HomeMy WebLinkAboutPass - Title V Inspection Report - 261 REA STREET 12/7/2005 COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
x a DEPARTMENT OF ENVIRONMENTAL PROTECTION
,a
t
� See
TITLE 5
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 261 Rea Street_
North Andover_
Owner's Name:_Mike Sipsey_ REC:DEPARTMEO]NT
Owner's Address: 261 Rea Street_
_North Andover,Ma 01845_
Date of Inspection: 10/24/2005_ DEC
Name of Inspector: Neil J.Bateson TOWN OF N
Company Name: Bateson Enterprises Inc._ HEALTH
Mailing Address: 111 Argilla Road_
_Andover,Ma.01810_
Telephone Number:_(978)475-4786_
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
F 'ls
9
Inspector's Signature: /j,
- Date: _10/24/2005_
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 is a shared system or 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 should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments:After permit from B.O.H.,installation of new d-box by FP Reilly&Sons,inspection
from B.O.A.,septic system now passes Title 5 Inspection.
****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.
y
hii
i
Mill!:A. ,,.k� Et VIt,,_ #'. �''3, -F ;' ,5 .°t'"S6� �'a {,3¢...a�,.�.. .a`.i. 3�i -✓#-# .�`',-.
i. �fi�.-,..#w`3�.'�. •°'`,;?L a:�,w}' fir, ''3+. +S�`.�i,.at #t- 'Y,; dtgv ._`»` v l.act
# r
T .:.
4
_- �,-: .i�+sf af- L'i#s.$TI�C. �•Yx k.::-.r 2 14'�:���3� w42$r."i.J't`b.A a �"+ �� '.f.-�.� •.f �•ti;.fsP
'.T �,#*i
oil
23,411,
. �. . -� _ ... -'tad r d gz g;l ° t-°iF:•.`�1�: ,._,. .e.Snr�'1Pe,1'.�
.day;Y`A v k:1 9.;��.
.'f"
r
i #401,f MUM MU)i"'"'. .#An! K r E fl q R:3-d?'
r.r �fiy,':, f.'i}�?'F#d I. 3.�*}f.r .ri(� ,C �<>t.°x� :.fir�y l:�Y��dv�J�•i.� -
_ri3 t3 ..;�.: a :i."+r ai:':' .f;@i1 x•{' F s qX who Sn p mysawnt - 1 ,. y
UOR,605{" owl 0 km1L, fr.el-`_; _ :F {t�,��:� 50 ya ?z MI.TOW-1-
J
d. tti.; C ,t# f.:,({# :�.t,�ke. A ' R } 0 a. �SO Y r.r s x i Lq??
}?4� .r.t;us 4',W— It'i 4,`"{7oj4
:r*� `B; ._.a •a*Is. =E3:d�'1„�S�° �` `F,�, .:k , �t7 a.`t':c o >. �" � ,fit a"r k.ies
i4w 7,rd.-- Z41 r d . _Slt#"
Tel: (978) 475-4786
Fax: (978) 475-5451
BATESON ENTERPRISES, INC.
Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service
111 Argilla Road Andover,Mass. 01810
Title 5 Inspection Report
Property Address: 261 Rea Street, North Andover
Owner: Sipsey
Date of Inspection: 10/7/2005
My report contained herein does not constitute a guarantee of future usage and the functionality of the existing
septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further
operation of your current septic system.
e4k t�_41
Neil J. Bateson
Bateson Enterprises, Inc.
K.
f
.., _�dx._., i.�_. ,. .. .�:: .:f. r �iii 1 �>h:.i.,t�€ ;•Y:_, r .es. =.)t`)!E ._ f.,:* s )j
r
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
Z
DEPARTMENT OF ENVIRONMENTAL PROTECTION
s�
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:_261 Rea Street_ _
North Andover_ F_HEAL'H
Owner's Name:_Michael Sipsey_
Owner's Address:_261 Rea Street
_North Andover,MA 01845_ 1 4 2005
Date of Inspection:_10/7/2005_
R I tl 1e1,400VER
EPARTMENT
Name of Inspector:_Neil J.Bateson_
Company Name: Bateson Enterprises Inc._
Mailing Address:_111 Argilla Road_
_Andover,Ma.01810_
Telephone Number:_(978)475-4786_
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
X Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
is
Inspector's Signature: Date: _10/7/2005_
The system inspector shall submit a copy o this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or 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 should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments:
****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.
gg �
it + �� ?.00 JAY ::,Si MOMI S! .}0. ,f VIO'r._7'4a,r KING i i F r ?
IT iii
OANWA dine,,
:"a.'a}1 �^x P:s ti:�;:T. (F�l�;„ «<;a �#.::,ip @�a#'f'•°'-:ati?�3'
•� ♦ '$t�i15. ). � ram.1 � ��.�� '{ i .,��� �..'��'���..Y
t.,.`.a 1 mmusy iwxf&? ! ,.. ...t :$:'t taAt-. F , '•f: -1 `,.`.`'j; i __.':?'i
. C°k AN_.. .1 I4w7t. s 9 At e.:. .,3-ri�i a a�':.�-.�t..3zet�_'I�i �4,�i�i.. Y� : 'a '� agy., Sr•
c:
$i'� is ". d '.}t •: .; _` _ _ R e i
. -Fc, s. ,- 1" J�:+i:ir<.. -1:?-T sikf � :6 t.;�v�.F, ;t;- �'?. ,64: 2!, f?:.r:. a d;- t;l•; r... .. -� -
`P; s •d
� {�i✓. .ct�l p@rl� -- -t4�..,r i.�i : S.�' > � - c. i�.Y ! _ ...J !. {..0�� i ti�.�g :' r,. -. __
A now, ..'Yr�,S snawn is. ' m:g ..a i:. >:I: f+€e! i .."� .., i tr1 64i., IL -1 .j �... .,.-t i`7
Ti .�Y 4 :F.
p
an in ImOb$r,o+F wh i i1i.i.+ ml.FX=,.F,.,$.,�b,: F. YYS�.,�.ri :. YH v,i.!'rY?' a t,s.3� .-'&��� h..,ary, r r+. '.,
.
ImAGO in ywae:ssm irmg"W,13 < . .?, `r ;tic, •a a > ,flr av f€ skywad synnug won r 3 b .l�0l x.cj;t pi Adjow.
Page 2 of 11.
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 261 Rea Street_
_North Andover_
Owner: Sipsey—
Date of Inspection:_1017/2005_
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. 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:
B. System Conditionally Passes:
X 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.Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not
determined"please explain.Replace d-boa
N 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.
ND explain:
N 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
obstruction is removed
distribution box is leveled or replaced
ND explain:
N 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
obstruction is removed
ND explain:
t�
y
Wrk.. ,gw ... M i 4.$+ P'. JY
A 1 ILA I
N�t
{'w b,.wA . . Yn.
�. ., .. f.{ c 1,N..i!'ity .. r .. • ,. _.! ..r i:.r.. . 1 x9. �.. t.,�.[ r a if. _
l• �.7��.:i- d._iJ -' i [t:i., :}n... may; .1 Ow jai,..
r`J
a..aei. `•. ' .ekT ,.r°' .,i_ ;.'f$9 4 iit' .., f'`fa L`:.-: .+ -
a Inv Ow
y"_f'�.
_ .�-fir_-{.`✓�..
Owl dgid ly
f y runu Show t..:00 f.iii . .
z!J
t„"AmS in .. .f_r
1
Page 3 of l l
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_261 Rea Street_
_North Andover
Owner:_Sipsey_
Date of Inspection:_10/7/2005_
C. Further Evaluation is Required by the Board of Health:
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.
1. 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:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. 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:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
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 coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.
3. Other:
r=
s TK -
-c f-A!"OIAJ4p
q$WaAV Why
irs:s 'f 1 .:• srah t a) 7F->r' r r f Y�.i:;-. ' woo'...
.. . ,. �.1- ,!1: :.r. . � :`rl:-i�.53,1.:F_4t[ .f.i. l�-'S fwl� Es:f fv. �'I.p� ♦ ,tyt.;,i
--tip i „
O tun
3t'kiYf3it r �a.?' i R aE:z e N .*mad d+# 'w{1m4i'�r. fi:Fa;sY 6:tnsI43#'_< $i Ftg�e.;C'`P »�i��too.-S kf;
a
Y'•s,+ x.✓1.4':,.r:c 1� s;l-8i_ t' F4i.�y�1 ;z .. i;., f;n.:µ -
i 2 T y r ..&x;.hhx ..,.may: r€ - "- `g (,t -
,:.r _3_1 S. _ .�sf tc.v sl'_:i�` rA$. ..�.� Fii 8s, ;tr-:§tt�..t:}1}.k33 two ifM •.3U o ti.
0MUPOW °us to to
ad 5 i3 "i ip r�;k. &`4 �"'A " to } !tL-tYt.�,''sr a kS J!d n:.-'."
°tom mta r+:: .+ ,a ".>'3a l Wr-, .}:o; :i
1.= . .. 0 Won 410 err 1 d.._ _ d
' ,YP.;<7 . ... ;;.r .. .�', � e [•" ._., r.Lt... _ ..'i. tt„1Ji'Li 4.i'!{i�: }:: �4 ,. r Fi±,
t
if':', 1.., 14�.P S:::rl� >'3'j...�.� .. •�'..2„Z.]<P.r¢k3? �; 1 � ry 3 i-.. t rr A'.�
apok t`''rf ._ 10 .,3, ,bys a3: + , i .+f li• .. , .. �...
�i>"}' p;f-1�r#' •r,... r ,z ' scd;:-s .Id .=sl.X� i-. .11: Y%s ti'r ? - i.. .-,i -.tt.,. # ,�: ;t.: .� aa�.-`72i'' r
t.d. .T ..A)R,4 v 4 a j• l4f, nlAJ. N tej rr. A� Y"+e Ft- i'.��;i.aif ..� f.s+.s+: �'!`i'-.
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 261 Rea Street_
_North Andover
Owner:_Sipsey—
Date of Inspection:_10/7/2005
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
_ _No_ on
Backup of sewage into facility or system comp due to overloaded or clogged SAS or cesspool
_NoL Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
No Liquid depth in cesspool is less than 6"below invert or available volume is'/z day flow.
No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
No Any portion of the SAS,cesspool or privy is below high ground water elevation.
_No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
No Any portion of a cesspool or privy is within a Zone 1 of a public well.
_ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ _No_ 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility 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.]
No (Yes/No)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
E. 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.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
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
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
s�
to -11.3 SW .t,
_�' ":�:' &:•.act. -�F... a'ib+.. a„r;���.' �.
3K#` Cowl 3 y.2:IiY
... ', ev: _ r ,_.0 t 3yojqj., Sd9 tyow - 1 d:is_'', ..W _...
`C2 "- .e ,' 7S1 5 5,i _5 . ,)won _'g ."..i! ,., } .F
4 rye 3 �r'i•-.: � ,.
•„ .f ' '..•_�xJtr r,.,r.i ..li�ril a ;t'r :-'.' '.. ..a:,:.: ,•' ..._,,,.. .. �_ .. . ....{iy �`. ..< :5,:. .:.s'. `} i�,_'i .#-#..' ),.
. ,.50- i !F' w .». S<t won .i
I ton
vi r: 'e a!' •..,,rr ,. .•.�:..3, �. i ..:�.+ •Kf a! .. ,$.4r, .Yn t_,. ,. !'.it<.
`t
+.1`',Y ' .d•. Cs ..� out°i ')uai�.J# t+r..'+�
+
#5.)a.'�y s_ . g)#+sma,••{ -n..;:Lt , no .A wws at:t:4,1,p.4 ¢t;.A and F i:MM!3i4= dl .:;, +..gat
As 10 ° .. . - t'� i a
a.3rfE�3 ;sc r x# .. .a tiYe. }it Say arx'e :. ? iga,. .s-t
SCUMM5. 0. NOW - .i ',)'b_p ., onto .. 'I _rT& r it xv
.. ,. i:,��. Ad ... {'.1 :T..-. •-t! rl lI.'•v-L ADZ.r f W, 1, ..
so
e. lxzv "M
.
a,
.!.'� .. ;+ _.'•:FJ, ,_, f1:1y:+ r - _;.�i_ . y .!':, arr F}.•rt; t J .., �«r tire„.1Y{ a-.. I ... .;i��
rN' 0:_ .,..)+:,:. ,.,.+ay :;:f«'Ion-" P.0 �� r;
Page 5 of l l .
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 261 Rea Street_
_North Andover
Owner:_Sipsey_ —
Date of Inspection:_1017/2005_
Check if the following have been done.You must indicate`yes"or"no"as to each of the following:
Yes No
Yes _ Pumping information was provided by the owner,occupant,or Board of Health
No Were any of the system components pumped out in the previous two weeks
Yes_ _ Has the system received normal flows in the previous two week period?
No Have large volumes of water been introduced to the system recently or as part of this inspection?
_Yes_ _ Were as built plans of the system obtained and examined?
Yes_ — Was the facility or dwelling inspected for signs of sewage back up?
Yes Was the site inspected for signs of break out?
Yes Were all system components,excluding the SAS,located on site?
_Yes_ _ 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 ?
_Yes_ _ 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:
Yes no
_Yes_ _ Existing information.
_Yes_ _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of
distance is unacceptable) [310 CMR 15.302(3)(b)]
ski
�,i�fr'r i.•..
Al it:�w't�AM'j+`l.s a;TP..�.A ��1. ._�)9t.��p� ��.�1"7. b,l., �; ....�3.ck4f..��� i_,��� d�:�g�+#"�•�j a:.11 ��3'k!F}a�.b
f
, '
Nis
!
... _ .. ..mr.,,,m ,..ew�.ma.w.+.�;,.-.., .. «.�. _.....,..«...,r,.+».r+t......... ..+..-..«-wiw.w...,. �.... ..y.»,�
;'. .. ,
too 1yOT
v,
,
,ij
Any
Page 6 of I 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 261 Rea Street_
_North Andover_
Owner:_Sipsey_
Date of Inspection:_10/7/2005_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_4 Number of bedrooms(actual):_4_
DESIGN flow based on 310 CMR 15.203_600_
Number of current residents:
Does residence have a garbage grinder(yes or no): Yes_
Is laundry on a separate sewage system(yes or no):_No_
Laundry system inspected(yes or no): —
Seasonal use:(yes or no):_No_
Water meter reading: Yes_
Sump pump(yes or no):_No_
Last date of occupancy:—
Current-COMMERCIAL/INDUSTRIAL
Type of establishment:_
Design flow(based on 310 CMR 15.203):___gpd
Basis of design flow(seats/persons/sgft,etc.):—
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:_Pumped last year,owner_
Was system pumped as part of the inspection(yes or no): Yes_
If yes,volume pumped:_1000_gallons--How was quantity pumped determined?_Measured tank
Reason for pumping: _Inspect tank&baffles
TYPE OF SYSTEM
X 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)
_Tight tank _Attach a copy of the DEP approval
Other(describe):_
Approximate age of all components,date installed(if known)and source of information:_29 years old,
3/27/1976,as built plan_
Were sewage odors detected when arriving at the site(yes or no): No
.Q
row. dl wQ.+.s li 5iistmul.t mu m ,l
404,
V .sywy. 3+,.,,
- �r�kith _. �g✓.r ...�'.�`Q�
,
AI It"!F.+ z
- msk, jot, a alvi.. malm VON w" .. ij _
Page 7 of 11,
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_261 Rea Street_
_North Andover_
Owner:—Sipsey—
Date of Inspection:_10/6/2005_
BUILDING SEWER_X_ (locate on site plan)
Depth below grade:_24"_
Materials of construction: _X_cast iron _X 40 PVC other
Distance from private water supply well or suction line: —
Comments(on condition of joints,venting,evidence of leakage,etc.) 4"Cast iron thur wall.3"PVC in house,
no leaks visible
SEPTIC TANKS: X
Depth below grade:_12"_
Material of construction:_X concrete_metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: 7' x 5'x 4'_
Sludge depth 1"_
Distance from top of sludge to bottom of outlet tee or baffle:_31"_
Scum thickness:_I"
Distance from top of scum to top of outlet tee or baffle:_8"
Distance from bottom of scum to bottom of outlet tee or baffle: 15"_
How were dimensions determined:_Tape Measure_
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc. Pumped septic tank.Inlet baffle ok.Outlet bade ok.Depth
of liquid at outlet invert.No evidence of leakage._
GREASE TRAP:_(locate on site plan)
Depth below grade:_
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Y�
r
r� 1 4 &r ,+., ., t_: h,pp #. �+y( Y4 gts r+3 t ✓" �fftJ4 ira $u :. y' �' Ef1 •_g df.. t .:
��, .�/? �:4 'i ...�.'x tf�'�$ si ,� L��.r k \'`- •:3.:� t 4 ie".�.,�li w[ i'�`.3 t` :'>3ti��.,�s.`, .P�tr$ i. -
I,whnd, glitz
:FA.,. a"a'e K oA.i13:.J.,
�g y
1 [
Wood ., it _"k�t: 6.,t�; }� i F.- � {' %P " .T 1 ^00A Si(n'i35-Jl_ti. a f1x.
44AT MAY
t S ,`ter.', �P' ii.4li.l. >?:.. i4,. ti•_` i '^ 1S�e..:�':. tJ .A ,. .. . too.
P.
.(�4ih
: F{«i it .•�. siSk j"t d t ,.r'i.... .t
i:.. ....
't^ �. ._.
Vial
ALE ,
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 261 Rea Street
_North Andover-
Owner:_Sipsey_
Date of Inspection:_10/7/2005
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/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOXES: X
Depth of liquid level above outlet invert: _0_
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):_D-box badly corroded. Needs replaced.Evidence of leakage.Evidence of
carryover,pumped d-box to clean_
PUMP CHAMBER:_(locate on site plan)
Pump in working order(yes or no):_
Alarm in working order(yes or no):_
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
newAL..{{t"lRR e v`D�1 P. :.�rt•F���.d`fi.�Y' ;Oii WIN!! `�Y() ��.. �+5.'i 5*�E in . .gg1�_4.� ,;{,"�
VA 1 0 � �.�,gp.t a `�A.AM '�t y �.Y " ..
low
.., :��r.. aa_s_,.p�,:: i l:,�i:f-- Fw n:. r it.".- S� ','-_.�''i _. �l., ,' ...••.F fl ,. .. P�Fe" '�,a`
10k a RSO
._?
Page 9 of 11.
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 261 Rea Street_
_North Andover_
Owner:_Sipsey—
Date of Inspection:_10/7/2005_
SOIL ABSORPTION SYSTEM(SAS):_X (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:
X leaching field,number,dimensions:—1 field 20'x 45'_
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):—Soil oL Vegetation oL No sign of ponding to surface_
CESSPOOLS:
Number and configuration:
Depth—top of liquid to inlet invert:_
Depth of sludge layer:
Depth of scum layer:_
Dimensions of cesspool:
Materials of construction:_
Indication of groundwater inflow(yes or no): _
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):_
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.):
yJ� p �) �?Q.;�.� � .°_s��Y; _S .; %•.F.'��.�'�-�.J_
`!-'A C;.: ..i..Y',t"Il VlY-6(J.. P�0i ff f.} f�FE .l'.�.�µ y{{.���
d lJE.�..
� 9.=•'is.I a.. ,: s>r ' _.. e L.A:. IAJ A 3 2. A'0 n'.`.'.
z -4 t.`fi7:J.� . .,aSk.f7,{,3T�74'r.#.`+k�s.»'r -A4 .x, s-,, ;t
yi3:iS�4 J'Sti'i :-
' - i,fjY l:!`i fP.Lf�.e;i rvd is-.>af! f.�'• S ,wi:Fd;�,i`-;
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_261 Rea Street_
—North Andover—
Owner:_Sipsey_
Date of Inspection:_10/7/2005
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
Porch
Deck
House
Driveway
A B
Water Meter
Septic Tank
D-
Box
-T
A to Tank=20'8"
A to D-Box=36'1"
B to Tank=2615"
B to D-Box=2316"
If
VA nsft.azYF} Ft`sis ,; 'y
�i
VA
10
61
i}f 1 �F ., � wr Ir:r�' ..1���. 'i. :.p:: 1: ..-, rs114' :a,a •.r �r1 _ - 5 .r ali ., 1 ._,...1, r.
- •.5..-�., -p.S`r�s,< k,i filf, .k`�4a �i'.3 .i:A� r i ,.f a��. ...t 3f'�� �F2.. �.. J5't 1�:_� t� r r -
i
e
Y �
r.
qq
a v
i
i
Page 11 of It
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 261 Rea Street_
_North Andover_
Owner• Sipsey_
Date of Inspection:_10/7/2005_
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water _4'_
Please indicate(check)all methods used to determine the high ground water elevation:
_X Obtained from system design plans on record-If checked,date of design plan reviewed: 3/27/1976_
Observed site(abutting property/observation hole within 150 feet of SAS)
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:_As per design plan_
as
TO r F7_ d d,�e # i �,jp '3 �'t.. aa i.
i LL {� tt ri�. ,��:y,i lr"'.�t'7 sgc,.,>d�1. ,�„r.
.z �f ..'�, R y''�� .1 s'�'coil l s_t} .�`a.�e*.,;yR�'.±-t '� -I-v,
fr,;.:_it
t
��::,`. .�: �.a'id,. '::7.d.Mt #,y - :.� =<i. > .-✓': Y-7 .x..: li - i+Y.rS'-l�I -'� `-v,�14sa4l�:it."i..::Jti'i,
,-Ai a
_. . i.... a e . ; a'. .. 11mvp {i:EA'tl
0 ma_'al #3i#?ay tt;`.:i%ry d .i. t> .r J`r •!1:.5
t
EEN 775 f{"
r
j Telnet 10.1.71.55
W/S ACCOUNT HISTORY 2100516-SIPSEY, MICHAEL L. METER #f1: 21005i6
------------------ BH:261 REA ST
4 CYCLE SERVICE PRIOR CURRENT USE WATER SEVER FEES TOTAL
1 1999-100 07/15/1999 106.47 0.00 0.00 106.47
2 1999-130 OS/15/1999 0.00 0.00 0.00 0.
K - 3 1999-160 02/06/1999 2.11 0.00 0.00 2.11
4 1999-190 12/29/1998 0.00 0.00 0.00 0.00
print
5 2000-12 08/05/1999 3766 3833 67 182.91 0.00 0.00 182.91
6 2000-22 12/10/1999 3833 3892 59 161.0? 0.00 0.00 161.07
7 2000-32 03/13/2000 3892 3924 32 87.36 0.00 0.00 87.36 >�
8 2000-42 05/23/2000 3924 3948 24 65.52 0.00 0.00 65.52
9 2001-12 08/09/2000 3948 3982 34 92.82 0.00 11.00 103.82
10 2001-22 11/15/2000 3982 4005 23 62.79 0.00 11.00 73.79
11 2001-32 02/15/2001 4005 4028 23 62.79 0.00 11.00 73.79 �
12 2001-42 OS/23/2001 4028 4053 2S 68.25 0.00 11.00 79.25
13 2002-22 12/12/2001 4086 4119 33 84.87 0.00 5.55 90.42
14 2002-32 03/18/2002 4119 4148 29 79.47 0.00 5.55 85.02 -
15 2002-42 OS/17/2002 4148 4164 16 39.52 0.00 5.55 45.@
16 2002-12A 08/07/2001 4053 4086 33 96.07 0.00 S.55 101.62.
17 2003-12 08/07/2002 4164 4210 46 146.40 0.00 S.97 152.3
18 2003-22 11/13/2002 4210 4252 42 12S.52 0.00 5.97 131.49
REUIEII CHOICE 4 or CENTER) MORE HISTORY:
s
e F,
r
a ��i : � n • :: . 1 :.ram .,: y� � 1 1
•_ • 1 1/ 1 /
j Telnet 10.1.71.55 •
W/S ACCOUNT HISTORY 2100516-SIPSEY, MICHAEL L. METER #1: 2100516 Q
------------------- BK:261 REA ST
# CYCLE SERUICE PRIOR CURRENT USE WATER SEWER FEES TOTAL
1 2003-32 02/11/2003 4252 4268 16 38.08 0.00 5.97 44.05
2 2003-42 05/07/2003 4268 4304 36 108.40 0.00 5.97 114.37
3 2004-12 08/13/2003 4304 4335 31 81.80 0.00 7.42 89.22
pod4 2004-22 11/06/2003 4335 4357 22 52.94 0.00 7.42 60.36
REUIEW CHOICE # or <EETER> MORE HISTORY:
«t �
a
�. • 1 1/ I 1
Summary Record Card generated on 10/7/2005 10:58:46 AM by Lisa Warren Page 1
Town of North Andover
Tax Map # 210-038.0-0032-0000.0
261 REA STREET
SIPSEY, MICHAEL L.
261 REA STREET
N. ANDOVER, MA
01845
Class 101 Single Family Property Type 1 Residential
Size Total 1.04 Acres
FY 2006
UB Mailing Index
Name/Address Type Loan Number Active/Inact. From Until
SIPSEY, MICHAEL L. Payor
261 REA STREET
N. ANDOVER, MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 14019.0 - 261 REA STREET Last Billing Date 8/31/2005
2100516 02 Cycle 02 Active
UB Services Maint.
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.63 5/8 7.82 1/
WTR WATER 01 ALL METER SIZE 200.30 /1
UB Meter Maintenance
Serial No Status Location Brand Type Size YTD Cons
0022746055 a Active ENC L ? w Water 0.63 0.63 0
Date Reading Code Consumption Posted Date Variance
8/10/2005 4561 a Actual 45 9/12/2005 29%
5/11/2005 4516 a Actual 30 6/8/2005 20%
2/22/2005 4486 a Actual 31 3/15/2005 63%
11/17/2004 4455 aActual 19 12/17/2004 -38%
8/12/2004 4436 a Actual 27 9/20/2004 14%
5/18/2004 4409 a Actual 25 6/14/2004 5%
2/17/2004 4384 a Actual 27 4/16/2004 0%
1 1/6/2003 4357 n New Meter 0 1 1/6/2003 0%