The URL can be used to link to this page

Home My WebLink AboutCourtesy Copy-Septic in Boxford - Title V Inspection Report - 128 BRADFORD STREET 9/4/2025 rr rVi Inio . File From,z Jeri Battersby, Health Assistant Date: October 15, 2025 . 12 Bradford Street . Courtesy Copy of Title 5 Official Inspection Form The attached Title 5 Inspection Report dated 9/4/2025 is a'courtesy,colpyreceived from J & S Development/Stewart's Septic Service on 1 /15/25. The septic system is located in Boxford. "Therefore, the permit was pulled and filed with the Town of Bcxfcrd Commonwealth of Massachusetts Town of North Andover T"Itle 5 Offmi'cial Insection Form OCT 15 `2025 Subsurface Sewage Disposal System, Form Not for Voluntary Assessments -N, .......... 1 28 Bradford Street f-", 11.. ......... Property Address ........ c Harwood Scotto Owner Owner's Name information:is req u ired for every No. Andover_..._... MA 01845 09/04,/2025 page. City/Town State Zip Code Date of Inspection 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 A. I nspector Information filling out forms on the computer, Sohn ., DiVince,nzo use only the tab Ivey to move your Name of Inspector cursor-do not �J & S DevelopMenV _Service use the return key. Company Name 58 So. Kimball St. Company Address Bradford MA 01835 City/Town State Zip Code 978-372-7471 S113386 Telephone Number License Number B. Ceftification I certify that: I am a DEPA approved system inspector in full compliance with Section 15.340 of Title 5 (31 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 inspectioni;1 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. 0 Passes, 2. El Conditionally Passes 3. EJ Needs Further Evaluation by the Local Approving Authority 4, EJ Fails ........... 09/04/202,5 ............. I e Act 01�,s S i g n re Date The system inspector shall subm t, copy of this inspection report to the Approving Authority (Board of Health or DE,P) within 30 days of completing this inspection. If the system: has a design flow of 1 0X0 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the D,EP. 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. t5insp,doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System,-Page 1 of 18 Commonwealth of Massachusetts, VIM iciaio Imnsp a T im t I e .5� ff ection Form Subsurface Sewage Disposal System, Form Not for Voluntary Assessments 128 Bradford Street Property Address Harwood, Scott Owner Owner's Name information is No. Andover MA 01845 09/04/20�25 required for every .................... ....... ..................... page. City/Town State Zip Code Date of Inspection C. I nsp ection Su mmary Inspection Summary: Complete 1, 21 3, or 5 and all of 4 and 6. 1) System Passes-. 1 have not,found any information which indicates that any of t'he failure criteria described in 310 CM R 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments,: .............. ................ 2) System Conditionally Passes,-, one or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health) will pass,. Check the box for"yes", "no)) or"not determined" (Y, N, ND for the following, statements. If"not determined,"' please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits,substantial infiltration or exfilt,ration 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 Explain, below): ............ ................ t5insp.doc-rev,7/26/2018 Title 5 Official Inspection Form-,Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts rintle 15 Otticiial Inspect"ion Form IA J > Subsurface Sewage Disposal System Form Not for Voluntary Assessments 128 Bradford Street Property Address Owner Harwood, Scott Owner's Name .�... . . _ .._......_ __. information is No. Andover MA 01845 09/04/2025 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System conditionally Passes, (coat..): Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarm,s are repaired. El Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): El broken pipe(s) are replaced E:1 Y 0 N 0 ND (Explain, below)-. EJ obstruction is removed Ej Y [:1 N 0 ND (Explain below).- distribution box is leveled or replaced FI Y [:1 N 0 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): El broken pipe(s) are replaced 0 Y El N 0 ND (Explain below).: obstruction is removed El Y El NEI 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 3110! CMR 15.303(l)(b) that the system is not functioning in a manner which will protect public health, safety and the, environment: t5insp.doc-rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 k,kkl it Commonwealth of Massachusetts T"tle 5 U'T'T'"Iciai inspect,ion Form > Subsurface Sewage Disposal" System Form Not for Voluntary Assessments 128, Bradford Street Property Address Harwood, Scott Owner Owner's Name information is No. Andover MA 01845 09/04/2025 required for,every ..................... ................... ........... page,. City/Town State, Zip Code Date of Inspection C. Inspection Summary (cont.) Ej Cesspool or privy is within, 50 feet of a surface water E:1 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier,: if any determines that the system is functioning in a manner that protects the public health, safety and environment: 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. Ej The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. E:1 The system has a septic tank and SAS and the SAS is within 5 feet of a private water supply well, Ej 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 E,P certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis Must be attached' to this form., c. Other: ............... ....... 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all 'Inspections-, Yes No D Backup of sewage into facility or system component due to overloaded or z clogged SAS or cess pool 0 z Discharge or p:onding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5i sp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts 'itiel 5 U'T't'i"ci"alm lonspection Form 13 Subsurface Sewage Disposal System Fore Not for voluntary Assessments t* Ll 128 Bradford Street Property Address Owner Harwood, So _._ .. .._. __ ._........_ Owner's Name information is No. Andover MA g 1 45 09/04/2025 required for every _ . .. ----_�.e, �..n�. ------ page. City/Town State Zip code Date of Inspection C. Inspection Summary (cont,.) 4 System Failure criteria Applicable to All Systems: (coat. Yes No 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 / day flow Requiredplumping times in the last year NO due to clogged' or more than obstructed pipes . Number of times pumped, El N Any portion of the SAS, cesspool or privy is below high ground water elevation. El N An portion of cesspool or privy is within 10o f surface water supply or p p p y sat of a tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑' N Any portion of a cesspool or privy is within 50 foot of a private water supply well. Any portion of a cesspool or privy is less than 100,feet but greater than; 50 feat from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a D P certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or leas than 5 pp i, provided that no other,failure criteria are triggere . A ropy of the analysis and chain of custody must be attached) to this +orm The system is a cesspool serving a facility with a design flow of 2000 gpd- 10 00o gp d. sy stem term fails. I have determined the r more of the' ya t one o 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, Large Systems, To be considered a large system the system must serve a facility with a design flown of 1+ , 010, gpd to 15,000 gpd. For large systems, you must indicate either`°yres" or,"no" to each of the following, in addition to the questions in Section C. . "Yes No [I E] the system is within 400 feet of'a surface drinking water supply El 1:1 the system is within Zoo feet of a tributary to a surface drinking water supply El 1:1 the system is located in a nitrogen area (Interim Wellhead head protection Area, I'' PA) or a mapped Zone 11 of a public water supply well t insp.d c.raw.71 6/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 5 of 18 Commonwealth if Massachusetts T I�itle 5' U'T""c'lal lnspv%ection Form Subsurface Sewage Disposal System Form Not,for Voluntary Assessments 128 Bradford Street Property Address Harwood, Scott Owner Owner's N ame information is No. Andover MA 01845 09/04/2025 required for every ................. ..................... 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 threat, or answered "yes" to any question in Section C.4 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. 61. You must indicate "yes": or"no"for each of the following for all inspections: Yes No 0 0 Pumping information was provided by the owner, occupant, or Board of Health EJ Z Were any of the system components plumped out in the previous two weeks? Has the system received normal flows in the previous two week period.? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system, obtained and examined? If they were not available note as N' /A) Was the facility or dwelling inspected for signs,of sewage back up? Was the site inspected for signs of break out? Z Were all system components, excluding the SAS, located on site? Z 1:1 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 1:1 Was the facility owner and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Z 1:1 Existing information. For example, a plan at the Board of Health. Z El Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5l)] t5insp.doc-rev,7/2612018 Title 8 Of Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Oft uommonwealth of Massachusetts 4 go T itle 5 U00"'TTIcial Insup&ection Form > Subsurface Sewage Disposal System Form Not for Voluntary Assessments 128, Bradford Street Property Address Harwood, Scott Owner Owner's Name information is No., Andover MA 01845 09/014/2�025 required for every .............. ........................--------------- . .....page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Condi tions,., 4 4 Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CIF 15.203, (for example: 110 gpd x#of bedrooms).. 440 Description: Number of current residents: 4 Does residence have a garbage grinder? Yes 0 No Does, residence have a water treatment unit? El Yes H No If yes, discharges,to: Is laundry on a separate sewage systern'? (Include laundry system inspection El Yes N No information in, this report.) Laundry system inspected'? El Yes [:1 No Seasonal use? Yes H No Water meter readings, if available (last 2 years usage (gad)); Detail: .......... ............ Sump pump? EJ Yes [E No Last date of occupancy: Occup!�d Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts 'itle 0"' 1 Inspecti"on Form !s tticia Subsurface Sewage Disposal c sal System Form Not for Voluntary Assessments 128 Bradford Street Property Address Harwood, Scott Owner Owner's Name information is H'o, Andover CIA 1� 4 / 4/2 25 required for every � _ _._ ....... --- pa e.. City/Town State Zip Cede rate of Inspection----- D. System Information (cont. 2. Commercial/in ustrial Flow Conditions: Type of Establishment: Design flay (based on 310 C1 R 15.203): _ __..... Gallons per day( pd) Basis of design flog (seats/persons/swft., etc.): Grease trap present's 0 Yes [I No Water treatment unit present's El Yes El No If yes, discharges tc: �.._._w..� . Industrial waste, holding tank present? El Yes No Non-sanitary waste discharged to the Title 5 system' Yes F He Water meter readings, if available: �... _...__. _. ._... Last date of occupancy/use Date Other(describe Below): 3, Pumping Records. Last pump�12/2 /202 Source information: .._.... Was system pumped as part of the inspection? Yes 0 He If yes, volume pumped: 1 500 �" gallonis Heir was, quantity pumped determined?' �gay_ge can truck. Reason for pumping: Inspect tank� t5insp.doc,rev.7/ /2018 Title 5 Official Inspection berm:Subsurface Sewage Disposal System•Page 8 of 1 mmonwalt, I + f"Massachusetts i 5 attici O%ec- tle al lns&p tion Form 101 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 28 Bradford Street Property Address Harwood, Scott Owner Owner's Name information is No., Andover MA 1848, required for every/ _._ _ 41� � page. C ity/Trawn State Zip Cade Cate of Inspection D. System Information (cunt. . Type of,System: 0 Septic tank, distribution box, soil absorption system Single cesspool 1:1 Overflow,cesspool E] 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 he obtained from system owner) and a copy of latest inspection of the I/A system by system operator under,contract El Tight tank. Attach a copy of the DEFT approval. El Other(describe): Approximate age of all components, date installed if Known) and source of information: 28 Were sewage odors detected when arriving at the site` Yes No 8. Building Sewer(locate on site plan): 411 Depth below grade: feet p � feet. Material of construction.. El cast iron M 40 PVC [ other(explain),: � _._._._.. .. Distance from private water supply well or suction line: �__... . .._......__ _.. feet Comments on condition of joints, venting, evidence of leafage, etc.):. t5lnsp. cc.rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage disposal System-Page 9 of 18 Commonwealth of Massachusetts PA tie 5 Official Inspect"ion Form A > Subsurface Sewage Disposal System Form Not for Voluntary Assessments 128, Bradford Street Property Address Owner Harwood, Scott ......... ....... ..... Owner's Name information is No. Andover MA 01845 09/04/2025 required for every ................... page. City/Town State Zip Code Date of Inspection D. System I nformation (cont.) � i 6. Septic Tank (locate on site plan): Depth below grade: 8 feet Material of construction: 9 concrete El metal' El fiberglass El polyethylene El other(explain) If tank is metals list age: years Is age confirmed by a Certificatewof Compliance? (attach a copy of certificate) El Yes El No Dimensions: 5 X 10 X 4 311 S l ud g e depth: Distance from top of sludge to bottom of outlet tee or baffle 3011 Scum thickness 0 611 Distance from top of'scum to top of outlet tee or baffle 1511 Distance from bottom of scum to bottom of outlet tee or baffle � How mere dimensions determined ? Tape measure/sludgej ydge Comments on pumpling recommendations, inlet and outlet tee or baffle condition, structural integrity, l iquid levels as related to olutle�t invert, evidence of leakage, etc.): Both baffles are in good shill No leakage liquio"e. , level is good., ........... ............. ........... ....... ............ ............- ........... t5insp.doc-rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title; 5 Official Inspect"illon Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 41 128 Bradford Street Property Address Harwood, Scott Owner Owner's Name information,is No. Andover M�A 01845 09/04/2,025 required for every ........ ............... page. City/To�wn State Z,ip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: 0 concrete F1 metal El fiberglass F1 polyethylene El other(explain),: Dimensions: Scum thickness ........ Distance from top of scum to top of outlet tee or baffle ..... ....... .............. D istance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on:, pumping recommendations, inilet 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: I F-11 concrete El metal El: fiberglass El polyethylene El other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp,doc-rev.7/26/2018 Title 8 Official Inspection Form:Subsurface Sewage Diisposal System-Page 11 of 18 Commonwealth of Massachusetts o t I e on Form 2,� Ti icial Inspectin > Subsurface Sewage Disposal System Form - blot for Voluntary Assessments 128 Bradford Street Property Address Owner Harwood, Scott ......-- Owner's Name information is No. Andover MA 01 845 09/04/2025 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: El Yes, [:1 N o Alarm level: Alarm in working order: El Yes r-1 No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required), Is copy attached? El Yes [:1 N o 9. Distribution Box (if present must be opened) (locate on site plan): 0.......... ............. 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.): Equal distribution, no leakage, no solids carryover. t5insp,doc-rev,7/26/2018 Title 5 Of Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 uommonwealth of Massachusetts, T"tle 'ff iciial Inspecti"on Form > Subsurface Sewage Disposal System Form Not for Voluntary Assessments 128 Bradford Street Property Address Harwood, Scott Owner Owner's Name information is No. Andover MA 01845 O�9/04/2025 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: 0 Yes Ell , No* Alarms in working order: F1 Yes No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.)- ............. ...... If pumps or alarms are; not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 'Type: El leaching pits number: leaching chambers number: El leaching galleries number: 4 -401 leaching trenches number, length: leaching fields number, dimensions.- El overflow cesspool number: El innovative/alternative system Type/name of technology: Infiltrator system ........... t5insp.doc-rev.7/26/2018 Title 5 Official Inspection,Form:Subsurface Sewage Disposal System-Page 13 of 18 uom nwealth of Massachusetts 9� UTTIcia tie I Inspection Form > Subsurface Sewage Disposal System Form Not for Volluntary Assessments 12,8, Bradford Street Property Address Harwood, Scott Owner .......... ....... Owner's Name requnnation isired for every No. And MA .09/0,4/2025 page. City/Town State Zip Code Date of Inspection D. System: I nformation (cont.) 11. Soil Absorption System (,SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp solil, condition of vegetation, etc.): hydraulic failure, no ponding, no damp soils. Opened soil inspection ports. Sand is clean & ...... ........ 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 El Yes El No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ........ ....... t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth onwealth f Massachusetts w n ■ Hue UTTIciai insp ion Form ect Subsurface Sewage Disposall System Form _ Not for Voluntary Assessments 128 Bradford Street Property Address Harwood, Scott Owner Owner's Name information is required for every 1o, Andover M 01845 .. /C� l202 page. City/Town Mate Zip Cede Cate of Inspection D. System Information 13. Privy (locate on site plan): Materials of construiction �.._. Dimensions Depth of solids __..... _...._ Comments (note condition of sail, signs of hydraulic failure, level of ponding, condition of vegetation, etc. t8in p,doc-rev. /26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 15 of 1 A*% uomm,onwealth of Massachusetts Hiclai p ion Form PA 1 "Itle 5 U"" " Insmoltect" 01 0 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 128 Bradford Street Property Address Harwood, Scott, Owner Owner's Name information is No. Andover MA 01845 09/04/2,025 required for ever., ............ .............. ...... _-............ page. City/Town State Zip Code Date of Inspection 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 sup ly enters the building. Check one of the boxes below: Ej hand sketch in the area below drawing attached separately t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 �4,ek4 t%l N, %,ommonwealth of Massachusetts, li 5l icia(�p tie ff I Insr%ection Form F > Subsurface Sewage Disposal System Form Not for Voluntary Assessments 128 Bradford Street Property Address Harwood, Scott Owner Owner's Name information is No. Andover MA 01845 09/04/2�0,25 required for every --- ........................ page. City/T'own State Zip Code Date of Inspectio-n '-- D., System Information (cont.) 15. Site Exam: Check Slope Surface water Check cellar Shallow wells Estimated depth to high ground water: 61 feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record /2 If checked, date of design plan reviewed. 04/01 008 Date`-- Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Pulled file Checked with local excavators, installers - (attach documentation) El Accessed USES database - explain: ............. You must describe how you established the high ground water elevation: No sump,_p,u,mp in the basement. Basement is dry. Bottom of s, stem is 4' above the water table, .........................swamp" ............ .............. ........................................... ................. .................... ............ ...... ..................... Before filing this Inspection Report,, please see Report Completeness Checklist on next page. t5insp.doc-rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 t;ommonwealth of Massachusetts att!i,ciai inisp PA tie 5 ection Form !subsurface Sewage Disposal stem Fore _ Not for Voluntary Assessments *k 128 Bradford Street _.... w Property Address Harwood Scott Owner Owner's Name information is required for even N . Andover I _.... 01845 ...... 9l l2 25 page. City/Town Mate Zip Code Date of Insection�.�.....�._ E. Report Completeness Checklist Complete all applicable sect,ions of this form inclusive of: A. Inspector Information: Complete all fields in this section B. Certification: Signed & Dated and 1, 21, 3, or 4 checked C. Inspection Summary: 11 + , 3, or 5 completed as appropriate (FailureCriteria) and 6 (Checklist) completed D. System Information: For : Tight/Holding Tank Pumping contract attached For 14: Sketch of Sewage [disposal System dawn on pg. 16 or attached For 1 5a Explanation of estimated depth to high groundwater included thin p.dnc*rev.7/26P 618 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 f?I-ell l > ' � � RY F INVERTS BUILDING TIES _VIER 0 FDTN. 951-86(!!�_OFF) BLDG. CORNE:P, A 8 c THIS PIAN & CERTIFICATION IS NOT EPTIC TANK IN 95.40 SEPTIC TANK OUT 33.1" 26.0 A WARRANTY OF THE , USSUP ACt DISPOSAL SEPTIC TANK OUT 1 95,2611, DI `T. BOX 104.5'91.51 SYSTEM, IT IS A RECORD P T14E LOCATION ?N I I T. BOX IN 92.46 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX OUT 92.29 COMPONENTS, INV. IN GRAD. 1& 2 92.2 INV. IN + I-4AM. 3&- 1 90M6!9 BOTT, CI-IAM. #1& 2 91.60 1 HEREBY CERTIFY THAT THE SEWAGE BUT. CHA . :3& 4 90.10 DISPOSAL. SYSTEM HAS BEEN INSTALLED IN ACCORDANCE WITH THE PROVISION F ,510 CM . 15-00 (TITLE 5AND THE APPROVED DESIGNS PLANS. THIS PLAN AND cERTIncATIQ"N APPLIES ONLY TO THE SYSTEM COMPONENTS WHICH WERE REPLACED. 3 ia ter: FORT PORT Box WTIC too,A14C)OVER TO',,, 150,00, ° � � ... BRADFORD STREET ,w 'AS .1 b__'N U I L "'LAN x F e--1 T e-4"RFA"*"-_l AL ;�5 u-bb U LOCATED N BOXFORD, MASSr/,, FORD STREET AS PREPARED FORDATE: 4-1-08 TM 61 t - a MERRIMACK ENGINEERING 66 PARK STREET