HomeMy WebLinkAbout- Title V Inspection Report - 864 WINTER STREET 5/31/2019 I U
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Commonwealth of Massachus,eft
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I 5 Utticial Insap&ecinon For
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S su�rface Sewage D,isp rs l System Form Not for'voluntary Assessments
864,Winter,Street �
Property Address
Adam Clark
Owner Owner's Nr°
information is
required foreveryNorth Andover, 5 5-21-2 9
page,, ICity/Town State Zip Code Date of Inspection
Inspection results must be submitted on this f r w. Inspection forms may not be altered iin any
way. Pleas see completeness checklist at the end' of the form.
Important:WhenA. Inspector Information
filling.out forms
the mi ut r,
use,only the tab ell James, Batesion
key to move your Name of Inspector
not ateson Enterprises Inc.
use the return Company a
Argilla Road
ab Company Address
Andover, 1
CIt own State ,...mm _...,, Zip Code
Telephone,Number License Number
B, Certification
I certify that; I am a DEP approved systems inspector in full com,pliance with 'Section 15.3 of Title
(3110 CNIR , ; I have personally inspected the sewage disposal system t 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' n my training and experience in the proper funiction
and maintenance of on-site sewage disposal systems.After r a ctin this inspection I have determined
that the system:
1. Passes
kt
2. Conditionally Fusses
3. Needs Further Evaluation by the Local Approving Authority
. Fails
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5 21^2 19,
Ire i t is Signature Date
The system inspector shall submit a copy of this inspection report to t�he Approving Authority (Boa
f Health or E within 30 days, of completing this inspection. if the systern has a,design flow of
101 000 gpd or 19 reater,, the inspector and the system owner shall submit the report to the appropriate
r firm should, a sent t the system owner office f tl�� �I The original rur n ies sent to
the buyer,. if applicable, and the approving authority,,, k�
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Please inote:This repot only describes conditions of the time,of Inspectmion and under the
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conditions f use at that flme.This, inspection does not address how the system ill erf r �
in the future under the same or different conditions use. d
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t in p. .rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System*Page 1 of 1
Commonwealth of Massachusetts
Ti'tle 5 u4"'Llillil'icmial Inspection Form
I Subsurface Sewage Disposal System Form Not for'Voluntary Assessments
864,Winter Street,
Property Address
Aden Clark
Owner Owner's Name
information is h Andover MA 01845 5-21-2019
required,for every Nort —, — �!I I
page, dit—Y/Town", State Zip Code Date�of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
T) System Passes,.,,
I have not found any information which indicates that any of the failure criteria described
ire 310 CM R 15.3 03 or in, 310 C M R 1 5.304,exist. Any failure crite ri a riot eva I u ated, are
indicated below.
Comments:
2) System Condifflonally 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 It yes", "no" or"not determined"" (Y, N, ND) for the following statements. If"not
$1
determined, please explain,.
The septic tank is metal and over 20 years old* or the septic tank (whether it tal or no is structurally
unsound. exhibits substantial infiltration or eAltration 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 N E] ND (Explain below)1,1
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t5hsp.doc-rev.7/26/201 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Rage 2 olf 18
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Commonwealth of Mass c
A, T'lotle 5 Offl*c*1al Inspection Form
Subsurface Sewage Daisposall System Form Not for Voluntary Assessments
864 Winter Street
Property As.
1
Ada Adan Clark
Owner Owner's Name r
information is
MA 018,45 5 -2 19
rr for eves Andoverth
cityffown State Zip Code Date of Inspection r r
C. Inspect"I'lon Summary (cont.)
2) System, Condi l ll as coat. '
Pump Chain er umps l rr s, not operational. System will pass with Board of Health approval i
rows/alarms are rice .
1
Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipes) r due to a broken, settled or uneven distribution x. System will
pass inspection i, (with approval of Board of Health):
El broken pi s are relic Y I N E] ND (Expla,in below):
obstruction is removed Y N NCB (Explain below).
distribution box.is leveled or replaced N N (Explainbelow):
,
The stern required pumping more than 4 times a year de to broken or obstructed piple(s). The,
system,will pass inspection if(with approval of the Board of Health)"
El broken pipe(s) are replaced El '" El N E] ND (Explain below):
El obstruction i''s removed 01 Y [:1 N E:1 ND (Explairl below).
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3) Further Evaluation is Requilred by the card of Health.-
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Conditions exist which require further,evaluation the Board of Healthin order to determine if
the system is failing to,protect public health, safety or the environment.
. System will pass, unless Board Health determilnes Oin acco�rdancewith ,310 CMR.
1' 6.3 31 'l)(b)that,the system is not n t 'i r whi"ch Mill protect publlc health,
safety and the environment:
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T*tle 5 Offmicia
Subsurface ace Sewage Disposal System 'Form - Not for,Voluntary Assessments
1
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864 Wint,er Street
Property Address
A are Clark
lwn r Owner's Name
information
North Andover '� 5 5-2 1-2019
required for eves State Zip Code Date of Inspection
page. l
C. Inspection Summary (cont.),
Ej Cesspool or privy is within 50 feet of a surface water
E] Cesspool" or privy is within 50 feet of a bordering vegetated wetland, or a salt marsh
. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system isfunctioning in a m,an,ner that protects the publichealth,
safety,and environment:
E] 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*
F1 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.
Ej The system has a septic teak 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:
`his system passes if the well water analysis, performed at a. DEP certified laboratory, for fecal V
coliform bacteria indicates, absent and the presence of ammonia nitrogen and nitrate nitrogen is equal �
t+o or less than 5 ppm, provided that no other failure criteria are triggered,. A copy of'the analysis must
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be attached to this form.
.
c" Other:
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System Failure Criteria Applicable to,All System-
You must indicate"Yes" r"No"to each of the following for all inspections:
4 �
Yes N
Backup of sewage into facility or s stern,component dine to overloaded or
El Z
clogged SAS or,cesspool'
IEJ Z Discharge or ponding of effluent to the surface of the ground or surface waters
dine to an overloaded or clogged SAS or cesspool
t5i p,d w rev,711261/2018 Title Biel inspection Form.Subsurface Sewage Disposal.System.,page 4 of 1
Commonwealth of assac efts
"A, T P
6? it,le 000 OTO"T'Plmcimal ins ect*ion Form
A Subsurface Sewage Disposal System Form -Not for"voluntary Assessmentslie
864 Winter Street
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Property address
Adan Clark
Owner Owner's Name
lrtfor nation is
North Andover `
required r� �
City/Town State ZipCode Date Inspection,
page
C. Inspection Sa cont
t
System Failure criteria Applicable to All Systems. (coat.),
Yes N tl
Static liquid level in the distribution box above outlet inveirt due to are overloadedq
r clogged SAS or cesspool
Liquid depth in cesspool is less than 6" below invert or availlable volume is lessEl 0
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than %day flow
Required pumping moregears,4 times in,the last year NOTdueto clogged orEl E
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obstructed e s , Number of times pumped:
Any portion of the e SAS, cesspool r priory is below high run water elevation.
1:1 Ell Any po rt,io n of cesspool o r privy is with1n 100 feet of a sur ace water supply o r
tributary to a surface grater supply.
El El Any portion of a cesspool or privy is within Zone, 1 of a pudic water supply
well.
E] 0 Any portion of a cesspool or priory is within 50 feet of a private water supply well.
El Z Anyportion, of a cesspool a l r privy is, less than 100,feet but greater than 50 feet
from a private water supply well with no,acceptable grater quality analysis. '[This
system passes It 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, g
r l l th at their ilur+ criteria are triggered# A copy of tie aanal si
and chain olf custody must be,attached to this rm.',
'The s stern is a cesspool serving a facility with,a design flow of 2 , gp -
El S 10,1000 gpd.
El N 'The system falls. 11 havedetermined that one or more,of the above tllur
criteria exist as described in 310 CMS 15.303, therefore the system hells, The
systems owner should contact the Board', of Health to determinehat will be
necessary to correct the failure.
5), Large y tems: To be consildereda large system the stemma must,serve a facility t i a
design flow of 10,000 gpd t , 15,000 gpd.
For large systems, you must indicate either"yes r"n "to each of the following, in addition to the
questions in Section CA.
Yes No
E] E] the system is within 4010 feet of a surface drinking water supply
a
El 1:1
the system is within 200 feet,of a tribunary to a surface drinking grater supply
the system'is located, in a nitrogen sensitive area I nterim Wellhead Protection �
El El �u
Area IWP r a mapped Zone 11 of a public water supply well
16insp.doc rev.712,612018 Title 5 official inspection Fora:Subsurface SewageDisposal System.Page 6 of 18
Commonwealth f Massachusetts
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t Subsurface Sewage Disposal System Form I rwt r �� � me nts
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864 Winter Street
Property Address
Adan Clark,
Owner Owner's
information NorthAndover � t
required for every
State Zip Code :t InspectionCityfT'own
C,, 'Inspection Summary (coat.,),
If you have answered "yes" to any question in Section C.5 the system is considered significant
threat r answered "yes,"to anyquestion in Section CA above the large system s failed. The
owner or operator of'any large system considered a significant threat at under Section GM5 or Boiled
under r Section, C.4 shall upgrade,the system in accordance with 3110 CAR 15.3104. The system wner
should contact the appropriate regional office of the Department.
4 You must indicate,"yes" or"no"for each of the following for all inspections:
i
Yes N
E El Pumping information was provided by the wn r, occupant,, or Board of health
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Were any of the system components pumped Dint in the,previous two,weeks?
0 El Has the system received normal flows in,the previous two week period? �
Have large volurnes of water been introduced to the system recently, r as part of
Eli 0 this Inspection?
Were as built plans of the system obtain d and ex,au iin ' If they were not
available note as N/A)
Was the facility r dwelling inspected for signs of sewage back pup?
Was the site inspected for signs of break out?
Were all system components, excluding the SAS, located on site'
Were the septic tank manholes recovered, opened,, and the interior of the tare,
inspected for the r iti n of the baffles,or tees, material rial f construction,
dimensions, depth oif liquid, depth of sludge and depth of scum?
Was the facility owner(and occupants if different from wn r provided with
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information our the proper maintenance of subsurface sewage disposal systems? �
The s*11ze and location the Spill Absorption System (SAS) on the site has
been d term,1ned biased, on:
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Existing information. For example, a plan at the Board of Health,.
Determined in the field it any of the failure criteria related to, Peat C is at issue
2 El approximation distance is unacceptable,) 1 CIVIR 15.302,(5)]
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Mnsp. 'o -rear.7126/2018 Title 5 Official inspection Form,Subsurface SewageDisposal System-Fags 6 of 1
Commonwealth sac s
19 Titleect,ion Form
' Subsurface,sewage D[sposal System Form Not for Voluntary Assessments
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864 Winter Street
r rty Address
Adan Clark
Owner Owner's argil
information is MA 01845 5-21-2019
required for
State ZIP Code Date of InspectionPage. City/Town
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D,
System, Information
did
. Residenfial Flow Conditions,.,
o e
Number of bedrooms (design): -- Number of bedrooms (actual):
DESIGN flow based on 310 C M,R 5. (for3 exa mple: 110 g pd x#of b ed roo ms)
55
Description:
61
Number of current residents#
0
Does residence have a garbage!grinder? 0 'Yes E]
l
Does residence have a water treatment unit? E] Yes Z Igo
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If yes; discharges to.
Is laundry on a separate sewage system? include laundry system inspection El Yes Z N o
information in this report.)
Laundry system inspected? Ej Yes 0, No
S+ s+ r ' use? El Yes Z No
Yes
Water meter readings, if available (last 2 years usage g *
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Detail:
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Sump Pump El Yes Z No �10
Last date of occupancy: Current
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t inspi. o *rev.'7/2612018 TitleOfficial Inspection Form:Subsurface Sewage Di,Dis osal System,.Page 7 of 1
N
Commonwealth of Massachusetts
T*1t1e ,5 Official 8
Inspection Forim
Subsurface Sewage Disposal System Form Not for Vo+ lunta,ry Assessments
864 Winter Street
Property Address 1
Adan Clark
Owner Owner's Name
information is MA 01845 5-21-20,19
required for eves North Andover State Zip Code Date of Inspection
page. City/Town
D, System Information cone.
2. gamer a Indu r ] Flow Conditions:
Type of Establishment.
Des i n flow(based o n 3 1,0 C M R 1,5.2 0 3),
Gallons per dad,(gpd)
s
Basis of design flow(seats/persons . ., etc.):
Grease trap present? El Yes
NO
El Yes N
Water treatment unit resent'
If yes, discharges to:
Industrial waste holding tank present? Yes N
Non-sanitary waste discharged to the Title 5 system?
Water meter readings, it available,
Last date of occupancy/use:
Date
a
Other describe 'below `
3. Pumping (Records:
Source information:
P 2018, owner
Was s istem pumped as part of the inspection? Yes E] No
1200
If yes, volume pumped.
gallons
Measuredtank.How was,quantityau determined?
.
Reason for pumping:
Inspect tsar &t �e ® �
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Title 5 Official'Inspection Form:Subsurface Sewage Disposal System Pale 8 of 1
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Commonwealth of Massachusetts
Toltle 5 u,nicial Inspecion
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
864 Winter Street,
a
r
IProperty Address
Akan Clark
_... uumm�wmuumnmmi immmmu ..mom-r.�"numm mmmmmmmmmmr�— '++mmmm
Owner ner's Name
information is
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21-2 019 1
required for vth ,. . .. ..m. i �.
r, R Cityffow ;Mate Zip Code Date Inspection
age
,,, System Information (cont.
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. Type System:-
Septic tank,, distribution box, soil absorption system
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Single cesspool
G
c
Overflow ss 1
Privy
IT,
0 Shared system (yes or it yes, attach previous inspection records, it any)
Innovative/Alternative technology. Attach a copy of the current operation and
maintenance ntr t t(to be obtained from system, owner) and a copy of latest
inspection, of the I ,system by system, operator under contract
El Tight tank. Attach a copy of the DEP approvaL
Other(describe):
Approximate age of all components, date Install it known) and source information:
r� 1 - � �, � uilt plan
Were sewage odors detected when arriving at the site' El Yes El No �
5,, Building S it(locate on siteplan): V
1
Depth below grade: 1.7 � �. __. . . �...
feet
Material-of construction::
past iron PVC Ej other(explain):
Distance from private water supply well or suction line: feet
� .. �..
Comments meat n condition of late, venting, evidence of leakage, etc.).
" Cast Iron, through wall, 3'" 'PVC in house, no leafs visible.
y
t6i .d'o .rev.7/26,12018 Title i i i Inspection Form:Subsurface Sewage Disposal System#Page 9 of 18
Commonwealth of Massachusetts
m� Ti,tle 5 Off'iocoial
ice Sewage is lSystem Form Not for Voluntary Assess nt
n
864
Winter Street
IProperty Address
Adan Clam
. r
Owner Owner's Name
information i's
required'for veNorth An dove r r
page. City/Town State, ;dip Gode Date of Inspection
D, System Information (cont
61. Se til a loc t�e on siteplan):
0.
Depthelow grade: feet
Material t construction:
concrete metal fiberglass E:1 polyethylene El, other(explain)
1
1
I
It tank is metal, 'list age:
years
G
Is age confirmed Certificate of Compliance? (att ' o certificate) Yes Ej Igo
Sludgedepth:
3011
Distance from top,of sludge to bottom of outlet tee or baffle
311
Scum thickness
Distance from top of scum to tops,of outlet tee or baffle
12
Distance from bottom of'scum to bottom of outlet tee or baffle .�
n
Tripe, Measure.
How were dimensions determined?
Comments (ors purnpinig recommendations, inlet and outlet tee or baffle condition, structural integrity, d
liquid levels s related to outlet invert, evidence of leakage, etc.)-
Inlet tee ok. Inlet baffle ok. Outlet tee o . Outlet baffle ok. Depth of liquid at outlet invert. No evidence
fleakage.
i
t5in,sp,doe-rev.,7/26/2018Tiff i 'N Inspection For,Subsurface Sewage Disposal S'y t n-Page 10 of 1
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Commonwealth os c e
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
IN 864 w
Winter Street
Property Address,
Adan Clark
i
Owner Owner's Name
information i Nosh Andover A 5 5-2 -2
I a
requ
"red for every
page. Cit fTo State ZipCode Date urr ion
D. Sysitlem Information coat.
1
, Greene Trap l i ate on site plan):
Depth, below grade: ,
feet
Material of'clonstruction.*
Ej
concrete El metal Ej fiberglass El polyethylene other(explain),
Scum thickness
q
Distance from top of scum to top outlet tee or baff l
Distance from bottom of scum to bottom of outlet tee or baffle
Date of lent mire i�
Comments (ors pumping recommendations, inlet and outlet tee or baffle condition, structural integrity',
liquid levels,as related to outlet invert, e i nice of leakage, etc.),
. Tli,ght or Holding Tank(tank must be r e at time inspection) (locate on site plea)
Depth below gr ,e:
Material of construction*,
El concrete n metal 0 fiberglass polyethylene E] other(explain,)-
Dimensions
gallons
4
Design Flow,, gallons per day
t5insp.doc,•rev.712612018 'Title 6 Offidal Inspection Forin.Subsurface Sewage Dispo s,all Systern•Page 11 of 1
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Commonwealth of Massachusetts
Tolt,le 5 M
Official 1ns&p^,ecAti1on Form
Subsurface ,Sewage Disposal System 'Form Not for Voluntary Assessments
6
Property Address
I
Adan Clark
Owner Owner's Name
information is, North Andover MA 011845 5-21-2019
required for every
CityrFown State Zip Code Date of Inspection
page.
D. Syst,em Information (ci )
o
1 . Pump Chamber(locate on site plan):
l,
I
�{ El Yes [:1 N *
Pumps, In workiAlarms in ring order, El ` �
Cornments (note condition, pur p chamber, condition of pumps and appurtenances, etc.).
If pumps or alarms are not in wring order, system is a conditional pass.
a
1 . Soil Absorption stems SAS) (locate on site plan, excavation not required).-
If required).-
If SAS not located, explain why,
Type.-
1 aching pits number*.
leaching chambers number*
leaching, galleries number:
leaching trenches number, I n t : l ng
El leaching fields number, dimensions-
s
overflow cesspool number:
innovative/alternative system
Type/na,m,e of tech n l g '. �...
tbin p„doc rear.712612018 Title 5 Official l Inspection Forma Subsurfaoe Sewage Disposial System-Page 13,of 1
Commonwealth of Massachusetts
Title 5 Off'"Ic"ial Inspect" Form
Not for Voluntary Assessments
> Subsurface Sewage Disposal System Form
864 Winter Street
Property Address
Adan Clark
Owner Owner's Name,
information
is, North Andover MA 01845 5-21-2019
required for every Cityfflown -�—tate Zip Code Date,of Inspection
page.
D, S Senn Information (cont.)
11. Soil Absorptilion 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 plonding to surface.,
12. Cesspools (cesspool must be plumped as part of inspection) (locate on site plan)*
Number and configuration
Depth—top of liquid toinlet,invert
Depth of Solids layer
Depth of scum layer
Dimensions of cesspool
Materials,of construction
Indication of groundwater inflow El Yes El No
Comments (note condition, of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc):
t5inspl,doc-rev.,712612018 Title,51 Official Inspection Form,,Subsurface Sewage Di l System Page 14 oaf'18
Commonwealth sc
Toltle 5 Official Inspect'ion Form
Subsurface Sew D'Is s l System Forte - � � � s ssments
864, inter Street
"r6rk Address
,Adan Clark
� J
Dinner r° Name
information is Noirth Andover MA 01845 5-21-2019
required for every pad
,wCity/Town State Zip,Code Date Inspection
. System Informatlion (cont)
i
3. Priory (locate on site,plea):
Materials of construction:
Dimensions
Depth of ssmmmm
Comments note condition of sail, signs of hydraulic failure,, level of ponding, condition of'vegetation,
etc.)*
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t5lnsp.doc, rev.7/26,12018 Title 5 Official Inspection Form,Subsurface Sewage Disposal System, Fags,l5 f 1
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Commonwealth of Massachusetts
T1'*t1`e 5 U� T'r-Tr'l'cima,l 1,ns -0,ect*io n For
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... Subsurface Sewage Disposal System, Firm Not for Voluntary Assessments
864 Wintr er Street
PropertyAddress
Adan Clark
s
Owner Owners Naas
Information is
th Andover MA 0,1845 5-2 1-2O 19
r u r �d for ever Ott Date Inspection
� ge. ���t r�
D. System I �format �c � t. s
14. Sketch Sewage Disposal stem: if
r i 1 the sewage disposal system, including ties t+ t least two permanent reference
landmarks r benchmarks. Locate all wells within 100 feet. Locate where public grater supply eaters
the buIlding. Check one of the boxes below'
hand-sketch in the area below
drawing attached separately
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Commonwealth of Massachusetts
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*tie 5 U0%TfiNr0 1, Ins
* Subsurface Sewage Disposal System Form Not fir Voluntary Assessments
864 Winter Street
Property,address
Adan Clark
,Owner Owner's Name
J
infoinnat
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on is North Andover MA 011,845 .6-21-2019
required for eves
Huge, CityfTown State Zip Code Date Inspection
D, System Information (cont.
5. Site Exam*
t
Check Slope
Surface water
Check cellar
Shallow wells,
Estimated depth to high ground water. . .� ..�
t
feet
t
Please Indicate all methods used to determine the high ground wafer elevation:
Obtained from system design, plans on record
6-4-1993
If coed, date of design plea rived Date
....� .
Observed site (abutting r rty servati n hole within 150,feet of SAS)
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Checked with local Board of Health -explain-
Design plan
E
El
Checked with local excavators, installers (attach documentation),
El Accessed USES database-explain:
1
You must describe how you established the high ground wafer elevation:
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s per test pit data on design plan
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Before fifli"ing this Inspection Report, please see Report Completeness Checklist on next page,
t in p,d c-rear.7/261/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 1 f 18
Commonwealth ofMassachusetts
A e
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Title 51,11,11111, tficial Insp-m-eicItion Form
Subsurface Sewage s s, ] System Form Not for Voluntary Assessments
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864 Winter Street
Property Address
e `
,Ada,n Clark
Owner Owner's Name
information i r Aired for ere North,Andoverpage. � � ��� �
it "own State Zip Code Cate of Inspection
E. Report Completeness Checklist
Complete all applicable sections of thils form inclusive
• A. Inspector Information- Complete all fields in this section.
• B. Certification-, Signed & Dated and 1, 2� 3, or 4 checked
C. Inspection Summary-
1 21 3, or 5 completed as appropriate
I
(Failure Criteria)and 6 (Checklist)completed
Z D. i
System Information:
For : i ht/H l inu Teak Pumping contract attached
For 1 : Sketch Sewage Disposal System drawn on g,. 16 or attached
For 5,. Explanation of estimateddepth to high groundwater included
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4
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t iin m'oc;-rev. 12 1 Title 5 Official Inspection,Form, Subsurface Sewage Disposal System-Page 18 of 118 �
Summary Record Card generated on 5/14/2019 1:40 PM by Joanna SGlib Page I
Town of North Andover
Tax Map # 210-104.13-0081-,00010,.0,
Parcel Id 16404
8,64 WINTER STREET'
CLARK, ADAM9 R, Since Jan 20116
DEWOLFE, PATRICIAs M.
864 WINTER STREET
NORTH ANDOVER MA 01845
Class, 1011 Single Familly Property Type 11 Residential
Zoning! 1 Residential ZonIng3 I Residential
Size Total 1.02 Acres
FY 2019
UB Mailin,aindex
Name/Address Type, Loan Number Actip e/Inact. From Until
ADAM CLARK Owner Active
TRICIA DEWOLFE
864 WINTER STREET'
NORTH ANDOVER MA 01845
MOULT,ON, R,., DOUGLAS, Previous Customer inactive 9/301/2014
864 WINTER STREET
N.ANDOVER,MA
01845
U B Account Maint
Account No Cycle Occupant Name Active/Inactive
B Id'g Id, 18089.0-864 W 1,NTE R STRE ET Last Billing Date 4/9/21019
Ac
3180117 03 Cycle 103 tive
UB, Services Mint.
Account No.3180117
Service Code Rate Charge Mult!'pill"er/Users
MISCFEEADMIN FEE 0,636/8 7,82
WT'R WATER 01 ALL METER SIZE 144.40,
U'13 Meter Maintenance
Account No.3180117
YTD Cons
Serial No Status, Location Brand Type Size
299,55855 a Active 00 b Badger w Water .63 3981
Date Reading Code Consumption Posted Date Variance
3/1212019 5552 a Actual 38 4/16/20`19 -49%
12/12/201,8 5514 a Actual 713 1/22/2019, -48%
9/14/2018 5441 a Actual 1 47' 10/15/2018 166%
6/12/2018, 5294 a Actual 54 7/23/2018 58%
3/12/2018 5240, a Actual 33 4/23/2018
12/13/2017 52,07 a Actual 81 1/25/201 48%
9/13/2017 5126 a Actual 159, 110/1 8/2017 249% r.
6/13 '1 a Actual 4 '/25/2017 24%,
3/1012017 4920 a Actual 35 4/12,/2,10 17 31%
12/12/2016 4885 a Actual 1123/21017 -72�%
9/13/2016 4833 a Actual 184 10/24/2016 82%
6/1712016 4649, a Actual 108 8/2/2016 230%
ry
3/15/,2016 4541 a Actual 32 4/22/2016 - %
12/14/2015 4509 a Actual 121 1/20/20 1 -47%
9/1112015 4388 a Actual 222 10/16/2015 206%
r 1 1/2015 4166 a Actual 617 7,124/2,015 331%
3/1 8/2015 4099 a Actual' 17 4/28/2015 -18%
12/15/20114 4082 a Actual 17 1/15/201 5 -86%
9/3012014 4 f Final Bill 177 9,/29/2014 249%
6/112/2014 3888 a Actual' 42 7/1612,014 -72%
3/13/2014 3846 a Actual 151 4/11/2014, 282%
12,113/20,13 3695 a Actual 40 1/1 7/ 14 -69%
9/13/2013 3655 aActual 12,18 '10/15/20,13 157'%
6/1412013 35 tonal 47 7/24/2013 489%
Commonwealth of Massachusetts
City/Town of
Systvfn
Fnn 4
EP has rovided vide his m for l se.by, local Boards of Health. Other forme may' "used but the
informiation,must be substintially the tame as,that provided here. Before using.this fora,check with your
locilBoard of Health to determine the for they use. The$Ystern Pumping Record must be
subm t o
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e
An Factlity Informati"on
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. Date of Pumping . Qt� Pumped ......
Date Gallons
& Type-of system.,, C s i s) kl-- c'Tan
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. Effluent Tee Filterpresent? ' Yes It yes, was it cleared?0- Yes , No
6. Conde r of'Systr
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Neff.Batesbp
'Vehicle, LicenseNumber a�
B'ates E te risesInc-
Company
7. Lca here content&were disposed:
S-P Lowell Waste Water
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System Purnping Record
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h Andover
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Body Apt,Eashi
El Body Art Practitioner
Food Service-` :
Funeral Director
0 Massage Establishment
Massage
0 offal(Septic)H
Recreational Camp
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Sun tanning
swimming
Waste0 Tobacco
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Treasurer
ApplicantYellow-Health P Link