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HomeMy WebLinkAboutPass - Title V Inspection Report - 42 FOSTER STREET 9/6/2024 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 FOSTER STREET i rcrpsrty Address HEATHER PERKINS Owner Owner's Name _ information is required for every NORTH ANDOVER MA 01845 AUGUST 27, 2024 _�_.._.__._...._.__._ __._...__.,_._._.._...___.�.._...___...__.� page. Cltyfi own State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may,,not`be altered in any way. Please see completeness checklist at the end of the form. Important:when A. Inspector Information filling out forms on the computer, use only the tab Todd James Bateson, key to move your Name of Inspector cursor-do not Bateson Enter rises Inc.m~ _,_w... use the return —_._ ._�-.___ Company Name Q key. 111 Aglla Road Q Company Address Andover MA 01810 City[Tovwn State Zip Code 78-475-4786 Si-16 Telephone .._,.______.._.,_...,..._..___.._................_,._.....__..,....__._....�,__..____...._... _ ._,- Nurnkrer License Number B. Certification I certify that: i am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CHAR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above, the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. 23 Passes 2. ® Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4, Fails AUGUST 29, 2024 lnspe s Signature _ -.___.__.._ _.._. Date 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.doc•rev.712612018 Me e 5 Official Inspection Farm:Subsurface Sewage QtspoW System-Page 1 of 18 t Commonwealth of Massachusetts m . (p, Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments " '` 42 FOSTER STREET �. Property Address HEATHER PERKINS Owner .._..... . Owner's Name information is NORTH ANDOVER MA 01845 AUGUST 27, 2024 required for every _ -- page CItyrrown State Zip Code Date of Inspection _.....___..........__M_....__............._....__..._.._...._....._.....___........_.__ _....._..__.___ ___..._.._ _...._._..._....._.m__ ...............___.w..____.__.....__..____.__.._._ 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: Q One or more system components as described in the Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ND (Explain below): t5imsp.doc•rev 7/2612018 'ritie 5 official tnspectaon Form,Subsurface Sewage Disposal System-Page 2 of 18 " Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments F �� ,. •,,�`� 42 FOSTER STREET Property Address HEATHER PERKINS Owner owner's Name information is required for every NORTH ANDOVER MA 01845 AUGUST 27, 2024 . . ... page City/fown State _.''Z0,p,,,Code........._._..._..._Date of Inspection ..........._........M_.........._._.-._.......__... ____...___� �w..__.................___.__ _........ C. Inspection Summary (cont.) 2) 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 ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): distribution box is leveled or replaced ❑ Y ❑ N ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ 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 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"iinsp doc„M rev.'7f2612a16 Title 5 Official Inspection Farm Substi0ace Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form �i Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments . %� 42 FOSTER STREET Property Address HEATHER PERKINS Owner bwner s Name information is required for every NORTH ANDOVER MA 01845 AUGUST 27, 2024 page City/Town State Zip Code Date of inspection .._....._......_........... ._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: F1 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 wafter supply. R The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well,. [] The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: ........ ......... _ 4) System Failure Criteria Applicable to All Systems. You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool M Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t&nsp doc-rev 712612018 Title 5 OfflciM Inspection Form:Subsurface Sewage 176posal System-Page 4 of 18 � Commonwealth of Massachusetts Title 5 Off clal Inspection Form f, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 42 FOSTER STREET _,. Property Address HEATHER PERKINS Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 AUGUST 27, 2024 , page. CitydTown state Zip Cade Date of Inspection C. Inspection Summary (cant,) 4) System Failure Criteria Applicable to All Systems: (cant.) Yes No ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6° below invert or available volume 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: ❑ 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. ❑ 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 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.) 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 CA. Yes No ❑ ❑ 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 Zone II of a public water supply well t5insp.doc w rev.712572018 'title;5 Official Inspection Farm:Subsurface Sewage Disposal Systern-Wage 5 of 18 -.-_. ..... ........ ...... .....--------- ......... .__.._._. .......----- .---............... ------------------ ---------—---------_ -- ------"—..... Commonwealth of Massachusetts Title ❑ Official Inspection Form ° Subsurface Sewage Disposal System Form Not for Voluntary Assessments 42 FOSTER STREET Property Address HEATHER PERKINS Owner Own er"s Name information is required for every NORTH ANDOVER MA 01845 AUGUST 27..... . , 2024 ... page, CityFTown Mate 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 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Z Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ Z Have large volumes of water been introduced to the system recently or as part of this inspection? El ❑ Were as built plans of the system obtained and examined? (if they were not available note as /A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? 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 ❑ Existing information. For example, a plan at the Board of Health. Z ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp,doc-rev 7/26/2018 Title 5 Offval Inspec.ion Form.Subsurface Sewage Disposal System•Page 6 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments k, 42 FOSTER STREET Property Address HEATHER PERKINS _ Owner — Owner's Name information is required for every NORTH ANDOVER MA 01845 AUGUST 27, 2024 -.-- .. ............. page. C..ityTrown State Zip Code Date of Rnspection __._......_............. __------... D. System Information 1. Residential Flaw Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms); 330 GPD Description: Number of current residents: 2 Does residence have a garbage grinder? Fl Yes ® No Does residence have a water treatment unit? ® Yes Z No If yes, discharges to:Is laundry on a separate sewage system? (Include laundry system inspection El Yes Z No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes Z No SEE ATTACHED Water meter readings, if available (last 2 years usage (gpd)): _ Detail: -- --. Sump pump? ❑ Yes Z No Last date of occupancy: CURRENT_ Date r5lnsp.doc-rev 71260018 T'iCie 5 official inspection Form:Subsurface Sewage Dmposal Systern-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Farm � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments f; 42 FOSTER STREET Property Address HEATHER PERKINS Owner Owner's Name information is NORTH ANDOVER MA 01845 AUGUST 27, 2024 required for every page City/Town State Zip Code Date of Inspection _._.........._..........._.......................__.....____ ......._.._.._._____.._._._ D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): 11 a11ons per day(gpd) 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? ❑ Yes El No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: gate __ Other(describe below): 3. Pumping Records: Source of information: BATESON ENTERPRISES INC JULY 2024 Was system pumped as part of the inspection? ❑ Yes ❑ No If yes„ volume pumped: gallons How was quantity pumped determined? _ Reason for pumping: _ t5m%p.doc•rev.7/26/2018 Title 5 Official m9pection Form:Subsurface Sewage Disposal System w Page 8 of 18 Commonwealth of Massachusetts - � Title 5 Official Inspection Form wig Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 FOSTER STREET Property Address HEATHER PERKINS Owner Owner's flame information is required for every NORTH ANDOVER MA 01845 AUGUST 27A 2024 ..... _ page. Ctty/Town State Zip Code Gate of Inspection _.___.__._..___.......W.. __.__.._..._....... _..._...e_... . D. System Information (cant.) 4. Type of System: ® Septic tank, distribution box, sail absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy Shared system (yes or no) (if yes„ attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components„ date installed (if known) and source of information: 7 YEARS OLD INSTALLED OCTOBER 2017 DESIGNER'S CERTIFICATE Were sewage odors detected when arriving at the site? ❑ Yes Z No 5. Building Sewer(locate on site plan): Depth below grade: ee Material of construction: Z cast iron ❑ 40 PVC [] other (explain): Distance from private water supply well or suction line: fee ---- t Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS UNDER FLOOR- NOT VISIBLE VENTING OK-NO ODORS DETECTED NO EVIDENCE OF LEAKING --- .......... t51nsp riot-rev 7126120'18 Title 5 Official Inspection Form Subsurface Sewage Msposal Systerrn-Page 9 of'18 1 Commonwealth of Massachusetts Title 5 Official Inspection Farm .. j Subsurface Sewage Disposal System Form - Not for Voluntary Assessments f*' 42 FOSTER STREET Property Address HEATHER PERKINS Owner _....._........._. - ...._ Owner's Name information is required for every NORTH ANDOVER MA 01845 AUGUST 27, 2024 .. ... page, city/Town state zip code Date of"Inspection .... 1. :System Information (cant.) 6. Septic Tank(locate on site plan): Depth below rade 3.5' p g feet.. Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ 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: 10' X 5' X 4° _ .. Sludge depth: 12" 26" Distance from top of sludge to bottom of outlet tee or baffle __ _--------------- 1 ae Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? SLUDGE JUDGE AND TAPE MEASURE Comments (on pumping recornmendations, inlet and outlet tee or baffle condition„ structural integrity„ liquid levels as related to outlet invert, evidence of leakage, etc.): RECOMMEND YEARLY PUMP OUT AND FILTER CLEANINGS PLASTIC INLET AND OUTLET TEES OK LIQUID LEVELS GOOD TANK GOOD NO EVIDENCE OF LEAKAGE t8insp.doc•reev,7/26/2018 Title 5 Official Inspection Form:.SUbSUrface Sewage Disposal System•Page 10 of 18 ----------- ........ .........-----_ .....--.— ......_....---------------- ._..-.._. _. _--______........ . ...._.. f w Commonwealth of Massachusetts �I Title 5 Official Inspection Form 1, Subsurface Sewage Disposal System Form Not for Voluntary Assessments c 42 FOSTER STREET Property Address HEATHER PERKINS Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 AU(aUST 27, 2024 ...... -_.. page Cltydtown State Zip Code Date of Inspection _._,.___...---...._.............._.._._..._._._._...w_......_ D. System Information (cant.) 7. Grease Trap (locate on site plan): Depth below grade: -------- Material of construction: concrete metal ❑ 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 ---- — - Date of last pumping: date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: -... .................-...- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene M other(explain): Dimensions; Capacity: _ gallons Design Flow: gallons per day t5insp,doc•rev,7126Q018 rltle 5 Official Inspecton Form SWAUrface Swage Disposal System W Page I of 18 r Commonwealth of Massachusetts l Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 FOSTER STREET Property Address _ HEATHER PERKINS Owner ciwner s Name information is required for every NORTH ANDOVER NIA 51845 AUGUST 27, 2024 page. CIty/Town state Zip Code Date of Inspection D. System Information (cant.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ------------- *Attach copy of current pumping contract(required). Is copy attached? ❑ 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 IS LEVEL AND DISTRIBUTION IS EQUAL. NO EVIDENCE OF SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGE --------- - t5insp.doc•raw 7/26f2018 Title 5 Official Inspection Form,Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Ia Title 5 Official Inspection Form � "is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 FOSTER STREET Property Address HEATHER PERKINS Owner Owner's Name information is required for every NORTH ANDOVER MA 01645 AUGUST 27, 2024 .. _ page, City/Town State Zip Cade Cate of Inspection D. System Inf©rmatio_ n (cant,) 10. Pump Chamber(locate on site plan): Pumps in working order: Z Yes El No* Alarms in working order: ® Yes E] No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): PUMP CYCLED ON THEN OFF, ALL WORKING AS IT SHOULD ........... * 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: _. z leaching fields number, dimensions: 1; 1 ' x 40' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev 7/260018 'Title 6 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of'18 n p Commonwealth of Massachusetts Title 5 Official InspecUon Form °1> Subsurface Sewage Disposal System Form Not for Voluntary Assessments 42 FOSTER STREET Properiy Address HEATHER PERKINS Owner _ .__ ... Owner's Name information is NORTH ANCDOVER MA 01845 AUGUST 27, 2024 required for every page, City/Town State Zip Code Date of Inspection _._. _.__.____ __._.__r._......._.._......._.. .__...........__._.______ _._.a....................... D. System Information (cant.) 11. Soil Absorption System (SAS) (cant.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SOIL AND VEGETATION OK NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING 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.): _ ....._._ ------- .... _ _ ---- t5irlsp doc-rev 7/26/2018 Title 5 Official Inspection Form Subsurface Sewage DispasW System•Page 14 of'18 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 42 FOSTER STREET Property Address HEATHER PERKINS Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 AUGUST 27, 2024 .... page. cttyrTown State Zip Code Date of Inspection ......_........._............ D. System Information (cont.) 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.): __ t5¢nsp doc-rev.'7l1ea=18 Title 5 Official Inspection Form Su sudscz Sewage Disposal Systerr•Page 15 of 18 F Commonwealth of Massachusetts Title 5 Official Inspection Farm a Subsurface Sewage Disposal System Farm-Not for Voluntary Assessments 42 FOSTER STREET Property Address HEATHER PERKINS Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 AUGUST 27, 2024 .__ _ —. Cit frown State ZipCade [late of inspectio_...._.__...._.,__.d,_...._..._ _.. page. y __...�.___. coon 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: ® hand-sketch in the area below ❑ drawing attached separately {000 Qallo c;jwn6t r 110)1 o ra6 K 0 u 60X _ 6o 4Z 5 Mnsp4oc•raw.T/2612018 TWe 5 Official Inspection Form:Stitsurfaca Sewage Disposal System-page 16 of 18 ° Commonwealth of Massachusetts ` . Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 42 FOSTER STREET Property Address HEATHER PERKINS Owner .._.__. _._.. ........ ._.. - _ Owner`s Name information is required for every NORTH ANDOVER MA 01,845 AUGUST 27, 2024 -... page CIty/Tawn State Zip Cade Date of inspection _.___.__.._...._._................._._ D. System Information (cant.) 15. Site Exam Check Slope Surface water Z Check cellar ❑ Shallow wells Estimated depth to high ground water: I eat . Please indicate all methods used to determine the high ground water elevation: M Obtained from system design plans on record If checked, date of design plan reviewed: JULY 2017 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health -explain: PLANS ON FILE ❑ Checked with local excavators, installers - (attach documentation) [� Accessed USGS database-explain: You must describe how you established the high ground water elevation: DESIGN PLAN ON FILE. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp doc.-rev,7t2812016 Title 5 Official Inspection Bonn.Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title Off"Ici l Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 FOSTER STREET Property Address HEATHER PERKINS Owner Owner's Name _ information is required for every NORTH AN ROVER MA 01845 ANJGNJST 27„ 2a 4 _ page. City/Town State Zip Code Cate of Inspection _...__.. ._ ...._ _ ......... ___m_.._._._._.__..._.....w.. .� _.......... � __..m E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Z A. inspector Information: Complete all fields in this section. Z B. Certification: Signed 8t Dated and 1, 2, 3, or checked Z 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 System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5inEap.doc•rev.7/261201 fi '&'iN 5 Offictarel inspection Form.SubWdace Sewage Disposal Systert-Page'OS of 18 . S urumiraq Recovd Card generaled on 812 71202 4 8%58 AMr3 by Karvsrr5 Hanlon Page I Town of Forth Andover Tax Map # 210-104.D-0051-0000.0 Parcel Id 16739 42 FOSTER STREET JEREMY & HEATHER PERKINS 42 FOSTER STREET NORTH ANDOVER MA 01845 FY 2025 UB Mailing Index Narne/A,ddlress Twe Loan,Naarnber Ac1'faae/Iraact. From Until ,JEREMY 8 14E.ATHER PERKINS Owner A hva,' 42 FOSTER STREET NORTH ANDOVER MA 0'1845 UANT'GOMO,PHILIP T. Prewl0us Customer nactw"a 3/2 812018 42 FOSTER STREET NORTH ANDOVER,MA 01845 UB Account Malnt. Account No Cycle Occupant Narne Active/Inactive Bldg Id. 17726.0-42 FOSTER STREET Last Etllllrag Date 7/15/2024 3170390 03 Cycle 03 Active UB Services Maint. Account No 3170390 Sorvice Code Rate Charge t ulliplterfUsers 11S EFEE AOMIN FEE 0.63 5/8 7.82 1/ WW'1`R WATER 01 ALL.METER SIZE 60,80 d1 UB Meter Maintenance Account No 3170390 Serial No Status Location Brand Type Size YTD C arms 16748968 a Active ERT METE METE w Water r 0,6250625 625 217 Elate Reading Trade Consumption Posted Date Variance 6/12/2024 353 a Actual 16 712212024 4% 3/11/2024 337 as Actual 15 4/16/2024 '10% 12/111202 3 322 as Actual 13 1115/'2024 .14% 9/'15/2023 309 a Actual 17 10/1312023 1% 6/912023 292 a Actual 16 7/14/2023 19% 3/812023 276 a Actual 13 4112/2023 .17% 12/812022 263 a Actual 15 '111612023 4 % 9113/2022 248 a Actual 12 10//812022 -2211% 6/9/2022 236 as Actual 15 7/18/2022 3% 3/812022 221 a Actual 14 4/13/2022 2'% 1219/2021 207 aActual 14 1/17/2'022 3% 919/2021 193 a Actual 14 1011 5t2021 -22% 6/712021 179 a Actual '18 7/2712'021 37% 3/5/2021 161 aActual 12 4/21/2021 -1% 12/912020 149 a Actual 13 /113/2021 -11% 918t202O 136 a Actual 15 101'412020 3% 6/5/2020 121 a Actual 14 7/15/2020 13"/o 3A6/2020 107 a Actual 12 4/8/2020 8% 12/9/2019 95 a Actual 11 1/1512 0"20 -25% 9/13/2019 84 a Actual 16 10110/2019 _1"yap 6110/20°19 68 a Actual '16 7/2512019 r`"rra 3/8f2019 52 a Actual 14 4/1 to/2019 1% 12110/20,18 38 a Actual 14 1122/2019 -,5% 9l1212018 24 a Artuual 16 10115/2018 48% 6/7/2018 8 a Actual 8 7123/2018 -'100% 3127/2018 0 f Final Rill 0 3127/2018 •11001yu 12f712017 0 a Actual 0 1125/2018 .100% 10/2312017 0 n New Meter 0 1/25/2018 -100% 9/25/2017 899 rn Manual estimate 15 10/18/20"17 -17%