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Home My WebLink AboutTitle V Inspection Report - PASS - 03/09/2025 r ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form a Not for Voluntary Assessments 89 Gray Street Property Address Decaro Owner — — Owner's Name information is North Andover MA 01845 March 9 2025 required for every -. _-—' _ _._...... ........ page. bkoown State Zip Code Date of Inspection i Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form, Important:When s y filling out forms A. Inspector Informationwn � r on the computer, use only the tab Benjamin "Jamie" Prescott key to move your Name of Inspector - - - cursor do not Down East Title V Inspections, LI-CAR use the return Ivey. Company Name Po sox 81 art, ent rcb Company Address 'Dep t ° Rowley MAga 01969 ` Cityrrown State Zip Code „n (351)444-7672 S113851 Telephone Number License Number I B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 GMR 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. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the local Approving Authority 4. ❑ Fails March 9, 2025 Inspector': :ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note., This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 15insp.doc°rev.7/2 612 0 1 8 Tills 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth Of MaSSaGhUSettS Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form Not for Voluntary Assessments 89 Gray Street Property Addf ass Decaro Owner Owner's Name information is required for every North Andover MA 01845 March 9, 2025 page. CityfTown 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: 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: THIS SYSTEM MEETS ALL CRITERIA FOR A PASSING TITLE V INSPECTION PER THE GUIDELINES FOUND IN 310 CMR 15.303 ......................... ........ ..... 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 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 El N El ND (Explain below): .............. [Sirtsp.dnc-rev.71261201 6 Title 6 Official Inspection Form Subsurface Sewage Disposal System Pogo 2 of 18 Commonwealth of Massachusetts _ � a ' II e _ - 1 - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e.« v 89 Gray Street Property Address — Decaro Owner Owner's Name . information is required for every North Andover MA 01845 March 9s 2025 -.......___ _._....._._ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cons.) 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 Nigh static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): E i i ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health; ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303('l)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: I5insp,doc•rev.712612018 T"Ato 6 Official Inspection Foftn:Subsurface Sewage Disposal System•page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Gray Street Property Address Decaro Owner Owner's Name information is required for every North Andover MA 01846 March 9, 2025 .... ........ ............... page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) F1 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 (and Public Water Supplier, if any) determines that the systern is functioning in a manner that protects the public health, safety and environment: El 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. E] The system has a septic tank and SAS and the SAS is within a Zone I 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 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 pprn, 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: y3s No Backup of sewage into facility or system component due to overloaded or El 0 clogged SAS or cesspool El Discharge or ponding of effluent to the surface of the ground or surface waters E due to an overloaded or clogged SAS or cesspool iblnsp,doc rev.7126/2018 TillabOfficial lnspe&oni:orrn:Subsurface Sewage Disposal Syslarn-Page4ol`16 Commonwealth of Massachusetts Its 5 Official Inspection Form Subsurface Sewage Disposal System Forme Not for Voluntary Assessments 89 Gray Street Property rty Address Decaro Owner Owner's Name information is required for every North Andover MA 01845 March 9, 2025 page. Cilyfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems, (cont.) Yes No El 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2day flow El N Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El 0 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, El M Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. El M Any portion of a cesspool or privy is within 50 feet of a private water supply well. E] 0 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 COIKOrfln bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or loss than 6 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 F1 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. El 0 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 thy;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 El El the system is within 400 feet of a surface drinking water supply EJ E-1 the system is within 200 feet of a tributary to a surface drinking water supply EJJ 11 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 15hsp.doo rev.7126f2018 Tithe 5 Official lupecVon Form Subsurface Sewage Disposal Syslern-Page 5 of 18 Commonwealth of Massachusetts ��°^�H �� Official N Inspection �� Title 0�� * N�� 0��0� @ �U�w �� V�� u��n�� wu�� ~ u �� w�xmu ��muwm Subsurface Sewage Disposal System Form - Not for Vo|unta/yAssessments 8Q8 Street .. '. _�___�-___--_-__ Property Address uooaro Owner -- —�� ------�--------- � information is required for every North Andover �� MA 01845 K8m/oh0 2025 page. m�yr"wn 0vya �w�o*, 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 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 ohoU upgrade the oyotnnn in accordance with 310 CkAR 15.304. The system owner should contact the appropriate regional office of the Department. G. You must indicate "yes" or"no"for each of the following for all inspections: Yes No N El Pumping information was provided by the owner, occupant, or Board of Health Fl 0 Were any of the system components pumped out io the previous two weeks? �� Has \ �� ! F� �� Have large Volumes nf vvaharbeen introduced to the system namonUyoraapmdnf �� this inspection? i / Were oa built plans of the system obtained and examined? (if they were not available note as N/A) N El Was the facility nr dwelling inspected for signs of sewage back up? Was the site inspected for signs nf break out? 9 El 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 ofconstruction, � dimensions, depth of liquid, depth of sludge and depth nfscum? / VV �� l aathe facility ovvnor(and occupants if different knmowno� provided vvith ^~ �~ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) nn the site has been determined based on: K� Fl Existing information. For a plan at Board of | \ �8 El Determined in the�e|d (if any nf the haUuroodhoderelated toPo�Cioatissue � �� approximation of distance io unacceptable) [81UCN1R15.302(5)] i ! � | | � ' mm�u�'m°712612018 mm*Official inspection mrw Subsurface o�"ge Disposal System'Page 6u18 � � Commonwealth of Massachusetts Imp Title 5 Officialion Form ,. a — Subsurface Sewage Disposal System Form -Not far Voluntary Assessments 89 Gray Street Properly Address Decaro Owner Owner's Name information is required for every North Andover MA 01845 March 9 2025 -.._..._........� page. CitylTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): N/A Number of bedrooms (actual): FOUR (4) DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): NIA i Description: THERE IS NO DESIGN FLOW 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: — --._...._._.._......_._.._.___.._...__................._..._......__..___.__--- I 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 ears usage d SEE ATTACHED g { Y g (gP )) REPORT Detail: i Sump pump? ® Yes ❑ No Last date of occupancy: CURRENTLYOCCUPIED t5insp.doo-rev.712612018 Title 5 Official Inspection Form:Subsorlace Sewage Ulsposel System-Pago 7 of 18 Commonwealth of Massachusetts F, ~�~~��N �� Official N Inspection Form � Title N��N�� 0�� D�W�� Q m�Q�� /8 & ��w��8 �" .�� m �� ^��na �� vmm Subsurface Sewage Qimpwmm| Symbuno Form ' Not for Voluntary Assessments ` 99G Street -- ��-- --- ----- --- --Di Owner owne, Owner's Name - -------------'-------------------'---------- information is required for every North Andover MA 01845 N1ovohQ 2025 page. City/Town --- n�� z| Cvu��-- lDate of InspecBon------------- D. System Information /CODf.\ 2. Commercial/Industrial Flow Conditions: Type ofEstablishment: ' ------------- --------'------- Design flow(based on310CK0R1O2O8): Gallons per day(gpd) Basis of design flow(neatm/pnmnns/sqft. ehzj: --------------------'------'-- Grease trap present? Fl Yes El No Water treatment unit present? [] Yes F1 No If yes, discharges to: -------------------- '--------'--------------- Industrial waste holding tank present? El Yea El No Non-sanitary waste discharged to the Title 5system? El Yes El No Water meter readings, if available: -----'-----------'--------------- Lmotdahaof000uponoy/uoa: Date Other(describe below): 3. Pumping Records: THE SYSTEM WAS LAST PUMPED ON Source of|nfonnaUon� � NOVEM8BR 0l2O17 PER THE 8OH F��E______�� Was system pumped as pail nf the inspection? Yes M No |f yes, volume pumped: galions How was quantity pumped determined? — -- ReosonhorpumpinQ: mm"v'mn'rev.'/2wmw Tire^u1 Inspection Form:v"ns.rfac"Sewage i System'Page o./,n � � � Commonwealth of Massachusetts m w w q Inspection Ij; --- I1 �r Subsurface Sewage Disposal System Form q Not for Voluntary Assessments �C•,; .t«�<:•='l 89 Gray street Property Address Decaro Owner Owner's Name information is North Andover MA 01845 March 9, 2025 required for every _...� page, City/Town State Zip Code Date of Inspection D. System Information (cunt) 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 1 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 (i€known) and source of information: THE PLANS FOR THE SYSTEM ARE DATED FEBRUARY 5, 1975. THE SAS WAS REPLACED IN 1989. THE DISTRIBUTION BOX WAS REPLACED IN 2018. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: f e 5 Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet i Comments (on condition of joints, venting, evidence of leakage, etc.): THE BUILDING SEWED PIPE IS IN GOOD CONDITION WITH NO EVIDENCE OF LEAKAGE. 15insp.cdoc•rev.7/2 812 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title Official Inspection Form !_ mm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !� p Y ry 89 Gray Street Property Address Decaro Owner Owner's Name information Is required for every North Andover MA 01845 March 9 2025 _.._.._....__....__ __ page. CttylTown State Zip Code Date of Inspection D. System Information (conk.) 6. Septic Wank (locate on site plan): .5 Depth below grade: - -- feet- Material of construction: j ® 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 8'Lx5'Wx4'D Dimensions: 11, I Sludge depth: _._______. Distance from top of sludge to bottom of outlet tee or baffle 21" 2" Scum thickness 5e Distance from top of scum to top of outlet tee or baffle - -- -- ---- - -........_.._.................................. Distance from bottom of scum to bottom of outlet tee or baffle 15" R 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.): I THE SEPTIC TANK IS 6" BELOW THE CURRENT GRADE. THE INLET BAFFLE AND OUTLET PVC TEE ARE BOTH IN PLACE, THE LIQUID LEVEL IS NORMAL AND EQUALS THE OUTLET INVERT, THERE IS NO EVIDENCE OF LEAKAGE AND THE SEPTIC TANK APPEARS TO BE STRUCTURALLY SOUND. PUMPING IS NOT REQUIRED BASED ON THE GUIDELINES FOUND IN 310 CMR 15.351, ! l5insp.doc•rev.712612016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 89 Gray Street Property Address Decaro Owner Owner's Name information is March 9 226 required -c , 0 e ulred for every North Andover MA 01845 M 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 El metal El fiberglass El polyethylene El other(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: 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.): j 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 El metal [I fiberglass El polyethylene El other(explain): .......... ------- Dimensions: Capacity: -gallons I.1 11 Design Flow: gallons per day UUP.doc rev.r12612018 Tillo 501ficial rnspeclion Fofrn:-Subsuffaca Sawagn Disposal Syslem-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.. : 89 Gray Street Property Address Decaro Owner Owner's Name information is required for every North Andover MA 01845 March 9, 2025 _._... page. CitylTown Stale Zip Code Date of Inspection Da System Information (cont.) i 8. Tight or Molding Wank (coat.) Alarm present: ❑ Yes ❑ 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? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): nir 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 16"x 16". THE LIQUID LEVEL IS NORMAL AND EQUALS THE OUTLET INVERTS. THERE IS NO EVIDENCE OF SOLIDS CARRYOVER AND THE D-BOX APPEARS TO BE STRUCTURALLY SOUND. THERE IS EQUAL DISTRIBUTION BETWEEN THE THREE (3) LINES LEAVING WITH SPEED LEVELERS IN PLACE, THE OUTLET INVERTS ARE 29" BELOW THE CURRENT GRADE. 15insp.doc rev.712612018 Title 5 Olricial Inspection Form'Subsurface Snviage Disposal System Page 12 of 18 '.. Commonwealth of Massar-hmse8ts =�'"��N �� Official N Inspection �� Title ��N�� H�� R�� N �0�� /NUB�� mN Bmu�m � �� u o ��wv�� m��nm ��monn Subsurface Sewage Disposal Systern Form - Not for Voluntary Assessments 89 Gray Street -- Property Address ��----------�—'----------------'----------------------- ueomm Owner Owner's Name ` information is required for every North Andover _ _ KAA 01845 Nlamh9 3825 �� - �� 8�o ��'��--- »aoo. °`r'"w" Date=Inspection D. System Unfmrrnati on (cont.) 10. Pump Chamber(locate nn site pksn): Pumps|n working order: Yes No° Alarms in working order: [l Yes El No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc,): � � ° |f pumps o;alarms are not in working order, uyoteminm conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): |f SAS not located, explain why: Type: leaching pits number: ''"`EE Lj leaching chambers number El leaching galleries number: El leaching trenches number, length: Fl leaching fields number, dimensions: -��—'-------- \ �J overflow cesspool number El innovaUvola|h*roaUveayatem � � Type/name pfhyuhno|uQy- � ffm,p*oo'*°.nz612m,a Title oo1ficu/Inspection p�".Subsurface Sewage oupm"/System^Page m*m 1 Commonwealth of Massachusetts =�"�� "�D N��°�� Title �� /Q �@��mR Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 89 Gray Street -- Property Address -------------- ------------------�� umoam Owner ----- - information Is required for every North Andover MA 01845 Mmn:h0 2025 page. City/Town State zip Code �� D. System Information (cont.) 11. Soil Absorption System (SAS) (nont) Comments (note condition of soil, signs of hydraulic huUuny. level of pond|ng, damp uoU, condition of vegetation, etc.): THERE |SNOPOND|NG OVER DR SIGNS C)F HYDRAULIC FAILURE WITH THE SAS. THE SAS |Q |N THE FRONT YARD AND THE VEGETATION |S CONSISTENT WITH THE REST OFTHE PROPERTY, THE SAS CONSISTS OF THREE (3) SHALLOW LEACHING PITS, THERE WAS NO STANDING WATER |N THE PITS WHEN INSPECTED WITH A CAMERA. THERE |GN{} EVIDENCE OF INTERFACING BETWEEN THE BOTTOM OF THE SAS AND GROUND WATER. THE BOTTOM 0F THE SAS |653" BELOW THE CURRENT GRADE, ' -- ��.......... 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 ofcesspool K8wUer|a|o of construction --- Indication of groundwater inflow El Yes El No Comments(note condition of soil, signs of hydraulic hui|uva. |ovo| of pnnding, condition of vegetation, *to]: nu�000`rev.rs°m"o Title vomu81uspecoon Form:submffa" Sewage uIs*os" System'Page,"w," Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form Not for Voluntary Assessments 89 Gray Street .............. Property Address Decaro Owner Owner's Name information is required for every North Andover MA 01845 March 9, 2025 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): .. ........................... 15[nsp doc•rev.712612018 Tilla 5 Official inspection Form:Subsurface Sewage disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 89 Gray Street Decaro Owner Owner's Na-me --, information is required for every North Andover MA 01845 March 9, 2026 page. cityrrown ion D. System Information (cont.) 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 E] drawing attached separately NO ��CALC A 17, �r A Y 151risp.cloo rev.7/26120M Title 5 OfficiaF Impaction Fenn:Subsurface Sewage Disposal Systent-page 16 or 18 Commonwealth of Massachusetts =N�"�8 8� Official N Inspection �� Title ��U�� Q�� N�� / 0 v�U�� q��8 ��m�� nm�� nv �� m�� Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89Gra Street pm�nAdums Demam nvo°, Owner's Name information is =«oire«for every North Andover MA_ 01845 PWaroh8 3025 PaU*� state �p7o��--- Date of inspection D. System Information (cont.) 15. Site Exam: Check Slope Surface water Check cellar Shallow wells E��|mahyUdepth tu high ground wmhpc feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans nnrecord FEBFlUARY5 1075 |f checked, date of design plan reviewed: Date 0boanxad site (abutting property/observation hole within 160 feet ofSAS) �l Checked with local Board of Health -explain: Checked with local excavators, installers (attach documentation) Fl Accessed USGS database 'explain: �� You must describe how you established the high ground water elevation: SOIL TESTING WAS PERFORMED ONAPR|L28. 1Q748YJ()SEPHJ. 8AR8A8ALLOWITH GROUND WATER AJA6". SOIL TESTING WAS ALSO PERFORMED AJ7Q GRAY STREET UN APR|L2Q. 1874 WITH GROUND WATER AT78" SOIL TESTING WAS PERFORMED ONJUNE24. 1SQ8ATQ0 GRAY STREET. 0P-1 WAS DUG AND OBSERVED T0A DEPTH OF98"WITH NO GROUNDWATER OBSERVED AND 0P'2 WAS DUG AND OBSERVED T0A DEPTH OF102" WITH NO GROUND WATER OBSERVED. AT THE TIME OF THE INSPECTION THERE WERE NO SHALLOW WELLS 0R SURFACE WATER ENCOUNTERED. THE CELLAR WAS DRY WITH A SUMP PUMP PRESENT. THE GRADE DROPS AVVAT FROM THE DWELLING, � Before filing this |nm9*ct|qn Report, please see Report Completeness Checklist on next page. � ` mm�o='rev.nzwumo Title^vm*slmsp.m. Form:Subsufface Sewage nmposa�System'Page,,of,o Commonwealth of Massachusetts W .-V Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessment s 89 Gray Street Property Address Decaro Owner Owner's Name information is required for every North Andover MA 01846 March 9, 2025 page. CityrTown State Zip Code Date of Inspection E. Report Completeness Cheiukfist 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 15insp.doc rev.7126/2018 Tille 5 Official lnspecfion Form:Subsurface Sewage Disposal Syslam•Page 18 of 18 I'mvi cit' North Arldover TAx Map U, 210-107,D-0030-0000,0 B9 GRAY STE E FT is GORDON, DM Sitice Jan 2008 00 ORAY STRFET WORTRANDOWR MA 0184K C. 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