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HomeMy WebLinkAboutPass - Title V Inspection Report - 134 FARNUM STREET 10/23/2023 � Commonwealth of Massachusetts Title 5 Official Inspection Form y Subsurface Sewage Disposal System Form - Not for Voluntary Assesmnts " 134 FARNUM STREET Orcperty Address __ .... _..... L.ISA SCUDDER Owner rvwner"s Ka-me requirdfo is NORTH ANDOVER MA 01845 OCTOBER fi7, 2023 required for every .._.___... ....._..� _..._..._. __. ___.. .... .......�... . ____.......... page. Cityfrown 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 farm. Important.when A. Inspector Information filling out forms on the computer, use only the tab Todd J Bateson key to move your Name of Inspector cursor-do not Bateson Enterprises Inc. use the return _ _...... key Company Name 111 Arlila Read Company Address _..... .... _. _.. __._.__.__.. Andover MA 01610 CrtylT`orrwn .. State .� Zip Code L�1_11 976 475-4755 SI 16 telephone Number License Number B. Certification I certify that: I am a DEP approved system Inspector in full compliance with Section 16.340 of Title (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-slue sewage disposal systems. After conducting this inspection I have determined that the system: 1, Z Passes 2 E] Conditionally Passes 3. Needs Further Evaluation by the Local Approving Authority 4. Fails OCTOBER 17, 2023 It, n 11 s 11 p or's big tIu 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. trurn%.).doc-rov."T�"l�Y';r13W 8 T@de 5 C')Rr'cier 1ns'9pcwt*n Fa inrr �Subswfare Sewage Msposa�System-Page I of 18 x Commonwealth of Massachusetts h Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET Property Address i_ISA SCUDDEi Owner Owner's Name requir7 required is NORTH ANDOVER MA 01845 OCTOBER 17, 2023 repaaiced for emery _ Pape City[Town. _ State Zip Code Date of Inspection _....,_ _ ._w..__ _._. _.. . ._.. ._ _ ,.,_..__.. ......... . .... C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 5. 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 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. C,M Y (w N [� Nth (Explain below): t"'In p Jar€; rev,0260016 t rtI e 5 off oaI Irispect(on 1 own Sub,SLir'iaCO Sr+Ww�Ge DiSP SW R yr;VOM•f'argO 2 Of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET Property Address LISA SCUDDER Owner Owner's,Name required for ds re NORTH ANDOVER MA 01845 OCTOBER 17, 2023 page, or every _qre City/Town State Zips Code Bate of&nsp�e0on C. Inspection Summary (coot.) 2) System Conditionally Passes (cant.): Pump Chamber purnpsfalarrns not operational. System will pass with Sward of Health approval if pumps/alarms are repaired. L.. 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): El broken pipe(s) are replaced ,m Y E N 0 ND (Explain below): obstruction is removed L_ Y ❑ N ND (Explain below): El distribution box is leveled or replaced Y N ,. ND (Explain below): The system required pumping more than 4 times a year due to broken or obstructed pipes) The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced [ Y N [,._.. ND (Explain below): obstruction is removed [..._] Y N [ ND (Explain below): ) Further Evaluation is Required by the Board of Health: EJ 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 CI'+PIR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ftSVnsp Cdoc'. rov.7/2612018 r me"' F. � , � S r tsposm systerrr•f age 3 of 18 l"» a C'7rflw,:(tal Qvos+�cErasrr F`cxrn�r. xGxr�.abuf�rc„F,s a.rp"ovrRa,Vaa G7' o° Commonwealth of Massachusetts Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET Property Address ._ LISA SCUDDER Owner Owner's Name regUiratifo us NORTH ANDOVER MA 01845 OCTOBER 17, 2023 regarired for every page CrytTown State lip Code Gate of Inspection C. Inspection Summary (cant.) ____.. ......._. . _____... Cesspool or privy is within 50 feet of a surface water [ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. 7 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. 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 pprn, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forrn 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 1-1 , Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El Z 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 rav "7i,`6120 6 1itle 5 Ofocial inspection 1=oim SUbSuffa ce"Seyvagee Disposal fSysti in•Page 4 of 18 Commonwealth of Massachusetts Title 5 Offi cal Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET 15rcperty Address LISA SCUDDER Owner bw"n"ers Name _ information is Nf RTH ANDOVER MA €�1845 OCTOBER 17, 202 required t for every ;. ._ _... _ page Cityffowwn State Z p Code Date of inspection ... .... ..... _.._....... _..._.... ,. _ __.. _..._..._ .... ... .__._......_ C. Inspection Summary (cant.) 4) System Failure Criteria Applicable to All Systems: (cant.) Yes No El E Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El IE Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped; Any portion of the SAS, cesspool or privy is below high ground water elevation. El E 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. 1:1 El Any portion of a cesspool or privy is within 50 feet of a private water supply well, EJ 11 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 E El The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems„ YOU must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No El 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 1 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5'rrrspr.doc•rev.rd2WO18 E"itie 5 01Yici al Bnspeoion I brrm:SUbsurfa,re Sewage Dsposal System•Page 5[rot 18 < Commonwealth of Massachusetts , 1; Title 5 official Inspection Form PAw Subsurface Sewage Disposal System Form • Not for Voluntary Assessrnents ` ` 134 FARNUM STREET Property,address l_ISA SCUDDER Owner Owner's Narne _ regUiredfn is NORTH ANDOVER MA 01845 OCTOBER 17, 2023 regeaired for every _-- _ page city/Town State zip docie Date of Inspection ............_.. _._... .... .. ........ 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 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 C.4 shall upgrade the systern in accordance with 310 CMR 15.304 'rhe system owner should contact the appropriate regional office of the Department. 5. You must indicate "yes" or"no" for each of the following for all inspections: Yes No 0 Pumping information was provided by the owner, occupant, or Board of Health El Z Were any of the system components pumped out. In the previous two weeks? Z E] Has the system received normal flows in the previous two week period? [lave large volumes of water been introduced to the system recently or as part of ❑ this inspection? Were as built pia f the systern obtained and examined? (If they were not available note a N/A Z 11 Was the facility or dwelling inspected for signs of sewage back up? El Was the site onspected for signs of break out? EJ Were all system components, excluding the SAS, located on site? 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, dirnenslons, depth of liquid, depth of sludge and depth of scram? 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 1:1 Existing information, For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Fart C is at issue approximation of distance Is unacceptable) [310 CMR 15.302(5)) t5mbp d<'x•r"ety 7/261201 E'1 Suebsud ace Sewage D1 spersal Syrktlon-Fyage 6 of 18 Commonwealth of Massachusetts wF T "le 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET ., r r'perty Address LISA SCUDDER Owner Owners Name _ informaturan Is regUa red for every NORTH ANDOVER MA 01845 OCTOBER 17, 2023 page city t own State Zip Cade Date of inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms (actual): _..._ DESIGN flow based on 310 CMR 15.203 (for exarnple: 110 gpd x#of bedrooms): NA Description:. Number of current residents: 2 Does residence have a garbage grinder? Yes No Does residence have a water treatment unit? Z Yes [J- No If yes, discharges to: FILTER ONLY Is laundry on a separate sewage system? (Include laundry system inspection El Yes Z No information in this report.) Laundry system inspected? Z Yes ❑ No Seasonaluse? El Yes Z No Water meter readings, if available (last 2 years usage (gpd)): SEE ATTACHED Detail: Sump pump? Z Yes E] No Last date of occupancy: CURRENT Date T5,nasp.doc.-rev 1126?018 `itfe 5 Official[rnpx,ctiori Form Subsurface Sewage G',?mposa4 Syro err,-Page"P of'18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREE T Property Address LISA SCUDDER (;)wner Owners Name infwmatuon is required for every NORTH ANDOVER MA 01845 OCTOBER 17, 2023_w111.. page. CetylTown State Zia Code Date of Inspection _ D. System Information (coot.) 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.): Crease trap present? F j Yes E] No Water treatment unit present? Yes E] No If yes, discharges to: Industrial waste holding tank present? Yes No Non-sanitary waste discharged to the Title 5 system? 0 Yes E) No Water meter readings, if available: Last date of occupancy/use: Date _ Other(describe below): 3, Pumping Records: FALL 2021 OWNER Source of information: Was system pumped as part of the inspection? ��,<. Yesj No If yes, volume pumped: 1000 GALLONS How was quantity pumped determined? TRUCK GAUGE MAINTENANCE Reason for pumping: t,`rmr p doc•mvr PN260018 I le 5 l";1ffimal frrs„faection iaarrn Subsurfaacs saw ape r)(spaosax System•page Ci cN Yfrt Commonwealth of Massachusetts Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET' Ptoperky Address LISA SCUDDER Owner ...... Owner's Name information is NORTH ANDOVER MA 01845 OCTOBER 17, 2023 required for every ._ . _... _ page CCity/Town State Zip Code Cate of inspection D. System Information (cant.) 4 Type of System: z Septic tank, distribution box, soil absorption systern Single cesspool Overflow cesspool [ ] Privy E' 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 l/A systern by system operator Linder 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: UNKNOWN BY OWNER Were sewage odors detected when arriving at the site" F Yes Z No 5. Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: cast iron 40 PVC El other(explain): Distance from private water supply well or suction line: feet _ Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS AND VENTING OK NO EVIDENCE OF LEAKAGE p5insp doc rnw 7l2612018 TWo S Offictal lns(Jw;7U ion Form Subsurface Sowaa¢'e Disposal SyMern-Page 9 of 18 Commonwealth of Massachusetts TM e 5 Official Inspection Form m Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET Property Address LISA SCUDDER Owner Owner's Name _ regUanon fls ired for every NORTH ANDOVER MAuw 0164 OCTOBER 17 2023 eua __ _ _ page. city/To1 State lop Cade Date of trispeaf.ion D. System Information (cant.) 6. Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction; Z concrete El metal fiberglass polyethylene other(explain) CENTER COVER RISER IN PATIO 6"° DEEP If tank is metal, list age: _ years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ] Yes No Dimensions: xt Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle Scurn thickness _ Distance from top of scum to top of outlet tee or baffle A" Distance from bottom of scurry to bottorn of outlet tee or baffle 1 3„ _ Flow were dimensions determined? TAPE MEASURE AND SLUDGE.. JUDGE Comments (on pumping re corn mendations, inset and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.). RECOMMEND PUMPING OLDER SYSTEMS YEARLY TANK IN GOOD CONDITION CONCRETE INLET AND OUTLET BAFFLES OK NO EVCDENCE OF LEAKAGE NORMAL LIQUID LEVELS f5ansp do.-i e v '7fdFa 2016 f We b OfflcLal h 5pandmi t'w.rn:Subsurface,Sewage r,'lir posa6 S',(a1wn Paged 10 o�16 ri Commonwealth of Massachusetts Ti +Cfil lrp► r �i ►r� Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET Property Address, LISA SCUDD R Owner Owner's Name required for is NORTH ANDOVRR MA 1845 OCTOBER 17„ 2023 required for every ._ ... page. Cito¢1wr State 2_ep dude Gate of Inspectioru D. System Information (cant.) 7. Grease Trap (locate on site plan): Depth below grade feet Material of construction: concrete El metal 0 fiberglass polyethylene E] 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 Gate Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: (._.W concrete metal —1 fiberglass El polyethylene ] other (explain): Dimensions: Capacity: gallons Design Flow: ga4Vonros per day t°";nip doc,,wv,712612018 B of lee➢S f.)kcal hspectlon 1,,olm Subsufface Sewage Disposal Syslem Page 11 of'P 8 � Commonwealth of Massachusetts �a Title 5 Official Inspection Form .... Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET Property Address LISA SCUDDER Owner Owner's Name q iet'� is required for for every NORTH ANDQVE.R MA 018,451. 11 OCTOBE _ R 17, 2023 page cityrrown State Lip Code Date of Inspection D. System Information (cant.) 3. Tight or Holding Tank (cant.) Alarm present; Yes No Alarm level: Alarm in working order: Yes [mm] 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 g Distribution Box (if present must be opened) (locate on site plan), Depth of liquid level above outlet invert Q 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 LIGHT EVIDENCE OF SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGE t5,i mp do,c-rev."V2 Q018 1 it90 5 Of4irol Inspect ion rwrn "Sut)sv dace S"wvage DFspcssa0 Sp+stefn-Page 12 of 18 Commonwealth of Massachusetts lfi i Title .5 Official Inspection Form i Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 134 FARNUM STREET Property Address LISA SCUDDE( Owner Owner's Name informrequired is NORTH ANDOVEI MIA 01845 OCTOBER 17, 20213, required for every .. ._ _ .. page. C1tyfTown State Zip Code fate of Bnspeot ot3 D. System Information (cant.) 10 bump Chamber (locate on site plan) Pumps in working order: Yes ( No* Alarms in working order. �.....� Yes E] No" Comments (note condition of pump chamber, condition of purnps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. 11. Sall Absorption system (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: D leaching pits number: _ (D leaching chambers nurnber: [.� leaching galleries number: z leaching trenches number, length: 50' LONG leaching fields number, dimensions' overflow cesspool number: [� innovative/alternative system Type/name of technology., t5(nsp dor iev f F2&'2010 7rtio 5 Official inspection Foiin &kbsurf ac,eu Suwaoe Disposal symof r•fl age'13 of 16 Commonwealth of Massachusetts ; a : " Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm Not for Voluntary Assessments ✓/" f roperty Address LISA SCUDDER Owrier Owner's' Narne' information is regUired for every NORTH ANDOVER MA 31345 OCTOBER 17, 2023 page cityfro l State Zip Code Date of inspection ._ .._..._...,,..__.. ....... .. .............. ... D. Systems Information (cant.) 11 Soil Absorption System (SAS) (coat.) Comments (note condition of soil„ signs of hydraulic failure„ level of ponding, damp soil, condition of vegetation, etc.): SOIL AND VEGETATION GOOD NO EVIDENCE OF HYDRAULIC FAILURE OR PONDINO 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 inflows Yes No Comments (note condition of soil, signs of hydraulic failure, level of ponding„ condition of vegetation, etc,) t5msf4.o0c•rov "Y 26/ 018 T ilia:',Offici<ai fnsrraction Vccwrn.Subsaul ace Sewage D4 osa System•Page 14 of 18 _.-- —.—....- -------------- .... .-..-- . ....... ...... Commonwealth of Massachusetts Title 5 0 ffieial Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 134 FARNUM STREET Property Address LIA SCUDDER Owner Owners Name information is required for every NORTH ANDOVER MA 01845 OCTOBER 17, 2fJ23 page. GBtyffown State Zip Code Cate of Inspection _, ___.... ..,.... _..,........__ ... ...._. ... _........ D. System Information (cotit.) 11 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 e}uc-rev.71,26/2015 Title 5 offlrr w Inspe a on F ran°i Subsurface Sewage DispuasW System.Page'15 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form .ry Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 EARNUM STREET . .... ._._. . _. ..__ _ _ .. ___..,..__.... ....._-- _ F�rfaperty Address LlSA SCUDDE:R Owner _. _...... Owner's Name information is NORTH ANDOVER MA 01845 OCTOBER 17 2023 required for every _. _w. . ......... ........_ _..__..._ -b-a--te- _.._... .�...._. .... _ .,.... page. Cdty[To-wwn State Zip Cade L7ate 6i lrlspectic-n 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: [D hand-sketch in the area below Z drawing attached separately X n G_ A. — .,, .Jt. QT 3 (� © t r� 0 S1�e 0 VA �Ofj t 4 I. tt 0,K ... r i r" t5hsp,doc tev.V2612016 '1'iilee h Official Inspectmn 1"ami SllbSUrfaC0 Sewage 6lspiml System-Page's 10 of 1S -- - _ Commonwealth of Massachusetts W4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET F roperly Address LISA SC;,UDDER Owner Owner's Name information fl<; NORTH ANDOVER MA 01845 OCTOBER 17, 2023 required for every pegs City/Town Mate lip Code Bete of Inspection D. System Information (cant.) 15, Site Exam: Check Slope Surface water Check cellar Shallow wells Estimated depth to high ground water: SUMP PUMP DRY IN CELLAR FLOOR feet Please indicate all methods used to determine the high ground water elevation: Obtained front system design plans on record If checked, date of design plan reviewed, fate ] Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health .. explain� TITLE V ON FILE. Checked with local excavators, installers - (attach documentation) Accessed USES database -explain: ESSEX COUNTY SOIL MAP You must describe how you established the high ground water elevation: SUMP PUMP IN CELLAR FLOOR DRY BACK YARD FILLED ABOVE ORIGINAL. GROUND WOODBRIDGE FIND SANDY LOAM DEPTH TO WATER TABLE 27" SYSTEM ABOVE WATER TABLE Before filing this Inspection Report, please see Report Completeness Checklist on next page. pbo iispb.doc: rrav 712&2018 N tle 5 C1Hra.ai naapsczcp on I orin Sub wf aca Sewage C'Dr�posa6 Systern•Panrg,o 1'7 ov 18 ommonwea{th of Massachusetts Title 5 Official Inspcti ►rr ,rml Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 FARNUM STREET Property Address LISA SCUDDER Owner Owner's Narne required for every on is uired FORTH ANDOVER MA 01645 OCTtOBER 17, 2023 re�:I�ai page, C:ityrTown State Zip code Date of Inspection _.__.._ ___...... ..... ...... ... -------- ...._ ........_ .... _,,......_._ ._....._.... F. Report Completeness Checklist Complete all applicable sections of this farm inclusive of. E A. Inspector Information: Complete all fields in this section. Z B. Certification: Signed & Dated and 1, 2, 3, or 4 checked C. Inspection urnmary: 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 tr,r^rrap doc w fev "7(26$:018 r itfv 1r Cw[ ref Beia,raection rorrr "Subsurface Sewage f')Nprosal Systerr Page 18 0 1h;4 Surnmary Rocvd(!,ard genouated or)10)1312023 8 14:49 ANI lay Of on Hwftn Nwe Town of 1"N'orth Andover Tax Map # 210-107.A-0072-0000.0 Parcel Id 17897 134 FARNUM STREET BRUCE SCUDDER LISA SCUDDER 134 FARNUM STREET NORTH ANDOVER, MA 01846 Class 101 Single Family Property Type I Residential Size Total 1.02 Acres FY 2024 UB Mailinn Index Name/Address Type Loan Number Active/Inact, From Until BRUCE SCUDDER Owner Adivn. USA SCUDDER 134 FARNUM STREET NORTH ANDOVER, MA 01845 CAGGIANO,ANTHONY Previous Customer Inactive 3/26/2004 134 FARNUM STREET N.ANDOVER,MA 01845 UB Account Maint. Active/Inactive Account No Cycle Occupant Name Bldg Id. 14225,0-134 FARNUM STREET Last Billing Date 9/1112023 2100221 02 Cycle 02 Active UB Services Maint. Account No.2100221 Service Code Rate Charge Multiplier/Users MSCFEE ADMiN FEE 0,635/8 7.82 if WTR WATER 01 ALL METER SIZE 60.80 UB Meter Maintenance Account No,2100221 Size YTD Cons Serial No Status Location Brand Type 16336459 a Active ERT METE METE w Water 0.625 0M5 190 Date Reading Code ConSUrnpflon Posted Date Variance 8/2/2023 1788 a Actual 16 9/18/2023 14% 5/9/2023 1772 a Actual 16 6/14/2023 -11% 2/V2023 1756 a Achml 17 311412023 4% 11/1/2022 1739 a Actual 16 12/19/2022 -14% 8/312022 1723 a Actual 19 9/20/2022 16% 5/3/2022 1704 a Actua 1 16 6/21/2022 -21% 2/2/2022 1688 a Actual 21 3/1512022 7% 8111/2021 1667 a Actual 19 12/7/2021 7% 8/3/2021 1646 a Actual 18 9/21/2021 17% 514/2021 1630 a Actual 15 6/1512021 -7% 214/2021 1615 a Actual 17 3/16/2021 2% 11/2/2020 1598 a ActL4 16 12/16/2020 -6% 8M/2020 1582 a Actual 18 9/9/2020 3% 5/1/2020 1564 a Actual 16 6/10/2020 54% 21412020 1548 a Actual 11 3M(312020 .14% 11/4/2019 1537 a Actual 13 12/23/2019 -15% 8/2/2019 1524 a Actual 15 9/26/2019 1% 5/2/2019 1509 a Actual '14 6/13/2019 8% 2/4/2019 1496 a Actual 14 3119/2019 14% 111212018 1481 a Actual 12 1211212018 -1% 8/2/2018 1469 a Actual '12 9/20/2018 8% 5/3/2018 1457 a Actual 11 612012018 -24% 2/2/2018 1446 a Actual 15 3/28/2018 13% 1111120,17 1431 a Actual 13 12/29/2017 31 1Vb 8/2/2017 1418 a Actual 110 9/20/2017 7% ..............