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HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 1895 SALEM STREET 4/29/2024 Commonwealth of Massachusetts itt Title 5 Official Inspection Pram Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G 1895 SALEM STREET. . p'ropedy Address PAUL ROY Owner ame information is NORTH Aq` DOVEI MA 01845 ARIL 20, 2024 required for every _ _•..___. e. _. page biC awn State Zrp fade Clate of Inspeotuon 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. `�s= .. ,' Important:When A. Inspector Information ' fining out farms on the cornputer, 'r use only the tab Todd James Bateson _ ..__._ . .. . key to move your Name of Inspector '" cursor-do not ___..._. er rues Inc..._......_..,_ ...._. _..... _..._.. . ._....... _...---- _......... ._ m; _ use the return key. Carnpay Narn.. Road 111 A _ _.. _ .... . _ ..._.., ___._._. r Ilia ad ompeny Arddres _ .- Andover MA 01810 _S1�0 ATown _. . ........_. State ipCode �� l 18 .�� ' 978-47 a-4785 _._ . . _._.,. ..... 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 5 (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-sine sewage disposal systems. After conducting this inspection I have determined that the system: 1. [l Passes 2. F] Conditionally Passes 1 F-1 Needs Further Evaluation by the Local Approving Authority 4. Fails APRIL 23 , 2024 Insp or's Signal hate 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. t5insp,rloc,rev.712612018 rim 6 Official Inspection Fornv:SursWarer S w ws,Disposal System*Paper 1 of 18 Y " Commonwealth of Massachusetts Title 5 Official Inspection Form n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments eel rh � ^Vwn M 185 SALEM STREET r5roperty/address PAUL ROY Owner Owner's Name equiretion is NORTH ANDOVER MA 91845 APRIL 29 2024 required for every _ page. d yytown State Zip Code Date of InsIpechon 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, NC) 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 cornplying septic tank as approved by the Board of Health. k A rnetal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. [] Y N ND (Explain below): a5iirFaaga aSoc rev."df261201 ff rwe°a offlc[w r€ rn Subsurface Sewage D,.,.kaa sa Symom Pa go 2 of 18 ° Commonwealth of Massachusetts hu Title 5 Official Inspection Form _ yin Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 1595 SALEM STREET Property Address PAUL ROY wuner Owner's Narne information as NORTH ANDOVER MA 01545 APRIL 20, 2024 required for every ace, _..._ .... ..... ._._....... p. ..,_..,.... _ ._. nspection City/Town......_........ ... ..__._._._._ _ .. ..... .. hate �i Code Date of V..._ .._........., . ..__...... ............._._....... G. Inspection Summary (cant.) 2) System Conditionally Passes (cont.): F-1 Pump Chamber pumps/alarms not operational. System wiltl pass with Board of Health approval if pumps/alarms are repaired. Z 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 D Y F] Nw ND (Explain below): obstruction is removed E] Y E] N ND (Explain below): distribution box is leveled or replaced Z Y [I N D ND (Explain below);. D-BOX IS DETERIORATED 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 ❑ N 0 ND (Explain below): obstruction is removed 0 Y ❑ N 0 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 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. t"'bvrt±agy.doc.-rev.ia•;dFoBsr(:'!S Nle 51�Official hspecton F oarn Subswla hA Sewage 9:hso xiaa0 System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 SAL.EM STREET Property Address PAUL ROY Owner Owners Name rlforrxlaton is NC,ORTH ANDOVER MA 01845 APRIL 20, 2024 required for every _. _. .. page. Cntylfown state Zip Cade Clete of Inspection _... _.,,.W.... C. Inspection Summary (cant.) F Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b, System will fall unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ] The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. M 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 clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Ctiorrorap doe•rev 7126'2018 Till W 5 C ff)c iw Prrsptwu&w i'ux rn Subsurlace Sewage Oussr, sW System-Page 4 of 1 R Commonwealth of Massachusetts Title 5 Official Inspection Form µ Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 1805 SALEM STREET Property Address PAUL ROY Owner Owner's Name information is NfORTH ANDOVER MA 01845 APRIL 20, 2024 required for every ... -...... page. City/Town state Zip Code Slate of Inspection C. Inspection S t�m _ _-.....�_..._ .... _...,...... .. w._..._...m......_____... ..._.._..... n many (coot.) 4) System Failure Criteria Applicable to All Systems, (cant.) Yes No 1:1 z Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 7 z Liquid depth in cesspool is less than " below invert or available volume is Tess than '/2 day flow 11 z Required purnping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ___. 11 z Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ z Any portion of cesspool or, privy is within 100 feet of a surface water supply or tributary to a surface water supply. El 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. 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 form.] 1:1 z 'The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. 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 0 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 ?_one 11 of a public water supply well t5insp ciao•aev,7'126/2018 1"olio"„"s(')ffwiw Insprea to n Form Subsurface Sawage Dspos4 System•Page 5 of'18 v Commonwealth of Massachusetts Title 5 Official Inspection Form '1 AA Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 1895 SALEM STREET Property Address _ _... ..,. PAUL ROY Owner _ ._..__.. _. ...__. ._ ....... ...... . . . ..... ._ ._._ _..... _._.. Owner's Name information is required for every NORTH ANDOVER MA 01845 APRIL 20, 2024 , .. page. Clty/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 Z ❑ Pumping information was provided by the owner, occupant, or Board of Health 0 Z Were any of the system components pumped out in the previous two weeks? Z ❑ Has the system received normal flows in the previous two week period? 7 ® Have large volumes of water been introduced to the system recently or as part of this inspection? El ® Were as built plan of the system obtained and examined?(If they were not available note a N/ Z ❑ Was the facility or dwelling inspected for signs of sewage back up? Z ❑ Was the site inspected for signs of break out? ® 0 Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, 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 Existing information. For example, a plan at the Board of Health. Z 7 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)] 15insp.doc•rev,7/2612 0 1 8 Title 5 Official l inspection Form,Subsurface Sewage DVsposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 SALEM STREET Property Address PAUL ROY Owner Owner's Narrle inforire dfo is NORTH ANDOVER MA 01845 APRIL 20 2024 rpe�grred for every ---_.... _ City/Town _ _.. ... State Zip Cade 17ate of ins�aectlon D.,.,SStert"1.. ___.n .. ._.,._....._.___....._._.__..__. ._. .w.rv.. .._.....w.. ....,�_..__-..._ ....__.....n....-_w_ . _....__...._..._._.._.___.....w.._ .._.. y Information 1, Residential Flow Conditions: Number of bedroors (design); Number of bedrooms (actual): 3u DESIGN flown based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): NA Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes M No Does residence have a water treatment unit? F-] Yes Z No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) [� Yes No Laundry system inspected? ® Yes [] No Seasonal use? 7 Yes Z No Water meter readings, if available last 2 ears usage d SEE ATTACHED g" C y g (gp )} Detail: ....- ..... Sump pump? [I Yes Z No Last date of occupancy. CURRENT" Crate t5 sp doo rev.7/2612 0 1 8 1'(lla 4 OfflcW lnspaukd n Form 9ubsarYace"Sewage Disposal System"6''apa 7 C)r 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1805 SALEM STREET" Pr'o'Wy Address PAUL ROY Owner Owner's Narrre information is required for every NORTH ANDOVER MA 01845 APRIL 20, 2024 uir page Cly/Town State Lip Code Gate of Inspection _... Information ©. .�►ySt�t11 �I"1�1�►1"I"1"1��1 ion (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): .... _ ... ..... Caallons per day(9pd� Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Yes No Water treatment unit present? Yes No If yes, discharges to: Industrial waste holding tank present? E] Yes 0 No Non-sanitary waste discharged to the Title 5 system? Q Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: OWNER 2017 Was systern pumped as part of the inspection? [ 1 Yes Z No If yes, volume pumped; gallons How was quantity pumped determined? Reason for pumping: raln:sridoc w ieay.7f260018 1 trle ki Official Inspection F orav Subs¢ffacae Sewage Mspoial System^raga 8 of 16 Commonwealth of Massachusetts ~ r' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 SALEM STREET Property Address PAUL ROY C„caner — &nrner"s Name information is NORTH ANDOVER MA 01845 APRIL 20, 2024 required far every _._. ... .. page. CityPTow n State Zip Cade Date of Inspection D. System Information (cant.) 4. Type of System: z Septic tank, distribution box, soil absorption system Single cesspool (Overflow cesspool El Privy B._] Shared system (yes or no) (if yes, attach previous inspection records, if any) 11 innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner` and a copy of latest inspection of the I/A system by system operator under contract 0 Tight tank. Attach a copy of the DEP approval. 11 Other(describe): Approximate age of all components, date Installed (if known) and source of information: 48 YEARS COLD, INSTALLED 1976, OWNER Were sewage odors detected when arriving at the site? [ Yes M, No 5, Building Sewer(locate on site plan): Depth below grade: 20 feet Material of construction: cast iron ❑ 40 PVC (El other(explain): Distance frorn private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS AND VENTING OK NO EVIDENCE OF LEAKAGE Ef"znsp Mx.•rsw.'7T2612018 rvkke 5 ofAucwi Irwec&iorr Forrm.Subsurface eewJNa eV alspor a[Syxo,em•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ,p Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1895 SALEM STREET Proporty'"A"odress _ PAUL ROY Owner 6w rner°s Nameinfor _.-.. required vs NORTH ANDOVER MA 01845 APRIL 20, 2024 rer�uired for every _ _ gage, Cityifown Mate Zip Code Cake of inspection _... __ ..._ ...__._.._.. ..... ___.__,._._...._.__.._.. ......__....._. __......_. D. System Information (cant.) 5. Septic Tank (locate on site plan): Depth below grade: 8 feet Material of construction: Z concrete 0 metal E fiberglass ❑ polyethylene other(explain) If tank is metal, list age: years _ Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) F1 Yes 7 No Dlrnensions: 0, 5" 4' Sludge depth: 4„ Distance from top of sludge to bottom of outlet tee or baffle 34' Scum thickness 8 Distance from top of scum to top of outlet tee or baffle 8 V Distance from bottom of scum to bottom of outlet tee or baffle 11" Now were dimensions determined? SLUDGE JUDGE AND TAPE MEASURE Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural ontegrity, liquid levels as related to outlet invert„ evidence of leakage, etc,): INLET" CUTLET BAFFLES QK. LIQUID LEVELS NORMAL TANK OK NO EVIDENCE OF LEAKAGE TANK WILL BE PUMPED AT TIME OF D-BOX REPAIR t5inspAcc•rev.'712612018 'B'dl*5 Offir„tal @C&9:pec bon Fonn Subsurface Sewage DFposa€SsVem•Capps 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r, Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments 1895 SALEM STREET Property Address PAUL ROY Owner dNJner's Name inforrnatuon ds required for every NORTH ANDOVER M1A 01845 APRIL 20 2024 ._. page City/Town Mate Zip Code Date of Inspection St-1T1 Information. .._....... _ .. _,. _,. ...._,_.,......_.. ..__._._.._ _....__..._ .,__..._.... ..,,_.,_ ._,_e_.._._ D. y (cant.) T. Grease Trap (locate on site plan): Depth below grade: _ ........ feet Material of construction. ] concrete El metal ❑ fiberglass polyethylene (l other(explain): Dimensions: _. ., . .._.._. .... Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle [Gate 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: El concrete EI metal El fiberglass El polyethylene other(explain): Dimensions: .... ... . ....... Capacity: _ gallons Design Flow: gallons per day t"yrrtrosg;u a8a u;•rev 7126120'18 V uEl l;'4 C;lftua.rcrei VGrsBr t�oru I"ervrrt.'3 ubsurfare SewAge Ds osW System.Page 1 P of 18 Commonwealth of Massachusetts 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for"Voluntary Assessments 1895 SALEM STREET Property address PAUL ROY Owner C7wner's_Na.......m e ------ information for every on ds NORTH ANDOVER MA 01845 APRIL 20„ 2024 utyflrown required .._.._ ........ ...._ _ page. C State Zip Code Date of Inspection _,... ....._._,__ ......_... _ ..... .._...._ .._m a_....... _..._.._.._. ._.m... e.e_.....__.. .........w ...... ._..„ _ __..... D. System Information (cant.) 8. Tight or Holding Tank (cant.) Alarm present: El Yes E' No Alarm level: _.. _- Alarm in working order: F-] Yes FI No Date of Vast pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? El Yes E No 0, Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert _.. . 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 DETERIORATED AND NEEDS REPLACED t51ns{a-doc.eeav,7126f2018 ritle 5 Offmw Inspa(Ason Form.SLAbsurfa.,o Sewage Disposal SyMe m-Pages 12 Crt 18 Commonwealth of Massachusetts LL Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1895 SALEM STREET Aroperty Address PAULROY OwnerName-- information .._ _ _.... Owner's eirefo r NORTH ANDOVER MA 01545 APRIL 20, 2024 required for every page. Cpty�1 ovrn State Zip Code mete of Inspection _._ _.... ___...... --__._._ ._._...., ...__ . ___...,..._..ti._. w__..._ _ ......._._ _.__._.,.... _...._..._.__ ._.....__.__ _. ..... D. System Information (cant.) 10. Pump Chamber(locate on site plan): Purnps in working order: 0 Yes ❑ No* Alarms in working order: [I Yes D 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: [� leaching pits number: __.... [� leaching chambers number: leaching galleries number: [_] leaching trenches number, length; 1, 20 leaching fields number, dimensions: X 50' overflow cesspool number: [� innovative/alternative system Type/name of technology: lSwrrp atop»rev 762&2.018 Title 5 Offiv of lymp ecEron Form Suuoxu.laaco Sewage Dsposaf SypsWrn•Page 13 of 18 ° Commonwealth of Massachusetts T"FE Ie 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1895 SALEM STREET F roperty Address PAUL ROY Owner _ Owner's Fame .... information is required for every NORTH ANDOVER MA 01845 APRIL 20, 024 ... page iityrrowr7 Mate Zip Code bate of Inspection D. .S..... .. .._ . ...__..___..._.___._w._..__..._..w. .....�--_.______...._.. _....__.w__...._w...._.�.. .. .M.,,..-. .._._....__..m_.__.....__...._._.____.... ySt411"1 Information (cant) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): RAN CAMERA INTO LEACH LINE SYSTEM WORKING NORMALLY SOIL AND VEGETATION OK NO SIGN 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 7 No Comments (note condition of soil, signs of hydraulic failure, level of ponding" condition of vegetation, tSlnrsp,cfoc rww.7/26/2018 'r@lar 5 Olficiral lrosPe ction Fovrr:SlAbsurface Sewage Disposal Systern•Page 14 of 18 Commonwealth of Massachusetts i V7. Title . Official Inspection Dorm Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments u:, 1895 SALEM STREET Property Address PAUL ROY Owner Owner's Nameinf _ requirationed is NORTH ANDOVER MA 01845 APR IL 20, 2024 required for even page. CityfTowr state Zip Cade. bate of lnspectior D. System Information (coat.) 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.): ------------ t5ins)s cdo ^ram.712662018 1'Me 5 Offl M IrbVecti n K°'aroTm Subsw'&we,o aewra p @)mposW System-Paige 15 018 Commonwealth of Massachusetts w � Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address PAUL ROY Owner t wrcier IVarne Information Is NORM- ANDOVER MA 01845 APRIL 20, 2024 requiredfor every _.._ _..____, _....._ ._...�....._ _.. _..,...._ .n__.__...._._._..___ __.__.....,...... ..__..._ _...._. , .,_,_.._.. _._..w....m pale Cltyll own State Zip Code Date of Inspection D. System Information (cant.) 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 JA 0 0 600Q(War) f � A_ � CW _ �CK ¢5hspAoo•Rev,7/2eV2 iS 1"'ale 5 otllr lal hspkrc ion Forrer,',SuegwfaOe Sewage DISP Sal SYSIO tro Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments ,.. 1895 SALEM STREET F rop'erty Address PAUL ROY Owner Owner'S dame information Is NORTH ANDOVER MA 01845 APRIL 20, 2024 required for every ._,._...., Pape Cityfrown State Zip Code Crate of Inspection _.... _.._... .._.___�___.,aw.._....._._ _..___.,w__._...._..W......___ ._w....__._ .__W...__.... ._ .._..n__.... _..._... ..._,.__..... .__. D. system Information (cent.) 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: El Obtained from system design plans on record If checked, date of design plan reviewed: - Gate Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: PREVIOUS TITLE 5 ON FILE Checked with local excavators, installers - (attach documentation) Accessed USGS database -explain: ESSEX COUNTY SOIL MAP You must describe how you established the high ground water elevation: CANTON FINE SANDY LOAM DEPTH TO WATER TABLE > 80" SYSTEM RAISED ABOVE ORIGINAL GROUND Before filing this inspection report, please see report Completeness Checklist on next page. t54r1sp doc•rev.'7/2612018 5 Qffiicw Irumfaaacteon fcwrn Subsurface Sewage MsposM System-Pugs 1'7 of 18 14 Commonwealth of Massachusetts h Title 5 Official Inspection Form 1a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1895 SALEM STREET Property Address PAUL ROY Owner Owner's Name information is NORTH ANDOVER MA 01845 APRIL 20, 2024 req�sired for every ._.. _.....__ _ ... ... _ page. CityPTown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of. Z A. Inspector information: Complete all fields In this section. Z P. Certification: Sinned & Dated and 1„ 2, 3, or 4 checked Z C, inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed Z 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 1Sinsp cdoc-fev 712612018 V"idle 5 Official 4rnspecluwo Form.:S ubwirfam Sewage D. srposaa SyWen Page'V6 of 18 Summary Record Card ganeroted on 3;26/2024 4:47:29 I'M by Karen 1-(anion Page 1 Town of North Andover Tax Map # 210-106.B-0060-0000.0 Parcel Id 17464 1895 SALEM STREET ROY, PAUL 1895 SALEM STREET N. ANDOVER, MA 01845 Class 101 Single Farrilly Property Type I Residential Size Total I Acres FY 2024 .............. UB Mailinn Index Name/Address Type Loan Number Active/Inact. From Until ROY,PAUL Payor Active 1895 SALEM STREET N.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Narne Active/inactive Bldg to. 17492.0-1895 SALEM STREET Last BIHIng Date 1/812024 3170162 03 Cycle 03 Active UB Services Maint. Account No.3170162 Service Code Rate Charge MultIpIler/Users MISCFEE ADMIN FEE 0.63 5/8 7.82 it WTR WATER 01 ALL METER SIZE 38,00 /1 UB Meter Maintenance Account No,3170162 Serial No Status Location Brand Type Size YTD Cons 13242615 a Active ERT HH METE METE w Water 0,626 0.625 82 Date Reading Code Consumption Posted Date Variance 31712024 651 a Actual 9 -15% 12/812023 642 a Actual 10 1/15/2024 -18% 9/1412023 632 a Actual 14 10/13/2023 21% 6/812023 618 a Actual 11 7/14/2023 -2% 3/7/2023 607 a Actual 11 4/12/2023 18% 12/6/2022 596 a Actual 9 1/16/2023 220% 9/9/2022 587 a Actual 3 10118/2022 52% 61712022 58�4 a Actual 2 7/1812022 -100% 31412022 582 a Actual 0 4/13/2022 -100% 1217/2021 582 a Actual 10 1/17/2022 237% 917/2021 572 a Actual 3 10/15/2021 55%* 6/712021 569 a Actual 2 7127/2021 -100% 3/4/2021 667 a Actual 0 4/21/2021 -100% 12/8/2020 567 a Actual 7 1/13/2021 128% 9/412020 560 a Actual 3 10/14/2020 -3% 6/312020 557 a Actual 3 7/15/2020 -100% 3/5/2020 554 a Actual 0 4/8/2020 -100% 12/10/2019 554 a Actual 7 1/15/2020 96% 9/13/2019 547 a Actual 4 101,1012019 86% 617/2019 543 a Actual 2 7/25/2019 -100% 3/8/2019 541 a Actual 0 4/16/2019 -100% 12/7/2018 541 a Actual 9 1/22/2019 146% 9/11/2018 532 a Actual 4 10/15/2018 -34% 618/2018 528 a Actual 6 712312018 -100% 3/6/2018 522 a Actual 0 4/23/2018 -100% 12/6/2017 522 a Actual 14 1/25/2018 -83% 91812017 508 a Actual 86 10/18/2017 2643% 6/6/2017 423 a Actual 3 7/25/2017 -100% 3/712017 420 a Actual 0 4112/2017 -100% 12/9/2016 420 a Actual 9 1/23/2017 127%