HomeMy WebLinkAboutPASS - Title V Inspection Report - 32 BANNAN DRIVE 9/19/2026 Commonwealth of Massachusetts
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icia
T"tle 5 Offn I Inspect'ion Form,
10 Subsurface
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Sewage Disposal System Form Not for voluntary Assessments
3 2 BANNAN DRIVE
Property Address
JOE FORD'
O
wner Owner"s I l_am;e
information,is 1 RT Al'�IIC OvER �...5 SEPTEMBER '9, 2 6
for every
�tylTev�r� State Zipcede Date of Inspection�' q
Inspection results must a submitted on this form. Inspection forms may not a paltered in n
ug
way. Please see completeness checklist at the end of the foam.
important:When A. Inspector Information
filling out ferrets
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use only the tab Todd
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City/Town
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B. Certification
1 certify that'. I ;ern a DEP, approved system inspector in full compliance with Section 15.340 of Title
3 ); 1 have personally inspected the wage 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 1 have determined
that the system:
1. Z Passes
2. Conditionally Passes
3. beads, Further Evaluation by the lead Approving Authority
M Fails
In� Wer"si�n�ture ._. � Date ..__ ._
star inspector shall submit a copy f this inspection report t the Approving Authority (Board
h y has a da�i �n flow f
of Health r EP within 30 days f completing this inspection. if the system
,� p pp 1p iata
eta rr� owner�r�shall a l l�� submit the report t�
� h . rand' the �� � � r r
�1�� C d r reefer, inspector
regional offie f the D P,, The original farm should be sent to the system owner and copies sent t
the buyer, if applicable, and the apipr ving 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.
tein ,doc•rev,7/261 fl18 Title 5 Official inspection Form:8ubSLIrface Sewage Disposal Systeni.Page 1 f 18
` Commonwealth of Massachusetts
1 R i
■ Inspection
Ti
� tle 5 Offcia
io Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
F
32 BANNAN DRIVE
Property Address
JOE FORD
Owner Owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2026
required for every State Zip Code Date of Inspection
page City/Town
.........
CW inspection Summary
Inspection Summary: Complete 1, 21 3, or 5 and all of 4 and 6.
1 3 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:
❑ 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):
t5insp.doc rev.7125120�8 Title 5 official inspection Farm:Subsurface Sewage Disposal System-Page 2 of 18
Commonwealth of Massachusetts
F Title 5 Official Inspection For
W Subsurface Sewage Disposal System Form Not for Voluntary Assessments
32 BAN NAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2026
required for every
page. City/Town State Zip Code Date of inspection
C. Inspection Summary (cunt.)
2} System Conditionally Passes (cant.):
El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
F-1 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):
E:1 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):
El The system required pumping more than 4 times a year due to broken or obstructed pipes). The
system will pass inspection if(with approval of the Board of Health):
El broken pipe(s) are replaced El Y El 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
15.343(l)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp,doc•rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection oran
BLS Subsurface Sewage Disposal System Form Not for Voluntary Assessments
I9 I�1
32 BANNAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2025
required for every
page City/Town State Zip Code Date of Inspection
C. inspection Summary (cunt.)
❑ 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 fall 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.
El The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ 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
El Backup of sewage into facility or system component due to overloaded or
E 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
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-#gage 4 of 18
Commonwealth of Massachusetts
Tm
fY mitle 5iciaInspection Forrn
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
W
9 J�
~ 32 BANNAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2025
required for every
page City/Town State Zip Code Date of Inspection
G, Inspection Summary (cant.)
4} System Failure Criteria Applicable to All Systems: (cont.)
Yes No
Static liquid level in the distribution box above outlet invert due to an overloaded
El E or clogged SAS or cesspool
gg p
Liquid depth in cesspool is less than 0" below invert or available volume is less
❑ than % day flow
El Required pumping more than 4 times in the last year NOT due to clogged or
E obstructed i e s . Number of times pumped:
pp � }
El E 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
El E tributaryto a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public water supply
El E well.
El E Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DFP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this forma
The system is a cesspool serving a facility with a design flow of 2000 gpd-
❑ ® 1D 00D gpd.
The system fads. I have determined that one or more of the above failure
❑ ®
criteria' exist as described in 310 CMR 15.303, therefore the system stem fails. The y
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
El ❑ 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
the system is located in a nitrogen sensitive area (interim Wellhead Protection
El 1:1 Area— IWPA or a mapped Zone II of a public water supply well
} pp
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 icia ns ectionForm
1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
jrf
32 BANNAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2026
required for every
pageCity/Town State dip Code Date of Inspection-
.
C, Inspection Summary (cont.)
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 C.4 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
El E Were any of the system components pumped out in the previous two weeks?
El E Has the system received normal flows in the previous two week period?
El Have large volumes of water been introduced to the system recently or as part of
E this inspection?
Were as built plans of the system obtained and examined? (If they were not
El available note as NIA
E El Was the facility or dwelling inspected for signs of sewage back up?
Z ❑ Was the site inspected for signs of break out?
E ❑ Were all system components, excluding the SAS, located on site?
E 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 maintenance of subsurface sewage disposal systems?
proper
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on
E El 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
E Elapproximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc►rev.7/2512018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System►Page 6 of 18
Commonwealth of Massachusetts
� Title 5 Off
ic"ial I Form
10 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M1
q J��
32 BANNAN DRIVE
Property Address
JOE FORD
Owner Owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2026
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. residential Flow Conditions:
of bedrooms (design): 4 Number of bedrooms (actual): 3
Number � }
w based on 310 CMR 15.203 for example: 110 d x#of bedrooms): NA
DESIGN flow � p gp }
Description:
0
Number of current residents:
Does residence have a garbage grinder? El Yes H No
Does residence have a water treatment unit? El Yes E No
If yes, discharges to:Is laundry laundry on a separate sewage system? (Include laundry system inspection El Yes E No
information in this report.)
Laundry system inspected? ® Yes No
Seasonal use? El Yes E No
last 2 ears usage d : ATTACHED
Water meter readings, if available � y g �gp }}
Detail:
Sump pump? D Yes ® No
L date of JAN UARY 2025
Last d t occupancy::p y Date
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System■Page 7 of 18
Commonwealth of Massachusetts
........ : - 4Official ion Forrr�
17 �0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
' n .,4* 32 BAN NAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH AN DOVE R MA 01845 S E PTE M B ER 19, 2020 mm
required for every
page City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
2. Commercial/industrial 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 ❑ No
Water treatment unit present? ❑ Yes El No
If yes, discharges to:
Industrial waste holding tank present? El Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other (describe below):
3. Pumping Records:
Source of information: NA OWNER
Was system pumped as part of the inspection? El Yes E No
If yes, volume pumped: gallons µ
How was quantity pumped determined?
Reason for pumping:
t5insp.doc-rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
Commonwealth of Massachusetts
Title Official Inspec ion Fors
�w �� I�N Q Subsurface Sewage Disposal System Form Not for Voluntary Assessments
32 BANNAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2025
required for every
page, City/Town 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)
El Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the IIA system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
El Other(describe):
Approximate age of all components, date installed (if known) and source of information:
38 YEAR OLD SYSTEM, INSTALLED DECEMBER 1988, AS BUILT PLAN
Were sewage odors detected when arriving at the site? El Yes E No
5. Budding Sewer(locate on site plan):
28"
Depth below grade: feet _.
Material of construction:
El cast iron E 49 PVC El other(explain):
Distance from private water supply well or suction line: feet _.
Comments (on condition of joints, venting, evidence of leakage, etc.):
JOINTS AND VENTING OK
NO EVIDENCE OF LEAKAGE
t5insp.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 For
�10 Subsurface Sewage Disposal System Form w Not for Voluntary Assessments
N
f� 32 BANNAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 01345 SEPTEMBER 19, 2026
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
16"
Depth below grade: feet
Material of construction:
® concrete El metal ❑ fiberglass El polyethylene Ej other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes [:1 No
84 x 5' x 4'
Dimensions:
4"
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
34"
lit
Scum thickness
6,1
Distance from top of scum to top of outlet tee or baffle
311
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? SLUDGE JUDGETAPE 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
CONCRETE INLET BAFFLE OK
PLASTIC OUTLET TEE OK
TANK IS OK
LIQUID LEVELS GOOD
NO EVIDENCE OF LEAKAGE
t5insp.doc-rev.7/2512018 Title 5 official Inspection Farm:Subsurface Sewage Disposal System-Page 10 of 18
;� Commonwealth of Massachusetts
Title 5 OfficiInspection Fors
f
� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
:. Jfrr
�4
rf-- 32 BAN NAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2025
required for every
City/Town State Zip Code Date of Inspection
page.
D. System Information (cont,)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
El concrete ❑ metal El fiberglass ❑ polyethylene Ej 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,):
8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
El concrete El metal El fiberglass El polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Form
Assessments
ro Subsurface Sewage Disposal System Form Not for Voluntary
9 /�W
�a- 32 BANNAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2026
required for every
State Zip Code Date of inspection
page. City/Town
D. System Information (cont.)
8. Tight or Holding Tank (cant.)
Alarm present: El Yes El No
Alarm level: Alarm in working order: EJ Yes El 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 El N 0
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
DISTRIBUTION IS EQUAL
HEAVY EVIDENCE OF SOLIDS CARRYOVER
NO EVIDENCE OF LEAKAGE
t5insp.doc►rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusetts
ra f Offici
al Inspection Form
a Title
}
5 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
32 BANNAN DRIVE
Property Address
JOE FORD
Owner Owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2020
required for every
page City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: El Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
El leaching chambers number:
El leaching galleries number:
El leaching trenches number, length:
leaching fields number, dimensions:
1; 20' x 40'
El overflow cesspool number:
El innovative/alternative system
Type/name of technology:
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Form
10 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
� T 32 BAN NAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2025
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
11. Soil Absorption System (SAS) (coat.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SOIL AND VEGETATION OK
NO SIGN OF HYDRAULIC FAILURE OR PONDING
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert µ
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction _ mm
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc►rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System►Page 14 of 18
Commonwealth of Massachusetts
fTitle 5Official ion Fors
17 Disposal System dorm Not far Voluntary Assessments
W �0 Subsurface Sewage p y rY
32 BANNAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 41 845 SEPTEMBER `I 9, 2926
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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.):
t5insp.doc-rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
:f itle 5 Official Inspection Form
mom
�
� Subsurface sewage Disposal System Form Not for Voluntary Ass
essments
32 BAN NAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2026
required for every State Zip Code Date of Inspection
Page. City[Town
D. System Information (cant.)
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 wafter supply enters
the building. Check one of the boxes below:
Z hand-sketch in the area below
El drawing attached separately
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t5insp.doc rev,7/26/2018 Title 5 Official inspection Form:Subsurface sewage Disposal System f Page 16 of 18
Commonwealth of Massachusetts
+, 7Title 5 Official Inspection ors
#r 10 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
32 BANNAN DRIVE
Property Address
JOE FORD
Owner Owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 19, 2025
required for every
City/Town State Zip Code Date of Inspection
page.
D. System Information (cant.)
15. Site Exam:
Z Check Slope
Z Surface water
Z Check cellar
El 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 NOVEMBER 1974, date of design plan reviewed: Date
El Observed site (abutting property/observation hole within 150 feet of SAS)
z Checked with focal Board of Health - explain:
AS BUILT ONLY, SECOND SYSTEM INSTALLED 1988
EJ Checked with local excavators, installers -(attach documentation)
EJ Accessed USGS database--explain:
You must describe how you established the high ground water elevation:
DESIGN PLAN
SYSTEM ABOVE WATER TABLE
Before filing this inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
.: ---- Title
Official
Forrr�
.Y
Subsurface Sewage Disposal System Form .. Not for Voluntary Assessments
32 BANNAN DRIVE
Property Address
JOE FORD
Owner owner's Name
information is NORTH AN DOVE R MA 01845 SE PTE M B E R 10, 2025
required for every
page City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 21 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 5 (Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank— Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp,doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
Summary Record Card generated on 9/16/2026 8:41:48 AM by Nancy Viens Page 1
61 1
Town! o�f i\jo�rth Andover
Tax Map # 210-03,8,0:-0109-0000.0
II
Id 10412
32 BANNAN DRIVE
FORD, JOSEPH
32 BANNAN DRIVE
N.ANDOVER, MA
01845
Class 101 Single Family Property Type I Residential
Size Total 1.17 Acres
FY 2026
UB Mailina Index
N
Type arne/Address Loan Number Activ ell nact. From Unfil
FORD,JOSEPH Mayor Acktive
32 BAN NAN DRIVE
N.ANDOVER,MA
01845
UB Account Maint.
Account No Cycle Occupant Name, Activelinactive
Bldg Id. 16101.0-32 BANNAN DRIVE Last Billing Date 7/1/2026
3160143 03 Cycle 013 Active
UB Services MaInt.
Account No.3160,143
Service Code Rate Charge Multipllier/Users
MISGFEEADMIN FEE 0.635/8 7.82
WTR WATER 01 ALL METER SIZE
UB Meter Maintenance
Account No.3160143
Serial No StatLIS Location Brand Type Size Y'TD Cotis
36348574 a Active 00 ERT HH b Badger w Water 0.6250.625 139
Date Reading Code Consumption Posted at Variance
9/3/2026 442 a Actual 0 -100%
6/2/2026 442 a Actual 0 7/10/2026 -100%
3/4/2026 442 a Actual 1 4/14/2026 -1%
12/3/2025 441 a Actual 1 1/12/2026 .49%
9/4/2025 440 a Actual 2 10/10/2025 96%
6/4/2025 438 a Actual 1 7/9/20125 2%
3/6/2025 437 a Actual 1 4/16/2025 -75%
12/4/2024 436 a Actual 4 1/14/2025 -43%
9/4/2,024 432, a Actual 7 10/8/2024 3%
6/6/20214 425 a Actual 7 7/22/2,024 -,2%
3/5/2024 418 a Actual 7 4/16/2024 15%
12/5/2023 411 a Actual 6 1/15/2024 -22'%
9/6/2023 405 a Actual 8 10/13/2023 -26%
6/5/2023 397 a Actual 11 7/14/202,3 -6%
3/3/2023 3816 a Actual 11 4/12,/2023 -1 3%
12/5/2022 375 a Actual 1'3 1/16/2023 25%
9/6/20122 362 a Actual 11 10/18/2022 -11%
6/3/2022, 351 a Actual 12 7/18/2022 62%
3/3/2022, 339 a Actual 7 4/13/2,022 -15%
12/612021 332 a Actual 91 1/17/2022 25%
9/2/2021 323 a Actual', 7 10/15/2021 38%
6/2/2021 316 a,Actual 5 7/27/2021 147%
3/3/2021 3,11 a Actual 2 4/21/2021 "66%
12/3/2020 309 a Actual 6 1/13/20121 3%
9/3/2020 303 a Actual 6 10/14/2020 %
6/1/2020 297 a Actual 7 7/15/2020 1%
3/4/2'020: 290 a Actual 7 4/8/2020 31%
12/5/2019 283 a Actual 5 1/16/2020 47%
9/12/2019 278 a Actual 4 10/10/2019 -26%
6/5/2019 274 a Actual 5 7/25/2019 -17%