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HomeMy WebLinkAboutPass - Conditional Pass - Title V Inspection Report - 252 BOXFORD STREET 8/7/2023 � Commonwealth of Massachusetts w ` T"itl 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 252 Boxford Street Property Address NJSP Realty Trust (Trustee: Peter Tardier_ Owner Owner's Name required for every informatione is Na Andover MA 01845 07/11/23 page. Oty/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. ....._____.. ............._.. . ...._..._.w.... .....__...... __.............. _....._. .. ......... . Important:when A. Inspector Information filling out forms on the computer, use only the tab Jahn L. DlVincena key to move your Name of Inspector cursor-do not J & S Development/Stewart's Septic Service use the return key. Company Name 58 So. Kimball St. r Company Address Bradford MA 01835 City/Town State Zip Code 978-372-7471 S11 3386 Telephone Number License Number _.._....___.u.._._.......__ .._, ..�._........_____.___.w. ...__ _ .......... ww __n_..._______w m ....._ ____.w.__.._ _.w.._..._,.,, _,. _.............. B. Certification i certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 ( '10 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. E Passes 2, E] Conditionally Passes 3. F] Needs Further Evaluation by the Local Approving Authority 4. El Fails p /nsor rtature 07111l2023 Clate inspector ;f'96bmit 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 shail 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. t5 rrsp ckuc-rev 70512018 rm6e 5 Offmc*w Onnyp ev ion f nrrn Subsurface Sewage Disposal SySrS ry.Page S of 18 . .� Commonwealth of Massachusetts ff Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Boxford Street Property Address NJSP Realty Trust (Trustee: Peter Tardie) Owner Owner's Name information is required for every No Andover MA 01845 07/11/2 page City/TownState ILp Code Cate of Inspection C. Inspection Summary lnspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: Z 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: Replaced distribution box. Systern built in 1067. Ran water to test leach trenches. Trenches are working and wrre_taking water at the time of inspection 2) System Conditionally Passes: El 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 f'or"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 E] ND (Explain below): (cirrus.d,,x•rrwv.7126 2010 TMe 5 Official Gnwiw:f"rare Form „;uhY;t.face Se wagR V,)(spwosai system•Page 2 of 18 aw Commonwealth of Massachusetts :.. Title 5 Official Inspection Form rct+ Subsurface Sewage Disposal System Farm Not for Voluntary Assessments 252 Boxford Street Property Address N,fSP Realty Trust (Trustee Peter Tardie) Owner Owner's Name _ information is No Andover MA 01845 07/11/23 required for every _ page. Cityf town State Zip Code Late of Inspection Inspection results mint be submitted on this farm. Inspection farms may not be altered in any way. Please see completeness checklist at the end of the form. Important:then _.._.... ............__ ........._ ....._.__.........__....____ . ....._........____.__....__.. _ ....� ___... fillingout forms �►. Inspector Information on the computer, use only the tab Johln,,L, l, DiVincenzo key to move your Name of Inspector cursor-do not J & S Development/Stewart's Septic Service use the return Company Name _ key. 58 So. Kimball St. Company Address: -.W.. Bradford MA 01835 fl, CityOTown ;state Zip Code 078-372-7471 S113386 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 (310 CMR 15.000); G 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, El Fails _ 07/11/2023 In ct is ignat e gate The system inspector li submit a copy of this inspection report to the Approving Authority (Board of Health or CEP) wi 0 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 DER 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. t5trisa.doc•iev.7P25C2018 Ii le 5 Official Irnpedicrrr Foring suasuifwe;$Owage I7isposaarl System-Pagel of 18 a ° Commonwealth of Massachusetts ^J T*'Lle 5 Offidal Inspection ction Form Subsurface Sewage [disposal System Form - Not for Voluntary Assessments * °✓ 252 Boxford Street Property Address NJSP Realty Trust (Trustee. Peter Tardie) Owner Owner s Name _ information is No. Andover MA 01345 07/11/2 required for every page City/Town State Zip Code Date of Bnspectton . _ _......._._............__._ _. ..._._...,_.... ...... ------- _............ .... ..... . .._,__.a_ __._,.............. _......._,__.,..... C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments:. System built in 1967. Flan water to test leach trenches. Trenches are working and were taking water at the time of inspection. 2) System Conditionally Passes: Z 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„ NCB)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 exf6ltration 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. El Y 0 N E:1 ND ('.Explain below):. t5or g,doc•rev N26120T8 Title 5 Official hspadi on Form Subsurface Sewage Disposal ayaCem-Page 2 rf 18 �. Commonwealth of Massachusetts ,r Title 5 Offidal Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 22 Boxford Street Property Address NJSP Realty Trust (Trustee. Peter Tardie)_ Owner Owner's Name informrequired �� Na Andover d' A 01€845 0 /11/2 rectu'rred far every -__......... . page City/Town State Zip Code tote of inspectiorn __.w...,..._.._ . ............ .... ...._. .... ... __--__v _ ....-__,_-------------------------_... _ ......... ,......_, 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. Sytern will pass inspection if(with approval of Board of Health): [� broken pipe(s) are replaced ] Y N ND (Explain below) obstruction is removed ❑ Y N ND (Explain below): Z distribution box is leveled or replaced Z Y 7 N NIA (Explain below): Box needs replacing due to corrosion around the outlet inverts ] 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): 0 broken pipe(s) are replaced (l Y 0 N El ND (Explain below): F-1 obstruction is removed Y PE] N E] ND (Explain below): .__ 3) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 1 .303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment. d°brsp adc,rt rev '7;2612018 Title fl of ic4d Mnsa^ectfor r nrrn Subsurface Sawage 4:gmposa!Systwn-Page 3 nf"8 n Commonwealth of Massachusetts Title 5 Official Inspection Form "bh Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Boxford Street Property Address NJSP Realty Trust (Trustee: Peter Tardie) Owner Owner's Name _. information is No. Andover MA 01845 07/11/23 required for every _ _. _. page Qty«Town State Zip Dade Date of Inspection C. Inspection Summary (cant.) [:] Cesspool or privy is within 50 feet of a surface water [:1 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. E 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. El 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 [l 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 around or surface w atore due to an overloaded or clogged SAS or cesspool trdiv Rp doc vev-71"bnFaY2018 1'i6�k&�t";C,,,YCY41M7k`kp Irus�ec°2it>u��rr,�rrvr Subsurface S o wage Dmpaux4ep Sytutr;rn•Page 4,of 18 Commonwealth of Massachusetts Title 5 Official Inspection Farm '"I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w Y I 252 Boxford street Property Address NJSP Realty Trust (Trustee: Peter Tardie Owner _ Owner's Name information is No. Andover MA 01845 07/11/23 required for every _..... __ . . ..... _. __ ......._... page. City/Town State Zip Code Date of Inspection —. �. _.....__......_,___...e.. ___ _..r._.._.__.__....._......................._..___,.___.._.._........._.._....._,_._,..__.....__w........._..._........___._.._._............_............ _. C. Inspection Summary (cant.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ E, Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Z Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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: ❑ ❑ 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. ❑ 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 C.4. Yes No ❑ [l 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 t5insla.doe•rev.7/26/2018 Ttfle 5 OffEc4 Inspect'Ion Form Subsurface Sewage DVsposal System-Page 5 of 18 Commonwealth of Massachusetts Tide 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments p 252 Boxford Street _- Property Address NJSP Realty Trust (Trustee Deter Tardier Owner .... Owner's Name information quire do. over far every is rN And MA 01845 07/11/23 egtarr - _ _..- page. &ty/Town State Zip Code Crate of Inspect*n _...._..._... ._........ _.m _........... .. _. ....... _,...,..,_ _....... ... ,.,. ..._........... C. Inspection Summary (cont) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section C.4 above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 C R 15. G44. The system owner should contact the appropriate regional office of the Department. 8. You must indicate"yes" or"no" for each of the following for all inspections: Yes No Pumping information was provided by the owner, occupant, or Board of Health [� Were any of the system components pumped out in the previous two weeks? El Has the system received normal flows in the previous two week period? d Z Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as NIA) Z 0 Was the facility or dwelling inspected for signs of sewage back up? E El Was the site inspected for signs of break out? Z 1:1 Were all systern components, excluding the SAS, located on site? Z 11 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 ❑ 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: * Ej 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) [31 Q CMR 15,332(5)] 6 irsra.doc x rev,712612018 TitWaa 5 officvW Insp ewt on Form.suu7sur6aau-,Sewage G7mposa4 Systern•Page 60 18 Commonwealth of Massachusetts � ' 5mmY f Title 5 Official Inspection Form li Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 252 Soxford Street Propeaty Address NJSP Realty Trust (Trustee. Peter Tardie) Owner Owner's Naane required is No. Andover MA 01845 07/11/23 reyurred for every ._. ..... ... ... .. page City/Town State ,dap Cade Date of Inspection _ .... .. ..............._ ,.. _._ _.._...,._..._.. ...._.,__....,.._.ww.,_ ....__..__....._.a ,,,,.,.. ..... __,_.......... . .... ..._ _ ...._. ..,,,.,. D. System Information 1. Residential Flow Conditions: Number of bedrooms (design)' 2 Number of bedrooms (actual): DESIGN flog based on 313 CIVMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: 2 - almost full time Does residence have a garbage grinder? ❑ Yes E] 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 7 Yes Z No information in this report.) Laundry system inspected? Q Yes E] No Seasonal use? ❑ Yes >w No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Yes No Last date of occupancy. D)ccuried IJat — t5if i wit c&oc^rev 7E26FXl8 "nEk 5 Offi:ml Or^r«apeebc ri Form Su bsuwfar.e Sewage C".is;mr sW System•Page e"r titre 18 ' Commonwealth of Massachusetts = Title 5 official Inspection Form 1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments xt'7 252 Soxford Street Property Address NJSP Realty Trust (Trustee; Peter Tardie) Owner .. Owner's Name information is No. Andover MA 01845 07/11/23 required far every - _. ... page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.); Grease trap present? ❑ Yes [ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? (❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Cate Other(describe below): 3. Pumping Records: Source of information: Last pump was 11/06/2000 Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped; 1000 gallons How was quantity pumped determined? Sight gauge on truck Reason for pumping: Inspect tank t5nsp,doc•rev.7/26/2018 Ti lei 5 Official Inspection Form SUbSLsrfne Sewage rDVsposW System-Page 8 of 18 Commonwealth of Massachusetts ', "idle 5 Offielal Inspection Farm 4 o Subsurface Sewage disposal System Form - Not for Voluntary Assessments 252 Boxford Street Prope ly Address NJSP Realty Trust (Trustee. Peter Tardie) Owner Owner's Name iequir�dfo is No. Andover NIA 01545 07/11/23 required for every __. . .. _. .. page. CityrTown State Zip Code Date of Inspection D. System Information (cant) 4. Type of System: z Septic tank, distribution box„ soil absorption system [� Single cesspool Overflow cesspool El 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 1967 Were sewage odors detected when arriving at the site" FQ 'Yes Z No 5. Building Sewer(locate on site plan): Depth below grade: 20 Material of construction: Z cast iron [ 40 PVC El other(explain): Distance from private water supply well or suction line: fe f ' et _ Comments (on condition of joints, venting, evidence of leakage, etc.); See well test results- included r5insp tilerc•rev 7126M201 8 1 itle`;k Official inspection P vri in Subsurface sewage omposa5 system•Page g 0t 18 Commonwealth of Massachusetts w , Title 5 Official Inspection Form ti ry Subsurface Sewage Disposal System Farm Not for Voluntary Assessments r 252 Boxford Street Property Address NJSP Realty Trust (Trustee: Peter Tardie) Owner Owner's Name information ie No Andover MA __ 01845 07/11123 required for every •_ . .._ --- page y . .. p Inspection City/Town 1Town State Zip Cade Date of kns ect D. System Information (cant.) 6. Septic Tank (locate on site plan): Depth below grade: 14 feet Material of construction: R concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) .... ........__.-- --___- _ __-__- _.-__ ........... If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes © No Dimensions: -4" 72 8" Sludge depth: ------ --------- 24" Distance from top of sludge to bottom of outlet tee or baffle _ _.. . ...._. 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 16" ---- - - -- --- Haw were dimensions determined? Tape measure/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.): Both baffles are in good shape. No leakage, liquid level is good t5inspAoc-rev 7/26120 1 8 Tide 5 Off oal InspecVson ForM SuSsufCace Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form c Subsurface Sewage Disposal System Form Not for Voluntary Assessments � 4a 252 Boxford Street Property Address NJSP Realty Trust (Trustee: Peter Tardie) Owner Owner's Fame information is No. Andover MA 0184�5 07/11/23 required for every _ _ ... page. City/Town State Zip Code Date of Inspection D. System Information (cons.) 7. Grease Trap (locate on site plan): Depth below grade: _ feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): (Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: 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.): B. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: ---- ------- Capacity: gallons Design Flow: gallons per day t5msp.doc-rev,712612018 Title 5 Official Inspecwn Farm:Subsurfaces Sewage Disposal System-Page 11 of 18 " Commonwealth of Massachusetts 6, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 252 Boxford Street Property Address NJSP realty Trust (Trustee. Peter Tardie). . Owner Owner's Name requir dfo 6s No. Andover MA 01845 07/11/23 required fear every ..._ . _. page ity/Town Mate Zip Cade Date of InspectioIn .._,_,.. ......_ __._..._. .....__w w......... . ....._._.__. _.___ D. System Information (cant.) 8. "Tight or Holding Tanis (cant.) Alarm present: E] Yes .] No Alarm level; Narrn in working order: El Yes L] No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? Yes No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Box needs replacing, because the side is completely mgssinc .___ No solids carryover. ...._...._ _ f5iris(r.r„1ara:.-rev.712W21018 'Title 5(")4'fnr•M Inspecrion For In S ubSUfiat*;rrasvrage Disp os&a6 Systern-Page 12 of 16 Commonwealth of Massachusetts - I Tide 5 official Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments �w ,❑` 252 Boxford Street ------------- Property Address NJSP Realty Trust (Trustee: Peter Tardie) Owner Owner's Name information is No Andover MA 01845 07/11/23 required for every _.� _. ._._.. . . page. Cltyf town State Zip Code Date of Inspection D. System Information (cant.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ Now Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required):. If SAS not located, explain why: ---- ......... ......... .. Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: 4_ ❑ leaching fields number„ dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5tnsr,doc•rev.7/26 st718 TiMe 5,Official Inspec:ton Foan Subsurface Sewage Disposal system-Page'13 of 18 r " Commonwealth of Massachusetts Title 5 Off c"al Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 252 Boxford Street Property Address NJSP Reality Trust (Trustee Peter Tardie) Owner Owner's IUarneinfor _ regUiredfo is No Andover MA 01545 07/11/23 required for every .. . _ page, Ctlyrrown State Zip Code Date of Inspection __�._ ......__,_... ........... _.w...... D. System Information (cant.) 11. Sail absorption System (SAS) (cont) Comments (note condition of sail, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No hydraulic failure, no ponding. Ran water. Field is taking on water at time of inspection. Field is from 1967 but meets Title 5 criteria. ___ 1 . Cesspools (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration ____.._ Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.); t51nsp dm-w'avv."7126B'dr118 Title 5 f,ffic,uai Inspa'sr,hon Form Subsurf,^ac�e Sewage DfspwuAaf Systw n.Page'Y 4 of 18 '� k,,v Commonwealth of Massachusetts Title 5 Official Inspection Form {,` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Boxford Street Property Address N,7SP Realty Trust (Trustee: Deter Tardie) Owner Owner's Narne required fn is No. Andover MA 01845 07/11/ 3 required for every _ page, City/Town ;state Zip Code Date of Inspect on ..,...,._ ................ _.._......... ©. System Information (cant.) 1 , 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.): ......... t5insrv.doc^rety.7/26/2018 1)fle,5 016(,rW Inspection F wrn Su)s.,urla co Sewage Mspoga f System•Page 15 of 18 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -trot for'Voluntary Assessments 252 Reford Street _..w.. .. Prerperty A,etclres JSP Realty Trust..°Trustee Peter Tardier Owner .r. _...... owner's Name ., .... ...._..______.�_,_ .... .... . .... tion requir dfo No Andover MA 01845 required for every _........ . . _.� ...m_...___ ..__.__.�._____....... . ..._.. ..., , .. _...._. ._..w..�._.._.ww... __ ._.. � ._��.............. ....___.. page. Cityrrown 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 El drawing attached separately ... q 9WIw t5insp r&m.rev 71�261X s "W iw 5 CY'fimaf V ispectuon Form:Subsurfate Sewage Esispr a� System Page 16 of I Commonwealth of Massachusetts a : 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 252 Boxford Street Property Address NJSP Fealty Trust (Trustee Peter Tardie)__ Owner Owner's Name information is Pao. Andover MA 01845 07/11/23 required far every . . .. page. City/Town State Zip Cade Gate of inspection _..._-...___.,,,...,. _....... ._.....__.. ......,.m _ ...._.... .._.......... D. System Information (cont.) 15 Site Exam: Check Slope [ Surface water Check cellar El Shallow wells Estimated depth to high ground water: 8„ 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: rate [� Observed site (,abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Pulled files Chucked with local excavators, installers - (attach documentation) [] Accessed USES database -explain: You must describe how you established the high ground water elevation: No sump pump in basement. Bottom of trenches approximately T above the basement floor Before filing this Inspection Report„ please see Report Completeness Checklist on next page. t5 nspu doc•i ev 7f2W2018 'Rlm" 5 Offical Insp',ueac to rz r'orrr Subsurface sew&#�va rmp oral„Sy+tetW>xrr-Page 17 of 18 Commonwealth of Massachusetts 10 l Ttl ; 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Boxford Street Property Address NJSP Realty'Trust Jrustee. Peter"Tardie) Owner Owner's Name ... q information"s No, Andover MA C 1845 07111/23 page, k"red for every _ _ .._ _ Cutya"'t"r�wn _. . _ State Zip Code [late of Inspection _...._. __.. .... _... . ..... _.............. __.._ . ..., ....... ............. ..... _........_....__ . ------ _._.v.._. _ .... E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. inspector Information: Complete all fields in this section.. B. Certification: Signed & Dated and 1, 2, 3, or 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 Wank— 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 C,i nsp drlm rev."712612018 "Falee 5 OfPtua. Inspenmion 6"rag' i SUtrs urfac r Sewage Disposal SyMem-Page'18 d 16 94orrheasr 7&7 7 44 'ENVIRONMENTAL LABORATORY, INC. MASSACHUSMS DEP#RCMA123 CHAIN OF CUSTODY a Y°JrwP�,4G. . i X ''5 r,C g6 `.�rtisYr"rt�k ki, TP'li`i :F~a[6�"TfG�,P�1 r ,�..aCo-ir,P�arr rrub�.P.'xfrrarraar°���aptua? I i 1 Q CJ T awE'>t�r d. C,` �,and C A 1,W, r �.,C�J q v .. a .,� �,.. � ( "� ���'L'".6.n�Qt.`r�� 0��4��'.:, A .,. i . L YID hX SAMPLE PLE S.w GN'iND DFV0;V 4JV A C r �� Sr ° C 6lC u,,. ,.. .�. .�w:. ...,.." ...: .. ..�.. . ._.. . C1 kCaC ?"RP ! 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Marcet Laboiatory [)wector Microbac Laboratories, Inc. - Dayville CERTIFICATE OF ANALYSIS D3G1 385 Northeast Environmental Lab Project Name: 62180 Tyler Marcet Project/ PO Nurnber: 62"18000CI 41 Dayton ST Received: 07/13/2023 Danvers, MA 01923 Reported: 07/20/2023 Analytical Testing Parameters Client Sample V A61,MA, a Sample Matrix: L) ll� w, Collected By: Lab Sarnp[e,ID: '3 a ilr•r Collection Date: J Inorganics Total Result Limits) RL Units Note Prepared Analyzed Analyst Method:Wet-Distillation-DWEPA,350.1,Rv.2(1993) Awirnonia as N <0 0200 0,0200 rng/L yl 07/18)23 1227 Results tri bold have,exceeded a limit defined for this proloct, Limit&are provided for referencv but as regulatory firnits change frequently, Microbac Laboratories, Inc adwses,the recipient of this relmd to confir'M SLIClT fin)fb;and units of concentration with the appropriate Federal, stale or local authorthes before acting ora the dat& Definitions MCL: US EPA Maximum Contaminant LeveI mg/L: Milligrams per Liter RL: Reporting Urnit yl: Accreditation is not offered by the accrediting body for this arudyte Project Requested Certification(s) Microbac Laboratories, Inc:. .Dayville M-CT008 Massarhi.rsetts Department of Environmental Protection Report Comments Reviewed and Approved By: Sarnples eve received in proper coodition and the r6.'iportc�d rpsults conform to J f, "Art", 7'('r' 1 applicable accreditation standard unless otherwise noted the data and information on tha,,, and other accorrpanyiog docurnents,nepresents only the sarnple(s)analyzed This reporl is iocoarplete unless all pages indicated in the footnote are Melisa L.Mantgornwy pre sent and an authorized sigoature is indudpo, The services were provided under and Quality Assurance Officer subioct to Microbac's standard terms and conditions which can be located and Reported: 071M2023 13:34 reviewed at rvl A 61 Louisa Viens Drive I Dayville,CT 06241 1860174.6814 p I www,microbaccorn Page i of