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Home My WebLink AboutConditional Pass-PASS - Title V Inspection Report - 90 LACY STREET 8/19/2026 Commonwealth of Massachusetts -am& AW ONO .............. TI'tle 5 Utticial Inspection Form ........ �0 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 90 Lacy Street ..................... ...................... ........................ Property Address McG,ar,vey,,_,,,Diane Owner -------------------- ........... Owner's,Name information is No Andover MA 01845 08/19/20�26 requiredfor every __.............................................................. ....................... page. City/'Town State Zip Code Date of Inspection Iris cifresults must be subm*1tted on this form. Inspection forms may not be altered in any, way. Please see completeness checklist at the end of the form. Impodant:When A. Inspector Information filling out forms on the computer, John L,. DiVinc,enzo use only the tab ............. ............................... key to move your Name of Inspector curso�r-coo not J &SDe velopment/Stewart's S 1c Service use the return .... ..............._.......... key. Company Name p 58 So. Kimball St. tab Company Address Bradford MA 01835 City/Town State Zip Code 978-37'2-7471 S113386 Telephone Number License Number B., Certification I certify that'. I am a DEP approved system inspector in full compfliance with Sect'lon 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection, and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system* 1. Z Passes Conditionally Passes I El Needs Further Evaluation by the Local Approving Authority 4. E] Fails 08/19/2026 .......... ............. ect r's curs Date The system inspector shall submit a y of this inspection report to the Approving Authority (Board of Health or CEP)within 30 days of completing this inspection. If the system has a design flow of 101000 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 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 coy d*ltl"ores of use at that tiume. Thils Ins pectlion does not address how the system will perform in the future under the same or different conditions of use. t5insp,doc-rev,7/26/2018 Tifle 5 OffidaA inspection Form Subsurface Sewage Disposai Systern-Page 1 of 18 Commonwealth of Massachusetts �M w ■ t1e 5 Otficial Ins-10-ec von For �a Subsurface Sewage Disposal System Form Not for Voluntary Assessru tints 90 Lacy Street +.. Property Address McGarvey,_Diane __...... .. _.__.------ _..............._..�..... ... . .. ..... ............... ......_....... Owners Name information is required for eve 1�� page. City/Town State Zip Code Date of Inspection C,. Inspection Summary Inspection Summary, Complete 1, 21 3, or 5 and all of 4 and 6. System Passes.- 1 have not found any information which indicates that any of the failure criteria described in 310 C R 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments- Replaced .. a and 3 " pipe from tan t box ....d_..b .......� .. . _.w _._ .�.._...a.... _.... ��.. . 2 System Condiltionally Passes-, One or more system components as described in the "Conditional Pass section reed 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 44yes", "n� " or"not determined" (` , N, ND for the following statements. if"'not determined," please explain. The septic teak is metal and over 20 years Bald* or the septic teak whether,metal or riot) is structurally unsound, exhibits substantial infiltration or exfiltrati n or tank failure is imminent. System will pass inspection if the existing teak is replaced with a complying septic teak as approved by the Board of Health. A metal septic teak 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 0 N ND Explain below): t5insp. o .rev,,7/26/2018 Title 5 Offic4 Inspection Form.,:Subsurface Sewage ispr s �S st r -Page 2 of 1 w. Commonwealth of Massachusetts T il 10 s Subsurface Sewage Disposal System Form Not for Voluntary,rotary ssess tints 90 lac, 'treet �w _,.._.. ..... __.__. _. _ma... ._ w. _._._.. _. .. ..W......w._....... _....... _m..._.......�............... ._w..... Property Address Inc arve Diane Owner .. ..... .. n. .... _. .....m..__.._..,.__,..._.._ .. .. ...._.._v_._ Owner's Name information is required for ever Andover 4 i /� �6 y � cad ..�� ... .� ....... ....... ........_ ..-------_._...n....__.__� ...m.__....� Inspection Inspectimn results must be submitted on this form. Inspectlion forms may not be altered iir are way. Please see, completeness ch eckfist at the end of the form. fillingImportant:When out forms A. InspectorInationform n the computer, useonly the take John... II rc .r. . _.m....--__...___.__.__ _.. ._..w _._ _...._.. .M._ .._... .._.......... ......w.._._.....__.__.... .___._ .. ._.....w...._ ..._...___.__ ....�...._.. _........ ____ __._.__._.__m...m key to rove your Name of Inspector ttor cursor not �J._w& .De v l _... ent/St a :_..._..__._.mm..Septic. use the return key. Company Name 58 S urd11 t. _._ ... _ _.. .... .. ___.__. ..__..._...... ...._..._...._..........._._.._....._...._..._........ _....._ _.._............ tab Company Address _. ._..._ --,Bradford 1835 __._.._.....__... ..........................._.......�...... ......_.._.___._.............__.... - _ _....__.. ..pry.... �w......... ..._..... .__._..__._..____. ....._..._�.�..._..w � . . ....... _..... ........_......._._ ..... ... City/Town State Zip Cade License16MAN-__--;, Telephone Number Number B. Certification certify that: I am a DEP approved system line ect r lin full caw dance with Sectl'on 15.340 of Tl*tle 5 (310 CMR 15. ; 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. ,fitter conducting this inspection I have determined that the system- 1. El Passes w Conditionally Passes 3. Needs, further Evaluation by the Local Approving Authority 4. E] Fail ._... .. . __ _ .._... _.w..._ ......�...........w... /3 /2 26 . .. ..._.. _....__.....__ ._........_....._ _...._ ........... ......... _. .. ...... ._.__.._. . _...m......................__._...._._.........._ l actor's Signature late The system inspector,shell submit a copy of this inspection report to the approving Authority oar of'Health r EP) within 30 days of completing; this inspection. of the system has,e design flow of OtOOO gpd or greater, the inspector and the system owner shell submit the report to the appropriate regional office of the DER The original form should be sent to the system owner and copies sent to the buyer, it applicable,ehle, and the approving authority, Please note: Th s report only descril es condilitilonspit the tilme of iinspection and under the coed bons of use at that time. T"h ils li rs ectioun does not address how the system fill perform in the future under the same or different condiffilons of use. t5ins .du .rev. / /01 "fl NCO Inspection Forma:Subsurface Sewage Disposal System«Page 1 of 18 �,ommonweal�th of Massachusetts ............ Tl*tle 5 Q' t'tici'al 1ns&4%ect"ion Form 10 Subsurface Sewage Dilsposall System For Not for Voluntary Assessments 90 Lac Street ............ Property Address McGarvey,_Diane Owner Ow —---------------ner's Name .............................. information is No. Andover MA 01845 07/30/2026 required for ever�y ------- page. City/Town State Zip Code Date....ofinspection C. Inspection Summary Inspection Summary* Complete 1, 21 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- ...................... ----------- ............ 2) System Condiltilonally Passes-, One or more system components as described in the "Conditional Pass" section need to be replaced or re aired'. 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 N ND (Explain below)* ............. t5insp.doc-rev.7/2 /2018 TMe 5 Offic4 Inspection Form:Subsurface Sewage Dis System-Page 2 of 18 Commonwealth of Massachusetts TUEle 5 Q'"' fficial Inspecti*on For l o Subsurface Sewage Disposal System FormNot for Voluntary Assessments a Lq " w90 Lac tree Property Address Gar� , Diane Owner m __-____.------ w_.._......_w.w_m.._M.........�_..._.._..._....__�_..____u_..__.. _......_.._._.__..... __._._-._...... �_...___._. w.w_ ._...-_w-------- Owner's ..__. information is No. Andover ILIA 01845 7/3 /20 required for eves _._w_.... page. City/ 'own State Zip Code Cate of Inspection C. Inspection Summary (coat. 2 System C:ondit'lionally Passes (cont.),-, Pump Chamber pumps/alarms not operational. System will pass with Beard 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 E Y El l (Explain below). obstruction is removed Y 0 N [:1 ND (Explain below)- distribution box is leveled or replaced El Y 0 N 0 N (Explain below).. Distribution box is corroded around the outlet inverts. 3 ' of pipe is crushed in two spots from large rocks and needs to be re .l..aped. m__.._.._ ....__.. ..w._.. _._.__.._._. . The system required pumping more than 4 tunes a year due to broken or obstructed pipes .. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced 0 Y El N E ND (Explain below). obstruction is removed Y" l ' ND (Explainbelow)- .. 3 Further Evaluation is Re aired by the Board of Health-. El 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 15.3C13(1)(h)that the system is not functioning in a manner which will protect public health, safety and the environment.,, t ins . n •rev.7/2 /2 18 Title Official Inspection Form.-Subsurface Sewage Disposal yst m•Page 3 of 1 %,ommonwealth of Massachusetts T"Itle 5 "Ica Ins-pAk&ectoion Subsurface Serge Disposal System Form Not for Voluntary Assessments 90 La Street Property Address m.... c a rle ,_ is Ownerm .. ......_ . ._...ner"s Nae _ .... .... ._...._ .. __._.__...___....__.._. w......_....... ___... information is No. Andover 01845 7/30/2026 required for eve _____ _.. _....._.__W_...._..__...._____._.. .. ._.... _.... .. _.......... _............... ....m...... ..._ _.__.... .... _......_. page. City/Town City/Town State Zip Code Date of Inspection C. Inspection Summary (;coat.. Cesspool or privy is within 50 feet of a surface water Cesspool or priory is within 50 feet of a bordering vegetated wetland or a salt marsh 1 . System mill fall unless the Board of Health (and Public ester Su ►ller, if any) e ermlnes that the system is functimnIng In a manner that protects the publilc health, safety and envlronme t: 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 tr% u�tary to a surface water supply. E] e system as a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. [:1 The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply ell. [:1 e system has a septic tare.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 distances. This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal c liforrn bacteria indicates ates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or lass than 5 ppm, provided that no other failure criteria are tri are . A copy of the analysis must be attached to this form. c. Other- .. System Fall are Crlt rla Applicable to All Systems-, You must In dlcate "Yes" or"No"' to each of the following for all inspecU ns. Yes No Backup f sewage into facility or system component dues to overloaded or clogged SAS or cesspool El E Discharge or ponding of affluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.d c•rev.71 /018 Tiff 5 Offic4 Inspection Form,Subsurface Sewage Disposal System-Page 4 of 1 tommonwealth of Massachusetts T"Itle 5 Q" T'T"'Icial Inspect"ion For fl Subsurface Sewage Disposal System Form Not for Voluntary Assessments s gg Lqq Street Property Address cG a r w ,..._.Diane Ownerm ._.v__v__... _..._,.w............... .....__..._.. _..._...._._._._. informatioln is requi .m�, ... _.._......... _....__.._........_........._..._... _. a. ._red r eve ___............_ .. . age City/Town State Zip Code Date of Inspection C. Inspection Summary (c n System Failure Cniteria Applilcable to All Systems: (cont.) Yes No El El Static liquid legal in the d strlhu�tl n box above outlet invert due to an overloaded r clogged SAS or cesspool El E Liquid depth in cesspool is less than " below invert or available volume is less than Y2day flow E] z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes . Number of times pumped: El E Any portion of the SAS, cesspool or privy is below high ground rater elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply r tributary to a surface rater supply. El E Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. Any portion of a cesspool or privy is within 50 feet of a private rater supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private rater supply well w,ith no acceptable titer quality analysis. T *Is system passes i"the well water ar ai' sirs, performed at a DEP certif le laboratory,for fecal colilform bacteria lin dicates absent and the presence of ammonia nli rogen and nitrate nil r gen is equal to or less than 5 p prc "ded that no other failure criteria are triggered. A copy of the analysis and chain of custody must he attached to this form.] The system is a cesspool serving a facility it a design flow of 20 1 g, gg gp . 0 z The system u . 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303 therefore the system tails. The system ner should contact the Beard of health to determine what will be necessary to correct the failure. 5 Large Systems: To be conslidered a large system the system must serve a facility wit h 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 N El El the system is within 400 feet of a surface drinking rater supply the system is within 200 feet of a tributary to a surface drinking titer supply the system is located in a nitrogen sensitive area (interim Wellhead Protection Area—1 r a mappedZone 11 of a public water supply well t5in p. -rev. /26f201 Title 5 Official Inspection Forn Subsurface Sewage Disposal System-Page 5 of 18 common w ea h oW ■ Massachusetts ' 'E tficia 18j'le 5 0 1 Insvp%ecuon F "� Subsurface Sewage Disposal System Form Not for Voluntary Assessments 910 Lacy Street Property ert address McGarv�e Diane y, ......_.._..... __... _..._ ....._._ _w,..__ ....._...... ...... _ _. ....... _......--------_..._. ..... _._._.__........ ._...__-._._.... _._...._...��_..._.._. ....._ ...._ �. _. Owner's Name information is 01845 07/30/2026 required o eve .._._.. ..._..._.... .. .._... ..v.._._.. ...._..... _..._.__..._._..._.._ _..... ....... ... _._ w_......,..,._.�........�.__._. _._......�. ....... ,........ ....._. .... page. cat own State Zi ode Date of Inspection C. Inspection Summary (cont.) If you have answered Uyes" to any question in Section C.5 the system is considered a significant threat, or answered ii es" 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 tailed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following owing r a inspections.- Yes No z El Pumping information was provided by the owner, occupant, or Beard of health 0 z Were any of the stela components pumped out in the previous two weeks? z 1:1 Has the system received normal flows in, the previous two weekperiod? 1:1 z Have e large volumes of ater been introduced to the system recently or as part of this inspection? Z El Were as wilt plans of the system obtained and examined? (if they were not available note as N/A) z 1:1 Was the facility or dwelling inspected to signs of sewage hack u z El Was the site inspected for signs of break cut? Z [:1 Were all system components excluding the SAS, located on situ` z El Were the septic tank manholes les uncovered, opened, and the interior of the tank inspected to the condition of the baffles or tees, material of construction dimensions, depth of liquid, depth of sludge and depth of scum? z 0 Was the facility owner (and occupants it different from nerd provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (S S on the site has been determined based on: z 1:1 Existing information. For example, a plan at the Board of Health. z 1:1 Determined in the field it'any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 C R 53 t5in p.dc »rev.7/26/2018 Title 5 Official Inspection Fora,,Subsurface Sewage Disposal System•Page 6 of 1 Commonwealth of ssac use T atle 5 UA"6' fficial Inspecti8on For =: I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 90 Lac Street _.. __....______...___.___.._._.._..___,_,..._.... _.... ... .............._..._... ______ .._ .___.__-____._.._._._.._.__.___.__.______._,.v_..M.,......M._._a.,... _.....__......._m...___...._.w.._._. _... Property address McGarve ...!.a:.n c ri er ------- .......... Owner's Name information Is No Andover 01845 �7/3 2 2 requiredfor ever � ._ w_ __w. �..._...._�__�.__......_ . ..........._. .._........._.............. ........._....___ page ;dip code Cate of Inspection D. System Information 1. Resi"denUal Flow Coed ions,,, Number of bedrooms (design): Number of bedrooms (actual)* DESIGN0 flow based on 31 CIS, 15.2 3 for exar le: 11 d x of bedrooms).- � ...._ .W..... .__._w_._. Description: Number of current re. idents: 1 Does residence have a garbage grinder?" Z `des No Dees residence have a water treatment unit? 0 Yes No If yes, discharges to- _.._...._..... _.w_....._..._.._.. ___._._w._______._.__.__...,,.M_ ._.._.._re_...w__ . _____w_.._-.___n_ ..._ Is laundry on a separate sewage system? (Include laundry system inspection El 'es Z No information in this report.) Laundry system inspected' des El No Seasonal use?" EJ "des Z No Water meter readings, if available (last 2 years usage d : Detail: Sump pump? El Yes Z No Oc .Last date of occupancy: ate ......_w__.-_._..._____w__- t rosy, oc.rev.7/ f t 18 Title 5 Official Inspection Form,Subsurface Sewage Disposal System.Page 7 of 1 Commonwealth of Massachusetts T'lotle 5 Offiocial .. lei Subsurface Sewage Disposal System Form Not for Voluntary Assessments 6Z 90 Street Property Address Owner Owner's Naas information is 'c�. Andover 01845 '/3 /2 2 requiredfor every ____. .__.___._____.._.__.__.__..____.__._____..._________.__._ __..__.____. .._______.______..___....__..___..__.__..._ _..... _ .__. ___. _.M....... __.._._...._.a..... page. City/Town State Zip Code Date of Inspection..�... .___.. .._..... ._..�___._�_...�.� D. System Information (cont. Type of Establishment: _. _._.... _.__.___. __ _...... ........._......___ ...._ _..___ _____.__..__....... Design flaw (based on 310 CM 15..2 3): ._ ._..__ __ _._..____.. _____________._.-_ ______.__.__.........__ _...___.._...... _ Gallons per day( pd Basis of design flow(seats/persons/s wat., etc.): __.. ..._...... ...M.... m_.w..ww........._._v..... _...m.._._...._ ..... ...w._. _.___........ _.__.__._ ..._..___ Grease trap present's El 'des No Water treatment unit present? El Yes El N o If yes, discharges t .- Industrial waste holding tank present? El Yes No Non-sanitary waste discharged to the Title 5 system? Yes No Water meter readings, if available: __ ________ _..... .........__.. Last bate of occupancy/use: Date _...w_ _._w... w. .... .._....._._.w.... Other(describe below): 3. Pumping Records-., Lastpump*... . _ / / 2 23 Source °l"information: _._�___. _ _ Was system pumped as pert of the inspection's Z Yes o 500 If es, volumepumped: 1 ygallons, How was quantity pumped determined` .Sig _� _ � Inspect w anWl Faxon for pumping: .__... t nsp.de •rev.7/26/2018 Title 5 Official Inspection Fora.Subsurface Sewage Disposal System.Page 8 of 1 Commonwealth of Massachusetts ion For Tatle 5 Offnicial Inspect* l� Subsurface Sewage D s + sal System Form _ Not for Voluntary Assessments c. Street Property Address McGarvay Diane Owner ------ Owner's Name information Is No. Andover MA, �45 07/ �/202 requiredfor every _.__. _.__ � �__.�__.__�._. __....__. ......_� . ._...._ �__.w ..........................w..... page. City/Town State Zip Code Date of Inspection D,. System Information (cont. . Type of System-. `optic tank, distribution box, soil adsorption system Single cesspool Overflow cesspool El Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract Fight tank. Attach a copy of the DEP approval. EJ Other (describe): Approximate age of all components, date installed if known) and source of information- 1978 Were sewage odors detected when arriving at the situ 0 `lea Z No 5. Building Sewer(locate on site plan): th below radar ..2611�-______._.._______.�.___......__.._._....... ..._... . ............._._.._......_..�. ��....�.._._._._.__.._. p feet Material of construction- cast ironPVC El other(explain): _.____.__.w.._w......M_._._ M......_.._..___ ..--._-_w-_.. Distance from private water supply well or suction lire: __feet "___.___.�.___..�.....M... ._...�.__....._._.w_.�._.. �... _.....___ __... p pp y feet Comments on condition of joints, venting, evidence of leakage,e, etc.): t in p.do .rev.7/26/2018 Tide 5 Official Inspection `corm:Subsurface Sewage Disposal System•Page 9 of 1 %oommonwealth of Massachusetts T"Itle 5 Q' ffi"ci"al Inspecti"on Subsurface Sewage DIsposall System Form Not for Voluntary Assessments 90 Lac Street .. . ......__ _.. .._.. _w.._.....m..w._-------- mm ... .... _. Property Address McGarvey Diane Owner _.'",__""'___ '_1____""'............... Owner's Name information is Andover /30/2026 required for eve _..__..._........_._._.._.w_..... _.......n...�..._.. ..........._ ...._..._..... _. _. _..... ......w.... __. _.._ ......_. page. City/Town Mate Zip code Date ofinspection D. System Information (coat.) 6. Septic Teak(locate on site plea): WV Depthbelow grade: ° ................. __......� _... _ _...... _.w... fe Material of constructi n- concrete El metal fiberglass polyethylene El other(explain It tank is metal, list age: ...._.. ......... .... _.._...__ _.... ......_... years Is age confirmed by a Certificate of Compliance? attach a copy of certificate) Yes No 4 Dimensions- 611 �� Sludge depth* ......_. �......... 261 Distance from top of sludge t Otto of outlet tee r daffy _. _w_ _._.._...._...m.... _.... Scum thickness Distance from top of scum to top of outlet tee or baffle �.�_._ .........__.. ..__w__...__... .. _..... Distance from Otto scumt bottomoutlet tee or baffle ..M 1.1 e judge How were dimensions determined? _....�...��..._. �� _. M_. ..... Comments on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakages, etc.)- Both is are in od sha No.......... ..I a ,_wl'rquid level s...good..... t5an . .rev.7/26/2018 "title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 1 uommonwealth of Massachusetts FA Toitle 5 0'0m"" ff*icia1 Inspect0ion For I> Subsurface Sewage Disposal System Form Not for Voluntary Assessments p ° . 90 LacvStreet Property Address McGar r y w_C Icyn '_._..._. _4......w Owner r Owner's ner's Name information is o. Andover l l 01845 7/3 /2 2 requiredfor every __ �._____�.______._..__.._.__.___ww.__....__.___w._..________.....____.___.._...__._n._-._. . ........ _._.__.. _._ .___�.. _.__._..._..__ _..___..... pa ' City/Town state Zip code Date of Inspection D. System Information (cont.) . Grease Trap (locate on site plan), Depth below grade: fee t _....._W__.._._�.._.__.._.._.....__.....------ Material of construction.: El concrete 0 metal El fiberglass polyethylene El other(explain): Dimensions: _......_ ......... ._....... ._..__...._......_ __....._..........._..�............. _................._............._..._..___......................._........_........_.--___.... Scum thickness ��_.. .�...._....... ............ ..____.w._._ Distance from top of scum to top of outlet tee or baffle ______wLL_..__ __ ______________.___._ Distance from bottom of scum to bottom of outlet tee or baffle __.._mn___.-__._-.__.___......._�.._.___. ..... _.._...._ . ....... _.....m... _........_. Date of lest pumping-, Da .... _._ .._.._ .. _..... __........_.._.... Comments (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 Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below Braden aterial of construction: 0 concrete 0 metal fiberglass El polyethylene other(explain)- Dimensions: __._�.__�____.__.__.__-.____.m___._a_m__.___.m_�....__.___.m..____..._..M_._..._..�_.._._.m�......w�w..__�_..._..�.._..._....��ti......_._..�.._�_._�....._...........�._�w._�_..�..... .........�..........�.�_W.�_.....�...... Capacity, - -- _......._____-----__..._._ ___._____.._______.____.._...___..___.__.______...._______..____.__.._.......__...._. ___......._...._.._.......__ gallons Design Flow: __ _._.__ gallons per day t inap.d -rare. /2 12018 title 5 Official Inspection Forma:Subsurface Sewage Disposal System.Page 11 of 18 a 'OVA ea t of Massachusetts T*tle 5 a iciai.v :. inspecto Form w. Subsurface Sewage Misposall System Form of for Voluntary Assessments e t m � �� try Property Address ...m� rv . .. is ne Owner Owner's Name information is No Andover 5 7 3 2 2 6 required for every ...... ......... ..... _.._..m..........__.. _._ ....._ .._.......__.. ... _...__. . . page. City/Town State Zip Code Date of Inspection D. System Info at o (cont,.) . Tilght r Holding Tank (cant.) Alarm present: El Yes Alarm level: _. _....._...._...............N... � _......_. _.......... Alarm in working order- El `des Comments ments (condition of alarm and float switches, etc.)* -- Aftach copy of current pumping aping contract(required). Is copy attached? El Yes No 9. istri uti+ x (if present must be opened) (locate on site plan): Depth of liquid level above outlet inert 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.).- Box needs replacing dine to it being broken around the inlet and the outlet inverts are corroded. Full f' solids from broken concrete and dirt. t5in p,d .rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposai System»Page 12 of 1 Commonwealth of Massachusetts Tl*tle 5 Official Inspect'ion For p Subsurface Sewage Disposal System Form Not for Voluntary Assessments 90 Lai Street Property Address Owner M_cGarvey.,.:: _Dwarf._ Owner's Name information is 01845 26 required for eve ......w.._..... _..w_._.._.._._W......_.._....... . w...w __..__......................w.w_...._ ......._.__. ...._...w..._ _. ._.__. ..... ...... .�......_ ..........a�...�_� _.______._...._...__.....�.�. ...�... anew City/Town own State Zip Code Date of Inspection D. System Information (cont. 10. Pump Chamber(locate on site plan)- Pumps in irkingorder- El Yes No* Alarms in working order: 0 Yes El Comments (note condition of pump chamber, condition pumps and appurtenances, etc. It pumps or alarms are not in rking order, system is a conditional pass. 11. Soil �bs tii System (SAS) locate on site plan, excavation not required)- If SAS not located, explain why: ' e: 0 leaching pits number* El leaching chambers, der: _ ..._ ._..._tt_..w.. ..� ........ E] leaching galleriesnumber- E] _.....__....__. _... _...� ___._.__..�... leaching trenches number, length: 40 leaching fields number, dimensions: � � overflow easel number: �......_..._.__. .._._.. ... ....... ... El innovative/alternative system Type/name of tech log - � _.._.. _ �___. .__........_. . .....�__........�.�ti._..__..._..w._..m.__... ..__ ........ _........ ........ t insp.d r .rev.7/26/2018 Ttle 5 Official inspection Form ubsurfaceSewage Disposal System•Page 13 of 1 uommonwealth of Massachusetts Tl utficia e ct"i o n"tle 5 w _.. Form 1> Subsurface Sewage D*Isposal System Form Not for Voluntary Assessments � M 90 Lacy Street Property ddress ..__._ ......... _......_. _. __......W ........ ...w...... ... .._..... _..._._..._...._...._.__.._...... _..._....... _...�.................. _...._._.......... _......... �....... _. �_........w.__...a._..._. ..._.._..._.._ .._._........... Owner Owner's Name information is Moro Andover A 01845 /3 2 26 required r every __..m_._ _....._ _......�.� �... . .............. _.........��__.___.._ ._....... ........... ...._...._ .�.�.� ..._...._..._....._._......_........ _....w_w........ ....�........�. .... page. City/Town State Zip Code Date of Inspection D. Syste ormation (coat.) 11. So*11 Absorption System (SAS) (coat. Comments (note condition soil, signs of hydraulic failure, level of ponding,, damp soil, condition vegetation, etc.): r itT no dampsoils, no h C raulic failure 12. Cesspools (cesspool mast be pumped as part of inspection) (locate on site plan): Number and conf'iguration _... ... _. __......... .........__. _... Depth —top of liquid inlet inner _.. _...__. .....__.._.. _..._._._._.__. _. Depthof solids layer _w....._w.._.,___..._....._...__..._ _...........�__.__...__..._.ry....._.._ Depth of'scum layer, _._... ......._... __ .._..... Dimensions of cesspool ........_ _.._._..w ._....._ .......__....... _.. ..... _. Materials of construction __.__. .._..__._..............._._.__... . .. _.w..... _.... Indication of groundwater inflow Yes No Comments (mote condition of soil, signs of hydraulic failure, lentil of ponding, condition of vegetation, etc.): t5in . o -rev.7126/2,018 Title 5 Official Inspection Form,Subsurface Sewage Disposal System.Page 14 of 1 %oommonwealth of Massachusetts -- 5 Offinc'ilal Inspecto tle ion For I Subsurface Sewage s osall Systern For of for Voluntary Assessments 90 Lacy.,Street Property Address Owner McGarvey,',,,,Diane _.._....._......._._. .. _.. ...._...._ _-____.w____.. _._..._.... Owner's Name information is No /30/2026 required for ever _... _�___..__.... .. __.... _... ..... ............. �.. _......_. .._.w... .._.. .. ...... �................._.. _.. _. page. City/Town Mate Zip Code Date o Inspection D. System Information (cont,.) 13. Privy (locate on site plea).- at rials of construction* ___�__..._ ......... .M..._�. __.__..._ .. _. ._.._.._..._.W._._..... ._...._... .. ...w -.____.___.. Dimensions . _.___.._.__.._ _.__...._.... ....w__...w.._ .............. _.._.. _......ry ._..._. ........... .ww Depth of solids Comments (rote condition of soil, signs of hydraulic failure, hirel of ponding, condition of vegetation, etc.): t5 nsp,do -rev.7/26/2018 Title 5 Offic4 Inspection Form:Subsurface Sewage Disposal System.Page 15 of 1 Commonwealth of Massachusetts *tie 5 Off* I I Inspect* For jF T1 icia ion Subsurface Sewage Disposal System Form- Net for Voluntary Assessments y /Jq 1 90 Lapy Street Property Address McGarve , Diane Owner Owners Name information is No. Andover MA 01845 07/30/2026 required for every page. GitylTawn State Zip Code mate of inspection D. System Information (cant.) 14. Sketch of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below .drawing attached separately 1 400 ..- .� f t5insp.doc•rev.M&20!8 Me 6 official Inspection Form:Subsurface Sewage Disposal System•Page IS o€18 Commonwealth of Massachusetts q ==_ .,_------- Title 5 "ff ec'" 0 icial Insp tion Form Subs ace Sewage Disposal System Form Not for Voluntary Assessments �a µ �.. Lai Street Property Address McGarv _Dian..... Owner __...... ... ne�r's Name information is, required for eve _._..... _...... age City/'Town State Zip Code Date of Inspection s ecti rw ......�.... �... �a. D. System Information (cont.) 5. S*Ite Exam: Check Slope Surface water Check cellar EJ Shallow wells Estimated depth to l ground water'. .��..... _....._ . __.......a_........_...m.... ..__.... _..... ...... _.......... �' � feet. Please indicate all methods used to determine the high ground water elevation: Obtained fro system design plans on record / /�1 78 If checked, date f design plan reviewed.- _...Date ._ .. ...m...._........ _._._w_.._.....__.. �.._.�.._._..._ __. Observed site (abutting property/observation bole within 150 feet of SAS) Checked e with local Board of Health explain.- called file Checked with local excavators, installers (attach documentation) Accessed USGS database x lain- You must describe how you established the high ground grater elevation.. Taken..........from files on record Before filing this Inspection Report, please see Report Completeness Checklilst on next page. t5insp.do rev.7/26/2018 Title Official Inspection Form,Subsurface Sewage Disposal System•Page 17 of 1 lq�""\ t.;ommonwealth of Massachusetts T*tle 5 Offnici*al Inspect'ion Form :. 10 Subsurface Sewage Disposal System Fors - Not for Voluntary Assessments 90 Street .. w :!.. .w __..M _.___...w_...___. _ ._..___.__...M. __M_...._._.._... ...........__.__-__w Property Address __..._. _rvtzy, Diane...w.. _____._w_ Owner rn r wner's Name information is Igo. Andover M 1 45 7/3 /2026 required for errs _�.._.. ._._ _ ._....w_M�.w m.....__ � ...._..__ ____.. pages. City/Town/Town State ZipCade Cate of Inspection E. Report Completeness Checklist Complete all applicable sections of thla►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 21 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed D. System Information.- For : Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System dram on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5 nsp.dcc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 1