HomeMy WebLinkAboutPASS - Title V Inspection Report - 83 WILLOW RIDGE ROAD 6/22/2026 6 I
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Commom'ealth of Massachusetts
Title i to JUN
� 2026in
Subsurface Sewage disposal System Form -Not for Voluntary Assessments
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= `�� 83 willow laid Health
-�. Det)artment
Property Address
Leccese
Owner Owner's Name
information is North Andover lt�lA o�845 n 2
required for every June 2,2026
page. Cityrrom state Zip Code Gate of Inspection
Inspection results must be submitted on this form,Inspection forms may not be altered in any
way.Please see completeness checklist at the end of the form.
Important:when
filling out forms A. Inspector
on the computer,
use only the tab Benjamin"Jamie"Prescott
key to move your Name of Inspector
cursor-do not DoWnEast Title V Ins ecticns, LLC
use the return Company Name
key.
PO Box 81
rib Company address
Rowl
ey MA 01969
CityfTown State Zip Code
rr A 351 444-78 2 S113851
Telephone Number License Number
B. Certification
I certify that:l am a DEP approved system inspector in full compliance with Section 16.340 of Title 5
(310 CMR 1 6 000); l 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:
. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
June 22,202E
Inspect rs Signature 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
01000 god or greater,the inspector and the system owner shall submit the report to the appropriate
regional office of the DFP.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.
t6lnap.doc-rev.712612010 Title 5 Offtetal l ion Farm:Subsurface Sewage
age Disposal System•Page 1 0#18
f
Commonwealth of Massachusetts
Title Official Inspecti For�
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r
83 Willow Ridge
Property Address
Leccese
Owner owner's Name
information is North Andov6r MA_ 01845 Jun 2
required for every North 2�,20 0
page. cityrrown 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:
1 have not found any information which indicates that any of the failure criteria described
in 310 CIMR 15.303 or in 310 CM 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
THIS SYSTEM{MEETS THE CRITERIA FOR A PASSING TITLE V INSPECTION AS DESCRIBED
IN 310 CMR 1 a.303.
2) System Conditionally Passes.-
One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes";"no"or"not determined"(y, N,ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,'exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass
inspection:if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound,, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t6fnsp.doc•rev.7/2&201 B Me 5 MOM Inspection Farm:Satsurfsoa Sewage t]iWa!System•Page 2 of 18
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comnnanreath of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal system Form-Not for Voluntary Assessments
-tr
�4J /
rd ff 83 ■•illowld e
Property Address
Leccese
Owner Owner's Name
information Is North Andover MA 01845 June 22 required for every ,2026
page. citylTown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
1
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumpslalarms not operational.System will pass with Board of Health approval if
pumps/alarms are repaired.
Ej 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 pipes)are replaced El Y ❑ N [j ND(Explain below):
❑ obstruction is removed ❑ Y E] N ❑ ND(Explain below):
❑ distribution box is leveled or replaced El Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
El obstruction is removed ❑ Y El 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 GMR
15.303(i)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
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Commonwealth of Massachusetts
fT"Itle 5 Official Form
L
t Subsurface Sewage Disposal system Farm -Not for Voluntary Assessments
83 Willow-Ridge
Property Address
Leccese
Owner Owner's Name
information is North Andover MA 01845 June 22,2025
required for every
page. Gityrrowt l State Zip Code Date of inspection
C, Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
E:1 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 I of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal
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 mus;,Indicate"Yes"or"No"to each of the fallowing for all inspections:
Yes No
❑ ® Backup 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
tatnsp.doe-rev.7/26/2018 Me 5 official Inspection Form:subsurface Sewage Disposal System•Page 4 of 18
E
{
commlom' ealth of Massachusetts
Title 5 Off' i
'ionFor
t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�L
83 Willow Ridge
Property Address
Leccese
Owner Owner's Name
information is North Andover MA 01845 June 22 2025
required far every ,
page. Cityffown State Z.ip Code Date of inspection
C. Inspection Summary (cont.)
4} System Failure criteria Applicable to All Systems: (cent.)
Yes No
Static liquid level in the distribution box above outlet invert due to an overloaded
❑ ® or clogged SAS or cesspool
00 spov
❑ ® Liquid depth in cesspool is less than 5"below invert or available volume is less
than Yz day flog
❑ ® Required pumping 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 elevation.
❑ ® Any portion of cesspool or privy is 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 I of a public water supply
well.
El ® 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 coliforrn bacteria Indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than a ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd-
101000 gpd.
El ® The system fai s. l have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system falls.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
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ [� 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 11 of a public water supply well
talnsp.doc•rev.7/26/2018 Me 5 Official Inspe0lon Form:Subsurface Sewage❑Isposal System-Page 6 of 18
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Commonwealth of Massachusetts
T'Itle 5 Official Inspect'ionan
Subsurface Sewage Disposal Systems Form-Not for Voluntary Assessments
�L
83 Willow Ridge
Property Address
Leccese
Owner Owner's Name
information is Noah Andover MA 01845 June 22,2026
required for every
page. Gity[Town State Zip Gode date of inspection
C. Inspection Summary (cunt.)
If you have answered oyes"to any question in Section C.5 the system is considered a significant
threat,or answered"yes"to any question in Section G.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 Ryes"or;ono"for each of the following for aff inspections:
Yes No
1Z 1:1 Pumping information was provided by the owner,occupant,or Board of Health
❑ 0 Were any of the system components pumped out in the previous two weeks?
® ❑ 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
El ® this inspection?
® 0Were as built plans of the system obtained and examined?(if they were not
available note as N/A)
CQ 0 Was the facility or dwelling inspected for signs of sewage back up?
❑ Was the site inspected for signs of break out?
0 ❑ Were all system components,excluding the SAS,located on site?
C� 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 ow
Z ❑ 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
Q approximation of distance is unacceptable) 310 GMR 15.30 5
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Commonwealth of Massachusetts
Title 5 Official Inspection atria
M
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
y�C1�
33 Willow Ridge
Property Address
Leccese
Owner Owner's Name
information is North Andover MA 01345 June 22,2026
required for every
page. Cityrrown State Zip Code Date of inspection
D. System Information
1. Residential Flow Conditions:
FOUR 4
Number of bedrooms(design): Number of bedrooms(actual): FouR_(4)
for example: 11 a d x�of bedrooms): 600 GPD
DESIGN flow based on 31 o GMR15.203� p gp �
Description:
THE DESIGN PLAN ON FILE WITH THE BOARD OF HEALTH IS DATED SEPTEMBER 34, 1976
AND PREPARED BY JOSEPH J. BARBAGALLO.
TWO Q _.
Number of current residents:
Does residence have a garbage grinder? ❑ Yes 0 No
Does residence have a water treatment unit? 0 Yes Q No
If yes,discharges to: BUILDING SEWER
Is laundry on a separate sewage system?(include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ED No
(last� ears usage d PRIMATE WELL
Water meter readings, if available t y g (gp )
Detail:
THE DWELLING IS SERVICED BY A PRIMATE WELL> 1 DI]'FROM THE SOIL.ABSORPTION
SYSTEM(SAS)
Sump pump? 0 Yes 0 No
CURRENTLY
Last date of occupancy: OCCUPIED
t5nsp.doc-rev.712612018 Thle 5 dff dal Inspection Fmm:Subsurface Sewage Disposal System-Page 7 of 18
Commonwealth of Massachusetts
fTitle 5 Off Fort�1
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r
83 Willow Ridge
Property Address
Leccese
Owner Owner's Name
information is Noah Andover MA 01845 June 22,2026
required for every
page. City/Town state Zip Code date of Inspection
D. System Information (cont.)
2. Commerciall ndustrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seatslpersonslsq.ft.,etc.):
Grease trap present? El Yes [:1 No
Water treatment unit present? 0 Yes El No
If yes,discharges to:
Industrial waste holding tank present? El Yes No
Non-sanitary haste discharged to the Title a system? Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
NIA
3. Pumping Records:
Source of information: THE SYSTEM IS PUMPED ANNUALLY PER THE
HOMEOWNER.
Was system pumped as part of the inspection? E Yes Ej No
If yes,volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7126/2018 Tdfe 5 offidal inspection Form:Subsurface Sewage Disposal Sptem•Page 8 of 18
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Commonwealth of Massachusetts
T'Itle 5 Official Inspection Form
L
Subsurface Sewage Disposal Syatt+em Form -Not for Voluntary A5sessrrnent�5i
` 83 Willow Ridge
Property Address
Leccese
Owner Owners Name
information a North Andover Iti�lA 01845 Juno 22,2026
required for every
page. City/Town state Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
Z Septic tank,distribution box,soil absorption system
El Single cesspool
[� Overflow cesspool
❑ Privy
[� Shared system(yes or no)of 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 IIA system by system operator under contract
[l Tight tank.Attach a copy of the DEP approval,
❑ Other(describe):
Approximate age of all components,date installed(if known)and source of information:
THE CERTIFICATE OF COMPLIANCE ON FILE WITH THE BOARD OF HEALTH IS DATED
DECEMBER 27, 1976.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth belowgrade: 'S
feet
Material of construction:
® cast iron ❑40 PVC ❑other(explain):
Distance from private water supply well or suction line: fee
a p PP Y feet
Comments (on condition of joints,venting,evidence of leakage,etc.):
THE BUILDING SEXIER IS IN GOOD CONDITION WITH NO EVIDENCE OF LEAKAGE.
15insp.doc•rev.7126f2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
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Commonwealth of Massachusetts
fTitle 5 Official Inspection
k subsurface Sowage Disposal system Farm -Not for Voluntary Assessments
01
4 83 Willow Ridge
property Address
Leccese
Owner Owners Name
information is North Andover MIA 01845 June 22, 2026
required for every
page, City/Town State Zip Code Date of inspection
D. System Information (cost.)
6. Septic'Tank(locate on site plan):
Depth below grade., .g�
p g fit
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)
If tank is metal,list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: S'L x 5:W x 4`D logo GALLONS
811r
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle 2
Oil
Scum thickness
Distance from top of scum to top of outlet tee or baffle N/A
Distance from bottom of scum to bottom of outlet tee or baffle N/A
l
How were dimensions determined? TAPE MEASURE AND SLUDGE
JUDGE
Comments (on pumping recommendations,inlet and outlet tee or baffle conditions structural integrity,
liquid levels as related to outlet invert,evidence of leakage,etc.):
THE SEPTIC TANK IS 11"BELOW THE CURRENT GRADE.THE LIQUID LEVEL IS NORMAL AND
EQUALS THE OUTLET INVERT.THE INLET AND OUTLET CONCRETE BAFFLES ARE IN PLACE.
THERE IS NO EVIDENCE OF LEAKAGE AND THE TANK APPEARS TO BE STRUCTURALLY
SOUND. PUMPING IS NOT REQUIRED PER THE GUIDELINES FOUND IN 310 DMR 15.351.
tftsp.doc•rev.T126Wi 8 Title 6 official fospWion Form:Subsurface Sewed Disposal System-Page 10 of 18
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P,� Commonwealth of Massachusetts
Title 5 Offic Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
�y
� 83Willow Ridge
Property Address
Leccese
Owner Ownees Name
information is North Andover MA 01845 June 22,2026
required for every
page. Cftyffown State Zip Code Date of InsWtion
D. System Information (cunt.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete 0 metal ❑fiberglass ❑ polyethylene ❑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 fast 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.):
N/A
8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Maternal of construction:
❑ concrete El metal El fiberglass El polyethylene Cl other(explain):
Dimension:
Capacity:
gallons
Design Flow: gallons per day
Wnsp.doc*rev.7126/2018 Me 5 offidat inspection Form:Subsurface Sewage Disposal Syslem•Page 11 of 18
Commonwealth of Massachusetts
Tl"tle
5 Offi*ci"al Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
�A 83 Willow Ridge
Property Address
Leccese
Owner Owner's Name
information is Noah Andover MA 01845 June 22, 2026
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: d Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches,etc.):
NIA
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
0
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal,any evidence of solids carryover,any
evidence of leakage into or out of box,etc.):
THE DISTRIBUTION BOX(D-BOX)IS 18"BELOW THE CURRENT GRADE AND IN FAIR
CONDITION.THE LIQUID LEVEL IS NORMAL AND EQUALS THE OUTLET INVERTS.THERE IS
MINIMAL EVIDENCE OF SOLIDS CARRYOVER.THERE IS EQUAL DISTRIBUTION BETWEEN
THE OUTLETS.THERE IS NO EVIDENCE OF LEAKAGE OR INFILTRATION AND THE D-BOX
APPEARS TO BE STRUCTURALLY SOUND.THE OUTLET INVERTS ARE 28"BELOW THE
CURRENT GRADE.
t5hsp.doc-rev.712612018 Me 6 Offidal Inspection Farm:Subsurface Sewage Disposal System•Page 12 of 18
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_ Commonwealth of Massachusetts
Title 5 Offici*al Inspection Form
Subsurface Sewage Disposal stem Form-No for L � p Y t o Voluntary Assessments
83 Willow Ridge
Property Address
Leccese
Owner Owner's Name
Information is North Andover MA o1845 June�
required for emery ,2026
page, Cltyrrown State Zip Cade Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: El Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments mote condition of pump chamber, condition of pumps and appurtenances,etc,):
N/A
If pumps or alarms are not in working order,system is a conditional pass.
11. Soli 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:
❑ leaching trenches number,length:
leaching fields number,dimensions: ONE(1)
2g x 45
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Wnsp.doc•rev.712 Oi 8 Tide 5 official Inspe ion Form:Subsuffaoe Sewage Disposal System•Page 13 of IS
Commonwealth of Massachusetts
In
Title 5 Official Form
Subsurface Sewage Disposal System Forms Not for Voluntary Assessments
83 willow Ridge
Property Address
Leccese
Owner Owner's Name
information is North Andover MA 01845 June 22 2026
required for every ,
page. CityrTown State Zip Code Date of Inspection
D, System Information (cunt.)
11. Soil Absorption System(SAS)(cont.)
Comments (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of
vegetation,etc.):
THERE IS NO PONDING OVER OR SIGNS OF HYDRAULIC FAILURE WITHIN THE SAS,THE
VEGETATION IS CONSISTENT WITH THE SURROUNDING AREA.THE SAS CONSISTS OF
FOUR(4) LEACHING LINES IN A LEACHING FIELD MEASURING 20'x 48'wITH AN EFFECTIVE
DEPTH OF 12".THERE WAS NO EVIDENCE OF SOLIDS CARRYOVER WHEN THE PIPES WERE
INSPECTED BY CAMERA,THE BOTTOM OF THE SAS IS 40"BELOW THE CURRENT GRADE.
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
Indi2ation of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,
etc,):
NIA
t5lnsp.doc-rev.7IM01 8 Title 5 official lnspedion Farm:Subsurface swage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewa a Disposal stem Form-Not for Voluntary Assessments
� � � �
1 „
` 83 ■1 illow Ridge
Property Address
1..,.eccese
Owner Owner's Name
information is North Andover IAA 01845 June 22 2026
required for every
page. Cityffown State Zip code Date of inspection
D. System Information (cunt.)
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.):
NIA
tftsp.doc-rev.7/M018 Me 5 MUM Inspee n Form:Subsurface Swage Dlsposal Sys#em•Pace 15 of 18
5
Commonwealth of Massachusetts
T'Itle 5 Offi'ci*al
Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Willow Ridge
Property Address
Leccese
Owner Owner's Name
Information is North Andover ILIIA D18��
required for every June 22,2026
page. City[Town State Zip Code Date of inspection
D. System Information (cunt.)
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
Wnsp.doc-rev.712612018 Tft 5 Offal InspWIon Form:Subsurfaoe Swage Disposal System•Page 16 of 16
Commonwealth of Massachusetts
fOfficial
Subsurface Sewage Disposal System Fora -Not for Voluntary Assessments
1
= 83 Willow Ridge
Property Address
Leccese
Owner Owner"s Name
information is North Andover It�IIA 01845 June 2�
required far every 2026
page. City/To►m State Zip Code Date of Inspection
Caw System Information (cant.)
15. Site Exam
® Check Slope
® Surface water
Check cellar
( Shallow wells
Estimated depth to high ground water: 6
feet
Please indicate all methods used to determine the high ground water elevation:
Obtained from system design plans on record
If checked, date of design plan reviewed: SEPTEMBER 30, 1976
Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with Total Board of Health-explain:
❑ Checked with local excavators,installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
SOIL TESTING WAS PERFORMED ON MAY 190 1976 BY JOSEPH J. BARBAGALLO AND
WITNESSED BY THE NORTH ANDOVER BOARD OF HEALTH. HIGH GROUND WATER 1!'tIAS
DETERMINED TO BE AT 72"IN T--1 WHEN DUG AND OBSERVED TO A DEPTH OF 96". PER THE
DESIGN PLAN THERE IS 4'OF SEPARATION BETWEEN THE HIGH GROUNDWATER AT
ELEVATION 128.00 AND THE BOTTOM OF THE SAS AT ELEVATION 132.00.AT THE TIME OF
THE INSPECTION THE GRADE WAS FLAT OVER THE SYSTEM.THERE WAS NO SURFACE
WATER OR SHALLOW WELLS OBSERVED WITHIN 1 00'OF THE SAS.THE CELLAR WAS DRY
WITH NO SUMP PUMP PRESENT.
Before filing this Inspection Report, please see Deport Completeness Checklist on next page.
161nsp.doc•rev.V2612018 Trtte 5 Oftai inspe Alon Form:Subsurface Sewage Disposal Splem-Psi 17 of 18
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Commonwealth of Massachusetts
Off'
Title 5 ic'ial
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
.' 83 willow Ridge
Property Address
Leccese
Owner Owner's Name
Information Is North Andover MA 01845 June�� ���e
required for every ,
page. Cityrrown State Zip Code Date of Inspection
E, Report Completeness Checklist
Complete all applicable sections of this form inclusive of;
A. Inspector Informatiom Complete all fields in this section.
® B.Certification:Signed&Dated and 1,21 3}or 4 checked
C. Inspection Summary:
11 21 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 1 4:Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5#nsp.doc•rev.7126/2098 Me 5 Offidat tnspadlm Form:Subsurfsoe Sewage Disposal Pa
ge 18 of 1 B