HomeMy WebLinkAboutPass - Title V Inspection Report - 124 COLONIAL AVENUE 4/17/2024 Commonwealth of Massachusetts
im
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
P.,zo 124 COLONIAL AVE ............
Property Adttress
JIN GANG ZHANG
Owner
information is NORTH ANDOVER MA 01845 MARCH 30, 2024
required for every di--,_,_,_,-_--" ___"_,____ ""' -, _- -_ -"--- " __ ,, ,, , -"""'"'""',_ "_-
page� ityfTown State Zip Code Date of 4ispection
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.
Importarrt:When A. Inspector Information
f Ming out forms
on the computer,
use only the tab Todd James Bat so
key to move your Name of Inspector
cursor-do not Bateson Enter crises Inc.
use the return Company Name
key,
111,Ar9jlla Road.--
Company Address
Andover MA
''State Zip Code
978-475-4786 SI-_16______......
"feieplio-n"i...N_6mb_er _ License Number
B. Certification
I certify thatW I am a DEP approved system inspector In full compliance with Section 16.340 of Title 6
(310 CMR 16.000); 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 I have determined
that the system:
1. Passes
2. Conditionally Passes
3, Needs Further Evaluation by the Local Approving Authority
4. El Fails
APRIL 4, 2024
jii�_ �O/ -- --- -___ 15afW.1._.___.__I _...... ._ -1 1___......1 1 -
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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
124 COLONIAL AVE
r rcfp'ert'y Address
JIN GANG ZHANG
Owner bw''ner's 'Name
information is
required for every NORTH ANDOVER MA 01845 MARCH 30, 2024
page. City/Town State Zip Code Date 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:
2) System Conditionally Passes:
El One or rnore system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
Y ❑ N ND (Explain below):
..........
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Commonwealth of Massachusetts
1 Title 5 Official Inspection Farm
ro" Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
124 COLONIAL AVE
i5rperty Address
JIN GANG ZHANG
Owner _...... ..... _ _ .. ...
Owner's Name
information is NORTH ANDOVER MA 01845 MARCH g
required for every .. 30 224- ....__......
page. CityrTown State Zip Code Crate of Inspection
,...__._,...__., .......... . __..__.... ....._ _ ._...._.. __ __.._..._.e..__._.. .._ _._.. _ .. _�._. ...
C. Inspection Summary (cant.)
2) System Conditionally Passes (cant.).
E] Pump 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):
E] broken pipe(s) are replaced 7 Y 7 N ND (Explain below):
obstruction is removed 0 Y 0 N ND (Explain below):
�] distribution box is leveled or replaced El Y ❑ N F� ND (Explain below):
E] 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 E] Y E] N D ND (Explain below):
obstruction is removed E] Y ❑ N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
[ Conditions exist which require further evaluation by the Board of Health in order to determine if
the systern is failing to protect public healthy 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
mm Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
124 GOL.ONIAI.. AVE
, ---
i arty Address
JIN GANG ZHANG
Owner .... . ... ....
Owner's Na"' '
information is required for every NORTH ANDOVER MA 01845 MARCH 30 2024
. .... . - _ ...__.......
page. Cttylf'own Mate Zip Cede Cate of Inspection
C. Inspection Summary (coat.)
Q Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
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 C!BP 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
clogged SAS or cesspool
1:1 z Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5lnsgr cm-rev 7/2612018 1ato 5 U/V6cf al Inspection Form Subsurface Seawag o CJksposaNl System-Page 4(if 18
Commonwealth of Massachusetts
ry � Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
124 COLONIAL AVE
Property Address
JIN GANG ZHANG
Owner
Owner's Name
Information is required for every NORTH ANDOVER MA 01845 MARCH 30, 2024
_ ._ ... _
page City/Town Mate Lp Code Gate of Inspection
_._ __ _.... .__. _ ..... ._w,.,._..WW._.
C. Inspection Summary (caret.)
4) System Failure Criteria Applicable to All Systems: (coat.)
Yes No
7 z 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 Fo" below invert or available volume is less
than '/2 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: _ ,
0 z Any portion of the SAS, cesspool or privy is below high ground water elevation,
7 z Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
7 z Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
El 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
The system is a cesspool serving a facility with a design flow of 2000 gpd-
10.000 gpd.
7 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
11 El the system is within 400 feet of a surface drinking water supply
0 the systern 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— IWWPA) or a mapped Zone ll of a public water supply well
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Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
" 124 COLONIAL AV
Oreperty Address
JIN GANG ZHANG
Owner Owner's Name
required
e uiredfo is NORTH AND R MA 0134 MARCH 30„ 2024
information
for every _... ..
re u
ge £tytTown Mate pup Cede Coate of tnspectrcn
C. Inspection summary (cunt.)
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.
. You must indicate "yea" or"no" for each of the following for all inspections:
Yes No
Z Fj 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?
Z 0 Has the system received normal flows in the previous two week period?
1:1 Q Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® D Was the facility or dwelling inspected for signs of sewage back up?
Z 11 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 siudge 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 D Existing information. For example" a plan at the Board of Health.
Z 11 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
=8h TMe 5 Official Inspection Form)
> Subsurface Sewage Disposal System Form Not for Voluntary Assessments
124 COLONIAL AVE
Property Address
JIN GANG ZHANG
Owner
fawner's Narne
information is NORTH ANDOVER MA 01845 MARCH 30, 2024
required for every .. _._.. _._._..
page. Coty/Tooan State Zip Code Gate of Inspection
_._w....r. ._.__._.._
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual):
DESIGN flow based on 310 CMR 18.203 (for example: 110 gpd x#of bedrooms): 440 GPD
Description:
Number of current residents:
2
Does residence have a garbage grinder? [l Yes E No
Does residence have a water treatment unit? F ] Yes ,/, No
If yes, discharges to: _------- .....
is laundry on a separate sewage system? (Include laundry system inspection El Yes M No
information in this report.)
Laundry system inspected? Yes [:] No
Seasonaluse? 0 Yes E No
Water meter readings, if available last 2 years usage d SEE ATTACHED
Detail'
Sump pump? 0 Yes E] No
Last date of occu p y:ano CURRENT
caste
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........ ..........
Commonwealth of Massachusetts
Title 5 Official Inspection Form
µ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
14 COLONIAL AVE
Property Address
JIN GANG ZHANG
Owner Owner's Name ___.,.._.._.... ..,.... .
information is
NORTH ANDOVER MA 01845 MARCH 30 2024
required for every __._ _ __
page CotyrpTo wn State by Cods Crate of Inspection
._...n...____ .....__.._._ .._.w_..._w_. _........ ......__.__._ _,....m.....w. ____ ....._._._ _____.__._._. _.M._.__....M...,_ .._._w.
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment: _
Design flow (based on 310 CMR 15.2 ): Gallon1s fixer day—(gp,d
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? [-1 Yes F1 No
Water treatment unit present? F7 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:
Coate
Other(describe below):
_ ...
3. Pumping Records:
Source of information: OWNER 201
Was systern pumped as part of the inspection? Ll Yes ] No
If yes, vo8ume pumped:
galwons
How was quantity pumped determined?
Reason for pumping:
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W Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
124 COLONIAL AVE
Property Address
JIN GANG ZHANG
Owner Oaener"s Name
required fien
is NORTH AN iOVER MA 01845 MARCH 30, 21024
required for every .. _.
page. cltyrtown State Zip Code Efate of Inspection
D. System Information (coot.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
Overflow cesspool
Privy
❑ Shared system (yes or no) (if yes„ attach previous inspection records, if any)
E 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 IfA system by system operator under contract
❑ Tight tank. Attach a copy of the CDEP approval.
13 Other (describe):
Approximate age of all components, date installed (if known) and source of information;
27 YEARS, INSTALLED NOVEMBER 1997, AS BUILT
Were sewage odors detected when arriving at the site? El Yes Z No
5. Building Sewer(locate on site plan);.
Depth below grade: 3
feet
Material of construction;
0 cast iron Z 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 OF LEAKAGE
t5insp,duc-rev 712612018 1"otle 5 Official Inspection Form;Subsu"Bace Sewage Disposal System•Pape 49 of 18
° Commonwealth of Massachusetts
Title 5 Official Inspection Farm
.... ., !4 Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
,• .;; 124 COLONIAL AV
Property Aciciress
JIN GANG ;HANG
Owner owners Narne
information is NORTH ANDOVER MA 01845 MARCH 30, 2024
required for every _ .m_...... . . ._ ..._
Page. y.._ _ ....,_. ......M.., _ is Y..__.._ _..._...Date Inspection
apt Prawn _w._.__.__......_.__.._....__....____.._m.__.._..._._ _._state...... w Cade Gate at i ._w..._.. _._. ...._...._.... .__
D. System Information (cant.)
6. Septic Tank (locate on site plan):
24" CENTER COVER 6"
Depth below grade: tees _..
Material of construction:
concrete [ metal (] fiberglass (j polyethylene ❑ other(explain)
If tank is metal, list age, I y Ieasy
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes E] No
1 O' X 5" 4'
Dimensions;
4"
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle 34"
6
Scum thickness
Distance from top of scum to top of outlet tee or baffle 6
NA
Distance frorn bottom of scum to bottom of outlet tee or baffle
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
PLASTIC INLET AND OUTLET TEES
TANK IN GOOD CONDITION
NO EVIDENCE OF LEAKAGE
LIQUID LEVELS GOOD
45mspa.doc^eev.712612018 1 Ce 5 CBMd'wtaf InspectPzw'n Form Subsurface Sewage Dispxwsrsf System•Page'10 of'G s
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage disposal System Form - Not for Voluntary Assessments
«. 124 COLONIAL AVE
Property Address
JIN GANG ZHANG
Owner
Owner's Name
information is NORTH ANDOVER PUPA C1 45 MARCH 3g„ 2C124
required for every _ _... _ ......_ ..._........ _ _ _ ... ...
page. bty� wo r State Zip Code date of Inspection
D. System Information (cant.)......
7. Grease Trap (locate on site plan):
Depth below grade: feet _ ...._.
Material of construction:
7 concrete El metal E] fiberglass polyethylene other(explain):
Dimensions: _----------
Scum thickness
Distance from top of scum to top of outlet tee or baffle _._.. __ ._.........
Distance frorn 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.):
& flight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: _ 1-1-111111111
Material of construction:
[ concrete _ metal 0 fiberglass El polyethylene other(explain'):
Dimensions: _ . .. . ------
Capacity, _...
gaVlorrs .._. .
Design Flow: _
gallons per day
6fwsp,docr•rev.rflf 12018 "6'Me 5 Off crM dnspoc oro Form SubsurPocs Sowage DsfrosW System-Rage 11 of 18
Commonwealth of Massachusetts
1, Title 5 Offic"al Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
124 COLONIAL AVE
Property Address
JIN GANG ZHANG
Owner _ _ .... _ ..,....
Owner's Name
information is NORTH ANDOVER MA 018145 MA,RCq f 0 02_4
required for every .. _....... _____. _..._._.._ . ..
page. Cptyrtown State Zip Code Date of Inspection
D. System Information (cant.)
8. Tight or Holding Tank (cant.)
Alarm present: Yes D No
Alarm level: __. _.___---... Alarm in working order: El Yes El No
Date of last pumping: mate
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? El Yes E] No
9, Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 9
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 EQUAL
LIGHT SOLIDS CARRYOVER
NO EVIDENCE OF LEAFAGE
t�diap rjoc•rev.76,16P2018 1We 5 r;p?4mW tympae,;lim Form Subsu.zrfac*Swwagea DmpaeaiW Syskem•Page 12&18
w Commonwealth of Massachusetts
g . Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
124 COLONIAL AVE
Property Address
JIN GANG ZHANG
Owner 6 n-er°s Norne
inforrequired is NORTH AND R IAA 01845 MARCH 30 2024
required for every ,._ _ ....... __..... .._
rage City/Town state zpp Code bate of
_ Irspection
_.__..._ ._.__.._.._.....
_.._
D. _ ....._.._
System Information Gant.)
10. Pump Chamber(locate on site plan);
Pumps in working order: [ Yes E] Noy"
Alarms in working order; El Yes 0 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, expbain why;
Type;
} leaching pits number:
leaching chambers number;
El leaching galleries number:
leaching trenches number, length: 2 40" LONG
11 leaching fields number„ dimensions: __..._....._..
] overflow cesspool number:
[TM] innovative/alternative system
Type/name of technology:
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
it Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
124 COLONIAL AVE
Property Address
JIN GANG ZHANG
Owner Owner's Marne
requred for every n rs
Ared NORTH ANDOVER MA 01845 MARCH 30 2024
r f .... ...__ ----- _.... ........ _.......
page. City/Town state Zip Cade Cate 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 O
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 Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.).
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Commonwealth of Massachusetts
1&� Tiff 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
124 COLONIAL AVE
Property Address
JIN GANG ZHANG
Owner 6 vner"s Name
MorregLJredfo is NORTH ANDOVER MA 01845 MARCH 30„ 2,124
re�aauretMi for every __ _,
page. city/towrn State Zip Cade 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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
124 COLONIAL AVE
Property Address
J IN GANG ZHANG
Owner Owner's Name
Information Is NORTH ANDOVER MA 01845 MARCH 30, 2024
required for every State -ba-te'of I—nspection
Page. CitylTown—
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:
Z hand-sketch in the area below
El drawing attached separately
�()
'N,
'41
J
ry
I 4'Q Ir- 3 I o'
OLI OttH(4- 34' 6 (1
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Commonwealth of Massachusetts
= � T"tle 5 official Inspection Form
Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
124 COLONIAL AVE
&5roperl'y Address
JIN GANG ZHANG
Owner owner"s Nacre
information is NORTH ANDOVER MA 01845 MARCH 30, 2024
required for every _... ........ ...
page. City/Town State Zip Cade Date of Inspection
D. System Information (font.)
15. Site Exam:
E Chuck Slope
Z 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:
Obtained from system design plans on record
If checked, date of design plan reviewed; JUNE 1996
Date
Observed site (abutting property/observation hole within 156 feet of SAS)
z Checked with local Board of Health - explain:.
DESIGN PLAN AND AS BUILT PLANS ON FILE
E] Checked with local excavators„ installers - (attach documentation)
Accessed USGS database -explain:
You must describe how you established the high ground water elevation.
DESIGN PLAN
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
6iinsp dor,•rev-7126Q.0 8 TAW 5 CYrnom irusrakr��kon Form Subsurface Sewage airspcsW Systemic-Page 17 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
• , !%
124 COLONIAL AVE
Property Address
JIN GANG ZHANG
Owner owner's NarrMe
anquired for
is NORTH ANDOV R MA 01845 MARCH 3Ct, 2624
required t'or every _ _. ..... � _ _
page. City/Fown State Zip Cade gate o4 Inspection
_...... __......w._._.. ..._w._. _-_____ _...._.. .............................._ _ _._.........
E. Report Completeness Checklist
Complete all applicable sections of this form Inclusive of:
A. Inspector Information: Complete all fields in this section,
8, Certification: Signed & Dated and 1, 2, 3, or checked
I C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
D. System lnformation:
For 8: Tight/Holding flank— Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 1 : Explanation of estimated depth to high groundwater included
k"`r(nsps.efsxaa•rev.712612018 roue 5Offi6al Braw kwia n F Fero Subsurface Sewage B:BMaspr&W Syatram•Page 18 of 16
Surmnafy Rerord Card generated on 3QW024 I�15:12 PM by Karen I larVon Pago I
Tarn of North Andover
Tax Map # 210-107.B-0137-0000.0
Parcel Id 18260
124 COLONIAL AVENUE
JIN JANG ZHANG
XIAOLEI QI
124 COLONIAL AVENUE
NORTH ANDOVER, MA 01845
Class 101 Single Family Property Type I Residential
Size Total 0,5 Acres
IFY 2024
..........--
UB Mailing Index
Name/Address Type Loan Number ActIve/Inact, From Until
JIN JANG ZHANG Owner Active
XIAOLEI QI
124 COLONIALAVENUE
NORTH ANDOVER,MA 01845
JODI MATTHEWS Previous Customer Inactive 1217/2007
124 COLONIAL AVE
NORTH ANDOVER,MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg id. 14092.0-124 COLONIAL AVENUE Last Billing Date 3fl/2024
2100031 02 Cycle 02 Active
UB Services Maint.
Account No.2100031
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0,635/8 7.82 I/
WTR WATER 01 ALL METER SIZE 34.20 /1
UB Meter Maintenance
Account No,2100031
Serial No Status Location Brand Type Size YTID Cons
34769972 a Active ERT F.RT b Badger w Water 0.6250,625 257
Date Reading Code Consumption Posted Date Variance
2/1/2024 1712 a Actual 9 3/14/2024 -10%
11/1/2023 1703 a Actual 10 12/13/2023 -67%
8/112023 1693 a Actual 29 9/18/2023 233%
5/4/2023 1664 a Actual 9 611412023 -25%
2/112023 1655 a Actual 12 3114/2023 -59%
11/1/2022 1643 a Actual 29 1211912022 -43%
8/212022 1614 a Actual 51 912012022 284%
512/2022 1563 a Actual 13 6/21/2022 -5%
211/2022 1550 a Actual 14 3/15/2022 -27%
11/1/2021 1536 a Actual 19 12113/2021 -44%
812/2021 1517 a Actual 34 9/2112021 138%
51312021 1483 a Actual 14 6/1512021 4%
2/3/2021 1469 a Actual 14 3/16/2021 -57%
11/2/2020 1455 a Actual 32 12/16/2020 -61%
8/3/2020 1423 a Actual 84 9/9/2020 605%
5/1/2020 1339 a Actual 13 6110/2020 -7%
213/2020 1326 a Actual 15 3/16/2020 -67%
'111112019 1311 a Actual 44 12/2312019 47%
8/112019 1267 a Actual 30 9126/2019 164%
6/112019 1237 a Actual 11 6113/2019 -5%
211/2019 1226 a Actual 12 3/19/2019 -59%
11/1/2018 1214 a Actual 29 12/12/2018 -33%
8/112018 1185 a Actual 43 9120/2018 197%
5/112018 1142 a Actual 14 6120/2018 .7%
211/2018 1128 a Actual 17 3/28/2018 -52%