HomeMy WebLinkAboutPASS - Title V Inspection Report - 39 SPRING HILL ROAD 8/4/2026 Commonwealth of Massachusetts, Town of Nofth Andover
TI'tle 5 Official Inspection Form
SEP 112026
I> Subsurface Sewage Disposal System Form Not for Voluntary Assessments
maw 3 9 Sp in'gh�ill Road
—--—--------------
Property Address
Bosco, Mark
Owner . ..................... .......
Owner's Name
information is No. Andover MA 01845 08/04/2026
required for every ...... .......... .......
page. City/Town State Zip Code Date ofinspection
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. Inspector Information
filling out forms
on the computer, John L. DiVincenzo
use only the tab
key to move your Name of Inspector
cursor-do not J,-&.SD.eve-,I.Opment/Sty wart'sSeptic Servicuse the return
key. Company Name
58 S . Kimball St.
--------------
tab
Company Address
Bradford MA 01835
City/Town State Zip Code
978-372-7471 S113386
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5
(310 CM R 15.000),- 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below,is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system-
1. Passes
2. Conditionally Passes
3. Needs Further Evaluation by the Local Approving Authority
4. E] Fails
08/04/2026
I ector's ignature Date
The system inspector shall s m a copy of this inspection report to the Approving Authority (Board
ub '
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the systern owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note.- This report only describes conditions at the time ofinspection and under the
conditions of use at that time. This iinspection does not address how the system will perform
in the future under the same or different conditions of use.
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ico I
ion
r Inspect"
Subsurface Sewage Misposall System Form Not for Voluntary Assessments
-.rO39 Sp n hill,
.__. a
..... ._....., _........ _._...... .. ..............................._...
Property Address
Bosco, Mark
Owner Owner's Name ....... .............. .........................
information is o. Andover A� C 1 5 / 202
requiredfor even _µ.._.._..... ... __... .�.,_M...__........ _w._..._.._........__.. . _... .._._.. ..... . ........._..._.....
page City Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary- Complete , 2 3, or 5 and all of 4 and 6.
System Passes.:
l 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-
Lines, in the leachf eld� have grease in them. `the field should be jetted t get the grease out before it
_.._�
causes a r hle Roving.emthe arhn� dis�,p. gal is rec� ends .
System Conditionally Passes:
El e or more system components as described in the "Conditional nal Pass" section n 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"yes", "no" or"not determined" , N, for the following statements. if"not
determined,11 please explain.
The septic tank is metal and over 20 years olds` or the septic tart (whether metal or riot) is structurally
unsound exhibits substantial infiltration or exfiltration or tank failure is imminent. System ill pass
inspection n if the existing teak is replaced with a complying septic teak as approved by the Board of
Health.
metal septic teak w,ill 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.
F1 Y N ND (Explain below):
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Commonwealth of Massachusetts
u"'"
ffici'a
Inspect"
............. -------
ion For
VA TItle 5
o 10 Subsurface Sewage DIs oral System Fore Not for Voluntary Assessments
3 ....MSpri hill Road
Property Address
Basco, Mark ..Owner _ __....... .......... _4_ _..... . ------_-____..._____.__--_.__-_.._____
Owner's Name
information is c. Andover 45 / 4/,2 2
required for eve � _...�_...___....�__..__._.__�...____________._____.______.__ _.__..____ . _......___. _____.�__�__._ _..__.._____.._..___...__._...________
page. own State Zip cede Date of Inspection
C. Inspection Summary (coat.)
System Conditionally Passes (cont.):
El Pump Chamber pumps/alarms not operational. System will pass with Board of health approval i
pumps/alarms 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):
broken pipe(s) are replaced El Y El l N (Explain below):
obstruction is removed 0 ND (Explain below).-
E]
distribution box is leveled or replaced N N (Explain below)"
The system required pumping more than 4 times a year due to broken or obstructed ipe(s). The
system will pass inspection i (with approval of the Board of health):
broken pipe(s) are replaced El Y El I (Explain below):
obstruction is removed 0 C I (Explain below):
3 Further Evaluation iIs Required by the Board of Health:
Conditions exist which require further evaluation by the Beard of Health in ardor to determine if
the system is tailing to protect public health, safety or the environment.
a. System will pass sunless Board of Health determines in accordance wlth 310 CMR
15.303(° ( that the system is not functioning ire a manner,which will protect public health,
safety and the environment:
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Commonwealth of Massachusetts
pection For
------- 'tie 5 1 Ins
Ti Otticia
_..
-- - I> Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
� .. 39 S rare hall Road _.
Property Address
Bosco, Mark
Owner .....................
Owner's ner's Name
information is
requiredfor ewes �_.�_�_.___.w._w._......_w_....___....___-___...._._w....._w.ww__.w.__ __....__..__..__.__ _.........__.__........_.___M.__M..._.___m_w.._
page. City/Town. .w.__w. ._. _ State Zip :ode (date of Inspection
C. Inspection Summary Cont.
0 Cesspool or privy is within 50 feet of a surface grater
El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
. System will fall unless the Board of health (arid Public Water Supplier, If any
determines that the system is functioning in a manner that protects the public health,
safety and environment
[] The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface grater supply or tribunary to a surface water supply.
[:] The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply..
El The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
[:] The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance-
This system passes if the well water analysis, performed at a [CEP certified laboratory, for fecal
colifcrm 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
1:1 z Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
0 z qq p
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
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uommonwealth of Massachusetts
PIS
TI'tle
n a Subsurface Sewage a isposa System Form Not for Voluntary Assessments
ri hill Road
. - __S
Property Address
Bosco, a
Owner er ....... .......
Owner's Name
information is No. Andover 5 2 26
required for oven y_- _m.__...__.v. _............ ... _.....w_ ... ...........
page. City/ own State Zip Code Cato of Inspection
C. Inspection Summary (cont.)
4 System Failure Criteria Applicable to All Systems: coot
Yes No
El Z Static liquid level in the distribution box above cutlet invert due to an overloaded
or clogged SAS or cesspool
Liquid depth in cesspool is loss than 6" below invert or available volume is less
than Y2day flow
1:1 z Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pies . flu ber of times, pumpedw
E] z Any portion of the SAS, cesspool or privy is below high ground water elevation.
ED z Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
El z Any portion of a cesspool or pr,ivy is within a Zone I ot'a public water supply
well.
1:1 z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. hia
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal colilform bacteria indicates absent and the presence
of ammonia onia niltro a and nitrate n*1tr gen *is equal to,or less than 5 ppm,
provided that no other faflulr+e criltaria are triggered. A copy of the analysis
and chain of custody a st be attached to this form.
El z The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 g d.
0 z The system Wills. 1 have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.,303, therefore the system Carla. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5 Large Systems: o be considered a large system the system must serve a fa ty wl"th o
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section CA.
Yes No
El the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tri'butary to a surface drinking water supply
the system is located in a nitrogen sensitive area ('Interim ellhad Protection
Area- 1 or a mapped Zone 11 of a public rater supply well
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Commonwealth f Massachusetts
61 .. :w e 5 ionFor� y��
:. to
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
tip.
39
Spriggh
Property Address
Bosco, Mark
Owner ......
Owner's Name
information is No. Andover MA 01845 0 /04/202
required for every �it,._M� ��.... ._..__... �t�t��.__ Zip Code _ _m.....u..._._. _._..__. �_._„m._. _.._ .._�.____.w_w._v........._.. _..._
Date of Inspection
C. Inspection Summary (coat.)
If you have answered "yes' to any question in Section C.5 the system is considered a significant
threat, or answered `1yes" 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.
6. You must r dicate "yes" or"no"for each of the following for allinspections:
Yes No
Pumping information was provided by the owner, occupant, or Board of Dealt
Were any of the system components pumped out in the previous two weeks
Has the system received normal flows in the previous two week period?
Have large volumes of enter 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 seepage back ups'
E E] Was the site inspected for signs of break out'
E 1:1 Were all system components, excluding the SAS, located on site?
E El 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(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on*
Existing information. For example, a plan at the Board of Health.
Determined in the field if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) 310 C P 15.302 5
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Commonwealth of Massachusetts
'Inspection T"Itle 5 u'ff'icia
10 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
a
,ter
M 39 r r hill Road
Property Address
Basco, Mark
Owner
n is Mama .......... --------- ..........
information Is No., Andover MA 01845 /04/2026
requiredfor a re ry __..____._._.__.___-__-_-_- _-.__.__._._�____.__.___.._._..-..._--.-_..__.,...__..._-_._..._..-mM__.__ __.... �....._ __�_.._ ___
page. City/Town State Zip fade Date of Inspection
D. System Information
1. Residential Flow Cond'itions,*
4 4
Number ber of bedrooms (design)* _.._....___ .m_..._..._w_._...__ Dumber of bedrooms (actual)-
DESIGNflow based on 31 C 15.203 for example- 11 d x of bedrooms)-
_
Description:
Number of current residents: ._ ......
Does residence have a garbage grinder's Yes No
Does residence have a water treatment unit? El Yes El No
Ifyes, discharges to: - _ .._._ _-_ ____.______._..___._____r_._.________. _..__,_.. M. ._.m __..... _.._._____, . _. ._ __._-.___._...
Is laundry on a separate sewage system' (include laundry system inspection El Yes
[Z No
information in this report.)
Laundry system inspected' Yes o
Seasonal used' El Yes o
Water meter readings, if available (last 2 years usage 'pd _._M_....._......__._W..-. ..M._. -.....___._
C etail-
Sump pump' El Yet No
Last date of occuncy,
Date
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Commonwealth of Massachusetts
_.. Title Ot"t'i'llci'al Inspect*ion
a _._.. N Subsurface Sewage Difsposall System Form Not for Voluntary Assessments
39S rin hill Road
. __
Property address
Bosco, Mark
Owner ...... -----------
Owner's Name
information is .. Andover 45 4'2 26
required for ever ..... ..w.. ..w. ...........�....M..M_.._..M ___.__ww.._....__ � ... _...w........_.
page. Inspection
D. System Information (cont.)
2. C+ rr merc al Industrlal Flow C n l l r s
Type of Establishment-
Design flaw based on 310 CMR 15.2 3 - _..... .. �. .._w......_..... .�.......�......._............_w... ��._...� �w...._..w_.._�...._�_.
Gallons per duly d
Basis of design flow (seats/persons ft., etc.). .__ ..._.�..__.......� �. ._w. ..�...._..........._�...�._.__.. _._v._wv...._._
crease trap present? El Yes No
Water treatment unit resent? El Yes Ej No
If yes, discharges t ....... ... . ............_ � ......_.....
..
Industrial waste holding tank present? es No
Non-sanitary waste discharged to the Title 5 system? Yes No
Water meter readings, if available-
Lastdate of occupancy/use- D ate.......w�.. . .........____.._ ._...._......... _......_._._. _ .._rvw_w...__._._.... ...__..............
Other(describe del
3. Pumping Records:
Source of information- ......... . . .... ...... .... _................... __ .._. _ _ _. ._.........._..... .. -----
as system um ed as part of the inspection? Yes No
1500
If yes, volume pumped-
gallons
Si'. .... e on truck.
How was quantity a ......pumped determined? _._...m _._.. _._.__.__...__ ........_.._..w.w_........ _._........ ...._..._.......
Reasonrn in lns....:egtmtan ....... .._..... ._ . . _ .. .... _._._._ . ._..... . .......... ._... ........... ...__...........
t5ins . -rev.7/26/2018 "title 5 Official Inspection Forma Subsurface Sewage Disposal System.Page 8 of 1
t;ommonwealth of Massachusetts
------- T'Itle 5 OtAt"'icial Inspecti"on For
:. 10 Subsurface Sewage *Is osal System Form Not for Voluntary Assessments
9 Sprip hill Road
Property Address
Bosc
__...._.._ .. . ..
Owner Owner's Name
information is o. Andove... 01845requiredCity/Town ... ........ __.. ..._.__......�.�._._._�..._. _._._..._��._.._��.__.... ..._
page State Zip Code Celts of Inspection
D. System Informati (coat.)
4. Type of System
Septic tank, distribution box, sail absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to he obtained from system owner and a copy of latest
inspection of the I/A system by system operator under contract
Tight tank. Attach a copy of the IEP°approval.
El Other (describe).-
Approximate age of all components, date installed if known) and source of information-
1986
Were sewage odors detected when arriving at the situ El Yes Z No
5. Buildilng Sewer(locate on site plan):
1 NM
epth below grade: .. ._. _....
__ .______...________ .__._._w_..___.___
feet
Material of construction:
cast iron 0 40 PVC other(explain). _.._.._w._.. ..M....__..... ._w.__.._ ._...W n_w.. __..... _._......�... _....._m_...�
Distance from private water supply well or suction line: fee, _._,_..ay..m._,.., ._..a w. _._.___ ._....___ _...._._..__. _....._..... ____ .__.n..._ ..
Comments on condition of joints, venting, evidence of leakage, etc.):
t iinsp.doc•rev,7N 1;1 18 Title 5 Official Inspection Fora:Subsurface Sewage Disposal System•Fags 9 of 18
' �, I weal h ofMassachuseft
von
UTTIcs a a_.. _... Form
Tatle 5 0"wo's iai inspec"Lo
µ_ Subsurface Sewage Disposal System Form Not for Voluntary Assessments
..
39_§p� ill Road
........ .__...._.. ...._._.._W.._......___._.
Property Address
Bosco, Mark
Owner r r��ry...... . ------
w... . ......... �_.
Name
026
information is ....... ......... _m......_.__..___.._...�._._..._.�...._M. __._.._..�.m._..�._� _........... _.... __w._..__.. _....required r every page. fit ��� " ate _.__.......�..._w _._..�.. ......... _�.__.._._
_..W.. .....__ Zip Code Date of Inspection
D, System Information (cont.)
6. Septic dank (locate on site plea)::
lift
Material of constr ction-
concrete El metal El fiberglass 0 Polyethylene El other(explain)
Iftank is metal,, list age-
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Yes [I No
4
Dimensions.
� �l �
S�l dge depth: .__._..._.. ..._w...._........._...... _. ..w. ..._..........�.
2411
Distance from top of sludge to bottom of outlet tee or baffle _....w._.. .... _.......___.... .�_....m.......__a.. _. _.._ _..
Scumthickness
_ ..111..............._.. . ......_.__......_ ._. w_._._..n..._._..w....._ __...._ _ w............
211'
Distance from top of scum to top of outlet tee or baffle _.... ..__......_..�..........._..� ....... . ...._......_. _....._....
611
Distance from bottom of scum to dotter of outlet tee r ale ......_n--____w_._..__ _..._. ...... ..._...._ . _.......... ........_
o dimensions were di ens s determined? T .__............................easura/�lu � .. .
Comments (ors pumping recommendations, inlet and outlet tea or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.)-
Both of baffles are in god m..e.....__l 1eage....�pjd...11.1" cad.
t5l . 1 .rev,7/26/2018 Title 5 Official Inspection Fora;Subsurface Sewage Disposal System.Page 10 of 1
Commonwealth of Mass c setts
's
T'tleuOtticiaect ion Forb
- � Subsurface Sewage C lispos l System FormNot for Voluntary Assessments
. 39 hill Road
w� .
Propert/Address
Basco, ark
Owner
Owner'sName ................ .........
information is plc. Andover IAA_ 01 5 C / /2026
required for ever It �Torn/r� �t�t� ,._.._ .�i ��d�_.._.__._._. ... ,......_..r.,_�_� _��_._._. .._... .�__.________ _________...___.
page. y _ __._____._ p ate of Inspection
D. System Information (coat.)
7. Grease Trap (locate on site plan)*
Depth th below grade.: -fee
feet ------ ________._..__..e_..._........... _._.... ........... ._.,._............._.
Material of construction.
El concrete El metal fiberglass polyethylene El other(explain):
Scum thickness __-___......._.._
Distance from top of scum to top of outlet too or baffle
Distance from bottom of scum to bottom of outlet tee or baffle _.._.._ ._.._.._.a. .. ..... _.__ _ ______-______ __-__
Date of last pumping. -atte ...... ...._.. __w__.___-_
Comments (on pumping recommendations, Inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.).
. T*Ight or H t ding Tan (tank must st be pumped at time of Inspection) (locate on site plan).
Depth below grade-
Material of construction.
El concrete 0 metal El fiberglass polyethylene El ether(explain).
-------
Dimensions- ._.._..._._. ..___w_w._ __-__.__.... ��_�......._._.....M... ...�_..._....._.__.....�..._..� �......�....
capacity. __.._....___.__
gallons .____.__.__..M ...__...._........���..._....._�.�......_.�._..._.. �..�__..m_-
Design n Flow. ____.___ ___..__,_ _.__..
gallons per day
t5in . cc•rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 11 of 1
Commonwealth of Massachusetts
i ci"a
Title 5 ff" I Inspectnion For
ra
_..._.._
:.. ' Subsurface Sewage Disposal System Form Noto l r Assessments
39 S r n hill load
Property/Address
Bosco, Clark
Owner Owner's._ ___________._.___...__._ ._.____.__.___...........�,_.._a._.. ._.-----..._.. ._._...w.......
_�_..._ ...__.._._..........._.._____.._.._m.....,.__.__.__M.__.__._._..._.._._. ...._.._ _.____...
information is Noo. Andover A 01845 / 4 2 26
requiredfor every __.._m... ._.. ......_ _..w_._..wµ._......._._.___.._�_ ___.�.__..__-_______...___-____-__.__ _._.._. ..... ...._......
page. State Zip Code Cate of Inspection
D. System Information (coat.)
. Tight or H ld'In Tank(coat.)
Alarm present: `des El No
Alarm level: _..._. w._.__ .._ .__._..........._..__W..._..._Mµ. ...._ .. Alarm in working order. El Yet N o
Cateof last pumping: ..D _,,.._....___.__um..�.a�..w_.Ma.._.._. .� ...._., ._...__.._ ..w..... _......... .........� . .�...�......._.�.....m.�w....�_.. .
Comments condition of alarm and flout switches, etc.):
Attach copy of current pumping contract(required). is copy attached' Yes N
9. Cis r* rut*1on Box if present rust be opened) (locate on site plea):
.
Depth of liquid level above outlet invert -.._______.w__.___. mm... __.. .....__._._...___ ._.......__. ._...._�._. __.__ . ..._..._._..___.. ... ......._
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, with solids carryover. Pumped box at the time of septic tank pumping.
estem..needs_t to-be tt .d.�.�.._�_.
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uo�mmonwealth of Massachusetts
T"Itle 5 Off Forb
__._. Subsurface Sewage Disposal System Forme - Not for Voluntary ssessments
:63
39
h+
g G��
ill Road
..- .._
---
Property Address
Bosco, Mark
Owner Owner's Name ........ ...... ...... ......-------- .............
information is Isla►. Andover MA 5 / 4�/2 2
required for ever .__..M........ ...�._...._.w.....�.... _._.._ _.._.... _...__._ _._._ ....__..... _ _._�._.
page. City/Town State Zip Code Cate of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan).-
Pumps ps in workingorder.- El Yes [I
Alarms in working order: El Yes [] N
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. S lill Absorptilon System (SAS) (locate on site plan, excavation not required)-
If SAS not located, explain why:
Type-
El leaching pits number: ---___......____ ____. __
El leaching chambers number. ���. _.__________------_................
.____.
leaching galleries number.-
4 -201
leaching trenches number, length: ._._........._........__.__.__ _____.__.
El leaching fields number, dimensions-
0 overflow cesspool number: __.__.............______.___.._..._...__..M_.�.._...__....._
El innovative/alternative system
Type/name of technology: __.____...______
t5insp.b .rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal l yst rn-Page 13 of 1
uommonwealth of Massachusetts
ion
For
T"Itle 5 Offi'cial Inspect"
Subsurface Sewage Disposal oral System Form Not for Voluntary Assessments
39 S girt hill load
__._._w._._.l___ ..............------------- --------------- --------
Property Address
OwnerBasco, Marl
.._____.w.._.w_ ___ ...------_..__._.w_---------------_____---_------------..M----
Owner's Name
information is. No. Andover 01845 / 4/2 6
required for every __._..._........_,,.____M....._.M. _....�.._._........_........... M. ......_.. _._._____. _-_page. City/Town State Zip Code Cate of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (co�nt.
Comments (mote condition of sail, signs of hydraulic failure, legal of ponding, damp soil, condition of
vegetation, etc.):
No pondirtc , no hydraulic failure, no damp sails. Trenches reed to be jetted to remove grease in lines
before it becomes a problem!._-
12. Cesspool (cesspool must be pumped as pert of inspection) (locate on site plan)-
Number and configuration __ .w....
Depth pth—top of liquid to inlet invert ____..________.___._...._....._..._.w._ ....___.._..__.___w.___..__u .........__...
..__.
Depthof solids layer _._....__. __._.w. ...._ _. ___._______.__......_... _._......a_e...
Depth of scum layer _ _.w____. __.._._M_...._..... . ..._...... _. ......._._._.. .w_.__.____._..
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow El Yes fro
Comments (note condition of soil, signs of hydraulic failure, level of pondin , condition of vegetation,
etc.
t5insp.doo.rear.7/26/2018 Title 5 official Inspection Fora:Subsurface Sewage Disposal System•Page 14 of 18
J"k
t;om�lmonwealth of Massachusetts
T I c s, e UTTIa 11 1 n, c t
wtle 51 r%&*&wm ia ion For
k wA Subsurface Sewage Disposal System Form Not for Vol'�u�ntary Assessments
l.a39S Road
----------- .................
Property Address
Bos,col, Mark
Owner Ow�ner's Name
information is No Andover MA 01845 018/04/2026
required for every —-----
page. City/Town State Zip Code Date of Inspection
D., System, Information (cont.)
13. Privy (locate on site p:lan):
-------
M,ate�rials, of'co:ns,tru:cti�o:n: ------
Dimensions ............................................
............
Depth;, of s,ollids .......
Comments (note condition of soil, signs of hydraulic failure, level of poniding, clonditio�n of vegiletation,
etc.)-
............ ...... .............. ......... ...................
........... .......... ........................... .......... ------- ----------
----------
t5insp.doc-rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 115 of 18
Commonwealth, ioln For
Oiffi:ciall
SubsurfaceDisposal System Form gat for Voluntary Assessmen!ts,
61
., AIL Road
Property Address
Bosco, r
OwnerOwner's Name
information is
required,for r �. .... .m. _
page. City/Town State Zap Code Date of Inspection
D. System Information (cont.
. Sketch Of Sewage Dig oral e
Providei thea disposal I rn i s I i nl' � least �r reference
landmarks or benchmarks. Locate all wells within, 1010 feet. Locate where publicfir supply enters
the building. ck one of the boxesbelow,
El han�d'-sketch in the area below
drawing c separately,
Sun pod .rev.7/261'2011118, Title 5 Official Inspection Form.Subsurface Sewage Disposal System.Pale 16 of 181
uommonwealth of Massachusetts
�tt
T*itlei 5�! 0:Am ago! a ec'" For
o
a _ i l
mm
- � Form Not for Voluntary,Assessmen t
ry � ri ill Road
.a ....... _ .....m m �... _..... ._.�__..._. --_--- - __.�u.�__. ��--- --.--_.._.__.�_ ...�w._ ...... .....
Property dd�iress
_m_..._ ... _...Mark
Owner
.... . . ........_.. ..w ...........�
Owner'
ame
information isir . Ae r A 11 qit or every' ..... _.page. C,ity/Town S,tate Zip gods Date of Inspection;
Di. System Infoir iolnn .
1 *1te Exam��
Check Slope
Surface,water
Check cellar
El Shallow wells
11
Estimated depth t high ground water. -3 e
Please indicate all methods used to de�term!i�ne the high ground water elevat�i �n.,.
Obtained from system design plans on record
...Date 2 ,�w 1�95
I checked, date desi plan reviewed- __��.�...m��....._._ _.._.. �.��_� �_........._.
Observed:, site (abutting ro rtty o s rvati n hol within 150 feet of
Checkedit l'olca,l Board of Health - explain,
Pulled file
Checked with local excavators, installers w (attach docu �tat,ion)
El Accessed tabase,-explain*
You must describe howestablished the high groundwater l ti
Taken from design plans on file E. Neve Assoc., Inc. Water @ elevation1 . . Bottom
of't,ren,ch elevation 217.50.
re filling this Inspection Report, pillease see Report Completenessc Il t on next page.
t5in . -rev.7/26/2018 Title 51 Offic4 InspectionForm:Subsurface Sewage Disposal System*Page 17 of 1
t;ommionwealth
t
Title 5 %'JUIciall lns-Aw-ecti" Form
Ir Ir
'on
nj
f
M a Subsurface Sewage Disposal System Form Not for Vo:lu star Assessments
a,
Property Address
_M ...
B,osco, Mark
Owner Owner s Name
information is
o. over II '
r quire for even m.... .. . -----'�-_.�__... m......._ J� -----�_-_.__....____.....
page. City/Town State Z,ip Code Date of Inspection
E. Report Completeness
Complete all applicable sectilons of thi's form inclusive of:
A. Inspector Information: Complete II fielids in this section.
Z B. Certification.- i ne tod and 1, 21 , or 4 checked
Z C. Inspection Summary:
r 5 completedas appropriate
ilure Criteria), and 6 (Checklist) completed
SystemZ D. Information:
r : Tight/Holding —Pumping contract attached
r ; Sketch of Sewage Disposal System drawn on, �. 16 or attached
For : Explanationo ti to high groundwateri I
t5i .rev. / /' 1 8 Title5 Official Inspection Fora:Subsurface Savage Disposal System Page 18f 1
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