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HomeMy WebLinkAbout- Title V Inspection Report - 171 SUMMER STREET 4/18/2019 Commonwealth of Massachusetts lsgmu = Title 5 Official Inspection Farm w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is North Andover NIA 01845 3/27/2019 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. Important:when A filling out forms . Inspector Information on the computer, Anthonyuse only the tab R Mottolo key to move your Name of Inspector cursor-do not .John Zanni Pumping Co., Inc. use the return key. Company Name PO Box 407 rab Company Address North Reading MA 01864 Cityrrown State Zip Code (781) 944-0149 S15018 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 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. ❑ Fails 4/7/2019 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 DEP. 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �x = Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is North Andover MA 01845 3/27/2019 required for Query page, CikylTown State Zip Cade Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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. El Y El N © ND (Explain below): t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts iT = = Tate 5 Official Inspection Farm Subsurface Sewage Disposal System Form Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner Owner's Name ) information is required for every North Andover MA 01845 3/27/2019 page. City/Town State Zip Code date of Inspection � C. Inspection Summary (cant.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational, System will pass with Board of Health approval if pumps/alarms are repaired, ❑ 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 3) Further Evaluation is Required by the Board of Health: I ❑ 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: t5inspAoc•rev,712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 ' Commonwealth of Massachusetts Title"�°������ �� ��`���°��"��N 0��������°��~���� ������k� �� ��� QK��N�mN @mm�.��w����N�pmm Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 171 Summer Street -- Property Address Anthony Cerra Owner Owner's Name information is North Andover MA 01845 3/27/2018 required for every page. City/Town State Zip Code Date of|nopmmivn C. Inspection Summary (cont.) El Cesspool or privy ie within 5U feet ofa surface water R Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fall unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning |na manner that protects the public health, safety and environment: The system has o septic tank and soil absorption system (SAS) and the SAS iavvKhin --Ofeetofesurfaoewotaroupp|yortributmrytoosurfaoewoteraupp|y. El The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply, | R The system has a septic tankandSASandthe SAS |a within 5O feet ofa private water supply well. - Fl The has eseptiotonk and SAS and SAS is less than 10O feet but 5O feet or � �� � more from a private water supply wey". 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 ba attached to this form. � o. Other: i 4) System Failure Criteria Applicable tu All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility nr system component due tu overloaded or �l �� �� �� clogged SAS orcesspool Discharge orpondingof effluent ho the au�aoeof the ground orau�acewaters �l �� due toam overloaded or clogged SAS orcesspool mmo*o""`rev,x*m,o`o Title n Official Inspection Form:Subsurface sewage mspw"/a,"mm^pag"^ww Commonwealth of Massachusetts Title 5 Official Inspection For -_ � .. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments xr� 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is NIA 01845 3/27/2019 required for every North Andover page CitylTown State Zip Code Date of Inspection C. Inspection Summary (cunt.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool n ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ® Z 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 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. 5) 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 ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well 15insp.doc•rev.V2612018 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 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is North Andover MA 01845 3/27/2019 required for every page City/Town State Zip Code Date of Inspection C. Inspection Summary (cant.) 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? ® ❑ 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 El ® this inspection? M ❑ 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? ® ❑ 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts , mm = ❑ Tide 5 Official Inspection Form I. Subsurface Sewage Disposal System Form- Not for Voluntary Assessments V� 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is required for every North Andover MA 01845 3/27/2019 page. City/Town State Zip Code Date of inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): N/A Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A Description: 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ Na Does residence have a water treatment unit? ❑ Yes ❑ Na If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ® Na Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 100 gpd avg. g ( Y g (gpd)): Detail See attached printout from North Andover Water Dept. Sump pump? Z Yes ❑ No current Last date of occupancy: Date t5lnsp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts ix a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 171 Summer Street `x Property Address Anthony Cerra Owner Owner's Name information is North Andover MA 01845 3/27/2019 required for every page. City/Town State Zip Code Date of Inspection i D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq,ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No 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: Owner Source of information: Was system pumped as part of the inspection? ❑ Yes ® No d If yes, volume pumped:i gallons i How was quantity pumped determined? Reason for pumping: l5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts h. : Title 5 Official Inspection Form f - Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments - n 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information Is North Andover MA 01845 3/27/2019 required for every { page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 4. Type of System: M 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 ❑ Tight tank. Attach a copy of the DEP approval. Other(describe): Approximate age of all components, date installed (if known) and source of information: Septic tank: original. D-box and SAS: late 1990's, per North Andover Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 12" Depth below grade: feet Material of construction: ® cast iron ❑40 PVC El other(explain): N/A Distance from private water supply well or suction line: feet i Comments(on condition of joints, venting, evidence of leakage, etc.): All ok. No visible leakage. ewago Disposal System•Page g of 18 15insp.doc•rev,7/26/2018 Title 5 O fidal Inspection Form:Subsurface S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is North Andover MA 01845 3/27/2019 required for every " i page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6, Septic Tank(locate on site plan): 61' Depth below grade: feet Material of construction: E concrete El metal El fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) n Yes E] No 51-1 x TD Dimensions: 8.. Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28" 1 1/2" 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 16" How were dimensions determined? Mirror and 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.): Tank should be pumped once every year. Inlet baffle and outlet tee are intact and in good condition. Structural integrity of tank is good. Liquid level is at outlet invert. No visible leakage into or out of tank. 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �wm:0 Title 5 Official Inspection For LL Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. ! 171 Summer Street Property Address Anthony Cerra Owner Owners Name information is required for every North Andover MA 01845 3/27/2019 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 ❑ 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 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 ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts tSTitle 5 Official Inspection Form k Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is North Andover MA 01845 3/27/2019 required for every page. City/Town State Zip Code Date of Inspection 1 D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at inverts 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 is level and distribution to outlets is equal. No solids carryover. No evidence of leakage into or out of box. I t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System Page 12 of 18 Commonwealth of Massachusetts it . Title Official Inspection For 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' ,. 171 Summer Street { Property Address Anthony Cerra Owner Owner's Name Information is North Andover MA 01845 3/27/2019 required for every page. Cityl`fown State Zip Code Date of Inspection D. System Information (cant.) 10. 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. 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: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1, 28'x 48' II ❑ overflow cesspool number: ❑ innovative/alternative system i Type/name of technology: i f l5insp.doc•rev.712 8120 4 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Wage 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner Owner"s Name information is North Andover MA 01845 3/27/2019 1 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 11. Soil Absorption System (SAS) (cant.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc,): Soil is clean and vegetation is normal grass. No visible signs of hydraulic failure. 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 Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.dac-rev.7/26/2018 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 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is — MA 01845 3/27/2019 required for every North Andover 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.): t6insp.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 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is N— required for every orth Andover MA 01845 3/27/2019 page. City/Town 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: hand-sketch in the area below drawing attached separately l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 . . Commonwealth of Massachusetts ~�==~�M�� �� ����~��=��N 0��������~������� ����R~R�� Title �� ��y00 ������N 0mm���������0��mo Form � mm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 171 Summer Street — Property A4d*mo Anthony Cerra Owner Owner's Name information is North Andover MA 01845 3/27/2019 required for every pagoCity/TowCity/Town State Zip Code Date ofInspection D. System Information (cont.) 15. Site Exam: Check Slope �8 Surface water Z Check cellar Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: � �l Obtained from system design plans unrecord |f checked, date of design plan reviewed: Date B� Observed site(abutting property/observation hole within 158 feet ofSAS) Checked with local Board of Health-explain: Title 5 Report dated 3/14/2OO2 showed no water et7' El Checked with local excavators, installers- (attach documentation) Accessed US8S database-explain: You must describe how you established the high ground water elevation: Most recent test hole dug on 3/14/2002 showed no water present at 7' below surface. Checked sump pump in basement and found 2"of standing water(about O' below nurfaoe). Before filing this Inspection Report, please see Report Completeness Checklist mn next page. Commonwealth of Massachusetts V -= � Title 5 Official Inspection Far Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a = � 171 Summer Street Property Address Anthony Cerra Owner Owner's Name information is North Andover MA 01845 3/27/2019 required for every page City/Town 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 Z 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 I t6insp.doo-rev.7126/2M Title 5 Otfic al Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form x' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 171 Summer Street Property Address Anthony Cerra Owner Owner's Name I information is required for every North Andover MA 01845 7I6/2015 page. CitylTown State Zip Code bate of Inspection ..,.... _.._.,_.. ..,..., ... _.._ .. ..._. D. System Information (coat.) 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 „w__..... _..... �4 w' p wo...o Po ® wfl i a "'13 2,a m "S IJrna JIt f4 'ime 5 o nival Inspect ian Fomi sulastxrdaco sew,ago r7uSposal System r-ag"15 0 1'1 Summary Record Card generated on 31271201910:66:64 AM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-038.0-0039-0000.0 Parcel Id 13040 171 SUMMER STREET ANTHONY CERRA 171 SUMMER STREET NORTH ANDOVER, MA 01846 f Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1 Acres FY 2019 UB Mallina Index Name/Address Type Loan Number Active/Inact. From Until ANTHONY CERRA Owner Active 171 SUMMER STREET NORTH ANDOVER,MA 01845 ROBERTS,M.&CHIUCHIOLO,L. Previous Customer Inactive 11/20/2009 171 SUMMER STREET NORTH ANDOVER,MA 01845 MARC BOURASSA Previous Customer Inactive 11/30/2010 171 SUMMER STREET NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Activeltnactkve Bldg Id. 16162.0-171 SUMMER STREET Last Billing Date 1/16/2019 3160208 03 Cycle 03 Active UB Services Maint. Account No.3160208 Service Code Rate Charge MultiplierlUsers MISCFEE ADMIN FEE 0.63 5/8 7.82 1! WTR WATER 01 ALL METER SIZE 15.20 /1 UB Meter Maintenance Account No.3160208 Serial No Status Location Brand Type Size YTD Cons 33 29324776 a Active 00 b Badger w Water 0.63 0.63 Date Reading Code Consumption Posted Date Variance 3/6/2019 437 aActual 4 -1% 12/5/2018 433 a Actual 4 1/22/2019 -31% 9/6/2018 429 a Actual 6 10/15/2018 48% 6/6/2018 423 a Actual 4 7/23/2018 -2% 3/512018 419 a Actual 4 4/23/2018 -1% 1215/2017 415 aActual 4 1/25/2018 -16% 9/712017 411 a Actual 5 10/18/2017 0% 6/5/2017 406 a Actual 5 7/25/2017 16% 3/3/2017 401 a Actual 4 4112/2017 -13% 12/6/2016 397 a Actual 5 1/23/2017 -7%e 9/2/2016 392 a Actual 5 10/24/2016 -9% 6/6/2016 387 aActual 6 812/2016 79% 3/2/2016 381 aActual 3 4/22/2016 -46% 12/7/2015 378 a Actual 6 1/20/2016 -2%u 9/4/2015 372 a Actual 6 10/16/2016 19% 6/4/2015 366 a Actual 5 7/24/2016 0% 3/6/2015 361 a Actual 5 4/28/2016 -18% 1214/2014 356 aActual 6 1/15/2016 -12%e 9/512014 350 a Actual 7 10/15/2014 -1% 6/5/2014 343 a Actual 7 7/16/2014 40% 3/6/2014 336 aActual 5 4/11/2014 -18%e 1216/2013 331 a Actual 6 1117/2014 -2% jq 10(/ I : 5 7 Na ti 1 Town of North Andover HEALTH DEPARTMENT 'y*°nr.o �y4y MS$ACHU��i CHECK.#; � LOCATION: ��"� L�_� H/O NAME: CONTRACTOR NAME: Type of Permit g License: (Check box) ❑ Animal $ ❑ Body Art Establishment $. �.— ❑ Body Art Practitioner $_. -- ❑ Dempster Food Service-Type:-----. ❑ Funeral Directors $ — ❑ Massage Establishment $_ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ �— ❑ Recreational Camp $ ❑ Sun tanning ❑ Swimming Pool ❑ Tobacco ❑ Trash,/Solid Waste Hauler $ _ ❑ Well Construction $-- SEPTIC Systems: ❑ Septic m Soil Testing $— ❑ Septic-Design Approval $_ ❑ Septic Disposal Works Construction(DWC) $ _ ❑ Septic Disposal Works Installers(DVVV $_ 0 Title 5 Inspector $- Title 5 Report ❑ Other:(Indicate).-----. $ .Healtf 'Agent Initials White Applicant Yellow_-Health .fink-Treasurer