The URL can be used to link to this page

Home My WebLink AboutPass - Title V Inspection Report - 99 GRAY STREET 9/27/2023 Commonwealth of Massachusetts Title 5 Official InspecUon Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessrt 'trts Y_ 99 GRAY ST Pnipe,rty Address _..._......._ .._ NARY & MIKE Owner RO SENBERGER information is MA 01845 08P25/23 required for every Cutyown NORTH ANCIC�VER ..._.... ._ . ...... _......_._. . . ......... _ page. Mate Zip Code Cate 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. ..._................. .._ __._......_..........._._-..._____ n _ ._w_....________......... Important filling out When A. Inspector Information filling out forms on the computer, RALPH SIfv1ARD use only the tab _......... key to move your Name of Inspector cursor-do not use the return _ ._ .___._.._. ___. .._... key. Company Name PO BOX 436 r Company Address NORTHREADING MA 01864 _ _ Cc �€'own ... .. ._ skate Zap Code . 508-958 2002 Si13015 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 personaliy inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. Z Passes 2. Conditionally Passes 3, Needs Further Evaluation by the Local Approving Authority 4, D Fails 08125/23 Icaspecto" Date The sy tem 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 bu er„ if applicable, and the approving authority. Please no : This report only describes conditions at the time of inspection and under the Condit ons of use at that time. This inspection does not address how the system will perform in the uture under the same or different conditions of use. t5 nsp.*,-rev 7S26/2018 TfOe 5 offi ii�'W Inspestfon Frxm:SubscrO ace SewMa &;ba^pasW System•Gage 1 0 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 GRAY ST 0-r'o-perty Addre's's"_""------ ...... —MARY & MIKE Owner ROSENBERGER information is required for every d�iiy/t o"wr'iN_0"R"-TH'A'N,,-D 0V E-R_---------- MA 01845 08/25/23 .......... ............................ page, State Zip Code Date of Inspection .................. C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and ail 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: ............... .......... 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): ............ ... .......... 15�n,q),doc rev.71M2018 P"!Ue 5 Officta h'ispecnon Furrn Subswface Sawage DisposaB Syswm-Page 2 of 18 Commonwealth of Massachusetts Title 5 t fficial Inspection Form ° Subsurface Sewage Disposal System Form Not for Voluntary Assessments gg (BRAY ST Property Address MARY & MIKE Owner ROSENBERGER information is MA 0184 08/28l23 required for every City[Town NORTH ANDOVER -----.... - —_....__------ page. e cif Inspection _.........,_.,._..,..__,..._......_. .._._._......._._...._. .._ m._m. xtkeVio 44e Dc�t....,,_... m. .w_. . C. Inspection Summary (cons.) 2) System Conditionally Passes (cant.): Ej Purrip Chamber pumpslalarms 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 7 Y El N 0 ND (Explain below): (] obstruction is removed [:] Y 7 N 7 ND (Explain below): ( j distribution box is leveled or replaced 0 Y ❑ N EI ND (Explain below): [j 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): [l broken pipe(s) are replaced E] Y ❑ N 0 ND (Explain below): ❑ obstruction is removed Y ❑ N 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 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5irutsp,4dcx,•rev-7lM2018 TkO e 5 O fimaai hspeu hor ream:Subsurface:Sawvago Dispusal yMem•Page 3 of IS Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 GRAY ST Property Address —MARY & MIKE Owner ROSENBERGER information is required for every ��jj -n N0R-T"-H"--'A'-N-D-0E R—V MA 01845 08/25/23 ------------- page. State Zip Code Date of Inspection ..... C. Inspection Summary (cont.) ........ [I 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: 0 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 I of a public water supply. F� The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. E] 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 0 El Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool [I z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5osp doc-rev 7126/2018 Tbe 5 Offk-'ra @MPRCN)r��OM SUbsurface Sewage MSPOSM System-Page 4of F8 Commonwealth of Massachusetts ,k Title 5 official Inspection Farm _ fl7 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 GRAY ST Property.Address _MARY & MIKE Owner ROSENBERGER information is required for every City/Town N0'JRTk A_N"_aoVER MA 01845 06/25/23^ ._.._.... __ pager State Zip Code Date of Inspection _............ .__. C. Inspection Summary (cant.) 4) System Failure Criteria Applicable to All Systems. (cant.) Yes No El 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '12 day flow 0 z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El Z Any portion of the SAS, cesspool or privy is below high around water elevation. E_J Z Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supplyEl . Z Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. 7 z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a 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.) El Z 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 fallowing, in addition to the questions in Section CA. Yes No El ❑ 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 El 0 the system is located in a nitrogen sensitive area (lnterim Wellhead Protection Area_ IWPA) or a mapped Zone II of a public water supply well t5inspx.doc*rev.7P26r2018 'T Oe 5 C)PfaoW hispw t€w Form Sc5swface Sewage DISPoSM Systrfn•P�Ge 5 of f8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 GRAY ST ................ .........Property Address —MARY & MIKE Owner ROSENBERGER information is MA 01845 08/25/23 required for every C4yfT'own NORTH ANDOVER .. ........ page. State Zip Code Date of Rnspection 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 0 El Pumping information was provided by the owner, occupant, or Board of Health F1 Z Were any of the system components pumped out in the previous two weeks? Z 1:1 Has the system received normal flows in the previous two week period? EJ E Have large volumes of water been introduced to the system recently or as part of this inspection? 0 Z 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 dwelling inspected for signs of sewage back up? Z r_1 Was the site inspected for signs of break out? Z R Were all system components, excluding the SAS, located on site? Z EJ 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 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: Z ❑ Existing information, For example, a plan at the Board of Health. M Z Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15302(5)] t5insp doc-rev.7126/2018 Tillie 5 OffwW lrtsa*cfww Fom SUbSLXaCe SeWkM 0MVAM System-Page 6of 18 ------------ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage disposal System Form - Not for Voluntary Assessments 99 GRAY ST _...... ......_... ............_ . . .. ..... . ......... _._..__. ...__._ _.....__... �rrperty Address _MIARY & MIKE Owner ROSE,NBERGER rrof"r'n7atitmrt is MA 01845 08/25/23 required for every City/Town NORTH H ANDOVEFt �......... .. . _._ ....._.... _.... ........_... __._.._.._ . .._.. page. .state Zip Cade Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): - Number of bedrooms(actual): 440 _.. DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): -~ Description: 4BEDROOM 4 LINES 13X50 SAS FIELD 2 Number of current residents: 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 years usage (gpd)): .... ..... Detail: WATER USAGE WITHING THE 440 PD DESIGN Sump pump? ❑ Yes ❑ No Last date of occupancy: CURRANT gate.._...._..._. ..............._._..w.... g5wtsp.doc:•re,v 712612018 'Ni e 5 Ofr¢mt{n&pediur norm,subsuaface"sewAa!'p'e msrm.a9 System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 GRAY ST Property Address ................ —MARY & MIKE Owner ROSENBERGER information is re,quired for every C ifylr MA 01845 08/25/23 own NORTH ANDOVER ............ ........... page. 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): -n o-'s" per..day d a'_y"—(g pd) ........ GailBasis of design flow (seats/person s/sq.ft., etc.): ........ ------ ------------ Grease trap present? 0 Yes [I No Water treatment unit present? 0 Yes El No If yes, discharges to: .......—1................- Industrial waste holding tank present? Yes [] No Non-sanitary waste discharged to the Title 5 system? El Yes n No Water meter readings, if available: Last date of occupancy/use: Date --------............ Other(describe below): ............ ------- ................. 3. Pumping Records: Source of information: ................... Was system pumped as part of the inspection? El Yes n No If yes, volume pumped gallons How was quantity pumped determined? Reason for pumping: t5nsp doc-rev,712&2018 Ti fle 5 Officml hspecfion Fwn Subswface Sewaqe Msposai Sywem-Page 8 of 1 a Commonwealth of Massachusetts ex ❑ ; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 GRAY ST Property Address —MARY & MIKE Owner ROSENBERGER information is MA 01845 08/25/23 required for every City/ NORTH ANDOVER page, 4T�ode Date of Inspection . ...................... D. System Information (cont.) 4. Type of System: z Septic tank, distribution box, soil absorption system El Single cesspool El Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El 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. El Other(describe): Approximate age of all components, date installed (if known) and source of information: 1000 GAILLONTANK TO A 3 LINE SAS WORKING AS DESIGNED AT THIS TIME Were sewage odors detected when arriving at the site? D Yes ❑ No 5. Building Sewer(locate on site plan): 1.5 Depth below grade: 7Feet Material of construction: ❑ cast iron Z 40 PVC ❑ other(explain): ---------- Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): ALL PVC WORKING AS DESIGNED .................. t5insp doe-rev,7126/2018 Title 5 Official lnspection Forrm Subsurface Sewage Dsposai System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ii Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 GRAY ST ............ Property Address —MARY & MIKE Owner ROSENBERGER information is MA 01845 08/25/23 required for every City/Town NORTH ANDOVER -§t tat Zip Code Date of Inspection ___ page. D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: ..................feet Material of construction: E concrete F-1 metal F-1 fiberglass [I polyethylene El other(explain) 1000 GALLON PER PLAN STRUCTUALLY SOUND AND .............WATER TIGHT AS DESIGNED ----—--------- ...................... ...... If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Yes No Dimensions: 1 OX5.5X5 Sludge depth: 2 ........... Distance from top of sludge to bottom of outlet tee or baffle 37 Scum thickness — 5 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 9 How were dimensions determined? ROD W FOOT Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ALL WORKING AS DESIGNED AT THIS TIME ALL TEES WORKING AS DESIGNED ................. ................................................................................... .............................. ........ ................................— ........................ .............. .............................._1_'........... —------- ............ ........... t5insp,doc-iev.712612018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _ M 99 GRAY T _ ..._... _ .........._..... _ _.... __....._.... _._ ..... ...... __. ......... ... .... __ ...... Property Address _MARY & MIKE Owner ROSENBERGER information is �__... .... required for ever _.�.._.__ _.... _.. .... MA �1845 C1812". �t y Cik !'Town NaFtTii«AN(�aVER _ . page. State Ip Code Date of Inspection D. System Information (cant.) 7. Grease Trap (locate on site plan): Depth below grade: aei.....--___ ._...... .... _. ..._�._._ .._.... Materiel of construction: El concrete ❑ metal F-1 fiberglass Fj 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 beta.......- _._ _. ..... Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: ......____.._... . _.......... ....... ._..__.._.....m..._ Material of construction: [l concrete metal R fiberglass ❑ polyethylene F� other(explain): Dimensions: _ _ ... . .......... �_... .,,_._ .. ........... ........ .._...._ _. . . ... .._.... Capacity: gaGior� Design Flow: gallons.p e r day......__..._---..__-_. _......_.__ _._.... t5insp,doc-rev '7J2612�0'18 Title 5 Offici a8 Inspection Form Sula surface Sausage Disposal Systarn-Page age 11 ref 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 GRAY ST Property'- '""A'd dr,e's's. .......... ...... ............ .......... .. .... ...... . —MARY & MIKE Owner ROSENBERGER information qs required for every C_ity"_f"ro'w""ri N"_0_R_TH"___AND 0-_V"'_E'-R,""" ——-- MA-- ... 0.1 845__...____' 9§/25/2.3 __.._.__..... page. State Zip Code Date of Inspection ............ D. System Information (cont.) 8, Tight or Holding Tank (cont.) Alarm present: El Yes El No Alarm level: ... ..................... Alarm in working order: Yes No Date of last pumping, Gate Comments (condition of alarm and float switches, etc.): .......... ........... ......... --------- ........... ............... Attach copy of current purnping contract(required). Is copy attached? El Yes El No 9. Distribution Box (if present must be opened) (locate on site plan):. Depth of liquid level above outlet invert NONE...... 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 STRUCTUALL SOUND AND WORKING AS DESIGNED MINIMAL CARRY OVER ALL LINES ACCEPTING FLUID AS DESIGNED ............ ............. .............. ................... .............. ............. ---------- ...... ............ 66nsp doc,-rev V261201 8 Tiite 5 Offimm Pnspechan Form Subsijxface Sewage mswssai Sysism-Page 12 of 18 Commonwealth of Massachusetts =, Title 5 Official Inspection Form Subsurface Sewage Dispersal System Form - Not for Voluntary Assessments N, 99 GRAY ST Property Address MARY & MIKE Owner ROSENBERGER information is every CtybTaw ,f / required far eve n.......tJC1.R"rH...... A .__9VC1C1.__VP_f� ... ..._..., _......... __.... MA 01 84� .. __._ ..... ... .. �. page. .Mate Zip Code gate of Inspection .._,.,,,,...,....................ww_....._._ _ _..._ .._... _.w....w.._ _ _ .__...._" ._. D. System Information (cant.) 10, Pump Chamber (locate on site plan): Pumps in working order: (l Yes [-I No* Alarms in working order: (l Yes [: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: El leaching pits number: __._,..... D leaching chambers number: -- 0 leaching galleries number: ............ E] leaching trenches number, length: — z leaching fields number, dimensions: 1 18X50.... E] overflow cesspool number: -- El innovative/alternative system Type/name of technology: __. ...._. ___._....._ _.._ _......____ _ 6.Sinsp doe•rev.71261'22018 TWe 5 C:ffK,4 tln%w4w Form Subsurface Sewage Dwrzaxsal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 GRAY ST Property Address _NARY & MIKE Owner ROSENBERGER information is required for every City/Town NORTH ANDOVER y MA 01845 08/25123 page, 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.): Nb_r:'WEG—RE FOUND Nb_i5bi4b(Nb Y� 'f .................. ........................ . ......................... ——---- ....... -- ---- ................ ------ 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration ........... .... ..... Depth —top of liquid to inlet invert ....... Depth of solids layer Depth of scum layer Dimensions of cesspool ........... Materials of construction Indication of groundwater inflow El Yes 7 No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): .............. -------- ........................ ------------- ---------- ............ . ........ t5qlsp doc rev.7(26120 FJ Tf6o 5 OfficM lnspec,',on Fom Subsurfw.'m&waqe SysteM-Page 14 rA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 GRAY ST Property-' -;k a d r—e s"-s................... ------------ ---------------- -MARY & MIKE Owner ROSENBERGER information is MA 01845 08/25/23 required for every tjjy/_T_q'_w r --------------------------- ........... page. '_§faife�_ -Ztp C66e� date of D. System Information (cont.) 13, Privy (locate on site plan).- Materials of construction: Dimensions Depth of solids ............................... Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ---------- .............. .......... t5insp,doc-rev 7126=18 Title 5 Official Inspectior Form:Subsurface Sewage Disposat System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 GRAY ST .......... ........................ - -------- Property Address —MARY & MIKE Owner ROSENBERGER information is required for every Cut !Yawn NORTH-"XNDd�ff-----"-" MA 01845 08/25/23 ------- page. 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: F-1 hand-sketch in the area below drawing attached separately F t5insp doc-rev 7J26i2018 T41e 5 of ial Inspection Farm:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for VOILintary Assessments Properly�:�dress 99 GRAY ST MARY & MIKE Owner A0SENBERGER__,,_,,._,___ information is MA 01845 08/25/23 required for every �5�y_rrown''N'0 PT H'"'A""N-D—O_VE_R... ........... ............. page Zip Code Date of lnspectbor 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; E] hand-sketch in the area below drawing attached separately _N t5wmp doc rev.7/126d201 8 5 ofticia[ jnspacnan Porm Subsurlace Sewagv:OfSP01,8t SYVerl psge 16 Of�6 Commonwealth of Massachusetts, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 GRAY ST MARY & MIKE Owner AOSENBERGER �nforrnafion is jt�ylt(f7 --- MA 01845 08/25/23 ........... ...................... required for every own NORTH ANDOVER page, 'Zip C—o-d-eIt of Inspection — 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 4 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 15msp 6)r W rev,7(27&2018 TMe 5 ofncw 6nspect*n Form Subsurface Sewage DisposM Symern-Page 18 of 16 Commonwealth of Massachusetts ., Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 CLAY ST », _-- . . ------ .------- ._._... .._.__.� _...._...... .. MARY & MIKE Owner POSENSERCER required4on foris MA 01545 08/25/23 every Ciky/Town NORTH ANDOVER ...._ . ..... _......... _. ..___ _.___._. page State Lp Cade Date of Inspection D. System Information (coat.) 15, Site Exam: Check Slope Surface water Check:cellar Shallow wells Estimated depth to high around water: 5.5 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: SEPT 13 1997 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) Ej Accessed USCS database -explain: You must describe how you established the high ground water elevation. PLANS C"�N FILE AT BC7H SEPT 1J7_.SC�IL LOGS ____._.__ Before filing this Inspection Report, please see Report Completeness Checklist on next page. t?Sia^lap doc rev 711,&1.018 1 q'e 5 Offi mia gnss>ectxin Fc6m Subsurface Sewage.Dspos,aq S yaD em•Page 1'7 of is M� s. Fw 4 � y Y k Y dV 9NN tamtlR „�, yy� P'/ f f&N�'kd�w d^4bARt'N; _. N, _._... _.w.... ., ...__ 'r w �,Tk WIT IR MEN Jul MY p 3 ( as -4 € _„ imW Ion , yz pip W to H Via - Nil I VIA II �I 8 1 � a t SKY,- i _ _ B 4 I 3 no s .4* 7 a€ £ 2 . - E F I( �E.'s t£ I fitPg}O ho i $ M Ram m_ - it } €2€ LIU in! no W 6 ass. dot