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HomeMy WebLinkAbout- Title V Inspection Report - 540 SHARPNERS POND ROAD 5/28/2019 Commonwealth Off M �o IM Z imcia ion vllel e mom I Inspect" Form i yA i Subsurface Sewage Disposal System, Form Not for Voluntary Assessments 5 SHARPNERS FOND ROAD Property Address CHRIS MCCARTHY Owner 6 r� required for every page. State Zip,Code Date of Inspection Inspection results must be,submitted l form. I I forms may not be alteredany y Please see completeness checklist at the end' of the form. . Important-,W � nA. Inspector Information filling out forms, on the computer,use only the tali JAM ES ES I�. CURRIER 11 key to move your Nerve of Inspector cursor-do not YS SEPTIC & DRAIN use the return Company Name ro 311 FOREST STREET Address fs MIDDLETON MA 01949 a Cit /T own State Zip Code Telephone Number License Garr B. Certification I certify that I am a, DEP approved system inspector full compliance,with Section 15.3140i l (310 CMR . s l have personally inspected the sewage disposal system at the property address lusted 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 experilence In the proper r inction and maintenance of ors-site s wiage!disposal systems.After,con u tln this inspection I have determine that the system:: 1. El Passes 2. Conditionally Passes. 3. Ell fees Further Eul'uln by the Local Approving Authority . ED Fails 26 19 Irreor's Signature Data The system inspector shall,submit a copy of this inspection report to the,Approving Authority (Board of Health or F within 30, days of completing this inspection,. If the system, has a,design flow of 101000 gp ' or greater, the inspector and the system,.owner shall submit the report to the appropriate regional frica of the CHEF". The original Torn should ha sent to the system owner and copies sent t the buyer, if applicable, and the approving authority. Pleasenote. report only describes conditions at the t,iri inspection n and under the time.conditions of use at that his inspection does not address the system will perform iinu the future under the a different conditions of use. tfln p,do .r,ev.7/26/2018, Title 5 Official Inspection Form!,Subsurface Sewage Disposal tee,.Pugs 1 of I a Commonwealth i1cia Tatle 5 Off" 0 1 1,nspec ion Form, mi Subsurface a age Disposall System Form Not for Voluntary Assessrnents 5140SHARPNERS POND ROAD Fop e rty Addr CRT's MCCARTHY Owner Owner's.Nerve ,information is NORTH A V 2 9 required for eves .m page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1,1 21 3, or 5 and all of 4 and 6. 1) System saes El I have not,found any information which indicates that any of'the failure criteria described in 310 CAR 15.303 or in 310 CMR 15.31 exist. Any failure criteria not evaluated are indicated below. Comments- 2) System ndit un l y asses: one or more system components as descrillbed in the"Conditional Pass section need to be replaced or repaired. The system, upon c rn leti n of the replacement or repair,, as approved the Board of Health, will pass. Check the, ax for"yes", "no" or It not,determined" (Y, 1 , for the following statements. If"not eterminedp" please explain. The septic tarok 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 n if the existing tank is replaced with a come it ing septic tank as approved by the Board of Health,. . m tal septic tank will pass inspection if it is structurally sound, not le ing and if a Certificate of compliance indicating that the tank is lass than 20 years old is available. El N (Explain, below)* i t5insp,doc rev.,71261/2018 Title 5 Official Inspection Form,Subsurface ewage Disposal System.Page 2 of 1 Commonwealth oif Massachusetts Tille 5 Official Inspect6ion Form Subsurface Sewage Disposal System �F'orm Not for Voluntary Assessments, 540 SHARPNERS POND ROAD 0 r o"perty Address CHRIS MCCARTHY Owner Owner's Name information'is NORTH AN OVER MA 01 184 5 4/26/19 required for every - j) Ci'ty/Town State ZIP,Code Date of Inspection page. C. Inspection Summary (cont) 2) System Conditionally Passes (coat.)& E:I' Pump Chamber pum,ps,/alarms not operational. System will pass with Board of H lth approval if' purnps/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 unevien clistribution, box. System will pass inspection if(with approval of Board of Health): Ej broken pipe(S) are replaced N 0 ND (Explain below): E:1 obstruction is removed F] Y [:1 N E] ND (Explain below),: Zj distribution box is leveled or repilace NEI, ND (Explain below),-, BOX IS DETIORATED AND NEEDS TO, BE REPLACED. The system required pumping moire 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 ppi) are replaced Q Y [I NEI ND (Explain below): ob Y struction is removed N ND (Explain below),* 3) Further Evaluation is Relcluireld by the Board of Health: © Conditions exist which require further evaluation by the Board of Health, in order to determine if the system is,falling to, protect public health,,, safety or the environment. a. Systernwill pass unless Board of Health determines in accordance with 310 CIVIR 15.303(1,)(b)that the system Is not function"Ing in a manner which will protect public health,. safety and the environment: Mnsp.doc rev.712612018 Title 5 Ofly liciat Inspection Form*Subsurface Sewage Disposal Systlem-Page 3 of 18 uommonwealth of Massac,huseft A .0. T 1eOff I I 5 icia ns�pec ion orm Subsurface Sewage Disposal System Form Not for Voluntary Assessments 540 SHARPNERS POND ROAD, Property Address CHRIS MCCARTHY Owner 6w-­'n"ees Name information NORTH ANDOVER MA 01845 4/26/19 required for every ............................... y/Town Sta page. dit to Zip Code, Date,of Inspection C., Inspection Summary (cont.) El Cesspool oir privy is,within 50 feet of a surface water Ej Cesspooll or privy is within 50,feet of a bordering veg gate d wetland or,a salt marsh b. System will Boil 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. [:1 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, 0 The system has a septic tank and SAS and thie 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 an 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.- 41) System Failure Criteria Applicable to All Systems: You must'Indicate "Yes"' or"No"to each of the foilowing for all,inspections:11 Yes No El E Backup of sewage into facility or system component clue to overloaded or clogged SAS or,cesspool Discharge or ►nding of effluent to the surface of the ground' or surface waters due'to an overloaded or clogged SAS or cesspool t5insp.do c rev.7/2612,018 Title 6 Official Inspection Form:Subsurface Sewage Disposat System-Page,4 of 18 p Commonwealth of Massachusetts Ti ur_ mtle 5 Off' u ial Inspection Form Subsurface wags Disposal System Form Not f+ r voluntary Assessments 540 SHARPNERS, POND ROAD Property Address CHRIS MCCARTHY Owner bWner's Name information is NORTH ANDOVER MA 01845 26 19 required for every di a of Inspection C, Inspection Summary (cont 4) System Failure Criteriai to All Systems: (cont.) Yes No Static liquid level lino the ''istri box above outlet invert due to an overloaded E] El r clogged SAS or cesspool Liquid depth i ru,r cesspool i� less than,6" below invert or available volume is Iess than 1 day flow El 0 Required pumping more than 4 times in the last year due to clogged or obstructed ipe s . Number ber tires pumped: E] N Any portion f the SAS, cesspool or priory is blow high ground water elevation;. E]�)t Any portion f cesspool or privy is within 100,feet of a surface+ water supply or tributary to,a surface water supply,. "��Jjr Any portion of a cesspool or privy is within a Zone 1 of a public water supply D EJO well., El EX))r Any portion of a cesspool or priory is within 50 feet of a private water supply well. El 01�r Any portion f a cesspool or privy is less than 100 feet but greater than 50 feet from a private water suppler 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 j of ammonia nitrogen and nitrate nitrogen is equal to r less than 5 ppm, provided that no other faillure criteria are triggered. A copy of the analysts and chain, of custody st y must be attached to this,'form.] El N The system is a cesspool serving a facility with a design flow of 2 gpd- 1101000 gpd. The system,fails. I have determined that one or more of the above failure criteria exist as described in 310 CM R 15.303, therefore the system fulls. The system owner should contact t the Board of Health to determine what will be necessary,to correct the failure. 5) Large Syst m be consideredlarge system the system must serve a facility with a design flow of 10,000 gpd to 15,0001i For burgs systems, your rust indicate elth "yes r no" to each of the following, ire addition to the f questions in Section CA. w� Yes, No El Ej the system,, is within 400 feet of,a surface drinking grater supply El 1:1 the,system is within 200 feet of'a tributary to a surface c rinkin grater supply �! the system is located in a nitrogen sensitive area (Interim Wellhead r+ t ti r 0 ElArea� I ' r a rya a Zone Il f u�bli water,supply well lip Title 5 Official foal Inspection Form Subsurface Sewage Disposal System,.Page 5 of 1 f Commonwealth, of Massachusetts IN dd It icimal Inspectmion Form le 5 Offm :FA P Subsurface Sewage Disposal System Form Not for Voluntary Assessments 540 SHA,RPNERS POND ROAD Property Address CHRI CARTHY Owner Owner's Name, information is NORTH ANDOVER MA 01845 4/26/19 required forevery page. City/Town State Zip Code Date of'Inspection C. Inspection Summary (cont) If'you have answered "yes" to any question in Section C.5 the system is consider 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 G.5 or failed under Section CA shall, upgrade the system, in accordance with 3,10 CM R 15,304. The systern owner should contact the appropriate, regional office of the Department. 6. You must indIcatie"yes" or"no":for each of the following fbr all inspections: Yes No Pumping information was providied by the owner, occupant, or Board of Health E] Were any of the system,,components, pumped out.in the previous two weeks? H El Has the system received normal flows in the previous two week period? El Z Have large volumes of water been Introduced,to the system recently or as part of this, inspection? W re as built plians of the system!obtained and examined? (If they were not available note as N/A,) E El Was,the facility or,dwelling Inspected for signs of sewage back up? Z 1:1 Was the site inspected for signs of break out? Z E] Were all,system components, excluding the SAS, located on site? E 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 Z 1:1 information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soll Absorption Syste n the site has been determined based on: Z Existing, information. For example, a plan at the Board of Health. 0 Z Determined in the fielid (if any of the failure criteria related to Part C is at issue ap proxi m atin of d ist an e s u naccepta bl e) [31 C M R 1,5.30,2 5)] t5insp,doc rev.7/261/2018 Titte 5 Official Inspection Form,Subsurface Sewage Disposal System-Page 6 of 18 4�m Commonwealth of Massachusetts 11[le 5 O,fficial Inspecto Form Subsurface Sewage Disposal System Not for Vol u ntaryAssessore s A Property Address CIS MCC Owner ro an Name information is NORTH A i V 5 26/ 9 required for everyown ... State Zip Code Date of Inspection page. D. System Information . Residential Flow 4 4 Number of bledirooms (design). Number of'bedrooms, actual DESIGN flow based on 310 CMR 15.203 (for example, Description- Number of current residents: ... . Does residence, have a garbage grinder Yes 0 N Does residence have a water treatment unit? El Yes 0 N If yes, discharges to: Is laundry on a separate sewage system? (include laundry system inspection El Yes ED N information in this report.), Laundry system inspected? El Yes 0 N', i Seasonal use? El Yes E l WELL Water meter readings if availabl (last 2 years usage , : Detail: Sump m, Yes Z No IG CURRENT Last date of occupancy. Date t in .d .rev.7/26/2018 `title 5,Official Inspection F rr :Subsu Sewage Disposal System-Page 7 of 18 w Commonwealth of Massachusetts r, Form Toltle 5 Official Inspect"lon Subsurface + , w I Not for Vol afar , ss ssmer is mm � 540 SA1ES POND ROAD Property Address CS MCCARTHY Owner owner's Name information is NORTH ANDOVER MA 01845 4126/19 required for every di t y/Town State Zip Code Date,of InspectionD. System Information (cont) 2. Commerce I n a tr Flow Conditions: Type of Establishment* Design flow(based on 310 AMR 5.2 3): m..m 11 ay(gpid) �. .... Basis,of design flow(seats/p,ersons/sq.ft., etc.): ..,. .... Grease trap resent? D Yes _ N 'wafer treatment unit present? Yes No If Yes, discharges f ' ,�. . Industrial waste holding tank present? El Yes N Non-sanitary waste,discharged to the Title 5 system? Yes N Water aster readings, if all l Last eats of occupancy/use: Date ,.... Offier(describe below): 3. Pumping c LPD-96 , Source ofinformation: Was system pumped as part ofthe inspection? Yes No If yes,, volume pumpe& gallons How was quantify purnpled determined? _,. ...m. Reason for pumping-. .ry t t i p. .rev„7/2612018 Title 6 Official Inspection Fora;Subsurface Sewage Disposal System-Pugs 8 of 18 Commonwealth of Massachuseft 6 T, itle 5 011 icial Inspection Fol ? Le A Subsurface Sewage Disposal, System Form, Not for Vollu rat ary Assessments 540 SHARPNERS POND ROAD Property Address ,CHRIS MCCARTHY Owner Owner's Name information is NORTH ANDOVER MA 01,845 4/,26�/1 9 required for every , ...... page. City/"Town Mate dip Code Date of inspection D., System Information (cent.) 14. 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 are Innovative/Afternative 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 F1 Tight tank. Attach a copy of'the DEPapproval. ED Other(describe)- Approximate age of all components, date installed (if known) and source of inform,ationo AS BUILT DATED 5/4187 Were sewage odors,detected when arriving at the,site? 0 Yes Z No 5. trill inkSewer(locate on site plan)-: Depth below grade- 1011 Material et construction: El cast iron Z 40 PVC [:1 other(explain)- Distance from private water supply well or suction line* 26' feet Comments on condition of joints,, venting, evidence of leaka, e, etc. 9 t5insp.dQG-rev,7/26.12,018 Thle 5 Official Ire spedrion Form:Subsurface Sewage Disposal System Page 9 of'18, Commonwealth of Massachusetts T'Itle 5 Olff'icial n s' a ■I Form, Subsurface Sewage Disposal Sys,tem Form Not for Vo�luntary Assessments 5,40, SHARPNERS POND ROAD, (Property Aid d ress CHRIS MCCARTHY ................ Owner Owner's Name information is NORTH ANDOVER MA 011845 4/26/1 9, required;for eviery pagle. CityfTown State Zip Code Date of Inspection D, System Information (coat.) 6. Septic Tank(locate on site plan): Depth bielow gradew feef""" Material of construction.- Z concrete El metal, 0 fiberglass E] polyethylene other(explain) if tank is metal, list age* years Is age confirmed by a Certificate of Compliance,',? (aftach a copy of certificate) E] Yes No Dimensions: 1500 GALLONS 10'611 X 5,1811 Sludge,depth: Distance from top of sludge to bottom of outlet tee or baffle 3111 Scum thickness low 614 Distance from top of scum to top of outlet tee or baff le ............. 13 Distance from bottom of scum to bottom of outlet tee or baff 11 le, SLUDGE JUDGE H=were dimensions determined?, Comments (on pumping recommendations, inle't avid outlet tee or baffle condition, structural integrity, liquid levels as, related to outlet invert, evidence ofleakage, etc.): TANK DOES NOT NEED PUMPING AT THIS TIME,, INLET BAFFLE IN l LACE, OUTLET TEE IN PLACE. LIQUID LEVEL, IS CORRECT. t5insp,doc rev.7/2612,018 Title 5,Official Inspection Form,Subsurface Sewage Disposal System-Page!10 of 18 Commonwealth! of Massachusetts Arl_r 5 official I Title ns,pec ion Form 1� Subsurface Sewage Disposal System Form Not for Voluntary Assess,ments 5 SHARPNERS POND ROAD Property Address CHRIS MCCARTHY Owner Owner's Name information is NORTH AN'DOVER MA 01845 4/26/19 required for everymmm page. City/Town State Zip Code Date,of Inspection Do, System Information (cont.) 7. Grease Trap (loicate on site plan)* Depth below grades et Material of'construction: Ej concrete El metal El 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 ffle Date of last pumping: mmm Date uc , Comments (on pumpin u g recommendations nlet and outlet tee or baffle conditiI on, str tural integrity liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must b umpedme at ti of inspection) (locate on site plan)- rr Depth below grade: Material of construction* El concrete ED metal Ej fiberglass polyethylene El other(explain): Dimensions: Capacity: g I allons Design Flowl., gallons per 11 d 1.a y t5insp.doc rev,7'1216/2018 Title 5 Official Inspection Form-Subsurface Sewage Disposal System-Pugs 11 f 18 Commonwealth of Massachusetts Title, 5 otticiall Inspeiction Form Assessments Subsurface Sewage D11sposall System Form - Not for Voluntary 540 S,HARPNERS POND ROAD, Property Address CHRIS MCCARTHY ------ ................ .......... Owner Owner's Name Information is NORTH ANDOVER MA 01 84�5 4/26/19 required,fo r every di-t y--/Town, State Zip Code Date of Inspection page. U, System Information (cont) 8. Tlightor Holldling Tank(cont.), Alarm present- E] Y e s E] N 0 Alarm level: Alar�m in working ord Yes El N 0 Date of last pumping: -1 Date Comments, (condition of alarm and float switches, etc.,): ............... Attach copy of current pumping contract(required). Is copy attached? El Yes 0 No 9. Mistribution Box(if present,must be opened) (locate on,site plan): Depth of fiquid 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.): I BOX HAS DETIORATED AND NEEDS TO BE REPLACED. NO EVIDENCE, OF SOLIDS CARRYOVER. LIQUID LEVEL CORRECT., BOX IS 17" BELOW GRADE. ............. t5insp.doc rev.7/2612018 Title 5 Official Inspection For :Subsurface Sewage Disposal System-Pag 1,2 of`18 Commonwealth 6- ion Tolt,le 5 Official Inspectm Form Subsurface Sewage Disposalr Not for Voluntary Assessments i NN , 540,SHARPNERS POND ROAD Property Address CIS MCCARTHY Owner information is NORTH ANDOVE 5 26 9 required forevery � „ �mm � � page. bit '" rl Stag Zip Code bate of Inspection D® System Information (cont) 10. Pump Chamber(locate on, site plea): Pumps urn working order: El Yes N * Alarms in working order. El Yes [ l rr 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: i Type: ruching pity leaching chambers number: El leaching galleries, number: leaching trenches number, length-. El i leaching iei s number, imensi nsw El overflow c ss � 1 numbers innovative/alternative system of technology, t ire p -rev,712612018 `fide 5 Official Inspection Fenn;Subsurface sewage Disposal System-Pugs 13 of,1 i r Commonwealth on Form Tmitle 5� O,ffmicial lnspecti' Subsurface Se,wage Disposal System Form ® Not for Voluntary Assessments :a 540 SHARPNERS POND ROAD Pi-operty Address CHiRISMCCARTHY Owner Owner's Name information is NORTH ANDOVER MA 4/26/19 required for m.��,,.� .. ,.,,�., _ Date..of Inspection ate Zip Code page. Gity/Town D, System Information (coat.) 1. Soill Absorption SystemSAS) (cont. Comments (note condition of soil, signs of hydraulic failure, level of ponding, d'amp soil, condition of vegetation, etc,.)-SOIL® ", SIGN` I HYDRAULIC FAILURE, " ��1� I l NORMAL. 12. Cesspools (cesspool, must be pumped as, part of inspection) (loofa on site plan): Depth—top of liquid f inlf invert �..�..,, �.,., „,��_ Depth of solids brat Dimensions of cesspool ..... Materials f' nsfructi n -—------- El s, N o Indi ati n f gr �n at r inflow Comments (note, n ifi o of,soil, signs of hydraulic failure, lever of n i i,, condition of vegetation, etc.)- Title Official Inspection Poem Subsurface Sewage Disposal to -Page 14 of 1 i Commonwealth of Massachusetts mitle 5 Off ok� T I s cto Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 540 SHARPNERS POND ROAD Property Address CMS MCCARTHY Owner Owner's Name information is NORTH ANDOVER MA 01845 4�/26/1 9 requ ired for every - ................ te dip Code Date�of Inspection I City/Town Di. System Information (cont) 13. Privy (loots on site plan)", Materials of construction: "Ile Dimensions Depth of solids ........ Comments (notle condition! of soil,, signs of hydraulic,failure, level of ponding, condition of vegetation, etc.): t5inspAoc-rev.W2612018 Fills 5 Official Inspection,F'or Subsurface Sewage Disposal system-P=age 15,of I 8 Commonwealth of 'T"Itle 5 0ci � s io�nForm SystemSubsu,rfaceSewage Disposal Form Not,for Voluntary Assessments 540 SPS POND ROAD Property Address. CHRIS MCCAR ' Y Ownerbwner's,Name required for every information is NORTH ANDOVER, MA 01,845 4/26/19 page. fit n State Zip Code Date of Inspection D. Systern Information (cont.), v ewage Disposal m: Provide a view of the sewage disposal system, including,ties to at least two permanent reference landmarks or benchmarks. Locate ill wells,within, feet. Locate where public water supply eaters the building. Check one of the boxes, below: hand-sketch in the area below drawing attached separately i i I i t insp. ' •rev.7126/2018 Title Inspection Form,:Subsurface Sewage Disposal System-Page 16 of 1 I Commonwealth of Massachusetts ic*ial Inspect'l'on Form T"Itle 5 Off" Subsurfac,e Sewage Disposal System Form Not for Voluntary Assessments 540 SHARPNERS POND ROAD Property Address CHRIS IVICCAUHY ,Owner Owner's Name! information is NORTH ANDOVER MA 01845 4/26/19, required for every page. dityffown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: F� Check Slope El Surface water [:] Check cellar Ej Shallow wells, 138111 Estimated depth to high ground water'. feet .......... Please indicate all methods used to determine the high ground water elevation- 0 Obtained from system design plans on record, If checked, date of design plan reviewed,:, 1984 Date 1:1 Observed site(abutting property/observation hole within 150 feet of SAS) 1:1 Checked with local Board, of'Hall -eJilin: ( ), E] Checked with local excavators installers attach documentation I El Accessed USG S database-explain, You must describe how you established the high ground water elevation.- TEST PIT' DATA ON FILE WITH B.O.H., TEST I T'S PERFORMED ON 4/12/84., Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp doc rev.712612018 Title 6 Official Inspection For Subsurface Sewage Disposal System m Page,17 of 18 N Commonwealth chin 10 T"Itle 5 Offnicoial Inspectu n, Form fp Subsurface Selwage Disposal Syst,em Form Not for Voluntary Assessments 540 SHARPNERS POND ROAD Property Address CHRIS MCCARTHY Owner Owners Name information is 1 N V R �f 54,/.?6/19rw�rr fir e� .. .. .mmm ..m., .� City/Town State Zip Code Date of Inspection E. Report Complete l 1 c section i dorm *Inclusive of A., Inspector Information: Complete all fields in this section. E B. Certification,: Signed & Dated and 11 21 3, or 4 checked C. Inspection Summary.* 1 2, 3, or 5 completed as appropriate (,Failure Criteria) and 6 (Checklist) completed C . System Information, For : Tight/Holding Tan —Pumping contract attached For : Sketch of Sewage Disposal System drawn on pg. 16,or attached For 5: Explanation of estimated depth to high groundwater included, �i i i Mnsp. o r v,712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systems Page 18 of 18 wm"",Wxuq, .la's Ve? 4% a"t.rM'V7 'rr '- y».`w. wk+wter.: «w..XLe'" r«-y»«».;a,w,-)ISois'1. 'v tpamtt,V; 00) At 02 a 0 Iwo 04, I` a �N e w ` + w N w w w " r 1" 41 a » » " f( Town of North Andover HEALTH DEPARTMENT AC KU DATE.CHECK# J j / fi /Y) H/O NAME. m �a U w IM(@DWIVll v �a CONTRACTOR - �FlII�IViw"" IVUv� Ilm � 1111111 fir' fM�ww� a Permit or,License; (Check box) Animal Body Art Establishinent Body Art Priol ,I i jump Food Service-Type.--,-,.."-- LJ Funeral w I IU Massage Practice, * offalI S lip; Hauler r Recreational II Sun tanning swimmingPool Tobacco tj Tra,sWSolid Waste Hauler 13 Well Cs SEPTIC n . I _ '` " I ng Septic-Desigill Approva Septic Disposal ks onstm `+afj Septic Disposal Works litstalliers f � �iMwu r This 5 Repot W m^//„ M, II V El Other.- d P Healik"M lgent initials �I I ;d Applicant � q