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HomeMy WebLinkAboutPass - Title V Inspection Report - 325 BOSTON STREET 5/10/2021 Commonwealth, of Massachusetts Title Official Inspection Form f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments() ,6,l 325 Boston Street Property Address Richard Vance Owner Owners Name information is required for every , North Andover Isla 01845 4/13/2021 page (Town 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:Men A. Inspector Information filling out forms on the computer, use only the tab mean Dynan key to move your Name of Inspector cursor-do not Dean Dynan use the return Company Name key.. 2 Suntaug Street Company Address L nnfield Ma 01840 Cityrrown State Zip Code 508-726-9935 S112837 Telephone Number License Number B. Certification I certify than I am a DEP approved system Inspector in full compliance with Section 16.340 of Title 5 (310 CMR 16.000) 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 Lasses 3. [ Needs Further Evaluation by the Local Approving Authority 4. Fails [*^ A Inspectors Signature Cate The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or D P)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 DER 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 tinder 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. tsfnap.doc•rev..7126=18 Tale s ofrcw lnspwion Form:SubsixfaW SOwage piappa I System•POP 1 of t5 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form-Not:for Voluntary Assessments 325 Boston Street Properly Address Richard Vance Owner Ownees[Name information is required for every North Andover Ma 01845 4/1312021 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(wh er metal or riot) is structurally unsound, exhibits substantial infiltration or exfiltration,or tank failu s imminent. System will pass inspection if the existing tank is replaced with a complying se ' tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is stru rally sound, not leaking and if a Certificate of Compliance indicating that the tank Is less than years old;is available. 0 Y ❑ N ❑ ND (BxpI below): 15tnsp.doc•rev.72.=18 Title 5 Official rnspoction Form:Sutrswfero Sewage Disposal system•Page 2 of 15 Commonwealth..of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Boston Street Property Address Richard Vance Owner Owner's Name information is North Andover Ma 01845 4/13/2021 required for every page. Cityrrown State Zip Cade Date of Inspection C. Inspection Summary (cons.) 2) System Conditionally Passes (cunt.): ❑ Pump Chamber pumps/alarms not operational. System,lwill pass with Board of Health approval if .pumps/alarms are repaired. ❑ Observation of sewage backup or break or high static water level in the distribution;box due to broken or obstructed pipe(s)or du a broken, settled or uneven distribution box. System will pass inspection if(with approval oard of Health): ❑ broken pipe(s)ar . eplaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstructio ' removed ❑ Y ; ❑ N ❑ ND(Explain below): ❑ dis ' ion 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 El . (Explain below): El obstruction is removed ❑ Y '❑ ❑ ND (Explain below): 3) Further Evaluation is Required b e Board of Health: ❑ Conditions exist which re a further evaluation by the Board of Health in order to determine if the system is failing to test public health, safety or the environment. a. System will pa unless Board of Health determines In accordance with 3'10 CMR 15.303(1)(b)th the system is not functioning in a manner which will protect public.health, safety and t environment: Wrap.doc•ray.745=18 Title s of kw1 tspeCUM Form:subafffeee Sewage Disposal system•Page 3 of 18 Commonwealth of Massachusetts low Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Boston Street Propeity Address Richard Vance Owner Ownees Name information is required for every North Andover Ma 01845 4/13/2021 re page. cityrrown 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 4ny) determines that the system is functioning in a manner that protects the p ie health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) the SAS is within 100 feet of a surface water supply or tributary to a surface wat pply. ❑ The system has a septic tank and SAS and the SAS i Ithin a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS nd the SAS is less than 100 feet but 50 feet or more from a private water supply well" Method used to determine distance: ti "This system passes if the well ater analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates abs t and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provi d 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 Mnsp.doe•rev.712fi12018 isle 5 offdal tnspectlon Forth:GLdmdaw Sewage Plsposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments 325 Boston Street Property Address Richard Vance Owner Owner's Name information is North Andover Ma 01845 4/13/2021 required for every page. Citylt own state Zfp Code Date of Inspection C. Inspection Summary (cone.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6 below invert or available volume is less than %day flow [j ® 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 prlvy 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 504eet from a private water supply well with no acceptable water quality analysis:n"his 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 thane 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- El . 10,000 gpd. El ® The system fails. I have determined that one or more of the above failure criteria exist as,descdbed.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. 6) Large Systems: To be considered a large system the system mutt 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 I I of a public water supply well 151nsp dog•rev.7126fl078 ro 5 Offidal hspoctW Fam.SubsW=Sewage Dlgx"gYstm'Page 5 dr 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Boston Street Property Address Richard Vance Owner Owners Name information is required for every North Andover Ma 01845 4/13/2021 page, CitylTown 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.She 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 W,,,eek period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available 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? ® ❑ Was the site Inspected for signs of break our? ® [I 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 Sol]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(6)] l5lrtsp,doc•rev.7rd&W8 Title s OlRcfal hrspecftn Forth:Suturntace Sewage Disposal system•P6ge6 or to Comimonwealth of Massachusetts x a Time 5 0f-f cial Inspection Form Subsu.rface;Sewage;Disposal Sy stem.Form..Not.for-Volunf aryAqpqssments, w 325`$oston:Stteet., . Property Address Richard Vance Owner'. Ownees Name 16fdrmation is _ regatredfbr every North Andover ;Ma 01845 4/13/202i_ page, CitylTown 'State Zrp:Code. Date Inspection ection D. System,information 1. Residential Flow Conditiphs: t NuInber of be6 droom`s-.(design): 4 Ndmber-;of bedrooms°(actual): 4 DESIGN flow based on110 CMR 15.2013(for exam All O gpd'�x,9 of bedrooms): 440 Description: 4 Bedroom system with;150agalion'tank and four Hi,Cap`infiltrator trenches Numher'ofturrent residents; Does residencehave a garbage grinder? ❑ Yes ® No Does'residence hoe.a watertreatment unit? ❑ Yes 10 o, Ifyes;,discharg&#o: Is laundry on a separate sewage system?(Incline lauhdry`syMem inspection information In this report) 0 Yes No taundry system inspected? ❑ 'Yes .3 -No Seasonal use? ❑ Yes Z No W6ter-meter readings, if available°'(la6t2;.years usage:(gpd)) 150 qLd aVe. Detail: see attached 4 - Sumppump? ❑ 'Yes ® No Last date,;of occupancy: du6eht, Date 1$,*nsp;doo-rev.7rAM18 Ville 5 arrwi�Inspedion Form:.SOsurrece Sewage nlspgs !system•aoo To.!10 Commonwealth of Massachusetts Tiftle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Boston Street P—roperty Address Richard Van:ce Owner Ownees Name Information is required for every North Andover Ma 01845 4/1312021 page. 4frown State Zip Code Date of Inspection, . System Information (cont.) 2, Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 16.203): G ns per day,(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? Yes No Water treatment unit present? E3 Yes 0 No If yes, discharges W Industrial waste holding tank pres t? El Yes R No Non-sanitary waste dischar dI!to the Title 5 system? f-1 Yes E] No Water meter readings 'I available, Last date of occ ancy/use: Date Other(des ibe below): 3. Pumping Records: Source of information: Homeowner/Board of Health Pumped last year Was system pumped as part of the inspection? Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Mnsp.doc rev,7126MIS 'title 5 officw lnspwion Form Substalace Sewage Gaffs OSW Syslem-Page 8 Of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Boston Street Property Address Richard Vance Owner Owner's Name information Is North Andover Ma 01845 4/13/2021 required for every page. cftyrrcwn state Zip Code Date of Inspection - D. System Information (cunt.) 4. Type of System: ® Septic tank, distribution box, soil absorptioni system ❑ Single cessspool ❑ 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 11A 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: 2013 as per permit on file Were sewage odors detected when arriving at the site? ❑ Yes R No 5. Building Sewer(locate on site plan): 14, Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain)I Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): i sewer pipe in good condition 7-no evidence of leakage IShWdoc•rev,726=16 Title 6 Official Insp xUati Faun:SW=ff m sewage,Disposal System•Page 9 of 18 CommOriwealth,•Of Massachusetts= Title 5 official Inspection orm :IVot for i Volunta Pssessments Subsurface:5ewage Disposal System Form- y. 325;86stori Street,_ P(9peq Address 'k hartl'Vance - Owner 'O+wner's:Name - require tion ie -North Andover Ma 01845 4/13I202-'l required for exert' ' . . � - Ei frown State `Cade Date of inspection page: h' p:r D. System lnformation (cont), s 6. Septic Tank(locate:on site plan):= Depth be QW-grade: ,5,� - . .. �feei s Material'of coristructiori:. ®concrete. metal []fiberglass D polyethylene ❑other(explain) 1660 concrete tank with_covers t66"--from g ade i l if tank,ls metal,-jist.age: years. 1 Is:age.confirmed by a Certificate of Compliance?(attach a copy oF. rti ce icate) Q Yes .0. Vci Dimrzensfons: .11''X 5'10"-X 5'10" . Sludge depth: 3 Distance frotnIpp°of stud ge to bottom of outletApe or baffle 30". ` .,0r'1'�. ... ,scum thickness: Uistance,frorn top'of 5cumao'tOP:nf 6WEA We or baffle' Distance:from„bottom of scumto,bottom of-outlettee,o baffle 14' in, tiith"measure stick.arld.tei e- Howwere dimensions_.aetermined? - Co mments(on pumping,recorrirriendations, inlet and,outlet tee or baffle condition„siructurat integrity; liquid levets'as retate'd�to,outlet:invert, evidence of leakage;etc:): 1500,gollon concrete septic tank'with PVC inlet and outlet 'IL tank,n:work ng order with separation from inlet to,outlet,/ nd.eviderice.of;leakeage. recommend;purriping every two to three years depending on usage-and nurribe,of_occdpants t5irtsp.dx•rev:711612018 TiUeS gfr�al fnspaclron FGrtn SubsuifBca,Sewnge Oispasal,System'+'Page i0 or:18: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 325 Boston Street Property Address Richard Vance Owner Owner's Name Information Is required for every North Andover Ma 01845 4/13/2021 page. City/Town state Zip Code Date of lospection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: 0 concrete E) metal fiber ass El polyethylene other(explain), Dimensions, Scum thickness Distance from top of scu o top of outlet tee or baffle Distance,from bott , of scum to bottom of outlet tee or baffle Date of last pi ping: Date Commen on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid I els as related to outlet Invert, evidence of leakage, etc.)., & Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: 0 concrete D metal �fiibess polyethylene [I other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 15inap.40C TWe 5 OfficWl hspecWn Few Subsudace Serwage Disposm syaorn-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal-System Form-Not for Voluntary Assessments Y 325 Boston Street Property Address Richard Vance Owner Owners Dame —- -- require for is North Andover Ma 01845 4/13/2021 required for every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cunt.) Alarm present ❑ Ye ❑ No Alarm level'_ arm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and flo 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.): 6 outlet HD Concrete:D box level with four outlet pipes 1 little evidence of solids carryover 1 no evidence of leakage into or out of box 1 box has water levelers in outlet pipe D box in working order D Sox Is 12"below grade Mnsp.aon•rev.7rzs=1e Tub 5 O(Cictaf tnspsdlan Form:subsurface Sewage btsposd System•Pago 12 d1B Commonwee}th,of Massachusetts T01e 5 �C]ffici'a[ b Inspect or' Form Subsurface Sewage°Disposal System_Form Not for ry Volunta Assessments � 325 Boston:Street Property Address'" RidhardWr de. Owner'.. owner's Name inform dfor s North Andover, Ma ,Q1645- .. ._ -�4/13/202�1 requ[red far every .. P. 9e: Cityrrown, 5tata _- Zip Codk ::pale of Inspectlan D: System_Inforlrnatioin (cont): .: -- _ -� . 10. PUMP,Chambeu(locate on site-plan): r A f Pumps in.working-order: [], Yes:, [] Ne Alarms hworkir g order []. Yes; 0 No" CbhiMeh%.(note;cpridition of,_pUrho mber„condiU6h of pumps and appurtenances;etc.); *If pumps orralarms are not in,working order,'system is a=conditional pass. 1'l. soil AbsIqrpf jon System (SAS){locatb on Site:plan,excavation not;requ red) , If SAS:not,located, explain:why "Type- C leaching,'.pits number: El 1 hing:chambers number:. „] leach ing:galleries` number' } ® ieaching;trenches. n�.irnber, length: 4- 48',lon 0 leaching`fields n6 mber,,dimensions: [� overflow cesspool number: Q InhoVatlVe/altet iatiVe system Typelname of technology: I5snsp:dGC•.mv.72612018 U10 5 OfWa[Inspedian Form;Subsurface sewage QlspvssI System'-Pap,13 cf.18 .j i Commonwealth of'Massachusetts OWN Title 5 Official inspection .Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Boston Street Property Address Richard Vance Owner Owner's Name Information is North Andover Ma 01645 4/13/2021 Pgaited for every, Citylfown state Zip Code Date of Inspection D. System Information (cone.) 11. Soil Absorption System(SAS) (cant.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): drainfield found in green lawn area with slight slope so no to hold rain water / soils in good condition 1 no signs of hydraulic failure/ no ponding/ no damp soildt'grass is uniform in good condition Hi Cap infiltrator leaching trenches in working order see plan on:file/4 trenches 48'long 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 soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Mmp.doo•rev.71281201E Title 6 Official tnspeclton Form.Subsudaoe Sewage Disposel System•Page 14 0118 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 325 Boston Street Property Address Richard Vance Owner Owner's Name information is required for every North Andover Ma 01846 4/13/2021 page,. Cilyfrown State Zip Code Date of Inspection D. System Information: (cony.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note,condition of said, signs of !raulic failure, level of ponding, condition of vegetation:, etc.): isinsp doc-rev m6noia T09 5 Offidel InspecOon Farm:,Subsurface Sewage Disposal System-Page 15 of IS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Boston Street Property Address Richard Vance Owner Owner's Name information is required for every North Andover Me 01845 4/13/2021 page. myrrown state Zip Code Date of Inspedion 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 Whup.doc•rev.712MOIS Title S Offcriat tnspA.on Fomr Suhsecraee Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection .Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Boston Street Property Address Richard Vance Owner Owners Name Information is required for every North Andover Ma 01845 4/13/2021 page. Cityrrown State Zip Cade Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 45"+ 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: 2013 Date ❑ 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: Plans on file at BOH dated 2013 System is a gravity mound Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5€nsp.doc•rev.7126=18 Talo 5 Of dal tmpect€on Form:SubswA=Sewage Dispose]System•Page 17 or 18 tommwiwealth.of MassaohusOM Title 5. Off Mal Inspection, Fora -Subsurface.•Sewage-Disposal form-Not for.Voluntary Assessmen.is 325,Boston Street; Property Address Richard Vance Owner Owner's.Name - - information is NoCtl7 Andoyet. Me requited for:every Q1845 4/13/2021 Page, CityfTown State Zip Code Date of.lnspedion - . E;. Report Comple%enes`s Ch_eckiis# Complete all applicable sections of this form-inclusive of: A,,[rtspector'information::Complete:allFfelds:in thisisection.. ® B.,Cortiftati6n:Signed & Dated and 1,2,,3.:or 4'checked C. inspection,Summary: 1,2,3,.or 5 corrtpleted as appropriate 4'.(Faifu(e Crit6dti).and 6(Checklist)completed ® D.-System Information: For 8:TghtlFlolding Tank;--Pumping contract attached Fd�'14: Sketch,bf Sewage;Disposal System drawn on pg. 1- or attached For-15 Explanation&f estimated depth,to higa 9r94qjWqteF2 included" t5insg doc iev.712G12018 Tale S_O.filclal don on Form_Substance Sewage Disposal System 01g9.18¢f 18 a ✓��rro�r'd°1 r�ro r� , �,,.,ro ,yj,,.� �rru dTa°,,r+ I�;t ��r��� mf-�''„ � ��^ ,,., „�r,,;, ' rr k �Fgrs u i s,n i � t t7 a 3 ,+d� s�✓It Id�,�uo�i s o�� ski !fir!ai�u,r (I t^! r i; s � lrrr �/� Pik sr� u77d�s��ur�W � C=r fYrrfR ; s ,Q �'�rrr tnnrl'zi� 9r �r�;Xrla�✓�� �s� � ' { xn1 f e r tt rn 's vza�Fjnms a t r idtn ��r�a F i 9�t r 1 � u�r y T��� r�) �,��Yf✓�r�l�y✓ ���i rl�t r � v� i )� "f�7.' yi? 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"M" 2v, ; Pod ` y r J "r ` lyv P J} v u{r r ✓ r r ✓�� rrr r7su� (f4'a� !a � `� d n.+`'u'�J'�1"�a`'" ✓ st Yn lr��x�l�1l h°'r a(C j ,r i r { 7 ro .�" ,� li F d(7i✓ M , ; P� a m t r„ r KaerN 0�+,•ac y1Ar i f PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM--INSTALLATION CERTIFICATION The undersigned hereby certq that the Sewage Disposal System. constructed;( )repaired; By: U` [ (Print Name) Located at: 3 A 5 .BDS i7A/ (Installation Address) : Was installed in conformance with the North Andover Board of/Health approved plan,originally dated 7/13//3 and East revised on— bezel /�_ with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: Engineer Representative(Signature) And--Print Name Final Construction Inspection Date: Engineer Representative(Signature) And—print Name Installer: ...: (Signature) Date:��/ And--Print Name Enginere ignature) Date: _. PW/e-IP CHW/57717/VS c`/1, And—Print Name 1600 Osgood Street,North Andover,Massachusetts.01845 Phone 978.688.9540 Fax 978.688.847E We'h http://www.townofnorthandover.com Active Bldg Id 478ZO-33BOSTONSTREET U N U*1BUm Date 2/1SAM n e 1080577 01 Oycle 01 Aefim j� U8 Ser'Ams Ma1nt.. Acema t No.109OW Sewioe Cade Rate OWN Mtaltip mAheis MISCFEE ADMIN FEE 0.63518 7.82- 1A WTR WATER 01 ALL METER SIZE 60.41 111 I U8 Meter MaintengM Account Na 1090677 SeriatNo Status Location Brand Type Size YTDCm 45115M aAative ERTHH bBadger wWater 0.53Q63 18 Date Rearing Code CbmumOm AastedOate Variance 1/21/2021. 531 aActual 18 21231= 9% 10120/2m 513 aActual 17 111121Z020 2% 7/16/2020 486 aActual. 15 8/12/2020 4% 4/24/2020 481 aAetuil 17 5/13/2020 13*/* 11i712020 484 aActual 14 21101I020 •10% 10/18=9 450 aAcbW 15 i2/1812019 11% 7/22/2019 435 aActual 18 8/13/2019 10% 4A9/2019 417 aActual 16 5/15/m9 •11% 1/1712019 401 aA hW 17 2/18/2019 .2% 10/22mie 384 aActual 19 11M9/2018 23% 7/19/2018 365 aActual 15 8/15/2018 • 1.1 4/18/2018 350 a Actual 16 5/17/2018 2% 1/18/2018 334 aActual 16 2/20/2018 37F: 10/18120i7 318 aActual 25 11A312017 S7Z ?A9/211i7 293 aActual 15 - BA5017 1� 4/l9/2017 278 aAcW 15 5/17/2017 1119/2017 263 a Actual 15 2/16/2017 •15% 10/19/2016 249 aActuel 17 i111612015 24 7/22/2016 231 aActual 14 8/16/2016 •12% 4122I2016 217 aActual 1S 5126/2016 -5% . . : ::w,��w. . . . . �. . ®< : � »=�d �w - . _- ��\���/�^ � � / � � <fy> ���� � � � y � �- � ���% \ ©dt« . . . . .��� . .: .=« �y������\< . �m �z : ��_ � ������< -�. » � �2 � �\ � � : ��- :� � � . . . y6 � , � f (2p ° � am y : ( , £ �\ �} . l��ƒ � &d �> 1 C'ari g for your Septic:System.,A Rofdren:ce Guide for Homeowners.w GYngm yr Your pept ;System(Con ventionaf=Sept c.SyS#ern,'Iran,ovative!Alterriative:(!/A). S ste ',,or Coss oo1 The accumulated solids in•fhe„,bottom,.ofif e-s-eptIMtank;shouid be pumped out every, three years:#o. prolorg'the life_nf your system :Septic systems must be:maintalned regularly fo stay`workirag. Neglect ot-abise.,.of youtsySteth-can cause itto fail Fail.ing'§y-sfems:can cause.a serious.healfh:thteat�tci.your.family and neighbors; degrade:the en ironrr:ent; espe.cialfy;bakes,,:streams acid"grourldr' ter-, redt.ce the value of.your pr..oper=t�r; e ve ex ensive W.re air,b ry p p ands:put thousand of water supply users-,at risk if you:live irl a pudic water supply watershed and';fatl,to ffiwntairy:your system; Be:alert to these wammg signs o€:a failing system: 'sewage i6urf6cing ovel-the drajq eld (especially_after`storms); sewage_°back-:ups.in.(he house',: IusY�, green growth over the drainfiefd; • slow=draining toilets.or drains, sewage_odors ,. is r.M�t•r ��..;;r �r ."t ti ,. 1 � - `s � '9 't{:.��'�°::'Y� I.Y'H",,, S ��.•'4 S♦ +tai SY ;:: It:. (��'m0,3��pQlll};`GicS iy � gar•: s ;�t4r� , U'�i��i�.:.'i'px� �_. �(wl -... �'�1•fY � •1yZ'`1 .�C1:�,_{1 kA �'.if7 _` �3ftLc i`L'�':� �IM1Y.Yr����t i• �, l n � ,'1- y °Y' Y a��.'t.,�1�Z�1,t� 2 . - < < 1 *�4draliiOld a Tips to,Avoid Trouble bo have .your tank pumped:out and system. inspected ev 5 years by a licensed"septic contractor(fisted in .the-yeilbLW'pages):, httpsJlwww.townaf�ieW�uryorglpnnU47,1 - -'i13 1002020 Carin j foryour Septic System:A Reference Guide for Homeowners • DO keep 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 loam 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, leam.its location, and turn it once a year. Plow diverters can add many years to the fife 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. • DON'T 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, innovativelaltemative (I/A) systems, or cesspools)that use the soil to treat small wastewater flows, usually from individual homes..They are typically used in rural or large Iot settings where centralized 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 septicsystem treats your household wastewater by temporarily holding it in the septic tank. where heavy solids and lighter scum are allowed to separate from.the wastewater.This separation process is.known as primary treatment.The solids stored in the tank are decomposed by bacteria and later removed, along with the lighter scum, by a professional septictank pumper. After partially treated wastewater leaves the tank, it flows-into a distribution box, which separates this flow evenly into a network of drainfield trenches. Drainage holes at the bottom of each line allow the wastewater to drain into gravel trenches for temporary storage. This effluent then slowly seeps Into the subsurface soil where it is further treated andpurified secondary treatment).A properly functioning septic system does not pollute ^ groundwater.^ IN R a Town of North Andover, MA ,1)52.49 Paid aria Credit card enduing in 0897 Thanks for using the Online Service Center dean dynan Title 5 Official Inspection Form submittal#59877 May 8, 2021 Title 5 Filing Fee $50.00 Processing Fee 2A9 Total Paid $52.49 Powered by the ViewPcint Cloud platform Receipt number#27736