HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 32 EQUESTRIAN DRIVE 7/31/2019 Commonwealth of Massachusefts
'T Pod a 004k r r!M M 0
nie 5 unicial n Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments,
32 Equestrian Drive
Property Address
Loy_Wa e r
Owner Owners Name
information is
required for every North Andover MA 0 18 10 7-17-2019
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this,form. Inspection forms, may not be,alter in any
way. Please see completeness checklist at the end of the form. PON
its]
lmportaM:When A
Inspector Information
filling out fbrms
ort the computer,
A:
Nell James Batesion,
use only the tab
key to move your Name of Inspector
cursor-do not Bateson Enterprises Inc.
use the return
key. Company Name
l Argilla Road
...........
tab Company Address
Andover MA 01810
City/Town State Zip,Code
978-475-4786 SI-15,
Telephone Niumber License Number
B. Certification
* h econ 1 ,40 of 5
I certify that: I am,a DEP approved system Inspec tor in�full compl writ S ti 5.3 Title iance
(310 MR 15.000); 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
3. El Needs Further Evaluation by the Lo all pproving Authority
4. [j Fail,
'7-17-2019
.................... ...........
Inspe to" ftnature 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'
101 000 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 th,e.system owner and copies sent to
the buyerl if applicable, and the approving authonty.
Please note: This report only describes conditions at the time ofinspection and under the
condibons of use,at that time,.This 'Inspection does not address how the system will perform
in the future under the same,or differOnt conditions of use.
t 5 i nsp.doc rev.7/26M 18 Title 5 Official Inspection Form:Subsurface Sewage Disposal system Page 1 of 118
n
T tl,, ayncial In plection Form
I e, 5
Subsurface Sewage,Disposal Syste Perm ss Not for Voluntary Assessments
32 Equestrian Drive—
Property Address
Lou Wagner
Owner Owners Name
information is North w Andover A 8 -2 �19
requirpage.ed for �� ,,,,,. ��
�+ State � i Code Dateof Inspection
. ,
C, InspecUon, Summary
Inspection Summary: Co lete l,, r and all of 4 and 6.
System Passes:
i
El,
l have not.fund any information which indicates that any of the failure criteria describe
in 31 CMR 15.303 r in 310 CNIR 16.304 exist, Any failure criteria not evaluated are �
indicated below.
r
2 System Co it' a ly Prises'
One or more system compone, is as described in the"Conditional Pass, section reed to be
replaced or repaired. The syst m,, upon completion of the replacement or repair, as approved by
the Board of Health, will pass..
�aa at Oil �s�
Check e tm,�for s a r n tdtrrninedaim , N, N for followingffollowingstatements. if"n
ot
determined,"ined," please explain.
The septic tank is metal and over') yearsold* the septic teak(whether metal or not) is structurally
r,
unsound, exhibits,substantial infiltr ti ro or exfiltr tin or tank failure its imminent. System will pass
Inspection,if the existing tank is rep.l c d with a complying septic gunk as approved by the Board f
Health..,
i
metal septic ta,ni,k wlill pass inspection if it is structurally sound, not leaking and if a Certificate f
Compliance indicating that the tank is less,than 20 years old is available.
i
Explain lel w w
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t
t nspi.d rep.7/260.018 Title 5,Official Inspection F rn ubsuraSewage Di"sal System* "age 2 of I ar'
Commonwealth of Massachusetts
mom AM, VAr 10 M
ion
itie 5 UTTIcial nsecForm
Not for Voluntary Assessments
Subsurface,Sewage Dilsposall System Form
32 Equestrian Drive -.......
Property Address,
Lou Wagner
Owner Owner's Name
information is North Andover MA 01810 7-17-20,19
required for eve'ry City[Town State Zip,Code Date,of Inspection
page.
G. Inspection, Summary (cont)
2), System, Condit lonally Passes(cont.)-.
Pump,Chamber pumps/alarms not operational. System will pass ith Board of Health approval if
plumps/alarms are repaired.
E] Observation ofsewagel backup,or break,out or high,static water level in the clistribution box due
to broken or obstructed pipe(s)or due-to a broken, settled or uneven distribution box. Systpm will
pass inspection if(with approval of Board of Health):
broken pipel(s)are, replaced F] Y M NEI ND(Explain bellow),:
olblstruction is removed El Y [A NEI ND(Explain below):
EJ distribution box us leveled or replaced E1Y 0 NEI ND (Explain blelow):
............
Ej The system required pumpinl more than 4 times a yea du r e to broken or obstructed p1pe(s). The
9
system will pass inspection if(with approval of the Board of Health):
E] broken pipe(s) are replaced El Y 0 N [:3 ND (Explain below):
obstruction is removed E] Y E N ND(Explain below):
,3) Further Evaluatillon is Requllired by the Board of Health:
El 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 determilnes,iin accordance with 310 CMR
15.3,03(11)(b)'that the system,is not functioning In a,manne,r which will protect public health,
safety and the,environment:
t5 insp.roc,-rev.7/2612018 'Title 5 Of Inspection Form-Subsurface Sewage Disposaill System Page 3 of I a
Commonwealth of Massachusetts
T"tIe 5 O,ff icial Inspection
Form
Subsurface Sewaglo D'Isposal'Systelm Form,-1 Not for voluntary Assessments,
32 Equestrian Drive
Property,Address o
Lou Wagner
Owner Owners Name
information is
North Andover -MA 01810 7-17-2019
required for every
. City/Town state Zip Code Date of inspection
page
C. Inspection Summary (cont)
0 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 ma,rsh
b., System w1fill fatil unless the Board of Health(and Public Water Suppliler, if any)
determines,that the system "I's function1bg in a manner that protects the public health,
safety and envioronment:
The system has a septic tank and soil absorption system (SAS) and the SIBS its wit h�in,
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.
E] The system has a septic tarek and SAS and the SAS[is within 50feet of a private water
supply well.
0, The system Ihas,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:
asI
This system,passes if the will water analysis, performied 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,.
c. Other:
Outlet tee in septic tank & d-box needs to be replaced. Riser installed on top of d-box.
4) System Faillure Criterila,Applicable to All Systems:
You must,ind'icate"'Yes"'or"No"to each of the followiling for all,iinspect,ions:
Yes No
Backup of'siewage into facility or system component due to overloaded or
clogged SAS or cesspool
Disch po arge or ndin g of effluent to,the surface of the ground or surface waters
El Z,
due to an overloaded or clogged SAS or cesspool,
t5insp.dicc rev,.7/26/2018 Title 5 Official Inspection Form-Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
I Inspection Form
fficia
Title 5 0`0
Subsurface Sewage Disposal System Form, Not for Voluntary Assessments
32-Pquestrian Dri've
Property Address
Lou Wagner
Owner Owner's Name
information is North Andover. IVIA 01810 7-17-2019
equ rired for every
Page. CityfTown State Zip Code Date of inspection
C. I sect cont)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
El H Static liquid level in the,distribution box above olutlet invert due to an overloaded
or clogged SAS or cesspool
Liquid depth in cesspool is less than 6"'bellow invert or available volume is less
El El than, %day flow
Required pumping morethan 4 times in the last year NOT due to clogg,ed or
E] El obstructed pipe(s). Number f times uu l p
El M Any rtion,of the SAS,ces,splool or prive is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or
E] 0 tributary to a surface water supply.
Any portion, of a cesspool or privy is within. aZone 1 of a public water supply
well.
Any portion of a cesspool or privy is within, 50 feet of a private water supply we'll.
Any portion of a cesspool or privy Is less than 100 feet but greater than, 510 feet
from a private water supply well with no acceptable water quality analysis. [This
,system P,asses if the,well water analysis,performed at a DEP,certiff led
laboratory,for fecal coliform,bacteria inditcates absent and the presence
of ammoinia nitrogen and nitrate nits ogenis ual to or less than 5 pipim,
provided that no other faillure 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-
101000 gpd.
E] 0 The,system'fails. I have determined that one or more of the!above failure
criteria exist as described in 310 CIVIR 15.303 therefore the system fails.The
ril $
system owner should contact the Board of Health to determine what will be
necessary to correct,the failure.
6) 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 El the system is within 400 feet of a surface drinking water supply
the system is within 2,00 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellbead Prot�cfion
Area—I.WPA)or a m1apped Zone 11 of a public water supply well
S0surface Se�Wage Disposal S,y tem Page 5 of 18
1&nsp.doc-rev.7/26/2,018 Titfe,5 Official Inspection Flom
Commonwealth of Massachusefts
..........
10 Form
Title 5 Off"c"al Inspect
A- 11
Subsurface Sewage Disposal System, Form Not for Voluntary Assessments
32 Equestrian Drive
Property Address
Loy�a er
Owner Owner's Name
information,is, North Andover MA 01810 7-17-2,0191
required for every
tyfrown State Zip Code Date of Inspection
page.
C. Inspection Summary (coat.)
If you, have answered`yes"to any question in Section C.5 the system is considereda significant
threat, or answered "yes"to,any question in Section C. above 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 sha,111 upgrade the system in accordance with 310 CMR 15.3,04.The system owner
should contiact the appropriate regional office of the, Department.
6. You must ind"Icate "Yes" or,"no"for,each of the following for al/inspections.:
Yes No,
Pumping information was provided by the owner,, occupant, or,Board of Health
El M Were any of the system;components pumped out in the previous two weeks?
Has,the system, received normal flows in the previous two week period?
El N Have large volumes of water been introduced to the system recently or as,part of
this ins pect,ilon?
F] Were as built,plans of the system obtained and examined? (If they were,not,
available note as N/A)iti
Was,the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for silgris,of break out?
0 El Were all system components, excluding the SAS, loicated on site?
01 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 scum?
l
Was the facility owner(and occupants if diffe rent from owner) provided with
0 El
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil A,bsorpt,i!on System(SAS) on the site has
been determined based on:
F� Existing, information. For example, a plan at the Board of Health.
Determined in the field if any of'the failure criteria related to; Part C is at issue
approxima tin ofdistance is unacceptable) [310 CMR 15.302(15)]
t5in sp.doe rev.7/2612018 Title 5 Official Inspection Form,Subsurface Serwage Disposal System-Pagle,6 of 18
Commonwealth ofMazzachusefts
Uttic" I t i n, Form
e 5 ia
Sub,surface Sewage Disposal System Form Not for Voluntary Assessments
32
Property Address
Lou Wagner
Owner Owner's Name
information is North,Andover MA 011,810 7-17-201,9
required for every
page. �bityffown State Zip Code Date ofIre spection
D. System Information
1., Residential Flow Condiflons:
Number of bedrooms (design)-. 44 Number of bedrooms (actual): 4
6,00
DESIGN flow based on 310 CMR 15.203(for exampla-, 1,10 gpid x#olfbedrooms):
Description:
2
Number of'current residents:
Does residence have a garbage grinder? El Yes 0 No
Does residence have a water treatment unit? El Yes Ej No
Ices, discharges to,,
Is laundry on a,separate sewage system? (Include laundry system inspection El Yes EE, No
information in leis report.)
Laundry system inspected? El Yes 2 No
Seasona,luse? El Yes
Yes
Water meter readings, if available (last,2 years, usage (gpd")):
Detail:
SUMP pump? Yes No
Last date of occupancy- Current
Dateo
(5J nsp.doe-rev.7126t201 8 Title 5 Official In spectilon Form.Subsurface,Sewage Disposal System Pagel 7 of 10
Cm eat' Massachusetts,
I I n Form
Title 5 Officia nspe
> Subsurface Sewage Disposal System Form Not for Voluntary,Assessments
32 E(lyestrian Drive,�
Property Address
Lou Wagner
Owner Owner's Name
infomation is, North Andlov,er MA 01810 7-17-2019,
requi red for every ty/Town, State Zl'p Code Date of Inspecti
ge. on
pa
Cl., System Information (cont.)
2. Commercial/Industrial Flow Con,dl,tions:
Type of Establishment
eiwso3CR15-2Ds ba 03
Gallons per day(9pd)
Basis of design flow(seats/persons/sq.ft., etc):
Grease trap present? El Yes No
o j
Water treatment unit present? El Yes No
It yes, discharges to:
Industrial waste holding tare present? El Yes E] No
Non-sanitary,waste discharged to the Title 5 system? Ell Yes, [:11 No
Water meter readings,,, if available,.
Last date of occupancy/use:
Other(describe below).-
3. Pumping Records,.-
Pumped Dec 2018, owner
Source of information-.
Was system pumped as part of the inspection? El Yes 0 N o,
hies, volume pumped: ............
gallons
How was quantity pumped determined?
Reason for pumping:
Mnsp.doc-rev.712612018 IM96 Official.Inspection Form,Subsurfa,ce Sewage Disposal System,-Page 8 of 18
Commonwealth of Masseuse
Title 51 Orficial on Form
Subs,u,rface Sewage Disposal System Form Not for Voluntary Assessments
Property Address
Lou Wagner
Owner Owne(s Name
information is North Andover MA 01,810 7-17-2019
required for every City[To�wn State Zip Code Date�of Ins,piection
page.
D. System Information coat.)
4. Type of System,11,1
0 Septic tank, distribution box,,,soil; absorption system
1:1 Single cesspool;
1:11 Overflow cesspool
1:1 Privy
1:1 S,harIed system, (yes or no)(if yes, attach previous inspection records, IT any)
El Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained Ifrom 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 (i'f known) and source of information".
36, .-ears,old, 10-281-1,9816, as built plan,
Were sewage odors detected when arriving at the site.? El Yes El N o
5. Building Sewer(locate on site plan):
1.6
Depth below grade: feet
Material of construction,
castiron E 40 PVC Ej other(explain):
Distance from private water supply well or suction Iine: �eet
Com1ments (on condition, of'joints, venting, evidence of leakage, etc.):
4"Cast Iron through wall, 3" PVC in housel no leaks visible
ii
t5inspi.idoc rev.7126/2018 Title,5 Offidal Inspection Form,:Subsurface,Sewage Disposal System-Page 9 of 18
V ('
I
Commonwealth of Massachusefts
■ a K
nciaForm I I e 5 fw"Y' I Ins*p " �i o e
... Subsurface,rf" Sewage Disposall System Form Not for Voluntary ssessm nt , G
32 Equestrian Drive
PropertyAddress
, ...
Lodi nr
Owner,
information i
North Andover MA 01810 7-17-2019
r,eq u1red for e ve m
twit town State Zip Code Date of Inspection
t
i. SystemInformation (cunt,)
6 Septic Teak(locate on site,plan)::
0.6
Depthbelow grd �
feet
Material ria'l f constr tin .!
concrete Emetal fiberglass polyethylene other(explain,)
n
t
I
If tank is metal, list age. s
years
Is age confirmed by a Certificate of Carmine (attach a copy of certificate Yes No,
T, 'x5'x '
0
Dimensions .,
Sludge depth* . .
Distance from top of s,ludge to bottom f outlet tee or baffle ._
Scum thickness
ill =Outlet tee off.
Distance from top f snn t top,of outlet tee r baffle .�,.
r
Distance from bottom of scum to bottom of outlet tee or baffle NJ
How were dimensions determined? Tape Measure
Comments n pumping recommendations, inlet and outlet tee r baffle conditlon,, structural integrity,
liquid levels as related to outlet invert, ev,idence of leakage, etc.):
d
Inlet tee clogged clean same Outlet tee corroded off, needs to be replaced. Depth of, liquid at outlet
Invert. No evidence of leakage..
t In p.do rev,7/2612018 Title 5 Official Inspection Form:Subsurface Sew,age Disposal System,-Page 10 of 1
Commonwealth of Massachusetts
...
T
I Ttic," 1, Insso%ection Form
itle 5 0""' ia
a
Subsurface Sewn ge 'Dispos I System Form Not for Voluntary Assessments
32 Equestrian Drive ............
Property Address
Lou Wagner
Owner Ownee's Rame
information is North Andover MA 01810 7-17-2019
equ ry
rired'for eve
page. d,_Rf O—W n State Zip,Code Date of Inspectilon
D. System Informatio ct.
)
7. Grease Trap, (locate on site plan)",
Depth below grade- feet
Material, of construction:
El concrete El metal fiberglass polyethylene other(explain):
Dimensions:
Sicum thickness
Distance from top,of scum to top of outlet tee or baffle
Di'stance from bottom of scum to'bottorn 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 outletinvert, 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 E] metal 0 fiberglass El polyethylene, other(explain' .
Dimensions:
Capacity.: gallons
Design Flow- gallons per day
t5insp.doc-rev.M6120118 TWe 5 Official Ire specItion Form,Subsurface Sewage Disposal System-Page'i�i of 18
Commonwealth of Massachusefts
T't le 5 1 Insw%ecti'on Form
i Utticia
Subsu'rFace Sewage Disposal System Form Not for Voluntary Assessments,
32 Equestrian Dirive
Property Address
Loq_W!q er
a__................... ...............
Owner Owner's Name
information is Niorth,And ver MA 01810 7-17-2019
required for every City[Town State Zrp Co nsp
�de Date of Iection
page.
D. System Information (cunt®
8. Tilght or Holding Tank(cont.),
Alarm present,- El Yes N ol
Alarm level-1 Alarm in working order", El Yes N o
Date of last pumping:
Date
Comments (condition of alarm and float switches, etc.):
h
Attach copy of current pumping contract(required). Is copy attached? Yes No
9. 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 11ea1 into or out of box,, etc.):
D-box level and distribution, equal. Evidence of leakage,, has corrosion holes in d-box, Evidence of
carryover.,
.................
t5lnsp.doc-rev.'712612018, Tj,tl'e 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusefts
W T i I Lie 5 ial Inspectimon Form
Subsurface,Sewage Disposal System Form. Not for Voluntary Assessments
32 Equestrian Drive ..............
Property Address,
Lou Wagner
Owner Owner's Name
information is North Andover MA 7-17-2019
required for every
page. City/Town State Zip Code It f InspeGtion
D. System Informati on, (cont.)
10. Pump Chamber(locate on site plan).
Pumps in working order: E] Yes 0'� N o*
Alarms in working order: E] Yes 0 No*
Comments (note condition of pump chambert Condition of'pumps and appurtenances, etcj:
If'pumps or alarms are not in working order, system is,a conditional pass.
T
11. Soil Absorpt*Wn System (SAS) (locate ors rite plan, excavation not required): M.
If SAS not located,, explain wfiy-
.......... ......
Type.
El leaching plats, number:
leaching chambers number.*
El leaching galleries number.-
leaching trenches number,, length,-. 2 trenches 43'
lon
leaching fields number,:6mensions:
0 overflow cesspool number:
El inn ovativelalternative system
Typie/name of technology-
15insp.doc rear.7/26/2018 Title 5 Offilcial Inspection Form-Subsurface Sewage Disposal System-Page 13 of 1 a
i
t
I
i
Commonwealth Massachusetts
mm e e ct
Subsurface Sewage Disposal System Form Not o�r Voluntary Assessments
3� uestrian Drive
Property Address,
Q
Lou Wagner
Owner Owner's Name.
information i
Worth Andover MA 1 1 -1 -2
. ... ..
repagequired City/Town State Zip Code date Inspection
System Information (coat.)
11. Soil sor i i System (SAS) (coat.)
a
Comments (rote condition, of s ill s[9,ns of hydraulic failure, level of poniding, damp soil, condition of'
vegetatlon,, etc.,):
Soil ok. Vegetallion ok. No sign nding,to surface.
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 buyer
Depth of scum layer
Materials of construction
Dimensions of cesspool
d,N
Indication of groundwater inflow El Yes N �
Comments (,note condition + '1, signs of hydraulic failure, level of ponding, condition of vegetationy
etc.)..
l
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Vi
itl
1
i
f
1
t fn . oc*rev.7126/2018 Tift 5 Offidal Inspection Form::Subsurface Sewage Disposal System.Page 14 of 1
Commonwealth of Massachusefts
Titile 5 Uo"Ificial Inspection For
Subsurface Sewage Disposal S st,em Form Not for Voluntary Assess,ments,
40
W 32 Equestrian Drllve
Property Address
Lou Wa ner
9.......
Owner Owners Name
information is
required for every North Andover MA 0,1810 7-17-2019
page- CI t [f n Sta,te �i6o d e 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 fallure, level of'ponding, condition of vegetation,
etc.,
------.....
t6insp.doc rev.7126/2018 'Title 5 Official Inspection Form:SSul bsiurface Sewage Disposall Systern,-Page 15 of 18
Commonwealth of Massachusetts
&'1 5 Off I I wpm t F
III e
S,ubsurface Sewag,e D"Isposall System Form - Not for Voluntary Assessments
32 Equestrian Drive
Property Address
Lou Waqner
lolwner Ownees Name
information is
required for every North Andover MA 01810 7-17-2019"
CityfTown State Zip Code Date of Inspection
page.
D. System Information (cont.)
14. Sketch Of'Sewage,Disposal System,. j
Provide a view of the sewage displosal systemI including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply eaters
the building. Check one of'the boxes below:
El hand-skietch in the area below
drawing attached separately
�R
4
J6
YI 3
W Ir
Mn .do -rev.7/26/2018 Till 5 Official Inspection Form,Subsurface Sewage Disposal System Page 16 of 18
Commonwealth ssachusetts
T"Itle uni i nspection
N3, 5 c"a Form
lY
Subsurface Siewage Disposal System Form Not for Voluntary Assessments,
3,2 Equestrian Drive
Property Address
Lou Wagner
Owner Owners Name
Information required for evesNorth Andover MA 01810 7-17-2019
- -
page. City/Town State Zip Code Date of Inspection
D. System Information ciont)
15. Site Exam,.,
Z Check. Slope
Z! Surface water
Check,cellar
Shallow wells
4
Estimated depth to high ground water'. 'feet
Please,indicate all methods used to determine,the high ground water elevationi..
e .
Obtained'from system,design plans on record
11-28-19,84
If checked, date of design plan reviewed', Date
Observed site (abutting pro perty/obse rvation hole within 150 feet of SAS)
Checked with local Board of Health-explain't
es pima
plan
EJ Checked with local excavators, installers,-(attach documentation),
Accessed USES database -explain:
You must describe how you established the high ground water elevation..
Test pit data on design plan
........... .. ... ................ ....................
Before filing this Inspection,Report,please,see Report Completeness Checkilist on next page.
t5insp.do o rev.7/2612018 Title 5 Official Inspection Form Subsutface Sewage Disposal System-Page 17 of 18
Commonwealth of Massachusefts
T10tle 5 fw*lffiocimal Inspecti"'on Form
2— k, Subsurfaco Sewage Disposal System Form Not,for,Voluntary Assessments
32 Equestrian, Drive
Property Address
Lou Wagner
Owner Owners Name
information is North An MA 01810 7-17-2019
required for every dover
p ., City/Town State Zip Code Date of Inspection
age
E. Report Completeness, Checklist
Complete all applicable sections of this form *Inclusive,olf:
A. Inspector Information: Complete all fields in this section.
B. Certification: Sligned& Dated and 1, ZF 3, or 4 checked
C. Inspection Summary.-
11 21, 3, or 51 completed as appropriate
14 (Failure Criteria),and 6(Checklist)completed
D. System Informatiom
For 8: Tilght/Holding Tank,—Plumping 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
15insp.dam,-,rev.712,6120,18 Tifle 5 Official trispectioril Form,Subsurface Sewage Disposal System-Page 1 a of 18
Surnmary Record Card generated on 7/10120,19 2:23:33 PM by Karen Hanlon page I
A
Town of North /Andover
Tax Map # 210-105M-0139-00100.0
Parcel Id 17099
32 EQUESTRIAN DRIVE
WAGNER, LOUIS J,
32 EQUESTRIAN DRIVE
N. ANDOVER, MA
018145
Class 101 Single Fa,mily Property Type I Residential
Zon,ing,2 1 Residential Zoning3 1 Residential
is Total 1.13 Acres
FY 2019
UB Mailing Index
Name/Address Type Loan Number Aictive/Inact. From Until
WAGNER,LOUIS J. Payor Active
32 EQUESTRIAN DR,IVE
N,ANDOVER, MA
4
18,45
UB Account Mil .
Account No Cycle Occupant Name Active/Inact[ve
Bldg Id. 17537.0-32,EQUESTRIAN DRIVE Last Billing Date /9/2019
31,70207 03 Cycle 03 Active
UB Services Ma,"int.
Account No.3170207
Service Code Data Charge Multip,lifer/Users
MISCIFEE ADMIN FEE 0.63 518 7.82 1/
WTR WATER 01ALL METER SIZE 34.20 11
UB Meter Maintenance
Account No.3170207
Serial No Status, Location Bran d Type Size YTD Cons
29,955861 a Active ERT HH b Badger w Water 0.630.63 823
Date Reading Code Consumption Posted Data Variance
6/10/2019 1132 a Actual 11 14%
3/8/2019, 1121, a actual 9, 4/16/2019 -18%
121 10/201:8 11112 a,Actual il 1/22,/20,19 -82%,
9/13/2018 1101 a,Actual' 68 10/1512018 552%
6/8/20,18 1033 a,Actual 10 7/23/201 -3%
3/7/2018 1023 a Actual 10 4/2312018 -4,0%
12/712 017 1013 a,Actual 16 11251201 -,71%
9111/2017 997 a Actual 60 10118/2017 626%
6/8/2017 937 a Actual 8 7/25/2017 -14%
3/8,/2017 929 a Actual 9 4/121/2,1017 -58%
12/9/2016 920 a Actual 22 1/23/2017 -,73%
9/912016 898 a Actual 83 10124/2016 135%
6/8/2016 815 a Actual 12/2016 280%
3/8/2016 780 a Actual 9 4/22/2016 -64%
12,119/2015 771 a,Actual 25 1/2012016 -51%
9/10/'2015 746 a Actua 1 53 10/16/2015 419%
6/912015 6,93 a Actual 10 7/2412015 -18%
3110/2015 6183, a Actual 12 412812015 70%
12/10/20114 671 a Actual 7 1115 2015 -54%
9/12/2014 664 a Actual '16 10/15/2101 42%
6111/2O 11 4, 648, a Actual 11 7/16/2014 11%
3112/2014 637 a Actual '110 4/11/2014 22%
12/10/2013 627 a Actual 8 1/17/2014 -9%
111121 619 a Actual 9! 10/15/2013, -20%
6/11/2013 610 a Actual 11 7/24/2013 -34%
11 12 1 599 a Actual 17 4/22/2013 63%,
121'11/2 012 582 a Actua 1 10 1/912013 -23%
9/14/2012 572 a Actual 14 10/15/2012 22%
611112 0 12 6581 a Actual 11 '7/1611,2012 -10%
1,40 RTsj
i4quillb fib
Town of Noi �dover
HE�ALT'H DEPARTMENT
CH
DA'rE,-
CHECK
L OCATION:
„off i
H/O NAME L
j
'CONTRACTOR,NAME:
Type,,of Permit or Licens, e:,(Check box)
0 Anintal $
0I Body Art Establislunent, $
0 Body Art Practitioner $
0 Diumpster $
0 Food Service-Type,- $
0, Fimeral Directors
0 Massage Establishnient $
13 Massage Pralictice $
* Offal(Septic)Haider
* Recreational Cainp, $
�D Sun tannifig $
0 Swillintillig Pool $
[3 Tobacco $
• TrashlSolid'Write Hattler $'
• Well'Constmcfion $
SEP17C bins:
Ijg
• Septi
I
c-Soil Test' $
• Septic Approval $
1911'
Septic Disposal Works Construction( ,WC) $
11 Slepti'c Disposal Works Installers(DWT)
0 Title 5hispector I
001(
Title 5 Report $
.411
0 OtIter.-(Indicate) $
............
oil
.6ealih-Agent Initials
White,-Applicant Yellow-Health Pink--Treasurer