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HomeMy WebLinkAbout- Title V Inspection Report - 157 OLD CART WAY 11/29/2018 tI Q Commonwealth of Massachusetts E C 0 Tily ntle 5 Offici P al Inspection Form If a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 157 Old Cart Way Property Address Monte D. Kramer Owner Owner's dame information is North Andover Ma 01845 11/7/2018 required for 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:When A. Inspector Information filling out forms Sall. on the computer, use only the tab y Warren R. Pearce Jr. ke to move your Name of Ins e pctor cursor-do not Pearce Construction use the return C,ms� key. Company Name 196 Park St Company Address North Reading MA .01864 City/Town State Zip Code 978-664-5264 S11959 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 6 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. Passes 2. Conditionally Passes 1 ❑ Needs Further Evaluation by the Local Approving Authority 4. Fails LA --- ------- 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 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 DER The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. 15insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 ti Commonwealth of Massachusetts T mtle 5 Offidal Inspectmon Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 157 Old Cart Way - ---------- -- Property Address Monte D. Kramer Owner Owner's Name information is required for every North Andover Ma,,,., 018451--- 11/7/20-18 -—--------- page, City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: .......... 2) 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. F1 Y El N El ND (Explain below): —----------- —--—----------------------------- ............ [5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form Not for Voluntary Assessments -157 Old Cart Way Property Address Monte D. Kramer,_ Owner information is Owner's Name North Andover Ma 01845 11/7/2018 required for every ------------------ ------ --------- —------- page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): F] Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): El broken pipe(s) are replaced F Y F-1 N El ND (Explain below): ❑ obstruction is removed n Y El N R ND (Explain below): Fj distribution box is leveled or replaced R Y 0 N F-1 ND (Explain below): __-------- El 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 El Y R N F-1 ND (Explain below): El obstruction is removed 0 Y Fj N F-1 ND (Explain below): ------------------ 3) 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. a. 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: t5insp.doe•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 16 Commonwealth of Massachusetts =�""��0 �� Official 0 Inspection �� Title N��Q�� �������� 0���� ������� B �@�� �� ��y� � m�� ��N �m m�� ��� �~ ' m m �e�� u��m � ��mmmu Subsurface Sewage Disposal SyotenmFormm - NntfVrVo|untaryAmeeaamentm 157 {}|d Cart Way Property Address N1onteO. Kramer Owner Owno/mName � ------------ information is required for every North Andover Ma 01845 11/7/2018 page. cnynown State Zip Code Date o[Inspection C. Inspection Summary (cont.) El Cesspool or privy is within 5O feet mfa surface water El Cesspool or privy ia within 5O feet nfa bordering vegetated wetland ora salt marsh b. 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: El The system has a septic tank and soil absorption system (SAS) and the SAS is within 1OO feet ofe surface water supply or tributary toe surface water supply. El The system has a septic tank and SAS and the SAG is within a Zone Y of public water supply. 0 The system has a septic tank and SAS and the SAS io within 5O feet ofa private water supply well. E] 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 we||*° Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal uo|iform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or |eao than 5 ppnn. provided that Do other failure criteria are triggered, /\copy of the ona|ym|o must be attached to this form. o. Other 4\ System Failure Criteria Applicable tn All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yea NV �l �� Backup cf sewage into fat|Uxo/ component due toovedmadedor �� �� clogged SAS orcesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ,m"ov.uoe'rev,numovm Title o official Inspection Form:Subsurface Sewage Disposal System'Page 4"/m Commonwealth of Massachusetts o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 157.01d.Part Way Property Address Monte D. Kramer Owner Owner's Name information is required for every North Andover Ma 01845 11/7/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El N Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool E-1 R Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2day flow El N Required pumping more than 4 times in the last year NOTdue 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 N Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 0 N Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. El 0 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 PEEP 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 2000 gpd- 10,000 gpd. The system fails. I have determined that one or more of the above failure El N 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. 5) 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 CA. Yes No El ❑ the system is within 400 feet of a surface drinking water supply El E-1 the system is within 200 feet of a tributary to a surface drinking water supply E-1 El the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 16 Commonwealth of Massachusetts ��"��� �� �w����" � N Inspection Form � Title Q��N�� ���������� N���� ������� � � ���� �� q��� @m������ Qmw�� � �� ' ������ u��n m ��m � mm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 157 Old Cart VVa Property Address MonteO. Kramer Owner Owner's Name � information is required for every N Mu 01845 11/7/2018 page. C|tynvwn State Zip Code Date o[Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered ''yee" to any question in Section C.4above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office nf the Department, Q. You must indicate"yes" or'^mo"for each mfthe following for all inspections: Yes No E Fl Pumping information was provided bythe owner, occupant, or Board nfHealth El E Were any of the system components pumped out in the previous two weeks? 0 El Has the system received normal flows in the previous two week period? �� Have large volumes ofvvaber been introduced tothe system recently ormopm�of �� �� this inspection? �� �� VVereao built plans of the ayetenoobtained and examined? (if they were not �= �� available note as N/4\ El Was the facility or dwelling inspected for signs of sewage back up? �H 0 Was the site inspected for signs of break out? E El Were all system components, excluding the SAG. located on G|bg7 E El Were the septic tank manholes unoovenad, opened, and the interior ufthe 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 onthe proper maintenance of subsurface sewage disposal systems? The size and location mfthe Soil Absorption System (SAS) on the site has been determined based on: El Existing information. For example, e plan at the Board of Health, Determined io the field (if any of the failure criteria related b) Part Cis at issue �� �� approximation of distance ie unacceptable) [310CK8R15.3O2(6)] Commonwealth of Massachusetts um Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 157 Old Cart Way — ._...... Property Address Monte D. Kramer Owner Owner's Name information is North Andover Ma 01845 11/7/2018 required for every _.. __......__...w _....._._. _......._ __— — ......._ page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flaw Conditions: Number of bedrooms (actual): 4 - - Number of bedrooms (design): _ 4 w.-- ( ) DESIGN flow based on 310 CMR 15,203 (for example: 110 gpd x#of bedrooms): 660GPD Description: 2 Number of current residents: __......_. Does residence have a garbage grinder? ❑ Yes H No Does residence have a water treatment unit? © Yes ® No If yes, discharges to: _ _......_ _..._.... ____- ....- Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 years usage d 254 GPD avg _ Detail: 10/19/2016 to 10/23/2018 24,900 cu.ft. Sump pump? ❑ Yes ® No Current Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 157 Old Cart Way Property Address Monte D. Kramer Owner Owner's Name information is required for every North Andover Ma 01845 11/7/2018 page. &it y/_T o­wn e— Zip"Code_—_ Date of inspection-- D. System Information (cont.) 2. Commerciallindustrial 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 Water treatment unit present? El Yes El No If yes, discharges to: Industrial waste holding tank present? El Yes E] No Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No Water meter readings, if available: —----- Last date of occupancy/use: Date Other(describe below): —--—--------- -—----- --------------- --------- _-—--------- —----_ 3. Pumping Records: Source of information: Pumped in September 201 7 per.the owner. Windriver Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.dor-rev,7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 57 Old Cart Way Property Address Monte D. Kramer Owner Owner's Name information is required for every North Andover Ma 01845 11/7/2018 .............. page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: Septic tank, distribution box, soil absorption system El Single cesspool ❑ Overflow cesspool D Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) 0 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): Approximate age of all components, date installed (if known) and source of information: Installed October 3, 1996 per the as built. 224-ears old.-,--- Were sewage odors detected when arriving at the site? F-1 Yes M No 5. Building Sewer(locate on site plan): 1611 Depth below grade: feet-" Material of construction: El cast iron N 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): "11 d shape inside the house. 151nsp.doo-rev,712612018 Title 5 Official Inspection Form'.Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Tftle 5 Offic"lial Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 157 Old Cart-Way Property Address Monte D. Kramer I ------- - --—-----___- Owner Owner's Name information is required for every North Andover Ma 01845 11/7/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): 91t Depth below grade: feet Material of construction: 0 concrete El metal El fiberglass n polyethylene F-1 other(explain) ........... —---_-----__ If tank is metal, list age: —-----__ years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) M Yes El No Dimensions: -10'6" by 5'8" b 5' deep Sludge depth: At r. .- ____----------- Distance from top of sludge to bottom of outlet tee or baffle 2811 Scum thickness < in Distance from top of scum to top of outlet tee or baffle 611 ... ---------- 1711 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Tape Measure 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 is in place, outlet is a filter. The liquid is at_the proper level. The tank appears in good shape __-- --------_---- t5insp.doc•rev,7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form « Nat for Voluntary Assessments FJ 157 Old Cart Property Address Monte D. Kramer —------ Owner Owner's Name information is North Andover Ma 01845 11/7/2018 required for every state Zip C,ode Date of Inspection page. D. System Information (cont.) 7, Grease Trap (locate on site plan): Depth below grade: feet Material of construction: El concrete n 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El concrete El metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 15insp.doc•rev.7/2612018 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts N Tm-g-le 5 Offloc"al Inspection Form F It Subsurface Sewage Disposal System Form Not for Voluntary Assessments 157 Old Cart Wage ............... Property Address Monte D. Kramer Owner Owner's Name information is required for every North Andover Ma 01845 11/7/2018 page. Q—ty—/Tow—n — State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: El Yes n No Alarm level: —-------------- Alarm in working order: F1 Yes 0 No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): —--------- .......... —------- --—------- Attach copy of current pumping contract(required). Is copy attached? F] Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Olt Depth of liquid level above outlet invert 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 appears level, distribution is equal. D=box appears in good shape, minimal solids and no leakage. 23" below grade. —---------- —------------ -—-------- - ---—------- --—---------------- ....... 15insp.doc-rev,712.6/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systern-Page 12 of 18 Commonwealth of Massachusetts Subsurface Sewage Disposal System Form d Not for Voluntary Assessments _157 Old Cart Way _._....__ _....... Property Address Monte D. Kramer Owner Owner's Name information is North Andover Ma 01845 11/7/2018 required for every _.._.......,.___ ._ — —._.._._.. _— page. City/Town State Zip Code Date of Inspection b D. System Information (cant.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: __.__.. _-- ❑ leaching chambers number: - ❑ leaching galleries number: ® leaching trenches number, length: 2 51'trenches _._._.. -._.�... _____. ❑ leaching fields number, dimensions: (� overflow cesspool number: ----_.._...._._ _..............__ ❑ innovative/alternative system Type/name of technology: ........._ l5insp.doc-rev.7126/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 13 of 16 Commonwealth of Massachusetts �i Title 5 Off"Idal Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 157 Old Cart Way Property Address Monte D. Kramer Owner Owner's Name information is required for every North Andover --- Ma 01845 11/7/2018 —-—------------------- page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Na surface sign of problems, no sign in the d-box of a back up. —-------------- ...... 12. 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 R No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): --——------- t6insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 16 (�N Commonwealth of Massachusetts Thle 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 157 Old Cart W Property Address Monte D. Kramer ------------- Owner Owner's Name information is required for every North Andover Ma 01845 11/7/2018 page. State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): 15insp.doc rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Totle 5 Offacoal Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 157 Old Cart Way Property Address Monte D. Kramer Owner Owner's Name information is required for every North Andover Ma 01845 11/7/2018 page. d-tyffown State Zip.Code Date of inspection-'" D. System Information (cont.) 14. 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: El hand-sketch in the area below drawing attached separately t6insp.doc•rev.7/26/2018 Title 5 Official frispection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts OfficialTitle 5 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments x�. ! 157 Old Cart Way Property Address Monte D. Kramer Owner Owner's Name information is North Andover Ma 01845 11/7/2018 required for every ._...._.__— ...... _...._. _......, __._.—_.. .. .._..._._._ page. Cltyfrown State Zip Code Date of Inspection D. System Information (cons.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells _ 6" Estimated 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: July 25,1989 revised 12/21/1992 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Review files M Checked with local excavators, installers - (attach documentation) ® Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test hole data from the design plan dated July 25, 1989 Revised 12/21/1992 by Merrimack En ineering Robert Daley P.E. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l6insp.doc•rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 17 of 18 <, Commonwealth of Massachusetts Title 5 Official Inspection Form -8 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 157 Old Cart Way Property Address Monte D. Kramer Owner Owner's Name, information is required for every North Andover Ma 01845 11/7/2018 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Z A. inspector information: Complete all fields in this section. ED B. Certification: Signed & Dated and 1, 2, 3, or 4 checked Z C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed D. System information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 ;: a „r r ;..,//or!/ri•`l F�II��%�Jl�l����ri��ii/��/f��`rj /r�GliiYfJj�Jx71v/r/'/�/N�J�� �"�!I���/�%�;�� ! � r / r �`!�!i�9ti�'���)`�!rF/���✓���r��!�,��k�r��li���9//1w'/iir�%(�i/�✓ii?Ff/; d • /Cr r r'/?/J 1i/1 /ri r , r rliil����/p�l?//� ��o�'Ff r�����'�� � ���OY,s�, ar;r/a�l III di { � a lF Ir ..f�//Yrr�� �d!/r�p� 'F k�f'J/Yr�f/�`''�d�%!✓r� �, i ���;,ft� J� l/rl'y� /I���, r r/�!// J s7J !r`• Ct !(G�f �' Y i�l�!/fl�� �(r r/�/l/pJJrr��r°r � J r1Y�v/ rJ ✓y'" �� � �1�` '7PI (� ral/,k, ��A/� /si �iaf��/rlvar"�i rr ru , � .,c//r�l r�k �,wk`iN�l��,,��� 11�rI�f i a„/„r/, 9f rfJi/��i,��FTJ/ r•s �;�rir��i;(✓/�ri! /!(%fi1/. /��r��� lv, r�i °N //i� r ,i����' ry�rkfiurl f �!�6rr /ai � r ��a/i, � ..lrti -Yi////I/�.,k,%J✓y/� r/�/1//,ltr��;ip r�r rr�',r�% //r�%k%%���'!,'�a�/�f���v`>l��i��✓�l��jh'U�D��j,/'J,� v-M r ��%�/�l������j/i lC�js��I�Qrtl��yr� r 1��1��/f���j����/J,�!/f r „✓ �, ', r 5t { won, N l VOIN a a' a r/l „r / a Is /o li�/fl��✓����/� �r� 1 N 0 v, 2 0, L V 1 V I L: 2 1 p k.cl Oerd penereled on il/20=18 12:1&30 PM by 0rsn Hanlon No. 3 10 5 1/ P�Oa Town of North Andover Tax Map # 210-107.5-0104-0000.0 Parcel Id 18217 157 OLD CART WAY KRAMER, MONTE & KAREN 1 157 OLD CART WAY I NORTH ANDOVER, MA 01045 1 l class 101 Single Family Property Type 1 Residential Zonin92 1 ResidenUal Zoning3 1 Residential Size Total 1.39Acres FY 2019 UB Mailing Index Name/Address Type Loan Number Active/inact. From Until KRAMER,MONTE&KAREN Payor Active 167 OLD CART WAY NORTH AN DOVER,NIA 01845 UB Account Maint. Account No cycle Occupant Name Activellnaotive Bldg id. 13748.0-157 OLD CART WAY Last Billing Date 1116/2018 1000426 01 cycle 01 Active UR Services Maint. Account No, 1090426 Service Code Rate Charge MultipliedUsers MISCFEE ADMIN FEE 0.63518 7,82 1/ WTR WATER 01 ALL METER S)ZE 223,93 /1 UB Meter Maintenance Account No. 1090426 Serial No Status Location Brand Type size YTO Cons 32772762 aActive 00 b Badger w Water 0,63 0.03 1626 Date Reading Coda� Consumptlon Posted Date Variance 10/23/2018 1908 a Actual 47 11/1912018 -2% 7/19/2018 1861 a actual 46 8/1612018 2160% 4/18/2018 1815 a Actual 2 5/17/2018 •88% 1/18/2018 1013 aActua1 17 2/20/2018 -7B% 10/18/2017 1796 a Actual 77 11/13/2011 76% 7/19/2017 1719 a Actual 44 6116/2017 20760/6 4/19/2017 1675 a Actual 2 5117/2017 -85% 1/19/2017 1673 aActual 14 2/16/2017 -810/a 10/19/2016 1659 aActual 72 11/16/2016 16% 7122/2016 1587 a Actual 64 8/16/2016 392% 4/22/2016 1523 a Actual 13 5/2512016 -23% 1/22/2016 1510 aActual 17 2/19/2016 -67% 10/2212015 1493 aActual 51 11/20/2016 25% 7/24/2015 1442 a Actual 40 8/14/2015 182% 4/2712015 1402 a Actual 14 5/19/2015 -20% 1/3012015 1388 aActual 22 2/2012015 •63% 10124/2014 1366 aActual 56 11/14/2014 321/16 7/2512014 1311 aActual 42 0/13/2014 165% 4124/2014 1269 a Actual 15 5/15/2014 3% 1/27/2014 1254 aActual 16 2/1412014 -03% 10/2312013 1238 aActual 41 11/18/2013 -45% 7/23/2013 1191 &Actual 73 6/1512013 381% 4/24/2013 1124 aActual 15 5/2012013 -7% 1/25/2013 1109 aActual 17 2/13/2013 •74% 10/23/2012 1092 aActual 65 11/9/2012 .1% 7/23/2012 1027 a Actual 65 8/14/2012 282% 4/23/2012 962 aActual 17 5/9/2012 -19% 1/2312012 945 aActual 21 2/13/2012 -60% 10/24/2011 924 &Actual 54 11/14/2011 -11% � _- Swimming Pool $________ N N 60 O N W N