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HomeMy WebLinkAboutPass - Title V Inspection Report - 544 FOSTER STREET 5/2/2023 xf Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm-Not for Voluntary Assessments 544 FOSTER STREET ._.____ .._.._w___.... .. _ __..._.._ _............. _..._.___.__._.... _ ._._...... � _.__ ..___..._..__..._.._.._____...__._ Property Address TUNG PRAM Owner Cwner's Name information is NORTH ANDOVER MA 01845-____ APRIL 11, 2023 required far every _.: . ....___.._ .-....._ ,.._..�._.,-.-__._._.__._.___-r._._._. page. City State Zito Code Coate of Inspection Inspection results must be submitted on this farm. Inspection farms may note altered in any way. please see completeness checklist at the and of the form. Important:When filling out forms A. Inspector Information m , an the computer,use only the tab Todd James Bateson Name of ire to move our _Ba_teso Enter uses Inc � use the return pe.,.. ._..,. _.. ..,.._.. . . Ll ��� . Y y cursor-do not t use Company Name key 111 Ar ills Road VQ Company Address Andover MA 01810 tr City/Town State Zip Code rtwarm t 978-47 -4786 I-16 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 CHOIR 15.000); l 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. Z Passes 2. [ Conditionally Passes 3. ® Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails l APRIL 27, 2023 _.. _ _ ........... _ __. _ ...._...... ._ inspe tdr's Signature Coate 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 farm 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. t5map,doc-rev.712612018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-page f of 78 w Commonwealth of Massachusetts H�, = e) Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 544 FOSTER STREET Property Address TUNG PRAM Owner Owner's Name information is NORTH ANDOVER MA 01845 APRIL 11, 2023 required for every page. Ctty/Town State Zip Code Date of Inspection C. Inspection WSummlary _ _._ 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): tuinsp,doc-rev 7126/2018 i ale 5 officia6 Inspection Form,Subsurface sewage Msposal System•Page 2 o4'18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments .. 544 FOSTER STREET F'r op,eily Address TUNG PHAM C7wner Owner's Name requiratufooin oe NORTH ANDOVER MA 01345 APRIL 11, 2023 page. for every _ _ ... ._...._ a e. y State Zap Code Date of Inspection Ctt !Town C. Inspection Summary (cant.) 2) System Conditionally Passes (cant.): FI 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). E] broken pipe(s) are replaced F� Y [:1 N [I ND (Explain below): El obstruction is removed 0 Y 7 N 0 ND (Explain below): distribution box is leveled or replaced ❑ Y ❑ N [j 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 7 N ( ] ND (Explain below): [ obstruction is removed Y F� N ND (Explain below): 3) Further Evaluation is Required by the Board of Health El 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: o5inst,doc•rev 712612018 Tit[,»5 Official ksbaped(orr Form Subsurtatr a sewage C7fs.„osat;Systern-Sprigs 3,of 18 Commonwealth of Massachusetts �4 Title 5 Official Inspection Form �t Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 544 FOSTER STREET Property Address TUNO PRAM Owner Owner's P ame required is NORTH ANDOVER MA 01845 APRIL 11, 2023 required far every .. ............�. _... page dty'�sown State Zip Code Gate of Inspection _ . ....._... _._..,._..___,_.__._,_ C. Inspection Summary (cent.) Cesspool or privy is within 50 feet of a surface water Ell Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt rnarsh 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. F-1 The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 0 The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well", Method used to determine distance: " This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or l ® clogged SAS or cesspool 0 z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool f"whmxasgt.doc: rev 7m26V2018 y(fire 5 C"ftcl al IIns w tion Form Sutm.&f ac.o Sew ago Di1 i,wanmaaf Sy siery•Page 4 of 18 w Commonwealth of Massachusetts �p Title 5 affic"al Inspection Farm Subsurface Sewage Disposal System Form Not for Voluntary assessments Al 544 FOSTER STREET Property Address TUNG PHAM Owrner ...... Qwner's Narne required ie NORTH ANDOVER MA 01645 APRIL 11, 2023 informationired for every _ .._.... .... -- - _ page. City/Town State Zip Code Date of Inspection ...._.,..__._,_......_..... C. Inspection Summary (cant.) 4) System Failure Criteria Applicable to All Systems: (cant.) Yes No D z Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 1:1 z Liquid depth in cesspool is less than 6" below invert or available volume is less than "/2 day flow ❑ Z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: E] ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation, F� z Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. E] z 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. El Z 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 CEP certified laboratory, for fecal collform 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. El Z 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 2.00 feet of a tributary to a surface drinking water supply El 17 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 ¢,56ns p.d"•rev.712612'018 1'€96e 5 O6tlrr,rral 4nspnaut cn Form,Sritwea lace Sewage 8yoeposa[systei''T M Pap 5 of le Commonwealth of Massachusetts It Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 544 FOSTER STREET Property Address TUNG PHAM Owner _. -a' _. ......w..._ . . Owner's Marne ---- requiration is NORTH ANDOVER MA 01845 APRIL 11 2023 required for every _ _._ _ _ -- __ .... _ ._.._.. .. page. CttylTown 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 at/inspections: Yes No ❑ 7 Pumping information was provided by the owner, occupant, or Board of Health ❑ Z 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? F1 Z Have large volumes of water been introduced to the system recently or as part of this inspection? Z ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were ali 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? ® 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® Q 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 InspectBon Form,Subsurfaces Sewage Disposal System•Page 6 of 18 <; Commonwealth of Massachusetts T'le 5 Official Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 544 FOSTER STREET ._..._ ......._. w.. ......_ Property Address TUNG PHAM oweroer owner's Nanie information is NORTH ANDOVER MA 01845 APRIL 11, 2023 required for every page. City/Town _ State Zip Code Date of Inspection _.._w__..... .,.,_....._..,..,.._w.,..., ._...m .. v. _... _..w_..__.......,....._.. _... _ . D. System Information 1, Residential Flow Conditions: Number of bedrooms (design): 4 — Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x##of bedrooms): 440 GALLONS Description: Number of current residents: 4 Does residence have a garbage grinder? El Yes E No Does residence have a water treatment unit? ❑ Yes Z No If yes, discharges to: Is laundry on a separate sewage system? (include laundry system inspection 7 Yes Z No information in this report.) Laundry system inspected? ® Yes F] No Seasonal use? El Yes Z No SEE ATTACHED Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Z Yes 0 No Last date of occupancy: CURRENT Date t„rnsp idoic rev-7t;2E3f2016 Title 5 4;Mmpal hspreur ton Form 'Subscm, ace S4iwago Disposal SyMeern-Page 7 of 18 ;� Commonwealth of Massachusetts etts IT Title 5 Official Inspection Form }n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �� < ✓ 544 FOSTER STREET Property Address TUNG PHAM Owner _...w. Qner's Name . requiredfo is N0RTH ANDOVER MA 01545 APRIL 11 2023 required far every page„ City/Tow n State Zip Code Clete of Inspection D. System Information (cant.) 2. Commercial/industrial Flow Conditions: Type of Establishment; ----------- Design flow(based on 310 CMR 15.203): 11 _. aifa 11 rrs per day Ggpd) Basis of design flow (seatslpersonslsq.ft., etc.); Crease trap present? El Yes 0 No Water treatment unit present? 0 Yes E] No If yes, discharges to: _..... Industrial waste holding tank present? ( Yes ] No Non-sanitary waste discharged to the Title 5 system? Yes F-1 No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): ,.. .......... _ _....., 3. Pumping Records; Source of information: Jt9NE 2021 OWNER Was system pumped as part of the inspection? Z Yes ❑ No If yes, volume pumped: galio1500 GALLONS How was quantity pumped determined? TRUCK GAUGE Reason for pumping: MAINTENANCE t56rrW doc•raw 7/26P2018 T'ttla 5 of6aom lnsre:amcE on 4"o6m:Subsurface Sewage Cbdsposal System-Page 8 nt 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm Not for Voluntary Assessments 544 FOSTER STREET .. Property Address TUNG PHAM Owner Owner s Name information is NORTH ANDOVER MA 01845 APRIL 11„ 2023 required for every . . _ .. _ page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 4. Type of System: El Septic tank, distribution box, soil absorption system El Single cesspool Overflow cesspool E] 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 El Tight tank. Attach a copy of the DEP approval. El Other(describe): FAST MEDIA AND PRESSURE DOSING LEACH FIELD Approximate age of all components, date installed (if known) and source of information: 21 YEARS OLD, INSTALLED MAY 22, 2002, AS BUILT Were sewage odors detected when arriving at the site? ❑ Yes � No 5. wilding Sewer(locate on site plan): 3" Depth below grade: feet Material of construction: [� cast iron E 40 PVC F1 other(explain): Distance from private water supply well or suction Nine: feet Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS GOOD VENTING GOOD NO EVIDENCE OF LEAKAGE t5inspadoc rev 7126)2018 rPtPfe 5 Ctf`ioal Orrspoaaion Faaapeti.Siubsurfaatt Sewage Omp'oral systern-Page 9 of 18 Commonwealth of Massachusetts Tide 5 Official Inspection Form n Subsurface Sewage Disposal System Farm Not for Voluntary Assessments 544 FOSTER STREET Property Address TUNG PHAM Owner ._. _.._.....__..............__ _ . ._ .._ ..._ Owner s Name information`Is NORTH ANDOVER MA 01845 APRIL 11, 2023 required for every ._....... m..._.... ...._..._ _ page. Cityitown State Zip Code Date of Inspection D. System Information (coa7t.)____.___._.__...___.._............._.___�__ 6. Septic Tank (locate on site plan); Depth below grade-, 1 " fleet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) MAN HOLE COVERS TO GRADE if tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10' 5' X 4' Sludge depth: V _ ........._... _. Distance from top of sludge to bottom of outlet tee or baffle 37 Scum thickness 6„ Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 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.): RECOMMEND PUMPING YEARLY PLASTIC INLET TEE GOOD, CONCRETE OUTLET BAFFLE GOOD NO EVIDENCE OF LEAKAGE NORMAL LIQUID LEVELS TANK IN GOOD CONDITION t5insp,doc-rev.'7126/2 J18 Title 5 O ictW InspectPon Form Subsurface Sewage Disposal Systern-Page 10 of 18 . Commonwealth of Massachusetts Title 5 official Inspection Farm - µ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <� 544 FOSTER STREET Property Address TUNG PHAM Owner owner"s Dame required is NORTH ANDOVER MA 01845 APRIL 11, 2023 required for every _..__.._ -........._... _ . page. Cltiaown State Zip Code Date of Inspection D. System Information (cant.) 7. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete F-1 metal ❑ fiberglass ❑ polyethylene F-1 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: 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: gal Ion s..._.__ Design Flow: .._. per_ _ _.... _.._. ._ .._..._. gallons day t5iinsp,doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of'18 F Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Farm Not for Voluntary Assessments 544 FOSTER STREET Property Address TUNGPHAM Owner _ Owner's game information is required for every NORTH ANDOVER MA 01845 APRIL 11, 2023 _ ._....._. page. Clty/Town State Zip Code Date of Inspection D. System Information (caret.) — & Tight or Holding Tank (cant.) Alarm present: ❑ Yes ❑ No Alarm level: ------ ....................._._..._.—_._._ Alarm in working order: ❑ Yes M No Date of last pumping: _._- e ------------ Dat Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? El Yes 0 No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert NA 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.): PRESSURE DOSING SYSTEM, NO D-SOX. t5insp.doc•rev.7/26J2018 Title 5 Official Inspe0on Form Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts _ ,p Title 5 Official Inspection Farm Subsurface Sewage Disposal System Farm Not far Voluntary Assessments � p � Y � .„ 544 FOSTER STREET _ __....._ _. _ --- --.__-__ _ ._ __. _._ _.-. _,. _ ...._. _............ . ..... Property Address TUNG PHAM Owner Owners Name information is NORTH ANDOVER MA 01845 APRIL 11, 2023 required far every :.._ ._...._..._ _..-.__.... ...... .....__.__...-......._ .._-...__ page. CttyfTawn State Zip'code 'Date of Inspection D. System Information (Cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: Yes E] No* Alarms in working order: Z Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): PUMP CYCLED ON THEN OFF FLOATS IN WORKING ORDER * 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: __...__.._... Q leashing galleries number: _.. ❑ leaching trenches number„ length: leaching fields number, dimensions: 1; 36'X 41' ❑ overflow cesspool number: ® innovative/alternative system Type/name of technology: FAST MEDIA TO PRESSURE DOSING LEACH FIELD t5insp,doc-rev.7126/2018 'title 5 Official Inspection Form,Subsurface Sewage Disposal System-Pages 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !� 544 FOSTER STREET Property Address TUNG PHAM Owner Cbwner"s Name required is NORTH ANDOVER MA 01845 APRIL 11 2023 required far every _. ... page. City/Town State Zip Code gate 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.): SOIL AND VEGETATION GOOD NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING DUG TEST HOLE IN FIELD„ STONE DRY ANNUAL CONTRACT ATTACHED FOR MAINTENANCE OF FAST SYSTEM 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 M Yes 0 No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): . t5gnsp doz^rev,7!'26;2018 "Ole 5 oT'i barf G0%w„tram Form Subsurface Sewage DiNxmW Systw n•Page 14 Fro 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 544 FOSTER STREET Property Address .._.__..._........ TUNG PHAM ._s PJame._.._____.____.._...._.._. Owner C7wner' information is required for every NORTH ANDOVER MA 01845 APRIL 11 2023 _._. ...__.___._.. page CttylTown 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.): _ . _. .. . _ ......... t;,insp.doc•rev,7/261201 B Title 5 Off ckal Inspection Form:Subsurface Sewage 11sposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 544 FOSTER STREET Property Address TUN PHAM Owner Owner's_Larne - 'information is MA 01845 APRIL 11, 2023 NORTH ANDOVER Zip Code b­___.______ required for every ate of Inspection page. _67it—y/tow—n 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: Z hand-sketch in the area below F1 drawing attached separately pkc�c__ ku, 4 A -�cva�u,2, 4e-) Ir L Dolt, AQ tilje= 0 TA't Title 5 Official inspection Formr.Subsurface Sewage Disposal System•Page 16 of 18 15insadoc-rev.712612018 we Commonwealth of Massachusetts n T itle 5 Official Inspection Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments µ 544 FOSTER STREET Property Address TUNG PHAM Owner Owner's Dame _ information s NORTH ANDOVER MA 01845 APRIL 11, 2023 required far every .. ........_._. ..... ... _.._. page. Cttyirfawn State Zup Code Date of Inspection ......,.._..System Information (cont.) 15. Site Exam: El Check Slope Surface water Z Check cellar Shallow wells Estimated depth to high ground water: teat 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: NC7VEMBER 15, 2000 Date Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health - explain: DESIGN PLAN ON FILE Checked with local excavators, installers - (attach documentation) El Accessed USGS database-explain: You must describe how you established the high ground water elevation: DESIGN PLAN ON FILE Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15nsp.doc^raw.712V2018 11t6e 5 Off'tc,m Wrt4wrtton krorrrw.Subsurdace Sewage r)isttmal System-Page I,'od 18 Suunmwy Rowd Card genwated On 4MW2023 6:49 46 AM by Karen Ha,Oon Page I Town of North Andover Tax Map # 210-1043-0004-0000.0 Parcel Id 16333 544 FOSTER STREET TUNG & COURTNEY PHAM 544 FOSTER STREET NORTH ANDOVER MA 01845 Class 101 Single Family Property Type I Residential Size Total 0,695 Acres FY 2023 ....... ... UB Mailing Index Name/Address Type Loan Number Activelinact, From Until TUNG&COURTNEY PHAM Owner Ac€w! 544 FOSTER STREET NORTH ANDOVER MA 01845 HERMAN, KAREN Previous Customer inactive 1/17/2018 544 FOSTER ST NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id, 18085.0-544 FOSTER STREET Last Billing Date 415/2023 3180113 03 Cycle 03 Active UB Services Maint. Account No, 3180113 Service Code Rate Charge Multipiler/Users MISCFEE ADMIN FEE 0.63 5/8 7.82 1/ WTR WATER 01 ALL.METER SIZE 6080 0 UB Meter Maintenance Account No. 3180113 Serial No Status Location Brand Type Size YTD Cons 44152938 a Active 00 ERT HH b Badger w Water 0.63 0,63 201 Date Reading Code Consumption Posted Date Variance 3/9/2023 699 a Actual 16 4M 212023 -12% 12/8/2022 663 a Actual '17 1116/2023 -28% 9/14/2022 666 a Actual 27 10118/2022 49% 6/9/2022 639 a Actual 17 7/18/2022 -11% 3/10/2022 622 a Actual 19 4/13/2022 17% 12/9/2021 603 a Actual 16 1/17/2022 -42% 9/10/2021 587 a Actual 29 10/15/2021 16% 6/8/2021 558 a Actual 24 7/27/2021 33% Summary Rocord Gard ganef ated or)40012023&49:46 AM by Karen I I a nlon Page 2 Town of North Andover Tax Map # 210-1043-0004-0000.0 Parcel Id 16333 644 FOSTER STREET TUNG & COURTNEY PRAM 644 FOSTER STREET NORTH ANDOVER MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 0,695 Acres FY 2023 3/10/2021 534 a Actual 18 4/21/2021 2% 12/10/2020 516 a Actual 18 1/13/2021 -33% 9/9/2020 498 a Actual 27 10/14/2020 27% 6/9/2020 471 a Actual 21 7/15/2020 58% 3/10/2020 450 a Actual 13 4/8/2020 14% 12/12/2019 437 a Actual 11 1/16/2020 -53% 9/17/2019 426 a Actual 26 10/10/2019 98% 6/1412019 400 a Actual 13 7/25/2019 -31% 3/12/2019 387 a Actual 18 4/16/2019 27% 12/12/2018 369 a Actual 14 1/2212019 -26% 9/14/2018 355 a Actual 20 10115/2018 22% 6/12/2018 335 a Actual 16 7123/2018 -2% 3/12/2018 319 a Actual 11 4/23/2018 50% 119/2018 308 f Final Bill 14 1/16/2018 -16% 9/13/2017 294 a Actual 13 10/18/2017 -11% 6/1312017 281 a Actual 15 7/2612017 -27% 3/10/2017 266 a Actual 19 4/12/2017 2% 12/12/2016 247 a Actual 19 1/23/2017 -47% 9113/2016 228 a Actual 35 10/2412016 152% 6/1712016 193 a Actual 15 8/2/2016 3% 3/14/2016 178 a Actual 14 4/22/2016 1111/0 12114/2015 164 a Actual 13 1/20/2016 -33% 9/11/2015 151 a Actual 19 10/1612015 46% 6/11/2015 132 a Actual 12 7/24/2015 9% 3/18/2015 120 a Actual 12 4/28/2015 -3% 12/15/2014 108 a Actual 12 1/15/2015 -57% 9Y1612014 96 a Actual 30 10/15/2014 169% 6/12/2014 66 a Actual 11 7/1612014 -1% 3/13�/2014 55 a Actual 11 4/11/2014 -26% 12113/2013 44 a Actual 15 1117/2014 -17% 9/13/2013 29 a Actual 18 10/15/2013 13% 6/14/2013 11 a Actual 11 7124/2013 -71% 4/12/2013 0 n New Meter 0 7/24/2013 -100% 3/20/2013 928 rn Manual estimate 50 4122/2013 85% 12/26/2012 878 ni Manual estimate 30 1/9/2013 26% 9/24/2012 848 rn Manual estimate 25 10/15/2012 15% 6/16/2012 823 rn Manual estimate 20 7/16/2012 21% 3/20/2012 803 ry)Manual estimate 15 4/14/2012 27% MSG 12/2912011 788 n,i Manual estimate 15 1/17/2012 -45% MSG 9116/2011 773 a Actual 25 10M312011 97% 6/13/2011 748 a Actual 12 7/20/2011 -20% 3115/2011 736 a Actual 15 4113/2011 0% n AST S"YSTEM R0UTINE INSPECTION ADDRESS: 544 Foster Street North Andover OWNER: Phtarti DATE: Noveiriber 4 2022 OPERATOR: Mario Rosa SYSTEM STATUS Septie 'rank Isr Compartment 2nd Compartment SCunl Depth: _..__._.�12"/48"__ 01/48" Sludge Depth: _ 6"/48" ..u.0 __.._m 16" 8" Tank Condition: NIA N/A. (Measured on November 4, 2022) (See comments) E+ASI' Air Pump Amperage Setting: 2.9 atxltr� Pump Condition: Air Cleaner: Cleaned Dosing Tank Pump 1-OA Setting;: �_. Auto adnel zq ho;lxs Alarm Selector: _W._. � _ On tested _ Exercise Pump: Yes Test & Clean bloats: _....�_...w.. O.k., clean _. Tank Conditiow Good Effluent quality Viscral Inspection: _..__.._._.,�..__ Clear,_,l)o odor Sample: ate;"_f j�issc�lved Qxyg�n ;C)2 r ),/t L 'I'grbiciit,y 4JO l'�"1`U Comments: Rc:c:c>zija:nenduan I.a & 2'°`a cplaig tmniei t o se a�t�cJank. Signature: _nw ._.._. ....._w.._... __...µ. Certificate# 15652 PCB Box 825, Ipswich, MA 01938 978- 6-0779 " Fax 97 -356-5500 wwwwxM earwatereN dustrios.mm loose ro otres FIELD INSPECTION & SERVICE REPORT FAST- wastewater treatment systems INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address 544 Foster Street,North Andover Name Clear Water Industries Owner Narne Tung&Courtney Pharn Street 22 Mitchell Road, Ipswich Mail Address 544 Foster Street Mail Address P.O. Box 825 City North Andover State, MA Zip 01845 City Ipswich State MA Zip 01938 Phone Fax Phone (978)356-0779 Fax (978)356-5500 E'.-rnail E-mail in fb(r clearw aterind u stri es.corn INSTALLATION INFORMATION Model No. Serial No, Date of"Installation Date of last purnpout MAINTENANCE PERFORMED EQUIPMENT` YES NO AND COMMENTS Electrical Panel(s) Visual Alarm Operating X Audio Alarm Operating X (it" resent) Blower(s) Air Inlet Filter Clean X Blower flood Vents Clear X Excessive Noise Excessive Vibration X Treatment Unit(s) Unusual Odor X Purnpout Required: I Primary Settling Lone X Aerobic Treatment Zone X EFFLUENT(options) LIMIT RESULT Estimated Daily Flow pH(Standard Units) 6-9 S.L.J. pi 1 6,8, Dissolved Oxygen n=4.02 Ing/1,TUrbidity 430 NTLJ Color Clear Temperature Odor No odor OWNER SIGNATURE TECHNICIAN SIGNATURE SERVICE DATE 7' November 4, 2022