HomeMy WebLinkAboutPass Conditional Pass - Title V Inspection Report - 140 VEST WAY 3/27/2024 Comtmonwoalth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage disposal System Farm -Not for Voluntary Assessments
140 VEST WAY
i5ioperty Address
ROBERT KATSEFF _.... ..._ . .....__..
Owner ne,Wi Narne
information is NORTH Alw ROVER state g1545 MARCH 13, 2024
required for every _.._...._. _ ._.__.... MA .. _.
page C�ty�B oven 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.
P"
Important:Men A. Inspector Information
filling out forms
on the computer, Todd James Bateson
useonly the tab _.,.,...__ __..._ _............ _.._ _. .......,.. _.._.. _ ,... _..
key to move your Marne of pe �tor
Bateso Ins
cursor-do net Enter rises lnc �
use the return Compadny rdarme
key.
111 Arilia Road
t6mpany Address
Andover MA 018io
Cit frown Code
978-475-4 `86 I-1
Telephone Number L.ioense Number
B. Certification
I certify that: I am a DEP approved system Inspector in full compliance with Section 1.6.340 of Title 5
(310 CMR 16.000)„ 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. Z masses
2. Conditionally Passes
3, Needs Further Evaluation by the Local Approving Authority
4, Fails
MARCH 19 2024 _..._... __.r_._.._.,_. __,,..... ._..
Inspector" Signature sate
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.
Pleaseto This report only describes conditions at the time of inspection and under the
condi
tions 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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Commonwealth of Massachusetts
I, x` Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 VEST WAY_
Property Address
ROBERT KAT EF
Owner 6w'ner°s name
requirt required for
is NORTH ANDOVER MA 01845 MARCH 18 2024
regr�ireti frar every
page Ity/Town tarn Zip Code Gate of Inspection
_._.__. .._.._.. ._...
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:
PERMIT- BOARD OF HEALTH
PUMP OUT-
INSTALL NEW D-BOX
EXCAVATE OUTLET SIDE OF PIPE, INSTALL NEW PIPE INTO TANK
INSTALL OUTLET TEE AND GAS BAFFLE IN TANK
INSPECTION - BOARD OF HEALTH
2) System Conditionally Passes:
C] One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacernent 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.
(l Y .] N F-1 ND (Explain below):
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N"
Commonwealth of Massachusetts
i Title 5 Official Inspection Form
LL Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
140 VEST WAY
Property Address _.......
ROBERT TEFF
(finer .__..._.._. ..._...._. �_.......... _._.. .....__._....._...___.___ . ___.. . . ... _. ..
Cdnaruer°s Name
information us NORTH AID D VER MA 01845 MARCH 14„ ; 0 4
required for every ___... _ _._....._...._.__.�_.__.____.____......_.... _.__._. __.
dt Ptowvn State dp Lode Date of Inspection
page. . ...____ _._._.. _.__ _...
Inspection results must be submitted on this form. Inspection forms may not "altered in any
way. Please see completeness checklist at the end of the form.
A. Inspector IrlfrmI,. .__..._ .._. _._ ... .._._.__ .. ...... . ._ _. _ ._..w _._w
Important:When
filling out forms
on the computer„ Todd James Bateson __._....... __._.....
use only the tab .. _.... ....... .... ... ......_... ._. __.___ .._... �.. ' ...__..._...
key to move your Name of Inspector
cursor-do not Bateson Enterprises Inc.
usethe return drrpdayName __._.._... ......_ .... _...____. __ _....... .... __......_____._....._ _..... _.. .ury.,... ___._._._._._.
key,.
J
111 Arcilia Road
ornpany Address
� Andover IAA 01810
i*i"r own .._ __._.._ ___...._.�.. ...__� .w... _. _ _ State ..._.... _ ....___^ gyp Code
978-47 -4786 I-16
"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
( 10 CMR 15.000) 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection 1 have determined
that the system:
1. 0 Passes
g. Z Conditionally Passes
3. El deeds Further Evaluation by the Local Approving Authority
4, El Fails
t �
MARCH 19„ 04
Cate __...._. . _......... ...___..._.. ._.._.._........._.. .... ..
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.
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Commonwealth of Massachusetts
0 "tie ► Cuffi.ri Inspection Form
q( Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
!� 140 VEST WAY
Property Address
ROBERT KATSEFF
Owner owner's h ame
information is NORTH ANDOVER MA 01845 MARCH 14, 2024
required for every . ..._. ..
page Cityl own State Z.ip Code Cate of Inspection__.
_,.. ..._.... _....__........__._ _...._._._ _ w...__._-.___ ........_ __ 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:
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.
El Y ] N ND (Explain below):
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Commonwealth of Massachusetts
..An Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
g p Y rY
140 VEST WAY
Property Address _ _ _....
ROBERT KATSEFF
Owner _m_ _
Owner"s h}ae _
information is NORTH ANDOVER MA 01845 MARCH 14, 2024
required for every _ ---..... . .___._--
page. City[ own State Zip Code Date of Inspection
................_....m......,.,__.....__._._ _ ,_,__... __._..------_ .._....._._.___.__.._._.,.,,_,__...__...___.___._._...__.,.
C. Inspection Summary (coot.)
2) System Conditionally Passes (cant.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
F1 broken pipe(s) are replaced Y ❑ N ❑ ND (Explain below):
F obstruction is removed Q Y F N ❑ ND (Explain below):
Z distribution box is leveled or replaced Z Y ❑ N El ND (Explain below),-
PIPE OUTSIDE TANK IS COLLAPSED,
D-BOX IS ROTTED AND NEEDS REPLACED
(� 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 ❑ Y El N El ND (Explain below):
[� obstruction is removed ❑ Y Ej N 0 ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
El 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:
1.51nsp doc-rev.7/2 812 0 1 8 Titles 5 O ficW Insptedw Fom Subsurface Sewage Disposal System-Page 3 of 18
Commonwealth of Massachusetts
Title 5 Off dal Inspection Form
4* Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
I
ry+ 140 VEST WAY_
Property Address
ROBERT KATSEFF
Owner Owner's Name
uequiredfo is NORTH ANDOVER MAIII 01845 MAR CH 14 2024
required for every
page. cetyrrowra _ state Zip Cade Date of Inspection
C. Inspection Summary (cant.)
D Cesspool or privy is within 50 feet of a surface water
El 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.
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
El 1-71 Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
] 7 Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5nsp.doc-raav '71M20'16 r'10 r 1,C'7YYnal Inspection h Qlrn SubiaaAace Sewage Disposal SyNtem•Page 4 of 18
'f S
Commonwealth of Massachusetts
r � Title 5 Official Inspection Form
V b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,,
J A 140 VEST WAY'
Oroperty Address
ROBERT KATSEFF
Owner Owner's Name
information is NORTH ANDOVER MA 01118451MARC i 14," 210214-111111111
required for every _
page, City/Town State Zip Code Date of Inspection
C. Inspection Summary (corit.)
4) System Failure Criteria Applicable to All Systems: (cant.)
Yes No
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
0 z Liquid depth in cesspool is less than " below invert or available volume is less
than "f2 day flow
El z Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe( ). Number of tirnes pumped
[_j z Any portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
D z Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
El z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
0 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 forma
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 following, in addition to the
questions in Section C.4,
Yes No
El El the systern is within 400 feet of a surface drinking water supply
El E] the system is within 200 feet of a tributary to a surface drinking water supply
E] El 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
c.a;nsp doc•rev iQHy 2018 9'tG e 5 Offjc•W Ursp ectkori rrzrrn ,13"bsurlace Sewage Disg°oa'isaf a,'yWern Page 5 caf'18
Commonwealth of Massachusetts
-M f Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 VEST WAY
Property Address
ROBERT KATSEFF
Owner
Owners Name _
information is NORTH ANDOVER MA 01845 MARCH 14, 2024
required for every _ ..._ _ _. . _... -- .._._.. _ ... �......
page. City/Town state Zip Code 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 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
M ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ Z Were any of the system components pumped out in the previous two weeks?
® ❑ 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?
Z ❑ Were as built plans of the system obtained and examined? (if they were not
available note as N/A)
• ❑ Was the facility or dwelling inspected for signs of sewage back up?
• ❑ Was the site inspected for signs of break out?
• ❑ 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:
Z 1:1 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)]
t5insfa doc-rev V26/2016 'rifle 5 Official inspection Farm Subsurface Sewage Disposa{System.Page 6 of 18
qk
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 VEST WAY
r5rdperty Address
ROBERT ATSEFF
owwner ... _ ..._ _.._.. _
Owner's Name
required
is NORTH ANDOVER MA 01845 MARCH 14, 2024
required for every . _ . . ...... _
page. City/Town State Zip Cade Cate of Inspection
D. System Information
1. Residential Flaw Conditions:
Number of bedrooms (design): _ Number of bedrooms (actual).
DESIGN flow based on 310 CMR 15,203 (for example: 110 gpd x#fi of bedrooms): 600 UPD
Description:
Number of current residents: 2
Does residence have a garbage grinder? 0 Yes M 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 Z No
information in this report,)
Laundry system inspected? ® Yes Q No
Seasonal use? El Yes E No
Water meter readings, if available (least 2 years usage (gpd SEE ATTACHED
)):
...
Detail:
Surnp pump? 0 Yes N No
Last date of occupancy: CURRENT
bate..,.
6nsp doe':^raay.7 26/2018 !"ae 5 Offi at tr.v%a ecfioli Form arrraswfface Sewage Diigpxmaa System Page 7 off 18
d Commonwealth of Massachusetts
Title 5 f "c al Inspection Form
n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
., 140 VEST WVAY
Property Address _._
ROLERT KATSEFF
OwnerOwner"s Name ... ..._....
regUiredfn is NORTH ANDOVER MA 01845 MARCH 14, 2024
required far every _..
page. City/Town State dip Code [late of Inspection
D. System Information (cont.)
2 Commercial/industrial Flow Conditions:
Type of Establishment;
Design flow (based on 310 CMR 15.203): Gallons per day..(9p )
Basis of design flow(seats/persons/sq.ft., etc.),-
Grease trap present? E] Yes ❑ No
Water treatment unit present? D Yes D 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;
Gate
Other (describe below):
3. Pumping Records:
Source of information; LAFRANCE SEPTIC SERVICE
Was system pumped as part of the inspection? Z Yes Ej No
1500 GALLONS
If yes, volume pumped: gallons _
How was quantity pumped determined?
TRUCK GAUGE
Reason for pumping: MAINTENANCE
t5irasp.6x row.7/26/2018 TIVO 5 MOM 1119.7cxc€W FOMI:,Subsurfaaco Sewage Da spotsral System•rape 8 of 18
_.. ...--
Commonwealth of Massachusetts
� M Title Official Inspection Form
j Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
140 VEST WAY
t roperty Address
ROBERT KATSEFF
Owner Owner's Name
information is NORTH ANDOVER MA 01845 MARCH 14 2024
required for every
page. Cit bity/town State Zop Code Date of&nspecbon
D. System Information (cant.)
4° Type of System:
z Septic tank, distribution box, soil absorption system
❑ Single cesspool
Overflow cesspool
El Privy
[l Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
M Tight tank. Attach a copy of the DEP approval.
[ Other (describe):
Approximate age of aii components„ date installed (if known) and source of information:
41 YEARS, INSTALLED JULY 12, 1983 AS BUILT PLAN
Were sewage odors detected when arriving at the site" 0 Yes Z No
5 Building Sewer(locate on site plan):
Depth below grade, feet
g teat
Material of construction:
cast iron R 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 AND VENTING OK
NO EVIDENCE 07F LEAKAGE
t5nsp doc•mv.7/26/2018 TO le(i C,,)8ficAl gnspection F orm SuPB'sr8Oace Sewage DisptrsW Syster n-Page 9 of'18
Commonwealth of Massachusetts
Title a Official Inspection Farm
I Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
< � 140 VEST WAY
r5rdperty Address
ROBERT KATSEFF
Owner bwner"s Nafr1e
information is NORTH ANDOVER NBA 01845 MARCH 14, 2024
required for every .. _...
page. city7Town state Zip Code Date of Anspection
D. System Information (cant.)
. Septic Tank (locate on site plan):.
Depth below grade. 6.5'
feet
Material of construction:
Z concrete 0 rnetal El fiberglass 0 polyethylene other (explain)
If tank is metal„ list age: _
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Ej Yes ❑ No
Dimensions: 5" 4"
Sludge depth 4,0
Distance from top of sludge to bottom of outlet tee or baffle 4
218
Scum thickness
Distance from top of scum to top of outlet tee or baffle 6
._..
Distance frorn bottom of scum to bottom of outlet tee or baffle
12"
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.):
RECOMMEND PUMPING OLDER SYSTEMS YEARLY
INLET BAFFLE OK, OUTLET BAFFLE NEEDS REPLACED
TANK IN GOOD CONDITION
NO EVIDENCE OF LEAKAGE
NORMAL LEVELS IN TANK
BROKEN PIPE OUTSIDE OF TANK. NEEDS REPAIRED WHEN INSTALLING OUTLET TEE
[fnrwsp doc•rear.'7126,1201 H I itlni,5 orfcral indpe,,on Form.Subsurface,Sewage 9:)amosaV sy verrr•Page 10 of 18
" Commonwealth of Massachusetts
iT i tl,, Title 5 Official Inspection Farm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
I
�l •.,= ,nr° 140 VEST WAY
Property Address
ROBERT KATS FF
Owner ..___
owner`s Dame
information Is NORTH ANDOVER MA 01848 MARCH 14, 2024
required for every ..
page dityfC'own State _ Zip.Code gate of Inspection
D. System Information (cant.)
7. Grease Trap (locate on site plan):
Depth below grade:
ieet
Material of construction:
El concrete 0 metal F.1 fiberglass El polyethylene other(explain):
Dimensions,-
Scum thickness
Distance from top of scurry to top of outlet tee or baffle
Distance from bottorn 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 bellow grade:
Material of construction:
concrete metal Q_ fiberglass D polyethylene [ITS other(explain):
Dimensions:
Capacity:
galNc�ns
Design plow:
gallons per day
15msp.dor eerv.'U26/2018 '1'Me 5 Offiv„W Inepociiun Form Subsurface Sewage Disposal System.Page 11 of 18
w ' Commonwealth of Massachusetts
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
t� .
140 VEST WAY
Property Address
ROSERT KATSEFF
Owner Owner's Name
required for
is NORTH ANDOVER MA 01845 MARCH 14„ 2024
required fcrr emery
page. Gity/Town State ;dip Code Coate of Inspection
D. System Information (cent.)
8. Tight or Holding 'dank (cant.)
Alarm present: El Yes � ] No
Alarm level: Alarm in working order: (l Yes No
Date of Cast pumping, -C7- _ _
ake
Comments (condition of alarm and float switches, etc.);
* Attach copy of current pumping contract(required). Is copy attached"? E] Yes No
g. Distribution Box (if present must be opened) (locate on site plan)
[Depth of liquid level above outlet invert g
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
DISTRIBUTION IS NOT EQUAL
HEAVY EVIDENCE OF SOLIDS CARRYOVER
EVIDENCE OF LEAKAGE
D-SOX ROTTED AND NEEDS REPLACED
€5insp.tYr,c-rev 7l2Fth 01 B 1+tle 5 Official Inspection F:errrrr. >ubsuifsc,� Sewage C')isposal System-Page Q of 18
Commonwealth of Massachusetts
Title 5 official Inspection Form
1�`1) Subsurface Sewage Disposal System Form • Not for Voluntary Assessments
140 VEST WAY
Property Address
ROBERT KATSEFF
Owner .. __
owner's Nar^ne
requiredfo is NORTH ANDOVER MA 0184 MARCH 14, 2024
ertuired for every .. _.
page. City/town State 'ip Code Date of Inspection
__................_.. _..w.0_...__.a.. ..... ......._... _........._,_w...,,.... _......_ ...,_., _....,_
D. System Information (cant.)
10. Pump Chamber(locate on site plan):
Pumps in working order: 0 Yes E] No*
Alarms in working order: �. 'Yes No*
Comments (note condition of pump chamber„ condition of pumps and appurtenances„ etc.)
* If purrips 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:
El leaching pits number: 2
El leaching chambers nur•nber:
leaching galleries number:
leaching trenches number, length
Ej leaching fields number, dimensions
E' overflow cesspooe number.
El innovative/alternative system
Type/name of technology: _
thinf,p adoc on '712612018 1 m,)5 offi¢rlr,al Inspection Rrrrdt:Subsurface Sewage Disposal SyMerm•Page'13 o,f 18
Commonwealth of Massachusetts
Title 5 OfficialInsplection Form
5� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 VEST WAY
.,,....,ALL. .._ ....
Property Address
ROBERT KATSFF
(Owner bwner's Name
requiredfn is NORTH ANDOVER MA 01845 MARCH 14, 2024
required for every .. __ ....
page. dityaown State zip, Cade Coate of Inspection
D. System Information (cant.)
'11. Soil Absorption System (SAS) (cant.)
Comments (note condition of soil„ signs of hydraulic failure„ level of ponding, damp soil, condition of
vegetation, etc.):
SOIL AND VEGETATION OK
NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING
RAN CAMERA DOWN TO PITS FROM D-BOX,
WATER LEVEL OK IN PITS
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 F� Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5msapar doc•rmv 'PlMOOI5 SuErsaar1'a co Sewage Disposal System•Page'1 4 nY 1 R
Commonwealth of Massachusetts
Title 5 Official Inspection Form
rare{"�h
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
. 140 VEST WAY
Property Address
ROB-ERT KATSEFM=
Owner Own'er°s Narneinfo
required
for
is NORTH ANDOVER MA 01845 MARCH 14, 2024
page
for every _
,a e C ity/Town State Lip Code Gate of Inspection
D. System Information (cont.)
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,):
f5oisp doc^ran,+ 7yM2018 'T oe,5 Q,`dtificima vi[t4,'ea an, Vorrri SI abssurfaace Sewage Disposal System-Parga 15 0� 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
140 VEST WAY
Property Address
ROBERT KATSEFF
OwnerCtwner's Name
information is
required for every NORTH ANDOVER MA 01845 MARCH 14, 2024
page. CityfTown State Zip Code Date of Inspection
J—--------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:
Z hand-sketch in the area below
drawing attached separately
ox,
q'4o k
a C cl
PJ
c .� t
box
35'
t5hspAoc-rev 712.&2018 Title 5 Official Inspection forcer:Subsurface Sewage Disposat System-Page 16 of 18
�4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 VEST WAY
Property Address
ROBERT KATSEFF
Owner
Owner's Name _.._. . . _._ ..__._
infornrnation is NORTH ANDOVER MA 01845 MARCH 14, 2024
required for every
page. City/"town State Lip Cade Date of Inspection
D. System Information (cant.)
15. site Exam:
Creak Slope
Z Surface water
E] Check cellar
l Shallow wells
Estimated depth to high ground water: -- _.. _.
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: MARCH 17 1983gate
El Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health - explain:
DESIGN PLAN ON FILE
[ ] Checked with local excavators, installers - (attach documentation)
[� Accessed USGS database- explain.
----------
You must describe how you established the high ground water elevation:
DESIGN PLAN ON FILE
SYSTEM ABOVE WATER TABLE
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins9 doc•oaew 7f'26t,018 9 ft16 5 of icIa[In,pmeegon 1 onn Subsurface Sewage Dspossa0 SyMem•Page 17 of t8
>>f
11 '` Commonwealth of Massachusetts
Tide 5 Official Inspection Farm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 VEST WAY
q_...fl ....
Property Address
ROBERT KATSEFF
Owner Owner's Name w .. ----
information is NORTH ANDOVER MA 01845 MAR-PH14, 2024
required for every
page. Slate Zip Code Gate of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
Q 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/Hoiding 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
t5lnsp.doc•rev.7/2612018 '1 Ale 5 Official Inspection Form:Subsurface Sewage Disposal Systanr•Page of't8
wwary Record Card ganarated on W2024 2A016 PM by Karam Meurtidrar Pala 9
TOWn of North Andover
Tax Map # 210-104.D-0100-000 .0
Parcel Id 16787
140 VEST WAY
ATSEFF, ROBERT
140 VEST WAY
N. ANDOVER, MA
01846
..»_......._.,........ ..,.,..................._...._.__... .._._....�... .._...............m.__ .._.,,...,....,._ ...»..... ...._.._...........,....._ ..,.., .._.».,.......,».. .,.,..».,.,..»... _.......,..... »,,...,.,._,..,_.,......»............»..........,....._.........._,....,e,.,,........
Class 101 Single Family Property Type 1 Residential
Size Total 1.17 Acres
FY 2024
LIB Mailing Index.
Name/Address Type Loan Number Activ+a/enact. From Until
KATSEFF>ROBERT Payor Acive
140 VEST WAY'
N.ANDOVER,MA
01845
UB Account Mainta
Account No Cycle Occupant Name Activelinactive
Bldg Id. 17827.0-140 VEST WAY fast Billing Date 1/8/2024
3170492 03 Cycle 03 Active
UB Services Maint.
Account No.3170492
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.63518 7.82 11
WWTR WATER 01 ALL METER SIZE 64.60 /1
UB Deter Maintenance
Account No,3170492
Serial No Status Location Brand Type Size YTD Cons
41832379 a Active ERT HH to Badger w Water 0,62,5 0,625 524
Date Reading Code Consumption Posted Date Variance
12/1212023 2087 a Actual 17 1/15/2024 -61%
9/15/2023 2070 a Actual 49 10/13/2023 -5%
6/90023 2021 a Actual 49 711412023 150%
3/812023 1972 a Actual 19 4/1212023 -35%
12/8/2022 1953 a Actual 28 111612023 -75%
9/13/2022 1925 a Actual 127 10/18/2022 356%
6/912022 1798 a Actual 27 " 7/1812022 36%
3/8/2022 1771 a Actual 19 4/1312022 8%
12/9/2021 1752 a Actual 18 111712022 -77%
9/912021 1734 a Actual 81 10/15/2021 80%
6/812021 1653 a Actual 44 7/2712021 98%
3/912021 1609 a Actual 22 4/2112021 -7%
12/9/2020 1587 a Actual 24 1113/2021 -67%
9/9/200 1563 a Actual 76 10/14/2020 94%
61512020 1487 a Actual 36 7/15/2020 9211A
3/912020 1451 a Actual 19 4/612020 -40%
12//10019 1432 a Actual 30 1/1512020 -57%
911712019 1402 a Actual 80 10110/2019 276%
6/1112019 1322 a Actual 20 7/25/2019 16%
3/1112019 1302 a Actual 17 4/16/2019 -12%
121,11/2018 1285 aActual 19 1/2 /2019 -85%
9/1312018 1266 a Actual 141 14/15/2018 662%
61712018 1125 a Actual 17 712312018 23%
3/9/2018 1108 a Actual 14 4123/2018 -16%
12/812017 1094 a Actual 16 1/25/2018 -67%
9/1212017 107B a Actual 53 14/18/2017 196%
6/812017 1025 aActual 17 7/25/2017 -1%
/9/2017 100,8 a Actual 17 41l2/22017 -2%
12/912016 991 a Actual 18 1/23/2017 -85%
9/7/'2016 973 a Actual 113 10/24/2016 194%