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HomeMy WebLinkAboutPass - Title V Inspection Report - 26 EASY STREET 10/23/2023 , �4 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 EASY STREET JEFF HART Owner Owner's Name information is NORTH AID DOVER MA 01845 OCTOBER 19 2023 required for every _ .. . page Cltyi"€own State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection farms may not be altered in any way. Please see completeness checklist at the end of the form. Important:when filling out forms A. Inspector InformationiInformation on the computer, use only the tab Todd James Bateson key to move your Name of Inspector cursor-do not Bateson Enterprises inc. use the return . ._ key. Company Name __....__._...,_ �.. ..._ _....... 111 Argilla Road __._ . _._....... . Company Address Andover MA 01810 City town State Zip Code LIZ, 978-475-4786 SI-16 Telephone Number License Naamber ..._,__,... B. Certification I certify that; I am a. DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000); I 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. [21 Passes 2. ] Conditionally Passes 3. Needs Further Evaluation by the Local Approving Authority 4, Fails OCTOBER 1g 2023 _._....__. . ....._ ........ _.... _. _......_ .. ....._.__.... ,..... Inspec r"sSignatr 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. t5irrsp,doc-rev.7126t2018 'Tills 5 Official Inspection Fora:Subsurfracaa Sowage Disposal Systom•Page 1 of 18 Commonwealth of Massachusetts _1 I : Tide 5 t ► #icial Inspection orm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 EASY STREET Property Address JEFF HART Owner Owner's Name requiratufo is NORTH ANCDOVER MA 01845 OCTOBER 19, 2023 required for every _ page tyo rowri State Zip Code Gate of lnspeotaon ...... .......... .......... ., __.. m....... ... ... . Inspection Summary Inspection 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: 2) System Conditionally Passes: f..,. One or more system components as described in the "Conditional Fuss" 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 staternents. 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 immanent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A rnetal 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 G.... N C .� ND (Explain below): tainsp doc•vev.712.612018 'Twe E,Oft"mi Enspectiw Foirn Sutrsudaco S awage r7o^apos al System•Page 2 rid'W .° ommonwe lth of Massachusefts *r T We 5 Official Inspection Farm Subsurface Sewage disposal System Form - Not for Voluntary Assessments J ;' ✓� 26 EASY STREET Property Address JEFF HART Owner _.. �wner°s Name rrrEop`rredfn ws NORTH ANDOVER I"vf1A 0 84d OCTOBER 19, 2023 k°oc�uirod for every _ pace; Catyft'own State Zip Dodo Cate of lnspectwon C. Inspection Summary (cant.) 2) System Conditionally Passes (cont,): .. Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. El 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 C ,j Y D N [I ND (Explain below): obstruction is removed [] Y L-1 N E) ND (Explain below): distribution box is leveled or replaced [,. Y N [ NCB (Explain below): __ El The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): F] broken pipe(s) are replaced � Y E N [ Nth (Explain below): �._.� obstruction is removed Y [ N Nib (Explain below)i: 3) Further Evaluation is Required by the Board of Health: [_1 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 systern is not functioning in a manner which will protect public health, safety and the environment: t,lonrsa'r.doc:•rage 712Cia2'018 r iVe 5(.'Afica finsplutbd'.ttoo r k orrar 1;ar4's urfw.:e Sewage wage Disp.uah„al Systerrii•Parre 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .,. ,, ,,;,a 26 EASY STREET F roperty Address JEFF HART Owner _ Owner's Name information is NORTH ANDOVER MA 01$45 OCTOBER 1g, 2023 required for every page, City(Town Mate Zip Code Date 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 fall 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. ❑ 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 17 z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 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—rev.'7/2612018 1 We 5 Official lnspeecWn For in:Subsurface Sewage C isposai System-Page 4 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form n Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 26 EASY STREET Property Address JEFF HART w Owner _ C} ner' 1�1 s Nae_. _ information is required for every NORTH ANDOVER MA 01845 OCTOBER 19, 2023 .... page city/Town State Zip Code bate of Inspection __„ ....... .......... C. Inspection Summary (cant.) 4) System Failure Criteria Applicable to All Systems: (cant.) Yes No ❑ Z Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El Z Liquid depth in cesspool is less than 6" below invert or available volume is less than '/ 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. ❑ z 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. E z 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.] ❑ 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 following, in addition to the questions in Section CA, Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply E] [l 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 t5msp>doc•rev 7126/2018 C'itie 5 Offic sl Inspection Form Substeaoe Sewage Drsposat System M Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Farm �n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 EASY STREET Property Address JEFF HART Owner Owner's Name _ information is required for every NORTH ANDOVER MA 01845. OCTOBER 19, 2023 _ . _ . page, y p Inspection City/Town!Town State Zip Cade Date of 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 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 Z ❑ Pumping information was provided by the owner, occupant, or Board of Health (l Z Were any of the system components pumped out in the previous two weeks? Z ❑ Has the system received normal flows in the previous two week period? F Z Have large volumes of water been introduced to the system recently or as part of this inspection? Z 11 Were as built plans of the system obtained and examined? (If they were not available note as N/A) Z ❑ Was the facility or dwelling inspected for signs of sewage back up? Z ❑ Was the site inspected for signs of break out? Z 0 Were all system components, excluding the SAS, located on site? Z ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction„ dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on. Z ❑ Existing information. For example, a plan at the Board of Health. 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 15.302(5)) t5in5pa,doc•rev,7/26/2018 'riUaa S Offi oV Inspretr.t¢on Form Subsurface Sewage Disposal System-Page 6 of 18 '` Commonwealth of Massachusetts Zl- °w �S Title 5 O fic"al Inspection For Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 26 EASY STREET Property Address JEFF HART Owner bwner`s Name _ information is required for every NORTH ANDOVER MA 01345 OCTOBER 10, 2023 page. City/Town State lip Code Date of Inspections D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Nurnber of bedrooms (actual). DESIGN flow based on 310 CIVIR 15.203 (for example: 110 gpd x#of bedrooms): 500 GPD Description: Number of current residents: 4 Does residence have a garbage grinder? El Yes Z No Does residence have a water treatment unit? El Yes Z No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No Information in this report.) Laundry system inspected? Z Yes [:] No Seasonal Use? 0 Yes Z No Water meter readings, if available last 2 ears usage d SEE ATTACHED g ( y g (gp ))� Detail. Sump pump? Z Yes No Last date of occupancy, CURRENTp y� Date t5sosp."doc rey "7f2612018 tl itte 5 OfficiW dnspection Forrr.SVJbsu face Sewage Disp sal Syvern E'"a%fie 7 0 18 � Commonwealth of Massachusetts Tide 5 Official Inspection Farm . Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 26 EASY STREET Property,address JEFF HART Owner Owner's Narne information is NORTH ANDOVER MA 01€345 OCTOBER 19, 2023 required for every _.. _ ...__.. _. _. _... page Gty/town State Zip Code mate of Inspection _. __ w._.....____._.._� _._w.. . .___... ___ _.._ _ _ ......._... . ._.......__ _._,..._....._.._. D. System Information (cunt.) 2. Commercial/industrial Flow Conditions: Type of Establishment: _. Design flow (based on 310 CMR 15.203): Ga 11 llons 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: -Date Other(describe below): 3. Pumping Records: Source of information: APRIL 2023 OWNER Was system pumped as part of the inspection? ❑ Yes Z No If yes, volume pumped: g aeons How was quantity pumped determined? __- Reason for pumping, t5visp,dr>c*rear.7126Q018 'r'itie 5 Official Inspection Form,Subsurface Sewage Dsposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 EASY STREET Property Address JEFF FART Owner Owner's Narne required for is NORTH ANDOVER MA 01845 OCTOBER 19„ 2023 rega�nreeV 6or every .. page, yPT cwrr .mm....m.._.._..... ... ate Lip Code gate of Inspection It ..._..._._._ ......_...._... .._.... ._ ..... _...... _.__.. _. __._. ...... _._ __..____..._. D. System Information (coot.) 4, Type of System: z Septic tank, distribution box, soil absorption system 0 Single cesspool 11 Overflow cesspool [:1 Privy 7 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 0 Tight tank. Attach a copy of the DEP approval. Other(describe): Approximate age of all components date installed (if known) and source of information: 40 YEARS OLD, JUL.Y 1983, AS BUILT PLAN Were sewage odors detected when arrivVng at the site? [eJ Yes Z No 5. Building Sewer (locate on site plan); 16" Depth below grade: feet Material of construction: 0 cast iron Z 40 PVC other (explain'): Distance frorn 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 taunsu C1oq'; rsav 7C2"tr,n r r Title b olfocoa Inspect c�l[�ogrn Sauhs� f ac*Sewage Dis�prosW system•Page 9 0:f 18 ^ 'tS Commonwealths of Massachusetts ,3, Title 5 Offi c"al Inspection Farm W j Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments �fQ: s �e 26 EASY STREET Property Address JEFF HART Owner Owner's Name _ requ �eldfr os NORTH ANDOVER MA 01845 OC'TOBER `{9, 2023 rcep�anred far every ---------- page. City/Town State lap Cade rate of Bnspectian ....... ..._... _ . __ w ... _.......... __..._.._._. .. ............ D. System Information (cent.) 6. Septic Tank (locate on site plan): 4" Depth below grade-,p g feet _. Material of constructuon: concrete E] metal El fiberglass polyethylene other(explain) If tank is metal„ list age: years Is age confirmed by a Certificate of Compliance"? (attach a copy of certificate) E] Yes No Dimensions: x 4" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 NA Distance from top of scum to top of outlet tee or baffle Distance from bottom of scurn to bottom of outlet tee or baffle N [low were dimensions determined? SLUDGE JUDGE AND TAPE MEASURE Comments (on pumping recommendations, inlet and outlet tee or baffle conditions structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.). RECOMMEND PUMPING OLDER SYSTEMS YEARLY INLET BAFFLE CONCRETE - OK OUTLET TEE PLASTIC - OK TANK IN GOOD CONDITION NO EVIDENCE OF LEAKAGE NORMAL LIQUID LEVELS t5ir ap.�7ax. rev 7:266120163 l-me r7(awrai tnsp.Terav on a rarni Subsurface 13ewaagea a:mpasal System Page 10 aad 18 Commonwealth of Massachusetts _ lV Title 5 Official Inspection Form :F: w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 EASY STREET Property Address JEFF HART Owner Owner Name information is NORTH ANDOVER MA 01845 OCTOBER 19, 2023 required for every _-__ page, cety/Town State Zip code Date of Inspection D. System Information (cant.) T Grease Trap (locate on site plan): Depth below grade: _ feet Material of construction: ❑ concrete Q 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.): 8. Tight or Molding 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 15nsp doc-rev 7126W 16 Title's Official pnspe otorw Form Subsurface Sewage Disposal Syslearc-Page 11 of 18 � , Commonwealth of Massachusetts Title 5 Official Inspection Farm 4I" 'Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 EASY STREET Property Address JEFF HART Owner Owners Name [equiredfn us NORTH ANDOVER MA 01845 OCTOBER 19„ 2023 recfaired for every pace. Cwtyffown State Zip Code Date of Inspection .... _ _,�.. .,._._.. _ .. ........ _._ ..._ .. .............._ ...._.._,... D. System Information (cant.) 8. Tight or Holding Tank (cant.) Alarm present: (l Yes No Alarm level: Alarm in working order 0 Yes E] No Date of last pumping: Dat e Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract(required). Is copy attached? F1 Yes E] No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 _ Comments (note if box is level and distribution to outlets equal„ any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-BOX IS LEVEL AND DISTRIBUTION IS EQUAL. D-SOX HAS SPEED LEVELERS NO EVIDENCE OF SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGE rbzin sp doe,•rev.7'/26t2018 0 ifie 5 Q„mcia[€rrmapa,»cijon rrx'n „au.0 nurfne sowaage tl)isposai swW„ei r^Page 12„rrf't8 Commonwealth of Massachusetts Title 5 Official In peet"on Form `. n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 EASY STREET Property Address JEFF HAFT Owner Owner's Name information is NORTH ANDOV R MA 01 4 OCTOBER 19 2023 rer�:alre�!for every _ _ pace City/Town State Zip Code Gate of Inspection D. System Information (cant.) 10, Pump Chamber(locate on site plan):. Pumps in working order: Yes No* 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 11 leaching pits number: (_) leaching chambers number: ( � leaching galleries number: _. M leaching trenches number„ length: 3; 65' LONG leaching fields number, dimensions: _ overflow cesspool number. El innovative/alternative system Type/name of technology: rhir'rtrp cdoc vey.7d'2ErC O18 TMe 5 Offaa W insrNammon 4'u^ev'n Subs ula ce Sewage ilmpos l,3'ystem•Page'k 3 U1 18 Commonwealth of Massachusetts Title 5 Official Inspection Form R} Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 EASY STREET Property Address JEFF HART Owner bw-ner's Name informationis required for every NORTH ANDOVER MA 01845 OCTOBER 19e 2023 page City/Town State Zip Cade Date of Inspection- --D. System Information (writ.) 11. Sail Absorption System (SAS) (cant.) Comments (note condition of sail„ signs of hydraulic failure, level of ponding, damp sail, condition of vegetation, etc.): SOIL AND VEGETATION OK NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING 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 F1 Yes F] No Comments (note condition of soil, signs of hydraulic failure, level of ponding„ condition of vegetation, etc.): t5vfsp:„.eoc rev.7f260 18 Titles f„Mtl IC4 hsapstrd*rr Form Subsurface Sewage 01(spyarsa� Sy stem in•ha,age 14 0 18 Commonwealth of Massachusetts I Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm Not for Voluntary Assessments 4 e 26 EASY STREET Property Address JEFF HART Owner Owner's Name information is required for every NORTH AN ROVER MA 01845 OCTOBER 15, 2623 page Cityf"rowrr State Zopa Code Date of Inspection ........... ... .,........, . . . ......, .e __....... . .........__........ D. System Information (cant.) 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.): P5msrr.doc,rev.7126120 V 8 Tille 5 Official Ia�isp„er4o n Form Subsurface Sewage fl7 SPOSW System•Page 15 of 18 Commonwealth of Massachusetts. Title 5 Official Inspection Form - � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 EASY STREET . _....... ... __._____._._ Property Address JEFFMART ___. _._ .._.._.__ ....._..____._... Owner owner s Name information is MA 01840 ©CTOBER 19, 2023 NORTH ANDQVER required for every _...184 � _ .._. page CitylTown State Zip Code CJate 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 Z drawing attached separately 1 f .. ° K A- A , . .. 2 0 V if t6lnsp.Joc-rev.712612U16 'Pith,5 Official Inspection Fortin Subsurface Sewage 0005W Sysfern-Page 16 of 18 Commonwealth of Massachusetts ° Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 EASY STREET Property Address JEFF HART Owner Owner's Name e required for every at'iran is r NORTH ANDOVER MA 0184 OCTOBER 19, € 23 requir page, City/Town State Zip Cede Date of Inspection D. System Information (coot.) 15, Site Exam Z Check Slope Surface water Z Check cellar E] Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: z Obtained from system design plans on record If checked, date of design plan reviewed: MARCH i 1981 _A _. Gate El Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health - explain TITLE V ON FILE. l_.l Checked with local excavators, installers - (attach documentation) E' Accessed USGS database -explain: You must describe how you established the high ground water elevation: DESIGN PLAN SYSTEM ABOVE WATER TABLE Before filing this inspection Report, please see Report Completeness Checklist on next page. v°.nsp,doc vw:v 7/2kxB2018 1 rtw 6 Official Ir1sp;e tan r rrrrrr Subsurface SevragA 1')rEaBxo sal Syckeir.Page 17 of'18 Commonwealth of Massachusetts ---- d Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments >. ; w 26 EASY STREET Property Address JEFF HART Owner Owner's Name regK�irereat uid for �r every Nn RTH AC`�DOV R MA Cl1&345 OC:,TOBER 19„ 2023 fa page, CFtyrrown State Zip Cade gate of Inspection . ........... _ _.......... .. _. ___......._.. _... .. ...._._..,.. .,..._.. _ _ . .... _e__.... ......._.__.. ....... E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Z A. Inspector Information: Complete all fields in this section. Z B. Certification: Signed & Dated and 1, 2, 3, or 4 checked Z C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed D. System Information: For 3: 'Fight/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 t5,n mp.afar, r"v "1126120 18 't tki b C9a4PvaC 4rn%>;ranron rvbrr'n Subsurfw*Sewage Doga xnsn SyMerar Page 18 of 16 m r. „unimBry Record C'wd gesnarWeed On 1011312023 8; 14;20AM by Koren rteWrs Page 1 Torn of North Andover Tax Map # 210-038.0-0165-0000.0 Parcel Id 1954 26 EASY STREET JEFFREY & CHARLENE HARTS 26 EASY STREET NORTH ANDOVER MA 01846 Class 101 Single Family Property Type / Residential Size Total 1,09 Acres FY 2024 UB Mailing index Name/Address Type Loan Number Active/Inact. From Until JEFFRE'Y&CHARLENE MARTE Owner Active 26 EASY STREET NORTH ANDOVER MA 01845 SULLIVAN,PAUL&:LETITIA Previous Customer Inactive 7/18/2014 26 EASY STREET N.ANDOVER,MA 01846 UB Account Maint, Account No Cycle Occupant Name Active/Inactive Bldg Id. 13987.0.26 EASY STREET Last Billing Elate 9/11/2023 2100549 02 Cycle 02 Active UB Services Maint. Account No.2100549 Service Code Rate Charge Multiplier/Users MISCFEEADMIN FEE 0,63 5/8 7.82 1/ VV'TR WATER 01 ALL METER SIZE 86.72 /1 UB Meter Maintenance Account No.2100549 Serial No Status Location Brand Type Size YTD Cons 36207139 a Active E-:RT i-II-I b Badger w Water 0.625 0.625 320 Date Reading Code Consumption Posted Elate Variance 8/3/2023 1634 a Actual 22 9/18/2023 66% 51312023 1612 a Actual 13 6/14/2023 •17% 212/2023 1599 a Actual 16 3/14/2023 -44% 11/2/2022 1583 a Actual 26 12/19/2022 -30% 814/2022 1555 a Actual 41 9/20/2022 74% 5/412022 1514 aActual 23 6/21/2022 -18% 213/2022 1491 a Actual 29 3/15/2022 -50% 1112/2021 1462 aActual 55 12/13/2021 61`la 8/5/2021 1407 a Actual 35 9/21/2021 40`"frb 51612021 1372 a Actual 25 6/15/2021 -23% 2/4/2021 1347 a Actual 33 3/16/2021 -37% 11/3/2020 1314 aActual 51 12/16/2020 -10`"/w 8/5/2020 '1263 a Actual 57 919/2020 78% 5,/6/2020 1206 a Actuai 32 6/10/2020 -19% 215/2020 '1174 a Actual 40 3116/2020 -32% 1115/2019 1134 a Actual 61 12/23/201 J 22% 8/2/2019 1073 a Actual 48 9125/2019 849% 5/3/2019 1025 a Actual 25 6/13/2019 -20% 2/5/2019 1000 a Actual 33 3/19/2019 -'16% 11/5/2018 967 aActual 39 12/12/2018 -53% 8/6/2018 928 a Actual 88 9/20/2018 228% 512120,18 840 a Actual 24 6/20/2018 19% 2/5/2018 816 a Actual 22 3/2812018 -58% 11/3/20'17 794 aAcdtuaV 51 12/29/2017 24% 8/312017 743 a Actual 41 9/20/2017 72% 5/312017 702 a Actual 23 6/26/2017 3% 213/20/7 679 a Actual, 23 3/'14/201 7 -49%