HomeMy WebLinkAboutConditonal Pass - Title V Inspection Report - 284 SUMMER STREET 10/11/2024 y Commonwealth of Massachusetts
r � Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
r.; 284 SUMMER STREET
Property Address
STEPHEN SCURIhlk
Owner 6wvruers Name
information Is NORTH AfJDtDVER MA 01845 .. ._. SEPTEMBER 30, 2024
required for every __.............
page rty/Town State Zip Code Date,of Inspection
Inspection results must be submitted on this form. Inspection farms 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, Todd James Bateson,
use only the tab w.... ..._�.. . _..... ....
key to move your Name of Inspector
carrsor-do riot Bateson Enterprises Inc.
use the return ......,_...... _._ ,......... ,
key. Company Name
_. 111 Ar illa Road
Company Address
W Andover MA 01810
78-47 -4788 _ . .. ate yip ante
a park, y 11 6
;kt /rohPVl"t
-Azz
Telephone Number License Number
... ............
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 GIMP 15.000); l have personally inspected the sewage disposal system at the property address
listed above„ the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on.site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. Passes
2. ti' Conditionally Passes
1 feeds Further Evaluation by the local Approving, Authority
4. Fails
_._...
C7CT(3BER 3„ 2C124
iris ctor s Si na reDate
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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Commonwealth of Massachusetts
Title 5 Official Inspection norm
i
" Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
264 SUMMER STREET
Property Address
STEPHEN SCURINI _
Owner Owner's Narmne
information ns NORTH ANDOVER MA 01545 SEPTEMBER 30, 2024
required for every
page. City/Town State Zip Code 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 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, exh¢bits 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 N E] ND (Explain below):
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
41
Y Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
iv,
284 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner Owner's Name
mforrsatnon s NORTH H ANDG)VER MA 01845 SEPTEMBER 30, 2024
required for every _
page. City/Town State Zip Code gate of Inspection
_.._.... .. ...._,__...... _....... ... __w._.. _.. _a,..... _.. .. _ ._......
C. Inspection Summary (cant.)
2) System Conditionally Passes (coat.).
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):
El broken pipe(s) are replaced ZY E N Q ND (Explain below):
obstruction is removed D Y O N 0 ND (Explain below):
Z distribution box is leveled or replaced fir, Y ❑ N [ ND (Explain below):
D-BOX DETERIORATING AND LEAKING;
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 [.M Y R N Ej ND (Explain below):
obstruction is removed ❑ Y ❑ N EI ND (Explain below):
) Further Evaluation is Required by the Board of Health;
El 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
1 .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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e Commonwealth of Massachusetts
T We 5 Official Inspection Form
��1 Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
284 SUMMER STREET
s~ Property Address
STEPHEN SCURINI
Owrier Owner's Name
information is NORTH ANDCIVER MA 01845 SEPTEMBER 30„ 2024
required for every _
page City/Torun State Zap Code Coate of Inspection
_..... ._------- .. - ......
.._
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:
❑ 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.
] 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
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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
264 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner Owner's Name
information is NORTH ANDOVER MA 01545 SEPTEMBER 30„ 2024
required for every
page Clty�Towwn State Zlp Cade gate 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
E 1 Liquid depth in cesspool is less than 6" below invert or available volume is less
than "✓2 day flow
El 0 Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
Fj 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.
1:1 z Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
El z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
El z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
El z The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
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 16,000 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
C] ❑ 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
El 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 rev.7f2r)/2018 1 il,le 5 Of"110al InSPOCUWI F01Tn SUbsaurfice Samage Disposal!Sysiern•Page^b 0 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�ro Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
284 SUMMER STREET
Property address
STEPHEN SCURINI 11
Owner Owner's Narne
infornregWred frr Es NORTH ANDOVER MA 01845 SEPTEMBER 30, 2024
requdred for every _ ..
page City/Town State Zip Code Fete of tnspe11 ot11 Fon
.,..._ ........._ _.. ..... ....._.......
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
C] 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?
* 1:1 Has the system received normal flows in the previous two week period?
D 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 N/A)
0 Was the facility or dwelling inspected for signs of sewage back up?
Z 11 Was the site inspected for signs of break out?
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 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:
F1 Existing information. For example, a plan at the Board of Health.
Z El 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
k I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Y h n
84 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 SEPTEMBER 30, 2024
_
page city/Town state Zip Code Date of Inspection
___-------------_....._..... _......., -................._.�........._._._......_ _..................,_............................
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 4.... Number of bedrooms (actual): 4 -
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 600 GPD
Description:
3
Number of current residents:
Does residence have a garbage grinder? ❑ 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? Z Yes ❑ No
Seasonal use? ❑ Yes Z No
Water meter readings, if available last 2 ears usage d ATTACHED
g ( Y g (gp ))�
Detail:
Sump pump? Z Yes ❑ No
Last date of occupancy: CURRENT
Date
t!,insp.doc-rev '7126/2018 TAW 5 Official Inspection Form Subsurface Sewage Disposal System•Page 7 of'18
, Commonwealth of Massachusetts
�R to Title 5 Official Inspection Farm
—' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
t
284 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner Owner's Name
required o Is NORTH ANDOVER MA 01845 SEPTEMBER 30, 2024
required for every
page CityfTown Mate Zip Code Date of Inspection
D. System Information (cent.)
2. Commercial/industrial Flow Conditions.
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(god)
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 [ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes U No
Water meter readings, if available:
Last date of occupancy/use: gate
Other(describe below):
3. Pumping Records:
Source of information: BATESON ENTERPRISES INC APRIL 2023
Was system pumped as part of the inspection? [l Yes Z No
If yes, volume pumped; _
gallons
How was quantity pumped determined?
Reason for pumping:
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° Commonwealth of Massachusetts
Title 5 Official Inspection Form
a W Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�6
284 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner Owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 30, 2024
required for every
page CltyfTown Mate Zip Code Date of Inspection
_.. . . ..._._ __.___.. __.... — .
D. System Information (cant.)
4, Type of System:
z Septic tank, distribution box„ sail absorption system
El Single cesspool
Overflow cesspool
❑ Privy
[] Shared system (yes or no) (if yes, attach previous 'inspection records, if any)
Q 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:
39 YEARS„ DATE INSTALLED 1985, OWNER
Were sewage odors detected when arriving at the site? El Yes Z No
5. Building Sewer(locate on site plan):
24"
Depth below grade: feet
Material of construction:
0 cast iron Z 40 PVC [:1 other(explain).
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
JOINTS AND VENTING OK
NO EVIDENCE GE LEAKAGE
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° Commonwealth of Massachusetts
Title 5 Official Inspection Farm
' '
i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
284 SUMMER STREET _
Property Address
STEPHEN SCURINI
Owner bwner's Name
required fou is NORTH ANDOVER MA 01845 SEPTEMBER 30, 2024
required for every _ _
paps Cityrrowrr State Zip Code Date of Inspection
__. _,..._.._.. _. _... ..__.__ _ ..... _........ .. _........ ......
D. System Information (cant.)
6. Septic Tank(locate on site plan):.
Depth below grade: feet ..
Material of construction:
H concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain)
If tank is rnetal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes 0 No
Dirnensions: - 5' 4'
Sludge depth: 12,<
Distance from top of sludge to bottom of outlet tee or baffle
26"
Scurn thickness 2"
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 1 2„.
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.):
PUMP OLDER SEPTIC SYSTEMS YEARLY
CONCRETE INLET AND OUTLET BAFFLES O
TANK OK
NO EVIDENCE OF LEAKAGE
LIQUID LEVELS GOOD
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w � Commonwealth of Massachusetts
Tide 5 Official Inspection dorm
4.
Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
,47. 284 SUMMER STREET _
Property Address
STEPHEN SCURINI
Owner owner's Name
information is NORTH AND(7VER MA 01845 SEPTEMBER 30, 2024
required for every
page, City/Town State Zip Code Date of�nspectron
D. System Information (cent.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
[l concrete 0 metal El fiberglass 0 polyethylene E] 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: gate
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage„ etc.):
& Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
EJ concrete El metal ❑ fiberglass ❑ polyethylene E] other (explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
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°M Commonwealth of Massachusetts
Title 5 Official Inspection Farm
pRi Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
., 254 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner Owner's Name
intrarrrgat*11 Is NORTH ANDOVER MA 01545 SEPTEMBER 30, 2024
required for every
page Cityrrown State Zip Code Date of Inspection
- ...__................ . . ... ..... ...... __._._..... _...____.....................-__. ......... ...
D. System Information (cant.)
5. Tight or Holding Tank (cant.)
Alarm present:. ❑ "Yes E] No
Alarm level Aiarin in working ruder. El 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? El Yes E] 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 DETERIORATED AND LEAKING
DISTRIBUTION NOT EQUAL
LIGHT EVIDENCE OF SOLIDS CARRYOVER
EVIDENCE OF LEAKAGE
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
S Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c
..w 284 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner Owner's Narrie
information is NORTH ANDOVER MA 01845 SEPTEMBER 00„ 2024
required for every _
page City/Town State Lop Code Coate of Inspection
D. System Information (cont.)
10, Pump Chamber(locate on site plan):
Pumps in working order: F1 Yes El No"
Alarms in working order: D Yes El 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. Soul Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why;
Type:
0 leaching pits number. _
❑ leaching chambers number:
(El leaching galleries number:
E] leaching trenches number, length;
F: leaching fields number, dimensions: 1; 20' X 45'
overflow cesspool number:
EJ innovative/alternative system
Type/name of technology.
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; Commonwealth of Massachusetts
i Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments
284 SUMMER STREET
Property Address _
STEPEN SCURINI
Owner Owner's Name
information is reqUi¢ed for every NORTH ANDOVER MA 01845 SEPTEMBER 30, 2024
page. City/Town State Zip Cade Cate of Inspection
_...__... _... _.__..........__ _......,.....
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 SIGN OF HYDRAULIC FAILURE OR PONDING
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow [ ] Yes No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
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Commonwealth of Massachusetts
Title 5 offidal Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wr
284 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner Owner's Name
information as NORTH ANDOVER MA 01845 SEPTEMBER 30, 2024
rewired far every
page, cityrro wn Mate Zip Cade Date of 1nspeob rn
.. ........... ........... .........w ___.
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
x p, Title 5 official Inspection Form
Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
.4 w
284 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner 6wwner"s Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 30, 2024
required for every _ ...._...__,..._ _.._.__ _. _w__e.__.__� _-__ _.. . ......_.._--------
page. City/Towwn State Zip Code Date of Inspection
...._.....
.___
D. System Information (cant.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system„ including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below.
® hand-sketch in the area below
drawing attached separately
r
o
t5insp.doc-rev.712612018 Title 5 OfficW Vnspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
4 ,1
i' Tide 5 official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
284 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner Owner's Narne
information is NORTH ANC7OVER MA 01845 SEPTEMBER 30, 2024
required for every _ _
page City/Town State Lp Cade Date of Inspection
. ....... ...... .......... . ._. .... .... ._._ ...._.-.. ....... ..__ _... _... ._.. .._.......- ----------_---- _.......
D. System Information (cant.)
15. Site Exam:
E Check Slope
Z Surface water
71 Check cellar
El 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: EPTERVRBER 1 g34 _
Gate
El Observed site (abutting property/observation hole within 150 feet of SAS)
,nf Checked with local Board of Health - explain:
PLANS ON FILE
Checked with local excavators, installers - (attach documentation)
El 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
M
F« Title 5 Official Inspection Form
' + Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
284 SUMMER STREET
Property Address
STEPHEN SCURINI
Owner Owner's Name _
information is rettnired for every NORTH ANDOVER MA 01845 SEPTEMBER 30, 2024
page City/'town State Zip Code Date of Inspection
_._..... ..... .... .... ...._.. ....-..n__ .._..�............. „_ .. _........... _._... .... „_...._.-
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
A. inspector information: Complete all fields in this section.
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 System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
dRauomp dcv,-rev 7r>EW2018 1.V6fe 5 Off4rrM IrrspectQon Form SrxEnuamfiace Sewage P, spcmaX Systwn*Page 18 of 16
0 Su'prawy Rermd Cird gerwMed w 1912412024 10 19 45 AM by Kw en Hank)n Page I
Town of North Andover
Tax Map # 210-107.A-0225-0000.0
Parcel Id 18060
284 SUMMER STREET
SCURINI, STEPHEN & ROSEMARY
284 SUMMER STREET
NORTH ANDOVER, MA
01846
..........
Class 101 Single Farnily Property Type I Residential
Size Total 1 Acres
FY 2025
. ...............
UB Mailing Index
Name/Address Type Loan Nuawber Ar.flvatinact, From Until
SCUMNI,STEPHEN&ROSEMARY Payer 7cflv(':'1
284 SUMMER STREET
NORTH ANDOVER, MA
01845
UB Account Maint.
Accounthlo Cyde Occupant Narne ActivelInactive
Bldg dd, 14247.0.284 SUMMER STREET' Last Bilhnq Date 915/2024
2100243 02 Cycle 02 Active
UB Services Maint.
Account.No,2100243
Service Code Rate Charge Mulltipher/Osers
MISC FEE FEE 0635/8 7 82 11
W T'R WATER 01 ALL METER SlZE 81.17 111
UB Meter Maintenance
Account No, 2100243
Serial No Status Locatlon Brand 'Type Size YTD Cons
35650483 a Active ER,r HH b Badger w Water 0.625 0.625 292
Date Reading Code Consumption Posted Date Variance
81212024 1355 a Actual 21 9/12/2024 3%
5/212024 1334 a Actual 20 6/1312024 -141%,
2/2/2024 1314 a Actual 24 3114Y2024 24%
11/112023 1290 a Actual 19 12/1312023 -4%
8/212023 1271 a Actual 20 9/18/2023 -8%
5/212023 1251 a Actual 21 6/14/2023 10%
21212023 1230 a Actual 20 3/14Q023 106
111112022 1210 a Actual 17 12/19/2022 16%
8/3/2022 1193 a Actual 15 9120/2022 -18%
5/312022 1178 a Actual 18 6121/2022 -2%
21212022 1160 a Actual 19 31,15/2022 .4%
1111/2021 1141 a Actual 19 1217/2021 -2%
8/4/2021 1122 a Actual 20 9/2112021 -3%
5/4/2021 1102 a Actual 20 6/15/2021 11%
2/4/202 @ 1082 a Actual 19 311612021 1%
11/2/2020 1063 a Actual 18 @ 2116/2020 6%
8/4/2020 1045 a Actual 18 919/2020 -3%
51112020 1027 a Actual 17 6(1 O/2020 20%
2/4/2020 1010 a Actual 15 311612020 -10%
11/412019 995 a Actual 17 12/'2112019 4%
8/212019 978 a Actual 16 9/26/2019 -11%
502019 962 a Actual 17 6113/2019 8%
2/412019 945 a Actual 17 3fl9/2019 11%
11/212018 928 a Actual 15 12112/2018 -18%
8/2/201 8 913 a Actual 18 9120/2018 19%
51312018 895 a Actual 15 6/20/2018 -9%
212/2018 880 a Actual 17 312812018 19%
11/112017 863 a Actual 14 12/29/2017 -17%
8/2120 17 849 a Actual 17 9/2012017 -3%
5/2/2017 832 a Actual 17 6/2612017 31yo