HomeMy WebLinkAboutPass - Title V Inspection Report - 404 SUMMER STREET 7/15/2021 Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
404 Summer Street
Property Address
Jim Smyser
Owner Owner's Name
information is required for every North Andover Ma 01845 7/1/2021
page. City/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:When A. Inspector Information
filling out forms
on the computer, Dean Dynan
use only the tab
key to move your Name of Inspector
cursor-do not Dean Dynan
use the return Company Name
key.
2 Suntaug Street
,y Company
Address
Lynnfleld 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 16.340 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
y ✓"L7t6e z
I pector s Signature Date if I
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.7128/2018 Title 5 Official Inspection Forth:Subsurface Sawage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
404 Summer Street
Property Address
Jim Smyser
Owner Owner's Name
information is required for every North Andover Ma 01845 7/1/2021
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:
5 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 owing statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the se 'c tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration tank failure is imminent. System will pass
inspection if the existing tank is replaced with a co lying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection ' it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is ss than 20 years old is available.
❑ Y ❑ N ❑ (Explain below):
t5insp.doc•rev.7/2&2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18
�4 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 Summer Street
Property Address
Jim Smyser
Owner Owner's Name
Information is
required for every North Andover Ma 01845 7/1/2021
page. Cityfrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass wit Board of Health approval if
pumps/alarms are repaired.
El Observation of sewage backup or break out or i static water level in the distribution box due
to broken or obstructed pipe(s)or due to a b en, settled or uneven distribution box. System will
pass inspection if(with approval of Boar f Health):
❑ broken pipe(s)are replac; El Y El N El ND(Explain below):
❑ obstruction is remo d [I Y El N [I ND(Explain below):
❑ distribution b is leveled or replaced _] Y n N [] ND(Explain below):
el
El 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):
F] broken pipe(s)are replaced E] Y Ej N [] ND(Explain below):
E] obstruction is removed n Y El N D(Explain below):
3) Further Evaluation is Required by th oard of Health:
Evaluation is Required
red b
�D
y th oard
E] Conditions exist which requir rther evaluation by the Board of Health in order to determine if
the system is failing to pro ct public health, safety or the environment.
11
n
a. System will pas niess Board of Health determines in accordance with 310 CMR
15.303(1)(b)th e system is not functioning in a manner which will protect public health,
safety an environment:
15!nsp.doc•rev,7/W01 8 Tittle 5 official Inspection Form:Subsurface sewage Disposal System-Page 3 of 18
Commonwealth of Massachusetts
yx s� = Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 Summer Street
Property Address
Jim qrjjy§er
Owner Owner's Name
information is
required for every North Andover Ma 01845 7/1/2021
page, � — ----------------*ffown State Zip Code Date of Inspection
....................
C. Inspection Summary (cont.)
El Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetl r(d�ora salt marsh
b. System will fail unless the Board of Health (and Public W r Supplier, if any)
determines that the system is functioning in a manner th protects the public health,
safety and environment:
n The system has a septic tank and soil absorption stem (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a rface water supply.
[:1 The system has a septic tank and SAS an e SAS is within a Zone 1 of a public water
supply.
El The system has a septic tank and S and the SAS is within 50 feet of a private water
supply well.
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tic tank and and the A
The system has a septic tank d SAS and the SAS is less than 100 feet but 50 feet or
more from a private water suppl ell**.
Method used to determine di nce:
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�� 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
El 0 Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
El 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.7/2612018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
404 Summer Street
Property Address
Jim Smyser
Owner Owner's Name
information is required for every North Andover Ma 01845 7/1/2021
page. Cityfrown 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'/: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.]
El ® 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
El ® 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
t5insp.doc•rev.7JM018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
4C\ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 Summer Street
Property Address
Jim Smyser
Owner Owner's Name
information is North Andover Ma 01845 7/1/2021
every required for eve —------------------
page. i5ity—ffown 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
0 0 Pumping information was provided by the owner, occupant, or Board of Health
E] Z Were any of the system components pumped out in the previous two weeks?
Z El Has the system received normal flows in the previous two week period?
El 0 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?
0 El Were all system components, excluding the SAS, located on site?
1:1 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?
0 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:
z ❑ 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)1
t5insp.doc-rev.7126=18 Titio s official inspection Form:subsurface sewage Disposal system-Page 6 Of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface sewage Disposal System Form -Not for Voluntary .Assessments
z. V 404 Summer Street
Property Address
Jim Smyser
OwnerOwner's Name .. .._____.__...___......_.___....._,..___._.._.___.................._._..._.._..._._..____.__..___.._._..--------___,_w_w_._
information is _._.______,_.......__,..___.__.__...___. _.__.
required far every North Andover _ Ma 01845 7/1/2021
page, CityfTown State Zip Code Gate of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 5 — Number of bedrooms (actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550
Description:
5 Bedroom system with 1500 gallon tank/ pump chamber/ pipe in stone drainfield
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes N 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
g ( Y 9 (gpd)):
Detail:
see attached
Sump pump? ® Yes ® No
Last date of occu anc : currentate p Y [l
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
. ....I Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
404 Summer Street
l5r_opWj_Ad_d're_$s
Jim Sesser
Owner bwner's Name
information is North Andover Ma 01845 7/1/2021
required for every
page. CityrTown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203):
—dions per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): —-------
Grease trap present? Fl Yes ❑ No
Water treatment unit present? El Yes E] No
If yes, discharges to: .............
Industrial waste holding tank p sent? EJ Yes F-1 No
Non-sanitary waste disc rged to the Title 5 system? El Yes D No
Water meter readin , if available:
Last date of o upancy/use: date—..._.....--e
Other scribe below):
...........
3, Pumping Records:
Homeowner Board of Health
Source of information: not um ed since installation
Was system pumped as part of the inspection? ❑ Yes M No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
15insp.doc-rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
404 Summer Street
Property Address
Jim Smyser
owner Owner's Name
information is North Andover Ma 01845 7/1/2021
required for every
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:
12 / 2018 as per permit on file
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
20"
Depth below grade: feet
Material of construction:
❑ cast iron ®40 PVC ❑other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints,venting, evidence of leakage, etc.):
sewer pipe in good condition/ no evidence of leakage
t5insp.doc•rev.712=18 Title 5 Ofrxial Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
<L Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
404 Summer Street
Property Address
Jim Smyser
Owner Owner's Name
information is North Andover Ma 01845 7/1/2021
required for every
page. CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
2411
Depth below grade: feet
Material of construction:
0 concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
1500 concrete tank with cover to grade over filter
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
11'X 5'10"X 5'10"
Dimensions:
511
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle 3011
1-2"
Scum thickness
Distance from top of scum to top of outlet tee or baffle 611
Distance from bottom of scum to bottom of outlet tee or baffle 1*1
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 concrete septic tank with PVC inlet and outlet / Tank in working order with separation from
inlet to outlet / no evidence of leakeage
recommend pumping every two to three years depending on usage and number of occupants
filter in tank was cleaned during inspection / filter requires minimum annual cleaning to avoid back up
simple extraction rinse and reinsert
t5hsp,doc rev.712612018 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
404 Summer Street
Property Address
Jim Smyser
Owner Owners Nance
information is required for every North Andover Me 01845 7/1/2021
page. CitYfTown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: t
Material of construction:
El concrete El metal El fiber ZssC3yethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top scum to top of outlet tee or baffle
Distance fro bottom of scum to bottom of outlet tee or baffle
Date 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' spection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity: "X gallons
Design Flow: gallons per day
15hsp.doc•rev.7/2612018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Ftl i} Title 5 Official Inspection Form
_. _. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4❑ 404 Summer Street
Property Address
Jim Smser
Owner
Owner's Flame
information for
is North Andover Ma 01845 7/1/2021
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cant.)
8. Tight or Holding Tank (cant.)
Alarm present: ,Yes ❑ No
Alarm level; Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date —___...__......__....._..........w...._....._ _
Comments (condition of afar 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.):
6 outlet HD Concrete D box level with four outlet pipes / little evidence of solids carryover / no
evidence of leakage into or out of box/
D box in working order
D Box is 9" below grade
15insp.doc-rev,712612018 Title 5 official Inspection form:Subsurface Sewage(Disposal System•Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Farm
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
404 Summer Street
Property Address
Jim Smyser
Owner Owner's Name
information is required for every North Andover Ma 01845 7/1/2021
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.):
1000 gallon concrete pump chamber in working order/ cover to grade/electric in riser
*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:
® leaching fields number, dimensions: 1 @ 15'X50'
❑ overflow cesspool number.
❑ innovative/altemative system
Type/name of technology:
15insp.doc•rev.7fAM18 Title 5 Official Inspection fort:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
404 Summer Street
Property Address
Jim Sm ser. '
Owner Owner's Name
information is required for every North Andover Ma 01845 7/1/2021
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cant.)
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 not to hold rain water / soils in good condition /
no signs of hydraulic failure/ no ponding/ no damp soild/ grass is uniform in good condition
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.):
t5insp.doc•rev.7128r2018 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
" 404 Summer Street
Property Address
Jim Smyser
Owner owner's Name
information is North Andover Ma 01845 7/1/2021
required for every
page. Cityfrown 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, sXhyaulic level of ponding, condition of vegetation,
etc.):
tSinsp.doc•rev.7126=18 Tale 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 or 18
Commonwealth Of Massachusetts
........ Tide 5 Official Inspection Form
-X subsurface sewage Disposal System Form - Not for Voluntary Assessments
404 Summer Street
___.......___.....
Property Address
Jim Sm ser
Owner ___®___�__...._....____
Owner's Name
information is North Andover Ma 01845 7/1/2021
requiredfor every .........___.................._.._....------.-----._.__....._._.---..-----........----...---_,__...._._.. ._...,......_,._._.� ..._......._. __._._.__._..._
page. Clty/Town State Zip Code Date of Inspection
D. System Information (cant.)
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
lA- 6tfAQ
- 6
�
-7
t5insp.doc»rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage disposal System•Page 16 of 18
Commonwealth of Massachusetts
,y Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 Summer Street
Property Kidriiis..............
Jim Smy'ser
Owner Owner's Name
information is
required for every North a 01845 7/1/2021
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
Z Check Slope
Surface water
Check cellar
Shallow wells
Estimated depth to high ground water: EL 98.00-a-s-per_pjan on file
feet
Please indicate all methods used to determine the high ground water elevation:
z Obtained from system design plans on record
If checked, date of design plan reviewed. 2018
Date
El Observed site(abutting property/observation hole within 150 feet of SAS)
F-1 Checked with local Board of Health -explain:
F-1 Checked with local excavators, installers- (attach documentation)
F-1 Accessed USGS,database-explain:
You must describe how you established the high ground water elevation:
Plans on file at BOH dated 2018
System is a forced main mound
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
404 Summer Street
Property Address
Jim Smyser
Owner Owner's Name
information is required for every North Andover Ma 01845 7/1/2021
page. Cityfrown 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
Mup.doc•rev.7l26=8 Us 6 Official Inspection Forth:Subsurface Sewage Disposal System•Page 18 of 18
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9 ;Y E s ,, � JAY SOUSA 404 SUMMER STREET
s,.x 1 NORTH ANDOVER MA.01845
s i I jJt TAX MAP 107-A LOT 22
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JANUARY 4 2018
REVISED FEB. � 2018
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tip,
PUBLIC :HEALTH DEPARTMENT
Town of Norte Andover
Community and Economic Development Division
CER.TIFICA.TF OF
COMPLIANCE
As of: December 27, 2018
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Construct a new on-site Sewage Disposal System
By: John Chongris
.At: 404 Summer Street
Map 107.A Lot 22
North Andover, MA 01845
Th;an
ancZof * erti icate shall not be construed as a guarantee that the system will function satisfactorily.
BLaGrasse
Director of Public Health
120 Main St.,North Andover,Massachusetts 01845
Phone 978,688.9540 Fox 978.688.9542 Web www.nortliaiidoverma.gov
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Summary Record Card generated on Wal2021 8:06:02 AM by Sharon Coco Page i
Town of North Andover
Tax Map # 210-107.A-0022-0000.0
Parcel Id 17848
404 SUMMER STREET
LEIGH &JAME SMYSER
404 SUMMER STREET
NORTH ANDOVER MA 01845
Class 101 Single Family Property Type 1 Residential
Size Total 1.01 Acres
FY 2021
UB Mailing Index
Name/Address Type Loan Number Active/inact. From Until
LEIGH&JAME SMYSER Owner Active
404 SUMMER STREET
NORTH ANDOVER MA 018,%
VARNUM JR,THOMAS `` Previous Customer Inactive 10/27/2017
410 BLUE RIDGE ROAD
NORTH ANDOVER,MA
01845
PTARMIGAN LLC Previous Customer Inactive 5/10/2019
4 MONTCLAIR AVENUE
ANDOVER MA 01810
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id.14239.0-404 SUMMER STREET Last Billing Date 6/9/2021
2100235 02 Cycle 02 Active
UB Services Maint.
Account No.2100235
Service Code Rate Charge rfultiplier/Users
MISCFEEADMIN FEE 0.63 5/8 7.82 1/
WTR WATER 01 ALL METER SIZE 41.80 /1
UB Meter Maintenance -
Account No.2100235
Serial No Status Location Brand Type Size YTD Cons
49557826 a Active HH#404 b Badger w Water 0.63 0.63 20
Date Reading Code Consumption Posted Date Variance
5/5/2021 291 a Actual 11 6/15/2021 26%
2/4/2021 280 a Actual 9 3/16/2021 -89%
11/3/2020 271 aActual 82 12/16/2020 82%
8/4/2020 189 eActuai 47 9/9/2020 378%
5/1/2020 142 aActual 9 6/10/2020 6%
2/4/2020 133 a Actual 9 3/16/2020 -76%
11/4/2019 124 a Actual 39 12/23/2019 -53%
8/2/2019 85 a Actual '4 82 9/26/2019 -100%
5/2/2019 3 f Final Bill 0 5/6/2019 -100%
2/4/2019 3 a Actual 3 3/19/2019 -100%
11/2/2018 0 aActual 0 12/12/2018 -100%
8/24/2018 0 n New Meter 0 9/20/2018 -100%
11/1/2017 1037 aActual 0 12/29/2017 -100%
10/18/2017 1037 f Final Bill `0 10/18/2017 -1009A
8/2/2017 1037 a Actual 1 9/20/2017 -52%
6/2/2017 1036 a Actual 2 6/26/2017 30/o
2/2/2017 1034 a Actual 2 3/14/2017 -78%
li/2/2016 1032 aActual 9 12/19/2016 -25%
8/3/2016 1023 a Actual 12 9/21/2016 1%
5/4/2016 1011 a Actual 12 6/21/2016 -8%
2/2/2016 999 a Actual 13 3/2812016 -2%
11/2/2015 986 a Actual 13 12/3012015 -18%
8/4/2015 973 a Actual 16 9/14/2015 -16%
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
__L_AA,11 JAUJA
------------
wnf'wjlo r4c%6s
!o di5lnhboa
ta:r vdd;a�n field
Tips to Avoid Trouble
o DO have your tank pumped out and system inspected every 3 to 5 years by a licensed septic
contractor (listed in the yellow pages).
iitips://www.towriornewbury.org/pririt/471 1/3
10/6/2020 Caries§for your Septic Systdm: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,'avold long showers, and use water-saving features
in faucets, shower heads and toilets.
• DO learn the location of your septic system and drainfteld. 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.
• DON'T allow anyone to drive or park over any part of the system. The area over the drainfjeld
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, plastid, etc.
Poisons
gasoline, oil, paint, paint thinner, pesticides, antifreeze, etc.
Septic System Explained
Septic systems are individual wastewater treatment systems (conventional septic systems,
innovative/altemative (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 lot 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 septic system 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 septic tank 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�rther treated anenches for d rary purified {secondary treatment) A properly
e. This effluent then seeps
into the subsurface soil where it its
functioning septic system does not pollute the groundwater.