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HomeMy WebLinkAboutPass - Title V Inspection Report - 163 STONECLEAVE ROAD 9/9/2024 Commonwealth of Massachusetts UE 1" Subsurface Sewage Disposal System Form - Not for Voluntary assessments , 163 Stonecleve Rd ~two W Property Address Stadler Family Trust Owner Owner's Narne information is N Andover MA 01846 /2712b 4 required for every _ _... page, Cityh-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. ....... _. ..ww._ Irnportut forlfhen A. Inspector Information fillsng out orrrTs on the co+nputer„ use only the tab David Chandler key to move your Name of Inspector cursor-do not Suer Works use the return key. Company Narne 26 Hillside Ave _ Company Address Westford EWIa 01886 CityfTown State dip Code J 978-692-4410 S1 37 I- e(z Telephone Number License Number __...... . w .... ..._._ .... .. ..... ..... __._,...,_......................._.. _...... _...... _., ...... _............... _.,_...,. B. Certification 1 certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 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. Z Passes . [ Conditionally Passes 3. Needs Further Evaluation by the Local Approving Authority 4. E] Fails , ,. �. �ture E3/27l024 Inspectors S Cate 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. tt5jnsra duc,eaea 7/26/2018 Tole 5 Offirr,of Inspen.5ieaar Form SeAnurNa cu Sewage Dsreusral System.rkagee 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form Not for Voluntary Assessments w 163 Stonecleve lid Property Address Stadler Family Trust _ Owner Owner's game _ information is N Andover MA 01845 8/27l2t724 required for every _ _. _ .... page, C ity(Tow,n State Z[p bode mete 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: On this date the septic system for this property was inspected and evaluated. Based on what was observed during the inspection it was determined this day that the septic system did not meet,any failure criteria set forth by DEP, therefore the system passed Title 5. This report and this inspector make no judgement as to the future functioning or longevity of this septic system. 2) System Conditionally Passes: El 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 woll 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 E] N E] NC (Explain below): 15Vi•sg duc•rev.712612015 1 Me 5 Offic4al inspea;arm morn Subsurface Sewage Disp it Systerra.!'''eager 2 of'18 Commonwealth of Massachusetts i Title 5 Official Inspection Farm a T i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 163 Stonecleve lid Property Address Stadler Family Trust Owner Owner's Name information is N Andover CIA 01645 8/27/2024 required for emery .... page, Cityr r'own, Mate Zip Cade Date or pnspectiorn .... ............. ........._._. _._.n._.._.__ __ .._,.._...... C. Inspection Summary (cons.) 2) System Conditionally Fusses(cant.). [_ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumps/alarms are rewired.. Observation of sewage backtmp 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 F-1 Y Q N R ND(Explain below).- obstruction is removed El Y R N 0 ND (Explain below); distribution box is leveled or replaced El Y R 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): El broken pipe(s) are replaced ._ Y ❑ N ( ND (Explain below): obstruction is removed El Y �] N ] ND (Explain below): 3) Further Evaluation is Required by the Board of Health: E] 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: 0 somsp5.dr c, rev '7l2&2018 T fOe 5 P„ft iac lurosg,ao-wton r rap rn S4jb%,aa1race Sew a�p�Ma.pop.S'SWBaflaP m•Page 3&18 „ Commonwealth of Massachusetts G Title 0"Mi+ ial Inspection Form m Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I� 163 Stonecleve Rd Property address Stadler Farnily Trust Owner owner's Name information is N Andover NSA 01845 8/27/2024 required for every page. Cirty(Towwn State bp Code Date of Inspection C. Inspection Summary (cont.) [ 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 (arid 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. El The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. [„] The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well”. Method used to determine distance: * This system passes if the well water analysis, performed at a C FP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is ep,uai 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 El Z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool E5n!;4,r doc•wv '7P26120 18 di&e 5 Moat Yrwspkc4 on F or ina:4'?ubsudasce Sewage r:Mdsuosa"System-Page 4 06'f 8 Commonwealth of Massachusetts x Title 5 Official Inspection Form Subsurface Sewage Disposal system Form Not for Voluntary Assessments f 163 Stonecleve Rd Property Address Stealer Family"Trust Owner Owner's Name in fo is N Andover PEA 0,1845 8/27/2024 required for every _ _ Crty/Town State Zip Cade Date of Inspection _.._...........---.._ .......__.......... _..._........ _ ... ......_. _ ...._ ._ .... ..w....w,_.,.. _. ..,....... _........_ C. Inspection Summary (coat.) 4) System Failure Criteria Applicable to All Systems: (coat.) `yes No Static liquid level in the distribution box above nutlet 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 1/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times. pumped: ._ 0 z Any portion of the SAS, cesspool or privy is below high ground water elevation. El r7l 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. Ej E Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet frorn a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a CDEP 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 C.4. Yes No El El 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:—IPA) or a mapped Zone 11 of a public water supply well Rg"a€u sp Joa e agar 7126f2018 f to 5 Offfa m Orra oaatior rum SugusuH ace Sewage C;Sispusw wy e"I-Page 6 of 18 Commonwealth at Massachusetts N. Title 5 Official cial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Stonecleve Rd Property Address Stadler Family Trust Owner Owner's Name infq rfo Andover A is rroredec!for every N Ade_ .. _ 01345_ page City/Town State Zap Code late of inspection _....... _._.. ........ . C. Inspection Summary (cont.) 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 Iarge 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 El Purnpiing information was provided by the owner„ occupant„ or Board of Health ED 0 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? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as N/A) E Q Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Q Were all system components„ excluding the SAS, located on site? El Were the septic tank manholes uncovered„ opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction„ dimensions„ depth of liquid, depth of sludge and depth of scum? El H 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 EJ Existing information. For example„ a plan at the Board of Health. Determined in the field (if any of the failure criteria related to fart C is at issue approximation of distance is unacceptable) [310 CMR 15.30 (5)] tSmsp,doc rev.7r2&2018 Tv Ue 5 G;'.'a,.4 O nrwm°ucrron rcgr u Subsurface Sewage Di;.posai,SyMervn.Pap 6 of 18 Commonwealth of Massachusetts m Title 5 official Inspection Form Subsurface Sewage [disposal System Form - Not for Voluntary Assessments ' 163 Stonecleve Rd Property Address Stadler Family Trust Owner 6wrner's Larne information s N Andover MA 01345 3/27/2024 required for every page, City(T.own State Zip Cade Date of inspection _..... ........ _...__.... , _ D. System Information 1. Residential Flow Conditions: Nurnber of bedrooms(design) 4 Number of bedrooms (actual): DESIGN flow based on 310 GLAIR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd Description ......_... Number of current residents: Does residence have a garbage grinder? Z Yes El No Does residence have a water treatment unit? El Yes E] No If yes„ discharges to: cartridge filter with no discharge_ Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes Z No information in this report.) Laundry system inspected? © Yes Z No Seasonal use? F-11 Yes Z No private well Water,meter readings, if available (last 2 years usage (gpd)); Detail: Sump pump? ❑ Yes Z No Last date of occupancy: nataste a;yrrryp a1w',c•rev 7126r2018 Tale 5 Crfha a€IeagwAkart W o mi ;r bsu faace*wags?,Msyuo,4 Symern w Page 7 W 18 Commonwealth of Massachusetts Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w � 163 Stonecleve Ind Property Address _ Stadler Family Trust Owner owners 6Narne information is N'd Andover MA 01845 8/27/2024 required for every _ page. C4y1Town State Lp Cade Date of inspection W__ ...._........ ..w_.....__. _..._ _ .. . ... ...._. _. __ ..__ _ _,,,__...._..._ D. System Information (cent.) 2. Commercial/Industrial Flow Conditions; Type of Establishment: Design flow(Lased on 310 CMR 15.203): Gakions per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes [] No Water treatment unit present? El Yes E] No If yes, discharges to: lndustrial waste holding tank present? 0 Yes No Non-sanitary waste discharged to the Title 5 systern? ❑ Yes No Water meter readings, if available: Last date of occupancy/use: Crate Other(describe below): 3. Pumping Records: Source of information: customer Was system pumped as part of the inspection? E Yes ❑ No If yes, volume pumped: 100'0 gallon How was quantity pumped determined? known tank size Reason for pumping; check tank integrity t5or sp rkx•rev 7126�2018 Idle 5 0f iaa f hrwgaecbxr F orn'i Subsurface Sewwaqv 6.NspaawM syaswn.P hige e of 18 ommonrwealth of Massachusetts f .r TUE TT I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 163 Stonecleve Rd Property!address. Stadler pamfly Trust Owner Owners Name infonliation is regLnred for every NAndover MA 01345 (27/20 4_ _ page. bityr"ro-Wil Mate Zip Code Cate of Inspection ..w_-.............. .......... e..... ........-- ._..... ...._.w ... _....................... _. _..__......_...w__,.._..... .. . D. System Information (cant.) 4. Type of System. Septic tank, distribution box, sail absorption system Single cesspool Overflow cesspool [� Privy [l 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 El Tight tank. Attach a copy of the D P approval. Other (describe):. Approximate age of all components, date installed (if known) and source of information: constructed 1979 Were sewage odors detected when arriving at the site? ❑ Yes F1 No Building Sewer(locate on site plan): Depth below grade: 1 " feet Material of construction: cast iron ( 4G PVC [ other (explain): Distance from private water supply well or suction line: 30 _ feet Comments (on condition of joints, venting, evidence of leakage, etc.): a,nsp rt,,x•rev '712612, 18 Tde 5 Offi,o-ali doispe0onr F'om% Subsurface Sewwaggo D mg osW System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for'voluntary Assessments 163 Stonecleve Rd Property Address Stadler Famfly Trust _ Owner Owner's N wtle information is N Andover MA 61845 8/27120 4 required for every page, City/Town ante Zip Code Date of Inspection D. System Information . . ._...... ................._� ....... .__ __v,_.._._.u.... ..__...�...... _....___.._ _..... ......... (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 61 feet Material of construction: El concrete El metal ❑ fiberglass E3 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: 5 5"x3" Sludge depth: 1 „„5 Distance from top of sludge to bottom of outlet tee or baffle 6" 010 Scum thickness Distance from top of scum to top of outlet tee or baffle 7' Distance from bottom of scorn to bottom of outlet tee or baffle 14" How were dimensions determined? measured 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 yearly pumping,,baffle§ Intact„ no signs of any leaks or cracks liquid level at outlet invert_. tbrspy.a oc-rev "7P.:'&6 0� 8 Titkr 5(',ffio,al hspw�iaaw P':eam:Subsurface Sewage age npmapxnal System.Page 10 of 18 Commonwealth of Massachusetts TI 1e 5 +C�►�` idol Insp toon Form r= Subsurface Sewage Disposal System Farm - Not for Voluntary assessments A. A 163 Stonecleve Rd Property Address Stadler Family Trust _ Owner Owner's Narrye infora'nation is required for every N Andover MA CM1 t3i5 $l7/ C14_ page, Cwty(Town Mete Zip Code Date of inspection _...m._ ___.___ ...... ..... ....... .. .... ._. .,...__ ..w.._........, D. System Information (cant,) 7. Crease Trap(locate on site plan): Depth below grade: feet Material of construction: �ww] concrete D metal El 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 Bolding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El concrete El metal El fiberglass polyethylene F-1 other(explain). Dimensions; Capacity: gaPlw>ns Design plow: gallons per day V5in,V,pa.°joc­rev '7R260318 T'a6e 5 Q"7@C eel Vnwperton 8'onvi S1JbS,a.ee'Po-lce,1,'fwk4je Dmp owaao System.Page 11 of 16 Commonwealth of Massachusetts d Title 5 Official Inspection~ton Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 163 Stonecleve Fed Property Address _ Stadler Famaly Trust Omer owners Narne information is N Andover CIA 01845 8/27/20 4 required for every _ Page. CityFTown N Mate Zip Code Date of Vnspection D.k...�iyStE'.n"1 MClf4f`I"'M'"1�"�.....w_.......w._ .... .. ................. .... .. ...w...._._......._ .... .... m.._- Information (cons.) 8. Tight or Holding Tank(cant.) Alarm present: El Yes EJ No Alarm level: Alarm in working order: [,,, Yes El No Mute of last pumping: Cate 11 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): 011 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.): not original dbox, dbox was replaced at some point, no evidence of any solids in dbox, observed even flow, no signs of any leaks, added water to system via garden hose for 10 minutes and observed all leach lines accepting flow-_ t5insp doc•rev 70-V2018 rodW 5 OfWirml Inspection Form Subsurface SeRa age Disprasat System•Page 12 of 18 'u. Commonwealth of Massachusetts Title 5 Official Inspection Form ., Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Stonecleve Rd. Property Address Stadler FamiGy Trust Owner Owner's Narne regUiredfo is N Andover MA 01845 8/ 7/20 4 req�¢ired for every _ _ __ .. page. CityfTown Mate ,pep Cede gate at Inspection .... _ _....... _. .......�. ..... _.. ..__..,w. .._......... ._.._.._ . ......... D. System Information (cant,) 10. Pump Chamber(locate on site plan): bumps in working order: E-1 "Yes [l No* Alarms in working order: [I "Yes 7 No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.). If pumps or alarms are not in working order, systern is a conditional pass. 11. Soil Absorption System (SAS) (Vocate on site plan, excavation not required) If SAS not located, explain why: Type 7 leaching pits number: E] leaching chambers number: [ leaching galleries number: leaching trenches number, length: leaching fields number, dimensions 20x45° 11 overflow cesspool number: El innovative/alternative system Type/narne of technology: 6 msµ'drrc•rev.'7f2&2018 i'rP e 5 Ofscia,Ins;mcbon&earn:Subsurfacp Sewvragm 4:b6raflwosM Syca ern.If age'Q of 18 Commonwealth of Massachusetts ry Subsurface Sewage Disposal System Form Not for Voluntary Assessments 163 Stonecleve Fed Property Address Stadler Family Trust Owner owner's Name rinformationuired for every is N Andover MA 01645 8/27/2024 required page. CYtyffown State Zip Code Crate of Inspeotpon y ....... _...... ........_e_ D. S . ............ System Information ( cent.) 11. Soil Absorption System (SAS) (cant.) Comments (note condition of soil„ signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): observed gravel type soils, no signs of any hydraulic failure, no damp soils observed, grass over leaching area 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 El ``yes C-J No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5prmp ayoc rev 7"26120 8 rofi e 5 C'DmaaaB Inspocuon Pcann Subsurface Sewage DmposW Symem*Page 14 0 18 Commonwealth of Massachusetts Title 5 O fi i t Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,,. 163 Stonecleve Rd Property Address Stadler Family Trust Owner Owner's Name information for every eformation is N Andover MA 01845 8/27/2024 r .. .. __ page. city/Town State Zip code gate 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.): Ul,,msp do.:^rev.7t2612018 lfMe 5 Y;f iciial O ispechan Form Subsurtace Sewage GFmgrosW System Page 45&18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Stonecleve Rd property Address ..... . Stadler Family Trust Owner owner's Name required for Is N Andover l A 01845 8/2Tl20124 required fdr every _ _ page ctyfTown Mate by Code Crate of Irrspection _ .._.. _....., ...,.._.._ __...._.._. . _ .. ., _. ........... . ...... ._._ w.._...._ D. System Information (cone.) 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 (5(rrs p dcx--rev.70-V20 18 n tie 5 off( ,ai Enswgxwiarrr 6"a;nn aSttmufface Sewage r)is %n�Syve n•Page 16 of'8 ° Commonwealth of Massachusetts Tide 5 Offidal Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 153 Stonecleve Rd Property Address Stadler Family Trust Owner Owner's Name information is Andover VIA 01845 8/27/202�4 required far every _ _ .. _ page. Crty/Town State Zip Code mate of Inspection D. System Information (cons.) 15 Site Exam: El Check Slope Surface water Check cedar Shallow webs Estimated depth to high ground water: ,w+ Beet Please indicate all methods used to determine the high ground water elevation: Obtained from systern design plans on record If checked, date of design plan reviewed: gate _ Observed site (abutting property/observation hole within 150 feet of SAS) El Checked with local Board of Health -explain: _ Checked with local excavators, installers- (attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation. No sump pump in building. System constructed shallow with bottom of leach field appro . 2.5' below grade, Standing water(swamp) approx. 10'+ below leaching area grade _ Before filing this Inspection Report, please see Report Completeness Checklist on next page. err doc•rev "g SF tglCig Ti0e 5('7ffioat lnsgZa3r�gm n Form Subsurface Sswwug}s Y;7mp M System•Pg�K3s 1'8 of 1"§ Commonwealth of Massachusetts TI1I 5 I I Inspection ►r wi Subsurface Sewage Disposal System Form •Not for"voluntary Assessments t°�.„ ..: 163 Stonecleve lid Property Address Stadler Family_Trust Owner Owner's Name information is N Andover MIA t11845 8/27/2024 required for every _ .. page. Cityf own State Zip Cade Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this farm inclusive of: E A. Inspector lnformation; Complete all fields in this section. Z B. Certification Signed & 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 as msp doc,•rev.71260201B TPOe 5 Offi W tlnsp ctkon morn ;3aabsu0w*Sewage Msposa6 System Page 18 of 18 1 v