HomeMy WebLinkAboutPass - Title V Inspection Report - 1980 TURNPIKE STREET 3 10/20/2020 FILE #
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TITLE V INSPECTION
Dean G. Luscomb II & Sons
288 Maple Street
Middleton, MA 01949
978-774-4065
g' Licensed Plumber #20285
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
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03'0
C�
PROPERTY OWNERS NAME JuSS
PROPERTY ADDRESS 70 ion
DATE OF INSPECTION &'2
NAME OF INSPECTOR 7�)e� CD SCa�►�
Commonwealth of Massachusetts
Title 5 Official Inspection Form
� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner Owner's—
Name
information is MA 01845 September 25 2020
required for every North Andover _P
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may ntj Bred in any
way. Please see completeness checklist at the end of the form. R�G o`��`"'
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Itu
fining out forms A. Inspector Information QC� oR�NPN0��R
on the computer, �FN PRZM
Luscomb II G Dean G.use only the tab D -----------t�� -- --------
key to move your Name of Inspector
cursor-do not Dean G. Luscomb II & Sons
use the return ---_ - - ------ _ . ---- ---- ---------
---- _ - .
key.
Company Name
288 Maple Street
r� Company Address 01949
Middleton MA
City/Town State Zip Code
978-774-4065 S1848
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
September 25, 2020
Inspector'sre - - 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
Title 5 Official Inspection Form
I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner
Owner's Name
information is 2020
required for every North Andover MA 01845 September 25,
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® 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.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner — —
Owner's Name
information is
required for every North Andover MA 01845 September 25, 2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
O ❑ 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):
3) 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
Nthe 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:
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
— , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner -
Owner's Name
information is required for every North Andover MA 01845 September 25, 2020
_
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cant.)
❑ 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
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ 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 fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 4 of 18
Commonwealth of Massachusetts
�x --ire Title 5 Official Inspection Form
_- � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C - --
_ - -- — —
Property Address
J_u_ss_ee Inc.
Owner Owner's Name
information is MA 01845 September 25, 2020
required for every North Andover — — --
— — State Zip Code Date of Inspection
page. City/Town _ _ _ _ _
C. Inspection Summary (cont.)
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
® Liquid depth in cesspool is less than 6" below invert or available volume is less
El
than X, 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.
El/ 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.
❑ ® 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-
El10,000 gpd.
® The system fails. I have determined that one or more of the above failure
El
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 I e systems, you must indicate either"yes" or'no" to each of the following, in addition to the
questions ection C.A
Yes No
_..�
❑ ❑ the system iswvtthin 400_feet of a surface drinking water supply
❑ ❑ the item is within 200 feet tributary to a surface drinking water supply
the system is located in a nitroge—eve area (Interim Wellhead Protection
❑ -"� Area— IWPA) or a mapped Zone II of a publit—w�ter supply well
Title S Official Inspection Form.Subsurface Sewage Disposal System•Page 5 of 18
15insp.doc-rev.7126/2018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i�A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner - ._
Owner's Name
information is
required for every North Andover MA 01845 September 25, 2020
page. aw-rown 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 considered a significant
threat, or answered "yes" o any question in Section C.4 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
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as NIA)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® [I 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)]
t5insp.doc•rev.7/26/2018 1 itle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonweaith of Massachusetts
-� Title 5 Official Inspection Form
- 1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner -
Owner's Name
information is
required for every North Andover MA 01845 September 252 2020
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual): ------
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): - ---- --
Description:
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
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 ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)): --- - - -
Detail
Sump pump? ❑ Yes ® No
Last date of occupancy: Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C _
Property Address
Jussee Inc.
Owner ----- --- _ - - -
Owner's Name
information is MA 01845 September 25, 2020
required for every North Andover _ -__ p
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Industrial buildings �-__
[, Type of Establishment: -_- --- -_
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
_
Basis of design flow (seats/persons/sq.ft., etc.): 15 person .......
---. _ --
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:
current _ ______ __________
Last date of occupancy/use: Date
Other(describe below):
There is 3 commercial units with various businesses in them.
3. Pumping Records:
Pumps on a yearly schedule.
Source of information: - --
Was system pumped as part of the inspection? ❑ Yes ® No
zero
If yes, volume pumped: --__ --
gallons
How was quantity pumper! determined? _--no need at this time
Reason for pumping: - —- — -
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 18
1.17 , Commonwealth of Massachusetts
_- --r Title 5 official Inspection Form
— h Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
_
Owner -
Owner's Name
information is
required for every North Andover MA 01845 Se tember 25, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tack; 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:
System is from 1986 - 34 /rs old.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer (locate on site plan):
5'
Depth below grade: feet
Material of construction:
- ® cast iron ❑ 40 PVC ❑ other(explain): -- --- -- _--
i
Distance from private water supply well or suction line: -eet-- -- -- - - ---
f
Comments (on condition of joints, venting, evidence of leakage, etc.):
Main line and joints are in good condition, no signs of any problems.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 16
�= Commonwealth of Massachusetts
e Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner m- -_ - - -- -------- ---- - ---- — —
Owner's Nae
information is
required for every North_Andover MA 01845 September 25, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
6. Septic Tank (locate on site plan):
4'
Depth below grade: feet--- - - -
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
3500 gallon precast rectangular concrete.
S�Xzl Alla"LX/ r �Lll CU
f tank is-meta --
_....--*
Is age confirmed 6y a Certificate of Compliance? (attach a copy of certificate) e ❑—No
Dimensions: 6 6" deep_x 5'wide x 14' long
1"
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle 44"
1"
Scum thickness - - —
Distance frorn top of scum to top of outlet tee or baffle 6
24
Distance from bottom of sf�,urn to bottom of outlet tee or baffle
How were dimensions determined? by sticks and 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.):
The septic tank and baffle3 are in good general condition. The liquid in the tank is running at it's
correct working heigth.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspect;on Form.Subsurface Sewage Disposal System•Page 10 of 18
c z� Commonwealth of Massachusetts
- -_, Title 5 Official inspection Form
I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
e ,t,
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
- -- -
Owner - __ --
Owner's Name
information is
required for every North Andover MA 01845 September 25, 202.0
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
OMaterial of construction:
❑ concrete ❑ Metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions'
Scum thickness ---- ---- - ----- ----
Distance from top of scup- 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 ❑ polyethyle-ne ❑ other(explain):
Dimensions -- - --------------- ---- -
Capacity: gallons
Design Flow: _-...-- ------ _ _ -
9 gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page i I of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Ju_ssee Inc.
Owner Owner's Name
information is
required for every North Andover MA 01845 September 25, 2020
page. Ciyrown State Zip Code Date of Inspection
D. System Information
8. Tight or Holding Tank (cone.)
Alarm present ❑ Yes ❑ No
w� Alarm level: - - Alarm in working order: ❑ Yes ❑ No
Date of last pumping: -
Comments (condition of alarm and f lo5 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 Zero — -
/ 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.):
The d-box is 11" below grade with the cover built to grade and is 20" by 20" square. The d-box is level
and in good condition. The> d-box was replaced in 2017.
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
�L_, Commonwealth of Massachusetts
4 -- Title 5 Official Inspection Form
�.;
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner — -------- ----
Owner's Name
information is
North Andover MA 01845 September,25, 2020
required for every -
page. City/Town _ State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber (locate on site plan):
Pumps in working order ® Yes ❑ No'
/ Alarms in working order: ® Yes ❑ No'
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Both alarms and pumps afe in good working condition. Pumps were replaced in 2009. Top of pump
station is 4' below grade vvith the covers built to grade. 24" steel manholes.
" 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:
Located by asbuilt drawin{1s and d.-box to level area of yard.
Type:
❑ leaching pits number: - - — -
❑ leaching chambers number: --- -
❑ leaching galleries number: -- ---- -----
❑ leaching trenches number, length: - — - -
1 -40' x60'
® leaching fiE:ids number, dimensions: — — —
❑ overflow cesspool number: --
❑ innovative/alternative system
Type/name of technology: - --- --- ---. — -
t5insp.cloc•rev.7/26/2018 7itie 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Mas.3achusetts
- ip Title 5 Official Inspection Form
1, Subsurface Sewage Disposal System Form Not for Voluntary Assessments
o
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner - - -
Owner's Name
information is
required for every North Andover MA 01845 September 25, 2020
page. 6ity/Town State Zip Code Date of Inspection
D. System Informati an (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
The SAS is in good generil condition with no signs of any problems.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Numb nd configuration
Depth —top of liq " to inl(;t 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.doc•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
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner
Owner's Name
information is
required for every North Andover MA 01845 September 25, 2020
page. City/Town State Zip Code Date of Inspection
--- - ---- --- -----
. .
D. System Information (cons)
13. Privy (locate on site plan!. `
Materials of construction: - -- — �"---- - -- _
O
Dimensions ---------
Depth of solids ------
Comments (note condition, of soil, signs of-hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
-,r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
198.0 Turnpike Street Unit C
Property Address
Jussee Inc.
Owner -- — --
Owner's Name
information is
required for every North Andover MA 01845 September 25, 2020
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 of benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below: ACV r� r?•
�t r.
® hand-sketch in the area below Q b 2 �U
❑ drawing attached separately
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t5insp.doc•rev.7/2612 01 8 Title 5 0,cial Inspection Form:Sub urface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
- 11,, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee lnc.
Owner _ - - - _------__ ..-_-----------
Owner's Name
information is
required for every North Andover MA 01845 September 25, 2020
page. city/Town _ _ State _Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water Za441 GtrGG /4```�1
® Check cellar (Ll SC��
® Shallow wells 1J4n-l.
6'
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained fron't system design plans on record
If checked, date of design plan reviewed. 1986
Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
Proposed, asl.)uilt, previous title v's from 2008 and 2017 and pumping records.
❑ Checked with locai excavators. installers - (attach documentation)
❑ Accessed US;aS database -explain.-
You must describe how y)u established the high ground water elevation:
USGS map showed water depth at approximately 6' in this area. The d-box is 11" below grade. The
bottom of the field is approxii-nately 24" - 30" below grade.
Before filing this Inspec':.ion Report, please see Report Completeness Checklist on next page.
t5insp,doc•rev.7/26/2018 Title 5 Official Inspect;on Form:Subsurface Sewage Disposal system•Page 17 of 18
Commonwealth of Mas:iachusetts
,y Title 5 ®fficiElll Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1980 Turnpike Street Unit C
Property Address
Jussee Inc.
_
Owner
Owner's Name
information is
required for every North Andover MA 01845 September 25, 2020
page. City/T6wn State Zip Code Date of Inspection
E. Report Completeliess 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
® 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 1 anI<-- Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
Summary Record Card generated on 9/26,2020 7:50:53 AM by Karen i ianlon Page 1
Town of North Andover
Tax Map # 210-106.D-0017-0001.0
Parcel Id 17771
1980 TURNPIKE STREET U-1
CAPRI PRIVATE EQUITY LLC
ATTN: CHRISTOPHER CASTRO
1980 TURNPIKE STREET U-1 UNIT 1
NORTH ANDOVER, MA 01845
Class 405 405 Property Type 4 Industrial
Size Total 0 Acres
FY 2021
UB Mailing Index
Name/Address Type Loan Number Active/inact. From Until
CAPRI PRIVATE EQUITY LLC Owner
ATTN: CHRISTOPHER CASTRO
1980 TURNPIKE STREET U-1 UNIT 1
NORTH ANDOVER, MA 01845
ERLAB INCORPERATED Previous Customer Inactive 1/12/2009
388 NEWBURYPORT TURNPIKE
ROWLEY,MA
01969
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id.9929.0-1980 TURNPIKE STREET U-1 Last Billing Date 9/4/2020
2100051 02 Cycle 02 Active
UB Services Maint.
Account No.2100051
Service Code Rate Charge Multiplier/Users
MISCFEEADMIN FEE 11 9.18 1/
WTR WATER 01 ALL METER SIZE 11.40 /1
UB Meter Maintenance
Account No. 2100051
Serial No Status Location Brand Type Size YTD Cons
70
16372003 aActive ERT METE METE w Water 1 1 Variance
Date Reading Code Consumption Posted Date ne
ce
813/2020 455 a Actual 3 9/9/2020 6%
5/1/2020 452 a Actual 3 6/10/2020 -64%
2/3/2020 449 a Actual 9 3/16/2020 120%
11/1/2019 440 aActual 4 12/23/2019 0%
8/1/2019 436 a Actual 4 9/26/2019 29%
5/112019 432 a Actual 3 6/13/2019 3%
2/1/2019 429 aActual 3 3/19/2019 0%
11/112018 426 a Actual 3 12/12/2018 -25%
8/1/2018 423 a Actual 4 9/20/2018 -3%
5/1/2018 419 a Actual 4 6/20/2018 38%
2/1/2018 415 a Actual 3 3/28/2018 0%
11/1/2017 412 aActual 3 12/29/2017 -25%
8/1/2017 409 a Actual 4 9/20/2017 29%
5/1/2017 405 a Actual 3 6/26/2017 3%
2/1/2017 402 a Actual 3 3/14/2017 0%
11/1/2016 399 aActual 3 12/19/2016 -41%
8/1/2016 396 a Actual 5 9/21/2016 70%
5/3/2016 391 aActual 3 6/21/2016 -23%
2/112016 388 a Actual 4 3/28/2016 -25%
10/30/2015 384 a Actual 5 12/30/2015 7%
8/3/2015 379 a Actual 5 9/14/2015 -7%
5/1/2015 374 a Actual 5 6/22/2015 5%
2/3/2015 369 a Actual 5 3/20/2015 24%
11/4/2014 364 a Actual 4 12/15/2014 32%
8/6/2014 360 a Actual 3 9/11/2014 -20%
Summary Record Card generated on 9.28/2020 7:52 36 AM by Karen Hanlon Page 1
Town of North Andover
Tax Map # 210-106.D-0017-0002.0
Parcel Id 17779
1980 TURNPIKE STREET U-2
JJM HOLDINGS LLC
1980 TURNPIKE STREET, BLDG. 2, UNIT 2
NORTH ANDOVER MA 01845
Class 405 405 Property Type 4 Industrial
Size Total 0 Acres
FY 2021
UB Mailing Index
Name/Address Type Loan Number Active/inact. From Until
JJM HOLDINGS LLC Owner
1980 TURNPIKE STREET, BLDG.2, UNIT 2
NORTH ANDOVER MA 01845
BRATT MACHINE COMPANY Payor Inactive 9/29/2010
1980 TURNPIKE STREET
NORTH ANDOVER,MA
01845
BNB REALTY TRUST Previous Customer Inactive 3/22/2017
PO BOX 1210
MIDDLETON,MA 01949
JOHN JIUSTO Owner Inactive 1/22/2020
69 ELM STREET
BYFIELD MA 01922
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg id. 13236.0-1980 TURNPIKE STREET U-2 Last Billing Date 9/4/2020
2100053 02 Cycle 02 Active
UB Services Maint.
Account No.2100053
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.63 5/8 7.82 1/
WTR WATER 01 ALL METER SIZE 26.60 /1
UB Meter Maintenance
Account No.2100053
Serial No Status Location Brand Type Size YTD Cons
16338540 a Active HH#1980 U-2 b Badger w Water 0.63 0.63 764
Date Reading Code Consumption Posted Date Variance
8/3/2020 13 a Actual 7 9/9/2020 -9%
5/1/2020 6 a Actual 6 6/10/2020 -100%
2/18/2020 0 n New Meter 0 3/16/2020 -100%
2/18/2020 1590 s Reset meter 34 3/16/2020 -18%
11/1/2019 1556 m Manual estimate 35 12/23/2019 -5%
MSG
8/1/2019 1521 a Actual 37 9/26/2019 -43%
5/1/2019 1484 aActual 63 6/13/2019 117%
2/1/2019 1421 a Actual 30 3/19/2019 -14%
11/1/2018 1391 aActual 35 12/12/2018 21%
8/1/2018 1356 a Actual 29 9/20/2018 40%
5/1/2018 1327 a Actual 20 6/20/2018 59%
2/1/2018 1307 a Actual 13 3/28/2018 0%
11/1/2017 1294 a Actual 13 12/29/2017 62%
8/1/2017 1281 a Actual 8 9/20/2017 -9%
5/1/2017 1273 a Actual 4 6/26/2017 -10%
3/20/2017 1269 f Final Bill 5 3/20/2017 -2%
2/1/2017 1264 a Actual 10 3/14/2017 25%
11/1/2016 1254 a Actual 8 12/19/2016 -48%
Summary Record Card generated on 9/2P/2020 7:52.02 AM by Karen Hanlon Page 1
Town of North Andover
Tax Map # 210-106.D-0017-0003.0
Parcel Id 17780
1980 TURNPIKE STREET U-3
JUSSE INCORPORATED
1980 TURNPIKE STREET UNIT 3
NORTH ANDOVER, MA 01845
Class 405 405 Property Type 4 Industrial
Size Total 0 Acres
FY 2021
UB Mailing Index
Name/Address Type Loan Number Active/Inact. From Until
JUSSE INCORPORATED Owner �� -
1980 TURNPIKE STREET UNIT 3
NORTH ANDOVER,MA 01845
EAST COAST METAL WORKS CO Payor Inactive 11/15/2007
1980 TURNPIKE STREET
ATTN: LINDA DIORIO
N.ANDOVER, MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 9930.0-1980 TURNPIKE STREET U-3 Last Billing Date 9/4/2020
2100052 02 Cycle 02 Active
UB Services Maint.
Account No. 2100052
Service Code Rate Charge Multiplier/Users
MISCFEEADMIN FEE 0.63 5/8 7.82 1/
WTR WATER 01 ALL METER SIZE 22.80 /1
UB Meter Maintenance
Account No. 2100052
Serial No Status Location Brand Type Size YTD Cons
16337209 a Active HH#1980 U-3 METE METE w Water 0.63 0.63 509
Date Reading Code Consumption Posted Date Variance
8/3/2020 661 a Actual 6 9/9/2020 12%
5/1/2020 655 aActual 5 6/10/2020 -11%
2/3/2020 650 a Actual 6 3/16/2020 -16%
11/1/2019 644 a Actual 7 12/23/2019 -22%
8/1/2019 637 aActual 9 9/26/2019 -3%
5/1/2019 628 aActual 9 6/13/2019 33%
211/2019 619 a Actual 7 3/19/2019 0%
11/1/2018 612 a Actual 7 12/12/2.018 17%
8/1/2018 605 a Actual 6 9/20/2018 -3%
5/1/2018 599 aActual 6 6/20/2018 24%
2/1/2018 593 a Actual 5 3/28/2018 0%
11/1/2017 588 a Actual 5 12/29/2017 -29%
8/1/2017 583 a Actual 7 9/20/2017 -25%
5/1/2017 576 a Actual 9 6/26/2017 33%
2/1/2017 567 a Actual 7 3/14/2017 -22%
11/1/2016 560 aA.ctual 9 12/19/2016 26%
8/1/2016 551 aActual 7 9/21/2016 -74%
5/3/2016 544 aActual 28 6/21/2016 -5%
2/1/2016 516 a Actual 30 3/28/2016 8%
10/30/2015 486 a Actual 26 12/30/2015 16%
8/3/2015 460 aActual 24 9/14/2015 71%
5/1/2015 436 aActual 13 6/22/2015 5%
2/3/2015 423 a Actual 13 3/20/2015 -14%
11/4/2014 410 a Actual 15 12/15/2014 -22%
8/6/2014 395 aActual 19 9/11/2014 56%
5/9/2014 376 a Actual 13 6/12/2014 43%
o NOArN �y V J i
� s
• Town of North Andover
sue' HEALTH DEPARTMENT
SACHU
CHECK#: 880 DATE:
980 Ur,-
LOCATION: � _/ W 4L SE.
H/O NAME: �vsS ee- .roc.
' �
P CONTRACTOR NAME: -U5CO/►'M6 Type of Permit or License: (Check box)
❑ Animal $
❑ Body Art Establishment $
❑ Body Art Practitioner $
❑ Dumpster $
❑ Food Service-Type: $
❑ Funeral Directors $
❑ Massage Establishment $
❑ Massage Practice $
❑ Offal(Septic)Hauler $
❑ Recreational Camp $
E ❑ Sun tanning $
k ❑ Swimming Pool $
€ ❑ Tobacco $
❑ Trash/Solid Waste Hauler $
❑ Well Construction $
SEPTIC Systems:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑( Title 5 Inspector $
�I Title 5 Report
❑ Other. (Indicate) $
Health Agent Initials
ite-Applicant Yellow-Health Pink-Treasurer