10 WYMAN DRIVE (004) Commonwealth'of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John &Tracey Oleary
Owner Owner's Name
information
requ red forts Salem Me 01970 July 23, 2014
every page. Cityrrown 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 forth.
Important:
When filling out A. General Information
When
forms on the
computer,use 1. Inspector:
only the tab key
to move your Paul LeBlanc
cursor-do not Name of Inspector
use the return
key. LeBlanc Survey Associates, Inc.
Company Name
m 161 Holten Street
Company Address
Danvers Ma 01923
Cityrrown State Zip Code
978-775-6012 S11967
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. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
'�� X,6A.`, July 23, 2014
Inspector'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.
!Sins•3/13 Title 5 Official Ins
pection Farm:Subwrrace Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John &Tracey Cleary
Owner Owner's Name
information
required forts Salem Ma 01970 July 23, 2014
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:
The septic system does not meet any of the failure criteria listed in Title 5 at time of inspection
System Conditionally Passes:
❑ e or more system components as described in the"Conditional Pass" section nee e
rept or repaired. The system, upon completion of the replacement or repair, pproved by
the Boar f Health, will pass.
Check the box for" ", "no"or"not determined"(Y, N, ND)for the followi tatements. If"not
determined," please exp
The septic tank is metal and ov 0 years old'or the septic to whether metal or not) is
structurally unsound, exhibits subs 'al infiltration or exfilt on or tank failure is imminent. System
will pass inspection if the existing tank i laced with mplying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if' s struc Ily sound, not leaking and if a Certificate of
Compliance indicating that the tank is s than 20 years is available.
❑ Y ❑ N D(Explain below):
t5ina•3113 Title 5 Oficial
Inspection Farm:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John &Tracey Oleary
Owner Owner's Name
information
required fors Salem Ma 01,970 July 23, 2014
every page. Cityrrown State Zip Code Date of Inspection
Certification (cont.)
Pump Chamber pumpstalarms not operational. System will pass with Board of Health appro [ if
umps/alarms are repaired.
B) S tem Conditionally Passes(cont.):
❑ Obse tion of sewage backup or break out or high static water level in the distribu 'on box due
to broke r obstructed pipe(s)or due to a broken, settled or uneven distribution ox. System will
pass inspe ion if(with approval of Board of Health):
❑ broken ipe(s) are replaced ❑ Y ❑ N ❑ ND( plain below):
❑ obstruction removed ❑ Y ❑ N ❑ (Explain below):
Eldistribution box i leveled or replaced ❑ Y ❑ N ND(Explain below):
❑ The system required pumping more than 4 ti s a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approva f t Board of Health):
❑ broken pipe(s)are replaced Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y N ❑ ND (Explain below):
C)/Evaluatioaluatio is Required by the Board of Health:exis hich require further evaluation by the Board of Healt\3R rmine ifis iling to protect public health, safety or the environmentill pass unless Board of Health determines in accordR)that the system is not functioning in a manner which tic health,
the environment:
sspool or privy is within 50 feet of a surface water
spool or privy is within 50 feet of a bordering vegetated wersh
t5ins•3/13 Title 5 Ofidal Inspection Fmm:SuG rfaw Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John &Tracey Oleary
Owner Owner's Name
information
required forts Salem Me 01970 July 23, 2014
every page. Cityrrown State Zip Code Date of Inspection
. Certification (cont.)
System will fail unless the Board of Health(and Public Water Supplier, if any)
de rmines that the system is functioning in a manner that protects the public ealth,
safe nd environment:
❑ The sy m has a septic tank and soil absorption system (SAS)and th AS is within
100 feet of a s ace water supply or tributary to a surface water supply.
❑ The system h a septic tank and SAS and the SAS is within a e 1 of a public water
supply.
❑ The system has a se i tank and SAS and the SAS is wi 1 50 feet of a private water
supply well.
❑ The system has a septic tank a SAS and the SAS is than 100 feet but 50 feet or
more from a private water supply w "
Method used to determine distance:
"This system passes if the well water an sis, perfo ed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and presence of a onia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that other failure criteria a 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
❑ ® 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 %day flow
t5im•3/13 Title 5 Official I
nspection Form:Subsurface Sewage Disposal System•Page 4 or 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
10 Wyman Drive(Assessor Map 2 Lot 37)
Property Address
John&Tracey Oleary
Owner Owner's Name
informations Salem Ma 01970 Jul
required for Y 23, 2014
every page. Cityrrown 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.
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
n flow of 10,000 gpd to 15,000 gpd.
For large sy s, you must indicate either"yes"or"no"to each of the followi , in addition to the
questions in Sec
Yes No
❑ ❑ the system is 'n 400 feet of rface drinking water supply
❑ ❑ the system is within of a tributary to a surface drinking water supply
11 El Area
system i ted in a nitroge nsitive area (Interim Wellhead Protection
Area– A)or a mapped Zone II of blic water supply well
If you have answere es"to any question in Section E the system I nsidered a significant threat,
or answered" in Section D above the large system has failed. The ow or operator of any large
system co ered a significant threat under Section E or failed under Section all upgrade the
syst n accordance with 310 CMR 15.304. The system owner should contact the opriate
Zonal office of the Department.
Wins•3113 Tice 5 Official Inspection Pc m:Subsurface Same Disposal System•Page 5 of 17
� � � c k A � ,�, k:' . - £ x, i i �1''':.'t t. �"g.. T �aT +o �r FS r.v +� { yk t kAi 'F; te•J} Y } .
Commonwealth of Massachusetts
Title�5�Offi ' i I � "
,- c a ��Inspection Formri r � �
T�Subsurface Sewage Disposal System Form' Not for Voluntary Assessments` 4
1
A«y M"^•- e a,�....m% Y • `k+r +iw.�,..,�s''m'„ q s�oM ' rr-k�+ i m .+w.N- .i:,i44.w,aa'wn�.{iNa•+r«x wd,.. .
10 Wyman Drive(Assessor Map 2 Lot 37)
Property Address
a
'John 23<Tracey l)leafy �' �t.'.3 '" :' ,^ . ` .�e,
A owner Owners H8ro8
x 9
b information CS p y »' ,+.�
regwree for Salem _ �Ma "' 01970 "`fi 'July 23 2014
every page , . City/rown « �, ; w 140,, in,�,� . State ,Zip Code:, � . Date of Inspection:'
C Checklist
r
��
.- ;� w ry .a, €: 3rtX ;e+ . .ve gE� rs , 4 n Pr ,} .✓ §'W„ w- � u,t tis[ ,a. Y+e �+�. a d 3, y'+R i + „4?, ? »
( i Check if the following have been doneY You must Indicate yes°or"no as to each of the following e
r� �d H Y 3 f � 4 iW.v y b x ��MW •1 reG d rA 6 � 4 i i l'V �� V %.:
r
"'. _� �f d ::-.✓�' i 4;Y. � Y { � T .km .?`V , ,.'L'^k n '. ( of t.5k rd ty ,y n�i'
7+ s. * ; , -® �. �. x❑ , Pumping Inforbm^ ation was provided by the owner, occupant, or Board of Health
F +i4an mw..rs .tom: ism "' "' +aC nrr ew . rv+a `"NPot y. > l Hr 1` H `
� q ' *s ;s' ,§❑k «., ®s 1 ,� ,� ,t,' Z , 't '1: 3°y •s aj` ,',a
lv" 1 Were any of the system components pumped out in the previous two weeks?' " "
9
sT a '^/ X ^ k" ," X,A ;"1X�M "✓o-Sw,&+S y}'d'" 3typ a', p'"+. rr4#k r. ,,rrl ttt3Y" R' .«.i t;r z '^}.+> a Fk-
'^a.yg,T-- �7
system received normal flows in,the previous;two week penod? t= `
mh aY�a+sv"�i"" `^�„ -' ,." ,w-:b.,a
A xw r x Have large volumes of water been introduced to the system recently oras part ofd ---
q
this inspection?'-,,- fisif`m; n�-} be' rr a+h j:"s»
” "' t« * Were as built plans of the system obtained and examined? (If they were not
z` #ao 4
�,� �available note as N/A)
r v
Was the facility or dwelling inspectedf'or signs of sewage back ups s "
wkf x3 + �.kr,w'�2 :8 a� s?s f`� $ts'� �f m^ ��d '4�'*'+• 9pR'G•"
® ❑ , , Was the site inspected for sign`s of br"eak out?
t r r , . nv an.'r"`i 'b a`"�k. "kms r„: 2n?fl' v •`'#T h e.'r£ `T i . -„ .+ t^ . C'. "'”;r * *"'{'^#w""r �' "�"'k" xh„ ^.�-
4 s p,r lv ,r i t#•$
AiM� � u 1 ♦ .$t � +n . 3�- �a � �da*gy+.+ n +.� P3„ s ,.1 d`"4'��"'�' � �' -'�. +���?'t 'M��� f '.
pA , ,. .� �,s n ' -®� ". ❑ %, 1 �Were all system components i excluding the SAS located on site?';. W - ,
rs
°Were the septic tank manholes uncovered opened and the interior'of the tank `
inspected for the condition of the,baffles or fees material of construction
x * ' dimensions de th of liquid, depth=of stud eyand depth of scum?, 7>°
�4�= p grc Piz
rt , m u
Was the facility owner(and occupent8 if different from Owner)provided with sR�r'&
information on the proper maintenance of subsurfac se ewa a disposal s stems
p p . 9 p y
,The size and location of the Sod Abso tion S stem SAS on.the site has Irk
been determined based on y , �" y ( ) t r . ,
, s „+ 7y o-.%V
.®w F�rlsting information For example ;a plan at the Board of Health
wus,�,:aq
" " ® Detertnmed in the field(if any of the failure,critena-related to Part C is at issue `�^-
a approximation of distance Is unacceptable)[310 CMR 15 302(5)] i
0 C
�=xF
r D System Information � �"
�. ate. e� �*? w 4°` � •t o:
,", � „�, R'esidenUal Fiow Conditions , F� , ,`
fi S�.asa sw�a .»+. .-'§..�u�,,tir«` rx+.tl»i ,+su b�»'v'�3w^w�l�+,X � 4 ,1 rr?~;-J. + µgwa � � w � :a•+mT �3 6 � �.-�
� Number of bedrooms(design) � Number of bedrooms(actual) ^.
,,,, 7��%,!4»^€ to * �t '�. y •�s+",'� �v�wi % ..r,+ ;!*» ��,wc pia u�,�:!�S'0�,,x'���' n`� e:*c-.e+v..t r'n�� „� .
NFA basedon!310 CMR:15 203,(for example::;110 gpd;x;#of bedrooms).. ��,, w __..
Qs'r- �'.r _... ykt'+HrAMt x. tE.9a a J4 ,�• a.. ` a. n� e, n a w a, .A n Fx n . r n n e n......
. p ..-ti, . ... ys7am• ag96 ,.
t3ms•3n3
spa0on am'Subsurfeca Sewage Disposal.S P„ ,. .
of 77
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John &Tracey Oleary
Owner Owner's Name
required fors Salem Ma 01970 July 23, 2014
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
The S.O.S. has at least 3 feet of fill on top.
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
private well
Sump pump? ❑ Yes ® No
Last date of occupancy: Presently
occupied
mercialllndustrial Flow Conditions:
Type of Esta ' ent:.
Design flow(based on 310 15.203): Gallons per gpd)
Basis of design flow(seats/persons/sq.ft.,
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank nt? ❑ Yes ❑ No
Non-sanitary w discharged to the Title 5 system? es ❑ No
r meter readings, if available:
t5ms•3113 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
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John &Tracey Oleary
Owner Owner's Name
inmation
re uired forts Salem Ma 01970 July 23, 2014
every page. Cityrrown 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: No records of pumping at Board of Health
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined? 1500 per design plans
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/Altemative 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•3113 Title 5 Official Inspecean Fane:SubwRace Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John &Tracey Oleary
Owner Owner's Name
information
required for reQ Salem Ma 01970 July 23, 2014
every page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
November 2008.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 14
feet
Material of construction:
❑cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: > 130'feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
The plumbing in the basement was in good condition no evidence of leakage at time of inspection.
Septic Tank(locate on site plan):
Depth below grade: Plastic cover at finish grade.
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If eta], list age:
years
Is age confirmed by a Certiflca a iance?(attach a co Icate) ❑ Yes ❑ No
Dimensions:
p
t5ina•3113 Title 5 Ofidal 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
10 Wyman Drive (Assessor Map 2 Lot 37 )
Property Address
John &Tracey Oleary
Owner Owner's Name
information Salem Ma 01970 Jul 23, 2014
required for Y
every page. City/Town 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 2
Scum thickness
Distance from top of scum to top of outlet tee or baffle 5
Distance from bottom of scum to bottom of outlet tee or baffle 13' +/-
How were dimensions determined? Measuring stick and visual
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 liquid levels were normal at time of inspection, the effulent filter was removed and cleaned this
should be done on a yearly maintance schedule. The septic tank was not pumped for this inspection,
and should be done in the near future.
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•3113 Title 5 Oficial Inspection Farm: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
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John &Tracey Cleary
Owner Owner's Name
informations Salem Ma 01970 Jul 23, 2014
required for Y
every page. Cityrrown 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.):
The tank appeared structuraly sound at time of inspection liquid levels were normal, but cleaning the
filter is important.
' ht or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): /
Depth low grade:
Material of struction:
El concrete ❑ metal [I fiberglass El polyethylene ❑other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
ns per day
Alarm present: >float
❑ Yes ❑ No
Alarm level: Ala in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of aetc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ \No
t5im•X13 TRW 5 Offidal lnspe n Form:Subsurface Sewage Disposal System•Page 11 of 17
OComnionwealth of Massachusetts K,�: J
Title-5„ Officiail, Inspectio.n Form
,
ii Subsurface Sewage Disposal System Form"Not for Voluntary
'Y
10
Drive(Assessor Map 2 Co 37 X
nM�
Wyman Dni t
FI
P
roperty Address ,,4
Nl'-,v�,
0 a John &Tracciy
Owner '-4 Owner's Name
A-"i-P”
information A
Z,A"
-�e
Salem _7 W,Ma �MX 01970 2�_77)7hly23, 2014
required for I, I ` lo
every page.:l "Ot,Cityrrown "'Zip Zippode,��" r�,'I.Dateofinsoection�
l�owl 1
r
0" i
D. System Information (cont)
C
Distribution Box(if present must (locate n site plan):'s
Del
pth of liquid l6el'6b646utlet invert
4 �4q
ao C i6 if bo" 6el'atid of solids carryover, any
ornments no X.iil
J` evidence—of 16-alk'a-g2 into Or out of tiax' etc
4U-DUA III good condition no of soil I equal distributiont ti a d
Azp
lI ., , �' "`�, , - it, ffinish ,r
N inspection.,It was located 3'.below finish"'grade' withwithextension an, coverf,'
grade 4
e ittached pi6ture s
.Imi e, zgry-W-W
NW,
7.
111191 44 40-
,
p Ch7
amber(locate on site plan) r ) tea&5 ;
7
.11. Iv,
44,
'Pumps I 6irk
Jt�� -, 'N
ing order T l
�,Yesn� :q.
ZINC" ft
ft "I'
t
4� da El Yes N-0
Pjv�
Wi _4 ff.,Tg
- 'I 11 I"A' . "- , % . R
P
41 1, 'll I
�Comments(note
iti of pump charriber;condition'61"pumps and appu' naniissj-eto &"44
lu4
W, fISI F
A
yy 1A' IVRx,
"AW,W `yds �r;r4p�4 R Z
7,1%"P,
"'N
"X k-N,
q
R�X7V
-or
If'pumps alarms are 6(
not in Work�k order, system s'a con nal pass b; WS
,� ,�.,y; p '� ,�t Sotl Absorppon System(S (locate on site plan excavation not red) ,� ,�,� ��„,„ F ,�
V1
-Z-5
15im-3H3 TrUe
5 0"WP8cfi-Finn sLAagrace Sewage okPosd-SYst— Pap 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John &Tracey Cleary
Owner Owner's Name
informrequired forts Salem Ma 01970 July 23, 2014
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 -56' x 14'
❑ overflow cesspool number.
❑ innovative/altemative 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, ponding or breakout at time of inspection.
pools(cesspool must be pumped as part of inspection) (locate on site plan):
Number an uration
Depth-top of liquid to inle ' ert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of c ction
I ' tion of groundwater inflow ❑ Yes ❑ No
t5ins-3113 Title 5 Oficial Inspedon 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
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John &Tracey Oleary
Owner Owner's Name
information is Salem Ma 01970 Jul 23, 2014
required for Y
every page. CitylTown 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.):
System located in back yard with no signs of hydraulic failure or ponding.
(locate on site plan):
Materials o struction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of by ilure, level of ponding, condition of vegetation,
etc.):
Mrs•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 Form-Not for Voluntary Assessments
10 Wyman Drive(Assessor Map 2 Lot 37
Property Atldrass
John &Tracey Oleary
Owner Owner's Name
information is
required for Salem Ma 01970 July 23, 2014
every page. Cdyf 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
Q drawing attached separately
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
10 Wyman Drive(Assessor Map 2 Lot 37 )
Property Address
John&Tracey Oleary
Owner Owner's Name
information is Salem Me 01970 Jul 23, 2014
required for Y
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. TP1 @ 98.09-TP2 @ 101.11 &TP3 @
107.31
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: 2008
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:
This septic system had soil testing performed 8-23-06 by Benjamin Osgood the design engineer and
witness by Martin Fair North Reading Health Agent.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3113 Title 5 Official Inspection farm: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
10 Wyman Drive (Assessor Map 2 Lot 37 )
Property Address
John & Tracey Oleary
Owner Owners Name
informaequine for
is Salem Ma 01970 Jul 23, 2014
required for Y
every page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
W Inspection Summary: A, B, C, D, or E checked
IBJ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
50 Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
!Sins•3113 Title 5 Official Inspection FormSubsurface Sewage Disposal System•Page 17 of 17
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6/3012014 Una ficial ProperiyRecord Card
Unofficial Property Record Card - Salem, MA
General Property Data
Parcel ID 02-0037-0 Account Number
Prior Parcel ID —
Property Owner OLEARY JOHN P Property Location 10 WYMAN DRIVE
OLEARY TRACEY S Property Use One Family
Mailing Address 10 WYMAN DRIVE Most Recent Sale Date 10/17/2003
Legal Reference 76553.414
City SALEM Grantor SALEM CITY OF,
Mailing State MA Zip 01970 Sale Price 96,000
ParcelZoning Land Area 0.413 acres
Current Property Assessment
p
Card 1 Value Building Value 280,000 Xtra Features 0 Land Value 97,300 Total Value 377,300
Value
Building Description
Building Style Colonial Foundation Type Concrete Flooring Type Hardwood
#of Liv Ing Units 1 Frame Type Wood Basement Floor Concrete
Year Built 2008 Roof Structure Gable Heating Type Forced HIW
Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Oil
Building Condition Average Siding Clapboard .Air Conditioning 0%
Finished Area(SF)2819.6 Interior Walls Drywall #of Bsmt Garages 0
Number Rooms 7 #of Bedrooms 3 #of Full Baths 2
If of 3/4 Baths 0 #of 112 Baths 1 #of Other Fixtures 0
Legal Description
Narrative Description of Property
This property contains 0.413 acres of land mainly classified as One Family with a(n)Colonial style building,built about 2008, having
Clapboard exterior and Asphalt Shgl roof cover,with 1 unit(s).7 room(sh 3 bedroom(s),2 bath(sL 1 half bath(s).
Property Images
r1.
Disclaimer.This information is believed to be correct but is subject to change and is not warranteed.
hdp://salempabiotproper0es.cm✓RecordCard.asp 1/1
CITY OF SALEM MASSACHUSETTS
DEPARTMENT OF PUBLIC SERVICES
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MASSACHUSETTS 01970
�C�P1114B BRUCE D. THIBODEAU, P.E.
DIRECTOR OF PUBLIC.SERVICES/CITY ENGINEER
STANLEY J. USOVICZ, .IR. TEL: 978-745-9595 EXT. 321
MAYOR FAX: 978-745-0349
September 5, 2003
John O' Leary
137 High Street
Danvers, Massachusetts 01923
RE: Proposed Wastewater Collection System Extension Project— Wyman Area
Dear Mr. O'Leary:
I am writing in response to your questions regarding the above referenced sewer extension
project. The City, through this office, has funded the planning and design phase of the project to
extend the City's wastewater collection system from its terminus on Highland Avenue to Wyman
Ave. and continuing through out the area. This will result in a wastewater collection system
available to the properties on the various streets that make up what is known as the "Wymans".
We have begun the process by giving our consultants the notice to proceed with the design. We
expect the project to be completed in 3 to 5 years.
Should you have any questions or comments, please do not hesitate to contact me.
Very Truly yours,
Aw/i— �.
Bruce D. Thibodeau, P.E.
Director of Public Services/City Engineer
CC: Joseph Nerden, Assistant City Engineer
William Merrill, Assistant Director
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COMMONWEALTH OF MASSACHUSETTS
MASS.DEP
APPROVED TITLE 5 SYSTEM INSPECTOR
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Paul Leblanc
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52 Kenney Rd to
Middleton,MA 01949-
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PURSUAN-fifO67HE GENERAL LA4(RH 995 6/30/2016
COMMONWEALTH OF MASSACHUSETTS
MASS.DEP
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APPROVED SOIL EVALUATOR .•:#�
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Paul Leblanc C
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52 Kenney Rd tq
Middleton,MA 01949-
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PURSUAP"tPlE GENERALLAW12000 6130/2016