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HomeMy WebLinkAboutPass - Title V Inspection Report - 84 SUGARCANE LANE 5/21/2024 411\ Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 SUGARCANE LANE —--------- ---—-------- MELANIE LARGER Owner information is required for every NORTH ANDOVER MA 01845 MAY 11, 2024 page. -Zip­66 d-e- Cate f Inspection- - ", Inspection results must be submitted on this form. Inspection forms may, 0 jot,,I r in any _ way. Please see completeness checklist at the end of the form. Impoftnt:When A fiffingout forms P"W. Inspector Information on the computer, use only the tab Todd James Bateson key to move your Name of Inspector cursor-do not Bateson Enterprises Inc. use the return ------ Company Name key. 111 Arlla Road Company Address MA 01810 Andover —------- —------- State Zip Code 978-owm 475-4786 SI-16 Telephone Number License Number ................ B. Certification I certify that: I am a DEP approved system inspector In full compliance with Section 16.340 of Title 6 (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. Passes 2. Conditionally Passes 3, E] Needs Further Evaluation by the Local Approving Authority 4, ❑ Fails MAY 14, 2024 k Ins po O e na" -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 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. 45insp,doc-rev.70612018 Title 5 Official impaction Form:SubsLulace Sewage DisposaJ System-138"1 of 18 Commonwealth of Massachusetts WI! / Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 SUGARCANE LANE Property Address MELANIE GARNER Owner Owner"s Nam-e required is NORTH ANDOVER MA 01845 MAY 11 2024 required for every __._.....,... .. . _.,.... __..._ _ ._ .. .. page. CrtyFTowri State Zip Code Clete of Inspection C. Inspection Summary Inspection Summery; 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:. El 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. El Y Ej N (_] ND (Explain below) ktmnrp aloe-mv.7P26120181 ''me 5 Omcia[Vnspecuon i,orm Subsurface urfac,e Sewage U(sp sW System•Page 2 d 18 u Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments w TM 84 SUGARCANE LANE Property Address MELANIE LARGER Owner __...ne_.r's Na_.__. __. Owme information is required for every NORTH ANDOVER MA 01845 MAY 11, 2024 ..... page City/Town State Zip Code 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 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): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ------------ The system required pumping more than 4 times a year due to broken or obstructed pipe($). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y [❑ 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: t5Vnsp.doc•rev.7126/2018 Title 5 Official Inspection Forn Subsurface Sewage Disposal System*Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Farm my �4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 SUGARCANE LANE Property Address MELANIE GARGER Owner Owner"s Name information is required for every NORTH ANDOVER MA 01845 MAY 11, 2024 _.._.._._.. -- page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cant.) 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. 0 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 ElBackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5inspAoc-rev,7/26120 1 8 Tif e 5 Official Inspecfion Farm:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts � T il"Lle 5 Official Inspection Farm r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 SUGARCANE LAME faraperty Address MELANIE LARGER Owner 6 ner`s Name pinformation is urre NORTH ANDOVER MA 01845 MAY 11 2024 � a M p cCFrar every ,. _ _ e, City/rown ate Zip Code. .. Date of Inspection C. Inspection Sllµ...� .____. _..._._ ........_.__... .. . ._ mmary (cant.) 4) System Failure Criteria Applicable to All Systems: (cone.) Yes No 0 Ell Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 0 Z Liquid depth in cesspool is less than 6"° below invert or available volume is less than Y2 day flaw 11 z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: 0 Z Any portion of the SAS, cesspool or privy is below high ground water elevation. E] z 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. El E Any portion of a cesspool or privy is within 50 feet of a private water supply well. E 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 11 z The system is a cesspool serving a facility with a design flow of 2000 gpd- 10„000 gpd. ❑ z 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 1:1 the system is within 400 feet of a surface drinking water supply E] 1:1 the system is within 200 feet of a tributary to a surface drinking water supply El the system is located in a nitrogen sensitive area (Interim Wellhead protection Area— IWPA) or a mapped Zone lI of a public water supply well t5rsp,doc^rev.712 Q018 1 Me 5 Off c0i InspeclK)n Forrn:Subsurfasw lmwage Disposal System-Page 5 of 18 Commonwealth of Massachusetts wa,* Title 5 Official Inspection Form W Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments 84 SUGARCANE LANE Property Address MELANIE LARGER Owner Owner"s Name information is required for every NORTH ANDOVER MA 01845 MAY 11 2024 _.._...__ _ page. CitylT"own State Zip Code Date 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 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 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ r171 Were any of the system components pumped out in the previous two weeks? ® El 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? Were as built plans of the system obtained and examined? (If they were not available note as N/A) F1 El Was the facility or dwelling inspected for signs of sewage back up? 7 ❑ Was the site inspected for signs of break out? Z ❑ 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? ® El 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: ® ❑ Existing information, For example, a plan at the Hoard of Health. 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)] 15inspAcc•rev.7)26/2018 Ti49es 5 Otficial Inspection Form:Subsurface Sewage Disposal System•Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection ection or $ Subsurface Sewage Disposal System Form Not for Voluntary Assessments 34 SUGARCANE LANE Property Address MELANIE GARGER Owner 6 er"s Narne information is regcured for every NORTH ANDOVER MA 01345 MAY 11, 2024 _ . page, City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flaw Conditions: Number of bedrooms (design); Number of bedrooms (actual); DESIGN flow based on 310 CMR 15.203 (for example. 110 gpd x#of bedrooms): 60 GPD Description: Number of current residents: 2 Does residence have a garbage grinder? H Yes E] No Does residence have a water treatment unit? EJ Yes Z No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes Z No information in this report) Laundry system inspected? Z Yes F-1 No Seasonal use? [..7 Yes ® No Water meter readings, if available last ears usage d SEE ATTACHED ( y g (gp )) ... Detail. Sump pump"? Yes Z No CURRENT Last date of occupancy: bi�t _.-._.__ t,54nsp.doc•rew.';92612018 NO 5 ofrPr'7AAM hspea„dour^Form Subsurface Sewage Dksposas yrasda n.Page of 18 w Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 SUGARCANE LAME Property Address MELANIE GARGER _ Owner 6w"ner s Larne in formation d far every ory is r NORTFI ANDOVER MA 01845 MAY 11„ 2024 required ... page, Crty/Towvn Stake Grp Code Cate of Inspection _........ _....._. __.....__ .,._ ....._a._w . ._ _.. _...,_.__ _.___.._ _... ...... _......_. D. System Information (cont.) 2, Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 1 . Gallons per day ipd> Basis of design flow (seats/persons/sq.ft., etc.): _...... .. Grease trap present? ❑ Yes -] No Water treatment unit present? Yes E] No If yes, discharges to: _ Industrial waste holding tank present? Yes No Non-sanitary waste discharged to the Title 5 system? 7 Yes C] No Water meter readings, if available: _ Last date of occupancy/use; .-.--- tJake Other(describe below): 3, Pumping Records: Source of information: BATESON ENTERPRISES INC OCTOBER 2023 Was system pumped as part of the inspection? [l Yes Z No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: tbh n'p.doc,rwsw.711ef2 18 'nue 5 a;kaPvaai insp,ectim',Fonm &&ast✓^arw Sarw„age G;eusposnal Syslarn.Pap 8 L4 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments 84 SUGARCANE LANE Property Address MELANIE GARGER Owner 6wner"_ .s_._.....Nam___e information is required for every NORTH ANDOVER MA 01845 MAY 11„ 2024 _ ...w..... _ _ _. page. CltyJl ownnn^ Mate Zip Code sate of Inspection D. System Information (cont.) 4. Type of System. ® Septic tank„ distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool F1 Privy F1 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: 27 YEARS, INSTALLED FEBRUARY 1997, AS BUILT PLAN Were sewage odors detected when arriving at the site? ❑ Yes Z No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ 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 IN WALL- NOT VISIBLE VENTING OK- NO SMELLS DETECTED NO EVIDENCE OF LEAKAGE tSinsp,doc-rev 7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 84 SUGARCANE LANE ----------------- Pr6perty Address MELANIE LARGER Owner bwn-e-r-'s-Name information Is required for every NORTH ANDOVER MA 01845 MAY 11, 2024 page. Ciy"["T`o"qivn- -Sk-ate Zip Code Date of Inspection D. System Information (cont.) 6, Septic Tank (locate on site plan): Depth below grade: feet Material of construction: Z concrete El metal F-1 fiberglass F polyethylene E] other(explain) .................... If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes No 10' X 5' X 4' D�rnensions: 6" Sludge depth: " Distance from top of sludge to bottom of outlet tee or baffle 32 Scum thickness 7t' Distance from top of scum to top of outlet tee or baffle 13 Distance from bottomof scumto bottom of outlet tee or baffle " 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 PLASTIC INLET AND OUTLET TEES OK TANK IN GOOD CONDITION NO EVIDENCE OF LEAKAGE NORMAL LIQUID LEVELS a5Qnsp doc«w 7126(2018 TM9 5 Offic4 hmmclori 1'orm Sub such ce Sewwae MspasW Systern Page 10 0 45 Commonwealth of Massachusetts y Title 5 Offici l Inspection Farm �& Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� g p Y rY 84 St1GARCANE LANE Property Address MELANIE GARGER Owner _ i__.__n.. Owner"s. Ne_ information is required for every _NORTH ANDOVER MA 01848 MAY 11, 20_ - .. 24 .__,__... page Cnty/Town State Zip Code bate of Inspection ___..._------_._....___--.--....,_..___._.._...__._.___.___W_._... D. System Information (cant.) 7. Grease Trap (locate on site plan): Depthbelow grade: _iwi_--------------__._...... _ ...._.____....._....................._._......_.... Material of construction: ❑ concrete ❑ metal ❑ fiberglass © polyethylene ❑ other(explain): Dimensions: _ Scum thickness Distance from top of scum to top of outlet tee or baffle _... Distance frorn bottom of scum to bottom of outlet tee or baffle Date of last pumping: date _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to 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 n metal ❑ fiberglass ❑ polyethylene other (explain): Dimensions: Capacity: _ garicns Design Flow: _ . - ... galionon s per day t51nsp.doc•rev.7/26/2018 'I"atie 5 offr:ial inspection Farm;Subsufface Sewage DispnsM System-Page f I of 18 ." Commonwealth of Massachusetts k Ties 5 t f dal Inspect-on Farm Iro Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 84 SUGARCANE LANE Property Address MELANIE GARGER Owner owners Name required is NORTH ANDOVER MA 01845 MAY 11, 2024 cepuired for every m.._ _ _ _ page City/Town State Zip Code Date of Inspection D. System Information (cent.) 5. Tight or Holding Tank (cant.) Alarm present: Yes No Alarm level: Alarm in working order: D Yes E] 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 E] No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-BOX IS LEVEL AND DISTRIBUTION IS EQUAL LIGHT EVIDENCE OF SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGE SLIGHT CORROSION IN D-BOX t5iA*1p.cdoc^rray.712&2018 '1'qie 5 ot cpaaf Ouarua^Necw¢curo Fofrn Subssawl ace Sewage&'kry r saatl System•Page 12 of Is Commonwealth of Massachusetts sr �� Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 SUGARCANE LANE w. F roperty Address MELANIE GARGER Owner _ ...._ __ . _... .... _ Owner's Dame information is NORTH ANDOVER MA 01845 MAY 11, 2024 required far emery .......__._.. .. page. City/Town Mate "Lip Cade Date of Inspection D. System Information (cant) 10. Pump Chamber(locate on site plan): Frumps in working order: ❑ Yes 0 No* Alarms in working order. 0 Yes 7 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. Sail 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; �t, leaching trenches number, length: 8' LONG 2; 3 leaching fields number, dimensions: overflow cesspool number: [� innovative/alternative system Type/name of technology: - _ .. _ 15n9p.doc*rev,7/26201 e 1"itfe 5 affw4W Inspection Form:4ubawfzrre u+awage C]Is(osW System•Page 13 of'I W Commonwealth of Massachusetts Title 5 Official Inspection Form "'= a Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 84 SUGARCANE LANE _.....,. Property Address MELANIE LARGER Owner .. _..._ .._ ._ C7wner's Name information is required for every NORTH ANDOVER MA 01845 MAY 11, 2924-11 page City/Town State. Zip Code Date of Inspection D. System information (cant.) 11. Soil absorption system (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SOIL AND VEGETATION OK NO EVIDENCE 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 R Yes E] No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5msp doc•rev.7f28l2015 Title 5 Official inspection Fonn,Subsurface Sewage Disposal Systern•Page 14 of 18 Commonwealth of Massachusetts Y W"^wWW Title 5 Official Inspection Form ^: Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 84 SUGARCANE LANE property Address MELANIE LARGER Owner Owner"s Name information is NORTH ANDOVER MA 01845 MAY 11, 2024 required for every OutfT,._ page, y own State Zip Lode Cate of Inspection D. System Information (cent.) 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.). twins p alcc•rev.'7/2612016 'I'Mo 5 Of1icW hiss¢cton Form Subsurfer„e Sewage Disposal System-Page 15 of 18 o Commonwealth of Massachusetts Title 5 Offidal Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 84SUGARCANELANE ................................. ....................... Prt�party Address MELANIE GARGER Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 MAY 11, 2024 page� -------- State Zip Code Date of Inspection ......-—----- b. 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: hand-sketch in the area below ❑ drawing attached separately A- jtl 41 f 1(7" 4 QIA o� 6ck I io r ? xi 8 Z. )OX a 60( do N X Lel �11 to b- t5insp.cbc-rev 712W201 8 Title 5 OfficW Inspection per;Subsurface SewaQ0 Disposal Systern-Pace Is of I a Commonwealth of Massachusetts "Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'c 54 SUGARCANE LANE Property Address MELANIE LARGER Owner Owner's Name information is NORTH ANDOVER MA 01545 MAY 11, 2024 required for ever�a page, city/town State �Ip Code Coate of Inspection _... . ......... _,...... _._ .__.... __._ .. ..... ..w__..__.._._.._...w.......,. _.... _._.....w__—.. _.....,,.._..._. _ ... ..._.. ,. D. System Information (cant.) 15. Site Exam; Z Check Slope Z Surface water Z Check cellar Shallow wells Estimated depth to high ground 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: AUGUST 1 gg5 Gate [� Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health - explain: PLANS ON FILE �] 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 Report, please see Report Completeness Checklist on next page. t5insar.zoa,.•rov-7 8 2612 0 1 8 FitlBe 15 Offtci W Insupuaunton Form subsw faa&61JSewag e Disposal Sys€ern•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 SUGARCANE LANE Property Address MELANIE GARGER Owner' Owner s Marne _ -_ -----._ ..__.,... ....,.. ------- information is NORTH ANDOVER MA 01845 MAY 11 2024 required far every .,..__ _. ........ w_._..._.. _.__._.__.._.. . page. CltylTown State Zip Cade Date 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. Z B. Certification: Signed & Dated and 1, 2, 3, or checked Z 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— 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 t5insp,doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurfiace Sewage Disposal Systern-Page 18 of 18 Summary Record Caid ganerared on 516)2024 8 15°54 AM by Karen Hanlon Page I Town of North Andover Tax Map # 210-106.A-0266-0000.0 Parcel Id 17411 84 SUGARCANE LANE CHRISTOPHER MADIGAN MELANIE LARGER 84 SUGARCANE LANE NORTH ANDOVER MA 01845 Class 101 Single Family Property Type I Residential Size Total 0,966 Acres FY 2024 .......... UB Mailing Index Name/Address Type Loan Number Active/Inact, From Until CHRISTOPHER MADIGAN Owner Adive., MELANIE LARGER 84 SUGARCANE LANE NORTH ANDOVER MA 01845 HANSON,CHRISTOPHER Previous Customer Inactive 7/19/2018 84 SUGARCANE LANE NORTH ANDOVER, MA 01845 UB Account Maint, Account No Cycle Occupant Name AeUvelInactive Bldg Id, 17672.0-84 SUGARCANE LANE Last Billing Date 4/9/2024 3170342 03 Cycle 03 Active UB Services Maint. Account No.3170342 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63 518 7.82 I/ WTR WATER 01 ALL.METER SIZE 76.00 /1 UB Meter Maintenance Account No, 3170342 Serial No Status Location Brand Type Size YTD Cons 32772987 a Active ERT F, RT. b Badger w Water 0.625 0.625 894 Date Reading Code Consumption Posted Date Variance 3/11/2024 5375 a Actual 20 4/16/2024 .61% 12/11/2023 5355 a Actual 49 1115/2024 -49% 9/15/2023 5306 a Actual 109 10/1 a)2023 234% 6/912023 5197 a Actual 31 7/14/2023 78% 3/8/2023 5166 a Actual 17 4/12/2023 -57% 1217/2022 5149 a Actual 37 1/1612023 -74% 9/13/2022 5112 a Actual 161 10118/2022 139% 6/812022 4951 a Actual 64 7/18/2022 36% 3Y812022 4887 a Actual 46 4/1312022 -25% 12/812021 4841 a Actual 62 1/17/2022 -50% 918/2021 4779 a Actual 126 10/1512021 83% 6/8/2021 4653 a Actual 71 7/27/2021 124% 315/2021 4582 a Actual 29 4/21/2021 -58% 1218/2020 4553 a Actual 72 1/13/2021 -64% 9/912020 4481 a Actual 211 10/14/2020 228% 6/5/2020 4270 a Actual 59 7115/2020 139% 3/9/2020 4211 a Actual 25 418/2020 -50% 12/11/2019 4186 a Actuai 50 111512020 -66% 9/13/2019 4136 a Actua 1 166 10/10/2019 161% 6/10/2019 3970 a Actual 63 7/25/2019 59% 3/812019 3907 a Actual 37 4/16/2019 -31% 12/10/2018 3870 a Actual 54 112212019 -74% 9/12/2018 3816 a Actual 135 10M5/2018 177% 7117/2018 3681 f Finaf BN 113 7/17/2018 267% 3/7/2018 3568 a Actual 21 4123/2018 -53%