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HomeMy WebLinkAboutPass - Title V Inspection Report - 755 JOHNSON STREET 6/26/2023 c Commonwealth of Massachusetts Title 5 Official Inspection Form ��6`�M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 755 Johnson St �H D�PPR�M Property Address Julianne Pramas Owner --- ----- Owner's Name information is required for every North Andover Ma 01845 5/22/2023 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms on the computer, Dean Dynan use only the tab Y key to move your Name of Inspector cursor-do not Dean Dynan use the return Company Name key. 2 Suntaug Street � Company Address Lynnfield Ma 01940 Cityrrown State Zip Code 508-726-9935 S112837 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fa' 6 P7�3 In ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts --- = Title 5 Official Inspection Form -- , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 755 Johnson St Property Address - - - _— Julianne Pramas Owner Owner's Name information is North Andover Ma 01845 5/22/2023 required for every -_ -_ ___.- _ -__- --- 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: 0 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: septic system in working order 1000 gallon tank, d box, 2 shallow leach pits 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" ction need to be replaced or repaired. The system, upon completion of the replaceme or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for � following statements. If"not determined," please explain. The septic tank is metal and over 20 years old' or th septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltr ti n or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. A metal septic tank will pass insp ion if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the t is less than 20 years old is available. ❑ Y ❑ N ND (Explain below): t5insp.doc•rev 71213/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 16 Commonwealth of Massachusetts r ^ .�, Title 5 Official Inspection Form fitSubsurface Sewage Disposal System Form - Not for Voluntary Assessments 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover Ma 01845 5/22/2023 page. Cityrrown 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 ou r high static water level in the distribution box due to broken or obstructed pipe(s)or due t broken, settled or uneven distribution box. System will pass inspection if(with approval of and of Health): ❑ broken pipe(s) are r aced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction i emoved ❑ Y ❑ N ❑ ND (Explain below): ❑ distri tion box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broke r obstructed pipe(s). The system will pass inspection if(with approval of the Board of Healt . ❑ broken pipe(s) are replaced ❑ Y ❑ ND(Explain below): ❑ obstruction is removed ❑ ❑ N ❑ ND (Explain below): 3) Further Evaluation is Requi d by the Board of Health: ❑ Conditions exist whic require further evaluation by the Board of Health in order to determine if the system is faili to protect public health, safety or the environment. a. System w' pass unless Board of Health determines in accordance with 310 CMR 15.303(1)( that the system is not functioning in a manner which will protect public health, safety d 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover Ma 01845 5/22/2023 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated w nd or a salt marsh b. System will fail unless the Board of Health (and Public ater Supplier, if any) determines that the system is functioning In a manner at protects the public health, safety and environment: ❑ The system has a septic tank and soil absorp ' n system (SAS) and the SAS is within 100 feet of a surface water supply or tributary a surface water supply. ❑ The system has a septic tank and SA nd the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank a SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic t k and SAS and the SAS is less than 100 feet but 50 feet or more from a private water pply well**. Method used to determ' a distance: ** This system pa es if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteri indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less th 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attach to this form. C. er: 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.7128/2018 Title 5 Official Inspection forth:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Y } Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover Ma 01845 5/22/2023 page. Cityrrown 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 Y2 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 C.4. 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.7126t2018 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 0118 Commonwealth of Massachusetts Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �r 755 Johnson St Property Address ---- -- Julianne Pramas Owner -- ---- ------ -- - Owner's Name --- - -- information is North Andover Ma 01845 5/22/2023 required for every : _ - ---------- -- -_ --- -- _ —_ 5—ate _ page. City-if-own- State Zip Code Date of Inspectio—n C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No © ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ N 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? ❑ Z Were as built plans of the system obtained and examined? (If they were not available note as N/A) Z ❑ Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? © ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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.712612018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts - - p Title 5 Official Inspection Form �► Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover Ma 01845 5/22/2023 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A Description: 3 Bedroom system with 1000 gallon tank and 2 shallow leach pits Number of current residents: 3 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d < 150 gpd ave 9 ( Y 9 (gpd)): Detail: see attached Sump pump? ® Yes ❑ No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts niz Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover Ma 01845 5/22/2023 page. Cityr'rown 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/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tan present? ❑ Yes ❑ No Non-sanitary waste d' charged to the Title 5 system? ❑ Yes ❑ No Water meter re ings, if available: Last dat f occupancy/use: Date O (describe below): 3. Pumping Records: Source of information: Homeowner/Board of Health last pumped 2022 per homeowner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts -= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 755 Johnson St u Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover Ma 01845 5/22/2023 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: 1963 / info on file /original to house Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 18 feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): sewer pipe in good condition/ no evidence of leakage/there is an injector pump for downstairs bath I5insp.doc•rev.7/26=18 Title 5 Official Inspection 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 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover Ma 01845 5/22/2023 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 22 Depth below grade:p g feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gallon round septic tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 5'.6" DIA X 5'.6" H Dimensions: 6" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28" 2"-4" Scum thickness 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 14" How were dimensions determined? in field with measure stick and tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 gallon concrete septic tank with concrete inlet baffle Outlet baffle PVC good Condition Tank in working order with separation from inlet to outlet / no evidence of leakeage cover to 3" to grade recommend pumping every two years depending on usage and number of occupants t5'visp.doc•rev.726/2018 Title 5 O(ficlal tnspection Form:Subsurtaco Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts _- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y, 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is North Andover Ma 01845 5/22/2023 required for every page. CityrTown 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 Zglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from t/scum ee or baffle Distance from b 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' pection) (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 Commonwealth of Massachusetts 1 --- - Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 755 Johnson St Property Address Julianne Pramas Owner Owners Name information is required for every North Andover Ma 01845 5/22/2023 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Y ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm a oat 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.): 6 outlet H2O concrete D box level with 2 outlet pipes /no evidence of solids carryover /no evidence of leakage out of box/ levelers in outlet pipes D Box is 16" below grade d box in good condition l5insp.doc•rev.7/262018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 755 Johnson St Property Address Julianne Pramas Owner Owners Name information is required for every North Andover Ma 01845 5/22/2023 -- page. CityfTown 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 cham 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: 2 shallow pits ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5hsp.doc•rev.7/2612018 TIVe 5 Official tnspection form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form F' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover Ma 01845 5/22/2023 page. CitylTown 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.): 2 shallow leaching pits found in lawn area I soils in good condition / no signs of hydraulic failure I no ponding/ no damp soil/ top of pits at 20" / dip sticked pit to find depth of pit at 56" 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 inflo ❑ Yes ❑ No Comments (note conditio soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 154nsp.doc•rev.7/262018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover Ma 01845 5/22/2023 page. Cityrrown 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, si 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 16 Commonwealth of Massachusetts Title 5 Official Inspection Form _ �<} Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover . Ma 01845 5/22/2023 page. CitylTown 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 7�A;A j ! 7 �a� l I c t5insp.doc•rev.712612018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 755 Johnson St Property Address Julianne Pramas Owner Owner's Name information is required for every North Andover Ma 01845 5/22/2023 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: 65 " + /soil logs on file feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plans on file at BOH Checked abutters 707 Johnson ESHGW 66" soil test dated 1996 719 Johnson ESHGW title V inspection 6' dated 2010 731 Johnson ESHGW 88" soil test dated 2016 767 Johnson ESHGW 61" soil test dated 1997 The only way to determine ESHW is with deep hole soil test on site being inspected Sump pump is for emergency puposes only because of run off from slope Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5insp.doc•rev.7/2612018 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 755 Johnson St Property Address ---- Julianne Pramas Owner --- --- ----- Owner's Name information is North Andover Ma 01845 5/22/2023 _ required for every --__ _-_- page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: X A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 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 l5insp.doe•rev 7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 �w\01 -IT 1 44- t { Go ply We-1 Ls t-tj/ � �• D i j t s.4f �� r IIL} 111 - •SS Z � �'Ir .f .r x� j y + s• ' •�H yam) / ✓` e.��,'..'C^d�1+'� '+• Sa r * -��• I M � 1 ) w Summary Record Card generated on 519r2023 12,03 19 PM by Jennifer Bracero Page 1 Town of North Andover Tax Map # 210-038.0-0069-0000.0 Parcel Id 13151 755 JOHNSON STREET PRAMAS, CAMERON N. Since Dec 2019 PRAMAS, JULIANNE L. 755 JOHNSON STREET NORTH ANDOVER MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.03 Acres FY 2023 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until CAMERON&JULIANNE PRAMAS Owner Active 755 JOHNSON STREET NORTH ANDOVER MA 01845 LAMM, PAUL Previous Customer Inactive 12/5/2019 755 JOHNSON STREET N.ANDOVER. MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14356.0-755 JOHNSON STREET Last Billing Date 3/7/2023 2100360 02 Cycle 02 Active UB Services Maint. Account No.2100360 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63 5/8 7.82 1/ WTR WATER 01 ALL METER SIZE 34.20 /1 UB Meter Maintenance Account No. 2100360 Serial No Status Location Brand Type Size YTD Cons 16336177 a Active HH#755 b Badger w Water 0.625 0.625 122 Date Reading Code Consumption Posted Date Variance 2/2/2023 136 a Actual 9 3/14/2023 -67% 11/2/2022 127 a Actual 27 12/19/2022 -32% 8/3/2022 100 a Actual 40 9/20/2022 389% 5/3/2022 60 aActual 8 6/21/2022 2% 2/2/2022 52 a Actual 8 3/15/2022 11% 11/2/2021 44 a Actual 7 12/7/2021 3% 8/5/2021 37 aActual 7 9/21/2021 -14% 5/5/2021 30 a Actual 8 6/15/2021 3% 2/4/2021 22 aActual 8 3/16/2021 -22% 11/3/2020 14 aActual 10 12/16/2020 237% 8/4/2020 4 a Actual 3 9/9/2020 193% 5/4/2020 1 a Actual 1 6/10/2020 -100% 2/4/2020 0 a Actual 0 3/16/2020 -100% 12/4/2019 0 If Final Bill 0 12/5/2019 -100% 12/4/2019 0 n New Meter 0 12/5/2019 -100% 12/412019 1206 s Reset meter 19 12/5/2019 76% 8/2/2019 1187 a Actual 8 9/26/2019 -16% 5/2/2019 1179 a Actual 9 6/13/2019 143% 2/4/2019 1170 a Actual 4 3/19/2019 -3% 11/2/2018 1166 a Actual 4 12/12/2018 -69% 8/3/2018 1162 a Actual 13 9/20/2018 160% 5/4/2018 1149 a Actual 5 6/20/2018 1% 2/2/2018 1144 a Actual 5 3/28/2018 -38% 11/2/2017 1139 aActual 8 12/29/2017 2% 8/3/2017 1131 a Actual 8 9/20/2017 -64% 5/2/2017 1123 a Actual 21 6/26/2017 334%