HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 193 GRAY STREET 10/11/2024 Commonwealth of Massachusetts
Title 5 Official Inspection orm
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
�p
i5iBRAY STREET
Prrxperty Address
SCOTT TWADELLE
Ownerinf C7wner's Name
required
is NORTH ANDOVER MA 01845 SEPTEMBER 16, 2024
required for every ._.w.,_w.m _. ._..._.._.. __ ..... ..__ __..... _............ ...... _........_. "Zip'
.__........ ... . ......._._. . .. ..
pule. _....___ to a i bode Date of Inspection
Crt f C cswrn._...._.,. . _. _ 'State.._...._ p _ ......
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.
- ......................._.. _.M.m.__ ........ .......__ _.. __ ....._,_ _........_ _....... _.._..—_M.�_.._ ___..
Important:Men A
filling out forms . Inspector Information
on the computer,
use only the tab Todd James Bateson
key to moire your Name of Inspector
cursor-do not Bateson Enterprises Inc
else the return _ _ _ _ _... .......... ..... ..___ __. _. _.__.. __ .._ _....
company Name
key.wo
Liu 111 Ar II1a Road
Company Address
Andover MA 01810
-.- Cityf own State Zip oode
978-475-4786 I-16
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 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. El Passes
2. Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. Fails
rEPTEMBER 19, 2024
ins or"s 5lgnat a 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
10,00'0 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,
t xinsp dac-rev,7/28/2Q1B TPW 5 Official Inspection Farm:Sutrsurdaces Sewage Disposal Systorn•Page t of'98
Commonwealth at Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
s � 193 GRAY STREET
Property Address
aCOTT TWADEI..I..E
Owner Owners Name
information us NORTH ANDOVER MA 01845 SEPTEMBER 16„ 2024
required 6r�r every
Page. dity/Town State Zip Code Coate 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 316 CMR 15.334 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
deterr'nined„" 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 infiltratlon or exfiltration or tank failure is imminent. System wN 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):
6 nnsp doc.-E'ov M6P2,018 1160'b OffiClal iPlht(R4o;duCM F`cYi' I &Jbsur face Sewage C)*posal System•Page 2 cuff'18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
193 GRAY STREET
Oraperty'Address
SCOTT TWADELLE
Owner Owner's Name
irr�tt'r fa requ¢edi fo ir every NORTH ANDOVER MA 01t34� SEPTEMBER 16, 2024
. . . �....
taa.e. C ity/Town State Zip Code Cate of Inspection
C. Inspection Summary (coot.)
2) System Conditionally Passes (cant.):
[ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired,
Z 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 0 Y F] N [] ND (Explain below).
obstruction is removed Q Y 0 N 0 ND (Explain below):
Z distribution box is leveled or replaced Z Y M N 7 ND (Explain below):
D-BOX IS LEAKING AND NEEDS REPLACED
[ The systern required pumping more thane times a year due to broken or obstructed pipe(s), The
system will pass inspection if(with approval of the Board of Health):
L-1 broken pipe(s) are replaced D Y E N E] ND (Explain below):
f obstruction is removed Y E] N E] ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
F1 Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is falling 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:
t5nspr_doc rev ( s 2018 1`[tie 5 CY rc,al Irtspe ctia.on fl'""e rin aarE'asuface Sewage Dt sposai system-Page 3erf 18
Commonwealth of Massachusetts
� 14 Title 5 Official Inspection Form
i�F subsurface Sewage Disposal System Form - Not for Voluntary Assessments
193 GRAY STREET
Property Address
SCOTT TWADELLE
Owner Owner's Name
informatred O
on is
required NORTH ANDOVER MA 01845 SEPTEMBER 16, 2024
page for every _ _ ....._._ ... . ....._ .
CityrFow n State Zip Cade gate of Inspection
C. Inspection Summary (cone.)
Cesspool or privy is within 50 feet of a surface water
Q_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fall 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.
F1 The systern has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
[I 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 porn, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
d) 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
t5n, ,pr Srxc=rnv 71 6/.70J 8 1"(0e 5 Offlcra(hisp"tcCr n!�on n Su suu 8ace Sewage Lbrsposa� SyMern•Page 4 of 18
Commonwealth of Massachusetts
r ,f Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
' 103 GRAB" STREET
Property Address
SCOTT TWADFLLE
Owner Owner's Name
tequired for
Rs NORTH ANDOVEwR MA 01645 SEWPTE�MBER 16, 2024
I'ecll�ired for every
page, City/town state Zfp code Gate of In
C. Inspection Summary (cant.)
4) System Failure Criteria Applicable to All Systems: (cant.)
Yes No
Static liquid Vevey in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El z Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1r°2 day flow
Required pumping more than 4 times in the last year NOT due to clogged or
'f obstructed pipe(s). Number of times pumped: _
El 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
m tributary to a surface water supply.
-1 m Any portion of a cesspool or privy is within a Zone 'I of a public water supply
well.
D z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
._,.� 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 farm.]
El Z The system is a cesspool searing a facility with a design flow of 2000 gpd-
10,000 gpd.
The sy
stem 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.
) urge 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
El 1-1 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area
-- IWPA) or a mapped Zone 11 of a public water supply well
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Commonwealth of Massachusetts
a Tide 5 tffieil I11SeCiCa11 Fo1"t1'1
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
193 GRAY STREET
t�roperry Address
SCOOT TWADELLE
Owner Owners Name
onforniation is
required for every NORTH ANDOV'ER tV1A a1345 SEPTEMBER 16,12024
page, bity own State Zip Code Cate of Inspection
C. Inspection Summary (cant.)
of you have answered "yes"' to any question in Section C.5 the systern 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 roust indicate "yes" or"no" for each of the following for all inspections:
Yes No
Z L1 Pumping information was provided by the owner, occupant" or Board of Health
E Z Were any of the system components pumped out in the previous two weeks?
Z Ej Has the system received normal flows in the previous two week period?
0 Z Have large volumes of water been introduced to the system recently or as part of
this inspection?
Z El Were as built plans of the systern 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 E Was the site inspected for signs of break out?
Z [_.__] Were all system components, excluding the SAS, located on site?
Z EJ 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?
Z L Was the facility owner(arid 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.
°_[��_ El 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) [ 10 CMR 15,302(5)1
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
" Subsurface Sewage Disposal System Farm _ Not for Voluntary Assessments
' 103 GRAY STREET
rv,
Property Address
SCOTT TWADELLE
Owner __ ..
owner's Name _ . ... .
information is NORTH ANDOVER MA 01845 SEPTEMBER 16, 2024
required for every . . _ _ .___.._
page. City/Town State Zap Code Date of inspection
D. System Information
1. Residential Flaw Conditions:
Number of bedrooms (design): Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203 (for example 110 gpd x#of bedrooms) 600 GPD
Description,
Number of current residents: 3
Does residence have a garbage grinder? Yes No '
Does residence have a water treatment unit? Yes No
If yes, discharges to. _
Is laundry on a separate sewage system? (Include laundry system inspection E Yes Z No
information in this report.)
Laundry system inspected? Z Yes [w_] No
Seasonal use? [l Yes No
Water meter readings, if available last 2 ears usage d ATTACHED
g ( Y g (gp ))�
Detail'
Sump pump? El Yes Z No
Last date of occupancy: CURRENT
Date
t5insp doc;.rev.7126120/8 'Riffle 5 0tl'7 ce al inspection P::orm SubsWlface Sewage Disposal l System.Pages of 18
< °„ Commonwealth of Massachusetts
1, °A Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
f,
193 GRAY STREET
Property Address
SCOTT TWADELLE
Owner ___ _
Owner's Name _
ifarmatian is NORTH ANDOVER MA 01845 SEPTEMBER 15, 2024
required for every
page. City/Town State 2tq Code Gate of Inspection
_..... ........._.. __w_„__-_. .m..._....._ _. ._.... _......_.._ . .... ._. ._..._.____._ _.._.. _w_........... ..__.w .. . .... __..................._......
D. System Information (cant.)
2. Commerciallindustrial Flow Conditions.
.type of Establishment.
Design flow (based on 310 CMR 15.203): aEians per day(gpd)
Basis of design flow (seatslpersons/sq.ft., etc.):
Grease trap present? (l Yes E] No
Water treatment unit present? 0 Yes E] No
If yes, discharges to;
Industrial waste holding tank present? Yes _ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes F] No
Water meter readings, if available:
Last date of occupancy/use:
"ate
Other(describe below).
3. Pumping records:
Source of information: BATESON ENTERPRISES INC JULY 2024
Was system pumped as part of the inspection? (l Yes No
If yes, volurne pumped;
gallons
Now was quantity pumped determined?
Reason for pumping; _
t insp.We rey.7/20'1tD18 "I'➢e 5 Official Gnspgctiori,Form:Sutrsuffaace Sewage DisposW System.Page 8 of 18
� Commonwealth of Massachusetts
fi =Z7� T tl 5 Official ia1 Inspection n Form
k Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1'
�° . 19 GRAY STREET
Property Address
SCOTT TWADELLE
Owner Owner's Name _ —
information&s
required for every NORTH AND-OVER MA 01,845 SEPTEMBER 16, 2024...
page, City/Town state Zip Dade Date of Inspection
y term Infcrrmati66 (corlt.)
4. Type of System:
I Septic tank„ distribution box, soil absorption systern
E1 Single cesspool
ED Overflow cesspool
El 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:
SYSTEM 38 YEARS INSTALLED DECEMBER 1986 AS BUILT PLAN
Were sewage odors detected when arriving at the site? ] Yes Z No
5. Building Sewer (locate on site plan):
Depth below grade: 191,
feet
Material of construction:
Z cast iron 40 PVCW] 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 OF LEAKAGE
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Commonwealth of Massachusetts
^;
Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
193 GRAY STREET
Property Address
SCOTT TWADELLE
Owner Owner's Name
information Is required for every NORTH ANDOVER MA 0184 SEF'TEMBER 16, 2024
page, btyrrown State Zap Code Date of Inspection _.
D. System Information (cant.)
8. Septic Tank (locate on site plan):
Depth below grade: 6
feet
Material of construction:
,Z concrete 0 metal Ej 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: 1 X - 4
Sludge depth.
Distance from top of sludge to bottom of outlet tee or baffle
Scum thicknessNA
Distance from top of scum to top of outlet tee or baffle _.
Distance from bottom of scum to bottom of outlet tee or baffle _
How were dimensions determined? SLUDGE ,FUDGE 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
CONCRETE INLET BAFFLE OK
PLASTIC OUTLET TEE OK.
TANK OK
NO EVIDENCE OF LEAKAGE
LIQUID LEVELS GOOD
C''3ni p docr,•mv 7/2EW2016 Tit[a 5 Oflie al 4rw.wfwe tion r�rtwnr Subsuila e Siewage D,sposmf Systeemt•Page 10 of 18.
Commonwealth of Massachusetts
Title 5 Official Inspection Farm
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
., 193 GRAY STREET
Property Address
SCOTT TWWADELLE
Owner owner's Name— _
iratlan as required
NORTH ANDOVER MA 01845 SEPTEMBER 16, 2024
required for every _. _.
page City/Town State _. Zip Fade Date of Inspection
_. .._ ...__ee... ...... _. ..._.._w_w _....._.. _ ....._.. __,......__ ........_.. _w...._.
D. System Information (coat.)
7 Grease Trap (locate on site plan):
Depth below grade:
fret
Material of construction:
El concrete d metal Elfiberglass 7 polyethylene Fother(explain).
Dimensions; _._..._ . ..
Scurn thickness _
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle _
Date of last pumping: Cate
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.
El concrete EJ metal („ fiberglass F] poVyethylene (.j other(explain):
Dimensions:
Capacity:
gallons
Design Flow; gallons per day
15,nsp Vic-rev.1126r2018 p ifle 5 Official Insped ion Fom Subsurface SewaS r)ig'rousa�syster"-Page'C i of i s
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
193 (BRAY STREET
Property Address
SCOTT TWADELLE
(:owner bw'ner s Name
Oforrrequired
V�s NORTH ANDOVER MA 01845 SEPTEMBER 16, 2024
rerry�tYred for every _ .. -- --.__-_ ..
page. btyito-wn State Zip Cade Date of Inspection
__,,__ . ........._..__ _._.__._.._._..._. _.._.. ._......._. _...__._........ ....... --------------- w. _.w— __ _.._......._. ..
D. System Information (cant.)
8. Tight or Holding Tank (cant.)
Alarm present: El Yes [I No
Alarm level, Alarm in working order: ] Yes [ No
Date of last pumping:
Gate
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? El Yes ❑ No
g. Distribution Box (if present must be opened) (locate on site plan).
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.).
DISTRIBUTION IS NOT LEVEL OR EQUAL
D-BOX IS LEAKING AND NEEDS REPLACED
HEAVY EVIDENCE OF SOLIDS CARRYOVER
EVIDENCE OF LEAKAGE
- -------
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
193 CLAY STREET
Property Address
SCOTT TWADELL
Owner
Owner's Name
information is required for every NORTH ANDOVER MA 01645 SEPTEMBER 16, 2024
.... ._..
page. Cuty/Town Mate Zip ;ode Date of Inspection
_,_,_ _ . .... _ __.....w.._...... .. .....__.... ,_.._...,.w _ . ......_...._.....,
D. System Information (coot.)
19. Pump Chamber(locate on site plan):
Pumps in working order.: Yes No"
Alarms in working order; 0 Yes ❑ Nok
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.);
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):.
If SAS not located, explain why:
Type:
leaching pits number:
leaching chambers number:
leaching galleries number;
Beaching trenches number, length: 50" LONG
El leaching fields number, dimensions:
overflow cesspool number.
(� innovative/alternative system
Type/name of technology:
t5lw p doc rov 712&201' 1 iUea P'i"7mciai inspection Form Subssurfaco Sewage C?mr oral System•Page 13 of'18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Fd Subsurface Sewage Disposal Systems Form - Not for Voluntary Assessments
` ,. 193 GRAY STREET
Property Addrdss
SC(OTT TWADELLE
(Owner ..
(Owrner s Narrrelrifor
required
is NORTH ANDtOVER MA 01845 SEPTEMBER 15, 2024
required for every _,..
page, Cltyfrown State Zip Code Date of Inspection
D. System Information (cont.)
11, Soil Absorption System (SAS) (cant.)
Comments (note condition of sail!, signs of hydraulic failure, level of panding, darnp sail, condition of
vegetation, etc.):
SOIL. AND VEGETATION GOOD
NO SIGN OF HYDRAULIC FAILURE OR P ONDING
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 panding, condition of vegetation,
etc.):
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Commonwealth of Massachusetts
yy Iw� Tide 5 Official Inspection Form
i- Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
193 GRAY STREET
Property Address
SCOTT TWADELLE
Owner bw'ner"s Name
inforrequired
is NORTH ANDOVER MA 01845 SEPTEMBER 16, 2024
required far every
page, CIty/"ow n ;state Zip Code gate of Inspection
v __._ ....._._ .. _.._ _. _.__...... __...._... _...
D. System Information (cone.)
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
Title 5 Off"I i l Inspection Form
N Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
19 GRAY STREET
_..
Property Address
SC(OTT TWADELLE
Owner C)wartr r"s rJarre
required for is NfORTH ANDOVE_R MA 01645 SE�PTE�MBE�R 16, 2024
requiredfor every _ .... �._.....___,.._ ..._. . �. .....____ _ __. ___ ...... w..___...... ..._..
page Cityrrown State Zip Code Date of Inspection
D. Systems 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
House Water Meter
Deck
A to 1 : 1,5` [
A to 2 18 6 1_
A to ro 7°� 4" cpaCic .,.
A to D-t ux �52't£"" ank
3
Hto 1 ,a"60'9"
Fit to 2.-61',7,"
B to:3' =62.Apr"
B to 1`)-box 77'5,"
J
i
...... .. ... ......... _ ..w....... _ _ __....
@°aunspdat rev 7126(2018 0 z'a! r X7, 'S.:419'a';ti Y.r ..u..E, f,
� Commonwealth of Massachusetts
a te* Title 5 Official Inspection Form
11 , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
� p Y Y
,` 193 GRAY STREET
Property Address
SC OTT TWADELLE
Owner __ .... _
Owner's Name
information is
required for every NORTH ANDOVEI MA CI1845 SEPTEMBER 16, 2024 .
pace Cityf i own Skate Zip Cade Date of lnspe0on
D. System Information (cent.)
15 Site Exam:
Check Slope
Z Surface water
Z Check cellar
7 Shallow wells
_._..
Estimated depth to high ground water: Seek
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: AUGUST 14, 195
_.19 — _
Date
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health - explain
Checked with local excavators, installers - (attach dock.xmentation)
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.
ffansp doc»mv."7FIW018 'ntk e 5 C)tlr¢e;me R^,speecficn Form w,UbsuvlB;ce Sewage Dmposou System r ago'87 0 18
Commonwealth of Massachusetts
:µa µ Title 5 Official Inspection Farm
w Subsurface Sewage Disposal System Form Not for Voluntary Assessments
193 GRAY STREET
Property Address
SCOTT TWADELLE
Owner
Owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 16„ 2024
required for every _-_-._. ..
page city/1"owrw Mate ip,Dade Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
Z A. Inspector Information: Complete all fields in this section.
S. Certification: Signed & Gated and 1, 2, 3, or 4 checked
C. Inspection SUrnmary:
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 an pg, 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5msp cloc ra v,'k'f f2015 1,iie"r offic:iat Nnsprartion r'crrrn &Arras Alancm Sewage Msposa l System•Pagem 18 of 18
I rnMOEY R 0"Of d COW go t I WOW d On W60024 8 11 20 A by Kai en 8 sanlon Pope l
Town of North Andover
Tax Mai) # 210-,'10TD-0110-0000.0
Parcel Id '18647
193 GRAY STREET
TWADELLE, SCOTT
193 GRAY STREET
N. ANDOVER, MA
01845
Fy 2025
UB Mailing Index
NarnelAddress Type Loan Number Active/inact. From Until
"MADELLE,SCOTT Payor Active
193 GRAY STREET
N.ANDOVER, MA
01845
UB Account Maint.
AGCOunt No Cycle Occupant Narno Active/Inactivo
Bldg Id, 13741,(:)-193 GRAY STREET Last Bifl4iq Date 8/6/2024
1090419 01 Cycle 0 1 Active
UB Services Maint.
Account Nc. 1090419
Service Code Rate Char5p.) Multipllor/t)w rs
MISCIFEE ADMAN FEE M3 5/8 7,82 1/
VV I'R WATER 01 ALL METER SlZE 441.92 11
UB Meter Maintenance
Account No 1090419
Sorlat No Status Location Brand Typo Size Yro Coils
32634798 a Active 00 to Badger w Water 0.625 0,625 397
Dato Reading Code Consumption Posted Date Variance
7/19/2024 3320 a Actual 86 8/13/2024 609%
4118/2024 3234 a Actual 12 5/13/2024 71%
1118/2024 3222 a Actual 7 2/1,5/2024 -50%
10/19/2023 3215 a Actual 14 11/2112023 -46%
7/20/2023 3201 a Actual 26 8/14/2023 15713)
41M2023 3 175 a Actual 10 5/10/2023 -9%
1118/2023 3165 a Actual 11 2/14/2023 -80%
.10/1912022 3154 a Actual 56 11/9/2022 -36%
7120/2022 3098 a Actual 88 8/16/2022 8 4 6 6/o
4/1912022 3010 as ACtW'il 9 5/12/2022 .22%
1120/2022 3001 a Actual 12 2116/2022 -,16%
10120/202'1 2'989 a ACtUal 14 11/2212021 -40%
'7/22/2021 2975 a Actual 24 8/24/2021 83%
4/2112021 2951 a AcAual 13 5/18/2021 -12%,
,1/20/2021 293'8 a Actual 15 2/2312021 -09%
10/20/2020 2923 a Actual 51 11/12/2020 -53'%
711612020 2872 as Actual 94 8/12/2020 640%
4824/2020 2778 a Actual 15 5/13/2020 27%
111712020 2763 a Actua I 11 21 l 0/2020 -85%
t 0/18/2019 2752 a Actual 71 1211812019 230%
7122/2019 26&1 a Actual 23 8/1312019 105%
4/19/2019 2658 a Actual ll 5/15/2019 -I'i ItIq
1/17/2019 2647 a Actual Q 2/18/2019
IM2/2018 2635 as ACtU@t M 1 Ill 9/2018
7/1912018 2610 as Actmai 53 811512018 418%
4118/20 l 8 2557 a AC(Ual 10 5/17/20l 8 -27%
1/18/2018 2'547 a Actual 14 2120/2018 -5�7%
10/1812017 2533 a Actual 32 11/13/2017 10o
7119/2017 2501 a Actual 28 8/15/20 7 265%
41 19120 17 2473 as Actual 22 5/17/2017 -56%,
M9/2017 2451 a Actuat 51 2116/2017 -41%
1OIM2016 2400 a Actual 84 1111612016 -48%