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Home My WebLink AboutTitle V Inspection Report - 151 RALEIGH TAVERN LANE 8/18/2015 � Commonwealth of Massachusetts . =�=^°�� N��N 0��"�� N=�� Title �� m�@0@��Q Inspection N—��mmmm Subsurface Sewage Disposal System Form Not for Voluntary Assessments � 151 R | i h Tavern Lane Property Address � David Pinson Owner Owner's Name information is equiredfnrmery North Andover Ma 01845 8/18/15 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 ofthe form. � � Important:When A. ��U0��U UU0�m/�K�|��^��10 �Ui om�nno "~^ General Information ~~ on the computer, use only othe tab 1� |'-'-- key� — � cursor'dnnot KevnUejlton � use the return Name o[Inspector key. Wastewater Treatment Services mrQ Company Name � � 44 Commercial Street Company Address Raynham Ma 02767 ^---~�---^ CihNro*n State Zip Code � 8�� 508-880-0233 S113528 w��~�m�w� �� Telephone Number License Number �� 7R1� ��' � ° �°'° j,(jVYN or- B. Certification HEAU'11DEE MMER1, o I certify that I have personally inspected the sewage disposal system at this address and that the � information reported below is true, accurate and complete as of the time of the inspection. The inspection � was performed based on my training and experience in the proper function and maintenance of on site � sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title S (31UCy0R|15'OOO). The system: 0 Passes [ ] Conditionally Passes Fl Fails � El |Approving Authorih/ | � 8M015 |nspectkr'eGithufum Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board � of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or � has a design flow of1U.00Ugpdorgreater, the inspector and the system owner shall submit the � report to the appropriate regional office of the DER The original should be sent to the system owner � and copies sent b)the buyer, if applicable, and the approving authority. °°°^Thim 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 ofuse. mm".ono Title o Official Inspection Form:Subsurface Sewage Disposal System'Page 1 mn Commonwealth of Massachusetts Title 5 Official Inspection Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is required for every North Andover Ma 01845 8/18/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) 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: The system is operating as designed B) 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 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is North Andover Ma 01845 8/18/15 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ 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): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) 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. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is North Andover Ma 01845 8/18/15 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. 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: ❑ 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. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts v, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is North Andover Ma 01845 8/18/15 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is required for every North Andover Ma 01845 8/18/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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 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? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(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 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is North Andover Ma 01845 8/18/15 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: The system @ 151 Raleigh Tavern Lane is designed for 440gpd. The system includes a 1500 gallon tank with a I/A technology(FAST) system in the 2nd compartment for treatment. The treated effluent flows to a dosing chamber by gravity. The dosing chamber feeds a 30'x50' leaching field. 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gp d))� est.43gpd Detail the system is under its daily design flow of 440gpd Sump pump? ❑ Yes ® No n/a Last date of occupancy: Date Commercial/Industrial: Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is required for every North Andover Ma 01845 8/18/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) n/a Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ® Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is required for every North Andover Ma 01845 8/18/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 18 years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: fee t Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): All piping looks good, no signs of leakage and venting is good Septic Tank(locate on site plan): DeDepth below grade: COT p g feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) The septic tank has access covers to grade for pump out. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 10" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts . F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 01 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is North Andover Ma 01845 8/18/15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 0" Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The structural integrity of the septic tank is good. No signs of leakage or infiltration. The inlet tee is in good condition and the outlet tee is built into the FAST system. The liquid level is at operating level for a FAST system. No pump out recommendations were made the system, the system has been pumped in the last 2 years and is operating as designed Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments e 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is required for every North Andover Ma 01845 8/18/15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 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 grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of!Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is North Andover Ma 01845 8/18/15 required for every page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert n/a 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.): Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): The dosing chamber is in good condition with no signs of leakage or infiltration. The pump and on/off float was tested as well and the high water float. The tank alarm is located in the basement and is working as intended * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is North Andover Ma 01845 8/18/15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-30'x50' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No signs of hydraulic failure, the vegetation looks normal. No signs of ponding or damp soils. 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 ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is required for every North Andover Ma 01845 8/18/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forme Not for Voluntary Assessments 'can, 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is required for every North Andover Ma 01845 8/18/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 _I oa 5/tI n lair t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is North Andover Ma 01845 8/18/15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated fee depth to high round water: p g g feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1998 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Established ground water from the design plan on record with the Board of Health. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ;M 151 Raleigh Tavern Lane Property Address David Pinson Owner Owner's Name information is North Andover Ma 01845 8/18/15 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Aug, 26, 2015 1 : 33PM No, 6408 P, 1 Summary Record Card generated an 8/26120151:36:23 PM by Karen Hanlon Page 1 Town of Noah Andover Tax Map # 210-10o -0111-0000®0 Parcel Id 17936 151 RALEIGH TAVERN LANE DAVID & CAROLINE PINSON 151 RALEIGH TAVERN LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.06 Acres FY 2016 UB Mailing� ndex Name/Address 7Ype Loan Number Active/Inact. From Until DAVID&CAROLINE PINSON Owner 151 RALEIGH TAVERN LANE NORTH ANDOVER,MA 01845 ANTINORI,PAUL Previous Customer Inactive 11/15/2006 151 RALEIGH TAVERN LANE NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id.14139.0.151 RALEIGH TAVERN LANE Last Billing Date 6/4/2015 2100123 02 Cycle 02 Active UB Services Maint, Account No,2100123 Service Code Rate Charge Multiplier/Users MISCFFFADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 64.60 /1 UB Meter Maintenance Account No.2100123 Serial No Status Location Brand Type Size YTD Cons 32892263 a Active ERT HH b Badger w Water 0.63 0.63 767 Date Reading Code Consumption Posted Date Variance 8/4/2015 1118 aActual 39 124% 5/4/2015 1079 aActual 17 6/22/2015 16% 2/3/2015 1062 a Actual 15 3/2012015 -45% 11/3/2014 1047 a Actual 28 12/15/2014 190/0 8/1/2014 1019 aActual 22 9/11/2014 34% 5/5/2014 997 aActual 17 6/12/2014 -10% 2/3/2014 980 a Actual 18 3/17/2014 -41% 10/31/2013 962 a Actual 29 12/20/2013 9010 8/1/2013 933 a Actual 27 9/16/2013 35% 5/1/2013 906 aActual 18 6/18/2013 20% 2/7/2013 886 a Actual 18 3/13/2013 -27% 10/30/2012 870 aActual 22 12113/2012 -90/0 8/2/2012 848 aActUal 25 9/26/2012 36% 5/2/2012 823 aActual 18 6/20/2012 -11% 2/2/2012 805 a Actual 21 3/14/2012 15% 11/1/2011 784 aActual 18 12/15/2011 -34% 8/1/2011 766 a Actual 27 9/14/2011 72% 5/2/2011 739 a Actual 15 6/13/2011 9% 2/4/2011 724 a Actual 15 3/15/2011 -49% 11/1/2010 709 a Actual 26 12/13/2010 -30% 8/3/2010 681 a Actual 41 9/13/2010 31% 5/312010 640 a Actual 31 6/9/2010 -3% 2/1/2010 609 aActual 32 3/11/2010 -9% 1112/2009 577 aActual 35 12/11/2009 -32% 813/2009 642 aActual 50 9/11/2009 1% 5/612009 492 aActual 51 6/16/2009 2% 44 Commercial Street Raynham,MA 02767 Tel: (508)880-0233 Fax: (508)880-7232 October 16, 2014 North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Attention: Health Agent Reference: FAST®Wastewater Treatment System- Serial Number: MCF215 Attached please find the Field Inspection& Service Report with field test results for services performed on 10-9-14 at the property of David Pinson located at 151 Raleigh Tavern Lane, North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: David Pinson Massachusetts DEP N CC00 R P 0 R A T E 0 8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808 e-mail:onsite(a�-biomicrobics.com, www.biomicrobics.com, 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-MicNobics Single Home FAST'System 22663 INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address: 151 Raleigh Tavern Lane Name:Wastewater Treatment Services,Inc. North Andover,MA 01845 Owner Name:David Pinson Mail Address: 151 Raleigh Tavern Lane Mail Address: 44 Commercial Street North Andover,MA 01845 Raynham,MA 02767 Phone:978-681-6468-Home Fax: e-mail: Phone:(508)880-0233 Fax:(508)880-7232 e-mail: INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pump out MicroFAST.5 MCF215 9/21/1998 7/1/2008 EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating N/A Audio Al arm Operating (if present) Blower(s) Air Inlet Filter Clean x Blower Hood Vents Clear x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Pumpout Required x Primary Settling Zone 9" Aerobic Treatment Zone 9" EFFLUENT(optional) LIMIT RESULT Estimated Daily Flow 440 gpd pH(Standard Units) 7 Color Clear Temperature 69 Odor Earthy Comments:Pumps and floats were inspected and are operational.Alarm not accessible. TECHNICIAN SERVICE DATE David Zavelle 10-9-14 44 Commercial Street Raynham, MP, 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 INSPECTION AND TESTING AGREEMENT Agreement entered into by and between Wastewater Treatment Services,Inc. (herein called WTS) and the FAST'System OWNER(herein called OWNER)for the inspection by WTS of certain equipment of OWNER which is described below. Upon acceptance of this agreement at WTS's office,WTS will render the following services only: Equipment will be inspected at least 2 times per year that this Agreement remains in effect,with the first inspections beginning . These inspections will include: 1) Testing of the sludge depth in the septic tank. 2) Inspection,power testing and clean/replace intake filter of the air blower. 3) Inspection of the alarm system. 4) Inspect overall condition of FAST®System. 5) Notify OWNER of any problems encountered. 6) Service other than routine maintenance will be billed at an hourly rate,plus travel and parts. WTS shall notify the local Board of Health and Department of Environmental Protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. OWNER will be billed standard WTS charges for any parts used in repairs or maintenance. Any additional labor time will be billed to the OWNER at current labor rates of$78.00 per hour. Emergency service between regular inspections will be provided at standard labor rates during normal business hours; at time and one-half after 5:00 PM and on Saturdays; and at double time on Sundays and holidays. Emergency service charges will include a minimum four(4)hours of labor, plus standard WTS charges for parts, plus mileage and travel charges. The annual rate includes routine maintenance,but does not include repairs required for damages caused by abuse,accident,theft, acts of third persons, forces of nature, or alterations made to the equipment. WTS shall not be responsible for failure to render the agreed services if caused by strikes, labor disputes,non-cooperation by OWNER, or other factors beyond the control of WTS. OWNER understands and agrees that WTS is not responsible for special, incidental or consequential damages, including but not limited to loss of time, injury to person or property, or equipment failure. OWNER agrees that WTS may enter OWNER's property and have acceptable access to all areas deemed by WTS to be necessary or appropriate for WTS to perform its duties hereunder. Current WTS practice is to send OWNER approximately 10 days before expiration of the term of the current contract(1) either a new contract or an offer to extend the current contract's term, and(2) an invoice for one year of service. It is OWNER's responsibility to timely return the payment and either the new contract or the accepted extension, completed and signed. WTS must receive the payment and document before expiration of the then current contract year to assure continuous contract coverage. Failure to return such documents on time or to otherwise comply with this contract,may result in suspension of service, cancellation of the contract and/or nullification of warranties, at the election of WTS. OWNER may not assign this contract without the prior written consent of WTS. It will remain in force until a party cancels by written notice to the other at the address given herein, or until the contract term expires,whichever is sooner. MANUFACTURER MODEL NO SERIAL NO. LOCATION ANNUAL RATE PERMIT Bio-Microbics HomeFAST MCF215 North Andover,MA $400.00 Remedial Includes (2)Field Tests EQUIPMENT OWNER ff Wastewater Treatment Services,Inc. *Signed by OWNER: - David Pinson Signed: *Address: 151 Raleigh Tavern Lane 44 Commercial Street Raynham,MA 02767 Tele: (508) 880-0233 *City: State: Zip: Fax: (508) 880-7232 North Andover MA 01845 Telephon e 978-681-6468 Effective Date of Agreement Daytime Telephone: OWNER understands that(1)ANNUAL RATE payment is for one year only commencing on the effective date set forth above and is non-refundable; and(2) Current DEP Regulations require OWNER to maintain a service agreement for the life of the FAST®Syste I/RAVE READ AND UNDERSTAND THE FOREGOING. *Signed by OWNER: v A Field Testing Onsite testing performed twice per year will be used to demonstrate that the systems are operating at a secondary treatment standard of 30 mg/L of BOD5 and TSS. The following will be performed: 1) Visual examination of the effluent for color,turbidity and effluent solids. 2) Effluent pH to determine if the waste water is between 6 and 9 standard units. 3) Dissolved Oxygen, 2mg/L or more,to ensure that the system is operating. 4) Turbidity,less than or equal to 40 NTU. If the effluent does not meet effluent quality standards, a grab sample will be collected for laboratory analysis. Results sent to state and local Agencies as well as the OWNER. OWNER is responsible for providing acceptable access to effluent for field testing and/or to enable a grab sample to be taken for laboratory testing performed. If such laboratory sample is required, OWNER will be responsible for clia-rqs incurred. IF REQUIRED,THE COST FOR THIS ADDITIONAL TESTING BE $190 00/VI T. *Approval for Additional Testing if Required �� Homeowners Signature Operator assigned: William Everett Telephone: (508)400-3868 *Engineer: