HomeMy WebLinkAboutPass - Title V Inspection Report - 15 NORTH CROSS ROAD 4/25/2023 Commonwealth of Massachusetts
Title 5 Off icalal Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 NORTH CROSS ROAD
..........
CHRIS TARAPATA
Owner am,e, --------
information is
required for every NORTH ANDOVER MA 01845 �PRIL 1,2023
page. Cityfrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. InspectO ins may not be altered in any
way. Please see completeness checklist at the end of the
Important:When
filling out fornis A. Inspector Information
on the computer,
Todd James Bateson
use only the tab ....... ........ ....................... .................
key to move your Name of Inspector
cursor-do not Bateson Ente rises Inc. ,�l
use the return ........... ............i�
Gompany Name 0
key.
11 1Argilla Road
Company Address.
Andover MA 01810
6atydf Zip--C-----o-d--e-
978-475-4786 SI-16
Tetephone Number -i cen,-" s--a Number
umr
— --------L
Be Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 6
(310 CAR 16.000); I 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. R1 Passes
2. El Conditionally Passes
1 E] Needs Further Evaluation by the Local Approving Authority
4. [:] Fails
APRIL 1, 2023
I Is" i is 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 DEP. 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.
t5hsp d=M rev.MSMI 8 TWe 5 Offidat an"cfiw Form Substoface Sewage Chsposal System-Page 1 of 58
- Commonwealth of Massachusetts
Title 5 Official Inspection Form
(' t Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
15 NORTH CROSS ROAD
Property Address
CHRIS TARAPATA
Owner _...
Owner's Nerve _
information is NORTH ANDOVER MA 01845 APRIL 1 2023
required for every
page CVty/7own state 'Zip'Code Date of Inspection
_...w.,,.._ _.._.___,,,,...._._.. _....... ___........... ._.....__._ _______. _ ..__.... . .._ ...--- ____................
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.
Y N ND (Explain below):
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
1- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 NORTH CROSS ROAD
Property Address_.
CHRIS TARAPATA
Owner Owner's Name
information is NORTH AN DOVE R MA 01845 APRIL 1, 202
required for every _.......�. -
page. CityfTown State Zap Code Date of Inspection
G. Inspection Summary (cant.)
2) System Conditionally Passes (cant.):
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&eves 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 NCB (Explain below):
( ] distribution box is leveled or replaced [._ Y ❑ N NC (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):
F broken pipe(s) are replaced E) Y N NCB (Explain below):
obstruction is removed Y N NCB (Explain below):
3) Further Evaluation is Required by the Board of Health:
E] 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:
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�N, Commonwealth of Massachusetts
t_
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
� 15 NORTH CROSS ROAL7
Property Address
CHRIS TARAPATA
Owner Owner's Name
information is NORTH ANDOVER MA 01845 APRIL. 1, 202
required for every _,
page. 6iy/"6'own State Zap Code Date of Inspection
_.w._ ...__ww,.,_..._ A. .....,. . __ _..___.._._... _......
_.___._._._
C. Inspection Summary (cont.)
El Cesspool or privy is within 50 feet of a surface water
0 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a 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
100 feet of a surface water supply or tributary to a surface water supply.
El The system has a septic tank and SAS and the SAS is within a Zane 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.
c. Other,
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or
I."] z clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters
El due to an overloaded or clogged SAS or cesspool
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Commonwealth of Massachusetts
1; Tale 5 Official Inspection Form
we Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 NORTH CROSS ROAD
.a,M
Property Address
CHRIS TARAPATA
Owner owner"s Name
information is required for every NORTH ANDOVER MA 01845 APRIL 1 2023
_ .
page City9fown _ State Zip 'ode Gate of inspection
C. Inspection Summary (cunt.)
4) System Failure Criteria Applicable to All Systems: (cant.)
Yes No
z 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 Yz day flow
El Z Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
z 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.
F-1 Z Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
1:1 z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis, [This
system passes if the well water analysis, performed at a DEP certified
laboratory„ for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this forma
Z 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
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 C.4.
Yes No
11 1.1 the system is within 400 feet of a surface drinking water supply
❑ El the system is within 200 feet of a tributary to a surface drinking water supply
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
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Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 NORTH CROSS ROACH
Property Address
CHRIS TARAPATA
Owner Owner's-Name
information i e
required for every NORTH ANDOVER MA 01645 APRIL 1, 2023
_.....__........ ._ ..
page, City9Towwn State Zap Cade Clete of 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 "yes" to any question in Section CA 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 shall upgrade the system in accordance with 310 CMR 15,304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no" for each of the fallowing for a//inspections:
Yes No
❑ Pumping information was provided by the owner, occupant, or Board of Health
[ El Were any of the system components pumped out in the previous two weeks?
aZ 1:1 Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
this inspection?
El al 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?
(� Was the site inspected for signs of break out?
Z 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?
Z 0 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:
Z ❑ Existing information. For example, a plan at the Board of Health.
Ell F] 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)]
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Commonwealth of Massachusetts
c0 Tile 5 Official Inspection Form
a � Subsurface Sewage Disposal System Form Not for Voluntary Assessments
15 NORTH CROSS ROAD
Property Address
CHRIS TARAPATA
Owner Owner"s Name
informatiegUiredon is
r for every NORTH ANDOVER MA 01545 APRIL 1 2023
equired ._
page. City/Town State Zap Code Date of Inspection
__.___.___ ._ _...__.,W.,,..w_..___w_.. _,_a,.w.... _..._ ......_.,_,_._...,._._... __...._......._ ..._.....
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 GPD
Description
_....... _
Number of current residents:
Does residence have a garbage grinder? Z Yes ❑ No
Does residence have a water treatment unit? 0 Yes Z 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? Z Yes ❑ No
Seasonal use? [I Yes ❑ No
Water meter readings, if available last 2 years usage d SEE ATTACHED
Detail:
Sump pump? ❑ Yes ❑ No
Last date of occu anc CURRENT
__ . ..
p Gate
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Commonwealth of Massachusetts
TMe 51 Official Inspection Form
i. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 NORTH CROSS ROAD
_... Property Address
CHRIS TARAPATA
Owner Owner's Nameinfor
required
is feqed for
NORTH ANDOVER MA 01845 APRIL 1„ 2023
pegged r every _._.... ... r.......... .. ....._..... .._ ___..__. __._ .....,,....0
City/Town _ State Zip Cade Date of Inspection
..._...._ ............ _.. .._.. ... _.,..........__.....
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15103): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes 0 No
Water treatment unit present? 7 Yes E] No
If yes, discharges to:
Industrial waste holding tank present? Yes } No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes No
Water meter readings, if available:
Last date of occupancy/use:
Gate
Other(describe below):
3. Pumping Records:
Source of information: DULY 2022, OWNER
Was system pumped as part of the inspection? D Yes Z No
If yes, volume pumped: _ ...._...
gallons
How was quantity pumped determined? _. ------
Reason for pumping:
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tiw Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm • Not for"Voluntary Assessments
�fitya 15 NORTH CROSS ROAD
Property Address
CHRIS TARAPATA
Owner ..........r�. . ........
owners Na we
information is required for every NORTH ANDOVER MA 01545 APRIL 1, 2023
_.. .. .
page. CityfTown State Zip Code Cate of Inspection
D. System Information (cant.)
4. Type of System:
z Septic tank, distribution box, soil absorption system
❑ Single cesspool
E] Overflow cesspool
El 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
El Tight tank. Attach a copy of the DEP approval,
F-1 Other(describe):
Approximate age of all components, date installed (if known) and source of information:
20 YEARS, AS BUILT PLAN DECEMBER 17, 2003
Were sewage odors detected when arriving at the site? Yes Z No
5. Building Sewer(locate on site plan)
Depth below grade: feet
Material of construction:
v cast iron Z 40 PVC E] 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 VISIBLE LEAKS
JOINTS AND VENTING GOOD
NO EVIDENCE OF LEAKAGE
t5 nsp,rim•rev.'7126s"2018 "N(ea 5 Ofceak Inspection Form Subsurface sfawai�e V'JdKsp osal system•plsrae's 9 of 18
Commonwealth of Massachusetts
==,, Title 5 Official Inspection Form
Subsurface Sewage disposal System Farm - Not for Voluntary Assessments
15 NORTH CROSS ROAD
Property Address
CHRIS TARAPATA
Owner ....... ..__._.___ . . _
Owner's Name _........
information is required for every NORTH ANDOVER MA 01845 APRIL 1 2023
.._
page, City/Town State Zip Code Cate of Inspection
D. System Information (cant.)
G. Septic Tank (locate on site plan):
Depth below grade: 1
feet
Material of construction:
Z concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: _... . _. _ ....
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes C]' No
Dimensions: 10' }4 5' X 4'
Sludge depth ' . ..
Distance from top of sludge to bottom of outlet tee or baffle 3
Scum thickness 3,
6
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle -
How were dimensions determined? TAPE MEASURE AND SLUDGE
JUDGE
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
PLASTIC INLET AND OUTLET TEES OK
RECOMMEND PUMPING OLDER SYSTEMS YEARLY
TANK IN GOOD CONDITION
LIQUID LEVELS NORMAL.
NO EVIDENCE OF LEAKAGE
k n sp doe,-rev 7C264'lOI8 'Tlife 5 Off(:ia l 1n sr Acfirars Form Subsurface Sewage Disposal SyMeam»Page 10 of 1 h
Commonwealth of Massachusetts
Title 5 Official Inspection Form
tiA Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
15 NORTH CROSS ROAD
Property Address
CHRIS TARAPATA
Owner _
Owner's Name
information e NORTH ANDOVER MA 01845 APRIL 1, 2023
required far every . _ .
page. Cltyrfown State Zip Code Date of Inspection
_.....,.,_.. ___._...____.. _...... _ ..._ ..__ .._ _ _ ......._..____._. ........ ._ _.... .. _.....,_.., ......... _.......
D. System Information (cant.)
7. grease Trap (locate on site plan):
Depth below grade: _.._-..,,.
feet
Material of construction:
El concrete El metal E] fiberglass F� polyethylene [] other(explain).-
Dimensions:
Scum thickness
Distance from tap of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle _.... ,
Date of Gast pumping:
[late
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.
0 concrete j metal fiberglass polyethypene ] other(explain):
Dimensions:
Capacity:
gaBlons
Design Flow: galions Baer day
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Commonwealth of Massachusetts
k Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 NORTH CROSS ROAD
Property Address
CHRIS TARAPATA
Owner Owner's Narne
requiredfo is NORTH ANDOVER MA 01845 APRIL 1, 2023
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cant.)
8. Tight or Holding Tank (cant.)
Alarm present: El Yes [I No
Alarm level: _ Alarm in working order: Yes ❑ No
Date of last pumping:
Date
Comments (condition of alarm and float switches, etc,):
Attach copy of current pumping contract(required). Is copy attached' F1 Yes No
9, Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert O
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 AND DISTRIBUTION EQUAL
EVIDENCE OF SOLIDS CARRYOVER
NO EVIDENCE OF LEAKAGE
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Commonwealth of Massachusetts
=; Title 5 Official Inspection Farm
i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 NORTH CROSS ROAD
Property Address
CHRIS TARAPATA
Owner .... _ . .
owner's PJame
information is NORTH ANDOVER MA 018415 APRIL 1„ 2023
required for every _
page. Cltyrrown State Zip Code Date of Inspection
D. System Information (cont.)
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.
7 leaching trenches number„ length:
FIELD
fields number, dimensions. 1 F2I X 40'
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
15insp.doo-rev_71260"8 Illlw 5 MadW Inspediun Form.Sr bmofmace Sewage DirepoSal System Page 1.3 of 16
Commonwealth of Massachusetts
� � 1 Title 5 Official Inspection Farm
% Subsurface Sewage Disposal system Form - Not for Voluntary Assessments
15 NORTH GROSS ROAD
Oroperty Address
CHRI TARAPATA
Owner
Owners Name
information
orr is for every NORTH ANDfJVER MA 01845 APRIL
n 5t
1, 2023
regtrl ......._. _...... ..
page City[Tow ate Zip Code Date of Inspection
_ -
D. System Information (coat.)
11. soil Absorption System (SAS) (cant.)
Comments (note condition of soil, signs of hydraulic failure, Level of pondcng, damp sail, condition of
vegetation„ etc.):
SOIL AND VEGETATION O
NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING
......... _. .,..._
_......... - _ _— ----
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 d Yes No
Corments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation„
etc.).
t5vro 4)drx rev.712&2018 '1-We 5 Officwl dnsp7eclion Form Subsurface Sewage r'DispnsM System-Page 14 W 18
' Commonwealth of Massachusetts
�- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
- � 15 NORTH CROSS ROAD
Property Address _
CHRIS TARAPATA
Owner Owner`s Name
information is
required for every NORTH ANDOV R MA 01845 APRIL 1 2Q23
gage, City/Town State Zip Cade Date of Inspectiaro
D. System Information (cant.)
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.):
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Commonwealth of Massachusetts
Title 5 Cuff vial Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
15 NORTH CROSS ROAD
. .� Property Address
CHRISTARAPATA
Owner 6ti6er's Name- ...................
information is
required for every NORTH ANDOVER MA 01845 APRIL 1, 2023
....................
Page, City[Town 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*.
FA hand-sketch in the area below
El drawing attached separately
3
p it
tJ J, r 6
60X
Qn 555
Mop,dot,w rev.7126/2018 "non 5 Offidev lnspecVon Form:Subsurface Sewage MSPOSW System-Page 15 of IS
' Commonwealth of Massachusetts
mm�
Title 5 Official Inspection Farm
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 NORTH CROSS ROAD
Property Address
CHRIS TARAPATA
Owner
Owner's Name
information is required for every NORTH ANDOVER MA 01$45 APRIL 1, 2023
11
page. Cltyfl own State Zip Code Date of In
D. System Information (cant.)
15. Site Exam:
❑ Check Slope
Z Surface water
Z Check cellar
❑ Shallow wells
Estimated depth to high ground water; 4
-feet
Please indicate all methods used to determine the high ground water elevation;
z Obtained from system design plans on record
If checked, date of design plan reviewed: 7/29/2003
[late
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health-explain:
DESIGN PLAN
❑ Checked with local excavators, installers -(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
DESIGN PLAN ON FILE
Before filing this Inspection Deport, please see Report Completeness Checklist on next page.
t5insp dot:•rev,7£26£2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Pape 17 of 18
Commonwealth of Massachusetts
i Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 NORTH CROSS ROAD
property Address
CHRIS TARAPATA
Owner bw"ner's Dame _.
information is required for every _ ..NORTH ANDOVER MA 01845 APRII 1 2CI23
..._._. _..
page, CityrTown State Zip Code state of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
E] A. Inspector Information: Complete all fields in this section.
Z B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist)completed
Z D. System Information:
For 8: Tight/Holding Tank— Purnping 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
t51nspcfoc-rev.7/26/201 8 SubsurYar,:,a Sewage Disposal S,ystern•Paget 18 of 18
Sunrary Record Card generated on 313112D23&0639 AM by Karen HaMon Page i
Town of North Andover
Tax Map # 210-038.0-0188-0000.0
Parcel Id 13258
15 NORTH CROSS ROAD
CHRIS TARAPATA
KHRISTINE CARROLL
16 NORTH CROSS STREET
NORTH ANDOVER MA 01846
Class 101 Single Family Property Type 1 Residential
Size Total 1.16 Acres
FY 2023
UB Mailing Index
Name/Address Type Loan Number Activelinact. From Until
CHRIS TARAPATA Owner A(,kve
KHRISTINE CARROLL
15 NORTH CROSS STREET
NORTH ANDOVER MA 01845
HALL,LINDA Previous Customer Inactive 9i2512008
15 NORTH CROSS ROAD
NORTH ANDOVER,MA
01845
DONALD&TINA DOWDEN Previous Customer Inactive 1/14/2014
15 NORTH CROSS ROAD
NORTH ANDOVER,MA 01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id, 14001.0-15 NORTH CROSS ROAD Last Billing Date 3/7/2023
2100535 02 Cycle 02 Active
UB Services Maint.
Account No.2100535
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 1 1 918 1/
WTR WATER 01 ALL,METER SIZE 72,20 /1
UB Meter Maintenance
Account No.2100535
Serial No Status Location Brand Type Size YTD Cons
33244895 a Active ERT HH b Badger W Water 1 1 213
Data Reading Code Consumption Posted Date Variance
2/2/2023 2200 a Actual 19 3/14/2023 -36%
11/2/2022 2181 a Actual 29 12/19/2022 -31%
Summary Rewid Card generalod on 313 112 02 3&06A0 AM by Karen Harlon Pau"2
Town of North Andover
Tax Map # 210-038.0-0188-0000.0
Parcel Id 13258
15 NORTH CROSS ROAD
CHRIS TARAPATA
KHRISTINE CARROLL
15 NORTH CROSS STREET
NORTH ANDOVER MA 01845
Class iOl Single Family Property Type 1 Residential
Size Total 1.16Acres
FY 2023
.............................. ............ ------
8/4/2022 2152 a Actual 43 9/2012022 163%
5/4/2022 2109 a Actual 16 6/21/2022 -8%
2/3/2022 2093 a Actual 18 3/15/2022 -31%
11/212021 2075 a Actuate 25 1217/2021 -23%
8/512021 2050 a Actual 33 9/21 t2021 74%
5/6/2021 2017 a Actual 19 6/1512021 77%
2/4/2021 1998 a Actual 11 3/16/2021 -61%
1113Y2020 1987 a Actual 27 12/16/2020 -32%
8/512020 1960 a Actual 40 9/9/2020 67%
516/2020 1920 a Actual 24 6/10/2020 52%
215Q020 1896 a Actual 16 3/16/2020 -62%
11/5/2019 1880 a Actual 44 12/23/2019 -25%
8/2/2019 1836 a Actual 56 9/26/2019 123%
513/2019 1780 a Actual 24 6/13/2019 -2%
2/5/2019 1756 a Actual 26 3/19/2019 -46%
11/512018 1730 a Actual 48 12/12/2018 -30%
8/612018 1682 a Actual 72 9/20/2018 169%
5/2/2018 1610 a Actual 24 6/20/2018 25%
215/2018 1586 a Actual 21 3/28/2018 -65%
11/3/2017 1565 a Actual 59 12/29/2017 -19%
8/3/2017 1506 a Actual 73 9/20/2017 162%
5/3/2017 1433 a Actual 27 6126/2017 16%
2/3/2017 1406 a Actual 24 3/14/2017 -65%
11/3/2016 1382 a Actual 68 12/19/2016 -37%
8/412016 1314 a Actual 106 9/2112016 250%
5/6/2016 1208 a Actual 31 6/21/2016 36%
2/4/2016 1177 a Actual 23 3/28/2016 -51%
11/312015 1154 a Actual 45 12/3012015 -37%
8/612015 1109 a Actual 73 9114/2015 143%
5/7/2015 1036 a Actual 30 6/22/2015 11%
2/5/2015 1006 a Actual 28 3/20/2015 -31%
11/3J2014 978 a Actual 39 12/15/2014 -38%
8/5/2014 939 a Actual 62 9/11/2014 205%
5/9/2014 877 a Actual 21 6/1212014 11%
217/2014 856 a Actual 5 3117/2014 71%
1/1412014 851 f Final Bill 9 1/13/2014 -90%
11/1/2013 842 a Actual 104 12/20/2013 65%
8/5/2013 738 a Actual 68 9/18/2013 1421%
5/212013 670 a Actual 4 6/18/2013 -73%
2/6/2013 666 a Actual 17 3/1312013 -62%
1013112012 649 a Actual 39 12/13J2012 15%
8/6/2012 610 a Actual 37 9/26/2012 389%
5/4/2012 573 a Actual 7 6/20/2012 -2%