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Home My WebLink AboutConditional Pass - Title V Inspection Report - 130 WINDKIST FARM ROAD 4/17/2024 Commonwealth of Massachusetts Title 5 Offul ci l Inspection Form Subsurface Sewage disposal System Form Not for Voluntary Assessments 13 0 WIND IST FART 0rfaperky 6res6 _.. ._..._. POORNA PAVAN KUI AR I UTNURI Owner __..__.. .._.._.... _......._. _.._... information is �ityffown State required for every NORTH ANCDCtVER _ w.... . _...A 01845 MARCH 27, 2024 _........____.. &....._._., ..._ .ww__... _...,__._...._._._ page. C p Code_ Crate of InspecI n 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 filling out forms A. Inspector Information on the computer, Todd James Bateson use onBy the rota _._...___. .. ..,..... key to move your Name of Inspector _.....___.. ._. cursor-do not Rateson Enterprises Inc. use the return _....._...n .._ ..,.._.._ .____....___ key. Company Narrte ww..u..,w_.._..�.._._ _._....,...____ ,.... ......_..... .........._. 111pArg 11a Road .. ...... _..w_..._.. _ . ....._ ...w_._...__ .. ._...._.....'CIO ...... ,...,.. Company Address Andover MA 01810 � _.._. _ ,_..._ . . .. ..,..___. _u....w....w._._ _...__. CwtylTown Mate Zwp mode 978-475 478 i _ SI 16 .��"�" 1`elephaxne h-Iurnk. r License 4�urnkr B. Certification .._._�._.....___ I certify that: I am a DEP approved system Inspector in full compliance with Section 15.340 of Title S (310 CIM R 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 an 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. El Passes 2, Z Conditionally Passes Needs Further Evaluation by the Local Approving Authority 4. El Fails APR IL 16, 2024 Ins ors Igna re 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. tNrWP,slew:-rev.712612018 T'RIo 5 Official Ins ¢flan Form:Sutmolaacen Sewage Dispcwal System t Page 1 of 18 Commonwealth of Massachusetts I x Title 5 Official Inspection Farm Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 130 WINDKIST FARM Property Address _ _.....__.._. POORNA PAVAN KUMAR MUTNUR1_ Owner C?wner's Name information is required for every NORTH ANDOVER MA 01345 MARCH 27, 2024 ...._....._,.... ..__.. .._....._ __.._._._ page. CftyfTown 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: Z 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): 15insp doc-rev '712612018 1Etta 5 official inspection F�onm Sub&Arface Sewage Disposal System.Page 2 of 18 Commonwealth of Massachusetts - 1 Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °f 130 WINDKIST FARM Preperty,Address POORNA PAVAN KUMAR MUTNURI Owner Cawner"s INanileinforr r dfo is NORTH ANDOVER MA 01545 MARCH 27, 2024 pa ge for every _ .._ _.. .... 4 City/Town State Zap Cade Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cant.): Pump Chamber pumps/alarms not operational, System will pass with Board of Health approval if purnpsfalarms are repaired. Z Observation of sewage backup or break out or high static water Bevel 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 Z Y 7 N ❑ ND (Explain below): [_ obstruction is removed ❑ Y E] N 0 ND (Explain below): distribution box is leveled or replaced (-I Y [} N Ej ND (Explain below): WATER IS BACKING UP IN THE TANK BECAUSE THE OUTLET PIPE IS TOO HIGH. PIPE NEEDS TO BE LOWERED WITH FITTINGS OUTSIDE OF TANK 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 [j Y ❑ N [Q ND (Explain below): ] obstruction is removed [J Y ❑ N E1 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 C'MR 1 .30 (i)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: Cw'ionsp doc�rev 7r.161,1018 ru"erRn„.,ttface Sewage niypr„ns,of Syv am-Page l rA 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c . " 130 WINDKIST FARM Property Address POORNA PAVAN KUMAR MUTNURI Owner Owner's Name information r for every is required fo NORTH ANDOVER MA 01845 MARCH 27, 2024 page. dity/T°own State Zip Lode Date of Inspection __...._ ....., ._. .. ,...... m......... ... ...,,_.. __. .. _....._._._. .__...........__...._ C. Inspection Summary (cant.) 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 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, L] 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 farm. 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 1-1 z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 11 z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t,",rrmp drx•rev.7F26/2018 P`tie 1'6 r7i4ia iar Vnrtgroraca in r con Eubsud ate Sewage Du posa i Syslern-Page 4 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form . :. . ui° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �K ry , ' 130 WINDKIT FARM Property Address _.. POORNA PAVAN KUMAR MUTNURI Owner _ Owner's Name information is NORTH ANDOVFR MA 01845 MARCH 27 2024 required for every _...... ._. _..___. . . ._.. ... . ..,_,_. _, --- page, Clty/Town. . _ State Zip Code date of Inspection C. Inspection Summary (cant.) 4) System Failure Criteria Applicable to All Systems: (cant.) Yes No ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Z Liquid depth in cesspool is less than 6° below invert or available volume is less than day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped; [ ] Q Any portion of the SAS, cesspool or privy is below high ground water elevation. D ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. E Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ E Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 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.) ❑ 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 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 II of a public water supply well t5lnsp.doc rev 7/26/201 J Title 5 Official inspection Form:SubsLaface Sewage aisposai Systern 4 Page 5 of 18 Commonwealth of Massachusetts .r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 130 WINDKIST FARM Property Address POORNA PAVAN KUMAR MUTNURi Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 MARCH 27, 2024 page bty�Town State Zip Code Date of Inspection C. Inspection Summary (cent.) 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 ❑ Pumping information was provided by the owner„ occupant, or Board of Health ❑ Z Were any of the systern components pumped out in the previous two weeks? Z L-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? Z 0 Were as built plans of the system obtained and examined? (If they were not available note as N/A) El Was the facility or dwelling inspected for signs of sewage back up? Z D Was the site inspected for signs of break out? El Were all system components„ excluding the SAS, located on site? * 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? Z 1-1 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; ® E] Existing information. For example, a plan at the Board of Health. Z E' 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)) t5nsp doc rev 7Q612016 rifle 5 Official hisl,7r ,dlori FOrr,SkJbs iface Sewage DispusM System•Page 6 of'18 . Commonwealth of Massachusetts wrv-,g TIT Official i t Ir a tic n Form " Subsurface Sewage disposal System Farm - Not for Voluntary Assessments ., 1_30...WINDKIST.FARM Property Address PtOtRNA PAVAN KUMAR MUTNURI ......__. _----------- information .... c�wner^s ��,e requir etifo is NORTH ANDOVER MA 01345 MARCH 27 2024 required for every page. city/Town State Zip Code Clete of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): -... Number of bedrooms (actual): `- DESIGN flow based on 310 CMR 15.2.03 (for example: 110 gpd x#of bedrooms): 550 GPD Description: 4 Number of current residents: Does residence have a garbage grinder? 0 'Yes No Does residence have a water treatment unit? Q Yes No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes Z No information in this report) Laundry system inspected? ® Yes R No Seasonaluse? [] Yes Z No Water meter readings, if available (last 2 years usage (gpd)): SEE ATTACHED Detail: Sump pump? ❑ Yes Z No Last date of occupancy: CURRENT (w46raarro doc•ray.7F26=18 'dle 5 4'wP cia6&ampaciton F-ornv Subscdac'rr Sewage L7uaazosa6 SyMem-Page 7 of 18 �m Commonwealth of Massachusetts Title 5 Official Inspection Form wi° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ~ " .`^ 130 WINDKIST FARM Property address POORNA PAVAN KUMAR MUTNURI Owner 6wner's htatme information ws NORTH ANDOVER MA 01845 MARCH 27, 2024 recgtrkred for every ._ .__... ......._ . .......�.._. _ ___....... .... page. CityfTown State ZFp Cade Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CCMR 15.203); _...,.. Gallons par day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? 0 Yes E] No Water treatment unit present? D Yes E] No If yes, discharges to: Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? [ ] Yes ( No Water meter readings, if available: _ . _..... Last date of occupancy/use: oats _ Other(describe below): ---------.__ 3. Pumping Records: Source of information: OWNER 2021 Was system pumped as part of the inspection? ❑ Yes r�,l No If yes„ volume pumped: kw¢a gans How was quantity pumped determined? _ _..... . Reason for pumping: t°rodrrs'ga,ctoc rev-712&201 S 'T His 5 officw lo'rs;aecki wn Fotacre,Subsurface Sewage r7ksposae S'ystern•Page 8 of 18 Commonwealth of Massachusetts w Tale 5 Official Inspection Farr m Subsurface Sewage Dispersal System Form -Not for Voluntary Assessments -�/ 130 WINDKIST FARM Firoperty Address POORNA PAVAN KUMAR- MUTNURI Owner Owner's Name information Ve NORTH ANDOVER MA 01845 MARCH 27, 2024 required for every p��age. y State Zip Cade Date of inspection Cat Crown D. System Information cant,) 4. Type of System: z Septic tank, distribution box, soil absorption system EJ Single cesspool El Overflow cesspool n Privy Li Shared system (yes or no) (if yes, attach previous inspection records, if any) El 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. El Other(describe): Approximate age of all components, date installed (if known) and source of information; 6 YEARS, INSTALLED 2018, AS BUILT PLAN Were sewage odors detected when arriving at the site? D Yes Z No 5. Building Sewer(locate on site plan): Depth below grade: 1,5 feet Material of construction: El cast iron `�` 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 NOT VISIBLE _ INSIDE FINISHED WALL VENTING OK- NO SMELLS NO EVIDENCE OF LEAKAGE E6i nsp ti°.fcer-rev 7126f2a:Y 8 'Tive 5 6',)t6ww 8nsporkion Furm.Subsurface Sewage r)ur+pa sal System Page 9 of 18 Commonwealth of Massachusetts C Title 5 Official Inspection Form 4 w: Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 130 WINDKIST FARM Property Address POORNA PAVAN KUMAR MUTNURI Owner (7wner's Name Information is NORTH ANDOVER MA 01845 MARCH 27, 2024 required for every _ page. 6ii own State Zip Cade Date of inspection D. System Information (cant.) 6. Septic Tank (locate on site plan): 12" Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) _ _w.... .__..... . If tank is metal, list age: _ -. yeearar s Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10" X 5` X 4" 6r Sludge depth: _,.,__..._.---------— Distance from top of sludge to bottom of outlet tee or baffle 3. ..-.._ 4 Scum thickness 21' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 101, How were dimensions determined? SLUDGE JUDGE AND TAPE MEASURE Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc,): RECOMMEND PUMPING OLDER SYSTEMS YEARLY, AND CLEAN FILTER PLASTIC INLET AND OUTLET TEES OK 2 COMPARTMENT TANK - IN GOOD CONDITION NO EVIDENCE OF LEAKAGE TANK IS WORKING ABOVE NORMAL- OUTLET PIPE IS TOO HIGH IN TANK PIPE NEEDS TO BE LOWERED WITH FITTINGS OUTSIDE OF TANK t84nsp.doc t rev 712020/8 1itle 5 ofrielal Inspection Form:Subsudace Sewage Disposal System•Prager 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form ih Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 130 WINDKIST FARM Property Address POORNA PAVAN KUMAR MUTNURI oOwner _._..wner's blam__...._e... .._,. _... ...., ........... _........ equine fo d for information is r every require NORTH ANDOVER MA 01845 MARCH 27„ 2024 .. _ _.. _ .. __ ...... _ page. CitylTown. Mate Zip. _Code.._ Gate of Inspection D. System Information (cant.) T Grease Trap (locate on site plan): Depth below grade: feet -- Material of construction: 0 concrete C] metal ❑ fiberglass M polyethylene R other(explain): Dimensions: _. . . _ Scum thickness _.........___...._. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle _ Date of last pumping: Cake 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 El polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: _.._. _.._ gallons per day t5hsp,doc•rev.7126/2018 1`6ties 5 Officw impectian Form Subsurface Sewage Disposal Systern-Page 1 t of 18 ` k Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 130 WNDKIST FARM Property Address POORNA PAVAN KUf AR I UTNURI Owner ...w. ...._ _ . ... . . _ .. Owner's Name regUi edfo s NORTH ANDOVER MA 01845 MARCH 27, 2024 regraired for every _._ _.. _ . _ _ page. City/Town Mate rp Code Clete of Inspection D. System Information (cant.) 8. Tight or Holding Tank (cant,) Alarm present: E Yes El No Alarm level: _.. Alarm in working order: El Yes ❑ No Date of last pumping: _.. bate Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? Yes No g. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert g 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 HAS FLOW EQUALIZERS AND TWO RISERS D-SOX IS LEVEL AND DISTRIBUTION IS EQUAL LIGHT EVIDENCE OF SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGE t5nsp doc,•rey 7Q1612018 ri4fe @'b G'.'b68�s;dai 4aisspectwin F'oor S'aabSWface Sewage MsposM"S"p+sWn•Page 12 of 18 Commonwealth of Massachusetts w Title 5 official Inspection Form w Sewage Disposal System Farm - Not for Voluntary Assessments PSubsurface 130 W[NDKIST FARM Property Address POORNA PAVAN KUMAR MUTNURI Owner C}wner s Name requiredfo is NORTH ANDOVER MA 01845 MARCH 27 2024 required for every ....._._. . -..-.._ ...._. . _ page, Cityffown State Zip code [date at Inspection D. System Information (cant.) 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: El leaching chambers number: leaching galleries number: leaching trenches number, length: 4; 48' LONG ❑ leaching fields number, dimensions: ... ... ........._ ❑ overflow cesspool number: _ _. _..... ❑ innovative/alternative system Type/name of technology: _ t5fnsp doc.rev,'7/2612018 Title 5 Official Inspection Form SubsLgfacer Sewage Disposal System Page 13 of 18 Commonwealth of Massachusetts Ti Afle 5 Official Inspection Farm Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 130 WINDKIST FARM Property Address _.... _. . POORNA PAVAN KUMAR MUTNURI Owner Ow,+_ner's_fame _.__.._. rnftuired for every i is required NORTH ANDOVER MA 01845 MARCH 27, 2024 .. page. dhyPf6wn State Zip Code Mute of Inspection D. System Information (coat.) 11. Sall Absorption System (SAS) (cant.) Comments (note condition of soil, signs of hydraulic failure„ level of ponding, damp soil, condition of vegetation„ etc.): SOIL AND VEGETATION OK NO SIGNS 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 Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,. etc.): r 5nap doc•wv,7126J2018 Pme 5 offP c4u �nawraaction Form,SUbSU09CO Sewage rYfUxAM System Page 14 of f8 a„ Commonwealth of Massachusetts Title 5 Official Inspection Form 8 Subsurface Sewage Disposal System Form Not for Voluntary Assessments rr 130 WINDKIST FARM Property A66ress POORNA PAVAN KUMAR MUTNURI Owner Owner's Narne information is required�ired for every NORTH ANDOVE�R MA 01 E-45_ . MARCH 27, 2024 .... _. . __.. . page. State Zip Cade Date of Inspection D. System Information (coot.) 11 Privy (locate on site plan'): MateriaVs of construction; _... Dimensions Depth of solids _ Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): u5,f ipr doc-rev 7725P2018 Too 5''ffwral hsgz€aa;tiw P'axnn Subsu daara Se waago MsposW SysWrn,•Page 15 of 18 Commonwealth of Massachusetts Title 5 Offloculal Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 130 WINDKIST FARM party Address POORNA PAVAN KUMAR MUTNURI Owner Owner's Name ' information is NORTH ANDOVER MA 01845 MARCH 27, 2024 required for every ... -" page. ......... "'s-'take 21'p"'"C''o'd"e", ""D__a"'t"e---ofl- , Inspection D. System In f_or_m_a_ti_on (c_o_n 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 ail 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 PT r C S JZA 0 ftc) Q'v(ol Qd� r Ser R, q o D. 60tr A- 0 30E .� e) 0 , A- t5insp doe•rov,1126t2Y1 8 Title,5 Official Inspection Fow Subsurface sewage Disposal system-Pago 16 of 18 Commonwealth of Massachusetts °l Title 5 Official Inspect"on Form �a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 130 WINDKIST FARM i4noperty Address POORNA PAVAN KUMAR MUT"NURI Owner Qwner's Maine requiredfn ds NORTH ANDOVER MA 01E345 MARCH 27 2024 required for every page, City/Town State Zap Cade Date of Inspection D. System Information (cont.) 15, Site Exam; E Check Slope Z Surface water Check cellar U Shallow wells Estimated depth to high ground water: Beet 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 2017 Observed site (abutting p rope rtylobservation hole within 150 feet of SAS) z Checked with focal Board of Health - explain: DESIGN PLAN ON FILE Checked with local excavators, installers - (attach documentation) ED Accessed USES database -explain You must describe how you established the high ground water elevation. DESIGN PLAN SYSTEM IS 4' ABOVE WATER TABLE Before filing this Inspection Report, please see Report Completeness Checklist on next page. t"bmspa doc•rev.'7f2612018 ntw 5 t:bNI*al Inspr&srt kwi Fwn:SUbsurl aarea Sewago D€wttmeaG System•Page'17'od tS Commonwealth of Massachusetts Title 5 Official Inspection Farm i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments p,k:ap 10 WINDKIST�,,�m,," FARM ... property Address POORNA PAVAN KUMAR MUTNURI Owner Owner's Name Information for is NORTH ANDOVC�R MA 01845 MARCH 2 T, 2024 required for every _ � _ ...... .. . .... page CityfTown State Zip Code Jate of InspeotIon E. Deport Completeness Checklist Complete all applicable sections of this form inclusive of. E A. Inspector Information: Complete all fields in this section. 7 S. 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 D. System information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included laginra',r,doc-aaaw.?126f2018 1 i9io 5 Offi6W Inspection r°O"n Sutiswfac e Sewage(JdamgSosat System•Page 18 of 18 Summary Record Card germrwed on 4&2024 11�27:36 AN1 by Karen HftnWn Page I "TOwn of North Andover Tax Map # 999-9�99.9-9999-9999.9 Parcel Id 21158 74 PRESCOTT STREET POOMA PAVAN KUMAR MUTNURI 130 WINDKIST FARM ROAD NORTH ANDOVER MA 01845 FY 2024 UB Mailing Index Name/Address Type Loan Number Activelinact. From Until POOMA PAVAN Owner A,Uvu KUMAR MUTNURI 130 WINDKIST FARM ROAD NORTH ANDOVER MA 01845 SJK CONSTRUCTION Previous Customer Inactive 6/2612018 334 MAPLE STREET DANVERS MA 01923 RODRIGO GALLON Previous Customer Inactive 6116/2021 130 WINDKIST FARM ROAD NORTH ANDOVER MA 01845 UB Account Maint. ActivelInactive Account No Cycle Occupant Name Bldg td.25638,0-130 WINDKIST FARM ROAD Last Billing Date 218/2024 1090600 01 Cycle 01 Active UB Services Maint, Account No, 1090600 Service Code Rate Charge Multiplier/Users MISCFEEADMIN FEE 0.63 5/8 7 82 1/1 WTR WATER 01 ALL METER SIZE 10335 UB Meter Maintenance Account No. 1090600 Size YTD Cons Serial No Status Location Brand Type 48966739 a Active HH#130 b Badger w Water 0,6250,625 392 Date Reading Code Consumption Posted Date Variance 1118/2024 658 a Actual 25 2/15/2024 -17% 10/19l'2023 633 a Actual 30 11121/2023 8% 7/2012023 603 a Actual 28 8/14/2023 11% 4/19/2023 575 a Actual 25 5/10/2023 14% 111812023 550 a Actual 22 2/14/2023 -57% 10119/2022 528 a Actual 51 11/9/2022 15% 7/20/2022 477 a Actual 45 8/16/2022 74% 4/19/2022 432 a Actual 25 5/1212022 8% 1/20/2022 407 a Actual 24 2/16/2022 -22% 10/2012021 383 a Actua 1 30 11/22/2021 -61% 7/22/2021 353 a Actual 37 8/24/2021 164% 6/9/2021 316 f Final Bill 16 619/2021 73% 4121/2021 300 a ActuM 17 5/1812021 3% 1/2112021 283 a Actual 17 2123/2021 -65% 10/2012020 266 a Actual 50 111,1212020 -35% 7/16/2020 216 a Actual 67 8/12/2020 394% 4/2412020 149 a Actual 16 5/13/2020 14% 1/1712020 133 a Actual 13 211012020 -40% 10/18/2019 120 a Actual 21 12/18/2019 -49% 7/22/2019 99 a Actual 44 8113/2019 187% 411912019 55 a Actual 15 5/16/2019 27% 10712019 40 a Actuai 11 2/18/2019 -44% 10/23/2018 29 a Actual 22 11/1912018 5% 7119/2018 7 aActuai 5 8/16/2018 650%