HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 158 FOREST STREET 8/5/2024 Commonwealth of Massachusetts
P µ Title 5 Offic"lal Inspection Farr
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
* 158 FOREST STREET
_..._ ..__._..__..._.. .._.w.n .... - _.................. _ _.._ ....._... ....m..w.__..._. ._ .._.. ...._. ...._....
Property address
NICK TRIANO
Owner Crwrnee s Name
information fo Is NORTH ANDOVER IUtA 1J1845 DULY 3Ci" 2024
requ6red for every City-
page. .............. . . . .__ _._...........__ ............ ...____w..... ._. __.....__._.... .. ...... _._..._ _ ... .. .. _._..._...__._.
dTowrn State Zip Cade mate 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.
Important;When A. Inspector Information
felling out forms
on the computer„ Todd James Bateson,
useonly the tab ......._ .._._.... ...... .. .......__ __.__._..__ .....M_. .. .w._v ....w_....._ . .._._ ___._....... __. ._ ..._ . ._ ._...._.... _.�.-_.. .......
key to move your Name of Inspector
cursor-do not Bateson E.n_te_rp ises Inc._........._..__..______.._...._._..__ _..._.__w_... .._.._...._...... m....._. _._. . .. _... .. ___----
use the return Comp droy Name key, �__.. _....._...,._ . .....
111 ArcINla Road
Company Address
Andover IAA C11810
Cktylfown Mate Zip Code
78-47 - 786
TeNephone 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 CHAR 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. El Passes
2, Conditionally Passes
3. Need's Further Evaluation by the Local Approving Authority
4, Fails
AUGUST 1 2024
irbsp r"s 6r�nature bate
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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- ............................w------ . --- .... ...... ... ---------------
Commonwealth of Massachusetts
Tide 5 Official Inspcct'lon Form
1, Subsurface Sewage Disposal System Farm -Not far Voluntary Assessments
^� � P Y Y
155 FOREST STREET
Property Address
NICK TRIANO
Owner Owner's Marne
informabonrequired
ie NORTH ANDOVER MA 01345 JULY 30, 2024
ar.�c�uived far every
page. City/town State Zip Cade Date of inspection
-----.__. _.. .._..............
_._.e. ..__ .... ._ ._. w....... ,_ ....... ..w....,._ ......,. ,.ry ._... w._..,..w. _...... _......._ ._. _._..___._.....
C. Inspection Summary
Inspection Surnmary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
Cn.� 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:
l One or more system components as described in the "Conditional Kass" 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 structuraily sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available,
.w] Y �] N [ j ND (Explain below).
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Commonwealth of Massachusetts
�
I,^ Title 5 Official Inspection Form
ti Subsurface Sewage Disposal System Form Not for Voluntary Assessments
✓ 158 FOREST STREET
Property Address
NICK T"RIANO
f)wner Owners Name
nforrna6on us
re
quired for every NORTH ANDOVER MA JULY 30„ 20241,11111,
page. &iyl"rown State Zip Cade gate of Inspection
C. Inspection Summary (coot.)
2) System Conditionally Passes (cant.):
Frump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
purnps/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 . � N El ND (Explain below):
( obstruction is removed (.,M.M Y N [ ND (Explain below):
distribution box is leveled or replaced Y N [ ND (Explain below):
( The system required pun"rping 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 ] ND (Explain below):.
obstruction is removed E71 Y (I N _I ND (Explain below):
_... ....
3) Further Evaluation is Required by the Board of Health:
Conditions exist which regWre 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
Title . t�►" d l In p ton Form
( � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
158 FOREST STREET
Property Address
NICK TRIANO
Owner Owner's Name
required on us NORTH ANDOVER MA 01845 JURY 30, 2024
required for every _
page. Cotyffown State Zip Cade gate of Inspection
_._.. ........ .. ......._.__..... .w..... ......_ _ -_-____. .w. _w..
C. Inspection Summary (cant.)
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:
U 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.
F1 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
[n_ 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 from a private water supply well",".
Method used to determine distance:
" This system passes if the well water analysis, performed at a C Eli 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 forme,
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 Z 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
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5: Commonwealth of Massachusetts
h "i le 5 °I�fid l In p► cUon Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
155 FOREST STREET
Oroperty Address
NICK TRIANO
Owner 01wner's NamIe
----
information is
NORTH ANDOVER MA 01845 JULY 30, 2024
regf�orec9 for avert'
page. City[Town State Zip Code Date of Inspection
C. Inspection Summary (cant.)
4) System Failure Criteria Applicable to All Systems; (conk.)
Yes No
Static liquid level in the distribution box alcove outlet invert due to an overloaded
or clogged SAS or cesspool
Liquid depth in cesspool is less than 5" below invert or available volurne is less
than '/2 day flow
Required pumping 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.
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.
El Z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water duality 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
ID z The system is a cesspool sewing a facility with a design flow of 2000 gpd-
10,000 gpd
CJ 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 Hoard 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 E.3 the system is within 400 feet of a surface drinking water supply
❑ E 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 rnapped Zone II of a public water supply well
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Commonwealth of Massachusetts
" ,ro Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
158 FOREST STREET
Properly Address
NICK TRIANO
Owner Owner's Name
rq'rrfo NO J
m every is
e�i'icede>ct for ANDOVER MA 01845 ULY 30, 2024
r ._, _... .... _ _.,. , ...
page. ,4yC 9`rawn State Zip Code Date of Inspe
ction
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.
5. You must indicate "yes" or"no" for each of the following for all inspections:
Yes No
Z El Purnping information was provided by the owner„ occupant, or Board of Health
Ej Z Were any of the systern components pumped out in the previous two weeks?
Z 1-1 Has the system received normal flows in the previous two week period?
El Z 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 NIA)
0 El Was the facility or dwelling inspected for signs of sewage back up?
Z 0 Was the site inspected for signs of break out?
Z El 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 ow
Z 0 Existing information, For example„ a plan at the Board of Health.
Determined in the field ('if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15,302(5)]
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
158 FOREST STREET
r5roperty Address
NICK TR'IANO
Owner Owner's Name
information is NORTH ANDOVER MA 310,12024
required for eery _ 01-845 DULY 35__--
page. ,iryf"rowra State Zip Cade Date of Inspection
D. System Information
1, Residential Flaw Conditions:
Number of bedrooms (design): __ Number of bedrooms (actual): 4
DESIGN flow based on 310 CIAR 15.203 (for example: 110 gpd x#of bedroorns); 440 GPD
. ... . .........
Description:
—-----
Number of current residents: 2
Goes residence have a garbage grinder? El Yes Fx1 No
Goes residence have a water treatment unit? Q_ Yes 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? Z Yes [] No
Seasonal use? [I Yes Z No
Water meter readings, if available last 2 ear°s usage d SEE ATTACHED
g ( y g (gp ))
Detail:
Sump pump" ] Yes E] No
Last date of occupancy: CURRENT
r3ate
t5insrr doc.rev 712612018 Tole S Official Inspection Fofm Subsurface Sawag e Msfo$W System»Page 7 of 18
° Commonwealth of Massachusetts
III Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
158 FOREST STREET
Property Address _
NICK TRIANO
Owner Owwner"s Nwne
requiratifoi NORTHANDOVER MA 01845 JI�LY 30, 2024
required for every
osge Cityaown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions:
Type of Establishment:
Design flaw (based on 310 CMR 15. ): dallons per day(gpd) _
Basis of design flew (seats/persons/sq.ft., etc.),
Grease trap present? El Yes No
Water treatment unit present? ❑ Yes El 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:
Date
Other(describe below).
. Pumping Records:
Source of information: BATESON ENTERPRISES INC AUGUST 202
_.
Was system pumped as part of the inspection? El Yes Z No
If yes, volurne pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
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Commonwealth of Massachusetts
"Title 5 Official Inspection Form
w u = 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
158 FOREST STREET
Property address
NICK TRIANO
Owner owners Name
infaarired for every dorl its
required NORTH ANDOVER CIA 01845 JULY 0, 2924
oage. ity6Town Staten Zip Code Cate of inspection
_ ._ ..,_.,..,_, _.._..,_.... ..,_..,..._,. _......... __...,._, _.. _-___v..,_.__ ..nw...._ ..__,_....... ..... _.. .........
D. System Information (cant.)
4 "Type of System:
z Septic tank, distribution box, soil absorption system
Single cesspool
w Overflow cesspool
Privy
El Shared system (yes or no) (if yes, attach previous inspection records, if any)
E-1 Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained frorn system owner) and a copy of latest
inspection of the I/A system by system operator under contract
(,.... Tight tank. Attach a copy of the DEP approval.
EJ Other(describe):
Approximate age of all components„ date installed (if known) and source of inforrnation:
7 YEARS, INSTALLED APRIL 22, 1997„ AS BUILT PLAN
Were sewage odors detected when arriving at the site? El. Yes Z No
5. Building Sewer,(locate on site plan):
Depth below grade: et
Material of construction:
.l cast iron Z 40 PVC .9 other (explain): _
Distance from private water supply well or suction line: ft
Cornments (on condition of joints, venting, evidence of leakage,. etc.):
JOINTS AND VENTING OK
NO EVIDENCE OF LEAKAGE
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" Commonwealth of Massachusetts
TUEle 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
18 FOREST STREET
Property Address
NICK TRIANO
Owner Owner's Name
Information is required for every NORTH ANDOVER MA 01845 JULY :30, 2024
_
page. City/Town State Zip Code Coate of Inspecfion
_.. ._.. .... ... .... ........ w.. ...._...,_ ._......,..,. ..w_.....w_
D. System Information) (cant.)
8. Septic Tank (locate can site pion):
Depth below grade: 15
feet
Material of construction:
0 concrete D metal .. fiberglass (._ polyethylene F-1 other(explain)
If tank is metal, list age: _.
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) [] Yes No
Dimensions: 1 ° X 5' 4°
4"
Sludge depth:
Distance frorn top of sludge to bottom of outlet tee or baffle 4
Scum thickness °
Distance frorn top of scum to top of outlet tee or baffle 7
Distance from bottom of scum to bottom,of outlet tee or baffle 8,
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 CUTLET TEES OK
TANK IN GOOD CONDITION
NO EVIDENCE OF LEAKAGE
NORMAL LIQUID LEVELS
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Commonwealth of Massachusetts
Title 5 Official Inspection Farm
r3 LL ink Subsurface Sewage Disposal System Form - Not for Voluntary Asses rrt nts
158 FOREST STREET
Property Address
NICK TRIANO
Owner Owner's Game
regUiedfinformation is NORTH ANDOVER MA 01345 JU�LY 39, 2024
req�pired ra�c every _ .. __.
page. Ciity/Town state Zip Cade Date of Inspection
. _ ..........._..._— _ _m._.....
D. System Information (cont,)
T Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction.
concrete metes fiberglass polyethylene 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.):
3 Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction
El concrete Ej metal El fiberglass P polyethylene �.� other (explain):
Dimensions:
Capacity:
gallons
Design Flow:
galBons per day
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Commonwealth of Massachusetts
n Ti'le 5 Official nspect"o r Form
Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments
f
18 FOREST STREET
l5roperty Address
NICK TRIANO
Owner, Owner's Narne
information G
required for every .. .NORTH .
214
C t orn State l Code [take of lns` _. ..
page. Y pection
...._..._ ___-.ww____.w..........._..,.__ .... _.,.. ...__..,_,...,. _. .,..,, ., ..
D. System Information (cant.)
8. Tight or Holding Tank (cant.)
Alarm present: Yes [ I No
Alarm level: Alarm in working order� Yes No
Date of last pumping: rake
Comments (condition of alarnn and float switches, etc.):
Attach copy of current pumping contract (required). Is copy attached? El Yes D No
g. Distribution Box (if present must be opened) (locate on site plan),
Depth of liquid level above outlet invert 0
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 NOT LEVEL
MSTRIBUTION IS NOT EQUAL
LIGHT EVIDENCE OF SOLIDS CARRYOVER
EVIDENCE OF LEAKAGE
D-BOX HAS DETERIORATED AND NEEDS REPLACED
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
F, ff) Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
158 FOREST STREET
.*...
Property Address
NICK TRIANO
Owner Owner's Name _
information ds
regUired for every NORTH ANDOVER MA 01845 JULY 30, 2024
.............
page. CMty/Town State Zip Code Coate of Inspe'06on
D. System Information (coot.)
10. Pump Chamber(locate on site plan):
Pumps in working order: 0 Yes Ej No*
Alarms in working order: E] Yes F] No"
Comments (note condition of pump charnber, 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:
0 leaching pits number:
Ell leaching chambers number:
E"I leaching galleries number:
,.. 2; 58' LONC
leaching trenches number, length:
El leaching fields number, dimensions: _.
El overflow cesspool number:
El innovative/alternative system
Type/name of technology:
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Commonwealth of Massachusetts
Title Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'`` 158 FOREST STREET
Property Address
NICK TRIANO
C)wwner Owmner s Name
information s
regired for every NORTH ANDOVER MA 01845 JULY 30, 2024
rertwi
page. Citya/Towamr_. Stag ,Zip Code state of inspection
D. System Information (coot.)
11. Sail 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 HYDRAULIC FAILURE OR PONDING
12. Cesspools (cesspool must be purnped as part of inspection) (locate on site plan):
Number and configuration
Depth _..top of hquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow � Yes E! No
ComRrrents (note condition of soil„ signs of hydraulic failure, level of ponding„ condition of vegetation,
etc.):
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Commonwealth of Massachusetts
o ry � 1°0 Title Official Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
Ywe 158 FOREST STREET
Property address
NICK TRIANO
Owner ..
C w ,ner"s Nar._rre
mforrequired
is NORTH ANDOV� R MA 01845 JUL.Y 30, 0 4
rectuBred for every __ . .
page. city/town State Zap 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
=bk Title 5 Official Inspection Form
:.:. Subsurface Sewage Disposal System Form Not for Voluntary Assessments
158 FC7REST STREET
Property Address
NICK TRIANQ
Owner C7wner's hlame
information is required for every NORTH ANDOVER MA 01$45 1 1 DULY 30, 2024
1111
page. Citylt own State Zip Code Date of Inspection
__ _._._....._._ ..._................. ._.._..._..._w_________..___._...._
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:
E hand-sketch in the area below
�] drawing attached separately
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form - Plat for Voluntary Assessments
158 FOREST STREET
—------------
NICK TRIANO
Owner Owner's Name --—-------............
information is
required for every NORTH ANDOVER MA 01845 JULY 30, 2024
page. CttyfTown State Zip Code Date of Inspection
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
drawing attached separately
..........
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t5fnsp.dac-rev.7/2eJ2018 Title 5 Official Inspedon Porn:Subsurface Sewage Disposal SySterrl•Page 16 Of 18
Commonwealth of Massachusetts
T Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
• 158 FOREST STREET
Property Address .
NICK TRIANO
Owner ., � __ _...,.......
C"Dw�ne,rc�Narcne
information,is
required for every NORTH ANDOVER MA 01845 JLILY 30, 2024
page Cray/Town State 7 ago Code Date of Inspection
D. System Information (coot.)
15. Site Exam:
Check Slope
Surface water
E] Check cellar
E] Shallow wells
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation.
Obtained frorn system design plans on record
If checked, date of design plan reviewed: JUNE 27, 1005
Date
D Observed site (abutting property/observation hole within 150 feet of SAS)
` Checked with local Board of Health _ explain
FLANS ON FILE
El Checked with local excavators, installers - (attach documentation)
[ Accessed USES 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.
t.26rtnpedec rraw.7PM2018 1 itte 5 Officinal Oo•mpea„oon Four Subsu face Sewage D¢5r%rmM systwu•kPago 17 of 1 H
Commonwealth of Massachusetts
yr T" l 5 Offs ial Inspection Form
r, m Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
158 FOREST STREET
Properly Address
NICK TRiANO
Owner Owner's Name
fequiredfrn is NORTH ANDOVER NIA 01845 JURY 30, 2024
uea�uVred for every _
Pape. City/Town_ State Zip CIode Date of Inspection
E. Report Completeness Checklist. ....
Complete all applicable sections of this form inclusive of:
A. inspector Information: Complete all fields in this section.
r„ S. 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
w; 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
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Town of North Andover
Tax Map # 2#10.406.A-0190-0000.0
Parcel ld 17336
158 FOREST STREET'
TRIANO, NICK
158 FOREST STREET
NORTH ANDOVER, MA
01845
FY 2025
UB Mailing Index
Naino/Address Ty pe, Loan NUMbOr Artivo/Inact, Frore Until
TRIANO,NICK Payer Active
158 FOREST STREET
NOR l H ANDOVER, MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/hiactive
Btldg Id. 17614.0-158 FOREST STREET Last Billing Date 7/1512024
3170285 03 Cycle 03 Active
UB Services Maint.
Account Na. 3170285
Service Coda Rate Charge Multiplier/0sers
MISCFEEADMIN FEEE 0,635/8 7.82 1/
VVTR WATER 01 AU METER SIZE 13551 /1
UB Meter Maintenance
Account No 3170285
Serial No Status Location Braud Type size YTD Cons
36388093 a Active E RT H H b Badger w Water 0.625 0.625 513
Date Reading Code ConSUMIJ00o Posted Dato Variance
6/11/2024 2153 a Actual 31 7/2212024 230%
302024 2122 a Actual 9 4/16/2024 -75%
l 2/8/2023 21,13 a Actual 33 1/1512024 -15%
9/14/2023 2080 a Actuat 45 1011312023 -91YQ
6/8/2023 2035 a Actual 47 7/1412023 313%
3/7/2023 1988 a Actual 11 4/12/2023 -55%
12/7/2022 1977 a Actual 24 1116/2023 -74%
9/9/2022 1953 as Actual 96 10/18/2022 200%
6/8/2022 '1857 a Actual 32 7118/2022 206%
317/2022 1825 a Actual 10 4/1312022 -59%,
12/812021 1815 a ACtUaR 25 l 117/2022 -59%
9/8/20241 1790 a Actual 63 10/15/2021 77%
6/712021 1727 aActual 36 7/2712021 233%
3/51202 l 1691 a Actual 10 4121/2021 -74%
1202020 1681 a Actual 41 1/13/2021 -57%
9/812020 1640 a Actua8 99 10/14/2020 352%
6/512020 1541 a ActuaV 21 711512020 09%
3/6/2020 1520 a Actual 12 4/8/2020 -65%
12/9/2019 1508 a ActuaB 34 1/1512020 -57%
9/1312019 1474 a Actual 87 1 OY 10/2019 33011/0,
6110/2019 1387 a Actual 20 7/25/2019 70%)
3/8/2019 1367 as Actual 11 4116/2019 -71%
12110/2018 1356 a Actual 12 1122/2019 -83/6
9/12/2018 1344 a Actual 74 10/15/2018 23211/o
611112018 1270 as Actual 23 7/23/2018 441/16
31712018 1247 a Actual 15 4/23/2018 -50%
12/7/2017 '12 32 a Actual 29 1/25/2018 -65%
911 8 12017 1203 a ACtUatl 90 10/1812017 181%
618J2017 1113 a ActuaI 31 7/2512017 52%
3/8/2017 1082 a ACtUal 20 4/1212017 -24%
121812016 1062 as Actual 27 l/23/2017 -72%
,,1/71201 6 1035 a Actual 94 10/2412016 6311/o