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Home My WebLink AboutConditional Pass - Title V Inspection Report - 585 BOXFORD STREET 6/27/2023 Commonwealth of Massachusetts Title 5 Official Inspection Form w. Subsurface Sewage Disposal System Form - Not for Voluntary Assesments TO.�b`.A,... 585 BOXFORD STREET . _ ..._... ." Property Address CHARLES BROGAN _...___...............__.____............._.____..._........_....__._..___..__._.- �_ Owner Owner's Name information is NORTH ANDOVER MA 01845 JUNE 6 2023 required for every _.y._.._. _.__ .._-- _._ _ _.._._ _.._... .._-.._- ..._._ _.r........ page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. ...__ . ...__........._....-._..._....................._......__.._...__..,............... ....__._____ Impor A. spe tant:When ctor 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. usethe return ____. __._._.._ __.__.._.._..._._..........._.......__...a...._... -__._____ ____w_ ..___..............____. key. Company Name ..... . . ........ ..... ....._ . ._...._.. _._......_. 111 AjIIa Road � Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 SI-16 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. F� Passes 1 ® Conditionally Passes 3. F-1 Needs Further Evaluation by the Local Approving Authority 4. F� Fails JUNE 6 2023 Inspe is 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. t`msp.doc M rev.712SM..018 Title 5 Official Inspection Form:Subsurface Sewage nosposaf System-Page 1 of 18 Commonwealth of Massachusetts r ,�y Title 5 Official Inspection Form fn Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 585 BOXFORD STREET Property Address CHARLES BROGAN Owner Owner's Name . ... .. information is regctired for every NORTH ANDOVER MA 01845 JUNE 6, 2023 ,.,.,. .,..... _ ... . page. Clty/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; ❑ 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. Commentsr 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 eicc.rev.7126/2016 T'ik,5 Official Inn)action Form Subsurface Sewage Disposal Syskern-Page 2 of 18 W ' Commonwealth of Massachusetts ,. Tide 5 Official Inspection Farm Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments a 585 BOXFORD STREET ...... ,_.w. _ __.._ . .. Property Address CHARLES BROGAN Owner, _ _.. owner's Name regUiratifo is NORTH ANDOVER MA 01845 JUNE 6,, 2023 rewired for every page. City/Town State Zip Code Date of inspection C. Inspection Summary (cant.) _ 2) System Conditionally Passes (cant.): [� 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 [l N 0 ND (Explain below): obstruction is removed [l Y ❑ N ❑ ND (Explain below): distribution box is leveled or replaced Z Y ❑ N ❑ ND (Explain below): D-BOX IS ROTTED AND NEEDS REPLACED OUTLET TEE NEEDS TO BE INSTALLED IN TANK El The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): El obstruction is removed 0 Y E N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: [l 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: t51nsp.doc-fev.7P26J201 8 1Me fi Official Inspection Farm:SUbsarlace Sewage Disposal Systern-Page 3 of t8 Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 585 BOXFORD STREET Property Address CHARLES BROGAN Owner _. _. owner's Name . information i e required for every NORTH ANDOVER MA 01845 DUNE 6, 2023 --: _ ... . _ ..._.. _ _. page. 6ty/Town State Zip code Date of Inspection __... ._._.._..._........ ...,..., _... _....._..,__..__._..__._.._w_._.__................. _ ____._..__ ...._._._.. _....._.._.__,_..._._,_ �._.._....... C. Inspection Summary (cant.) ❑ Cesspool or privy is within 50 feet of a surface water Cl 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. El 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 ❑ z 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 t5msp.doc•rev.712W018 Title 5 OfficRal Irusp'aectlon Fenn.Subsurface Sewage Uisposral System-Page 4 of 18 yw °°ti Commonwealth of Massachusetts y mmMti Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 585 BOXFORD STREET Property Address, CHARLES BROGAN Owner Owner's Name ___ .... inforrnat*n Bs regUired for every NORTH ANDOVER MA 01845 JUNE 6, 2023 gage City/Town :state Zip code bate of Inspection C. Inspection Summary (cant.) _. 4) System Failure Criteria Applicable to All Systems. (coat.) Yes No El 171 Static liquid level in the distribution box above outlet invert due to an overloaded o�r clogged SAS or cesspool 0 z Liquid depth in cesspool is less than 6" below invert or available volurne is less than '/2 day flow El Z Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of firnes pumped: ...._--.", — F,I z Any portion of the SAS, cesspool or privy is below high ground water elevationEl Z . Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water suppiy. Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. 1:1 z Any portion of a cesspool or privy is within 50 feet of a private water supply well. l Z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet frorn 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 forma Ej z 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 EJ Z 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 F1 E-1 the system is within 400 feet of a surface drinking water supply l El 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 IB of a public water supply well v5,irSp vdoc•rerv.7a..69"J018 1 iue"S offici al Pnsp ec,kuwn 6 arm Suubswlace Sewage Ehur-tilrosal°')"mem-Plage 5 of 18 Commonwealth of Massachusetts x l TFE "le 5 Official Inspection Form mm_ " Alt Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 585 BOXFORD STREET Property Address CHARLES BROGAN Owner Owners lwd nwelnfor redfo is NORTH ANDOVER MA 01845 JUNE 6„ 2023 ��r��red far every _ City/Town State ZlIc Cade Date of Inspection _ _......... ..... .......__.._.,._. . .. .___..... __m_.. ..... ._...._._. ......,...._. C. Inspection Summary (cant.) 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 gander 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"nor" for each of the following for all inspections: Yes No Z El Pumping information was provided by the owner„ occupant, or Board of Health F Z Were any of the system components pumped out in the previous two weeks? El Has the system received normal flows in the previous two week period? E Z Have large volumes of water been introduced to the system recently or as part of this inspection? E El Were as built plans of the system obtained and examined? (If they were not available note as N/A) Z 1:1 Was the facility or dweliing inspected for signs of sewage back up? Z Ej Was the site inspected for signs of break out? Z 0 Were all system components, excluding the SAS, located on site? Z E] Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baff8es or teen 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: 0 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) [316 CMR 15.362(5)] tf er sp rdoc•rev.'7/26-t2CO8 rIfle 5 uffr ellaI Orrirar"mrc&urrrr r"ortyr Suxbsurf acre wage C)mp say System,Page 6urf tfr ° Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form Not for Voluntary Assessments 585 BOXFORD STREET Property Address CHARLES BROGAN Owner - - — ._.__.. �swr,er�s�Name ffifrequired for is NORTH ANDOVER l�A 01845 JUNE 6, 2023 required for every page. bty!Towrr_ State Zip Code . D to of Irspectaon ... _ _. . .................. __.�.. D. System Information 1. Residential Flaw Conditions: Number of bedrooms (design): NA Number of bedrooms (actual) 4 DESIGN flog based on 310 CMR 15.203 (for example: 110 gpd x##of bedrooms): NA Description Number of current residents: 2 Does residence have a garbage grinder? Z Yes ❑ No Does residence have a water treatment unit? 7 Yes Z No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection 7 Yes No information in this report.) Laundry system inspected? Z Yes [:] No Seasonaluse? 7 Yes Z No WELL Water meter readings, if availabie (last 2 years usage (gpd)): Detail: Sump purnp? ❑ Yes Z No Last date of occupancy CURRENT Gate iSvmp'M acc rev.7t26Pt'..)l8 'title 5 4 ffiuW Inspe>dion'e=rwrrn:Su bsfi.uadt'ace Sewage Dmp2osal 5yMe'rn•ParM 7 of 18 Commonwealth of Massachusetts sue* -" Title 5 Off dal In pect"on Form .r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 585 BOXFORD STREET Property Address CHARL S BROGAN Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JUNE 6„ 2023 page Cityaoown State Zip Code Cate of Inspe dior _.... . _.._._.._. _..._, .. _......_ .......__._........_._ ...... D. System Information (cant.) 2. Commercial/Industrial Flow Conditions. Type of Establishment; Design flow (based on 310 CMR 15.203): aHons per day(Apd) Basis of design flaw (seats/persons/sq.ft., etc.): Grease trap present? El Yes E] No Water treatment unit present? 0 Yes F] No If yes, discharges to: Industrial waste holding tangy present? F1 Yes El No Non-sanitary waste discharged to the Title 5 systern? El Yes C No Water meter readings, if available: Last date of occupancy/use: _..... Date Other(describe below): 3. Pumping Records: Source of information; OWNER - PUMPED 2020._ _ Was system pumped as part of the inspection? F Yes No If yes, voiume pumped: gaHor How was quantity pumped determined? _. Reason for pumping t'rr-rar dor,•rev 7/2&2018 71tGo 5 Offfrw Inwpedi��n F'Corm Subsurface Sewage l)vsposael sysrern•Page o of is Commonwealth of Massachusetts Title 5Official Inspection Ferran Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments 585 SOXFORD STREET Property Address Ci ARLES BROGAN Owner Owner's NJ me _ information is required for every NORTH ANDOVER IAA 01845 JUNE 5, 2023w page, C;ty4Towd rr ;M11 ate Zip C 11 ode gate of In 11 spection ---------- .. _.._.._.. ........._ ._ _. .. .__.... D. System Information (cant.) 4. Type of System: z Septic tank, distribution box, sail absorption system El Single cesspool 0 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 EJ- Tight tank. Attach a copy of the DEP approval. C:] Other(describe): Approximate age of all components,. date Installed (if known) and source of information: 3 YEARS OLD, AS BUILT PLAN, 1990 Were sewage odors detected when arriving at the site? 7 Yes Z No 5. Building Sewer(locate on site plan):. Depth below grade: feet Material of construction: 0 cast iron Z 40 PVC Cµ:) other(explain): Distance from private water supply well or suction line: — f�o Comments (on condition of Joints, venting, evidence of leakage, etc.): JOINTS OK VENTING OK NO EVIDENCE OF LEAKAGE t5o sp,ckx•rrtav 712612018 tRIa 5 0 N1cpaI P1SP(Wio i Form .}ub59 6tiYFp*svwap rkvaraals«aI sysiern Page 9 aof 18 Commonwealth of Massachusetts T"le 5 Offidal Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 585 BOYFORD STREET Property Address _. CHARLES BROGAN Owner t�wner`s Name . information is required for every NORTH ANDOVER MA 01845 JUNE 5„ 1120213 page, CityJTown _ State Zip Code Date oIf inspection ..._... ..._.. _.._._ _ M._._.... ...... .. __.w.....w.... ____. ...... .... .... ....... ....... .__......._ .. ,.... D. System Information (cant.) 5, Septic Tank (locate on site plan): Depth below grade: 4" feet Material of construction: concrete EJ 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: 1Ct' 5" 4` _ Sludge depth: 5 Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness " Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA 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 INLET CONCRETE OK, OUTLET ROTTED OFF TANK IS IN GOOD CONDITION NO EVIDENCE OF LEAKAGE LIQUID LEVELS OK tlwnsp.cdoc,rev 17260018 1„ie 5 off0ciW ruisparliion F or?n.Subsurfaaco„?;wurape DrspersM Syryae in•r"aprr M oT 16 .e Commonwealth of Massachusetts ir I Title Official Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 585 BOXFORD STREET Property Address CHARL.ES BROGAN t:Dwater Owner's Nar-re' requiredfo is NCORTH ANDOVER MA 01845 JUNE 6p 2028 recp�a4rerJ far every _ _ .... ..... page. C4tyl1 raven ....._. Steta Zip Cade Cate of Inspection _....__.. ._ ...__, _._ .... _. .. ...,., ._._...... ...... ..._. __ _._.,_.. _.......__ .........._.. _.... .... .. ....... .......... D. System Information (cant.) 7. Crease Trap (locate on site plan): Depth below grade: ffeet Material of construction. El concrete [-1 metal El fiberglass ❑ polyethylene other (explain). Dimensions: _ Scum thickness Distance from top Of SCUM to top of outlet tee or baffle _ Distance front 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,): & Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan),- Depth below grade: Material of construction. El concrete El metal L fiberglass [.) polyethylene other(explain) Dirensions: Capacity: _ gel4ans Design Flow: galions per day f"rrrsp 04n rev.'N2612016 [-roe 5 0, fom w Bn%;'Fectcc n Foram.Subsurface Sawag e Msrxr^aw System•Page I I of't R Commonwealth of Massachusetts ,=6� Title 5 Official Inspection Form -- 1n Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 585 BOXFORD STREET Property Address CHARLES BROGAN Owner owner's Name ti is reequiregUired f for every NORTH ANDOVER MA 01845 DUNE 6 2023 o _. page. d ty/Town State Zip Code Date of Inspection __.....__._.._._.___.._........._........._.w___. _._. _,_...___�_._._..__ ................ ........... _........____.. ___�..__.._ __....___._._..._.. .. D. System Information (cent,) 8. Tight or Holding Tank (cant.) Alarm present: [l Yes F� No Alarm level: _ Alarm in working order: ❑ Yes ❑ Na Date of last pumping: _. ._... Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes 7 No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 5 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 IS LEVEL AND DISTRIBUTION IS EQUAL HEAVY SOLIDS CARRYOVER ROOTS IN D-BOX D-BOX IS ROTTED, NEEDS REPLACED EVIDENCE OF LEAKAGE t5insg)Aoc.-rev 7/26120 1 8 TCOe 5 Official Vrasperc ion Form Suosudace Sewage Msposa(System-Page 12 of 18 Commonwealth of Massachusetts � l Ti le 'U"Wici l Inspection Form . mmr16 Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments * 585 BOXFORD STREET Property Address ,._ _ CHARLES BROGAN Owner ._ " _ CJwvners Name _... ._.... rregkaired for every�!'requiredatbn is NORTH ANDOVER MA 01845 JUNE 6, 2028 _._.. page. city/gown State Zip code Cate of Inspection D. System Information (cant.) 10. Pump Chamber (locate on site plan): Pumps in working order [j Yes El No* Alarms in working order: El Yes F-1 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: z leaching pits number: 2 1„ leaching chambers number: _ leaching galleries number: _ leaching trenches number, length: (l leaching fields number„ dimensions E] overflow cesspool number: (, innovative/alternative system Type/narne of technology: ¢,I nsp coc-rev.7126'2018 rY e officiai[rmpu cw:rn&'1wm:,r t surface Sowaqe G:b,spov.,A B S3yMann•Page 13 0 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r r ` 585 BOXFORD STREET Property Address CHARLES BROGAN Owner Owner's Name Proforrnation Ws required for every NORTH ANDOVER MA 01845 ,DUNE b, 2023 page CAty/Tow,n Mate Zip Cade Date of Inspection D. System Information (cent.) 11. Sail Absorption System (SAS) (cone.) Comments (note condition of sail„ signs of hydraulic failure, level of ponding, damp soil, condition of vegetation„ etc.): SOIL AND VEGETATION OK NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING RAN CAMERA DOWN TO LEACH PITS, PITS ARE WORKING NORMALLY 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 scurry layer Dimensions of cesspool Materials of construction Indication of groundwater inflow E_] Yes 7 No Comments (note condition of soup signs of hydraulic failure, level of ponding, condition of vegetation, etc.): B5nsp r'doc-rev.71261X'Pr8 Til 5 Official,i nsaueci[on Form Sub&.Err7.ice Sa!uvnvdgo C.Ud,e„.yowl uysiarn•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments r 585 BOXFORD STREET Property Address C HARLE a BROGAN Owner Owners Name uequi�redfoafion as NORTH ANI�CJVER IAA 01845 JUNE , 202 required for every _..... page, bty/Towr7 State Zcp dude Crate of Ins�aection _.m_ _......._.. _.. ..._._........_ _,... _._..... .... D. System Information (cant.) 11 Privy (locate on site plane Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc,) r5,nsW 6toc,rev 7126P1?O" 8 71fle 5 4r14nar €nsp;yev.ton Form Sussufface Sewage Dmposal Systern•Page 15 0 8 Commonwealth of Massachusetts - � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 585 B XFORD STREET Property Address CHARLES BROGAN Owner _._._ .. bwner"s Nerrie information is NORTH ANDOVER MA 01845 JUNE 6 2028 requiredfar every .M. _._.___ .. . __.__.. .......... _.__.._ _...... ____... .. _ ..._._. .,.._......_ page cityffown Mete Zip Cade Clete of knspeatiorn D. System Information (cant.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, Including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below drawing attached separately i � Pr 4 (J4 I ° " w 30' rr 371 `.,ep ca , oy, J t r w f5rnsgip,doc rev.M612'18 itrad 5 offi,w 6napa¢stliun Fa7"n.Subsua face S3arwra e DeSp sag System•6'age 16 of 18 Commonwealth of Massachusetts Subsurface Sewage Disposal System Form ri Not for Voluntary Assessments 85 BOXFORD STREET Property Address HARLES BROGAN Owner Owner's Name informations is required for every NORTH ANDOVER MA 01845 JUNE 8, 2028 _ page City/Town State Zip Code Date of Vnspectaon _.. _...._ __._.. __.. D. System Information (cant.) 15. Site Exam: Z Check Slope Z Surface water Z Check cellar Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: El 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: TITLE VON FILE, NO DESIGN PLAN Checked with local excavators, installers - (attach documentation) n Accessed UGS database - explain: You must describe how you established the high ground water elevation. AS BUILT PLAN HAS NOTE OF ENGINEERED PLANS DATED 1987 SYSTEM DESIGNED ABOVE WATER TABLE Before filing this Inspection Report, please see Report Completeness Checklist on next page. 6ms#p.doc•oev.r"FCPar O18 TtVe 5 OffciW hype ion d's:m¢ron :rsabguvla m Sewage Ois posal Systof t»Page 17 of 18 ZL&2' U'z! E"' 01 25MlC, Z>Box Id" I::7�"rwf 9 10 p-r-- h C,II, -50 Q b b, fF1'ro o'q 141,51,o r. 4 A-L r v'im,i A r AIV W E1alo, mot, 411 Pi 4_.l t L; e'k,b Or- "Tri-11 b U0, A (',v>v(-T t 1 r-r4 V' AS-BUILT PLAN OF SUBSURFACE DISPOS.A.RL SYSTEM LDCATEDIN �JOU-14' AULOVER, �JASS. AS PREPARED MR B6 B DAtE: SCALE: MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LANO SURVEYORS * PLANNERS 66 PA49 SIREIT # A#400YE&MASSACHUSt"S 011W i Ilk (617)475.335I,M-3121 Commonwealth of Massachusetts ,( Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments < , 585 BOXFORD STREET Property Address CHARLES BROGAN Owner Owner's Narne information is repUnrpd for every NORTH ANDOVER MA C11645 JUNE 6, 2023 .. page. aty/Town_ State _ Zip Cade gate of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields In this section. S. 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 Z D. System lnforrnation� For& Tight/Holding 1`°ank—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 t5io,s,p doc•rev.7oM201 8 f ik*",w e,v..�iaw Vnsk wwrcuon r 6fFmI Srabsuf Pace Sewage Div 6 s a€Sysle m•Page 18 of'12 Town of North Andover ... HEALTH DEPARTMENT Clff�'CK DATE: LOCATION: H/O NAME: CONTRACTOR NA m"�E: Type qjLf!�, heck box) .pn'it or Lic'e'nse: (C 13 Animal 0 Body Art Establishment 0 Body Art Practitioner 0 Dunipster $.......... n Food Service 0 Funeral Directors 0 Massage Establishment 0 Massage Practice 13 Offal(Septic)Hauler $...... 0 Recreational Carnp $.......... 13 Sun tanning n sjtqmjjirjg pool 0 Tobacco 13 Tras4lSolid Waste Hauler 0 Well Construction SIPTIC stuns. 0 Septic-Soil Testing 0 Septic-Design Approval 0 Septic Disposal Works Construction(D WC) 0 Septic Disposal Work's Installers(DWI) $--- 0 Title 5 Inspector Title 5 Report 0 Other. Wiffth Agent Initials White-Applicant Yellow-Health Pink-Treasurer