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Home My WebLink About242 Lacy Street - Title 5 Inspection Report - Title V Inspection Report - 242 LACY STREET 12/10/2024 | Commonwealth of Massachusetts "�~~�� Official K Inspection �� Title �� N�� 0*NMk� � D w�� m�� N0��xma� �vu�� ~ �� m��m m Form | Subsurface Sewage Disposal System Form Not for Voluntary Assessments 242La Street -- Property Address Manteiga � owner Owner's Name information is | required for every North Andover MA 01845 Dacomber10 2024 � page. oiN/Tn*o 8ww�� rhuxme bafv4 i nspe66iom�--'-........... ' Inspection results must be submittod on this form. Inspection forms may not be altered in any Please see completenesschecklist atth d ofth form. Important:When A. U��m� U��m��0^�� nmnuou�mm� ^ ^^ Inspector~~ Information ~" "w^ ` uv the computer, use only the tab key mmove your Name m/nypemm ,�� V ~ cursor do not DovvnEaat Title V |nn U LLC unomen$um | key, Company Name PO Box 81 Company Address Rowley MA 01969 City[Town State Zip Code &|13851 Telephono-NumW License Number B. Certification I certify that:1 am a DEP approved system inspector in full compliance with Section 15.340 of Title S (310CK0R 15.00O);| have personally inspected the sewage disposal system atthap address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that theoyabem� 1. 0 Passes 2. Fl Conditionally Passes � / 3. [] Needs Further Evaluation hy the Local Approving Authority . 4. r] Fails � Deuambev10 2024 Inspector'kkignature Date The systern inspector shall submit a copy uf this inspection report bu the Approving Authority (Board � of Health orDEP)within 30 days of completing this inspection. |f the system has m design flow of � 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original form should bosent tn the system owner and copies sent to / the buyer, |f applicable, and the approving authority. , Please note: This report only describes conditions ot the time qf inspection and under the | conditions wY use ut that time. This inspection does not address how the system will perform | in the future under the same mr different conditions ofuse. | wm�doc'"*numw^ Title^umda/mopem~n'wmowoorf"ce Sewage mspose$vystom'Page,of,o / � � ' I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ...`? 242 Lacy Street Property Address Manteiga Owner -...._..._ Owner's Name information is required for every North Andover MA 01845 December 10, 2024 page. Cdyllrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 16,304 exist. Any failure criteria not evaluated are indicated below. Comments; This system meets all criteria for a passing Title V inspection per the guidelines set forth in CMR 15.303 2) System Conditionally Passes: ❑ One or more system components as described in the"ConditionalPass"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): i5insp.ft, rev.712612018 Tole 5 Official Inspection Form:Subsurface Sewage Disposal Syslem Page 2 of 18 Commonwealth of Massachusetts _ = Title Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 242 Lacy Street Property Address ' Manteiga Own _ Owner -er'_-_s -- Name—- -- Own information is North Andover MA 01845 December 10 2024 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cunt.) 2) System Conditionally Passes (cont.): ❑ 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 ON ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ON ❑ 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 ON ❑ 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: t5fnsp.doc•rev.7126=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts °�'°��0 �� Official � Inspection �� Ti tic N��N�� %��~ N�� 0~N�� 8 m�0�� /HHmw�o�m� �mm*~ � �~ ��~��~ m��wm ��mwww Subsurface Sewage Disposal System Form' Not for Voluntary Assessments 242Lm Street Property Address -- Mantei Owner Owner's Name Information is required for every North Andover MA 01949 December �O24 Page. City/Town own � -- Zip Code C. Inspection Summary (cont.) L] Cesspool or privy io within 50 feet nfn 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 (and Public Water Supplier, ifany) determines that the system is functioning in m manner that protects the public health, safety and environment: ElThe system has a septic tank and soil absorption system (8A8) and the SAS iowithin 10O feet ofa surface water supply ur tributary kza surface water supply. LJThe system has septic tank and SAS and the 8/\S is within a Zone i of public water supply. � E]The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ElThe system has a septic tank and SAS and the SAS in less than 10U feet but 5U feet nr more from m private water supply weU^* Method used to determine distance: � —_�_-___-___'------- This system passes|f the well water analysis, per-formed ataDEP 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 bo attached hn this form. � o. Other: 4) System Pwi|uno Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No | / �l �� Backup of sewage into�ci|dvor system component due touvedoadednr �~ �~ clogged SAS orcesspool El �� Discharge or9nndingofofUuonthz the nu�omaof the ground ornu�aoowaters ^~ �~ due toon overloaded ur clogged SAS urcesspoolt5insp.doc-rev 7126/20118 Tille 5 Official Inspection Form:Subsuffaco Sewage Disposal System-Pago 4 of 18 | � Commonwealth of Massachusetts ��U�� J��X��"��N Q��°��°�� 8~M�� | NH�� °�� mB Inspection N—��" =� " Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 242 Lacy Street Mantelga owner Owner's Name information is required for every North Andover �� MA 01845 December 10 2024 page. u�lnwn awm Zip Code Date v/Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable hnAll Systems: (cont.) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded ^~ �~ or clogged SAS orcesspool �l �� Liquid depth in cesspool is less than 8" he|ovvinvedor available volume ieless | | �� than }6 day flow | Fl �� Required pumping n1onmthan 4Umesin the |mo clogged i^~ �� obstructed pipa(a). Number of times pumped: _____. / El 0 Any portion of the SAS, cesspool or privy |m below high ground water elevation, � ! F� �� Any pod�nmJ cesspool orpr�y �w�hin1UU feet ofoour�cawo�raupp�nr | ^� ~� tributary huo surface water supply. | �� Any pnrUnnofm cesspool orpdvy |a within a Zone 1ofo public water aupp� | �� well, El N Any portion of a cesspool or privy is within 50 feet of a private water supply well, El X 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 iy the well water analysis, performed m6aDEPcertified laboratory,for fecal coUform bacteria indicates absent and the presence | | mf ammonia nitrogen and nitrate nitrogen ia equal top,less than Gppnn' � provided that no other failure criteria are triggered. A copy of the analysis | and chain of custody must ha attached to this fonn.1 F� �� Thaoymtemisecasapoo| oamingafaoi|ih/vvithodeniQnOnvvof20UUgpd- ^~ �� 1O.000gpd. �� The system fails. | have determined that one or more nf the above foUuro ^� �~ criteria exist as described in 310 CMR 15.303, therefore the system falls. The system owner should contact the Board of Health to determine what will be | | necessary to correct the failure. 5) Large Syobmmno:Tm he considered a large wywdwnm the system must serve m facility with m design | flow of10'0p0 gpdto15`O0Ogp6. � � For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the � questions in Section CA. � Yea No [l 11 the system |a within 40U feet ofa surface drinking water supply � El R the system is within 20O feet ofo tributary tpa surface drinking water supply � �l F� the system is located in o nitrogen sensitive area (Interim Wellhead Protection � �~ ^~ Area—|VVPA) oro mapped Zone || ofm public water supply well . 16m.po='"w.7126f2018 rm"o Official Inspection Form:o"osumce Sewage ospo^"/System'mn owm | ' Commonwealth of Massachusetts _ Title Official Inspection Form — Subsurface Sewage Disposal System Form _Not for Voluntary Assessments cam/ 242 Lacy Street Property Address Manteiga Owner Owner's Name information is required for every North Andover MA 01845 December 10, 2024 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threk 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. B. You must indicate"yes" or"no"for each of the following for aff inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑lufA ❑ Were as built plans of the system obtained and examined? (If they were not 1 available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? *f ❑ 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? ® ❑ Wasthe 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. ® ❑ 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)] l5inspAcc•rev.7/2612018 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 C ` Commonwealth of Massachusetts r. p Title f i i I Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2y� 242 Lacy_Street j Property Address Manteiga Owner Owner's Name information is North Andover MA 01845 December 10, 2024 p required for every City/Town/Town w — _ — State Zip Code — Date of Inspection page, Y p ) D. System Information 1. Residential Flow Conditions: { Number of bedrooms(design): NIA Number of bedrooms(actual): Four(4) DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): NIA Description: There is no design plan available. Number of current residents: Two(2) i Does residence have a garbage grinder? ® Yes ❑ No Does residence have a water treatment unit? ® Yes ❑ No If yes, discharges to: Independent discharge through foundation Is laundry on a separate sewage system? (Include laundry system inspection ® Yes ❑ No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Private Well Detail: This property is serviced by a private well The laundry and water treatment discharge to a dry well 30" below grade. There is no ponding over or signs of hydraulic failure in the system. The bottom of the dry well is 63" below the current grade. Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied 15insp.doc•rev.712&2018 Title 5 Ofticiaf Inspection Form:Subsurface Sewage Oispasal System•page 7 of 18 Commonwealth of Massachusetts 90 T Off itle 5 icial Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 242 Lacy Street Property Address Manteiga Owner Owner's Name Information is required for every North Andover MA 01845 December 10, 2024 page, Cityffown 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): Gallons per day(gpd) Basis of design flow(seats/persons/sqft, etc.): Grease trap present? El Yes El No Water treatment unit present? El Yes F1 No If yes, discharges to: Industrial waste holding tank present? El Yes E] No Non-sanitary waste discharged to the Title 5 system? El Yes El No Water meter readings, if available: .......... Last date of occupancyluse: Date Other(describe below): .......... ................ ............. 3. Pumping Records: Source of information: The system was last pumped on February 6, 2023, per the Board of Health pumping records. Was system pumped as part of the inspection? El Yes N No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l6inspAoo-rev.712612G18 Title 5 Official Inspection Form!Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts I, -- Title Official Inspection Form { h Subsurface Sewage Disposal System Form Not for Voluntary Assessments 242 Lacy Street .......... _._.._.....__ _.._._.._._........____ i Property Address Manteiga Owner Owner's Name information is required for every North Andover MA 01845 December 10, 2024 page. Cityrfown State Zip code pate of Inspection D. System Information (cons.) 1 I 4. Type of System: ® Septic tank, distribution box, soil 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 IIA system by system operator under contract ❑ Tight tank. Attach a copy of the DFP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: Per the homeowner, the system was installed in 1979. There is no plan available for this system. F Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 1.83 Depth below grade: feet - _..............__._.m....._......._.... Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): — — Distance from private water supply well or suction line; 25 feet Comments(on condition of joints, venting, evidence of leakage, etc,): The building sewer pipe is in good condition with no evidence of leakage. 15insp,doc rev.712612018 Title 5 Official Inspectlon Form:Sulnurface Sewnge Disposal System•Pago 8 of la ' I Commonwealth of Massachusetts = - Title Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments <t �; 242 Lacy Street Properly Address Manteiga Owner ......__.__.-....- _.�........._.__.. Owner's_N.ame information is North Andover MA 01845 December 10, 2024 required for every page. City/Town State Zip Code Date of inspection D. System Information (cant.) 6. Septic Tank(locate on site plan): Depth below grade: 1.08 --- — 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: 8' L x 4' D 5' W Sludge depth: 6" __._.__..._..... _ __ ..__.._ Distance from top of sludge to bottom of outlet tee or baffle 25" Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? Tape Measure and Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The septic tank is 13" below the current grade. The inlet and outlet baffles are both in place. The liquid level is normal and equals the outlet invert. There is no evidence of leakage and the tank appears to be structurally sound. Pumping is not required per the guidelines in 310 CMR 15.351, Annual pumping is recommended for systems with a domestic garbage grinder. t5insp.doc•rev.70612016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 cry Commonwealth of Massachusetts Title f ci I Inspection Form Subsurface Sewage Disposal System Form _ Not for Voluntary Assessments <1, 242 Lacy Street Property Address Manteiga Owner Owner's Name _------- -_._._ _.-_.............. information is required for every North Andover MA 01845 December 10, 2024 - - ' page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 7, Grease Trap (locate on site plan): Depth below grade: feet 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 i 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 ❑ other(explain); Dimensions: ___.__..__._ __._..............___.... Capacity: gallons Design Flow: gallons per day t6insp.doc•rev.7/2612018 7iUe 5 Otriclal Inspection Form:Subsurface,Sewage Msposal System-Page 11 of 16 I Commonwealth of Massachusefts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 242 Lacy Street Property Address Manteiga _ Owner Owner's Name information is required for every North Andover MA 01845 December 10, 202_4 ......._.... page, Cityl-rown State Zip Code Date of Inspection D. System Information (cost.) 8, Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: -- - --- Alarm in working order: ❑ Yes ❑ No I 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 9. Distribution Box(if present must be opened)(locate on site plan): OR 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.): The distribution box(D-box) is 19" below the current grade and measures 20" x 20". The liquid level is normal and equals the outlet inverts. There is evidence of solids carryover and some corrosion. The distribution is equal between the four(4) lines leaving. The depth to the outlet inverts is 27". There is no evidence of leakage or infiltration and the D-box appears to be structurally sound. 15insp.doc-rev.7I26f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 112 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments f ;l 242 Lacy Street Property Address �� -- Manteiga _ Owner __. .......�.. _... ......._ ...._....- _..........__.— Owner's Name information is required for every North Andover_ MA 01845 December 10, 2024 _-.— ..__._...... - ... ._ _......, page. CitylTown State Zip Code Date of Inspection D. System Information (coat.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ Noy` 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: i Type: ❑ leaching pits number: ❑ leaching chambers number: - ❑ leaching galleries number: _......_.___.....__ ❑ leaching trenches number, length: ® leaching fields number, dimensions: One (1) @25'x 40' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.dor.-rev.7/26/2018 Title 6 Officlal Inspection Form:Subsurlaco Sowaga Dispasal Syslem-Page 13 of 18 Commonwealth of Massachusetts Title Official Inspection Form -- . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 242 Lacy Street 1� Property Address Manteiga Owner Owner's Name ---..._.._.._ information is North Andover MA 01845 December 10, 2024 required for every T. �...�.._..___ .�.._.— page. City/Town State Zip Gode Date of Inspection D. System Information (cant.) 11. Soil Absorption System (SAS) (coat.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There is no ponding over or signs of hydraulic failure within the SAS. The vegetation is consistent with the surrounding area. When a camera inspection was performed, there was evidence of solids carryover observed. There is no standing water in the lines. The bottom of the SAS is 33" below the current grade. There is no evidence of interfacing between the water table and the bottom of the SAS. 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.): l5insp,(too•rev.712BY2018 Title 5 Official Inspection Form:Subsurface Setivage Disposal System•Page 14 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 242 Lacy Street Property Address Manteiga _ Owner Owner's Name information is h Ando ver MA 01845 December 10, required for every — 2024 page, City/Town State Zip Code Date of Inspection D. System Information (cost.) 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.): i t5insp,doc•rev,712W2018 Title 5 Official Inspection Form!Subsurface Sewage Olsposal System•Page 15 of 18 Commonwealth wealth of Massachusetts r ; _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments f 242 Lacy Street Property Andress Manteiga Owner Owner's Name --- __ information is North Andover MA 01845 December 10 2024 required for every _. _ _ � v_ page. CitylTown Slate Zip Code Date of Inspection D. System Information (cons) 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 i NO ScAL E Ai = +�' f31 : g-7 C3: 3p' D3: 5q' e l3Lo ,�• A Q L_ ACY STREET t5insp.doc rev,712612016 Title 5 Official Inspection Form:SvbsurWe Sewage Disposal System•Page 16 of 10 Commonwealth of Massachusetts y y Title 5 OfficialInspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments car 242 Lacy Street Property Address Manteiga Owner Owner's Name__..._.......� _.....___w. _ information is required for every North Andover MA 01845 December 10 2024 _.._._.__.._ .. ' page. City/Town State Zip Code Date of Inspeclion D. System Information (cunt.) 15. Site Exam: i ® Check Slope ® Surface water ® Check cellar Q ® Shallow wells > 6' Estimated depth to high ground water: feat Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date------ --.__......_-._._......._.._..-.._ ❑ Observed site (abutting propertylobservation hole within 150 feet of SAS) ❑ 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: Map Number 37 of the USDA, Soil Conservation, Soil Survey of Essex County, Massachusetts, Northern Part identifies the soil in this area as Canton. This soil is somewhat excessively drained with a seasonal high ground water greater than 6'. The cellar is dry with no sump pump. During the inspection there was no surface water observed and the property sloped down away from the dwelling towards the road. There were no soil logs within 150' of 242 Lacy Street available at the time of this inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15insp,doc rev.7126/2018 Title 5 Official inspeelion Form:Subsurface Sewage Disposal System Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 242 Lacy Street Property Address Manteiga Owner Owner's Name information is required for every North Andover MA 01845 December 10, 2024 page, City/Town State Zip Code Date of inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. 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 t5insp.doc-rev,7126/2018 Tills 5 Official Inspeclion Form:Subsurface Sewage Disposal System-Pago 18 of 18