HomeMy WebLinkAboutFail - Title V Inspection Report - 531 JOHNSON STREET 12/18/2023 <'" C ommonweatth of Massachusetts
Subsurface Sewage disposal System Farm - Not for Voluntary Assessments
531 JOHNSON STREET
Property Address
TODD SORRIN
Owner Owner's Name
information is NORTH ANDOVER MA 01845 DECEMBER 12„ 2023
required for every
page, City,/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
mngout out forms When
filling A. Inspector Information
f
on the computer,
the tab Todd James Bateson
use only the tab
key to move your Name of Inspector
cursor-do not Bateson Enterprises Inc.
use the return Company Narne ......... .._.. ........ __ ,_., _... _... _... _..
key.
111 Argilla Road
Company Address
= Andover MA 01810
Y W City/Town State Zap Code
m it 978-475-4785 S1-15
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); l 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. El Passes
2. [ Conditionally Passes
3. [] Needs Further Evaluation by the Focal Approving Authority
4. Fails
"' . .. ._ DECEMBER 12, 2023
Inspe r°s Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 god 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.
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d Commonwealth of Massachusetts
Tile 5 O idal Inspection Form
Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
531 JOHNSON STREET
Property Address
TODD SORRIN _
Owner Owner's Name
required
s NORTH ANDOVER MA 01845 DECEMBER 12, 120,23
20,23
required for every _ _
page. City/Town State Zip Code Date of Inspection
_..._.._.._ .w u.._ _.._ _....,_._.,......_..._.__..__. _........... _._.. .......
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:
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 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.
El Y ❑ N FI ND (Explain below):
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"`„° Commonwealth of Massachusetts
I Tide 5 Official Inspection For
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
51 JOHNSON STREET
Property Address
TODD SORRIN
Owner 6wrner`s Name
information Is requured for everyNORTH ANDOVER MA 01845 DECEMBER 12, 2023
_ _
page City/Town State fop Code Date of Inspection
_ ..... ...........__...... _..._..........._. . ._ .. ....., _...__.. _... _.. .. .. ..... a ....
C. Inspection Summary (cant.)
2) System Conditionally Passes (cant.):
Frump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
E] 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 L Y ❑ N El ND (Explain below):
obstruction is removed E] Y F� N El ND (Explain below):
El distribution box is leveled or replaced E Y ❑ N El ND (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)
broken pipe(s) are replaced 0 Y F-1 N El ND (Explain below).
obstruction is removed ❑ Y F� N [ ] ND (Explain below):
3) Further Evaluation is Required by the Board of Health.
[l Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment.
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Commonwealth of Massachusetts
Ir Title 5 Official ici l Inspection Form
11 Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
531 JOHNSON STREET
Property Address _
TODD SORRIN
Owner Owner's Name
information is NORTH ANDOVER MA 01845 DECEMBER 12, 2023
required
for every
page. CrtytTown State Zap Cade Date of Inspection
C. Inspection Summary (cost.)
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:
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.
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..
] 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
Backup of sewage into facility or system component due to overloaded or
El F1 clogged SAS or cesspool
E Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5m4u.doc•rev P926= 8 TatW 5 C7rfl6a.W Vvrrsra+krOKM Fa mi Subsuface Sewage Diismnaa Sy skem•Page 4 caf 18
w� Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
531 JOHNSON STREET
Property Address
TODD SORRIN
Owner -
Owner's Name
information is required for every ..NORTH ANDOVER MA 01345 DECEMBER 12„ 2023
_
page. CItyJTown State Zip Code Date of Inspection
__ .... ............_....,.__................._........................_._........._....__.... _. ._.__... _.._......r_......_............._................_.._.......__.�.
C. Inspection Summary (cost.)
4) System Failure Criteria Applicable to All Systems: (cant.)
Yes No
® 1-1 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 "/a day flow
El ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
E] to Any portion of the SAS, cesspool or privy is below high ground water elevation.
Q z Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
a z Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
n 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. 1 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) Marge 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
❑ ❑ 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 II of a public water supply well
t5insp doa•rev 7f2612018 Title's Official Inspection forin,Subsurface Sewage DeposM System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments
531 JOHNSON STREET
Property Address
TODD SORRIN_
Owner owner"s Name
information isregUid for every NORTH ANDOV_ER _ ----- MA 01845 11 DECEMBE_R 12, 2023
_.
page. City/Town State Zip Cade Coate of Inspection
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
Z 1:1 Pumping information was provided by the owner, occupant„ or Board of Health
DZ Were any of the system components pumped out in the previous two weeks?
0 Z Has the system received normal flows in the previous two week period?
❑ Z Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were a built plans of the system obtained and examined? (If they were not
�� available note as /A
1:1 Was the facility or dwelling inspected for signs of sewage back up?
Z 7 Was the site inspected for signs of break out?
* El Were all system components, excluding the SAS, located on site?
El 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 Z 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) [310 CMR 15.302(5)]
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� Commonwealth of Massachusetts
M Title 5 Official Inspection Form
III Subsurface Sewage Disposal System Forms Not for Voluntary Assessments
F , � 531 JOHNSON STREET
Property Address
TODD SORRIN
Owner Owner's Name
regUiredpon fords emery NORTH AND OVER MA 01845 DECEMBER 12, 2023
page CrkyJown Mete Zip Cade Date of Inspection
........... __. _-..w _ .... ........ ....... __....._.� __..__. .... ..
D. System Information
1. Residential Flow Conditions.
NA 3
Number of bedrooms (design): Number of bedrooms (actual): _
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x##of bedrooms): NA
Description:
Number of current residents: VACANT
Does residence have a garbage grinder? D Yes E No
Does residence have a water treatment unit? ❑ Yes E 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? El Yes Z No
Water meter readings, if available 'last 2 ears usage d SEE ATTACHED
g ( y g (gp ))
Detail:
LAUNDRY NEEDS TO BE TIED INTO NEW SEPTIC SYSTEM
Sump pump? ® Yes No
Last date of occupancy SEPT. 2023
Cate
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
*r %� 531 JO!HN ON STREET
Property Address _
TODD SORRIN
Owner owner's Name
inforrrfor every is
regrtrreded ft~t NORTH ANDOVER A �1845 DEOEMBER 12, 2023
_ _ .. _ _
page City�rown State Zip Cade Clete of Vnspecfron
_ ........__.. . .. ._.e__.__.. . ....... ... .......... ...... _...... a._.. . ........ _ ..... _. _........ __w_._....w ._ .... __.. . ......... ....
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 OMR 15.203); <aaoons per day(qpd)
Basis of design flaw (seatslpersons/sq.ft.„ etc.); _
Grease trap present? El Yes ❑ No
Water treatment unit present? El Yes No
If yes, discharges to:
Industrial waste holding tank present? El Yes D No
Non-sanitary waste discharged to the Title 5 system? El Yes E] No
Water meter readings, if available:
Last date of occupancy/use sate _
Other(describe below):
3. Pumping Records:
Source of information: PUMPING SLIP BOH APRIL 2020
Was system pumped as part of the inspection? F1 Yes M No
If yes, volume pumped: gallons__
How was quantity pumped determined?
Reason for pumping:
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rh; Commonwealth of Massachusetts
m Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
531 JOHNSON STREET
Property Address
TO_DD SORRIN
Owner Owner's Name
information is NORTH ANDOVER MA 01845 DECEMBER 12, 2023
required for every ..
page CitylTown State Zip Code _...... Gate of Inspection
D. System Information (coat.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
Cl Single cesspool
❑ 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.
[] Other(describe):
Approximate age of all components, date installed (if known) and source of information:
NO AVAILABLE DATA
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
18"
Depth below grade: feet ---___--
Material of construction:
® cast iron ❑ 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
JOINTS GOOD
VENTING GOOD
NO EVIDENCE OF LEAKAGE
k 5insp.doc•rev.7!2512018 Title 5 Offocaal Inspection Form.Subsurface Sewage Disposal System M Page 9 of 18
„ Commonwealth of Massachusetts
T"Itle 5 Offic” l Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�. ..' 51 JOHNSON STREET
r roperty Address
TODD SORRIN
Owner C7wner°s Name
deformation Is required for every NORTH ANDOVER MA lJ1€345 DECEMBER 12, 2,023
_ _
page Cityfrown ...._.,_ State Zip Code Date of Inspection
_-..._._._..._...... _ _..._._... ._ .._.... _. __.e... ....... _..,_. _....,...._ ....w.._ _...... . ....
D. System Information (cont.)
6. Septic Tank(locate on site plan):
1
Depth below grade: feet
Material of construction:
concrete El metal [:1 fiberglass F� polyethylene other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ `des F No
Dirnensions: 8' 5 4
Sludge depth,
Distance from top of sludge to bottom of outlet tee or baffle NO BAFFLE
2"
Scum thickness _
Distance from top of scum to top of outlet tee or baffle A
Distance from bottom of scum to bottom of outlet tee or baffle A
How were dimensions determined? SLUDGE JUDGE AND TAPE
MEASURE
Comments (on pumping recommendations, inlet and outlet tee or baffle condition„ structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
INLET AND OUTLET BAFFLES RUTTED OFF
NORMAL LIQUID LEVELS
NO EVIDENCE OF LEAKAGE
k 5fnsp,doc rev,"7/26/2018 1"41e 5 Of iciai&nspeclion r'ovrn Subsurface Sewage Disposal S/stern-Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Grp
531 JOHNSON STREET
- ----,. ..
Property Address ......... ..... --------- --- -------_-
TODD SORRIN
Owner Owner"s Name
information is required for every NORTH ANDOVER MA 01845 DECE_MBER 12, 2023
page. oWtown State Zip Cade Date of Inspection
D. System Information (cant.)
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 tap 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 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
t5insp doc-rev.7/26/2018 Title 5 Official Inspection form SWb$Urfaca Sewage Disposal System w Page 11 of 18
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
` 531 JOHNSON STREET
_
Property Address
TGDD SORRIN
Omier bwer`s Name
requir"ti required
is NORTI d ANDOVER MA 01845 DECEMBER 12 2023
regr�ip�ed for every _ _
page City/Town State zip Cade Date of Inspection
_ww._....._ ....,. _............._.w.. ww . .........._........_ . ........
D. System Information (cant,)
8. Tight or Holding Tank(cant.)
Alarm present: El Yes El No
Alarm level: Alarm in working carder: F-1 Yes No
Date of last pumping: bate
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 PIPES ARE FULL
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 FLOODED
DISTRIBUTION IS NOT EQUAL
HEAVY EVIDENCE OF SOLIDS CARRYOVER
NO EVIDENCE OF LEAKAGE
rSirisp doc,r'ev 'f Y2612271 S rotor 5 chafe asp kruru�*cwyi Form Subsurface&YwaSa DmparasW Stskofn.Page 12 at 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
� .M Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
A , 531 JOHNSON STREET
Property Address
TODD SORRIN
Owner 0 vner`s Name
information Is required for every NORTH ANDOVER MA 01345 DECEMBER 12„ 2023
_ .. _ _
Page. Cityrrown State Zip Code Date of Inspection
D. System Information (cant.)
10. Pump Chamber(locate on site plan):
Pumps in working order: El Yes [:1 No*
Alarms in working order: El 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:
[l leaching pits number:
El leaching chambers number:
E-1 leaching galleries number: -
Ej leaching trenches number„ length. 3 LENGTH NA_
leaching fields number, dimensionso
El overflow cesspool number:
El innovative/alternative system
Type/name of technology: _
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Commonwealth of Massachusetts
d =, Tide 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
531 JOHNSON STREET
Property'Address
TODD SORRIN__
Owner Owner's Narne
inforrequired
is NORTH ANDOVER MA 01845 DECEMBER 12„ 2023
rea�rafred for every
paste, d tyito,wn State Zip Code [late of Inspection
_.._w._.._. .... _..w_. . . .... _._._...... . . .. ..... _._.. ........
D. System Information (cant.)
11. Soil 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 GOOD
EVIDENCE OF HYDRAULIC FAILURE
NO EVIDENCE OF PONDING
12. Cesspools (cesspool must be pumped as pert 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 pond►ng„ condition of vegetation,
etc,):
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Commonwealth of Massachusetts
Tile 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
31 JOHNSON STREET
property Address
TODD SORRIN_ _
Owner 6wner's Name
information is required for every NORTH ANDOVER MA 01815 DECEMBER 12 20,23
_ ._ ..
page. City/"town State Zip Code Date of Inspection
_.... . ........ .._. .....-------,_....._......._.._..
D. System Information (cant.)
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,):
____
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Commonwealth of Massachusetts
Tied 5 Official Inspection For
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
531 JOHNSON STREET
TODD SORRIN
Owner ..... ........... ...
........
_.... .. ... _. ,. ......,_ _ .......
Inquired for
Ie NORTH ANDOVER MA 01845 D CEMBER 12 2023
rewiredfar every C" fregwn _..... ___.._..._ _.._...w ...�_......._._ _............._ .. __. .______..... ....._.... ..� .,.._ . . ,_.....
page. rt� State Zip Cade Cate of Inspection
D. System Information (coat.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at ieast 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:
Z hand-sketch in the area below
] drawing attached separately
►� t ( 1
s :a �at
l
D- boy
r,
._
t rf
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` Commonwealth of Massachusetts
Ns, Title 5 Official Inspection Farm
1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
531 JOHNSON STREET
Property Address
TODD SORRIN
Owner Owner's Nerne
required for
is NORTH ANDOVER MA 01845 I ECEMBER 12, 202
rer�uired fcrr every
page. Y � ... P..... v _ of Inspection
City/Town fTowtr State Zip Code Date
D. System Information (cont.)
15, Site Exam:
Check Slope
Surface water
Check cellar
❑ Shallow wells
Estimated depth to high ground water. feet
Please indicate all methods used to determine the high ground water elevation:
C] Obtained from system design plans on record
If checked, date of design plan reviewed: Date _
El Observed site (abutting property/observation hole within 150 feet of SAS)
2 Checked with local Board of Health - explain:
NO PLANS ON FILE
El Checked with local excavators, installers - (attach documentation)
[W] Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
SUMP PUMP IN CELLAR FLOOR
SYSTEM 3' ABOVE WATER IN SUMP PUMP
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t°i€rmp.dor,•wv.7726rM8 fibe 5 Official lmK.o b on F aom Su@asur€ne Sewago Dir pow"B System•P'age 17 of 18
,r o. Commonwealth of Massachusetts
� � Title 5 Official In p►cc on Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
531 JOHNSON STREET
Property Address
TODD SORRIN
Corner Owner's Name
information is NORTH ANDOVER MA 01845 DEC:EMBER 12, 2023
required for every ..
page. Cityrro'wn State Zip Code Date of Inspecbon
_... ...._....._ ._... ,,.,.... . .... .... ...., _._....,_......... _..._..._w.._.... . . ....... .. ........_._.....,_.._.._..... _,.. . ..
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of.
El A. Inspector Information: Complete all fields in this section.
Ej 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
k°Pomasp aim-rev 71 420,18 B Wer 5 o0fcae l IauBupecGion Fufrn Subsurface Sewau M DvspaosM Sysremrn Pagpe 18 of 18
Sum nary ary Recofd C wd g enecnte4 w QR12023 1 04:10 PM ty^Karam IdaMoa Page 1
Town of north Andover
Tax Map # 210-099.A-0014-0000.0
Parcel Id 14878
531 JOHNSON STREET
TODD & PATTY SORRIN
531 JOHNSON STREET
NORTH ANDOVER MA 01845
Class 101 Singh Family Property Type 1 Residential
Size Total 1,01 Acres
F"Y 2024
UB Mailing Index
Name/Address Type loan Number Active/Inact, From Until ,
TODD&PATTY SORRIN Owner Active
531 JOHNSON STREET
NORTH ANDOVER MA 01845
DERBY, S'TEPHEN Previous Customer Inactive 9/812023
531 JOHNSON STREET
N.ANDOVER,MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 139%0-531 JOHNSON STREET last Billing Date 1216/2023
2100585 02 Cycle 02 Active
UB Services Maint.
Account No.2100585
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.63 5/8 7.82 1/
W rR WATER 01 All METER SIZE /1
UB Meter Maintenance
Account No.2100585
Serial No Status location Brand Type Size YTt7 Cons..
13242188 a Active HH 5/8",#531 b Badger w Water 0.625 0.625 188
Date Reading Code Consumption Posted Bate Variance
11/2/2023 0 a Actual 0 12113/2023 -1 QQ!/q .
9/5/2023 0 f Final Bill 0 9/7/'2023 -100%
9/512023 0 n New Meter 0 91712023 -100%
9/5/2023 2348 s Reset meter 23 9/7/2023 14521%
513/2023 2325 a Actual 14 6/14/2023 •19%
2/3/2023 2311 a Actual 18 3/14/2023 2%
11/2/2022 2293 a Actual 17 12/19/2022 -24%
8/412022 2276 a Actual 23 9/20/2022 25%
5/4/2022 2253 aActual 18 6/21/2022 -2%
21312022 2235 aActual 19 3/15/2022 -17%
11/2/2021 2216 aActual 22 1217/2021 2%
8/5/2021 2194 aActual 22 9/21/2021 3'7%
5/6/2021 2172 a Actual 16 6115/2021 -14%
2/4/2021 2156 a Actual 19 3/16/2021 -23%
11/3/2020 2137 aActual 24 12/16/2020 -13%
8/5/2020 2113 a Actual 28 9/9/2020 22%
5/6/2020 2085 a Actual 23 6/1012020 -20%
2/5/2020 2062 a Actual 29 3/16/2020 -14%
11/5/2019 2033 a Actual 35 12123/2019 -1%
81212019 1998 a Actual 34 9/26/2019 22%
5/312019 1964 a Actual 27 6113/2019 -4%
2/4/2019 1937 a Actual 29 3/19/2019 4%
111512018 1908 aActual 28 12/12/2018 -31%
8/612018 1880 a Actual 43 9120/2018 75%
5/212018 1837 a Actual 22 6/20/2018 10%
2/5/2018 1815 a Actual 22 3/2812018 -20"/o
11/2/2017 1793 a Actual 26 1212912017 -7%