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HomeMy WebLinkAboutPASS - Title V Inspection Report - 93 CRICKET LANE 6/4/2025 Commonwealth of Massachusetts TM n Title 5 Off Inspection Foft* 111 Subsurface sewage Disposal system Form ,Not for Voluntary Assessments ' 13 Cf(Cel(t,�t _L41 Property Address y Owner ifortio Is owner's Name mm.�m...�.... .. JV req u I red for every page. City/Town state Zip Code.._ Date of Inspection Inspection results must be submitted on this form. Inspection forms'may not e way. Please see completeness b sire in any p ness checklist et the end of the form. Iportain#;When Inspector filling out forms A. Information on the computer, use only the tab � �� 8 Or A C?,tK key to move your Name of Inspector cursor-do not Bo� �� � � � use the re(urn _ `„ '� 000- I ey. Cora any Na e ImCo an Address = TY it ff own State/-, 1 7 1/- '6%D:3 dip bode Telephone Number License Number B. Certification 1 certify that: I am a DEP approved system inspector in full eom i�arree with Section ` o Cl � '� ; 1 have ersonalI i '� � of`�'�t�e nspeoted the sewage disposal system at the propert address listed above; the information reported below is true a p orate and complete s of the time of ray inspection; and the inspection was performed based on ray training and experience in the h proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have e that the system: determined 1. X Passes El Conditionally Passes 3: ❑ Deeds Further Evaluation by the Local Approving Authority . EJ Falls 1 ector's s19natur [gate � The system inspector shall submit a copy of this inspection report to the Approving Authority of health or D within s p� (Board y f completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall ail obrnit the report to the appropriate regional office of the R The original form should be sent to the p 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 an conditions of use at that time under the . This Inspection does not address how the system will perform in the future under the same or different conditions of use. t fnSP.dec•rev.71 B1 018 T1Ue 5 0f i iaii Inspe Uon Forte:8 ubsurfece sewage Disposal System-page I of 18 Commonwealth of Massachusetts Title 5 Official i Inspection Fo ' rm Subs rfa Sewa a Disposal system Form Not for Vol nta .w f ry Assessments /0- 4.iv Property Address X�V%`M JrIU 714 Owner orr�er� a Information Is me requIred for every /,K7 04AP()0 Vcr page. City/Town 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: f l have not found any information which indicates that any of the failure criteria described in 310 CMR 1 . 0 or In 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below, 2) System Conditionally Passes: El one or more system components as described in the "Conditional4 Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, the Board of Health, will ass. as approved y Check the box for"yes,", U oas or„not determined" (Y, N, ND for the following statements. If"not determined," lease explain. The septic tank is metal and over 20 years old*or the septic tank (whether metaunsound ehiit s i y � � l or not) �s structurally u stantial 1nflltration or a filtration or tank failure is Imrn1nenL System will pass inspection if the existing tangy is replaced with a complying Health. septic tare as approved by the hoard of * metal septic tank will pass inspection if it is structurally sound not leaking Compliance indicatingthat the and �f a Certificate of tangy is less than 20 years old is available. E] Y N El ND (Explainbelow): tS insp.doc•rev.7/6/20V# Tide 5 oincial Inspe on Form;Subsursace sewage Disposal Page system. of 18 Commonwealth of Massachusetts Title 5 Offic'ial t Inspection Subsurface Sewage Disposal System Form Not for Voluntary Assessments esents 3 r ' , OL tA/ Property Address j� .(A,%� -;:� uvr� r , r� oar' Name rrrforatro � required for eve ry At-40VT page. Cltyffown StateZip Code Date of In e #pan C. Inspection Summary (cont.) 2) System conditionally 'asses (cont.): El Pomp Chamber pumps/alarms not operational. S s y terry will pass with Board Health i Pumps/alarmsapproval � are repaired. El Observation of sewage backup or break out or high static voter level in the distribution box die to broken or obstructed pipe(s)or duo to a broken, settled o uneven distribution Pass inspection if(with approval of Bo box. System will pp and f Health : [J broken pipe(s) are replaced El Y EJ N ND (Explain helot : El obstruction is removed El Y El NEI N plan below): El distribution box is leveled or replaced El Y El NEIND (Explain below) : El The system required pumping more than 4 times a will ass ins year die to broken or obstructed pip . �' system p Inspection if(with approval o the Board of Health): El broken pipe(s)are replaced El Y El N Ej N plain bloc ; EJ obstruction is remove EJ Y Ej N El N plain pow : 3) Further Evaluation is Required by the Board of Health' El Conditions exist which require farther evaluation the i t stern is failingto � Board of Health � order to determine � protect public health, safety or the environment. a* System will pass unless Board of Health determines in accordance i '� o 'l thatthe story Is not f with 'l cl functioning In a r a nerwl�ioh will protect public health, safety and the environment: 151nsp.do •rev.7rr018 TItle 6 orrdar ins ec#lon Form:subs Commonwealth of Massachusetts T"t1e 5 Off' iciwal Inspection For Subsurface Sewage Disposal system Form Not for Voluntary Assessments 13 Cjr�ckc/L, of , rrty-A'ddress . t tj F (eA informationOwne s N required for every AJ (I ef page. City/Town Ca Inspection Summary (cont. 11 Cesspool or priory Is within 0 feet of a surface water El Cesspool or priory is within 50 feet of a bordering vegetated ate etlan or a salt marsh b, system will fail unless the Board of Health (and Public Water Supplier, if are y) determines that the system Is functioning In a manner that protects the public health, safety and environment: El The system has a septic tank and soil absorption stem (SAS)pand the SAS is within 100 feet of a surface water supply or tributary to a surface water su p pl y, [1 The system has a septic tank and SAS and the SAS is within Zone 1 of public water supply. 0 The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. El 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's*. Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified labor colifor bacteria indicatesabsent a thelaboratory, for focal presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pion, provided that no other failure criteria are triggered. A co of the analysis be attacet to this form. py must 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 E Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El El Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5In sp.doc rear.71261201 a Title 6 Offf0a]In specdon Form;8 ubsurtoce Sewaga Disposal SysteM•Paga 4 of 18 �LN Commonwealth of Massachusetts NJ T*tle 5 Off'I ic'a il Inspectaion Form Subsurface sewage Wsposal System Foam Not for Voluntary Assessments Cr� � Property Address le--c-LA Owner Owner's Name Information Is required for every - 0 to Re. Qtyffown State ZIP Code Date of fnsptie C. inspectio Summary � n�� rl 4) System Failure Criteria Applicable to All systems: Cont. Yes No E] 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 e is less than %day flag E] Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes . Number of tunes aped: . El Any portion of the SAS, cesspool or privy is below l w high ground water elevation. E] Any portion of cesspool or privy is within 100 feet of a surface water supply r tributary to a surface water supply. P E Any portion of a cesspool or privy is within a Zone I of a public grater supply well. Any portion of a cesspool or privyis itprivate ��n o feet f a water supply well Any portion of a ce s s pool or privy t' less than 100 feet but greater than 50 feet from a private water-supply well with no acceptable water quality analysis. [This stern asses if the y well water'analysis, performed of a D P certified laboratory, for fecal collform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen � r� i equal to or less than 5 1 , provided that no other fail re criteria are triggered. A copy oft the analysis and chain of custody gust be attached to this form. The system is a cesspool.serving a foilly with a design flow of 2000 d- 1 o,000 pd. p El The system. I have determined that one or more of the above failure 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 wilt be necessary to correct the failure. 6 Large Systems: To be considered a large system the sYstem must r facility design flow f'� o to serve a fae���ty with gp 15, pd. For large systems, you must indicate either"yes"or"no" to each of the following, in ad questions in Section CA. addition to the Yes No 1:1 El the system is within 400 feet of a surface drinking water supply El El the system is within 20 feet of a tributaryto 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 t5lnsp,do +reV.7/261201a T1Ue 6 O#fidal InsPviGilon Form: ubsurrace Sawage DI spas aI Systeni.1 Papa s of 18 i Commonwealth of Massachusetts Title 5 1 W Official 'ion Form y Subsurface Sewage Disposal System Farm Not for Voluntary Assessments Propel Adress Owner Owners Name information is required for every r ............ .............. page. NtylTown state ip Coda Date of Inspection C, Inspection summary (cons.) If you have answered 94yes" to any question in Section C.5 the system is considered a significant threat, or answered J6yes"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 C.4 shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. . You must Indicate "yes" or"no" for each of the following for all Inspections: Yes No 11 )K Pumping information was provided by the owner, occupant, or Board of Health E Were any of the system components pumped out in the previous two weeps? Al Has the system received normal flows in the previous two weekperiod? E] Have lama volumes of water been introduced to the system recently or as part of this inspection's El Were as built plans of the system obtained and examined' If they were not available note as N/A El Was the facility or dwelling inspected for signs of sewage back up ❑ Was the site inspected for signs of break out? N D 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? Was the facility owner(arid occupants if different from owner) provided with information n 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- le,For ex ple, a plan at the Board of Health. eteriined in the field if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [ 1 o CMR 15.302(5)] 151nsp.doc-rev.W26/20i8 'i ue 5 official insper{lon Form:Subsurface Sewage NSP0581 SYSteM•PagO 6 0f 18 I I Commonwealth of Massachusetts Title 5 Official Subsurface x Sewage Disposal System Form Not for Voluntary Assessments Property Address LFlotA0 A Owner Owner's Nerve information is required for ever N7 N0ovcr 0/svr 2T page. City[Town tetra Zip Code Date of Inspection R, System Information 1 ResIdential Flow c ndifl ns: Number of bedrooms (design): � Number of bedrooms (actual).. DESIGN flow based on 310 CMR 15.203 example: '� f bedrooms): Description: tion: �ko c.4-tj -2 t , Number of current residents; Does residence have e garbage grinder's El Yes to Does residence have a grater treatment unit? Yes No If fires, discharges to; Is laundry on a separate sewage system? (Include laundrysystem inspection information are this report.) Yes o Laundry system inspected? Yes No Seasonal use? El Yes No Water meter readings, if available (last 2 years usage (gpd)): beta i Sump dump? El Yes N Last date of occupancy. C wrc Date �� ............ t5 Insp.doc•rev.71 l o1a This 6 Mum Inspectuon Form:subsurfate Sewage Disposal System#Page 7 o€1 um=ry Record Ca rdg anorated on 8/1 0 b 3:6 : 8 PM by Nancy Viens Town of North Andover page Tax Map # 210-107.,A,-0285,,0000.0 Parcel Id 18107 3 CRICKET LANE KEVIN & JENNIFER FLUTH 3 CRICKET LANE NORTH T AND V R, MA 01845 Class 10i Single Family Size Total 1.5 Acres Property Type 1 I esi eatlal Y 2025 U ailiIndex Name/Address Type Loan Numbor � VI JENNIFE I*L T'H Owner 1�a#� ellnact� From Unt11 93 CRICKET LANE Active NORTH AHDVR,MA 0146 CROWLEY,TIMOTHY PfeVfous Customer 93 CRICKET LANE Inactive8/22/2005 NORTH AN D VERI MA 01845 UG A UTHRIE PMVI u Customer 93 CRICKET'LANE Inactive 3171208 NORTH ANDOVER, MA 01846 UB.Account Ms I t. Account No cycle Occupant Name Bldg Id. 13 6 .0-9 CRICKET'LANE last�#Illy Date Active/Inactive 2100712 2 Cycle 02 131202 AtlVe Services Mail Account No.2100712 Service Code Pate Char MISC E l tl FEE 11 Multiplier/Users WTR EATER 1 ALL METER SIZE236.95 9.18 � 236.9 ! UB Meter" Maintenance Account No.2100712 Serial No Status Location Bran 1637 960 a Active T METE METE ape i e YTO Cons Date Reading g Cods ►Water 1 1 944 467 Actual 1212026 Consumption Posted gate 1lariace 21 f 2 49 8i42/22 ., o � a tub 67 J�31202 1114 912024 42 1 m annual estimate 67 3 214 2 40% *MSS 1 024 -16% 812/2024 4194 a Actual 67 9112124 6l212 2 4137 a Actual -10% 212/202 4076 a Actual 62 61 312624 3% 111112 23 4913 a Actual 2 3114/2024 4 % 81212023 3968 a Actual 66 2113/2 23 14% 11712023 391 a Actual 41 911812023 µ4 3% A* 4 6/14/2 23 4% 2121223 33 a Actual 31 111412 22 3798 a Actual 65 412023 9% 81312 22 3749 a Actual 49 4 211912022 4% 312022 3701 a Actual 48 9/20/2 22 2% 21212922 3656 a Aclua l 46 6121/2022 -1 % 11/212 21 3603 aActual 62 31 612022 - 4% 814l2021 3544 a Actual 9 12/13/2021 27° 51612021 3497 a Actual 47 9/2112021 13% 214/2021 3466 a Actual 1 6/1612021 .1% 11 3l2920 3413 a Actual 3 314812021 5% 81412020 3373 a Actual 40 12/16/2 20 -50% 51412020 3292 a Actual 1 91912020 12 % 30 811012020 -118% Commonwealth of Massachusetts, T mtle 5 Offic�ial Inspecti"on For ' Subsurface Sewage Disposal System Form -Not for Voluntary As semets _31_CI' Property Address Owner Owner's ... infomiation Is 1% required for every � M 000t /, page. City[Town state ZipCode � Date of Inspection D....System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow{based on 310 CM R 15.20 � Gallons r day pd Basis of design flaw setspersonss .ft., etc.) : Grease trap present's Yes No Water treatment unit present's � Yes El No If yes, discharges to: Industrial waste holding tank present? El Yes 0 No Non-sanitary waste discharged to the Title 5 system` EJ Yes El No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below), 3. Pumping Records: Source of information: Was system pumped as part of the inspection? Yes El No If yes, volume pumped: � gallons l ow was � antity pumped determined? � r�4 ��' Reason for pumping: A&t`* t5 Insp.do o-rev.7/2 61 018 Tare 6 Olwal fns ecxlon Form:Subsurface SaWage D)pmal SySteM•page 8 of j Commonwealth of Massachusetts ~/fey ns ec ion o T'tle 5 � a 7 Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address 1W Owner uv� r' arse ....y Information is required for every �— page. State Zip Code -bate of Inspection D. System Information (cont.) 4. Type of system: Septic tank, distribution tlon box s . oil absorption system Single cesspool El Overflow cesspool Privy Shared system (yes or no) (if yes, attach ' inspection records, •� 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� rator under contract EJ Tight tank. Attach a copy of the DEP approval, Other(describe): Approximate age of all components, date Installed If known and source of information: rnat�on. Were sewage odors detected when arriving at the site's El Yes o Building sewer(locate on site plan); Depth below grade; feet � Material of construction: El cast iron K40 PVC El other(explain): Distance from private water supply well or suction line: � feet Comments n condition of joints, venting, evidence of leakage, etc.) : 4-11 Xoi"V6 01h f P CAP t6In Sp.dao-rev, f S1 018 Me 5 0fi al Inspecuon Form.Sub&urfm sewage oI sposaI spqtem i Pa ge 9 0f 18 Commonwealth f Massachusetts (P T"t1e Official Subsurface Sewage Dis osai System Form -hoot for VoluntaryAssessments Property Address A owner 4-cul\v Information is Owner's required for every � iD .� pa itylTo�vr� State ZipCode Date of Inspection D. System Information (c n * . Septic Tank(locate on site plan). Depth below grade; feet Material ofconstruction: concrete El metal EJ fiberglass EJ polyethylene El other expll•n If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Ej Yoe No If m " 5 Dimensions: � 6' Sludge depth: 5/ Al // Distance from topor baffle of sludge to bottom of outlet tee 3/ Scum thickness of Distance from tOP of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Hour were dimensions determined? � Comments (on pumping recommendations, inlet and outlet tee or baffle condition, liquid levels as related to outlet in evidence n# structural integrity, nee of leakage,e, etc. ; � 1-�- ` t _For Mnsp.do •rear.71 12018 Me 5 officlal Inspecuon FOW Subsurface Sewage Disposal System-Page jo of 1 1 �., Commonwealth of Massachusetts } F? Title 5 Official Inspection For Subsurface sewage Disposal System Form y Not for Voluntary Assessments Cr 4 Property Address Owner Owner's Name Information I � �,� t required for ever ` � page, Cltyffownstate Zip code Date of Inspection D. System Information (cont. . Grease Trap (locate on site plan): Depth below grade; feet Material of construction: concrete El metal fiberglass El polyethylene ❑ other(explain): Dimensions; mti Scum thickness Distance from top of spurn to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comets 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 `dank(tank must be PLI p d at time of inspection) (locate on s1te plan): Depth below grade: Material of construction: [ concrete El metal El fiberglass Ej polyethylene El other(explain),- Dimensions: rapacity: � ..�.. .,�.�... ,.... _ gallons Design Flow: gallons per day ...._ t51nsp.doo•ray.V26/2018 r,tie 0 olncia#In5pealan Fore:8 ubsurrece Eje aga oispo at systom■Page 11 or I i Commonwealth of Massachusetts T"Itle 5 Offo icimal Inspection Form rt Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address X-eve" AA x �n�'C off I'���r --�--�-m ,... ... Information I required for every n J)0 V C page. City/Town State Zip Code Date of Inspection D. System Information (coat. . Tight or Holding Tank (count.) Alarm present: 'des El No Alarm level: Alarm in working order: Yes El No Date of last pumping: Date Comments (condition of alarm and float switches, etc,): *Attach copy of current pumping contract(required). is c attache ; p ' `des No . Distribution Box if present must be opened) (locate on site are ): Depth of liquid level above outlet invert /<Vc�I Comments (note if box is-level and distribution to outlets equal, any evidence of solid evidence f leal age'-int or out of box, e.c.); carryover, r, A/ (�_00A YL4,� t5Josp.doc•rev.71 61 D18 T1Ue 5 offtdaf inspecUOn FofM,Sub ur{are sewage DIsposW 6ystem*Page 12 of I Commonwealth of Massachusetts � +� w fA 1 cisInspection Subsurface Sewage Disposal System FormNot for Voluntary Assessments Crralt 4V Property Address ........ __ Owner nor` Information Is required for every 1p"Wo-AN Cc ev�- page- it own state Zip Code Date of inspection M System Information o, Pump Chamber(locate on site plan): 5 Pumps in working order; 'es El N o* Alarms in goring orator: Yes El No* Comments (rote cond ition of pump chamber, con ditl n of pumps and appurtenances etc, P-tw VN 0 oj Flo q h Ive-rc _P�6v e, /V ' if pumps or alarms are not In working order, system is a conditional pass. 11 i Soli Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: EJ leaching pits number: El leaching chambers number; W� El leaching galleries number: leaching trenches number, length: w leaching fields number, dimensions- over-flow cesspool number.- El innovative/alternative system Type/name f technology: t51nsp.doc r .7/28/201a TItie 5 0Mcial IflSP0C HOn Fenn:Subsurface Sawno DIsposaI system;Pa go 13 of io Commonwealth of Massachusetts I ici'al Inspect" T"tle 5 Off" ion Form Subsurface ewa Disposal system Form Not for Voluntary Assessments ents ` 95 Cr ccd(ut, 1-v Property Address Owner FluA InformationOwner's Io �s , required for every — 1q page. City/Town State Zip Code Date of Inspection D. system Information (cont. 1. Soil Absorption system (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of pondin , damp soil, condition of vegetation, etc,): dr� r' has 13 12. Cesspools (cesspool must be pumped as part of inspection) (locate on siteplan): Number and configuration Depth—top of liquid to inlet invert .� .y Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow Yes ❑ No Comments (note condition of sell: signs of hydraulic failure, level of pondingf condition of vegetation, etc. ; 151nsp.doo-rev.712 61 01a TiVe 5 Offdal InSPOCUOn FOM Subsurface Sewage Disposal syslem•page 14 of 18 i Commonwealth of Massachusetts Title 5 Offi cial inspection For Subsurface Sewage Disposal System Form Not for Voluntary Assessments f PropertyKd-'dress rtvtA Owner o�v�er' e information i required for every 611. ' ?CT" page. CRY/TownD, System Information (cont.) — �` _ � State Zip Code Date of I n"spection . Privy (locate siteplan): Materials of construction: - � Di aosions Depth of solids Comments (note condition of soil, signs o hydraulic failure level o . t po �� or��� �or� of vegetation, { tafnsp.doa•rev.71 1 018 TIUP 6 Off dal In peeUon Form:Subsurface Sewage Disposal System*Page 15of 1� <e, Commonwealth of Massachusetts ici'al T"t1e 5 Off" Inspection For `. Subsurface Sewage Disposal System Ferro Not for Voluntary f Cr C)&,Ik Property Address rOwner 1 information i wr�or' Name required for every � 1md � / �/� _ 6245 page City/Town State Zip Code Date of Inspection D 'System Information (cont. 4. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,, including tires to at be lar�d+rar� eorh a�� , Lena least two permanent reference aI wells within �10 feet. Lo ate wh ere public water s u pp I y enters the building. Cheek one of the boxes below: hand-sketch in the area below drawing attached separately t5insp.da ;rep.T1 61 01$ Tlue 6 0f#ic1a1 Inspacuon Form:subsudace sawa go f]fspesal Sys[ern•Page I s of is x AUGUs N SERVICES INC . • •+� i l - ~# ' I.X 4 ADDITION }. ism CIO PROPOI$ED ��z 0 ilk ROFOSED EROS CHIMNE ION JF 'OD NTROL BARRIER WORK � r -art+„� . } � ••t#`t ,+,` t J ti � � +fir+ � }•� ti } r CAM ,* r' fir AREA t `■ (TO REIAA� .--•- k fry P lop IL D BOX ANN L. REM IN r {. 1 ,5 ` \400 . -LIMIT OF2 4 r X0 .-S (3) %q- ROUNDs -! r/rr�YS{ � � l+la' �� * -ALL NOTE 4) NIP x.9 .S2 J is Y a L'�4 #ti � � �� 14 "=. t''.3� Jrr r'•�'i•J'• w,.i'4},±y `r� PROP*f'�' /'"� i'�y`•�+�i/f� �i�5 rl- �t4• �• der INSPE k. • t�.lr y-�.� �_P_ORTS (TYP�) AREA - j r �6 10 fr• 1 L f `� / � �.f-� �--�• � fry � ..� � { '� 1 r� L 00 * *- , �� # tom. �,Wor • •+{ -311.00 5.8,25. ..; + # �i LANE 0i {A , yr - i f f r i r' { OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM FART C SYSTEM INFORMATION Property Address:'93 Cricket Lane } North Andover. Omer: Guthr* Date octiou: 200 SKE TCH of SEWXGE DISPOSAL S SIN * ` .Pfovide a sketch of the sewage disposal system including ties to at least t wo permanent reference landmarks or benchmarks.Locate all is within 100 feet Lopt where public water supply eaters the building Louse Driveway Water Meter Pump Septic Tin Tank D-L o to Septic Tank--A"" to Pump Tank~ to Septic Tam=Ap C2 2 o Pump Tank to WBOX S ,.. Y t ., Commonwealth of Massachusetts CT d I ci'al' R T"tle 5 Offi Inspection Subsurface Sewage Disposal System Farm lot for veluntar h ess eats x Cr A C.at 40 Property Address -gSv�f, Owner informationowner's Name is -� required for every 7 IIAI�) t r 114h On Y�; &- page. Cif D./Tewrn #it - . y � s �� ode Date of I�nspeetior� coreSystem Information . _ 5. SiteExam: El Check Slope Surface water `Check collar Shallow wells Estimated depth to high ground grater: - 33 feet Please indicate all Methods used to determine the high round • g g water elevation; Obtained from system designplans on record f checked, date of design plan reviewed: ' , Dote 5 Observed site {abutting sere r er# p p aticn bolo within 150 et of SAS El Checked with local Board of Health play : El Checked with local excavators, installers - (attach doumtatln Accessed USGS database -explain: You must describe haw you established the high round water g elevation: *.. CP1V Before filing this Inspection Report, please see Report Completeness Checklist on next page Mnsp.doc•rev.7/2 12018 T]He 5 Official Inspection Form:Subsurface Sewage Disposal SysteW*Page 17 of 1 �C� Commonwealth of Massachusetts A I coial TIns ecti4on Subsurface Sewage Disposal system Ferro -- Not for Voluntary untry Assessments Property Address 1�` It Flvf-4 Owner Information Owner's Name required for every /V: v� cr �� .. page. ity[Tow .. �' ,Zia, State Zip Code Date of Inspection E. Report Completeness Checklist Co lee all applicable sections of this form 'Inclusive of: A. Inspector Information: Complete all fields in this section. � . Certification: Signed & Dated and 1 a 3, orb chocked jz,c. Inspection Summary: 11 2, 3, or 5 completed as appropriate (Failure Criteria)and 6 (Checklist)completed D. 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