HomeMy WebLinkAboutConditionally Passes - Title V Inspection Report - 234 BRIDGES LANE 6/13/2019 i
Commonwealth of Massachusetts ;
Totle 5 Ins—ection Form
N
Subsurface Sewage Disposal Systern FormNot for
Voluntary Assessments
234 Bridges Lane--,--,-,
Property Address
L rrairne McGovern
Owner Owner's Name
information is North Andover MA 1 5-29-2 19
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ru,id fir e� . . , �. .. � .. w., mm ....
page.
cit 'r n `t t ZI Code Date f Inspe t o n
1
Inspection
this form. Ins ,qg0alteredi i any+ y. a see cow lteeaa cklila t the,end the,formt
1
e,
Important.-When A Inspector Information
fillingout forms
on the computer,
Neil Jamey Bateson
use only the tad
m
key to move your Name of Inspector � W"
cursor,-do not Bateson Enterprises Inc.
use the return
111 A�g i�11 Road
fib
Company Address
Andover MA 01810
CItT' rn State Zip Code
Number".-AM. Telephone License umber
B. Certification
I Geri that- I am a DEP approvedsystem inspector In full,,compliiance with Title
sewage disposal system at thedress
listed above; the information reported bel w is true, accurate and complete as of the time of m
inspection, and theinspection was performed abased on any training and experience in the proper function
�
and maintenance f ors-site sewage disposal systems. After conducting this inspection I have determined n�
that the system*,
1,. Passes
2. Conditionally Passes,
3, ] Needs Further °al ati n by the Local Approving Authority
. Falls
5-2920 19
Inspector's 441uke Date
t
The system inspector shall submit a copy of this inspection report to theApproving Authority and
f Healtl r Ewithin 3 days of completing this inspection. if the system has a design flow of
102000 g id or greater, the inspector and'the system owner shall s u mit the report to the appr ►priate
*
regional office off'the DER The original'form should be sent to the system owner and copies sent t
the buyer,, 1fapplicable, and, the approving authority.,
1
Please note.,@ This report only describes conditions at the ItIme of inspection and under the
condifflions of use at that time.This inspection does not address how thie system will perform
in the future under the same or different condiflons of use.
t5lnsp.doc-rev.712612018 °"rite 5 Official Inspection;Form:Subsurfa Sewage Disposal System-Page 1,of 1
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Commonwealth of Massachusetts
bT"Itle 5 UITIcial Ins
u su a a Sewage deposal "+S s enn r - Not, Assess �
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ll �
a J,
234
� � s Leas
Property Address
Loraine McGovern
Owner Owners Name
information requiredi 1 5-2 -2 9
N r h,Andover .�� mm�------------
for every
.mm�
page. City/Town
State Zip Code Date of Inspection
Oil
C.
Inspection Summay
Inspection Summary, Complete 1 �, 3, r 5 n all n .
System, Fusses
F1 M
I have roof found information anywhich indicates that any of the failure criteria describe
airy 310 CM 5.3 03 or in 3,10 C M R 15.3 04 exist. Any failure c r�i eri a not evaIu a are
indicated below.
Comments:
I
2)
System Con di lonall ' Passes:
One or more system components as described in the"Conditional Passe section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
e
the Board of Health, will pass.
Check,the box for"yes" no" r"not determined" (" , N r AID)for the following statements. If"not
deterrnined, lease explain.
The septic tank is metal,and,over 20 years old* or the septic tank(whether metal, r roof) is structurally
unsound, exhibits substantial infiltration or exfiltra,ti in oran failure is imminent. System will pass
inspec i; n if the existing tank Is, replaced with a,complying septic tank as,approved by the Board of
Health.
.
metal septic tank will pass inspection n if it is, structurally surd, not leaking and if a Certificate of
Compliance indicating that,the tank,is lass than 20 years old is available.
le.
N F1 hI plain below):
Tank leaking, liquid level 1' below ve outlet invert.
a
t5insp.dbc rev.7126/2,018 "title 5 Official inspection Form,Subsurface Sewage Disposal system Page 2 of 1
Commonwealth of Massachuseft
Ell
'ns'n
m n Form,
UTTIcia S ectio
Twitle 5
for Voluntary Assessments
Subsurface Sewage Dils,posal Sy item Form, - Not,
23 Bridges fan .. m
Property AddressLorraine McGovern
r
t
Owner eras Name f
information t required fori
l; ' rtl!� � 1 5-2 9-2 � --
everyState Zip Code tel f Inspection mm
page
1
6 f
C. Inspection, Sa (cont)
System Conditionally Passes Cont.
El Pump Chamber plumps/alarms plumps/alarms not operational. System will pass with Board, of Health approval it'
pumps/alarms are repaired
Observation of sewage backup or brash out highstatic nt�r level in tldi�tri �ti distribution due
;
to broken or,obstructed p1 e ,s,or,due to a broken, settled oir uneven distribution box System will
pass inspection if(with approlval of Board of health):
t
broken pipe(s), are replaced Ej Y E N'f
NCB (Explain bellow):
E] obstruction is removed Y N ND (Explain below)":
E] distribution box is leveled or replaced I (Explain below),*
a
The system required pumping pumpling more than 4 times a year dine to broken or obstructed i e s .. T e
system will pass inspection it(with approval of the Board of Health):
E] rrl li s are replaced i (Explain below):
obstruction us removed, N Ej N (Explain bellow),,
Further Evaluation s Req,uilred by the Board of Health,.-.
Conditions exist which require,further evaluation by the Board of Health, in order to determine it'
the system is tailing to protect public health, safeityr the environment.
a. System will pass unless Board f Health determines w accordance witilh ,3110 CM
6.3 3 'l ( that the system is, not fu ct'i inn 'in a manner which will protect public health
safety and the environment:
(sinsp.d rear.712,6/20 18 Title 5 Offilicial Inspection orm Subsurface Sewage Oi posal System.Page 3 of 1
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Commonwealth of'Massachusetts
- "
ion
u icial Inspects' Form
TI"t Ile 5 4"'k ff
Subsurface Sewage Disposal System Fora Not for Voluntary Assess ents
234 qqq9es, .
PropertyAddress
i
Lorraine McGovern
Owner 6—w6er's Name
information
required for every
page
fit State Zip Code Date of Inspection �t
C. Insipection Summary, (cont)
Cesspooll or privy is within, 50 feet of a surface water a
El Ces,spooll or privy is within 50 teat of'a bordering vegetated wet,land or a salt marsh
bi. System will fail unless the, Board of Health (and Public"water Supplier, It a ),
determines that the system is functioning in a manner that protects, the pubfic alth,
safety and n r r nment
The system has a septic teak and s lil absorption system (SAS),an the S, S is within
100 feet ofa surface water supply r tributary to a surface ► iter supply.
E] The system has s a septic tarok and SAS and the SAS, is within a Zone I 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.
Eli The system has a septic teak and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supppl well".
Method used"to determine distance: d a�
w.
This system passes it the well waiter analysis, pe rrrr t certifiedlaboratory, for fecal i
itrr�r bacteriaindicates absent the
� presence, t arrtrtn'l rti,trrt rt nitrate nitrogen is Dual
t r less than 5 p p , provided that n other failurecriteria 1r triggered. A copy,of the analysis must
be attached to this form.
c. Other-
Septic tank, & -boxmeads to be replaced. -box needs riser, 3" deep. Outlet pipe t i-box has
broken and collapsed ps piece of pipe that needs to be repaired.
a.
4)
w
System ribs Criteria a ppwli 1 to All Systems,-,,
You must indicate"Yes" r"'No"to each of the following,for all,inspections:
Yes No
El E Backup of sewage into,facility or system component due to overloadedr
clogged SAS or cesspool
p
El E
Discharge r p nidi of effluent to the surface of the ground or surface waters
due to an overloadedr clogged SAS or cesspool
t5i ns,p.d rev,7/2612018 `title 5 Official Inspection F rm:Subsurface Sewage Disposal System-Page 4 of 18
m�
V
u
chusetts
Commonwealth of Massa
b
ubsurf ce Sewn a �'is + s ri System Forte 0, ,utticia nspectrion Form
Title
Not forVoluntaryAssessments
23 Brig �s Leas ......
Property Address
Lorraine McGovern
Owner Owner's Naas
,information is
required for every �Mt Town
State Zip Code Date f Inspection
pi
C. Inspection Su (cunt.)
A
System Faillure Criteria,Appflicable,to All Systems: (cont.),
Yes N
Static liquid level in the distribution bo,x aboveoutlet invert due to an overloaded
r clogged ,SAS or,cesspool
Liquid depth in cesspool is less than 6"' below inert or available volume is less
El N
than 1/2day flow
Required pumping more than 4 tiaras ire the last year NOT due to clogged or
E] N, obstructed pi s). Number of times pumped- - •
D N Any portion f the SAS, cesspool or privy is below high ground water elev�ation.
El N Any portion of cesspool or privy is within 1,00 feet of'a surface water supply air
tributary to a surface water supply.
El H Any portion f a cesspool or privy is within a Zone 1:1 of a, public water supply
well.
El E Any portion of a cesspool or privy is within 50 feet f private water supply well.
El 0, p p u cuter than 5 feetn portion, �cesspool or r� �� 1���tl �uru � feet but r
from a, private water supply well with no acceptable water quality analysis. [Thi
system passes if the well water analysis, performed at a DEP certwified
laboratory,
r'fecal colliform bacteria indicates absent and the presence
of ammonia moni, mitre en and nitrate nitrogen is equal to or less than, 51 ppm,
provided that no,other failure crifterilia are triggered. A copy of the,analysis
and chain of custody rust attached t ►this firm.']
El N The system is a,cesspool serving a facility with a design flow of 20,00 gpid-
%0,00
gp
d.
El N The system fails. i have determined that one or more of the above failure
eritena exist as d escri bled ire 3 1,0 C M R 15.303, th erefolre the s ystern fa 1Is, The
system owner should contact the Beard, of Health to determine what will be
necessary to correct the failure.
5) Large Systems: " consildered a, large system the system must serve a facility with
design,flow of , gpd to 15 gpd.
For large systems, your oust indicate either"yes or"no"to each, of the following, in, addition, to the
questions in Section CA.
s
Yes No
1:1 El the system is within 400 feet of'a surface drinking water supply
El El the system is within,2 feet of a tributary to a surface drinking water supply
El 0 the steno is, located in a nitrogen sensitive area interim Wellhead Protection
Area— I"PA or a mapped Zone 11 of a public water supply well
t5lns,p.do .rev.712612018 Title ifficl l Inspection Iorm Subsurface S e Displosal Systems-Page 5 of 18
i
Commonwealth of Massachusetts
TwItle, 5 Official, Inspection ors o
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
41
234 Bridges Lane, ................-
Property Address
Lorraine McGovern
Owner Owner's Name
information is, North Andover MA 0,1810 5-�29-201 9
required for ev�ery City/Town State Zip Code Date of Inspection
page.
C. Inspection Summary (cont.)
Ifyou have answered "'yes" to any question in Section C.5 the system is considered a sign ificant
threat, or answered yes"to any question, in Section C.4 above the large system has failed. The
owner or operator of any large system considered a Significant threat under Section C.5 or failed
u rider Section C.4 s ha I I u,pg rad e,the s stem 'I n accordance with 310 C M R 15.3 04. Th he system owner
should contact the appropriate regional office of the Department. T
e foowng all pec
61, You must indicate"yes"' or"no,"for each of th ll i for ins tions:
Yes No
0 El Pumping information was provided by the owner, occupant, or Board of Health
El 0 'Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two meek eriod?
Have large volumes of water been Introduced to the system recently or as part,of
this inspection?
Were as built plans of the system obtained and examined? (If they were not
available note as N/A),
Was the facility or dwelling inspected for signs of sewage back up?
1E El Was the site 'Inspected for signs of break out
Were all system components, excluding the SAS, located on site?
El El 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 scurn?
E El Was the facility owner(and ccupants if different from owner) provided with
information on the propler maintenance of subsurface sewage disposal systems?,
The size and location of the Soil Absorption System (SAS) on the,site has
been determined based no
Existing 'Information. For example, la plan at the Board of Health..
Determined in the field if any of the failure criteria related to Part C, is at issue
a ppro,xi�matio n of distance is u naccepta ble) [310 C M R 15.3 02(5)]
15fnsp,doc rev.7/2612018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
Commonwe,alth of Massa,chusetts
T
ici
a poftectmi
iI' Insw
Subsurface Sewage Dispoisal System Form Not for Voluntary,Assessments
234 Pridges,Lane
Property Address
Owner Owner's Name
information is 01810 529-2019
required for every North Andover .......... MA
page. F/T o I wn Ott e, Zip Code Date of Inspection
D, System Information
1. ResWerllfial Flow Cod ons:
4 r f e m
4_
Number of edrooms (actual).,
Numbe o bdroos, (design):
DESIGN flow based on 310, CMR. 5.2 13 (for example: 110 gpd x.#of bedrooms)'.
600'
Description:
------------------------
3
Number of current residents:
Does residence have a garbage grinder? Yes No
Does residence have a,water treatment unit.? El Yes H No
If yes, dischar�ges to:
Is laundry on a separate sewage systems (include laundry system inspection El Yes N No,
information in this report.),
Laundry system iris pact eld? El Yes, N o
Sward use? El Yestl
N No
Water meter readings, if available,(last 2 years usage (gpd)):1 Yes,
Deta,il:
Sump pump? El Yes H No
Last date of occupancy: Current
Date
t5insp.doc-rev.,712612018 Tide 5 Official tnspection Form:Subsurface Sewage Disposal System-Page 7 of 18
Commonwealth of Massachusetts
d
MA o a
Titie b off'lcial Ins ection Form
Subsurface Sewage Disposal System Form � Not for Voluntary Assessments
, wt
Property
Lorraine McGovern
...............
I
Owner Owners,Name X
information is North Andover 01810 5-2 -2 9
requiredfor every page.
City/Town Zip Code Fate Inspection
M System Information2. Commercial/Industriall Flow Conditionsl-.
Type of Establishment:
Design flow(based on 310 CAR 5.23 :
Gallons per dad _.
Basis of design flow s ats + rs ns s "ft. etc.):
Grease trap, rent' Yes E] No
El No
Water t "
treatment nit resent
Yes
e
If
yes, discharges to: . mm
P
'i in tarp resent?
Ir �tr��i wasteYes
Non-sianitary waste discharged to,the Title , stern? El Yes �
Water aster readings, if available: . .
i
Last data of occupancy/use.: � w.. ..
t
Other(describe below):
3Pumping Records:
Pumped 2018, owner
Source of information:
Was system pumped as part of the inspection? El Yes N
o-
If es, volume, pumped:
gaflons
How was quantity pumped I t rmin _.mm.
Reason for pumping., mm-... �... ,.mm.
t5insp,doe•rep. /2 '018 Title 5 Official inspection,Form:Subsurface Sewage Disposal System "age 8 of 1
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L�ommonwealth of Massachusetts
Icia
Inspeit..t,ion,
CJ M
Subsurface Sewage is sa System F rm l urt Ir � ���r �r�
'
2,34"1 ,es Lane
Property Address
Lorraine McGovern
Owner Owners Name
information is MA 01810
a�Ir � for � �
5-29-2019
North Andover
�
State ZipCode Date Inspection
page.
D. System In rmation (cent.)
o
y
. Type of System
Septic teak, distribution box, soil absorption system; �
Single cesspool
El Overflow cesspool
PrivyEl
shared system (yes or no) (if yes, attach pr,evious inspection records, if any)
El Innovative/Alternative technology. Attach, a copy of the current operation and
maintenance con�tra t,(to be obtained from system owner) and a copy of latest
inspection of the I system by system operator under contract
Ell Tight teak. Attach a copy of the DEP approval,.
r
Other(describe)-
f
X
Approximate age,of'all components, date installed ii(f known) and source information:
No as It 1rut "ts for dqs
ir plea w �erf' r�rn�� ® - 984.
Were sewage odors detected,when arr�iving at the site" El Yes 0 No
5, Bufldiinq Sewer(locate n site plan)-
3
Depth below grade: feet
Material of construction:
cast iron 0 40 PVC E other(expfaln)-
Distance from private water supply well or suction lire:
feet
Comments n condition of joints,, vsail evidence of leakage, etc.):
' Cast Iron through wall,, Y PVC in house, no leaks visible.
N
t5wn ,do -rev.7126120,18 Title 5 Offi l l Inspection Form:SuIbsurface Sewage Disposal System Page'9 of 1
Commonwealth of Massachusefts J!
T a A M c o T
Subsurface Sewage Disposal System Forte rtforarutr ssessrrt
234 B,(idges Lane
Property Address
Lorraine McGovern
uuurvnmmu uurmrn moumrmmmrmr�+'+vu,mm,
w.wnu�vwwwimnnmrmm.+�uwwm nxr uwi.: �wnmmmmmmmmnmma�'�rt unmmm mw r��-ruumm
Owner Owner's information .
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requiredNorth,Andover
� .� .. .mrrrvrry
City/Town State Zip Code Date Inspection
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D. SystemInformat"I'lon, (cont
6. S 'lic Tank (locate on, siteplan)*
Depth below grade, feet
Material of construction:
concrete El metal I ti'lber la ,s polyethylene other(explain)
f
If tank is metal, list age:
tiM
� j
rs
Is age confirmed by a Certificate of Compliance', (attach a copy of certificate) El Yes 0, No
Sludge depth: �.. . �
f
Tan
Distance sludge 'bottom outlet tee air b� ffl
le kin
Scum t i kness,
r
Distance frru tops of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom utl tee or baffle
1
How were dimensions determi ned?
Comments (,on purriping recommendations, inlet and outlet tie or baffle condition, structural integrity,
liquid', levels as related to outlet invert„ evidence of leakage, etc.):
Tank leaking badly. Liquid level >11' below outlet inert, dank.needs to be replace. Center cover has
access to grad. Outlet plipe t -box has llapsed & broken piece of'pipe that reeds to be repaired.
d w°
r
t5in p. -rev..7/26120,18 Titte 6 Official Inspection Porno Subsuiface sewage usposat System Page 10,of 18
Commonwealth of Massachusetts 0
a
Sub,su,rface Sewage D"Ispos,ali System Form Not for Voluntary Assessments,
o
r m J
234 Bridges Leas
-----
Vro,p—erty Address
Lorraine McGovern
t
Owner Owner's Name n
information[IS MA 01810 5-29-2019
North Andover
required for every �i /Town State Zip Code Date f Inspection
page. t
D, System Information (cont
7. Grease Trap�(l cate on site plan)*
Depth below grade: feet
Material of construction:
El concrete El metal El fiberglass polyethylene other(explain):
x
e
u
Dimensions'.Scum thickness
d-
r
Y
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, (ors pumping recommendations, inlet t and outlet tee or baffle condition,, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, t n),
tl
8.
Ep
Tilght,or !old*In Tank(tank must be dumped at time of inspection) (locate on site it n):
Depth below grade.
Material of construction:
El concrete 0 metal 0 fi er ,l ss, poilyethylene Ej, other(explain):
gallons,Design Flow:
h °c
6
gallons,pier day
d
t5insp.doc reap.712612018 Title Official Inspection Form Subsurface Sewage Disposal Systemi*Page,I I of 1
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Commonwealth Massachusetts
Timtle 5 Official
,m
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
s
t
234 Bridges Lane
Property Address
Lorraine r
Govern
Owner Nlhfll r1,s Name
North Andover
required for eves mm .,, C �
_
page. City/Town to f Inspection
n �
D. System Information (cont.)
y
8.
Tight or HoldIng Tank(coat.)
Alarm resent* El Yes l
,Alarm level: ,. Alarm in working order. Ell o
Yes l
Date of last pumping-., Date
1
Comments (condition of alarm, and float switches, etc.),
d
w�
Attach copy of current pump�ing contract (required),. Is copy attached" El Yes [:1 No
9, Distribution Box if present must be opened) (locate on site plea):
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to,outlets equal" any evidence of solids carryover,l any
evidence of leakage into r out of box, eta.):
-box level & distribution rn t equal. D-box badly corroded, needs to be replaced* D-box needs riser
installed, 3" deep. Evidence of ca,rrylover.
t5in p. o -rev,71 61'01 Title Ofrr l iI Inspection Form:Subsurface Sewage Disposal System Page 12 of 1
o
Y
i
Commonwealth as,sa
O%e
Title F) official
Subsurface Sewage Disposal Systems Forte � � � ssessments
234 Bridges
Property Address
Owner Owner's Name
information
required for every City/Town State Zip Cede Date of Inspection
D. System Information (cone.)
. Pump Chamber(locate c n sv plain):
o
Pumps In working, carder: EJ Yes Ej No*
� 1
4
Alarms in working order: �� �]
y
Comments (note condition of purriprn r, condition of pumps and appurtenances, etc.)-
......
if pumps or alarms are not in working order, system is a conditional pass.,
. Spill Absorption System (SAS) (locate on site plan, excavation not required):
o;
If SAS not located, explain why:
e�
Type:
i
leaching pits number,
leaching chambers number,
leaching galleries number:
leaching trenches numberl length:
a�
q
1 field 2 ' x 5 '
leaching field's number, dimensions:
� „
E] overflow cesspool number-
inn'l ati al ernatii e system
hype/name of technology:
t5i .d w •rev,7/26/2018 Tilde 5 Official Inspection Form:Subsurface Sewage Disposal y tee#Page 13 of 1
Commonwealth of Massachusetts
rAN
Title 5 afflal ici
Insmectio
am A�' N
Formn
°o l;
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
�� Lane
6
Property,Address
Lorraine, cG rug
Owner n rs dame
information is MA 018,10 5-29-20,19
required for every North Andoverm . .� State Zip Code Date of Inspection
..
page. City/Town,
r
D, System Information
(,cont.)
1 1. Soil Absorption System SAS) (cliont,
Comments rote conclition of soil, signs of,hydraulic failure, level n ling, damp soil, condition of
vegetation,,, etc.);
a
d
J
i
2. Cesspools (cesspool must be pumpeds art ins cti n) (locate on site plan):
Number r and configurafion
Depth—top of liquid to inlet invert mm... m.
Depth of solids layer
h
Depth of scum layer ..
Dimensions of cesspool �.. . ..
r
Materials construction
Indication of groundwater inflow El Yes F� No
Comments (note condition of soil, signs of hydraulic failure, level of p inning) condition of vegetation,
etc.)*
0
u
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V
e
t i nsp.d f rear.712612018 Title 5 Official inspection Fore Subsurface'Sewage Disposal system-Fags 14 of 1 18
Commonwealth of Massachusetts
1 s.. ect4-mi',on, Form
Title ,5 icia
TA
Subsurface Sewage Disposal Sy'stem Form Not for Voluntary Assessments
234 Bridges Lane
Property Address
Lorraine McGovern
Owner Owner's Name
infoffnation is North Andover MA 01810 5-29-2019
C
required for every - I
State Zip Code Date,of Inspection ity/Town
page.
D, System, Information (cont)
13. Prilvy (locate on site plan)"
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil,, siigns,of hydraulic failure, level of ponding, condition of vegetation,
etc.):
li
YI
pllWyt
t5insp.doc-rev.712612018 Title 5 Official Inspection Fora:Subsurface Sewage Disposal S,ystem Page 15 of 18
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Commonwealth ofMassachusetts
I'r" iI Insumection Form;
14 IV Subsurface Sewage Disposal System Form Not for Voluntary Assessments
234 B,ridges, Lane
Property,Address
Lorraine McGovern
Owner !Owner's Narne
informatrequiredion MA '1
North Andover �!
everyfor Opt � r� Inspection
page. Ds System Information (coat.) a a
. Sketch Of Sewage Disposal Systems
Provide view of the sewage disposal system, including ties to at least two rmanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where 1ic water supply ehters
the building. Check rye of the boxes below-
hand-sketch in the area below
drawing attached separately
Pe"
01
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10 ,
Ir
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t in . -rev.712612,018 Tilde 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18
E
A
Commonwealth of Massachusetts
.... .............
0
TI*,tl'e 5 ff'icial Insopp&ection Form
Not for Vo As sessments
Subsurface Sewage Disposal System Form luntary
2,34 Bridges Lane
Property Address
Lorraine McGovern
Owner 6-w—nir's Name
information is North Andover MA 018�10 529-20,19
required for every Gityffown .......--—----- State Zip Code Date of Inspection
page.
D. System Information (cont.)
15. Site Exam:
Check Slope
Surface watertl�
Check cellar
Z Shallow wells
4
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.* 5-91-1984
Date
Observed site (abutting property/observation hole within 15,0 feet of SAS)
Checked with local Board of Health -explain-
Design plan
Checked with, local excavators, installers - (attach documentation)
E] Accessed USES dat,abase,-explain-
You must describe how you established the high ground water elevation:
As per test pit data on design plan.
CY
Before filing Ithols Inspection Report, please see Report Completeness Checkl1st on It,page.
t5inspi,doe•rev.7126120118 Title 5 Official inspection Form:Subsurface Sewage Disposal System«Page 17 of 18
Commonwealth of Massachusefts
Title 5 i ial Ins-ft-ection Form
P
i Subsurface Sewage Disposal S,ystem Form Not for Voluntary Assessments
234 Bridges L,,a,ne-.-,
Property Address
Lorraine,McGovern
Owner Owner's Name
information is North Andover MA 01810 5-29-2019
required for every City/Town State, Zip Code Date of Inspection
page.
E. Report Completeness Checklist
Complete all applicable sections of this form incl'usive of:
A. Inspector Information, Complete all fields in this section.
B. Certification: Signed &, Dated and 1 2, '3,, o r 4 checked
C. Inspection Summary:
1,1 2,1 3 o r 5 com p leted 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
qJ
t5insp.doc rev.7126120,18, TiAle 5 Official Inspection Form.,Subsurface Sewage!Disposal System-Page 18 of 18
Summary Record Card generated on 613/20,19 9:39:42 AM by Karen Hanion Page I
Town of North /A-xndover
Tax a -104,,D-0088-0000,01
Parcel Id 16775
234, BRIDGES LANE
MCGOVERN, PAUL
234 BRIDGES LANE
NORTH ANDOVER, MA
01845
Class 101 Single Family Property Type 1 Residential
Zon ire g,2 I Residential Zoning3 1 Residential
Size Total 1.01 Acres
,1
FY 209
UB Mailing Index
Name/Address Type Loan,Number Active lire act., From Until
MCGOVERN, PAUL Payor Active
234 BRIDGES LANE
NORTH DOVER,MA
01845
UB Account, Maint,
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 17781.0-234 BRIDGES LANE Last Billing Date 4/19/2019
3170445 03 Cycle 03 Active
UB Services Maint.
Account No.,317'0445
Service Code Rate Charge Multipfier/Users,
MISCIFEE ADMI FEE 0.635/8 7.82 1/
WTR WATER 01 ALL METER SIZE 49,40
UB MiAter Maintenance
Account No.,3170445
Serial No Status Location Brand Type Size YTD Cons
36433625 a Active ER,T HH b Badger w Water 0.63 0.63 13139
Date Reading Code Consumption Posted Date Variance
3111/2019 13311 a Actual 13 4/16/2019 -46%
12111/2,018 1318 a Actual 24 1122/2,019 -63%
9/13/2018 1,294 a Actual 71 101/15/2018 98%
617/2018 1223 a Actua 1 33 7/23/2018 138%
3/9/2018 1 1910 a Actual 14 4/23/2018 -33%
12/8/20,17 1176 a Actual 20 1/25/2018 -58%
911212017 1,156 a Actu a 1 52, 10118120,17 105%
618/2017 1104 a Actual 24 '7/25/2017 83%
3/9/2 17 1,080, a Actual 13 4/1 2017 -251%,
12/9/2016 1067 a Actuall 18 1123/2017 -8,61%
1917,12016 1049 a Actual 121 10/24/2016 451%
6/1312016 9218 a,Actual 24 812/20,16 81%
3111/2P 16 904 a Actual 13 4122/201,16 -28%
12/10/2015 891 a Actual 18 1/20/2016 -80%
9/91201 3 a Actual 90 10/16/2015 127%
6/10/2015 783 a Actual 40 7/24/2015 139%
3/10/2015 743 a Actual 16 4/28/2015 -66%
12/12/2014 '727' a Actual 50 1/1512015 -42%
9/10/2014 677 a Actual 86 10/15/2014 247%
6/9120114 5191 a Actual 24 7/16/2014 40%
1111 14, 567 a Ac,tu a 1 17 4/1112014 -50%
12/12/2013 550 a Actual 35 1/17/2014 -54%
9/1212013 515 a Actual 76 10/15/2013 27%
6113/2013 439 a Actual 7/24/20 13 219%,
3/14/2013 379 a,Actu a 1 19 4/22/2013 1-6%
12/12/2012 360 a,Actual 20 1/9/201 -74%
9/1 2/ 12 340 a Actual 78 1 0/1�5/2012 267%
611212012 262 a Actual 21 7/1,612012, 1%
3/13/2012 241 a Actual 21 4114/2012 8%