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3 ELEANOR ROAD NOR ad a Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 ELEANOR ROAD, SALEM, MA 01970 AL Property Address CITI JAMES KONTOULES IRREVOCABLE TRUST 130ARD tur riu.0 H Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: Whennfilling out A. General Information forms on the computer,use 1. Inspector: only the tab key - to move your HAROLD T. LINCOLN, JR. cursor-do not use the return Name of Inspector key. RAGGS, INC. Company Name Q P.O. BOX 1027 Company Address CONCORD MA 01742 City/Town State Zip Code 978-369-1100 SI-4162 - Telephone Number License Number B. Certification 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes [ , Conditionally Passes ❑ Fails ❑669 Needs Further Evaluation by the Local Approving Authority Insp t 's Signature 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 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 should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5OfGcial Inspection Farm:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every 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: 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u„ 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 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•3r13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 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 El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3/13 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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. El ® 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 El El Area 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. t5ms•3113 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 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available 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. El ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 II 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 Seasonaluse? ❑ Yes ® No 172.19 Water meter readings, if available last 2 ears usage d AVG 9 ( y 9 (9p ))' AVG GPD Detail: 7/24/13-7/24/15: 16,805 CF Sump pump? ❑ Yes ® No Last date of occupancy: Date 5 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: (Sins•3113 Title 5Offloal 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 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: PUMPED OCTOBER, 2012 PER RECORD Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1,500 gallons How wasyp p determined?uantit um ed FIELD ESTIMATE q Reason for pumping: MAINTENANCE/TANK &TEE INSPECTION 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): (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every 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: AS-BUILT PLAN DATED 08/17/2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet 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.): GOOD, GOOD, NONE OBSERVED AT TIME OF INSPECTION Septic Tank (locate on site plan): 1.51 Depth below grade: feet feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'X5'X5' Sludge depth: 6 t5ins•3113 Title 5 Off cial Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every page. Citylrown 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 30" Scum thickness 4 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? FIELD ESTIMATE Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): RECOMMEND ANNUAL PUMPING; INLET AND OUTLET TEES INTACT;TANK APPEARED STRUCTURALLY SOUND AT TIME OF INSPECTION; LIQUID LEVEL AT OUTLET INVERT; NO EVIDENCE OF LEAKAGE OBSERVED AT THE TIME OF INSPECTION 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 15ins•3/13 Title 5 Oficial 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 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every page. CityfTown 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 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every page. City/Town 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 0 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 APPEARED LEVEL WITH EQUAL DISTRIBUTION. NO APPARENT CARRYOVER OR EVIDENCE OF LEAKAGE OBSERVED. 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.): * 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: isms•3113 Title 5 Official Inspection Form:Subsurtace Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every page. City/Town State Zip Cade 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: ❑ overflow cesspool number: ® innovative/alternative system Type/name of technology: INFILTRATORS: 3 ROWS @ 37.5' - SEE RECORD Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): LOAM AND GRAVEL; NO SIGNS OF HYDRAULIC FAILURE OR PONDING ABOVE GROUND; DRY; NORMAL (GRASS) 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 Offoal Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every page. City(Town Slate 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.): (Sins•3/13 Tllle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a— 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every 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 Sins•3113 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 u 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 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 depth to high ground water: +4' 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: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: CHECKED RECORD ON FILE AT BOARD OF HEALTH ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: CELLAR DRY WITH NO SUMP PUMP. REGULATIONS IN EFFECT AT THE TIME OF DESIGN AND CONSTRUCTION REQUIRED A MINIMUM FOUR FOOT OFFSET BETWEEN THE BOTTOM OF THE SOIL ABSORPTION SYSTEM AND GROUNDWATER. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Sins•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 3 ELEANOR ROAD, SALEM, MA 01970 Property Address JAMES KONTOULES IRREVOCABLE TRUST Owner Owner's Name information is required for SALEM MA 01970 AUGUST 5, 2015 every page. City/Town Slate 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 Sins•3113 Tule 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 07/31/201510:09SCITY OF SALEM, MA P 1 1479kmor UB Consumption History Report ubcnsinq Account Number Customer # Name Parcel Location Status Service Mfr Meter Number Cd Read Date Time By Bill # Curr Read Usage Repl Usage Charge Amt Billed Amt 010224 34823 . KONTOULES JAMES 300020 3 ELEANOR ROAD Active IWQ63R- 1 Q W 5/8 R MIU 111349790 A 07/23/2015 937180 17,731 5,168 0 150.91 150.91 1WQ63R- 1 Q W 5/8 R MIU 111349790 A 04/23/2015 920122 12,563 588 0 28.90 26.90 IWQ63R- 1 Q W 5/8 R MIU 111349790 A 01/22/2015 903936 11,975 474 0 28.90 28.90 IWQ63R- 1 Q W 5/8 R MIU 111349790 A 10/23/2014 888065 11,501 1,175 0 33.96 33.96 1WQ63R- 1 Q W 5/8 R MIU 111349790 A .07/24/2014 872159 10,326 2,983 0 86.21 86.21 1WQ63R- 1 Q W 5/8 R MIU 111349790 A 04/23/2014 856617 7,343 464 0 27.80 27.80 1WQ63R- 1 Q W 5/8 R MIU 111349790 A 01/23/2014 840781 6,879 473 0 27.80 27.80 1WQ63R- 1 Q W 5/8 R MIU 111349790 A 10/23/2013 825182 6,406 5,550 0 154.29 154.29 1WQ63R- 1 Q W 5/8 R MID 111349790 A 07/24/2013 811577 856 856 347 33.44 33.44 IWQ63R- 1 Q W 5/8 R I 06/12/2013 0 95,147 347 0 .00 .00 1WQ63R- 1 Q W 5/8 R ARB 2068940710 A 04/16/2013 797898 94,800 500 0 26.50 26.50 1WQ63R- 1 Q W 5/8 R ARB 2068940710 A 01/10/2013 782654 94,300 500 0 26.50 26.50 IWQ63R- 1 Q W 5/8 R ARB 2068940710 A 10/10/2012 767797 93,800 600 0 26.50 26.50 1WQ63R- 1 Q W 5/8 R ARE 2068940710 A 07/20/2012 752911 93,200 900 0 26.50 26.50 1WQ63R- 1 Q W 5/8 R ARB 2068940710 A 04/19/2012 729083 92,300 500 0 24.30 24.30 1WQ63R- 1 Q W 5/8 R ARB 2068940710 A 01/13/2012 713586 91,800 500 0 24.30 24.30 IWQ63R- 1 Q W 5/8 R ARB 2068940710 A 10/19/2011 698809 91,300 800 0 24.30 24.30 1WQ63R- 1 Q W 5/8 R ARB 2068940710 A 07/20/2011 684008 90,500 1,800 0 43.74 43.74 IWQ63R- 1 Q W 5/8 R ARB 2068940710 A 04/19/2011 669233 88,700 600 0 23.60 23.60 1WQ63R- 1 Q W 5/8 R ARB 2068940710 A 01/11/2011 654524 88,100 1,000 0 23.60 23.60 1WQ63R- 1 Q W 5/8 R ARB 2068940710 A 10/13/2010 639919 87,100. 1,300 0 30.68 30.68 IWQ63R- 1 Q W 5/8 R ARE 2068940710 A 07/13/2010 625359 85,800 1,800 0 42.48 42.48 1WQ63R- 1 Q W 5/8 R ARB 2068940710 A 04/06/2010 610789 84,000 500 0 22.70 22.70 1WQ63R- 1 Q W 5/8 R ARE 2068940710 A 01/14/2010 596477 83,500 500 0 22.70 22.70 1WQ63R- 1 Q W 5/8 R ARB 2068940710 A 10/06/2009 581664 83,000 600 0 22.70 22.70 1WQ63R- 1 Q W 5/8 R ARE 2068940710 A 07/20/2009 567062 82,400 500 0 22.70 22.70 1WQ63R- 1 Q W 5/8 R A 10/01/2008 523381 80,600 1,100 0 23.98 23.98 1WQ63R- 1 Q W 5/8 R A 07/10/2008 508912 79,500 3,100 0 60.74 60.74 1WQ63R- 1 Q W 5/8 R A 10/10/2007 465576 70,600 3,300 0 71.94 71.94 1WQ63R- 1 Q W 5/8 R A 07/13/2007 451301 67,300 3,400 0 74.12 74.12 1WQ63R-. 1 Q W 5/8 R A 10/05/2006 403802 59,500 1,800 0 39.24 39.24 1WQ63R- 1 Q W 5/8 R A 07/20/2006 393483 57,700 2,800 0 62.16 62.16 IWQ63R- 1 Q W 5/8 R A 10/19/2005 362613 50,400 3,400 0 75.48 75.48 1WQ63R- 1 Q W 5/8 R A 07/05/2005 352494 47,000 400 0 22.20 22.20 1WQ63R- 1 Q W 5/8 R A 10/20/2004 321674 44,600 3,500 0 77.70 77.70 ** END OF REPORT - Generated by Karen Moran ** a ng you Sittoo GGS P General Maintenance Recommendations Proper maintenance of your septic system can help preventpremature failure of your soil absorption system. RAGGS, INC. recommends the following: 4 DO PUMP your system on a regular basis, preferably ANNUALLY for most households. Larger systems, such as those serving multi-family locations or commerical properties, may require more frequent pumping. The purpose of pumping is to remove solid material and scum material from the tank. This will help prevent unwanted material floating out to the leaching facility. • DO OPEN your D.-Box every THREE TO FOUR YEARS. This is a good way to spot little problems before they grow into bigger ones. • DO ensure that your VENT PIPES are INSTALLED properly. Vent pipes are used to allow oxygen into the system,thereby allowing bacteria to breathe and grow.. • DO make sure you know WHERE your TANK is LOCATED. . Check the covers to make sure that they are not deteriorating and causing a potential hazard. • DO make sure you kriow WHERE your LEACHING.FIELD is LOCATED. If the field evergoes into failure and "break out", it would be necessary to isolate the area for health protection. i DO lodk for GREEN STRIPES over leaching field. If you see this, it Is indicative a field starting to back-up. Act immediately when you see this warning sign. 4 DO check to determine if you can smell any ODORS from field location. Odors can indicate that the leaching facility is having a problem. 4 DO raise the tank COVERS up to WITHIN 6" OF GRADE. 4 DO USE LIQUID DETERGENTS and USE SMALL AMOUNTS OF BLEACH when cleaning toilets, etc.. 4 DO USE NON-ABRASIVE HOUSEHOLD CLEANING PRODUCTS. R,AGGS SEPTIC SERVICE,INC. d.b.a.E.A.COMEAU SEPTIC P O.Box 1027 Concord,Massachusetts 01742 (978)369-1100 (800)287-5541 FA%(978)897.3848 website:http://wvnv raggsinc.cam e-mail:in€oCsraggsiac.com � S9 • DO USE ENVIRONMENTALLY SAFE PRODUCTS. • DO INSTALL WATER SAVING DEVICES, where appropriate. • DO AVOID having roof gutters and downspouts DRAIN ONTO the LEACHING FIELD. THE DON'TS DON'T DISPOSE any,NON-BIODEGRADABLE MATTER IN TOILETS. Foreign items can cause blockages in the.lines and:back-ups. (i.e.: cigarettes, sanitary napkins, diapers) 4 DON'T wash paint brushes used in latex or oil.PAINT. Paint residues are not broken down by a leaching system. In fact, they'will travel out to the leaching facility and impede its ability to function. 4 DON'T allow any PAINT,THINNERS, OR ANY OTHER TOXIC OR CAUSTIC LIQUIDS, to go down sink or toilets. 4 DON'T allow ANY GREASE or FAT to enter system. Residential sites do not have.grease traps. Therefore, if grease is allowed into the system it will congeal and travel out to the leaching facility leading to damage. -� DON'T DISPOSE BONES, EGG SHELLS, COFFEE GROUNDS, DENTAL FLOSS, OR FIBROUS MATERIAL, etc.when using a garbage disposal. However, it is recommended that garbage disposals aren't used at all. DON'T use POWDERED DETERGENTS with phosphates. They don't break down and can re-solidify. -� DON'T use any DRAIN CLEANERS, such as Drano®, LiquidPlumbr®. Call a rooter professional or buy a small rooter snake at the hardware store. Drain cleaners KILL bacteria. Bacteria keeps your system alive. RAGGS SEPTIC SERVICE,INC. d.b.a.E.A.COMEAU SEPTIC P.O.Box 1027 Concord,Massachusetts 01742 (978)369.1100 (800)287.5541 FAX(978)897.3848 website:http:/1www.raggsinc.com e-mail:ini'o@raggsine.com I P e fi,`ng YouSigne 1$ ' �GGS,AIN1 THE DON'TS DON'T use any ENZYMES or BACTERIAL ADDITIVES. These products usually have too low a pH to be effective. Often they are sitting on'a shelf too long. Normal activity and proper use of a septic system should provide plenty of bacteria naturally. • DON'T use any GREASE DISSOLVERS. Degreasers allow grease to flow out of the tank and into your field. 4 DO NOT ADD:ANYADDITIVES TO YOUR SYSTEM FOR ANY REASON. In the event of a clog or other plumbing problem, contact your local plumber, rooter or pumper. • DON'T PLANT any trees or shrubs WITHIN 10 FT. OF THE LEACHING FIELD. Root systems can cause damage to the piping in the leaching facility. • DON'T ALLOW SPRINKLER SYSTEMS or other WATERING DEVICES OVER the LEACHING.FIELD. Doing so will saturate the field, damaging the system's performance. Systems are designed to handle up to a certain quantity of flow. • DON'T DRIVE any VEHICLES.or place any HEAVY OBJECTS ON TOP of the LEACHING FIELD. Damage to piping could result. 4 DON'T INSTALL a swimming pool, a patio, or a driveway over the tank or leaching field. If installing a swimming pool, ensure that the backwash does not enter the leaching system. Do not obstruct access to the tank otherwise it will be difficult to maintain. 4 DON'T CONNECT a.basement SUMP PUMP to a household DRAIN. 4 DON'T ALLOW WATER USAGE to EXCEED the DESIGN FLOW OF YOUR SYSTEM. 4 DON'T ALLOW a WATER SOFTENER TO BE HOOKED UP to a SEPTIC SYSTEM. Check with the local authority to see if an alternative place for the backwash can be used. RAGGS SEPTIC SERVICE,INC- d.b.a. TC.db.a.E.A.COMEAU SEPTIC P.O.Bos 1027 Concord,Massachusetts 01742 (978)369.1100 (800)287-5541 FAX(978)897-3848 website:http://www.raggsine.com e-mail:info@raggsiaacom This is to certify that New. England Engineering Services Inc. Richard C. Tangard, PE Joint Venture has inspected the subsurface sewage disposal system installed at 3 Eleanor Road, Salem, MA. The system has been constructed in compliance with 310 CMR 15.00, the approved design plans doted 7/6/2004, and local requirements, except as noted herein. 4 Pr's qnn. dCj14 LUN CITY OF SALEM BOARD OF HEALTH WMM INVERT ELEVATIONS 1ND TANK IN 97.50 TANK OUT 97.25 N BOX D-BOX iN 97.15 D-BOX OUT 97.00 ON JK BOTTOM OF INFILTRATOR 1 96.33 4 96.29 2 96.33 5 96.29 FENCE EXISTING INVERT ELEVATIONS 0 74.92' LIMIT OF SAND TANK IN 97-50 SHED TANK OUT 97.25 —37 s' -�tr DISTRIBUTION BOX D-BOX IN 97.15 13' - D-BOX OUT 97.00 o ' 01 1500 GALLON :, 24' SEPTIC TANK t5. 000 BOTTOM OF INFILTRATOR PATIO �0 1D 2 96 33 5 96.296.29 z7 1,/P T 1'- ' I COVERED �,�... 3 98.3'4- PORCH N/ F r�� / I LtN.LI�N � ON SLAB O - , rn o EXISTING THREEBENCHMARK: CENTER OF SILL 100.73 BEDROOM HOUSE WOOD THRESHOLD - ELEV- 100.00 (assumed datum) z SYSTEM TIES N A TO TANK 16.0' w B TO TANK 21 .0' w A TO D-BOX 25.4' B TO D-BOX 29.6' 74.92`. BURIED PRESSURE ✓` WATER SERVICE A TO 1 22.0' A TO 4 26.9 B TO 1 28.0' B TO 4 52. D OR ROA ELEANOR ATO 3 29.3' A TO 6 31.9 JJL�J 1 V n BTO 3 37.0' BTO 6 57.0 LOCUS MAP . NOI TC i[ALE -BUILTEP-�Ir �YTEIv�� S i" o ELEANOR ROAD SALEM _Iv1A� LILIAN W AS SORS MAP 30, PARCEL 20 W ROAD SCALE: 1 " = 20' AUGUST 17, 200 W _.. = z NSW ENGLAND ENGINEERING SERVICE o RICHARD C. TANGARD, PE 's�. . ELEANCiB J JOINT VENTURE RiCHApr - SITE Rb 60 BEECHWOOD DRIVE T C.` �. . NORTH ANDOVER, MA 01845 30' AFTR (978) 686- 1768 F ' QO PLAN # DRAWN CHECKE 805A13 BY: You Since S 91� General Maintenance Recommendations Proper maintenance of your septic system can help prevent.premature failure of your soil absorption system. RAGGS, INC. recommends the following; • DO PUMP your system on a regular basis, preferably ANNUALLY for most households. Larger systems, such as those serving multi-family locations or commerical properties, may require more frequent pumping. The purpose of pumping is to remove solid material and scum material from the tank. This will help prevent unwanted material floating out to the leaching facility. 3 DO OPEN your D-Box every THREE TO FOUR YEARS. This is a good way to spot little problems before they grow into bigger ones. 3 DO ensure that your VENT PIPES are INSTALLED properly. Vent pipes are used to allow oxygen into the system, thereby allowing bacteria to breathe and grow. • DO make sure you know WHERE your TANK is LOCATED. Check the covers to make sure that they are not deteriorating and causing a potential hazard. • DO make sure you know WHERE your LEACHING FIELD is LOCATED. If the field ever goes into failure and "break out", it would be necessary to isolate the area for health protection. + DO look for GREEN STRIPES over leaching field. If you see this, it is indicative a field starting to back-up. Act immediately when you see this warning sign. + DO check to determine if you can smell any ODORS from field location. Odors can indicate that the leaching facility is having a problem. + DO raise the tank COVERS up to WITHIN 6" OF GRADE. + DO USE LIQUID DETERGENTS and USE SMALL AMOUNTS OF BLEACH when cleaning toilets, etc.. + DO USE NON-ABRASIVE HOUSEHOLD CLEANING PRODUCTS. RAGGS SEPTIC SERVICE,INC- d.b.a.E.A.COMEAU SEPTIC P.O.Box 1027 Concord,Massachusetts 01742 (978)369-1100 (800)287-5541 FAX(978)897-3848 website:http://www.raggsine.com e-mail:info@raggsinacom n i i e, V You Since 189 1P`gGGS, 1G 4 DO USE ENVIRONMENTALLY SAFE PRODUCTS. 4 DO INSTALL WATER SAVING DEVICES, where appropriate. 4 DO AVOID having roof gutters and downspouts DRAIN ONTO the LEACHING FIELD. �. \ ) THE DON'TS 4 DON'T DISPOSE any.NON-BIODEGRADABLE MATTER IN TOILETS. Foreign items can cause blockages in the lines and back-ups. (i.e.: cigarettes, sanitary napkins, diapers) 4 DON'T wash paint brushes used in latex or oil PAINT. Paint residues are not broken down by a leaching system. In fact, they will travel out to the leaching facility and impede its.ability to function. 4 DON'T allow any PAINT, THINNERS, OR ANY OTHER TOXIC OR CAUSTIC LIQUIDS, to go down sink or toilets. 4 DON'T allow ANY GREASE or FAT to enter system. Residential sites do not have grease traps. Therefore, if grease is allowed into the system it will congeal and travel out to the leaching facility leading to damage. 4 DON'T DISPOSE BONES, EGG SHELLS, COFFEE GROUNDS, DENTAL FLOSS, OR FIBROUS MATERIAL, etc. when using a garbage disposal. However, it is recommended that garbage disposals aren't used at all. 4 DON'T use POWDERED DETERGENTS with phosphates. They don't break down and can re-solidify. 4 DON'T use any DRAIN CLEANERS, such as Drano®, LiquidPlumbr®. Call a rooter professional or buy a small rooter snake.at the hardware store. Drain cleaners KILL bacteria. Bacteria keeps your system alive. RAGGS SEPTIC SERVICE,INC. d.b.a.E.A.COMEAU SEPTIC P.O.Box 1027 Concord,Massachusetts 01742 (978)369-1100 (800)287-5541 FAX(978)897.3848 website:http://www.raggaine-com e-mail:info@raggainc.com P s � � e, ng YOu �GGS, 1� J THE DON'TS DON'T use any ENZYMES or BACTERIAL ADDITIVES. These products usually have too low a pH to be effective. Often they are sitting on a shelf too long. Normal activity and proper use of a septic system should provide plenty of bacteria naturally. 4 DON'T use any GREASE DISSOLVERS. Degreasers allow grease to flow out of the tank and into your field. 4 DO NOT ADD ANY ADDITIVES TO YOUR SYSTEM FOR ANY REASON. In the event of a Clog or other plumbing problem, contact your local plumber, rooter or pumper. 4 DON'T PLANT any trees or shrubs WITHIN 10 FT. OF THE LEACHING FIELD. Root systems can cause damage to the piping in the leaching facility. 4 DON'T ALLOW SPRINKLER SYSTEMS or other WATERING DEVICES OVER the LEACHING.FIELD. Doing so will saturate the field, damaging the system's performance. Systems are designed to handle up to a certain quantity of flow. 4 DON'T DRIVE any VEHICLES or place any HEAVY OBJECTS ON TOP of the LEACHING FIELD. Damage to piping could result. 4 DON'T INSTALL a swimming pool, a patio, or a driveway over the tank or leaching field. If installing a swimming pool, ensure that the backwash does not enter the leaching system. Do not obstruct access to the tank otherwise it will be difficult to maintain. 4 DON'T CONNECT.a basement SUMP PUMP to a household DRAIN. 4 DON'T ALLOW WATER USAGE to EXCEED the DESIGN FLOW OF YOUR SYSTEM. 4 DON'T ALLOW a WATER SOFTENER TO BE HOOKED UP to a SEPTIC SYSTEM. Check with the local authority to see if an alternative place for the backwash can be used. RAGGS SEPTIC SERVICE,INC. d.b.a.E.A.COMEAU SEPTIC P.O.Boa 1027 Concord,Massachusetts 01742 (978)369-1100 (800)287-5541 FAX(978)897-3848 website:http://www.raggsinc.com e-mail:info@raggsinc.com This is to certify that New England Engineering Services Inc. Richard C. Tongord, PE Joint Venture has inspected the subsurface sewage disposal system installed at 3 Eleanor Road, Salem, MA. The system has been constructed in compliance with 310 CMR 15.00, the approved design plans dated 7/6/2004, and local requirements, except as noted herein. � r n�", 3 ELEANOR ROAD o ASSESSORS MAP 30, PARCEL 20 ��? 1 4 2GG4 6,743 SQ FT CITY OF SALEM BOARD OF HEALTH N/� tONI�ALR.1' N/ r POLM INSPECTION N/ F UZM RTS EXISTING FENCE INVERT ELEVATIONS 0 74.92' PO LIMIT OF SAND TANK IN 97.50 SHED r—T11 TANK OUT 97.25 37-5' —1 13, DISTRIBUTION BOX D—BOX IN 97.15 o D—BOX OUT 97.00 1500 GALLON 24SEPTIC TANK ts' O 0 oBOTTOM OF INFILTRATOR PATIO 27, "o� —10' 1 96.33 4 96.29 COVERED A\ TP 1/PT 1 2 96.33 5 96.29 o PORCH �0 N/ ri �� 3 96.34 9: .30 N/I Zk. rN 0 p ON SLAB 0) o 0 EXISTING THREE BENCHMARK: CENTER OF BEDROOMHOUSE SILL1 SILL 100..73 WOOD THRESHOLD ELEV. 100.00 (assumed datum) Z 3 SYSTEM TIES F- Ld V) A TO TANK 16.0' w o B TO TANK 21 .0' W A TO D—BOX 25.4' JL— B TO D—BOX 29.6' - 74.92 BURIED PRESSURE WATER SERVICE A TO 1 22.0' A TO 4 26.9' ELEANOR NO D B To 1 28.0' B TO 4 52.5' A TO 3 29.3' A To 6 31.9' B TO 3 37.0' BTO 6 57.0' LOCUS MAP NOT TO SCALE —BUILL,SEP E SFr o ELEANOR ROAD SALEM ftLIAN AS SORS MAP 30, PARCEL 20 W RIOAD ? SCALE: 1 " = 20' AUGUST 17, 2004 Z NEW ENGLAND ENGINEERING SERVICES, INC. o RICHARD C. TANGARD, PE ELEANOR J JOINT VENTURE RrcHApr, -. SITE RD 60 BEECHWOOD DRIVE C. Tyr- NORTH ANDOVER, MA 01845 20 0 20 40 60 1021 AFT (978) 686- 1768 PLAN //: DRAWN CHECKE _ - 8805A13 BY: S,G,C3, BY: PLO, Jr, 561 Main Street,Hudson.Massachusetts 01749 E-Mail: ENVIRONMENT, L Telephone 978.281.4443 Facsimile 978.283.0780 wrenvironmental.com FORMERLY R.B.STRONG 11y�1y JUL 12 2004 CITY OF SALEM BOARD OF HEALTH July 7, 2004 Wind River Environmental 163 Western Ave. Gloucester, MA 01930 Board of Health Administrator, This package contains the dump slips for the Board of Health from the field office located in Gloucester, MA. This is the work we have completed. If you have any questions, please feel free to contact our Director of Field Operations, Brad Robertson, at 978-282-7315. u, Miss anH Form 4 -- System Pumping Record Commawlealth of Niassochusetss L Massachusetts System Pumnim Raoad System owner System location ..aunino tzFstee Primary Nome 'i "!Ieal�or 1tC1. 3 -I t�uanor 14cl. , u,am, Mel, MA., 01,970 j -"Wy U14ii x i9'/8)-745-013Fs x nll . na Lrhna Type: Emergency Routine Cesspool: hia Yes Septic tank: hlo Yu �'i Date of Pumping: Quantity Pumped: �rawns System Pumped By: Wind Rina Enw"ientai, LLC Permit if: Contents transferred to: Contents Disposed at: 04 11n) Date: 2 V t Pumper Signature: Condition of Syrtem/other Comments C�� Ju CITY OF SALEM BOARD OF HEALTH UP Approved Form - 12/07/95