 a Actual 18 10/18/2017 -11% 6/6/2017 438 a Actual 19 7/25/2017 33% 317/2017 419 a Actual 14 4/12/2017 30% 12/812016 405 a Actual 11 1/23/2017 -55% 9/8/2016 394 a Actual 25 10/24/2016 -5% 6/7/2016 369 a Actual 26 812/2016 82% 31712016 343 a Actual 14 4/22/2016 -12% 1218/2015 329 a Actual 16 1/20/2016 52% 9/8/2015 313 a Actual 8 10/16/2015 2% 7/1/2015 305 f Final Bill 13 7/13/2015 -14% 3/9/2015 292 a Actual 12 4/28/2015 33% 1219/2014 280 a Actua 1 9 1/15/2015 -39% 9/10/2014 271 a Actual 15 10/15/2014 -6% 6/10/2014 256 a Actual 16 7/16/2014 2% 3/10/2014 240 a Actual 16 4/11/2014 23% 12/6/2013 224 a Actual 12 1/17/2014 -10% 9/10/2013 212 a Actual 14 10/15/2013 -7% 6/11/2013 198 a Actual 15 7/24/2013 -5% 3/12/2013 183 a Actual 16 4/22/2013 8% 1ORT41 0 Town of North Andover HEALTI-1 DEPARTMENT issACK CHECK. 'i'� "V DATE: LOCATION: H/O NAME: CONTRACTOR NAME: (Check box) 0 Animal • Body Art Establishment • Body Art Practitioner • Dunipster 0 Food Service- 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 Constraction HEZX-Sustems: 0 Septic-Soil Testing 0 Septic-Design Approval 0 Septic Disposal works Construction(DWC) 0 Septic Disposal Works,Installers(DWI) [3 Title 5 Inspector, Title 5 Report 0 Other. (Indicate)---.,-- 11�alth Agent Initials White-Applicant Yellow-flealth ?ink_®Treasurer