HomeMy WebLinkAboutPass - Title V Inspection Report - 49 WINDSOR LANE 3/3/2026 Commonwealth of Mas u s
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T t I e, 5� ff
° ., inspooec"
tion Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
9 Windsor Lane
... ...m,,mm.m �.:am. ... ._.. .............
Property Address
Kenne
Owne�r
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�r -s Name
required for even North.............. -------........ Ma !8, 21 2 '2
page. /Town .,. State Zip Coins Date lnspe@66—
Inspection
results
way., Please see completeness,checklist a end of the fore.
Imp,ortant:i When A, Inspector Information
iiin out forms
on he computer,
use only the tad � � � � .
key move your N r Inspector
ursr
not ean roan
use the return _.a ,,, ....-.�,,,, m w. ..... -—-- -
key
Company
fi
Name ...,,.
2 rota fee
Company Address—'--� _ ....� .,.:.._W , .nor �, w..- m �. . �.w,, w., ,. .. ...m � .
mm� ...m
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� iiMa 011940
CityfTown State Zip Code
510 2 3 2 3` .
. .�_ .. .. �.... v. ..m .� ...,..
-f h N'�umr license Number
B. Certification
i cer i that am a DEP, approved systems inspector in,fullcompliance with Section 115.340 of Title
(310 C 5.000); 1 have personally inspected the sewage disposal systems at the property address
above;listed the information reported below is true, accurate and c rn iete as the time of my
inspection, and e inspection was performed based on my trainingn experience in the proper,function
and maintenance of on-site sewage disposal systems, After'conducting tiffs inspection i' have determined
that the system.
Passes,
2. Conditionally Passes
3. El Needs Further Evaluation y the al Approving a rity
. El Fail
Ir�s (c ors Signature
The system snaps y inspection report o Approving, (Board
� r� ���I � �w � i� � ��, r �r�n �'t rat
of exit r D within 30 days of completin,9 this, inspection. If the system has a design flow of
0,p000 g d or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of t ie DEP. The original''form should be sent to,the system owner and copies sent,t
the buyer, it applicable, and the approving autl rit .
Please note.- ' s report only describes conditions at the,time 'Inspection and under the
conditions usle a that time. This inspection does not address how the system will perform
in the future under the same or different conditions, of use.
t5 n p.du rev,7/2612016 Title 5 Official Inspection F r °Subsurface Sewage Disposal Systern-Page I of 1
Commonwealth of Massachusetts
_ ■ w
Title 5 O Form
r
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
49 Windsor Lane
Property Address
Kenney Vertullo
Owner owner's Name
information is North Andover
required for every Ma 61845 2/12/2026
page. Cityfrown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 21 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that an of the failure criteria described
. .Y scrrbed
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
4 bedroom single family dwelling with pipe in stone drainfield in working order
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 b
the Board of Health,will Pass. Y
Check the box for"yes", "nos'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):
t5insp.doc*rev.7l26=18 Title 5 otfctal inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth ass chose
............. TI"tIe 5.. Off'icial' Inspecti*on
Subsurface Sewage Dos System s m r'm Not for Voluntary Assessments,
'
9 Windsor r Lane
r ...........................'................ "", _,...,,,""„.......................,... . �................. ..,,wow_,.. _..... .,..... .._.�.m ���.,, _�..m�..........
.m m_
Denney Ye�e ll
Owr ,, �. "...-
.................... .................................... ............................... ———----------------------....................... ...................................
information is
rth:
Ma 01845
required for every ���,.,.. ,u, ,.___w__ty/Town State Zip Code Date of'1-n's,pection:
.�..�.,.,..- , -',.-" .�w.��._ _m ���� _.�,.,.��mnm, �,�. �������� ........w- �,����. �..__� � � ��
page.
C. Inspection bummar,y ('cont)
2 Systems Condlitionally 'Passes c n . �
El Pump Chambler lumps/alarms not operationall, System will pass with Board of Health approval f'
pumps/alarms are repaired,
F] Observation ofsewage backup or break out or high, static water level in the distribution box due
to broken or obstructed e(s),or due,to,a broker, settled r uneven distribution box. System will
pass inspection N (with approval of Board of Health).-
F-11
brokenpipe(s) arle replaced'' El Y N' � ND (Explain elow)-
E]
obstruction is removed El Y N 0 N Ex lalin
below,),-
distribution i x is leveled or replace E:1 Y N 0 ND (Explain below):
The,system Arad pumping more than 4 times a year due to broken or obstructed is . The
ssern will pass inspection i (with approval of the Board of Health):
E] r ken iple s are replaced N (Explainbelow)-
E]
obstruction is removed
Y N 0 ND (Explain elm
3 Further Evaluation iIs Reiqulired by,the Beard. of Health-.
Conditions exist which requires further evaluation by the Board ofHealth in order to determine if
the system is failing to proltectpublic health, safety or the environment,.
a. System w11,11 pass unless Board of Health 'e a mli esa in accordance,wl*th 310CMR
16.303(11(b) that the system is not funictioning 'in a manner whilt� w W1111 Prefect pubIlIc health,
safety,and the en r n ent
t5h . revs. /61 1 8 Tille 5 Official inspection Forrn.,SUbsurface Sewage Disposal System-fags 3 of 1
Commoriweal'th of Massachusefts
u icia
T"tle 51 0"%ff* I Inspect'ion Form,
o,, Subsurface Slewage Disposal System Form Not for Voluntary Assessments
9 Windsor Lane
Property Address
em Veal.!„wll
Owner Owner's Name
information s th Andover M ' ' 2/12 2 126.
required for en � � m w. .� �.. . .
citi � State Zip,Code Date Inspection
C. Inspection
Ej Cesspool,, or privy, is within 50 feet of a surfacewater
EJ Cessplooll or priory is within 50 fbet of a bordering vegetated etl rrd or a sialt marsh
b. System willfaJilsunless the Board of Healthan ubill titer lier, if ny)
dietermines that the system is functioning in a manner rotectsthe public health,,
safety and r nimeri t
El, The system has a septic tank and s lil absorption system (SAS) arid' the SAS is within
100 feet of a, surface water supply or tributary to a surface water supply.
E:1 The system, has,a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
the systems has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
E:1 The system has a septic tank sand SAS and the SAS is less than, feet but 5 feet or
more from a private water sui1y well ..
Method used to determine distance,.
T is system passes, if the well ureter analysis, performed at a DEP certified laboratory, for fecal
c li 'erm bacteria indicates absent and the presence of ammonia nitrogen sand nitrate nitrogen is equal
'to, r less than 5, ppm, provided that no other failure criteria are triggered.. A ceps,ofthe analysis must
be attached to this term.
c, Oth r-
.
4 Sy ern Failure Criteria Applicable to All Systems:
u must,indica e "Yes" or"No"to each of the folliowling for all,inspections,.,
Yes No
Backup of sewage into facility or,system component due to overloaded or
El E Aged SAS or cesspool
el
E] E Discharge or pionding of effluent to the surface of the ground or surface waters
e to an overloaded or clogged SAS or cesspool
t i -red 7126/2018 Title,5 Offidaltnspeciion Form,Subsurface,sewage Disposal system.Page 4,of''18
1ITT "INIQ,I""111'7"Pa,
Commonwealth of Massachusefts
10 on Form I't I le 5 Off'i i'a,I I n s upwk,e,c
............
Subsurface, Sewage Disposal System Form Not for Voluntary Assessments,
.......... ......
X
49 Windsor ILane
�
.................... ................ .........................
rty dd
J15 Opi...............-
A ress
Kepri ._Vertullo
.......... ..................... ............ ..........................................
Owner Owner's,Name
information is
required for every North Andover Ma 0 1845, 211212 02 61
page. .............w............n........... -S—ta,t,e- 2 i-p","C-o,-d—'e b","""a.............t.............e,-o,—fI n-,s-p`e-m ,ry.,r,......
Inspection Summary (co,nt)
4) System Failure CrIterila Applicable to All Systems: (clont.,)
Yes No
Static,liquid' leviel in Nyet distribution box above outlet invert due to,an overloaded
or clogged SAS or cessipooll
Liquid depth in cess,pool' is, less than 6" below, invert or availlable volume is less
than 1/2day flow
Required purnpinn more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
Any portion of the SAS, cesspool or privy is below high ground water elievation.
El E Any portion of'cesspool or privy i's within 100 feet of a surface water supply or
tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
1:1 zi Any portion of a cesspool or privy is within 50 feet of a private water supply well.,
E] 0 Any portion of a cesspool or privy is, less than 100 feet but greater than 50 feet
from a, private water supply welll ith no acceptable water quality analysis. [This,
system passes if the well water analysis, pefformed at,a DEP certiffied
laboratory,, for fecal, colliform bacteria, indicates absent and the presence
of ammonia nitrogen and n1trate nitrogen is equal to or less,than 5 pprn,
provided that no,other faflure criteria, are triggered.A copy of the al' sus
land chain of custody must be attached to this form.,]
E] E The system is a cesspool serving a,facility with a, design flow of 2000 gpd-
101,0010 gpd.
El IE The system fails 1. 1 have dieteirmined that one or more the above failure
criteria exist as described in 310 CMR 15.3013, 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 la,rge system the system must serve a facility with a
design flow of 10,1000 g(pd to, 15,000 gpd.
For large systems, you mu st indicate either it yies" or"no" to each of thie following,, in addition to the
questions in Section GA.
Yes, No
the system is Mffiin 400 feet of a surface drinking water supply
E] 0
1:1 0 the system is with,in 200 feet of a,tributa,ry to a surface drinkinig water supply
El E the system is located in a nitrogien sensitive area (interim Wellhead Protection
Area —IWPA) or a mapped Zone 11 of a publIc water supply well
t5 ire sp.,doc-rev,7126/2018, Title 5 Official Inspection Forim Subsurf ace Sewage Disposal System-Page,,5 of 18
Commonwealth of Massachusetts
Title 5 O Form
y
r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
49 Windsor Lane
Property Address
Kenney Vertullo
Owner owner's Name
Information is North Andover Ma 01845 2/12/2026
required for every
page, CitylTown State Zip Code Date of inspection
C. Inspection Summary
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
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ED Were any of the system components pumped out in the previous two weeks?
Z ❑ Has the system received normal flows in the previous two week period?
❑ ED Have large volumes of water been introduced to the system recently or as part of
this inspection?
Z 1:1 Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® El Was the site inspected for signs of break out?
® El Were all system components, excluding the SAS, located on site?
Z 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?
® ❑ 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 Board 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
pp p � [ � )l
15insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
I Inspect,*
'*"Ie 5
i c i a ion Form
ii
i
Subsurface Sewage Disposal System Fora, Not for'Voluntary Assessments
49 Windsor Lane
O-
r �r r ss
Ken
Owner Owner's Name
information is, North Andover 2 ' ,2 2
r uired or eve ry � . _.: _
page, ate of Inspection
D. System Informationl
Numberbedroomi deli 'Number bedrooms (actual)-
DESIGN fio based on 310 CMR 15.203, (fir example. 110 gpd x#oftedrooms, 440
Description:
4 Bedroom system with 15010 gallon tank an ' 50' drainfielid
residents-
Does residence have a garbage grinder? Yes ! N
Does residence have a water treatment omit? des E N
If yes,,, discharges,to*
Is laundry on a separate sewage systems (Include laundry, system inspection El es
El No
information in this report.)
Laundry system inspected'?, El des No
Seasonal se? El Yes, E No
Water,meter reams, if available y (gpd))*:
Deta il..
see attached
El SIUMP, Plump?
Yes E N
current
Last date of ecearey: �,,...� ..
6�te
ins -ray V26120 18 Witte 5 Official Inspection Form,wSubsurface sewage Disposal S' I i-Page 7of
Commonwealth of Massachusetts
fT imtle 5 Offmicuia InspectimnnForm
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Y
y
49 Windsor Lane
Property Address
Kenney Vertullo
Owner Owner's Name -- - - _.. .---- ---•
information is North Andover Ma 01845 2/12/2026
required for every
page, City/Town State Zip Cade Date of Inspection
D. System Information (cont.)
2. Commerciallindustrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(9pd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? El Yes [:1 No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? El Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? EI Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Homeowner/Board of Health
Source of information: 112025 on file
Was system pumped as park of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc*rev.7/2612018 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
4 x
Commonwealth of Massachusetts
Timtle 5
w
Offimcimal Form
�
Subsurface Sewage Disposal System Form Not for Voluntary Assessments L
K
*r
491J11indsor Lane
Property Address
Kenney Vertullo
Owner Owner's Name
information is North Andover Ma 01845 2/12/2026
required for every
page. Citylrown State Zip code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no)(if yes, attach previous inspection records, if anY)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the f/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:
system installed 7/2014 /plan and COC on file
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
8e1
Depth below grade:
feet
Material of construction:
El cast iron Z 40 PVC El other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
sewer pipe no evidence of leakage
t5insp.doc rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage disposal System•Page 9 of 18
4
Commonwealth of Massachusetts
wQA"" fficial
1A
Subsurface Sewage Disposal Sys,tem Form Not for Voluntary Assessments,
49 Windsor Lane
Or-6'-p—e riy-A---d di:r�e ss
Keeney�"er 11
informationOwner Owner's is N" rf a Andover Ma 2 12 2 126,
required for every „w w . . m._ m............. m.. .�.wµ,.., ....� ..... _ , �w � ._. ....m �.
page" �� State Zip Code ate Inspection,
D. System for (cont.),
. Septic Tan (locate our siteplan):
Dept, below gra,dey 6,
..mm �. w.0 m,. .......
�
feet
Material of construction*
struuction*
N' concrete meta l El fiberglass polyethylene Ej other(explain),
1500 gallon concrete,septic tank withcast iron cover at grads over inlet and outlet
1f tanks metal, list age.
years
I's age confirmed: y a Certificate of Compliance? (attach, a copy of certificate) El Yes N
Sludge tu , w
2 911
Distance from top of sludge to bottom of outliet tee or baffle
201
Scum thickness
51."'
'Distance from top scum,to tow of outlet tee r baffle
istanc from bottom f scum t bottom u f outlet tee r baffle, in ��rv.�m... „ .......�...,,mm��
How were dimensions determined"?
uuined"? � m mmld' Ntl�u measure stick�u �
Comments (ors pumping recommendations,s, inlet and outlet tee or baffle condition, structural integrity,
liquid levels, as related to outlet,invert, evidence of leafage,, e,c.)*
concrete septic tank with, inlet and outliet PVC T 'Tank in working order with, separation from inlet t
outlet no evidence of leal + tarok In good c n itl u
Liquid at bottom of outlet invert filter in septic tank outlet T
Filter was cleaned t time of inspection,/ filter requires maintenance to avoid possible backup alter
should be cleaned Dace or twice a year to be determinedwith usage/cast iron cover to grade over
filer for easy access
recommend umping every two to,three years depending on usage and number of occupants
t5insp.doc rep.7126/201,8 Tifle 5 Official Inspeiction Fovm Subsurface Sewage 01sposalSystemi-Page 10 f'1
roCommonwealth of Massachusetts
m p
itle ' fficial Inspecti'on ,Florm,
. ..........
Subsurface Sewage Disposal Sys FormNot for Voluntary Assessments
4 rods r ,are
.�.,�.... � ��uw.:.:..m�...,� .�,,,, _., ..:. ..�. ...��.�M. �m� �...._._ ,.., M..., ,mrv, mm,,,,.
Property Address
Ken el� 4llo
�ry
Owner _�n
r
Name
information is North Andover � a, 1l 4 2 2 requiredfor eves w. n ,,,w : ...,,,, ,,.. ,-m ,. mW. .,mmmm ......� .. ... mm�.m� �-,�. � � W �, . ....
pale. Cityfflown State Zip Code Date of Inspection
D., System InfoIrmation (cont.
'. Grease Trap (locate on site
plan,)-
below grades ,..... ..
feet
Material of construction*,
El concrete metal fiberglass l e l y'l l offer(explain):
Dimensions- . w......,... ..... w,, �.... .. .. �...mrvm�.....
Scumthickness ........ -------------------------
Distance from scum to top of outlet tee or baffle
Distance from bottom of scum to blottom of outlettee or ba,ffle
Date of last pumping- .....�.�
Date
Commentspumping recommendations, inlet and outlet tee or baffle,condition, structural it e rl y
liquid' levels as related to outlet invert, evidence of lba'kage etc.).
8. Tight r Holding Tank (tank rust pumped at time of inspection) (locate on, site plan),,.
Depth below grade* mm _ �.....__ ro... �..mm.... ..
Material onstruction-
concrete meta i El fiberglass polyethylene other er(explain):
Capacity-
gallons
Design Flow
gallons per day
1 inn w -rev.7/26/20,18 Tifle 5,Official hspecfi tip Form,:Subsurface Sewage Disposai system-Page 11 of 1
Commonwealth of Massachusetts
Title 5 Off'iciIns ectionForm
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
49 Windsor Lane
Property Address
Kenney Vertu Ito
Owner Owner's Name
information is North Andover Ma 01845 2/12/2026
required for every
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: El Yes ❑ No
Alarm level: Alarm in working order: El 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' El Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
q
Depth of liquid level above outlet invert liquid at 0"above invert
P
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.):
16"X16" concrete HD box in good condition
no leakage into or out of box 1 Little to no solids carryover 1 D box is level
3 outlet pipes with levelers
D box is 9" below grade
t5insp.doc•rev.7/2W018 We 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Mass chefs
�cial Inspec ,ion For
T tle 5 Offil
Subsurface e a a Disposall System Form Not,for'Voluntary Assessments
49 Windsor Lane
Kenney V r u l l .
page. Cif own State.... �"�:� Date � e i .......
Dip,
do (cont.)
. Pump ChamIber(locate on, site, plan),,,
Pumps in working in order: Yes No
Alarms in working orders 0 Yies 0 No*
Comments (mote condition of'pu�mp 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 plea, excavation not required)*
If SAS not located, explain why-
Type,
leaching pits, number„
leach,ing chambers number-
El
leaching galleries number„ -- .......
leaching ren hes number, length- a_1
leaching fields number, dimensions* 1 �""� `
El overfiow cesspool number:
innovative/alternative system
Type/'name of technology: w . ..... ..� _� �......
t5insp.doc rep.712,612018 Title 5 Official Inspection Form-Subsurface SewageDisposal Systern-Peas 13 of 1
ail m e It . c ' fw '
iciial Inspecti"on Form
TI"tIe 5 Off*
.. Subsur face Sewage Disposal System Form - Not for Voluntary,Assessments
9,Windsor Lane
Pro
ess
,,rv,
Owner � �.
information is, North Andover Ma 01845, 2 2 2 26,
requiredevery ��.��._ mnn„. .,,,,,,,,,,..�..�� „W,,, .m........ ..... ....�..�.���. � .�������������.. "_w...._.�- _...n_
page. CityfTown � t Zip'ode Date ofinspection
D. System Information ('
. Spill Abso,rptlon System (SAS) (cone,)
Comments, (note condition of soil, signs of hydraulic failure, Bevel of plonding, damp soil, condition
eeai , etc.)-
Dra,infield found in green lawn area s 'll's In good c n l i n no signs of hydraullic failure no,
n In no damps it ' grass is uniform In good condition
Drain field is 1'5'X 5 " conventional system with gent in wrung order.
2. Cesspools (cesspool must be pumped as part of inspection) loc n site Ian),,
Number and configuration ..m..m.. .ry
Dept top of liquid inlet invert
Depth of solids layer
Depth of c rn Dwyer ...
Dimensions of cesspoola ..., .,,.
Materials of construction
Indication of groundwater inflow El Yes [:1 N o
Corn ens (note condition of soil, signs of'hydriaulic fa l r t level of pond'ing, condition of vegetation,
etic.,)
t5in s p. rev.71 /` 18, mill 1fu ii tl Inspection Form Subsurface Sewage 0 isposal System,-Page'14 of 1
Commonwealtha h u s
011T'I'tle 5
Off'ii,c*ial
Subsurface Sewage Displosal System Form Not for Voluntary Assessments
9 Windsor Lane
.., .,�.. ,...,,, ...m,,,,,, .m. .... .. ........
. ....,,,...
Key nOwner �.6- ners Vertu ll .., .....
information, is
North Andover a 845 2 2 2 2r ����� � �
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.,)
1. Prfivy (Irocate,on site plea).
Mat
� � construction'. rvrvrvrvrv.�.... �. ,. mmm.mm.....................� w�w, . �,„". .
Depth of solids ......
Comments (note clondition of soil, signs hydraulic failure, level'of ponds , condition of vegetation,
etc.
,t5 in s pa doc-rev,7126/2018 Tiff 5 Offidal Inspection Form,Subsurface w u Disposal Systern-Page 15 of 1
r
Commonwealt ssachusetts
ici'lal T Form'Imtle 5 i
lnspec!tion
Y Subsurface,Sewage Dlspopal System Form ® Not for Voluntary Assessments
,.� .
9 Windsor Lane
. �... ,.�µ�
Property,Address
ll
_w Owner
Winer s Name
information is North Ma 01845 2/12/'2026
re , for every
page.,M, �� " lw-n Mate Zip Code Date of Inspection
D. System Informaticord
14. SketO Of Sewage Disposal System:
Provide a view of the sewage disposal sysrn, including ties to at least two permanent reference
landmarks r benchmarks, Locate all wells within 1010feet. Locate where public water supply raters
the building.. Check one of the boxes belov
El hared-sketch in the area below
drawing, attached sera [
i
I i
I
t ins . oc-r m 712612018 Title Official Inspection Fore.Subsurface surfa Sewage Disposal sal System.Page 16 of 1
Commonwealth of Massachusetts
I Inspectil"on For�m
Tit
IIIA, 11 le, Off'
®R icia
a Subsurface
1 Leas
___... ..m .mm.. -------- m.,,. ..... --—-------- ............. �,�,.,,. � ....
Property Address
l�em m m�m V rtu l
Owner ,, .,, ...� m .., ..m . _.W , ..._.�.....,�,,. ... .. ....... ...:.. ,,.. _...
information is ner"s Name
th
6,
required for �,,,,�, ....rvrvrv. 2 ,
g w awn State Zi Code Date,of Inspection
D. System Infotion (cont)
. Site Exam:
Check Slope
Surface,water
Check cellar
Shallow wells
56" @ 131.4
Estimated depthto high ground water- feet
Please, indicate all meth s used to dietermine the high ground water elevation:
Obtained from system design plans on record
If chm c date deli n l n re G w 2 ..
Date
Observed site (abutting r ems o er ati n hole within 150 feet SAS)
1:1 Checked with local Board of Health -explain.-
0
Checked with local excavators, installers, (attache documentation)
Accessed USIGS, database explain,
'You s describe how you established the high ground water elevation:
Alarms on fille dated 2014 By Merrimac Fang
ysterrm is a, gravity mound with sloping lot
Before filling this Inspection Repot, pleasie see Report Completeness Ghecklist,on nest swage.
fun .dd -rev.712,612,018 Title 5 ofticiat inspettion Form Subsurface Sewage Disposal System 117 of 1
Commonwealth of Massachusetts
Tultle icial Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
i
v
49 Windsor Lane
Property Address
Kenney Vertullo
Owner owner's Name
information is North Andover Ma 01845
required for every 2I12I2026
page. Cityfrown State Zip Code 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.
® B. Certification: Signed &Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 21 3, or 5 completed as appropriate
4 (Failure Criteria)and 5(Checklist)completed
JZ 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.7f2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
i' f
SUMMARY OF INVERTS BUILDING TIES
SEWER 0 FDTN. PRE-EXIST. BI,.DG. CORNER A• B C D MOM
SEPTIC TANK IN 137.41 SEPTIC TANK OUT 37.8 25.3 _ 7NI3 PLAN & cERTIFIC�aTION is NOT
'
— a waRRaa,rTr of THE suesuaFaCE DlsPosAt
SEPTIC TANK OUT 137.15 DIST. BOX 80.2 56.5 - - SYSTEM. IT IS A RECORD of THE LOCH-noN
DIST. BOX IN 136.38 AND ELEVATION OF THE EXISTING SYSTEM
DIST. BOX OUT 136.23 COMPONENTS.
BEG INV. 136.15
END INV. 135.90 "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL;
EXPOSED COMPDNENT COVERS ETC., SHOWN ON THIS THIS AS BU LT SUBSTANTIALLY
AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK
OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN NET."
APPROVED DESIGNS PLANS. '
IGNATLIRE OF Q IGNER DA tE
(PAPER)
ss.00
IN ON .
L.E�A`M ART .
ura
VF�IT
SEP,�L woo,*,
DO °•
. �17No o
(44714 S.F.)
of
q�_ VLi AEM�4SR L 'G`
N4LCHE NOK �+
� 150.00'
!oN L��` �S'OR W
AS BUILT PLAN
OF
SUBSURFACE DISPOS
SYSTEM
LOCATED IN
NORTH ANDOVER„ MASS./49 WINDSOR LANE
AS PREPARED FOR
+� 0 SANDRA GARRON
m TX"' 106D
o DATE: 7-15-14 TL: 65
ft-b � SCALE: 1'=40'
.0 20 40 so
M
EP-RD"CK ENGMIlatING SERVICES
66 PARK STREET
a�
ANDovEP6, MASSACHmETTS 01816
« MORr�
� r•
1
TWO
PDBUC HEALTH DEPARTMENT RECE1 W
(ommunity Develapmecl Division
JUL � 2014
TOWN OF NORTH ANDOVER TOWN of N
SEPTIC DISPOSAL SYSTEM--INSTALLATION CERTIFICATION I 'REALT" o A�oov DEPARTMENT
The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired;
By: ' too-12 &-rec-74!Pt,'
Name)
Located at: 4,1 1Aj I P r?4e ro,,- Ln�w
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
r -- last revised on e''"�1+ with a design flow of
and �
f gallons per day. The materials used were in conformance with those specified on the
approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local
regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on
the As-built which has been submitted to the Board of Health.
r
Bottom of Bed Inspection Date:'
Engineer Representative(Signature)
And—Print Name
F Inal Construction Inspection Date: "7'11?'r q'
Engineer Representative(Signature)
I ire [�U
And--Print Nam
Installer: (Signature) Date:
w
��/
And--Pant Name
'
:z—
Enginer: i ature) Date:S( And—Print Name
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978-688.9540 Fax 978.688.8476 Web http://www.towaofnorthandower.com
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Summary Record Card generated on 2/1212026 2:58:45 PM by Susan Ccrresle Page 1
Town of North Andover
Tax Map # 210=106D�0066-0000sO
Parcel Id 17822
49 WINDSOR LANE
VERTULLO, KENNETH, R Since Jan 2016
VERTULLO, LINDSAY, P.
49 WINDSOR LANE
NORTH ANDOVER MA 01845
Class 101 Single Family Property Type 'I Residential
Size Total 1 Acres
FY 2026
UB Mailin Index
Name/Address Type Loan Number Activellnact. From Until
KENNETH&LINDSAY VERTULLO Owner Active
49 WINDSOR LANE
NORTH ANDOVER MA 01845
GARRON,MICHAEL Previous Customer Inactive 7/15/2014
49 WINDSOR LANE
N.ANDOVER,MA
01845
UB Account Maint,
Account No Cycle Occupant Name ActivelInactive
Bldg Id.13412.0-49 WINDSOR LANE Last Billing Date 12/4/2025
2100057 02 Cycle 02 Active
UB Services plaint.
Account No.2100057
Service Code Rate Charge Multiplier/Users
MISCFEE ADM1N FEE 0.63 6/8 7.82 1/
WTR WATER 01 ALL METER SIZE 285.36 /1
UB Deter Maintenance
Account No.2100057
Serial No Status Location Brand Type Size YTD Cons
33610784 a Active ERT HH b Badger w Water 0.625 0.625 357
Date Reading Code Consumption Posted Date Variance
213/2026 2643 a Actual 8 -86%
11/4/2025 2635 a Actual 58 12/12/2025 155%
8/1/2025 2577 a Actual 22 9/12/2025 37%
5/1/2025 2555 a Actual 15 6/12/2025 160/0
2/4/2025 2540 a Actual 14 3/13/2025 -34%
11/4/2024 2526 a Actual 22 12/12/2024 94%
8/1/2024 2504 a Actual 11 9/12/2024 8%
5/112024 2493 a Actual 10 6/13/2024 2%
2/1/2024 2483 a Actual 10 3/14/2024 0%
11/112023 2473 a Actual 10 12113/2023 -48%
8/1/2023 2463 a Actual 19 9/18/2023 34%
5/2/2023 2444 a Actual 14 6/14/2023 43%
2/1/2023 2430 a Actual 10 3/1412023 -38%
11/1/2022 2420 a Actual 16 12/19/2022 -48%
8/2/2022 2404 a Actual 31 9120/2022 176%
5/2/2022 2373 a Actual 11 6/21/2022 41%
2/1/2022 2362 a Actual 8 3/15/2022 -71%
11/112021 2354 a Actual 27 12/13/2021 -12%
8/3/2021 2327 a Actual 31 9/21/2021 241%
5/4/2021 2296 a Actual 9 6/16/2021 3%
2/3/2021 2287 a Actual 9 3/16/2021 -72%
11/2/2020 2278 a Actual 31 12/16/2020 52%
813/2020 2247 a Actual 21 9/9/2020 118%
5/1/2020 2226 aActual 9 6/10/2020 7%
2/3/2020 2217 a Actual 9 3/16/2020 -20%
11/1/2019 2208 a Actual 11 12/23/2019 37%
Caring for your, Septi I c System*, A Reference Guilde for,
Hawleowners,
Carl for Your Septic System (Conventional' Sept*c System, Innovative/Al''lliternative
System, ot- Cesspool),
The accumulated solids, in the bottom ofthe septic tank should be, pumped out everythree yea,rs to
prolong the lill of your systenil. SeptIcl sysiternis must be rinaintained regularly to stay working.
Neglect or abuse of yourl i Este. can, cause ]it,to fall. Failing systems can
ol cause a serious health thgreat to, your family and neighbors,
degrade the environment, especially lakes, streams and groundwater,
lo, reduce the valuel of your property,
o be very expensive to, rep a,i,r,
* and,, put thousand of water supply users at iiiiii if you live in a public water supply watetilished
andfbill to maintain your system.,
Be alert to these warning signs of a failing systerri:
* sewage surfacing over the-drainfield (especially after storms),
* sewage back- IT'S in the hOUse,
ILIsh, green grow,th over th:e, d I ra i",n fi e I ld,
to draining tollets orl dra'111,S)
o sewage odors
4.0;
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l '���'.,�r,�;J�' a�r'�'�y' Cd�.�1 "�, !� '�''��"�'1 r,,yiy�; ,�,�19i ,�a�,�„,�'ry J h�,� N� M�IIw�fN�?q �,q�M� '��,
ion, I'm4
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..........
Tips to Avoild 'Trouble,
DO have your tank p umpe WA nd system inspected every 31 tol 5 years by a licensed septic,
contractor (listed ]in, the yellow pagies).
ryorglpri nV4,7 1 1/3
}
1015l2020 WOO-for your Septic-Systern A Reference Guide for Homeowners
• DO keep a record of pumping, inspections,,and other maintenance. Use the back page of this
brochure to record main ten a nce'dates.
• DO practice water conservation. Repair dripping faucets and leaking toilets, run gashing
machines and dishwashers only when full, avoid long showers, and use water-saving features
In faucets, shover heads and toilets.
• Do learn the location of your septic system and drainfield, Keep a sketch of it handy for
service visits, if your system has a flow diversion valve, learn its location, and turn it once a
year. Flow diverters can add many years to the fife of your system,
• DO divert roof drains and surface water from driveways and hillsides away from the septic
.s stem Keeps and house footing drains away from the septic system as well.
Y sump P
• DO take leftover hazardous household chemicals to your approved hazardous waste
collection center for disposal. Use bleach, disinfectants, and drain and toilet bowl cleaners
sparingly and in accordance with product labels.
• DON'T allow anyone to drive or park over any part of the system. The area over the drainfield
should be left undisturbed with only a snowed grass cover. Moots from nearby trees or shrubs
may clog and damage your drain lines.
•
DON'T make or allow repairs to your septic system without obtaining the required health
p
department permit. Use professional licensed contractors when needed.
P P • • helpand Borne
ON'T use commercial septic tank additives.These products usually do not
D
may hurt your system in the long run.DON'T use Ypoison your se
our toilet as a trash can by dumping nondegradables down your 7
toilet or drai
ns.
Also, don't
• tics stern and the groundwater by pouring harmful chemicals
p y down the dram, y ,
The can kill the beneficial bacteria that treat your wastewater. Keep the
foilowing materials out of your system:
Nondegradables
grease, disposable diapers, plastics, etc.
Poisons
g �
gasoline, oil, paint, paint thinner, pesticides, antifreeze, etc.
Septic system Explained
• individual wastewater treatment systems (conventional septic systems,
Septic systems are s
• (I/A) cesspools)that use the soil to treat small wastewater flows,
elalternat�vesystems, or P � .innovator alined
individual are icalf used in rural or large tot settings where centralized
usually from homes. They typically Y
wastewater treatment is impractical.
There are man today, While all systems are individually designed for
y types of septic systems in use
most systems are based on the same principless
each site, Y
holding it in the septic tank
our household wastewater by temporarily g
Your septic system treats ye wastewater.This,separation
• scum are allowed to separate from th
where heavy solids and lighter are decomposed 6� bacteria
• treatment.The solids stared in the tank P
process is known as pnrnary tr tic tank umper.
P with the li hter scorn, by a profess�ona! sap P
and later removed, along g distribution box, which separates
• d wastewater leaves the tank, it flows into a e allow
After partially treated hales at the bottom of each line network of drainfield trenches. Drainagee s
this flow evenly into a storage. This effluent then slowly se P
o drain into gravel trenches for temporary g se
the wastewater t . . and purified (secondary treatment.A prop Y
into the subsurface sot! where it is further treated p .
is system does not pollute the groundwater.
functioning saps Y
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