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Home My WebLink AboutConditional Pass - Title V Inspection Report - 386 SHARPNERS POND ROAD 4/25/2023 Commonwealth of Massachuseft Title 5 Official Inspection Form r� subsurface sewage Disposal system Form Not for Voluntary Assessments 386 SHA4PNFRS PONCE ROAD Property Address ' ALISONNAFTAL . __..._...._. ..._ .... .. __....... ._ ..__ .._ ......_. . _..: ..._ . ._......._. .. . MA g145_...-__ APRI Owner Ciw�ner"s Name iM information is NORTH ANDOVER L 18 2C123 required for emery ___._ _....... _ _ State Zip Code mate of Inspection paw CctyFTown __ _._.... 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 Inspector Information filling out forms on the computer,, Todd games Bateson _..._....... use only the tab _._...._..... key to move your Name of Inspector cursor-do not Bateson Enterprlses_!�. .._ ._..._ .._. _.._._ .. _.__......... use the return _...._`m__._ Company Nacre key. 111 Ar Illa Road r �iimpany Address C11810 Andover MA _.._m. ......_ ... . _t .._ Zrp Code it .. ._.. .._..__.._._... ...... ..ry ..,......_._..... �....___ Staleate 978-475-4786 SI16 ne Numb er _.....__.. __..... ...... _.w,..._.. .. _ .._..,.._ _. k.I can se Number Tekepfro B. Certification I certify that: I am a DEP approved system Inspector In full compliance with Section 16.340 of Title 5 (310 CMR 16.000); I 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. E] Passes . Conditionally Passes 3, Needs Further Evaluation by the Local Approving Authority 4. [ Fails APRIL 18 2023 _ _ .. ...._ _.... .._.._....,_.�... _.. gate Iris._ or°s Sign Lire 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 1 o„00 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. 1'6k4s Cz oRkW hapedion 8 :Subasaprlacs Sewage D40SW SYStem-POP I Of 98 t6msp,doc•rev,712612018 �i Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments � P Y ry !� 386 SHARPNERS PONE? ROAD Property Address ALISON NAFTAL Owner Owner's Nameinform _ required is NOR-f H AI, ROVER MA 01845 APRIL ,18 2023 required for every .,...._._ _ _ _._.__ page. Cltyrfown 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: 1 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: r7l 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): Iri nsp,doc•rev 7/26/2018 'rrtles 5 Off oal Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts iQra µ 1 Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments W 386 SHARPNERS POND ROAD Property Address ALISON NAFTAL Owner _.. .... ..._ ._ Owner's Name .. .,.... ._.. _ ,... required for is NORTH ANDOVER MA €i18 5 APRIL ,18 2023 req�aeredforevery __ ., ... .. _ _.... _.......... . . .. ._ page. City[Town State Zip Code Crate of Inspection u...._ . ..__._._... _ ...._ . W__...... .... .__w_ _. _..__.. _ _..._.__....... ._....___------ _.__...._.. .. __....._...._ C. Inspection Summary (cont) 2) System Conditionally Passes (cant.): [ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired Z 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): Z broken pipe(s) are replaced Y N ND (Explain below): obstruction is removed Y N ND (Explain below): distribution box is leveled or replaced 0 Y 7, N ® ND (Explain below): E] 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 E.] Y ( N D 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: t5unep,doc•rev 706)701 8 Title P'otiic;iai inspection Form Subsurface Sewage Da%s ueeu System•Page 3 rvr 18 Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 386 SHARPNERS POND ROAD R ___..._Add._.___...___ress _ .._... ...... .... .. roperty ALISON NAFTAL . Owner C7wner's Name information is NORTH ANDOVER MA 01845 APRIt 18 2023 required for every _ page. CltyfTown State Zip Code Date of Inspection C. Inspection Summary (corn.) Q Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and -SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Criprnsp,doc-rev,7Q6/2018 Title 5 Officiai Inspection Form.Subsurlace,Sewage Disposal System-Faye 4 of 18 Commonwealth of Massachusetts ih Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments E ; 386 SHARPNERS POND ROAD Property Address ALISON NAFTAL Owner _- . Owner's Name information is NORTH ANDOVER MA 01845 APRIL ,18 2023 required for every . .. page. CltyfTown _ State Zip Code Gate of Inspection m._._..-.__..._.___._.__--------- ._ ._.__._.W-__.,._.__ ___.___.__. .._ ..____._._.__.. C. Inspection Summary (carat.) 4) System Failure Criteria Applicable to All Systems; (cant.) Yes No ❑ Ej 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 'f2 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 11 of a public water supply well t5insp doc rev.7126%d01 fit T661e 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Offici l Inspection Form �1) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 386 SHARPNERS POND ROAD Properly Address ALISON NAFTAL Owner CDwner's_Dame _ ...._ .._. ...._ . ._ gUir ed foti fo isr every reewire NORTH ANDOVER MA 01845 APRIL ,18 2023 __......... .. w page. Cityfrown State Zip Code Date of Inspection C. SummaryInspection .. . .�_.___W.._..._.___..__..___.. ._ _mw....._..__................ __W,.._...._..w.w._._.._...._.....___ _...___ (coot.) 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 Z ❑ 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? Z 1:1 Has the system received normal flows in the previous two week period? El Z Have large volumes of water been introduced to the system recently or as part of this inspection? Z 1:1 Were as built plans of the system obtained and examined? (if they were not available note as N/A) • 0 Was the facility or dwelling inspected for signs of sewage back up? • El Was the site inspected for signs of break out? Z 0 Were all system components, excluding the SAS, located on site? E] 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? Z El 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 j Existing information. For example, a plan at the Board of Health. Z 0 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)) train doc•rav M26(2.016 Ufa (4P faR Ouw pa h irti r'turm:st7bsul arA sawaoa C:fmPOSM syrstamv•Page 6 of 18 w Commonwealth of Massachusetts m I`� Title 5 Official Inspection Form .- _ .. l� Subsurface Sewage Disposal System Form Not for Voluntary Assessments 386 SHARPNERS POND ROAD Property Address ALISON NAFTAL Owner _ Owner's Name information is NORTH ANDOVER MA 01845 APRIL ,18 2023 required for every .... ....,_ .. _....r.., ._.m.....,.. page City/Town State Zip Code Date of Inspection D. System Information 1, Residential Flow Conditions: Number of bedrooms (design): NA- - Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 1 .203 (for example: 110 gpd x#of bedrooms): NA Description: Number of current residents: Does residence have a garbage grinder? El Yes 0 No Does residence have a water treatment unit? M Yes No If yes, discharges to: SAND FILTER DISCHARGES TO SEPTIC TANK Is laundry on a separate sewage system? (Include laundry system inspection Fl Yes [Z No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available last 2 years usage d WELL Detail: Sump pump? ❑ Yes 71 No Last date of occupancy', CURRENT Date_._..__.......... t5 nsp.dac-rev 7J2812090 fiitie 5 Official Insped on Form Subsurface Sewage Disposal System-Page 7 of 1s ............................._.._._.w......._....................._...._............_. ........w....._....... _ _.. ..... Commonwealth of Massachusetts Title 5 Official Inspection Form In Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 386 SNARPNERS POND ROAD Oroperty Address ALISON NAFTAL Owner _..... _.. _.__. t7wner's Name _,_.... __.m.. information Is NORTH ANDOVER MA 01845 APRIL 18 2023 required for every _......___ page. City(Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciai/industriai Flow Conditions: Type of Establishment; Design flow (based on 310 CMR 15.2 ): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? "Yes No Water treatment unit present? Yes ❑ No If yes, discharges ta: 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 INC MAY 2020 Was system pumped as part of the inspection? ❑ Yes ❑ No If yes„ volume pumped. _ . gallons How was quantity pumped determined? Reason for pumping: 85nsp.doc-rotor '703l2018 6 we 5 oMroiak Inspwciw,p:orn) Suasuur'w"e SeAgge D'Sp)saI;S'ymem•pages of I a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ky / 386 SHARPNERS POND ROAD Property Address _. ..._ ....... _.....__.., .,_._.. ALISON NAFTAL Owner _ __ ..._._ __-._..- _ .__._-_� . .._.._.._._ Owner's Name Information is NORTH ANDOVER MA 01845 APRIL ,18 2023 required for every _....._ . _._ _..__._. _....._. ...... ........... page. CityfTown State Zip Cade date of Inspection D. System 4. Type of System: ® Septic tank, distribution box, sail 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: 18"YEARS OLD, DECEMBER 2005, OWNER INFO Were sewage odors detected when arriving at the site? 0 Yes E No 5. Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC other(explain): 18, - . _....... ..... Distance from private water supply well or suction line: fe ea _.... et Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS GOOD VENTING GOOD NO EVIDENCE OF LEAKAGE 65o nsip doc-rev.7125/2018 Title 5 Official Inspacton Form:Subsurface Sewage Disposal system•Page 9 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 386 SHARPNERS POND ROAD Property Address ALISON NAFTAL Owner _ _._._ .__ .__... ___........ ..... ... _ Owner's Name inforrequired is NORTH ANDOVER MA 01845 APRIL ,18 2023 required for every __ .__ ._w_.. __._...._ _...._.__ ..__.._._ ....__.._.____. _... _ page, CItyrrown State Zip Code Date of Inspection D. System Information (coat.) 6. Septic Tank (locate on site plan). 8' Depth below grade: _....._.__...... feet Material of construction: E concrete F� 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: 8, Distance from top of sludge to bottom of outlet tee or baffle 30' Scum thickness 6 Distance from top of scum to top of outlet tee or baffle 1, 8<, 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 OLDER SYSTEMS YEARLY PLASTIC INLET OUTLET TEES OK STRUCTURAL INTEGRITY OF TANK GOOD NO EVIDENCE OF LEAKAGE LIQUID LEVELS OK t5lnsp doc•rev.V2812018 'Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a *ryl� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments { 386 SHARPNRRS POND ROAD Property Address ALISON NAFTAL Owner _.. _ Clwner°s Name inforrequired is NORTH ANDOVER MA 01845 APRIL „18 2023 requPred for every --. .. ...... ._w....... . . __...... . _. .. _......... .... page. CltyfTown State Zip Code Date of Inspection D. System Information (cont.) ?. Grease Trap (locate on site plan): Depth below grade: feet _ Material of construction: ❑ concrete ❑ metal 0 fiberglass E] polyethylene other (explain): Dimensions: __.._..._..... ._ .... . Scum thickness __... Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle �._.. _...._.. Date of last pumping: _.... Date-, Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: [ concrete ] metal ❑ fiberglass E] polyethylene other(explain): Dimensions: opacity: gallons Design Flow: gallons per day tl51nsp doe rev.7/2612018 'ride 5 official Inspooton form sLamiurtfiace Sewage Dsposal 'yslem•Pagos't I of Is Commonwealth of Massachusetts I Title 5 Official Inspection Form mm' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r f 386 SHARPNERS POND ROAD ---..- Property,Address ALISON NAFTAL Owner Owner's Nance requir required is NORTH ANDOVER MA 01845 APRIL ,18 2023 req�aured for every , page. CdtylTown State Zip Code Date of Inspection D. System Information (cant.) 8. Tight or Holding Tank (cant.) Alarm present: ❑ Yes Q No Alarm level: - Alarm in working order: Yes ❑ No Date of last pumping: Gate Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? 0 Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above cutlet 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.): D-SOX LEVEL WAS RUNNING NIGH SNAKED LINE AND FOUND ROOTS AND COLLAPSED PIPE DISTRIBUTION WAS EQUAL LIGHT EVIDENCE OF SOLIDS CARRYOVER EVIDENCE OF LEAKAGE D-BOX HAS DETERIORATED tw r•%rr rjoc rarr 71M20 8 1 it o 5(:ftm,ai ivisrectron F'orm Subsuoace sewage E'Yesposaf System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments y, 386 SHARPNERS POND ROAD Or,operty Address ALISON NAFTAL Owner .._.._..... ....._ Owner's Dame information is required for every NORTH ANDOVER MA 01845 APRIL „18 2623 _ _ _......._,...... page. Clty/Town State ,dip code Date of Inspection _. .,. ...... _..-.m,__ .... _.- _-.._._,.._w...__._. __...,.... D. System Information (coot.) 10. Pump Chamber(locate on site plan): Pumps in working order: Yes ❑ No* Alarms in working order: M Yes E] 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: _ _..._. E] leaching galleries number: leaching trenches number, length ; 65" LENGTH ❑ leaching fields number, dimensions; [� overflow cesspool number: _. El innovative/alternative system Type/name of technology: t"`bms{9.duc.rerv.7126/201 U Titlee 5 ott'ie;ial Irspeutlurr Forrw SSubsuifaree Sewage Disposal System-Page 13 of 18 �0 < °wW Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "" rw 386 SHARPNERS POND ROAD Property Address ALISO-N."N"'AFTAL- Owner Owner's Name information is required for emery NORTH ANDOVER MA 01845 APRIL „18 2023 ' .... .. , _....___ ........... _. page. Cety/Town 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.): SOIL AND 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 Fl Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): trfr+o uar6lr r�rnc,•rcav_7P,6(20 B TAte 5 OfficiW k nssiw.Uarrr Form,Subsurface swaew arjo r1apos of System-Pagel 4 of'48 .._....._......_......_...._.w..............._.._....._.._._.........._.....___..........._....._......_.._..........__... .......» ......... ........._ w Commonwealth of Massachusetts Ttle 5� Official Inspection Form i } Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 386 SMARPNERS POND ROAD Property Address ALISON NAFTAL. C7wner Owner's Name information as NORTH ANDOVER MA 01845 APRiL ,18 2023 required'far every _..._.__. ... .,. _., ,... page, City[Town State Zip Cade Gate of inspection D. System Information (cant.) 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.): U56nsp.duc•rov.7/2E3/2018 T410 5 official inspection Faun Subsu dacew Sewage Disposal System»Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 386 SHARPNERS POND ROAD ALISON NAFTAL Owner Cv�ner"s Name information is NORTH ANDOVER MA 01845 APRIL ,118 2023 required for every gage. CitylTownState 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: Z hand-sketch in the area below drawing attached separately —------------ A Ll L t,5unsp.doc,-rev,7/2612018 'TAW 5 Ofrdaj hspecfion Form Subsudtwe Sewage DOPOSW system-Page 16&70 � Commonwealth of Massachusetts Title 5 Official Inspection For I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 386 SHARPNERS POND ROAD property Address ALISON NAFTAL Owner C7wli Name information is requiired for every NORTH ANDOVER MA 01845 APRIL ,18 2023 _ .... _._ .............. _ .. page. City/Town State Zip Code hate of inspection D, System Information (cant.) 15. Site Exam: El Check Slope El Surface water Z Check cellar El 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: Date __.. _. .. _ ..._ Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health - explain: AS BUILT PLAN ONLY JANUARY 2006 Checked with local excavators, installers - (attach documentation) z Accessed USGS database-explain: ESSEX COUNTY SOWL MAP You must describe how you established the high ground water elevation: ROCK OUTCROP CHARLTON - HOLLIS DEPTH TO WATER TABLE> 80" SYSTEM ABOVE WATER TABLE _.. .. ....... Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15(1 mrl.dac.•rev,712612018 'T"ilia 5 Otlic(aaI Insaraw3ton Fo:arm.Su suffaace Sewage Disposal systorn Page 17 of 16 Commonwealth of Massachusetts } if Title 5 Official Inspection Form i,.� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 386 SHARPNERS POND ROAD Property Address ALISON NAFTAL Owner Owner's fame information is required for every NORTH ANDOVER MA 01845 APRIL ,18 2023 _ --..._. - _....... __ __.... .. _..... page. CityfTown state Zip Cade Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: M A. Inspector Information: Complete all fields in this section. Z B, Certification: Signed & Dated and 1, 2, 3, or 4 checked Z 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 t5msp.ft� -rev 712612018 'C'iMa 5 Official III ssaertion Fwrn Subsurface Sewage Dis posall systern•Page 18 of I