HomeMy WebLinkAboutTitle V Inspection Report - 111 CHRISTIAN WAY 1/5/2017 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°'' 111 Christian Wa °6u;�v l t`rd r", �V "�"{I �,C 9�Ir
_ -------- .._._.._ if
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PropertyAddress
° 4
Robert Parker
Owner Owner's Name
information is North Andover MA 01845 12-27-2017
required for every ._._.__ __._...._ _.,.._.... __..-...._— ,_ _._.
page, Cltyffown 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:When A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Neil J. Bateson
use the return ---
key. Name of inspector
Bateson Enterprises Inc.
_ __.._.______ .__,.__..------------
Company
--_....Company Name
111 Argilla Road
Company Address
Andover MA 01810
City/Town State Zip Code
978-475-4786 Si-15
Telephone Number License Number
----__---_ __.....__ _.
B. Certification
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 Fu er Evaluation by the Local Approving Authority
r 12-27-2017
Inspec e s Si nature 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 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.
t51ns.doe•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
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Title 5 Official Inspection Form
Subsurface Sewage 0��� ��m �� ~ ����|un���ammmen�
111 (�hrimti�nVV�
Property Address
Robert Parker
Owner Owners Name
information i's
North Andover 88A 01845 12-27`2817
|
required for every --
page. City/Townaate _p ��_ Inspection
B. Certification (cont.)
Inspection Summary: Check /\0.O.0orE/always complete all ofSection D
A) System Passes:
F-1 I have not found any information which indicates that any of the failure criteria described
in 310 CyNF< 15.309orin 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 pmee.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined." please explain.
The septic tank ismetal and over 2Oyears old* mr the septic tank (whether metal ornot) iostructurally
unsoVnd, exhibits substantial infiltration or exfi|tmstion ortank 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 ioless than 2Oyears old ieavailable.
[l Y 0 N n N0 (Explain below):
----------------
15!nuooc'mm6n6 Title 6Official Inspection mrm.Subsurface Sewage Disposal System`Page um,r
Commonwealth of Massachusetts
Title 5 Official Inspection Farm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address
Robert Parker
Owner Owner's Name
information is North Andover MA 01845 12-27-2017
required for every _ _------_---.�- —._..._ _____.... __.__.____ _.._._.-...-...__._._-��...._
page. Clty/Town State Zip Gode 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 [9 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
t5ms.doc•rev.6116 Title 6 official inspection Form:Subsurface Sewage Disposal System•Papa 3 of 17
Commonwealth of Massachusetts
w _ W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a
- 111 Christian Way
Property Address
Robert.Parker
Owner Owner's Name j
information is North Andover MA 01845 12-27-2017
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:
Outet tee in septic tank& d-box needs to be replaced. Install riser on d-box.
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 t
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 '/2 day flow
l5ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
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Commonwealth of Massachusetts
^
Title 5 Official Inspection Form
Subsurface Sewage Disposal Symtemm �#rmm ^ NPtforVo|untaryAu�em�m�nba
111Christian Way
Property Address
Robert Parker
Owner Owners Name
information inNo�hAndovar MA U184� 12-27-2017
mquimdfor ovm�
Poe*. ~'`''~^~'
State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
Required pumping more than 4times in the last year NOT due toclogged or
[� [�
obstructed pipe(s), Number oftimes pumped:
El 0 Any portion ofthe SAS, cesspool orprivy |ebelow high ground water elevation.
�� Any podionufcesspool orprivy iSvvithiU1OOfeet ofoou�acevvatersupply 0r
�� �� tributary hoasurface water supply.
Fl ��
Any portion ofacesspool orprivy iawithin a Zone 1ofapublic well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
El 0 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet �
from m private water supply well with noacceptable water quality analysis. [This �
system passes |fthe well water analysis, performed mtaDEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm,
provided that noother failure criteria are triggered. A copy mfthe analysis
and chain of custody must be attached tothis formm]
�� �� ThemysbannimaomssAoo| eem|ngmfmoiUtyvvithadeoignf|ownf2OOOgpd-
�� �� 10.000Qpd.
�� ��The system fails. | have determined that one ormore of the above failure
�� criteria exist aodescribed in 310 CMR 15.303. therefore the system fails. The
system owner should contact the Board ofHealth todetermine what will be
necessary hVcorrect the failure.
E\ Large Systems: To be considered a large system the system must serve a facility with a
design flow mf10.00Dgpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the fo||uvving, in addition to the
questions |nSection 0.
Yes No
El the system iswithin 40Ofeet nfGsurface drinking water supply
�� Fl the system is within 200 feet ofa tributary to a surface drinking water supply
�� Fl theaystemia |ocmtad |nmnitrogenaensitive area (|nter|rnVVeUheodPrVkauUon
�� ��
Area—|VVPA)oramapped Zone !| ofmpublic water supply well
|fyou have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yea" in Section [}above the large system has failed. The owner uroperator ofany large
system considered a significant threat under SooboO E or failed under Section O shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office ofthe Department.
ts=,»m'rev,w1e Title eOfficial Inspection Form:Subsurface Sewage Disposal System'Page amn
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
111 Christian Way
Property Address
Robert Parker ---------
Owner Owner's Name
information is
required for every North Andover MA 01845 12-27-2017
"t
page. City/Town tate 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
E n Pumping information was provided by the owner, occupant, or Board of Health
El 19 Were any of the system components pumped out in the previous two weeks?
E n Has the system received normal flows in the previous two week period?
El Z 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)
F] Was the facility or dwelling inspected for signs of sewage back up?
• El Was the site inspected for signs of break out?
• El 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?
E EJ 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.
0 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): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
t5ins.doc-rev.6116 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
111 Christian Wa�y_ -------
Property Address
Robert Parker
Owner Owners Name
information is
required for every North Andover MA 01845 12-27-2017
page. CityfTown State Zip Code Date of Inspection
D. System Information
Description:
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? F-1 Yes Ej No
Seasonal use? El Yes M No
Water meter readings, if available(last 2 years usage (gpd)):
Yes
Detail:
Sump pump? El Yes M No
Last date of occupancy: Current
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? n Yes El No
Industrial waste holding tank present? n Yes El No
Non-sanitary waste discharged to the Title 5 system? F-1 Yes R No
Water meter readings, if available:
t5ins.doc-rev.6116 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
111 Christian Way
Property Address
Robert Parker ......
Owner Owner's Name
information is
required for every North Andover MA 01845 12-27-2017
page. CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use:
Other(describe below):
—----------
...................
General Information
Pumping Records:
Source of information: Pumped 2017, owner
Was system pumped as part of the inspection? ❑ Yes No
If yes, volume pumped: g—allon-s ------
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.doc-rev.6116 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
111 Christian Way ---------
-Property Address
Robert Parker
Owner Owner's Name
information is
required for every North Andover MA 01845 12-27-2017
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
30 years old, 8-5-1987,as built plan ..........
...........
Were sewage odors detected when arriving at the site? El Yes E No
Building Sewer(locate on site plan):
1,6
Depth below grade: feet
Material of construction:
E cast iron E 40 PVC El other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
4" Cast iron through wall, 3" PVC in house, no leaks visible
Septic Tank(locate on site plan):
Depth below grade: 0.5
feet
Material of construction:
concrete F-1 metal ❑ fiberglass n polyethylene El other(explain)
------------------ ............
----------------------- ------------
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes E] No
1
Dimensions: 0' x 5'x 4'
Sludge depth:
t5ins.doc-rev.6116 Title 5 Official 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
111 Christianppy
PropertyAdd—ress
Robert Parker
Owner Owner's Name
information is 12-27-2017
required for every North Andover MA 01845 -6a teii�Inspection
page- Cityrrown State Zip Code
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle N/A
Oil
Scum thickness ......
Distance from top of scum to top of outlet tee or baffle N/A outlet tee off
N/A
Distance from bottom of scum to bottom of outlet tee or baffle
Tape measure
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Inlet tee ok. Outlet tee corroded off. Needs to be replaced. Depth of liquid at
outlet invert. No evidence of leakage.
---------- ------
Grease Trap (locate on site plan):
Depth below rade: feet
Material of construction:
El concrete EJ metal El fiberglass El 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:
t5ins.cloo-rev.6116 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
111 Christian Way ——------— ------
Property Address
Robert Parker_--,-- --
Owner Owner's Name
information is North Andover MA 01845 12-27-2017
required for every —----- -State ZpGo—de –Ir�s–pe(�tion
page. bittyffo—wn
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 F1 polyethylene F1 other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes E) No
Alarm level: Alarm in working order: R Yes Ej No
Date of last pumping:.
Comments (condition of alarm and float switches, etc.):
--------——-------------
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
15ins.doo-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of W
Commonwealth of Massachusetts
a Title 5 Official Inspection Form
— Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
-- .�'" 111 Christian Way
Property Address
Robert Parker
Owner Owners Name
information is North Andover MA 01845 12-27-2017
required for every _ __rth A _ _.�
page City/Town � State Zip Code Date of inspection
D. System Information (cont.) 1
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.):
D-box level &distribution equal. Corrosion around liquid level. D-box need to be
replaced. No evidence of leakage. Evidence of carryover.
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.):
i
-_-----___
* 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:
15ins.doc•rev.6l16 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
111 Christian
---
Property Adaress
Robert Parker
Owner Owners Name
information is
for every
required North Andover MA 01845 12-27-2017
page. city/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
Fl leaching pits number:
F-1 leaching chambers number:
❑ leaching galleries number: ........
❑ leaching trenches number, length: ----
1 field 20'
1Z leaching fields number, dimensions: x 40'
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.):
Snow cover yard, No evidence of ponding to surface, .
-----------
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 El Yes El No
t5ins.doc-rev.6118 Tile 5 Official Inspection Form:Subsurface Sewa®e Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
111 Christian Way
Property Address
Robert Parker
Owner Owners Name
information Is
required for every North Andover MA 01845 12-27-2017
page. CityfTown 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,doc-rev.6116 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
111 Christian Way....... -------
Property Address
Robert Parker
Owner Owners Name
information is
required for every North Andover MA 01845 12-27-2017
page. tky-/Irov;n 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:
M hand-sketch in the area below
F1 drawing attached separately
G�7
P
4v H:q P-7)
l5ins.doc-rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
- - Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
'4 111 Christian Wa
Property Address
Robert Parker
Owner Owner's Name
information is North Andover MA 01845 12-27-2017
required for every --__ .. _ _ ______ ._
page. Cltyirown State Zip Code Date of Inspection 1
D. System Information (cont.) 1
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
E=stimated depth to high ground water. 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: 8-23-1984
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:
Test
on its design plan.
p 9
I
f
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc-rev.6116 `rifle 5 omcial Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Form Not for Voluntary Assessments
Subsurface Sewage Disposal System
- °Y 111 Christian Wa
—--------------
PropertyAddress
Robert Parker ------------------------
Owner Owner's Name
information i's
required for every North Andover MA 01845 12-27-2017
page. �5ty�own 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,doc-rev.6116 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
uunmumy necueu 4,usu 9oncm...0 un "'-' , "--"'.uy Haran rums... aye
Town of North Andover
Tax Map # 210y104.D-0130-000'0x0
Parcel Id 16816
111 CHRISTIAN WAY
PARKER, ROBERT
111 CHRISTIAN WAY
N. ANDOVER, MA
01845
Class 101 Single Familyy^ _ Property Type1 Residential
Zoning2 1.Residential Zoning3 1 Residential
Size Total 1.1.Acres
FY 2018
_UB Mailing index
Namo/Address Type Loan Number Active/Inact. From Until
PARKER, ROBERT Payor
111 CHRISTIAN WAY
N.ANDOVER,MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 17763.0-111 CHRISTIAN WAY Last Billing Date 10/10/2017
3170427 03 Cycle 03 Active
UB Service's Maint.
Account No,3170427
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.635/8 7.82 1/
WTR WATER 01 ALL METER SIZE 64.60 /1
UB Meter Maintenance
Account No.3170427
Serial No Status Location Brand Type Size YTD Cons
36185597 a Active ERT HH b Badger w Water 0.63 0.63 664
Date Reading Code Consumption Posted Date Variance
9112/2017 664 a Actual 17 10/18/2017 130%
6/8/2017 647 a Actual 7 7/2512017 15%
3/9/2017 640 a Actual 6 4/12/2017 -22%
12/9/2016 6.34 a Actual 8 1/23/2017 -89%
9/7/2016 626 a Actual 66 10/24/2016 324%
6/13/2016 560 a Actual 17 8/2/2016 177%
3/11/2016 543 a Actual 6 4/22/2016 -50%
12/10/2015 537 aActual 12 1/20/2016 -68%
9/9/2015 525 aActual 37 10/16/2015 70%
6/10/2015 488 aActual 22 7/24/2015 251%
3/10/2015 466 a Actual 6 4/28/2015 -21%
12/12/2014 460 aActual 8 1/15/2015 -86%
9/10/2014 452 a Actual 59 10/15/2014 6146/o
6/9/2014 393 a Actual 8 7/16/2014 32%
3/11/2014 385 aActual 6 4/11/2014 -32%
12/12/2013 379 a Actual 9 1/17/2014 -69%
9/12/2013 370 a Actual 29 10/15/2013 222%
6/13/2013 341 a Actual 9 7/24/2013 14%
3/14/2013 332 a Actual 8 4/22/2013 -53%
12/12/2012 324 aActual 17 1/9/2013 -77%
9/12/2012 307 a Actual 74 10/15/2012 307%
6/12/2012 233 a Actual 18 7/16/2012 127%
3/13/2012 215 a Actual 8 4/14/2012 -35%
12/12/2011 207 aActual 12 1/17/2012 -66%
9/13/2011 195 a Actual 38 10/13/2011 174%
6/7/2011 157 a Actual 13 7/20/2011 57%
3/7/2011 144 a Actual 8 4/13/2011 -19%
12/8/2010 136 a Actual 10 1/12/2011 -89%
9/9/2010 126 a Actual 94 10/15/2010 200%