HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 46 SHANNON LANE 2/21/2024 Commonwealth of Massachusetts
Title 5 Official Inspection ForrWlE)`11
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
k_ W 46 SHAD LANE 2� It
...........
Property Address
GEOFFREY PLUME
Owner d�vn-er-'s''N"am"e
information Is
required for every NO,R,TH.ANIDIOVE R,.-. ..11...I MASS 011184�5 FEBRUIA. PY. 12
CityrTown State Zip Code Date of inspectJon
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. Inspector Information
Ming out forms
on the computer,
use only the tab Todd James Bateson
key to more your Name of Inspector
Cursor_do not Bateson.Enterprises Inc,
use the return - --------
key. Company Name
111 Arqilla Road
6oar-
' -pany_Address
Andover MA 01810
State Zip to
SI-16
978-475-4786
—----------
Telephone Number License Number
B. Certification
I certify that, I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(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, 0 Passes
2, Z Conditionally Passes
3. [] Needs Further Evaluation by the Local Approving Authority
4. El Fails
FEBRUARY 15, 2024
lnsp ors Ngnature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DER The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
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................——...-- ...............
9J
Commonwealth of Massachusetts
1 �k Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments
46 SHANNON LANE
Property Andress
GEOF REY Pi_UME
Owner _._., ..
Owner's Name .....__._.. .. _...._._....
information is
required for every NORTH ANDOVER MASS 01845 FEBRUARY 12, 2024
ffr�w�rr
psr�e. a It Y State Zip r;rrde Date of inspecfaara
C. inspection Summary
inspection Summary: Complete 1, 2„ 3, or 5 and all of 4 and 6.
1) System Passes:
El I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CIVIR 15,304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
Z One or rnore systern components as described in the "Conditional Pass" section need to be
replaced or repaired. The syst&11, 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 explains.
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 rnetal 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
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 SHANNON LANE
r5roperty Address
GEOFFREY PLUME
Owner _
�lwner s Name
information is NORTH ANDOVER MASS 01846 FEBRLIARY l2, 2624
rer�ukred far every _....
page C[8yr''awn SWe pup Cade Date of Vnspeafoon
C. 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.
Z 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):
[_] broken pipe(s) are replaced _1 Y [ j N ND (Explain below):
El obstruction is removed Y [ N [. ND (Explain below):
distribution box is ieveled or replaced 21 Y E N El ND (Explain below):
D-BOX IS ROTTED AND NEEDS REPLACED
_] 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 M, Y [ ] N [] ND (Explain below):
[� obstruction is rernoved [ Y Cj N [] ND (Explain below)..
3) Further Evaluation Is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
�
4 Subsurface Sewage Disposal System Fora, - Not for Voluntary Assessments
�W
45 SHANNON LANE
Property Address
GEOFFREY FLUME
Owner __ __......__ ....._ __ - ---.-...
C�w�rroer's Name
requiratifore NORTH ANDOVER MASS 01 45 FEBRUARY I2 024
rer�uired for every ........ . . .. _.._ ......... ._. ...._, _ _
pale City/Town State Zap Code Coate of[nspection
C. Inspection Summary (cent.)
F] 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 marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if arty)
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.
D The systern 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 systern 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 DBP 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
clogged SAS or cesspooi
F1 z Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
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n;
Commonwealth of Massachusetts
, Title Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address
GEOFFREY PLUME
Owner Owner's 9arne
regUi p informationtorevery NORTH ANDOVER MASS_ 01845 FEBRUARY 12, 2024
Y page.
Ott /Town _ State ZipCode Date of Inspection
C. Inspection Summary (coot.)
4) System Failure Criteria Applicable to All Systems: (coat.)
Yes No
Static liquid ie�vel in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
Liquid depth in cesspool is less than B"° below Invert or available volume is less
than 1/2, day flow
Required purnping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped: -
LI z Any portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or
C� tributary to a surface water supply.
Any portion of a cesspool or privy is within a Gone 1 of a public water supply
C_ wefii,
1:1 z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
El z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
frorn 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
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 systern fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) urge 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 roust indicate either"yes" or "no" to each of the following, in addituon to the
questions in Section CA
Yes No
E I_.j the systern is within 400 feet of a surface drinking water supply
ED EJ- 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 napped Gone Il of a public water supply well
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Commonwealth of Massachusetts
61
Tltic 5 Official Inspection Form
x
lr
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 SHANNON LANE:
Property Address
GE OFFRE�Y PLUME:
Owner
O anIr's Narne
o Is
requiVred fore very NORTH ANDOVER MASS 01845 FEBRUARY 12 2024
.. _....._. .._._ _._.m... __._. ._...._.
page. City/Town State Zip Code Date of Inspection
_......___u... ..__,,._.... _.........._. _.__..__ _...._.........___._._ ...____w_..... _...... ... ........___...._.__ ...____.._......... _..._..__......._. .____.......
C. Inspection Summary (coot.)
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 following for all Inspections:
Yes No
Z EI Pumping information was provided by the owner, occupant, or Board of Health
E Z Were any of the system components purnped out in the previous two weeks?
E Has the system received normal flows in the previous two week period?
Z 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)
Z 0 Was the facility or dwelling inspected for,signs of sewage back up?
Z 11 Was the site inspected for signs of break out?
" 0 Were all system components, exoludinq the SAS, located on site?
Z 11 Were the septic tank manholes uncovered" opened„ and the anterior 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?
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 D 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
Zapproximation of distance is unacceptable) [310 CMR 15.30 (5)1
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a 46 SHANNON LANE
Property Address
GEOFFC EY FLUME
Owner
r�vkormer"s Narrroe ... ..... .. . . ._....._. ._ __
wfor
required for
is NORTH ANDfOVER MASS 01845 FESRUARY 12, 2024 required for every ____.. ..... ... ..._ _..... _ .. .._ _ ..... w._... w --. __. _...
page City/Town State Zip Code Date of Ins pectnon
D. System Information
1, Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flaw based on 310 CMR 15,203 (for,example: 110 gpd x#of bedrooms): 600 Gf'D
Description
Number of current residents.
Does residence have a garbage grinder? ® Yes No
Does residence have a water treatment unit? [7 Yes Z No
If yes, discharges tc'
Is laundry on a separate sewage system? (Include laundry system inspection Yes No
information in this report.)
Laundry system inspected? Z Yes No
Seasor781 rase? F' Yes Z No
Water meter readings, if available last 2 ears usage d SEE ATTACHED
g C y g (9p )) ...
Detail:
Surnp pump? Yes No
Last date of occa~apancy: CURRENT
gate
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Commonwealth of Massachusetts
. tl'Ig4 Title 5 Official Inspection Form
µ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�h ufN
Property Address
GE OFFREY PLUME
Owner _
Owner's Name
Information us required for every NORTH ANDOVFR MASS 01845 FEBRUARY 12, 2024
_._ .._. _ .. _...._.... _....... _. _ _�. .... ........
page, City/Town State Zip Code gate of inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions.
Type of Establishment:
Design flow (based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow (seats/person s/sq.ft., etc.):
Grease trap present? E Yes E] No
Water treatment unit present? El Yes C] No
If yes, discharges to:
Industrial waste holding tank present? E Yes rl No
Nan-sanitary waste discharged to the Title 5 system? Yes ❑ No
Water meter readings, if available:
Last date Of Occupancy/use,: Date ____ -------
Other (describe below):
3. Pumping Records;
Source Of unformatior�: BATESfON MARCH 2O23
Was system pumped as part of the lnspection? �.] Yes ( .., No
If yes, volume pumped:
gallons
How was quantity ptarnped determined?
Reason for pumping _
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r Commonwealth of Massachusetts
,r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
46 SHANNON LANE
Property Address
GEOFFREY PLUME
Owner owner"s Name
information is
required for every NORTH ANDOVER MASS 01845 F BRUAR Y 12, 024
page City/ owan Stat11 e 71p Code Date of gnspection
._.__...___. .,._.___. ._..... _..,_.._.... . ._ ............. ..._.._. _......... ...e,_. _.,_,__,__..
D. System Information (cant.)
4 Type of System:
11 Septic tank, distribution box, soil absorption system
E Single cesspool
E-1 Overflow cesspool
[l Privy
El Shared systern (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
onspection of the IfA 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:
34 YEARS, INSTALLED APRI'L 1090 DESIGN PLAN AND TITLE 5 ON FILE
Were sewage odors detected when arriving at the site? E-] Yes L71 No
5, Building Sewer (locate on site plan):
Depth below grade: 4,
feet
Material of constrttCbOn:
cast iron E 40 PVC (_. 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 GOOD
NO EVIDENCE OF LEAKAGE
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Commonwealth of Massachusetts
27
r. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
45 SHANNON LANE
E Toy)ert;y Address _
GEOFFR'EY PLUME
Owner
Owner's Noma
information Is NORTH ANDOVER MASS 01845 FEBRUARY 12 2024
ra�puivadfarewary __... _.__........ _. _. _ _ _. ..._.,.,.. _,... _.
Page. CiCyfTawrt State Zip Code Data of Inspe0on
D. System Information (cant.)
5. Septic Tank (locate on site plan):
Depth below grade: 21"
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) [l Yes 0 No
10 5' X4'
Dimensions: ---_ _._ _ .......
Sludge depth
Distance from top of sludge to bottom of outlet tee or baffle NA
Scum thickness
Distance from top of scurn to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Now were dimensions determined? SLUDGE JUDGE AND 'TAPE
MEASURE
Comments (on pU niping recommendations, inlet and outlet tee or baffle condition" structural integrity,
liquid levels as related to outlet invent, evidence of leakage, etc.)
RECOMMEND PUMPING OLDER SYSTEMS YEARLY
CONCRETE INLET BAFFLE OK
OUTLET TEE MISSING, NEEDS NEW TEE
TANK IN GOOD CONDITION
NO EVIDENCE OF LEAKAGE
LIQUID LEVELS NORMAL
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m. Commonwealth of Massachusetts
a µ Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Oraperty Address ..
OEOFFREY?L LlM .. ..
Caner Owners Narne
required information is NORTH ANDOVER MASS 01845 FEBRUARY 12, 2024
required far every ....... . ..... ... _._ ... ..._.,. _ _.._ ._ ..... .. .. . ..... .. ._....
Page, CVty/Town State Zip rude Date of Inspection
D. System Information (cant,)
7 Grease Trap (locate on site plan):
Depth below grade: _..... __...
lee"
Material of construction:
concrete rnetai ] fiberglass polyethylene other (explain):
Dimensions:
Seam thickness _
Distance frorn top of scurry to top of outlet tee or baffle __ ____
Distance frorn bottom of scum to bottom of outlet tee or baffle - ......
Date of Vast pumping:
Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
[? concrete metal . fiberglass polyethylene other(explain);
Dimensions: _
Capacity;
ga6lons
Design Flow:
gallons per day
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Commonwealth of Massachusetts
� Tula 5 Off dal Inspection Form
Subsurface Sewage Disposal System Norm • Not for Voluntary Assessments
F<< 46 SHANNON LANE
Property Address
GEOFFREY PLUME
Owner
Owner's Name ._, ___..........
information is required for every NORTH ANDOVER MASS 01645 FEBRUARY 12 2024
page. CityNTown State. Zip Code Date of Inspection
D. System Information (cant,)
6. Tight or Holding Tank (cant.)
Alarm present: D Yes E] No
Alarm level; Alarm m wreaking, 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? Yes I No
g. Distribution Box (if present Dust 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 leakage into or out of box, etc.):
D-BOX IS ROTTED AND NEEDS REPLACED
EVIDENCE OF LEAKAGE
D-BOX IS LEVEL. AND DISTRIBUTION IS EQUAL
HEAVY SOLIDS CARRYOVER
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Commonwealth of Massachusetts
Title Official Inspection Form
i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
45 SHANNCON LANE
Property Address
GEtOFFREY PLUME
Owner Owners N_ame
rectregWllation isced for every NORTH ANDOVER MASS 01545 FEBRUARY 12, 2024
rr6 _
page ity/Town State Zip Code Crate of knspeoVon
D. System Information (cunt.)
10, Pump Chamber(locate can site plan):
Pumps in working order: [] Yes 0 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:
[l leaching galleries number:
z leaching trenches number, length: 3; 55' LIONG
(� leaching fields number, dimensions:
�} overflow cesspoou number: - --
[ innovative/alternative system
Type/name of technology.
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"a Commonwealth of Massachusetts
K m Title 5 Official Inspection Form
+ } Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 SHANNON LANE
Property Address
GEOFFREY PLUME
Owner Owner's Name
informarequired
is NORTH ANDOVER MASS 01845 FEBRUARY 12 2024
recleairedfor every _......... _.... .... __._...... .. _ _ .... .___...... . _..._. ,.._.- . ..._....._ ___ __.._..._. _.. .. _.a ...._..._......_....
page, Crty/7own State Zip Code Date of Inspection
D. System Information (cant.)
11, Soil Absorption System (SAS) (cant.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SOIL OK, VEGETATION GOOD
NO EVIDENCE OF HYDRAULIC FAILURE OR BONDING
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 'Yes 0 No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc,):
t5tnsp.doc-rev_7/26/2018 TIHa 5 OfficiM Inspection Form:SUIDSUrPace Sewage Disposal System•Page 14 of 18
W Commonwealth of Massachusetts
Tide 5 Off icial Inspection For
p4J Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 SHANNON LAME
Properly Address _
GEOFFREY FLUME
Owner _ .........
owner's Name __ .... ....._...... .._ _._....__.. __..___._._,_..
infor
required ctin is NORTH ANDOVER MASS g1845 RU „far every _ FEB_..._... ....ARY 12__2024
pa� recf ..,.._ ._.....
Catyl o' wn State Lip Code Gate of Mnspeat�on
D. System Information (cunt.)
11 Privy (iocate on site plan):
Materuals 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 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 SHANNON LANE
i 5�o'p'—e_rt y Address—_--" ......... ..........
GEOFFREY PLUME
Owner Owner's Name
Information is NORTHANDOVER MASS 01845 FEBRUARY 12, 2024
required for every
page, siak'e" 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:
Z hand-sketch in the area below
drawing attached separately
4 S�a fk LCI P1(L
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go _ [ - ` "
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Commonwealth of Massachusetts
�{ ;r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
-' 45 SHANNON LANE
Property Address
PEOFFREY PLUME
Owner
Owner's Name
informati
required
is NORTH ANDOVER MASS 51845 FEBRUARY 12 2524
ree8aanred for even _.....
page, Cuty/Town _ Mate Lip Code rate of Inspection
__.....,. . w .., .._....._.._.. . _......__ ..._. ... ....._.. _...._._ .._.... _._._.,_ __ .__._._.......w.._.
D. System Information (cant.)
15. Site Exam:
E Check Slope
Z Surface water
Z Check cellar
(_j Shallow wells
Estimated depth to high around water: _
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. APRIL 1 ggO
mate
[� Obser'ved site (abutting proper"tylobservation hole within 150 feet of SAS)
z Checked with local Board of Health - explain:
(DESIGN PLAN AND TITLE 5 ON FILE
] Checked with local excavators„ installers - (attach docurnentation)
l Accessed USGS database - explain
You must describe how you established the high ground water elevation:
DESIGN PLAN ON FILE
SYSTEM IS ABOVE WATER TABLE
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15inspe tiara rev,7/262016 1010 5 O ficol inspechon Form SUbsuiOaraa Sowaaggn,Dmposae System-Page 17 of 18
Commonwealth of Massachusetts
!(3 Title 5 Wfidal Inspection Farm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
t"t 46 SHANNON LANE
Property Address
GEOFFREY FLUME
Owner C7wner`s Nance
nfarrnatian is NORTH ANDOVER, MASS 01645 FEBRUARY 12, 2024
required for every _ __. _... _._. ......., .._ ...._
page, City/Town State Zip Cade Coate of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of;
Z A. Inspector Information, Complete all fields in this section.
S. Certification: Signed & (.)ated and 1, 2, 3, or 4 checked
Z C. Inspection Summary:
1, 2, 3, or 6 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
D. System Information:
For 6: Tight/Holding Tank — Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 16 Explanation of estimated depth to high groundwater included
ttiiv sp doc wr.'N d2G,§6".018 1 Me 5 Official inspe Eosin FotrrF Swbs�Oace Sewage D saposan System Page 18 of 18
Sumawy Rewd Card gunerWod on 21512024 3:I V;53 PM by Karen I I anlon Page 1
Town of North Andover
Tax Map # 210-107.A-0229-0000.0
Parcel Id 18064
46 SHANNON LANE
GEOFFREY & LISA PLUME
46 SHANNON LANE
NORTH ANDOVER, MA 01845
Class 101 Single Family Property Type 1 Residential
Size Total 3,28 Acres
FY 2024
UB Maillno Index
Name/Address Type Loan Number Active/Inact. From Until
GEOFFREY&LISA PLUME Owner Active
46 SHANNON LANE
NORTH ANDOVER,MA 01845
ANTINORI,PAUL Previous Customer Inactive 9/29/2005
46 SHANNON LANE
NORTH ANDOVER,MA
01845
U6 Account Malta.
Account No Cycle Occupant Name ActIvelinactive
Bldg Id. 13214.0-46 SHANNON LANE Last Billing Date 12/6/2023 Active
2100001 02 Cycle 02
UB Services Maint.
Account No.2 100001
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE OM 5/8 7,82
\NTR WATER 01 ALL.METER SIZE 49,40
UB Meter Maintenance
Account No.2100001 YTD Cons
Serial No status Location Brand Type Size
29408999 a Active E RT H H to Badger w Water 0.626 O.625 239
Date Reading Code Consumptlon Posted Date Variance
11/1/2023 1893 a Actual 13 12/13/2023 -47%
8/2/2023 1880 a Actual 23 9/18/2023 102%
519/2023 1857 a Actual 13 6/1412023 -5%
2/V2023 1844 a Actual 13 3/14/2023 -63%
11/112022 1831 a Actual 34 12119/2022 -17%
8/3=22 1797 a Actual 42 9/2012022 193%
513/2022 1755 a Actual 14 6/2112022 11%
212/2022 1741 a Actual 13 3/1 5Y2022 -34%
11/1/2021 1728 a Actual 19 12/712021 -23%
813/2021 1709 a Actual 25 9/21/2021 122%
5/4/2021 1684 a Actual 11 6/15/2021 -39%
2/412021 1673 a Actual 19 3/16/2021 -64%
t112/2020 1654 a Actual 51 12116/2020 31%
8/4/2020 1603 a Actual 41 9/9/2020 2 75%
5/1/2020 1562 a Actual 10 6JI 0/2020 -4%
214/2020 1552 a Actual 11 3/16/2020 -61%
111412019 1541 aActuaR 29 12/2312019 14%
8/2/2019 1512 a Actual 25 9/26/2019 97%
5/2/2019 '1487 a Actual 12 6/13/2019 0%
214/2019 1475 a Actual '13 3/19/2019 -59%
11/2/2018 14132 a Actual �31 12/12/2018 -10%
8/212018 1431 a Actual 34 9120/2018 140%
5/312018 1397 a Actual 14 6/20/2018 11%
21212018 1383 a Actual 13 3128/2018 -9%
111112017 1370 a ActuaP 14 12129/2017 -21%
81212011 1356 a Actua6 18 9/20/2017 45%
512/2017 1338 a Actual '12 6/2612017 -5%