HomeMy WebLinkAboutPass - Title V Inspection Report - 337 PLEASANT STREET 5/10/2022 Commonwealth of Massachusetts ��01ti
� . Title 5 official Inspection Form Mai
ce Sewage Disposal System Form - Not for Voluntary Assessments N OF t& MEND
Subsurfa g P
T STREET
337 PLEASAN — —
Property Address
JOE CLARKE ----
Owner Owner's Name MA 01845 MAY 5, 2022
information ion
is NORTH ANDOVER —
required for every State Zip Code Date of Inspect
page. City/Town
Inspection results must be teckl st at theorm. Inspection end of he formforms may not be altered in any
way. Please see completeness h
Important:When q, Inspector Information
filling out forms
on the computer, Todd James Bateson ---
use only the tab
key to move your Name of Inspector
cursor-do not Bateson Enterprises Inc.
use the return Company Name
key. 111 Argilla Road --
Company Address MA 01810
trh
Andover State de
City/Town SI-16
r 978-475-4786 License Number
Telephone Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.a40 ess of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property
dd
listed above; the informato me of my
reported erformed based onmy training and ccurate and l experience ete as of einl
was he proper function
inspection; and the inspectionp
ge disposal systems. After conducting this inspection I have determine
and maintenance of on-site sewa
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
s Date
Inspectpr's Signature
of this inspection report to the Approving Authority (Board
The system inspector shall submit a copy
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow
region go or greater,the
The origi al inspector and
forthe
m should be sent to the sm owner shall ystem tem owner and the
copie appropriate
to
regional office of the DE g approving authority.
the buyer, if applicable, and the app 9
Please note: This reportat that time.This conditions at the time of inspection and under the
conditions of use inspection does not address how the system will perform
in the future under the same or different conditions of use.
Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
t5insp.doc•rev.712612018
Commonwealth of Massachusetts
�x Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
P'
337 PLEASANT STREET
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
— _
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
c Commonwealth of Massachusetts
p Title 5 Official Inspection Form
,11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�,
337 PLEASANT STREET
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVE MA 01845 MAY 5, 2022
---
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:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
,I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
� / 337 PLEASANT STREET
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
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
El ® 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
' Commonwealth of Massachusetts
�x Title 5 Official Inspection Form
`I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
0 337 PLEASANT STREET
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
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 1/2 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
fx ,� Title 5 Official Inspection Form
10 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�� 337 PLEASANT STREET
Property Address
JOE CLA_R_KE
Owner Owner's Name
information is NORTH ANDOVER MA 01845 MAY 5, 2022
required for every —
page. City/ own 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 C.4 above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no" for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ® Were as built plan 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)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
g
lie Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
337 PLEASANT STREET
v� —
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
-
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): NA -
Description:
Number of current residents: 6
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
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d SEE ATTACHED
9 ( Y 9 (gp ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: CURRENT
p y Date
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
c Commonwealth of Massachusetts
- , Title 5 Official Inspection Form
i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
337 PLEASANT STREET
u- - - -
Property Address
JOE CLARKE
Owner Owner's Name
information is NORTH ANDOVER MA 01845 MAY 5, 2022
required for every — ---- -- - -- --
page. City/Town 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): Gallons per day(gpd)
Basis of design flow (seats/person s/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: BATESON ENTERPRISES MAY 2021
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1500
gallons
How was quantity pumped determined? TRUCK GAUGE
Reason for pumping: REGULAR MAINTENANCE
t5insp.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
I1; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
........... , 337 PLEASANT STREET
Property Address
JOE CLARKE
Owner Owner's Name
information is NORTH ANDOVER MA 01845 MAY 5, 2022
required for every
page. City/Town 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:
JUNE 1981 AS BUILT PLAN
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 1 ---
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.):
JOINTS AND VENTING ARE GOOD
NO EVIDENCE OF LEAKAGE
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
337 PLEASANT STREET
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
Depth below grade: 8
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
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 4' -
Sludge depth: 4"
Distance from top of sludge to bottom of outlet tee or baffle 29
Scum thickness - --
Distance from top of scum to top of outlet tee or baffle 5.5
Distance from bottom of scum to bottom of outlet tee or baffle 12 -
How were dimensions determined? TAPE MEASURE AND
SLUDGE JUDGE
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
INLET AND OUTLET TEES GOOD
TANK IN GOOD CONDITION
NO EVIDENCE OF LEAKAGE
LIQUID LEVELS NORMAL
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Cam" Commonwealth of Massachusetts
Title 5 Official Inspection Form
lio Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
337 PLEASANT STREET
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
-- -
page. City/Town 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: bate
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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
337 PLEASANT STREET
Property Address
- -- - - -
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
page. City/Town 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 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-BOX LEVEL AND DISTRIBUTION EQUAL
NO EVIDENCE OF SOLIDS CARRYOVER
NO EVIDENCE OF LEAKAGE
t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 12 of 18
c4� Commonwealth of Massachusetts
�r Title 5 Official Inspection Form
P
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4,
337 PLEASANT STREET
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
—_
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:
® leaching fields number, dimensions:
1; 32' X 38'
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology: -- -
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
337 PLEASANT STREET _
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
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.):
SOIL OK
VEGETATION GOOD
NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING
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.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 14 of 18
` Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
337 PLEASANT STREET
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
-- -- __
page. City/Town 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
ti Commonwealth of Massachusetts
�x Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
337 PLEASANT STREET
Property Address
JOE CLARKE -
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
-----
page. Citylfown 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
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A- JV1 ( - I
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b- 6o y 3�
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t5insp.doc•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
I1b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
337 PLEASANT STREET
Property Address
JOE CLARKE
Owner Owner's Name
information is required for every NORTH ANDOVER MA _ 01845 MAY 5, 2022
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: 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: -pate
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health - explain:
NO DESIGN PLAN ON FILE
❑ Checked with local excavators, installers - (attach documentation)
® Accessed USGS database -explain:
ESSEX COUNTY SOIL MAP
You must describe how you established the high ground water elevation:
ESSEX COUNTY SOIL MAP PAXTON SOIL
DEPTH TO WATER TABLE > 6' DEEP
SYSTEM ABOVE WATER TABLE
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
337 PLEASANT STREET
Property Address
JOE CLARKE
Owner --
Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 5, 2022
page. CitylTown 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
w Summary Record Card generated on 4/29I2022 6:05:32 AM by Karen Hanlon Page 1
Town of North Andover
Tax Map # 210-095.0-0070-0000.0
Parcel Id 13665
337 PLEASANT STREET
JOSEPH & KRISTIN CLARKE
337 PLEASANT STREET
NORTH ANDOVER MA 01845
FY 2022
UB Mailing Index
Name/Address Type Loan Number Active/Inact. From Until
JOSEPH&KRISTIN CLARKE Owner Adiv,-�
337 PLEASANT STREET
NORTH ANDOVER MA 01845
STRATTON,WILLIAM B. Previous Customer Inactive 11/12/2004
337 PLEASANT STREET
N.ANDOVER,MA
01845
ALAN FREEDMAN Previous Customer Inactive 5/16/2019
337 PLEASANT STREET
NORTH ANDOVER,MA 01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 16257.0-337 PLEASANT STREET Last Billing Date 4/7/2022
3150264 03 Cycle 03 Active
UB Services Maint.
Account No. 3150264
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.63 5/8 7.82 1/
WTR WATER 01 ALL METER SIZE 114.85 /1
UB Meter Maintenance
Account No. 3150264
Serial No Status Location Brand Type Size YTD Cons
35644530 a Active HH#337 b Badger w Water 0.63 0.63 159
Date Reading Code Consumption Posted Date Variance
3/1/2022 281 a Actual 27 4/13/2022 24%
12/3/2021 254 aActual 23 1/17/2022 -24%
9/1/2021 231 a Actual 30 10/15/2021 20%
6/1/2021 201 a Actual 25 7/27/2021 2%
3/1/2021 176 aActual 24 4/21/2021 -20%
1211/2020 152 a Actual 30 1/13/2021 -6%
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Summary Record Card generated on 4/2912022 8:05:32 AM by Karen Hanlon Page 2
Town of North Andover
Tax Map # 210-095.0-0070-0000.0
Parcel Id 13665
337 PLEASANT STREET
JOSEPH & KRISTIN CLARKE
337 PLEASANT STREET
NORTH ANDOVER MA 01845
FY 2022
9/2/2020 122 a Actual 33 10/14/2020 68%
6/1/2020 89 aActual 19 7/15/2020 0%
3/3/2020 70 a Actual 19 4/8/2020 7%
12/4/2019 51 aActual 18 1/15/2020 -35%
9/4/2019 33 a Actual 28 10/10/2019 58%
6/4/2019 5 a Actual 5 7/25/2019 -100%
5/912019 0 f Final Bill 0 5/9/2019 -100%
5/9/2019 0 n New Meter 0 5/9/2019 -100%
5/9/2019 331 s Reset meter 1 5/9/2019 -100%
3/1/2019 330 a Actual 0 4/16/2019 -100%
12/4/2018 330 aActual 1 1/22/2019 -80%
9/4/2018 329 a Actual 5 10/15/2018 -26%
6/4/2018 324 a Actual 7 7/23/2018 11%
3/1/2018 317 aActual 6 4/23/2018 43%
12/1/2017 311 aActual 4 1/25/2018 -25%
9/6/2017 307 a Actual 6 10/18/2017 -37%
5/1/2017 301 aActual 9 7/25/2017 45%
3/1/2017 292 aActual 6 4/12/2017 3%
12/2/2016 286 a Actual 6 1/23/2017 -1%
9/1/2016 280 a Actual 6 10/24/2016 -26%
6/2/2016 274 a Actual 8 8/2/2016 38%
3/4/2016 266 a Actual 6 4/22/2016 -26%
12/2/2015 260 aActual 8 1/20/2016 -12%
9/1/2015 252 a Actual 9 10/16/2015 -9%
6/2/2015 243 a Actual 10 7/24/2015 40%
3/2/2015 233 a Actual 7 4/28/2015 -46%
12/2/2014 226 aActual 13 1/15/2015 33%
9/3/2014 213 a Actual 10 10/15/2014 25%
6/3/2014 203 a Actual 8 7/16/2014 -2%
3/3/2014 195 a Actual 8 4/11/2014 -1%
12/3/2013 187 aActual 8 1/17/2014 -8%
9/5/2013 179 a Actual 9 10/15/2013 12%
6/5/2013 170 a Actual 8 7/24/2013 -11%
3/5/2013 162 a Actual 9 4/22/2013 -3%
12/3/2012 153 aActual 9 1/9/2013 4%
9/5/2012 144 a Actual 9 10/15/2012 -9%
6/4/2012 135 a Actual 10 7/16/2012 -12%
3/2/2012 125 a Actual 11 4/14/2012 17%
12/2/2011 114 a Actual 9 1/17/2012 11%
9/6/2011 105 a Actual 9 10/13/2011 -5%
6/1/2011 96 a Actual 9 7/20/2011 -3%
3/1/2011 87 a Actual 9 4/13/2011 -7%
12/2/2010 78 aActual 10 1/12/2011 25%
9/1/2010 68 aActual 8 10/15/2010 -69%
6/1/2010 60 aActual 25 7/15/2010 20%
3/3/2010 35 a Actual 21 4/14/2010 133%
r 4 Summary Record Card generated on 4/29/2022 8:05 32 AM by Karen Hanlon Page 3
Town of North Andover
Tax Map # 210-095.0-0070-0000.0
Parcel Id 13665
337 PLEASANT STREET
JOSEPH & KRISTIN CLARKE
337 PLEASANT STREET
NORTH ANDOVER MA 01845
FY 2022
12/2/2009 14 a Actual 9 1/12/2010 23%
9/2/2009 5 a Actual 5 10/15/2009 0%
7/2/2009 0 n New Meter 0 10/15/2009 0%
7/2/2009 13 r Replacement 13 10/15/2009
7/2/2009 0 n New Meter 0 10/15/2009 0%
6/2/2009 7507 m Manual estimate 8 7/20/2009 -100%
3/4/2009 7499 m Manual estimate 0 4/29/2009 -100%
MSG
12/2/2008 3302 a Actual 11 1/20/2009 -5%
9/3/2008 3291 m Manual estimate 12 10/10/2008 96%
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• . ,� � Town of North Andover
�.,s .•�� HEALTH DEPARTMENT
SACNUS!
CHECK 4:3 98/ DATE: �S l� -20Z2
LOCATION: J 3 ���Q4
H/O NAME: Claz-t-e--
CONTRACTOR NAME:
Type of Permit or License: (Check box)
❑ Animal $
❑ Body Art Establishment $
❑ Body Art Practitioner $
❑ Dumpster $
❑ Food Service-Type: $ _
❑ Funeral Directors $
❑ Massage Establishment $
❑ Massage Practice $
❑ Offal(Septic)Hauler $
❑ Recreational Camp $
❑ Sun tanning $
❑ Swimming Pool $
❑ Tobacco $
❑ Trash/Solid Waste Hauler $
❑ Well Construction $
SEPTIC Systems:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
Title 5 Report A-15 j $50
❑ Other. (Indicate) $
lkaM Agent Initials
White-Applicant Yellow-Health Pink- Treasurer