HomeMy WebLinkAboutPass - Title V Inspection Report - 292 CANDLESTICK ROAD 3/18/2021 Commonwealth of Massachusetts RECE�vEp
Title 5 Official Inspection Form
M MAR � 8 20Z1
_ ; Subsurface Sewage Disposal System Form - Not for Voluntary Assessmentso
ppVER
ORTH p,N
292 Candlestick Rd iODF RTMENT
Property Address -- -- — ---�
Owner
Linda McNabb
—_ _- _ _ ------- _______
Owner's Name
information is required for every North Andover Ma 01845 9/11/20
City/Town/Town
page. Y State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information
on the computer,
use only the tab Dean Dynan -
key to move your Name of Inspector -- -
cursor-do not Dean Dynan
use the return
key. Company Name -- — --- —
2 Suntaug Street
r� Company
Address
Lynnfield Ma _ 01940
City/Town State Zip Code
.,� 508-726-9935 S112837
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
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time. This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/262018 TWe 5 Official Inspection Form Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb _
Owner Owner's Name
Information is required for every North Andover Ma 01845 9/11/20
page. Cityrrown 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:
4 bedroom septic system in working order
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):
t5hsp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurfaco Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Yj Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
i 292 Candlestick Rd
Property Address
Linda McNabb
Owner Owner's Name
information is required for every North Andover Ma 01845 9/11/20
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.
❑ 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
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
15insp.doc-rev.7/262018 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
292 Candlestick Rd
Property Address
Linda McNabb
Owner Owner's Name
information is North Andover Ma 01845 9/11/20
required for every _.-
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
15insp.doc•rev.726/2018 Title 5 Official Inspection Forth:Subsurface Sawago Disposal System•Page 4 of 18
Commonwealth of Massachusetts
r
- -__ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb
Owner - — — --— — —---
Owner's Name
information is required for every North Andover Ma 01845 9/11/20
page. City/Town State Zip Code Date of Inspection
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
than 1/z day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ® the system is within 400 feet of a surface drinking water supply
❑ ® the system is within 200 feet of a tributary to a surface drinking water supply
❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
151nsp doc•rev.7f2612018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb
Owner Owner's Name
information is required for every North Andover Ma 01845 9/11/20
page. CityTrown 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" to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t51nsp.doc-rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Se vage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb
Owner Owner's Name
information is required for every North Andover Ma 01845 9/11/20
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Description:
4 Bedroom system with 1500 gallon tank and 2 pipe in stone trenches
Number of current residents: 1
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 ears usage d < 150 GPD ave
9 ( Y 9 (gp ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Date20
Date
t5insp.doc•rov.726/2018 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
292 Candlestick Rd
Property Address
Linda McNabb
Owner Owners Name
information is required for every North Andover Ma 01845 9/11/20
page. City/Town State Zip Cade Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.): -
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: homeowner/Health Dept
Pump slip on file 2018
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined? -
Reason for pumping:
15insp.doc•rev.7f2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pago 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb
Owner Owner's Name
Information is required for every North Andover Ma 01845 9/11/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if 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:
1993 as per permit on file
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 22"feet
Material of construction:
❑ cast iron ® 40 PVC ❑other(explain):
Distance from private water supply well or suction line: n/a
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
sewer pipe in good condition/ no evidence of leakage
t5 insp.doc•rev.7126l2018 Title 5 official tnspection Form:Subsurface Sewage Disposal System-Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb
Owner ------- ---____ __
Owner's Name
information is required for every North Andover Ma 01845 9/11/20
page. CityRbwn State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
Depth below grade: 1
p feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1500 gallon septic tank with center cover 12"to grade
If tank is metal, list age: ----- _ ---
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 10'X 5'�X 55'8" -T
Sludge depth: LAJ ! a h
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness —
Distance from top of scum to top of outlet tee or baffle Distance from from bottom of scum to bottom of outlet tee or baffle 13"
How were dimensions determined? in field with measure stick and tape
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
1500 gallon HD concrete septic tank with PVC T's inlet and outlet / tank is new see COC
cover to grade
Outlet T has zable filter that requires annual maintenance/ extract ,rinse,insert
recommend pumping every two to three years depending on usage and#of occupants
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
`\ Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb------.
-
Owner
Owner's Name
information is North Andover Ma 018_45 9/11/20
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: ____----_-_-------___--
feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions: -------
Scum thickness ---
Distance from top of scum to top of outlet tee or baffle - --------- - - - ---
Distance from bottom of scum to bottom of outlet tee or baffle - ---- ------ - --- -----
Date of last pumping: Date-- - -- — -----
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions: ------------— -------- --
Capacity: gallons
Design Flow: __ -__- _ -_-_-_-
gallons per day
t5insp.doc•rev-7/26/2018 Tdle 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
-W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb
Owner Owners Name
Information is required for every North Andover Ma 01845 9/11/20
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank (cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: --
Date
Comments (condition of alarm and float switches, etc.):
`Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box (if present must be opened)(locate on site plan).-
Depth of liquid level above outlet invert liquid at 0"above invert
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.):
10"X 15"concrete D box level with 2 outlet pipes and diffuser T / little evidence of solids carryover
No evidence of leakage into or out of box
D Box cover is 30" below grade
d box in good condition
t5!nsp.doc•rov.7/26M18 Title 5 Official tnspection Form:Subsurface Sewage Disposal System•Pago 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb
Owner Owner's Name
information is North Andover Ma 01845 9/11/20
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.):
If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
® leaching trenches number, length: 2 @ 45'
❑ leaching fields number, dimensions:
❑ overflow cesspool number: -
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rov.7/26120 1 8 Tdle 5 Officlal tnspection Forth:Subsurface Sewage Disposal System-Pago 13 of 18
Commonwealth of Massachusetts
=W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
292 Candlestick Rd _
Property Address
Linda McNabb
Owner Owner's Name
information is required for every North Andover Ma 01845 9/11/20
page. City/Town State Zip Code Date of Inspection
D. System Information (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.):
Trenches found in sloping lawn area/ soils in good condition / no signs of hydraulic failure/ no
ponding/ no damp soil/
trenches constucted of pipe in stone in working order
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration - -
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool -
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
15insp.doc•rev.7726MI8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
Q7 ^_; Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
292 Candlestick Rd _
Property Address
Linda McNabb
Owner - - --__---- _-----
Owner's Name - -- - --- -— -
information is required for every North Andover Ma 01845 9/11/20
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction: --- - -- - - -
Dimensions - -- -- -- ---- - .—------
Depth of solids - - - - --
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev 7/262018 Title 5 Official Inspection Pone-Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
--,�� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
vl' 292 Candlestick Rd
Property Address
Linda McNabb
Owner ---------- -_
Owner's Name
information is North Andover Ma 01845 9/11/20
required for every _
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
Sinsp.doe•rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
— ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb
Owner ------ -----
Owner's Name � - -
required for every information is North Andover Ma 01845 9/11/20
require _ _ _
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 2'+ as per plan on file
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 1989 —
Date
❑ Observed site (abutting propertylobservation 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:
Plans on file at BOH dated 1989 soil test gound water at 72"
No sump pump in basement/ basement floor 7'+ below grade where trenches located
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
292 Candlestick Rd
Property Address
Linda McNabb
Owner Owner's Name
information is required for every North Andover Ma 01845 9/11/20
page. Citylrown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information.- Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank— Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
P.O. Box 135
Page.10 of 11 M:icklletan, MA 01949
1-978-774-4065
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: �Z
f�i4 OvIef—
Owner: It-are
Date of Inspection: 6
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide asketch 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.
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�ilIISj� O"=Pn==on 8118r1eY0 8:17:35AM by Sharon Coo
Town of North Andover Pap
Tax Map # 210-106.A-0246-0000.0
Parcel Id 17391
292 CANDLESTICK ROAD
KARETA, STEPHEN
292 CANDLESTICK ROAD
NORTH ANDOVER, MA
01845
Class 101 Single Family Property Type 1 Resldontlal
Size Total 1.12 Acres
FY 2021
UB_MaHinla Index
Name/Address Type Loan Number Activotinac. From Until
KARETA,STEPHEN Paycr Active
292 CANDLESTICK ROAD
NORTH ANDOVER,MA
01846
UB Account Maint.
Account No Cycie Occupant Name ActiveRnactive
Bldg Id.17647.0-292 CANDLESTICK ROAD last Billing Date 71W020
3170317 03 Cycle 03 Active
UB Services Maint,
Account No.3170317
Service Code Rate Charge Multiplier/Users
MISCFEEADMIN FEE 0.63 5/8 7.82 1/
WTR WATER 01 ALL METER SIZE 15.20 /1
UB Meter Maintenance
Account No.3170317
Serial No Status Location Brand type Size YTD Cons
36393645 a Active ERT HH b Badger w Water 0.63 0.63 933
Date Reading Code Consumption Pasted Data Variance
6/5/2020 933 aActual 4 7/15/2020 1%
3/9/2020 929 aActual 4 4/8/2020 -89%
12/11/2019 926 aActual 13 1/15/2020 72%
9/13/2019 912 a Actual 49 10/10/2019 223%
6/10/2019 863 aActual 15 7/25/2019 251%
31M019 848 aActual 4 4/16/2019 -56%
12/10/2018 844 a Actual 9 1/22/2019 -82%
9/12/2018 835 aActual 53 10115/2018 128%
6/11/2018 782 aActual 24 7/23/2018 462%
3/7/2018 768 aActual 4 4/23/2018 -71%
12i7/2017 754 a Actual 13 1/26/2018 -68%
9/12/2017 741 aActual 45 10/18/2017 439%
6/8/2017 696 a Actual 8 7/26/2017 -3%
3/8/2017 688 aActual 8 4/12/2017 -52%
12/9/2016 680 a Actual 17 1/23/2017 -83%
9/9/2016 663 a Actual 94 10/24/2016 202%
6/13/2016 669 aActual 34 &=016 537%
3/9/2016 635 a Actual 5 4/22/2016 -74%
12/10/2016 530 a Actual 20 1/20/2016 -60%
9/9/2015 510 a Actual 49 10/16/2016 75%
6/10/2015 461 a Actual 26 7/24/2015 454%
3/11/2015 433 a Actual 5 4/28/2015 -68%
12/11/2014 428 a Actual 16 1/15/2015 -74%
9/11/2014 412 aActual 63 10/15/2014 271%
6/11/2014 349 a Actual 17 7/16/2014 236%
3/11/2014 332 aActual 5 4/11/2014 -790A
12/10/2013 327 aActual 23 1/17/2014 -71%
9/12/2013 304 a Actual 81 10/15/2013 472%
6/12/2013 223 aActual 14 7/24/2013 183%
3H3/2013 209 aActual 6 4/22/2013 .3%
Caring for your Septic System: A Reference Guide for
Homeowners
Caring for Your Septic System (Conventional Septic System, Innovative/Alternative (I/A)
System, or Cesspool)
The accumulated solids in the bottom of the septic tank should be pumped out every three years to
prolong the life of your system. Septic systems must be maintained regularly to stay working.
Neglect or abuse of your system can cause it to fail. Failing systems can
• cause a serious health threat to your family and neighbors,
• degrade the environment, especially lakes, streams and groundwater,
• reduce the value of your property,
• be very expensive to repair,
• and, put thousand of water supply users at risk if you live in a public water supply watershed
and fail to maintain your system.
Be alert to these warning signs of a failing system:
• sewage surfacing over the drainfield (especially after storms),
• sewage back-ups in the house,
• lush, green growth over the drainfield,
• slow draining toilets or drains,
• sewage odors
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Tips to Avoid Trouble
• DO have your tank pumped out and system inspected every 3 to 5 years by a licensed septic
contractor (listed in the yellow pages).
htlps://vnnv.to:mofnewbury.org/prinU,171 1/3
90M020 Caftrtg for yaw Septic System:A Reference Guide for Homeir mers
• DO [seep a record of pumping, inspections, and other maintenance. Use the back page of this
brochure to record maintenance dates.
• DO practice water conservation. Repair dripping faucets and leaking toilets, run washing
machines and dishwashers only when full, avoid long showers, and use water-saving features
In faucets, shower heads and toilets.
• DO learn the location of your septic system and drainfield. Keep a sketch of it handy for
service visits. If your system has a flow diversion valve, learn Its location, and turn it once a
year. Flow diverters can add many years to the life of your system.
• DO divert roof drains and surface water from driveways and hillsides away from the septic
system.Keep sump pumps and house footing drains away from the septic system as well.
• DO take leftover hazardous household chemicals to your approved hazardous waste
collection center for disposal. Use bleach,disinfectants, and drain and toilet bowl cleaners
sparingly and in accordance with product labels.
• DONT allow anyone to drive or park over any part of the system. The area over the drainfield
should be left undisturbed with only a mowed grass cover. Roots from nearby trees or shrubs
may clog and damage your drain lines.
• DONT make or allow repairs to your septic system without obtaining the required health
department permit. Use professional licensed contractors when needed.
• DONT use commercial septic tank additives.These products usually do not help and some
may hurt your system in the long run.
• DONT use your toilet as a trash can by dumping nondegradables down your toilet or drains.
Also, don't poison your septic system and the groundwater by pouring harmful chemicals
down the drain.They can kill the beneficial bacteria that treat your wastewater. Keep the
following materials out of your system:
Nondegradables
grease, disposable diapers, plastics, etc.
Poisons
gasoline, oil, paint, paint thinner, pesticides, antifreeze, etc.
Septic System Explained
Septic systems are individual wastewater treatment systems (conventional septic systems,
Innovusually
from terra ive dual homses. The' or cesspools)that use the soil to are typically used In rural or lag blot settings where centralizat small wastewater ed
usually from Individual Y
wastewater treatment Is impractical.
There are many types of septic systems in use today. While all systems are individually designed for
each site, most systems are based on the same principles.
Your septic system treats Your household wastewater o separatef from the wastewate It In trhe septic tank
This separation
where heavy solids and lighter scum are allowed
process is known as primary treatment.The libds astored in thnekparehade pumper. by bacteria
and later removed, along with the lighter scum, Y professional
which separates
After partially treated Was leaves the tank,it flows into a distribution box,
each line a
this flow evenly into a network of draintield trenches.temporary Drainage
inage holege.atThi effluent then slowly seeps iw
the bottom of
the wastewater to drain into gravel trenches for
into the subsurface soil where it is further treatedand purified
(secondary treatment).A properly
functioning septic system does not pollute _ groundwater.
11/18/2020
Date:November 16,2020
Certificate of Compliance #5664i
This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointdoud.coml#/records/67393
• ,�"'°ram COMMONWEALTH OF
MASSACHUSETTS
TOWN OF NORTH ANDOVER {14; ,Y
BOARD OF HEALTH
This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION:
Repair or replace an existing system component
septic tank
by: Dean Dynan, Dean Dynan
At:
292 CANDLESTICK ROAD
106.A-0246
The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily.
e lk k
BRIAN LAGRASSE
DIRECTOR,BOARD OF HEALTH
1/1