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HomeMy WebLinkAboutPass - Title V Inspection Report - 85 WINDKIST FARM ROAD 9/1/2023 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form- Not for Voluntary AssessrCtents w 85 WINDKIST FARM ROAD l5roperty Address _....... _.......... . ............_ ...._ _...__. - SHEPARD DAVIDSON Owner 7wner's Name informregUir dfo is N0R1 H AN DOVE R MIA 01845 AUGUST 22 2023 required for every ..._... ....... .... ..... _....._._.__...... �..... ___. page City own State 7np Code Crate of Inspectron Inspection results must be submitted on this farm. Inspection farms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When tlllAngoutforms, Inspector Information on the computer,use only the tab Todd James Batesan key to move your Name of Inspector cursor-do not Bateson Enterprises Inc. use the return _. key. Company Name 111 Ar Illa Road bompany Address Andover MA 01810 CIty n State Zip Code k� ' 78-475-4786 al-16 l'e[ephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title (310 CMR 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. Ox Passes 2, Ej Conditionally Passes 3. [ Needs Further Evaluation by the Local Approving Authority 4. ( Fails c s sI AUGUST 22, 2023 Inspe ,.faa _akure ". Gate The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or UEP) 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. t5insp,doc-rev.7r2612015 'nlle 5 Official lnsrre clion Form,Substolam Sewage Dsposw Syslem•Psgx 1 of 1 r,4 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 WINDKIST FARM ROAD Property,46dress SHEPARD DAVIDSON ....... _ Owner Owner's Name information is NORTH ANDOVER MA 01845 AUGUST 22, 2023 required for every _ 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, ❑ Y [] N F� ND (Explain below): tainsp doc•reay.7/26dw018 T ite 5 Offical Xnspe4lt on Foirn Subsurface Sewage Disposal System-Pager 2 of 18 Commonwealth of Massachusetts m Title 5 Official Inspection Form y Subsurface Sewage Disposal System Form - Not for Volt.antary Assessments 85 WINDKIST FARM ROAD Property Andress SHEPARD DAVIDSON Owner Owners Name �nfryrtn d for every Uon Is ettatiired for NORTH ANDOVER MA 01845 AUGUST 22, 2023 ......,..-. _ page City/Town__ state. - Lp Code Crate of inspection _._............___......... _........... . . .............. C. Inspection Summary (cant.) 2) System Conditionally Passes (cant.): El 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) Cw... broken pipe(s) are replaced _.. Y __ N _ ND (Explain below). obstruction is removed YN ND (Explain below): } distribution box is leveled or replaced ,,..m Y N (.._] ND (Explain below): The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): [... broken pipe(s) are replaced [I Y El N El NIA (Explain below): E.] obstruction is removed El Y 0 N [._) ND (Explain below): ) Further Evaluation is Required 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 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: t5 nsp doc^f ev 7r.6,t2'I't+,',a '1"rfl e 5 Offf,iaA Inspection r eomr wr Z Rudaeco Sewage CJ agtralaW,yy&tem-Page 3 of t 6 Commonwealth of Massachusetts �Y Title 5 Official Inspection Farm Subsurface Sewage Disposal System Farm Not for Voluntary Assessments r 85 WINDKIST FARM ROAD Property Address SHEPARD DAVIDSON _...._.__.... _._ Owner Owner's Name information is NORTH ANDOVER Culp, 01$45 AUGUST 22 2023 required for every _...,..._ _ _ - _. _. page, Cityrrown State Zip Code Date of Inspection _. ._ ... .___... _.....__...._._. C. Inspection Summary (cant.) El Cesspool or privy is within 50 feet of a surface water F� 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: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliforrn 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 clogged SAS or cesspool El E Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool tP Ansp doc•rerv.'7/2612 0 1 8 Title 5 Off c4 ln:vq:ruaction Form,&jbsurfaace Sewage Disposal Systern-Page 4 of 18 Commonwealth of Massachusetts 1"FE , t ►f icial In ►p► c is rr Form '11ro Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments ` 55 WINDKIST FARM ROAD Property Address SHEPARD DAVIDSON Owner Owner's Name �nfrequnredfn is NORTH ANDOVER IAA 01545 AUGUST 22, 2023 requered for every _ ... page. C�utyl"fawn State Zip Code Cate of Inspection C. Inspection summary (coot.) 4) System Failure Criteria Applicable to All Systems: (cant.) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El s Liquid depth in cesspool is less than below invert or available volume is Bess than 1/2 day flow El Z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes). Number of tunes pumped: E_j z Any portion of the SAS, cesspool or privy is below high ground water elevationEl Z . Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply, D Any portion of a cesspool or privy is,within a Zone 1 of a public water supply well [l Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. D 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 form.] El 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 CA, Yes No D the system is within 400 feet of a surface drinking water supply El [_1 the systern is within 200 feet of a tributary to a surface drinking water supply the sstern is located in a nitrogen sensitive area (Interim Wellhead Protection Area-- IWPA) or a mapped Zone II of a public water supply well t5lnsp GJoc'rev 7f 60018 "rill(-)5 offEcwi n srYR*C:ion r orn) S6s'tY'suf face::ieW&Yge DmpY;4sal System^Page 5 of'18 Commonwealth of Massachusetts File 5 Official Inpecticrnorrr� Subsurface Sewage Disposal System Form Not for Voluntary Assessments 85 WINDKIST FARM ROAD Property Address SHEPARD DAVIDSON Owner owner"s dame _ information is required for every NORTH ANDOVER MA 01845 AUGUST 22, 2023 11, page. btyaown State Zip Code Cate of Inspection C. Inspection Summary (cant.) 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 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 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 following for all inspections: Yes No Z ❑ Pumping information was provided by the owner, occupant, or Board of Health E Z Were any of the system components pumped out in the previous two weeks? Z F� Has the system received normal flows in the previous two week period? El Z Have large volumes of water been introduced to the system recently or as part of this inspection? Z El Were as built plans of the systern obtained and examined? (If they were not available note as N/A) [l Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? M ❑ Were all system components, excluding the SAS, located on site? Z [] 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? F, El Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systerns? 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. Z ❑ 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)] t5'xnsp Uoc-rev.I04312018 1 flea 5 Official tnsracclAon F crna Subsurface Sewago fDisposrai Syste rn.Page 6 of 18 r: Commonwealth of Massachusetts Title .5 0"W ci l Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 85 WINDKIST FARM ROAD Property Address SHEPARD DAVIDSON Owner owner's Name ntermabon Is NORTH ANDOVER MA 01845 AUGUST 22„ 2023 etgnx ed for every _ page CityfTown Mate Lp code Fate of Inspection __. ........ _._....._.. . ........ _..._.._. .. ....._.__.. .. .. __..... _... ... _... ..... _.w.....,,, D. System Information 1. Residential Flow Conditions: NA 4 Number of bedrooms (design): _ Number of bedroors (actual); DESIGN flown based on 310 CMR 15.203 (for example: 110 gpd x##of bedrooms). NA Description: 2 Number of current residents: Does residence have a garbage grinder? ® Yes (� No Does residence have a water treatment unit? [l 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? El Yes Z No Water meter readings, if available last 2 ears usage d SEE ATTACHED g ( y g (gp )) _. Detail. Sump pump? 0 Yes Z No Last date of occupancy: CURRENT Crate s aingp a,9oc•rev.7)26/2018 Tiro 5 0"ftcim Inspection Form.Subsurface Sewage nu,posaaf S VRe7m•Paige"7 of'tl8 Commonwealth of Massachusetts x � w Tide 5 Official Inspection Form T k Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85 WINDKI aT FARM ROAD Property Address SHEPARD DAVIDSON Owner C7'�o�ers N�aor e information is NORTH ANDOVER MA 011845 AUGUST 22, 2CJ23 req�aerec}for every .. rv_ ............... page Guty61'cwn State ifs Code Date of Inspection ..........., ... _... _ ...._.._.__..._......_......... _.........._._.....,.._ D. System Information (caret.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: _ Design flow (Lased on 310 CMR 15.203): Gailon per dray d9pd Basis of design flow (seats/personsfsq.ft,, etc.): _ Grease trap present? Yes El No Water treatment unit present? 7 Yes E] No If yes, discharges to Industrial waste holdung tank present? El Yes L No Non-sanitary waste discharged to the Title 5 system? 0 Yes ( No Water meter readings, if available: Last date of occupancyAlse; te ----- Other(describe below): 3 Pumping Records: Source of information: BATESON ENTERPRISES INC APRIL 2023 Was systern pumped as part of the inspection? EJ Yes Z No If yes, volume pUrnped: gaaders How was quantity pumped determined? Reason for pumping; �Smsp da, re, 7f260Y B rme 5 Of icw& fr7spec.kon Form SuEpsQ.dac e,iewsge Mspo at GSyme m•Page 8 of 18 Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "w 85 WINDKIST FARM ROAD ._..._.__ ... Properky Address SHEPARD DAVIDSON Owner Uwner's Name information is NORTH ANDOVER MA 01845 AUGUST 22, 2023 required for every page City/Town State Zip Code Date of Inspection D. System Information (cant.) 4, Type of System: z Septic tank, distribution box, soil absorption system (� Single cesspool [� Overflow cesspool Privy F7 Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest. inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: 25 YEARS, INSTALLED JULY 1998, AS BUILT Were sewage odors detected when arriving at the site? 0 Yes Z No 5. Building Sewer(locate on site plan): 3" Depth below grade: feet Material of construction: El cast iron Z 40 PVC [1 other (explain): Distance from private water supply well or suction line: — _ feet Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS AND VENTING OIL NO EVIDENCE OF LEAKAGE __....... _ t insps.doc•rev.7126/2018 rifle 5 Official Inspection F'omi SubsurP'acer Sewage Disposal Sys&cam-Page 9 of Is Commonwealth of Massachusetts I Title 5 Official Inspection For I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85 WINDKIST FARM ROAD Property Address SHEPARD DAVIDSON Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 AUGUST 22, 2028 page. tityl'Town _ ._.. ...._ State . _..._ ..zip Cowie ...__-..___.'bate of inspection D. System Information (cent.) 5. Septic Tank (locate on site plane. Depth belowgrade: feet Material of construction: ;{ 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) Ej Yes Ej No 1tl' X5` X4' Dimensions, 4" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance frorn top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA Hoer 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.): PUMP OLDER SYSTEMS YEARLY PLASTIC INLET AND OUTLET'TEES OK TANK OK LIQUID LEVELS NORMAL NO EVIDENCE OF LEAKAGE t,"gasp doc-rev.7 2612016 1'iiio t`,off c.as Inspection r orua S¢.abmacta',aco Sewage Disposal Syste n-Page 10 of'18 r ` Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form Not for Voluntary Assessments 85 WINDKIST FARM ROAD Property Address SHEPARD DAVIDSON Owner Clwner's Name information is required for every NORTH ANDOVER MA 01845 AUGUST 22, 2028 _ page. City/Town State Zip Code Date of Inspection __...... .------ _. .............._..._......__.___ D. System Information (cant.) 7. Grease Trap (locate on site plan): Depth below grade: feet _ Material of construction: [l concrete F-1 metal ❑ fiberglass 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 cutlet tee or baffle Date of last pumping: Crate Comments (on pumping recommendations, inlet and outlet tee or baffle conditions 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: concrete metal ❑ fiberglass ❑ polyethylene [ other(explain): --- Dimensions.- Capacity: gallons Design Flow; gallons per day t5insp,doc rev.Fl.6/2018 'T'ifle 5 Official Inspection Form Subsurface Sewage Disposal System,•Page'11 of 18 Commonwealth of Massachusetts Tile 5 Official Insp c ion Form . % Subsurface Sewage Disposal System Farm Not for Voluntary Assessments , ° 8 WINDKIST FARM ROAD r3raperty Address SHEPARD DAVIDSON f:1wnE*r owner's Name �nforequr'red fn is NORTH ANDOVER MA 01845 AUGUST 22, 2023 ire2pf2or�;d for wary __.. page. Cityffown State Lp Cade Date of Inspect6on _. ......._._..._ ..... _. _. . . ......, .m_........_ D. System Information (cant.) 8. Tight or Holding Tank (cant.) Alarm present: E] "Yes Ej No Alarm level: _ — .- Alarm in working order: El Yes F] No Date of last pumping: ratite Comments (condition of alarm and float switches„ etc.): Attach copy of current pumping contract (required). Is copy attached? El Yes No 9. Distribution Box (if present must be opened) (locate on site plan): 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 LEVEL AND DISTRWTIGN EQUAL LIGHT EVIDENCE OF SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGAE BOX IN GOOD CONDITION tSicrawp.doc rev 70,12018 rMo 5 C:>P IC4 h6poaruolon roan.Subsurfare Sewage Disposal System•Page'12 of 18 Commonwealth of Massachusetts a � � Title 5 Official Inspection Form "En Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85 WINDKIST FARM ROAD Property Address SHEPARD DAVIDSON Owner owner's Name required for is NORTH ANDOVER MA 01845 AUGUST 22, 2023 required for every _ page. Oty/Town___ . ... Mate Lp Cade Date of Inspection D. System Information (cent.) 10. Dump Chamber (locate on site plan): Pumps in working order: �,...� Yes No* Alarms in working order: El 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 I.wl leaching pits number: E—I leaching chambers number: ._j leaching galleries number: . .... ........ . leaching trenches number, length; z leaching fields number, dimensions. 1' 30' Y.45" �-] overflow cesspool number: innovative/alternative system Type/name of technology: fP:w,5pr ctr,c-rev 7/2 6121 1 8 'Title 5 Official Pr•iri parrymn F orm Subswface Sewage Dispck W System•Page 13 of 18 Commonwealth of Massachusetts "Title 5 Officlel Inspection Farm y, ry Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r � 55 WINDKIST FARM ROAD Property Address SHEPARD DAVIDSON Owner Owner's Name �nfrequired is NORTH ANDOVER MA 01545 AUGUST 22„ 2023 re*a7r~sorr� for every _ _. page. 4yfT`own state ._.._.......Zip Code"' .... Date of Inspection D. System Information (cant.) 11. Soil Absorption System (SAS) (coat.) Comments (note condition of so0, signs of hydraulic failure, level of ponding, damp sok, condition of vegetation, etc.): SOIL AND VEGETATION OK 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 E Yes No Cornmeats (note condition of s6l, signs of hydraulic failure, level of ponding, condition of vegetation„ etc.): t5instip d„;c. rev ]1260)'B I tkj 5 Official 6ns➢rarw,&rcn orm 'tiwafSraulaace Sow«ras m C7mpalasii System•range t4 of 18 Commonwealth of Massachusetts , , T1ef ci l Inspection p �ti Form i P Subsurface Sewage Disposal System Farm - Not far Voluntary Assessments P{r;, 85 WINDKIST FARM ROAD Pro'pert Address SHEPARD DAVIDSON Owner Owner's N«arne nfruire dfo 'os NORTH ANDOVER MA 01845 AUGUST 22, 2023 ee��ired far every ..... I)age. city�fo w'll.. estate zap Cede. Date of Inspe'dion 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.). t.xnspa rc;oc rev 7Q6/2018 TMW 11 OfNca p i%s earaori Fovyrr &ak9u'uif ace Sewage D7 Spa"xs,al"System•Page 15 of ter Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 WINDKIST FARM ROAD ... ......... .. .......... Property Address SHEPARD DAVIDSON Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 AUGUST 22, 2023 page„ ClkyfTown State Zip Code Date of Inspection D. System! Information (coat.) 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: ® hand-sketch in the area below drawing attached separately � jlj(qf 6 d t00 t5lnsp.drrc-rev..7126f2018 Title 5 Official Inspection Form:Subsurface Sewage DYspcaal system-papa 16 of 18 Commonwealth of Massachusetts e:wYtiW::w°k Totic 5 Official Inspection Ferri 'i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85 WINDKIST FARM ROAD Property Address SHEPARD DAVIDSON Owner Owner's Nar ne mforr„atcon rs NORTH ANDOVER MA 0184 AUGUST 22, 2023 required for every page � to of inspection C;otylTorsvrr ... ,Mate ZNp bode �a D. System Information (coat.) 15. Site Exam: Z Check. Slope Surface water Check cellar El Shallow wells Estimated depth to high ground water: feed Please indicate alB methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: mate El Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health - explain: AS BUILT PLAN ON FILE, NO DESIGN PLAN [... Checked with local excavators, installers - (attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: DESIGNED BY ENGINEER 4' ABOVE WATER TABLE NO PLAN AVAILABLE FROM TOWN OF NORTH ANDOVER Before filing this Inspection Report, please see Report Completeness Checklist on next page. f5invp doc: rev 7h261 016 Tf la'r 5 Inspection Fora, ru4bsuf„,ace Se.age r1,Sraosas System^page I of 1„,f Commonwealth of Massachusetts w If Tine 5 Official Inspection Form T— o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 85 WINDKIST FARM ROAD Property mciress SHEPARD DAVIDSON Owner Owner's Name information is NORTH I ANDC VFR MA 01845 AUGUST , 2023 required for every gage Crty[T"owwn state Zip Code rate of @nspecffron E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this sectlon. % 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 1 ; Explanation of estimated depth to high groundwater included tl,m mara Kkuu -rev 712612O 8 1 it(0 5 Off I(-,a I jm4pecflon q o1 m; Subsuilaur o Sewa gr DmIxr)±„aI;^Sy lwr ra'"age 18 of 18 Summ ry E'Rowrd Card gatnerss@ed an ek1512Q23'1:00:1 fi PM by Karen I IAnlran P"aage'f Town of North Andover Tax Map # 210-109.0-0052-0000.0 Parcel id 18866 85 WIN©KIST FARM ROAD DAVIDSON, SHEP 85 WI DKIST FARM ROAD NORTH ANDOVER, MA 01845 Class 101 Single Family Property Tyke 1 Residential Size Total 1.66 Acres FY 2024 UB Mailing Index NamelAddress Type Loan Number Activellnact. From Until DAVIDSON,SHEP Payor ive 85 WINDKIST FARM ROAD NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle (Occupant Name Active/Inactive Bldg Id, 13775,0-85 WINDKIST FARM ROAD Last Billing Date 8/7/2023 1090452 01 Cycle 01 Active UB Services Maint, Account No. 1090452 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 1 1 9,18 1/ WTR WATER 01 ALL METER SIZE 103.37 11 UB Meter Maintenance Account No. 1090452 Serial No Status Location Brand Type Size YTD Cons 32948535 a Active 00 d Badger vy Water 1 1 361 Date Reading Code Consumption Posted Data Variance 7/20/2023 2666 a Actuall 25 8114/2023 175°lax 4/19/2023 2641 a Actual 9 5/10/2023 -31% 1/18/2023 2632 a Actual 13 2/14/2023 -88% 10/19/2022 2619 a Actual 108 11/912022 35% 7/20/2022 2511 a Actual 81 8/16/2022 1467% 411 9/2022 2430 a Actual 5 5/12/2022 -73% 112012022 2426 a Actual 19 2/16/2022 -44% 1012012021 2406 a Actual 33 1112212021 -1% 7/22/2021 2373 a Actual 34 8/2412021 156% 4/21/2021 2339 a Actual 13 5/1812021 -360/6 1/21/2021 2326 aActual 21 2/23/2021 -77%