HomeMy WebLinkAboutPass - Title V Inspection Report - 140 COLONIAL AVENUE 6/17/2024 Commonwealth of Massachusetts
- 1 Title 5 �` id l Inspection Farm
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
` ;; 140 COLONIAL AVEWe
X -
Oio'perty Aw dress
MIKE FANNING
Owner ............... . . .... _.._. _.m._
required
is NORTH ANDOVER MA 01845 AUGUST 1 2,3
re aired for every
page. City/Town _ State Zip Code C1ate of{ m tpd " s
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.
niImportant:f when
figo A. Inspector Information
fillingouttforms
on the computer„
use only the tab Todd James Batesoq
key to moire your Nauss of Ins or
cursor•do not Sateson Enterprises Inc.
use the return _ __....._
key.
Company Name ..,...__ ._._ .... ._._.._._ _ .... . .... .. ..._...... _.__
111 Ar Ilia Road
Company Address . ...._ ._..__.______. . ._...._._.__. ..
%41Z_1
Andover 1' A 01810
CctyfTown State Zip Cads
fp 978.475 4786 Sl 1Fa
Telephone Number Incense Number
B. Certification _...
I certify that: I am a DEP approved system inspector In full compliance with Section 15.340 of Title 5
(310 CIVIR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed aboveu 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 Passes
2. Conditionally Passes
3, Needs Further Evaluation by the Local Approving Authority
4. Fails
AUGUST 17, 2023
Ins ors Signature Gate
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 god or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
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*N
Commonwealth of Massachusetts
I,a
Title 5 Official Inspection Farm
r
iM Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
7 140 COLONIAL AVE
Property Address
MIKE FANNING
Owner Owner's Nam-e
regwred o i`is NORTH ANDOVER MA 01845 AUGUST 15, 2023
rer.�uAred frrr every _ .. . ..
page City/Town State Zip Cade .... 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:
2) System Conditionally Passes:
one or more system components as described in the "Conditional lass"' 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 fallowing 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 F N C.� ND (Explain below):
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Commonwealth of Massachusetts
� ME 17, Title 5 Official Inspection Form
411, Subsurface Sewage Disposal system Form - Not for Voluntary Assessments
140 COLONIAL AVE
Property Address
MIKE FANNING
Owner Owner's Namie
ki r r s
equhred for every NORTH NDOVER MA 01845 AUGUST 15 2023
page, Duty/Towrq.. _
Mate Zip Cade Date of Inspection"
C. Inspection Summary (coat.)
) System Conditionally Passes (cant.):
El 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):
broken pipe(s) are replaced El Y F1 N (. ND (Explain below):
obstruction is removed ( Y El N ND (Explain below):
.� distribution box is leveled or replaced ( Y [l N El ND (Explain below):
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 El N E] ND (Explain below)°
( � obstruction is removed Y N NCB (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:
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Commonwealth of Massachusetts
ltis Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 CC1L0NIAL AVE
Property Address
MIKE FANNING
Owner
Owner's Name
regUire for
is NORTH ANDOVFC MA 01845 AUGUST 15, 2023
regrr�ured ffor every
page. City/Town State Zip Code bate of 6nspaection
_._..... _. _._. _.. ._._..._... _._... _ . ........... ........
C. Inspection summary (cont.) . . ........._ _. ...... ....____. ....�.._. ....__......... ...._ .._w__. . .......
G. 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:
El 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.
D 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.
El The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more frorn a private water sarpply 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 pprn, 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 mkt indicate "Yes" or"No" to each of the following for all inspections:
Yes No
E] z Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
Cl Z Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
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Commonwealth of Massachusetts
1`ile 5 Official InspectionForm
31) Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 COLONIAL AVE
Property Address
MIKE FANNING
Owner ow-ner's Name _
requir dfo us NORTH ANDOVER MA 0184 AUGUST 15, 20 3
required for every _..
page bty/To�wn _ State dip Code Date of 2nspection
C. Inspection Summary (cont.) _ .._...._... .._....__.....
4) System Failure Criteria Applicable to All Systems: (coat.)
Yes No
1:1 z Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El z Liquid depth in cesspool is Tess than " below invert or available volume is less
than 'Y2 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: _ „.
Ll z Any portion of the SAS, cesspool or privy is below high ground water elevation.
El z Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
1-1 z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
F1 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.
El 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
El [. j the system is within 400 feet of a surface drinking water supply
11 El 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
_ .u.w Area— IWPA) or a mapped Zone ll of a public water supply well
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Commonwealth of Massachusetts
l Title 5 Official Inspection Form
" 1 Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
140 COLONIAL AVE
Property Address
PIKE FANNING
Owner Cwnerr"s h eme
drrrfarwa for every is
repaaared ta NORTH ANDOVER MA 01845 AUGUST 15, 2023
_
page bty/Town estate Zip Code Date of Inspect ior7
_... _ .... _.... _. .... ...._... _._. .. .._,..__ _........ _ .. ............v w ___
C. Inspection Summary (cant.)
If you have answered "yes" to any question in Section C.5 the system is considered a significant
threat, or answered "yes" to any question In Section C.4 above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 313 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 al/inspections;
Yes No
Z 11 Pumping information was provided by the owner, occupant„ or Board of Health
L.,.,W1 Z Were any of the system components pumped Out in the previous two weeks?
0 Has the system received normal flows in the previous two week period?
1-1 Z Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were a built plans of the system obtained and examined? (lf they were not
❑ available note as N/N
Was the facility or dwelling inspected for signs of sewage back up?
Z El Was the site inspected for signs of break out?
Z 11 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?
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:
E] Existing information. For example„ a plan at the Board of Health.
Z 1:1 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
r�
{F Title 5 Official Inspection Form
- Subsurface Sewage Dispersal System Farm- Not for Voluntary Assessments
% 140 COLONIAL AVE
Property Address
MIKE FANNING
Owner Owner's Nan7e _
uequi"edfo is NORTH ANDOVER MA 01845 AUGUST 15„ 2023
r'ertt�nred for every _......_ ..........._...._
page CitynI oo+ywrrr State Zip Code Date of Inspection
..7r _.
D. ...fit.._...__. ,,._._................w,_ .._. ....... _.._.,.._.._ ....__......_.... ... v....,_.,........W_.._____.._._,_ ......_.....,_w.__._._.._..___..._._ w.._.,,.....,_.,... .__ _
_ em Information
1. Residential Flaw Conditions:
Number of bedrooms (design) -- Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for exarnple: 110 gpd x##of bedrooms): 440 GPD
Description:
1
Number of current residents: .... _
Does residence have a garbage grinder? ❑ Yes Z No
Does residence have a water treatment unit? Q Yes Z No
If yes,, discharges to:
Is Laundry on a separate sewage system? (Include laundry system inspection E Yes Z No
information in this report.)
Laundry system inspected? `w Yes El No
Seasonal use? [l Yes Z No
Water meter readings, if available (last 2 years usage (gpd)): SEE ATTACitED.
Detail:
Sump pump? E-1 Yes ] No
Last date of Occupancy: CURRENT
Date _
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Commonwealth of Massachusetts
s Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for` OIUntary Assessments
A;
140 COLONIAL AVE
6)roperty Address
MIKE FANNING
Owner Owner's Name
requiredoo7 os NORTH ANDOVER MA 01845 AUGUST 15, 2023.
etquired for every _ _ _
page, City/ own State Zip Cade C1ate 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(gpd)
Basis of design flow (seats/persons/scl t., etc.):
Crease trap present? El YesI No
Water treatment unit present? El Yes [._1 No
bf yes, discharges to:
Industrial waste holding tank present? [I Yes E] No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes El No
Water meter readings, if available:
Last date of occupancy/use: Late _
Other(describe below):
3. Purnping Records:
Source of ir7formatuon: BATESON ENTERPRISES INC_.DECEMBER 2021
Was system pumped as part of the inspection? El Yes 4 No
If yes, volume pumped: gallon
How was quantity pumped determined?
Reason for pumping:
fl.5hnsp doc•raav FF,S&r`2018 'rtfaa 5 offieaaa!Inspect*n F'Onn s ubuautaaco Sewage k;isposall system Page 8 d'6e
Commonwealth of Massachusetts
3
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
140 COLONIAL AVE
riroperty Address
MIKE FANNING
Owner
Owner's Name
required
ms NORTH ANDOVER MA 01645 AUGUST` 15, 2023
required for every _. _
page. City/Town State Zip Cade Luke of Inspection
Lea System Information.. . ... ..._ _. -_ _._... .... .._w_.-.__._-_.___.. ..... w. _..._.. ...._.. .... .._.._._._..m..__ .w..
}/ (cont.)
4, Type of System:
H Septic tank, distribution box„ sail absorption system
E] Single cesspool
E] Overflow cesspool
[l Privy
0 Shared system(yes or no) (if yes, attach previous inspection records, if any)
El Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the IIA system by system operator under contract
E-1 Tight tank. Attach a copy of the DEP approval.
El Other (describe)
Approximate age of all components, date installed (if known) and source of information:
26 YEARS AS BUILT PLAN, INSTALLED OCTOBER 1997
Were sewage odors detected when arriving at the site? I Yes Z No
5. Building Sewer(locate on site plan).
Depth below grade: 14"
feet
Material of construction:.
--
(� cast iron 0 40 PVC �,.�] other (explain): IN FINISH WALL,-NOT VISIBLE--
Distance from private water supply well or suction line:
feet
Comments (on condition of joints, venting„ evidence of leakage, etc.):
,POINTS IN WALL - NOT VISIBLE
VENTING OK- NO SMELLS DETECTED
NO EVIDENCE OF LEAKAGE
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Commonwealth of Massachusetts
FA
if Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
140 COLONIAL AVE
Property Address
MIKE FANNING
Owner Owner's Dame _
mforrnatbn Gs
required for every NORTH ANDOVER MA 01845 AUGUST 15, 2023
1)age. City/Town State Zip Cade gate of Inspection
__ ..__... .. _._....._., ..,._._.._. ...._..._ .... ..,.._. .. _.._.._ ._. w_._......--- ._._....,w._....._._,. ...... ......,_._.
D. System Information (coot.)
5. Septic Tank (locate on site plan).
Depth below grade: 4,
feet
Material of construction:
concrete El meta8 E] fiberglass El polyethylene other(explain)
If tank is metal, lust age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) 0 Yes Ej No
Dimensions: °Jk 5' 4" _ _.
4"
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
34"
Scum thickness _
Distance from top of scum to top of outlet tee or baffle NA
Distance frorn bottom of scum to bottom of outlet tee or baffle NA
Mow were dimensions determined? TAPE MEASURE AND SLUDGE
JUDGE
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 TEES OK
TANK OK
NO EVIDENCE OF LEAKAGE
LIQUID LEVELS NORMAL
t51nr,W doc^rev 7/26/2018 ritie 5 Offi ias tnspecmon Fo"rr.Subsurface Sewage V3usgccssW Syskorn»Page 10 of 18
aAN,°°. Commonwealth of Massachusetts
Ix m Ti'le ►° fial In. percn Form
Ic Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 COLONIAL AV
Oroperty Address _
MIKE FANNING
Owner Owwner's'iarne
"ecluvedufo os NORTH ANDOVER MA 01845 AUGUST 15„ 2023
er�uored for every
page City/Town state Zip Code Date of Inspection
D. System Information (cons.)
7. Grease Trap (locate on site plan):
Depth below grade: /eet _
Material of construction:
El concrete 0 metal 0 fiberglass ❑ polyethylene ❑ other (explain):
Dimensions:
Scurn thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: i 'tc
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Molding Tank (tank must be pumped at time of inspection) (locate on site plan)
Depth below grade: _
Material of construction:
concrete EJ metal fiberglass F-1 polyethylene E] other(explain)
Dimensions: _
Capacity
gaAons
Design Flow:
gallons per day
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Commonwealth of Massachusetts
lV Title 5 Official Inspection Form
l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 COLONIAL AVE
Property Address ..
DIKE FANNING
Owner Owner's game
information 6s NORTH ANDOVER MA 01845 AUGUST 15, 2023
required for every . ...
page City/Town State Zip Code Date'of Inspection
a.... ....._ _... _._.... ....,.. __..,....._ _.... __.._.. ..... _ ..._.._._
D. System Information (coot.)
8., Tight or Holding Tank (coat.)
Alarm present: "Yes No
Alarm level: Alarm in working order: El Yes No
Date of last pumping:
Cate
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached" El Yes No
g. 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 LEVEL AND DISTRIBUTION IS EQUAL
LIGHT EVIDENCE OF SOLIDS CARRYOVER
NO EVIDENCE OF LEAKAGE
REPLACED D-BOX COVER
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Commonwealth of Massachusetts
TWe 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
»: 140 COLONIAL AVE
Property Address'
MIKE FANNING
Owner Owner's Name
requiredfsrr'is NORTH ANDOVER VIA 01845 AUGUST 15, 2023
required for fcrr every ...
page C;tyffowru Make Zip Cade Date ref inspection
D. System Information (cant)
101 Pump Chamber(locate on site plan):.
Pumps in working order: El Yes El No*
Alarms in working order: El Yes E] 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:
Ty pe:
7 leaching pits number:
leaching chambers number:
❑ leaching galleries number:
z leaching trenches number„ length: " 5Z5" i"CNC
[� leaching fields number,. dimensions:
[] overflow cesspool number:
innovative/alternative system
Type/name of technology; 11 1
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"4
Commonwealth of Massachusetts
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
l�
140 COLONIAL. AVE
Property address
MIKE FANNING
Owner
Owner's Name ... .._.
information is
required for every NORTH ANDOVER __ MA 01345 AUGUST 1 , 2023
page. city/Town State zip Code [late of inspection
D. System Information (cant.)
11. Sall Absorption System (SAS) (coat.)
Comments (note condition of sail„ signs of hydraulic failure, level of ponding„ damp sail„ condition of
vegetation„ etc.):
SOIL AND VEGETATION OK
NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING
12. Cesspools (cesspool must be pumped as part of inspection) (locate oil site plan):
Nurnber 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
Tide a Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
140 COLONIAL AVE
a
Property Address
MIKE FANNING
Owner Owner's Marne
required on is NORTH AND( VER MA 01845 AUGUST 15 2023
required for every �. _.
page. City/town State Zip Code Date of 9nspection
_,,. _., .__..m_.. _.... ..._ .... _,.,..__. .....w.........,.__ ... . .,, _ .... ......
D. System Information (cant.)
13. Privy (locate on site plan):
Materials of construction;
Dirmension _
Depth of solids
Comments (note condition of soil„ signs of hydraulic failure„ level of ponding, condition of vegetation,
etc.).
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Ur
Commonwealth of Massachusetts
Title 5 Official Inspection Farm
t1; Subsurface Sewage Disposal System Farm - Not for VoVuntary Assessments
140 COLONIAL AV
�roperty Address
MIKE FANNING
Owner Owner s game _
requir required
as NORTH ANDOVER MA 01545 AUGUST 15, 2023
rectalrred for every ....
page City/Town ;Mate Zip Code Date of Inspection
D. System Information (cent.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal systern, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
hand-sketch in the area below
drawing attached separately
}
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n
Commonwealth of Massachusetts
y ,xf Title 5 official Inspection Form-. i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
' u 140 COLONIAL AVE
Property Aftess
MIKE FANNING
Owner
Owner's Name
information is NORTH ANDOVER NIA 01845 AUGUST 15, 2023
required for every _ _ ___ _
page. City/Town State Zip code fate of Inspection
..,.... .._. _....... _._..__... .. ... _......_.._._... .......
........._ , .,......_... .._...... _.... _.,,.
D. System Information (cont)
15. Site Exam:
Z Check slope
Z Surface water
Z Check cellar
:] Shallow wells
Estimated depth to high ground water: feet -
Please indicate all methods used to determine the high ground water elevation:
z Obtained from system design plans on record
If checked, date of design plan reviewed: OCTOBER 1098
Cate
(.., Observed site (abutting property/observation hole within 150 feet of SAS)
z Checked with local Board of Health -explain:.
DESIGN AND AS BUILT PLANS ON FILE
El Checked with local excavators, installers - (attach documentation)
�...m Accessed USGS database -explain:
You must describe how you established the high ground water elevation;
DESIGN PLAN ON FILE
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
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Commonwealth of Massachusetts
Tile 5 Official Inspection Form
. I :subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
140 COLONIAL AVE
property Adclress _
MAKE FANNING
Owner Owner's Marne
information us
required for every NORTH ANDtOVER MIA 0184 AUGUST 15, 2023
Cut ffowa._ _
par��'a. Y State Zop..Cade Date of ins-
pection
E. Report Completeness Checklist
Complete all applicable sections of this farm inclusive of:
E A. Inspector Information: Complete all fields in this section.
O B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
D. System Information:
For 8: Tight/Holding Tank-- Pumping contract attached
For 14: Sketch of Sewage Disposal Systern drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
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