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Home My WebLink AboutTitle V Inspection Report - 43 WINTERGREEN DRIVE 5/27/2015 Commonwealth of Massachusetts ��"��M�� 2�~��°��U ��°�� 0°0�� dxlf� ��&�� /� @U��Q��Q Nmm��Q��nm 0-�pmuun Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 43 Winterqreen Orivm Owner Owner's Name information is Noth Andover W1/\ 01845 5/�7/15 C/~ mquinedf» CityTown Some--- zp nouo oakanf|nopocinn evey pagu. Inspection raou1be must basubmitted on this form. Inspection forms may not bmaltered in any way. Please see completeness checklist et the end mf the form. �� m��~_�° ~ �~~ bnpodom: out A. ��y��raU U80f«�r0��t~��X� JUN � � ��1 \\ �� -_ -filling °~, . . �°,° � forms on the computer, use 1� Inspector: T�WNOFNDRTHANDOVER tab �E�3HDEPARWEA3 0o move your Jonathon Gnanz ovmnr-Uonm use the return -me of Inspector` k*y Preventative and Drain L.L.C. Company Namo 327Aob Street Company Address South Hamilton MA 01082 City/Town State Zip Code --�� 078-408-9001 S113405 / | Telephone Number License Number . | B. ��t'�� -_ Certification __-__ � | certify that| have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. | am m DEP approved system inspector pursuant to Section 18'340 of Title S (31OCK8R15.000).The system: �7�� Fl Passes �� (�^^dit��- UyPoeaen F-1 Fails Needs Further Evaluation by the Local Approving Authority Th , ystem 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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 mr different conditions ofuse. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title��~��B�� d��%��0 N��"�� N~�� q��@@ �� mw��B��om Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 43 Winterqreen Drive Anil & Nancy Kumar Owner Owner's Name information is No�hAndover MA 01845 5/27/15 eqvied�/ �--�- --�---- every page. City/Town State Zip Code Date nfInspection B. Certification (cont.) Inspection Summary: Check A.B.C'DorE/always complete all of Section D A^> System Passes: F-1 I have not found any information which indicates that any of the failure criteria described -- in 310 CMR 15.303orin 310 CKAR 15,304 exist. Any failure criteria not evaluated are indicated below. Comments: B) 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 unoound, exhibits substantial infiltration orexfi|tration 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 2Uyears old is available. El Y Z N F1 ND (Explain below): t5ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts ��=��N�� `��~��°��0 ��"�� H�� 0 ��N�� °�� U��H 0mm��0��mm 8-��mmmm Subsurface SexvagaDispmsa| SystennFmrnm - NotforVn|untaryAoeeosmento 43 Wintercireen Drive � Property Address Anil & N Kumar Owner Ownor'omome information is North Andover [NA 01845 5/27/15 required for mt�Tuwn So�,�- Zip Code Date of|nnpo�ion *ve�v=ou� B. Certification (cont.) Fl Pump Chamber pumps/alarms not operational, System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (oont]: Observation uf sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to u broken, settled or uneven distribution box. System will pass inspection if(with approval of Board ofHem|th}: F� broken pipe/s\ are replaced El Y 0 N El ND (Explain below): F-1 obstruction is removed El Y El N F-1 ND (Explain below): Z distribution box is leveled or replaced H Y El N [l NO (Explain below): Distribution box is in very poor condition, corroded, cracked, structually un-sound and needs to be replaced. E] 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): Fl broken pipe/a\ are replaced El Y F-1 N Fl ND (Explain below): � obstruction is removed El Y F1 N F1 ND (Explain below): C) Further Evaluation is Required by the Board mfHealth: 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. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.3p3(1)(b)that the system is not functioning ino manner which will protect public health, safety and the environment: El Cesspool or privy ie within 5O feet ofe surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts ��°��N�� n��.~��B N��"�� N�0�� 0 ��0�� =�� U ��0��D Num��H��mm 0—��mmmm Subsurface Sewage Disposal System Form Not for Voluntary Assessments 43 Winterqreen Drive Property Address Anil & N o Kumar Owner owner'oNome informudonie NodhAndove[ MA 01845 5/27/15 mquied�r every page. Qty[Town State Zip Code Date ofInspection B. Certification (cont.) 2. Svmtann 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: F-1 The system has a septic tank and soil absorption system (SAS) and the SAS is within 1OO feet ofa surface water supply or tributary ton surface water supply. F-1 The system has a septic tank and SAS and the SAG is within a Zone 1 of public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. �l The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from o private water supply wa||^° 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. 3. Other: O) System Failure Criteria Applicable toAll Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded nr clogged SAS orcesspool Discharge or ponding of effluent to the surface of the ground or surface waters � due tnan overloaded or clogged SAS orcesspool � �� StaUoliquid level in the distribution box above ouUetinve�due toanoverloaded �� = or clogged SAS orcesspool Liquid depth in oeaepno| is less than S" below invert or available volume is |nos �� than 1/2da flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i Commonwealth of Massachusetts --= Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i A 43 Wintergreen Drive Property Address Anil & Nanc Kumar Owner Owner's Name information is North Andover MA_ 01845 5/27/15 required for every page. City/Town — -- State Zip Code Date of Inspection B. Certification (cant.) Yes No El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ N 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 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) 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 D. 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 ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 43 Winterqreen Drive Property Address Anil & N Kumar Owner Owner's Name information is North MA 01845 5/27/15 required for ---- ��---�- | every page. Qtyl-rmwn State Zip Code Date nfInspection � C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: | Yes No Z Fl Pumping information was provided by the owner, occupant, or Board of Health El Z Were any of the system components pumped out in the previous two weeks? Z n Has the system received normal flows in the previous two week period? � � �� Have large volumes ofvvater been introduced to the system recently oraapa�of �� this inspection? �l VVenyas built plans of the system obtained and examined? (If they were not �� available note as NIA) �� VVaethehaoi|ib/ordvv�||inginspeotedforsignoo�mewagoba�kup? / �� Z Fl Was the site inspected for signs of break out? | Z 0 Were all system componente, excluding the SAS, located on site? Z n Were the septic tank manholes uncovered, Vpened, and the interior ofthe tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth ofscum? �� Fl VVaethe facility owner(and occupants if different from owner) provided vvith �� 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: Z EJ Existing information. For example, a plan at the Board of Health. [� [� Determined in the field (if any of the failure criteria related hoPa d{| ieetissue ^� �� approximation of distance ieun000eptab|a) [31OCPNR 15.302(5)] D. System Information Residential Flow Conditions: Number nf bedrooms (design): 4��-----� Number of bedrooms /act 4 uo|)� GOO DESIGN flow based on310CW1R152O3 (for example: 110 godx#ofbodrnomo\: per plan t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Fran Subsurface Sewage Disposal System Forme Not for Voluntary Assessments 43 Wintergreen Drive Property Address Anil & Nancy Kumar Owner Owner's Name information is North Andover MA 01845 5/27/15 required for - — - - every page. City/Town State Zip Code Date of Inspection D. System Information Description: S yste m is composed of 1500 Gallon septic tank, distribution box and three 72' leaching trenches. Number of current residents: 2 i Does residence have a garbage grinder? ❑ Yes ® No 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 ® No Water meter readings, if available (last 2 years usage (gp d))� 151.03 GPD Detail: Water meter readings were provided by the North Andover water department, usage was averaged from 3/20/13-3/18/15, 728 days (see attached copy). _- Sump pump? ❑ Yes ® No Current Last date of occupancy: Date i Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: - - I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Wintergreen Drive Property Address Anil & Nancy Kumar Owner Owner's Name information is required for North Andover MA 01845 5/27/15 -- -- --._ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): I i General Information Pumping Records: Source of information: Last pumped 9/14/12, per BOH records. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? - Reason for pumping: -- — Type of System: ® Septic tank, distribution box, soil absorption system i ❑ 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 I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 43 Wintergreen Drive Property Address Anil & Nancy Kumar Owner -Owner's Name information is North Andover MA 01845 5/27/15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: The as-built is dated 7/30/87, per 130H records. Were sewage odors detected when arriving at the site? ❑ Yes Z No Building Sewer(locate on site plan): 14" Depth below grade: feet Material of construction: Z cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line. n/a feet Comments (on condition of joints, venting, evidence of leakage, etc.): Buildinq sewer is in good condition with no signs of leakage, backup or any other problems. Septic Tank (locate on site plan): 611 Depth below grade: feet Material of construction: Z concrete ❑ metal ❑ fiberglass F-1 polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) F-1 Yes ❑ No 101 x 5'W x 4'D effective Dimensions: Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts =�~~*�D�� d��~��°��U N��~�� N�� 0 ��~ �� /� DN��N��N Inspection 0—��mmmm Subsurface Sewage Disposal System Form Not for Voluntary Assessments 43 Wotergreen Drive Property Address Anil & Nanc Kumar Owner Owner's Name information is NodhAnduv�r MA 01845 5/27/15 mquied�r ____� _��__ every page. CityrT»w» State Zip Code Date nfInspection D. System Information (cont.) Septic Tank (oont.) � 31" Dia�noefmm �pofs|udgo� b��mofou�� ee orbffe Scum thickness 61' Distance from top of scum to top of outlet tee mbaffle 14'' Distance from bottom of scum to bottom of outlet bm or baffle J d �/Te re How were dimensions determined? G|ud e Comments (on pumping recommendations, inlet and outlet tee or baffle oondition, structural integrity' liquid levels ns related to outlet invert, evidence nf leakage, etoj: Tank is in good conditon, structually sound, no signs of leakage or infiltration, liquid at outlet invert, Inlet has a concrete baffle in good condition, outlet has a PVC T in good condition. "this tank dnot require -pumping at this time** | Grease Trap (locate on site p|an): Depth below grade: feet Material nfconstruction: F-1 concrete El metal El fiberglass El polyethylene F-1 other(oxp|oin): � � Dimensions: Scum thickness � Distance from top of scum to top cf outlet tee orbaffle Distance from bottom of scum to bottom of outlet tee orbaffle Date of last pumping� � Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 x�~ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 43 Winterqreen Drivn � Property Address Anil & N Kumar Owner Owner's Name information is No�hAndover MA 01845 5/27/15 equ|edfur every page. City/Town State Zip Code Date ofInspection D. System Information (cont.) Comments (on pumping nenommendationm, inlet and outlet tee or baffle condition, structural integrity, \ � liquid levels as related to outlet inmert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate onsite plan): Depth below grade: Material of construction: Fl cononabs El metal F-1 fiberglass El polyethylene El other(explain): | Dimensions: ""r~~r: guUnne Dee�nF�� ~ gallons per day Alarm present: Fl Yon Fl No Alarm level: Alarm in working order: El Yea No Date of last pumping� � Date Comments (condition of alarm and float switches, etc.): °Attach copy of current pumping contract(required). Is copy attached? [l Yes El No t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 43 Wintergreen Drive Property Address Anil & Nancy Kumar Owner Owner's Name information is required for North Andover MA 01845 5/27/15 every page. City/Town State Zip Code Date nfInspection D. System Information (cont.) Distribution Box (if present must beopened) (locate on site plan): | " DDepth cf liquid level above uudetinvor 0 Comments (note if box is level and distribution to outlets equal, any evidence ofsolids carryover, any evidence cf leakage into nr out nfbox, etc.): The distribution box is in poor condition, cnaoked, corroded and is in need of replacement. Liquid level ioot the outlet inverts, no solids carryover. O-box is 23" below grade, outlet inverts are 32" below ,grade. Pump Chamber(locate on site p|an>: Pumps in working order: [l Yes El No* Alarms in working order: [l Yes R No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): ^ |f pumps oralarms are not in working order, system inaconditional pass. � Soil Absorption System (GAS) (locate on site p|an, excavation not required): If SAS not|ooabad' explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Wintergreen Drive Property Address Anil & NanccvKumar Owner Owner's Name information is North Andover MA 01845 5/27/15 required for - - — - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: - ❑ leaching chambers number: - ❑ leaching galleries number: - ® leaching trenches number, length: -3 @ 72 ❑ leaching fields number, dimensions: — i ❑ overflow cesspool number: - ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil over system is dry,grassy and consistent with surounding yard with no signs of ponding, breakout or abnormal vegetation. i Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration ..... Depth–top of liquid to inlet invert -- Depth of solids layer - Depth of scum layer Dimensions of cesspool - Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Wintergreen Drive ----------- Property Address Anil & Nancy Kumar Owner - - Owner's Name information is required for North Andover MA 01845 5/27/15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ------ ......... f 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.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Winter reen Drive Property Address Anil & Nancy Kumar Owner -------- ---------- Owner's Name information is North Andover MA 01845 5/27/15 required for _-. .__ — _---- _-_ _._ _ every page. CityrFown State Zip Code Date of inspection D. System Information (cont.) 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 N�r 17 17 VFI/14 47 It r 13i DOD i �i X107— 76_' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 43 Winterqreen Drive Pmpeuy�ddmno Ai| & Nano Kumar Owner Owner's Name information is North MA O......required for every page. City/Town State Zip Code Date ofInspection D. System Information (cont.) Site Eomnn: | Check Slope ( Surface water Check cellar Shallow wells Estimated depth to high ground vvo�er 4' Be|mwSAS foot Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record 7/11/8G If checked, date | . � Date � [7 Observed site (abutting property/observation hole within 150 feet of SAS) � Checked with |ncu| Board of Health -explain: Plan on file for the d i fthio e � m � �l Checked with local excavators, installers- (attach documentation) Fl Accessed USGS database -exp|ain: You must describe how you established the high ground water elevation: Soil testing was performed for the design of this system on3/25/85 & 5/15/84by Dan O'Connell & Steve Durso, witnessed by Mike Graf& Mike Rosati, groundwater was found at elevations ranging from 128.00-138.00' the bottom of leaching trenches are ot 132.00 (per plan). This system was installed in an elevated (above natural grade) area with a4' aepenstinn from groundwater, it is not i terf a i n with ndvvobar. Before filing this Inspection Report. please see Report Completeness Checklist on nmo± page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 43 Wintergreen Drive Property Address Anil &_NanKumar Owner Owner's Name information is required for North Andover.--.--.------ MA 01845 5/27/15 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist • Inspection Summary: A, B, C, D, or E checked • Inspection Summary D (System Failure Criteria Applicable to All Systems) completed • System Information— Estimated depth to high groundwater • Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file it t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 if summmy Rvtanl Cmd qwwraloO v"6/90015 3.21 AII W by Ma"I*op.1AAk6ay Pago I Town of North Andover Tax Map # 210-1043-0203-0000.0 Parcel Id 16527 43 WINTERGREEN DRIVE KUMAR,ANIL 43 WINTERGREEN DRIVE N. ANDOVER, MA 01846 Class 101 Single Family Property Type I Residential Zon1nq2 I Residential Zonin93 I Residential Size Total 1.28 Acres FY 2015 .................. UB Mailing Index NametAddress Type Loan Number Active/Inact. From Until KUMAR,ANIL Payer 43 WINTERGREEN DRIVE N.ANDOVER,MA 01846 UB Acc unt Maint. Account No Cycle Occupant Name Active/inactive Bldg Id. 18042.0-43 WINTERGREEN DRIVE Last Billing Date 4/1612015 3180071 03 Cycle 03 Active US Services Maint. Account No,3180071 Service Code Rate Charge Multiplier/Users MISCFEEADMIN FEE 0.635/8 7,82 I/ WTR WATER 01 ALL METER SIZE 60,80 11 UB Meter Maintenance Account No,3180071 Serial No Status Location Brand Type Size YTD Cons 32945227 a Active 00 b Badger w Water 0.63 0.63 537 Date Reading Code Consumption Posted Date Variance 3/1812015 700 a Actual 16 412812015 -9% 12115/2014 684 a Actual 17 1/15/2015 -43% 9/16/2014 667 a Actual 32 10/1512014 88% 6/1212014 635 a Actual 16 7/1612014 •8% 3114/2014 619 a Actual 17 411112014 13% 12/16/2013 602 a Actual 16 1/17/2014 •9% 9/13/2013 586 a Actual 17 10115/2013 0% 6/14/2013 569 a Actual 16 7124/2013 0% 3/2012013,— 553 a Actual 18 4122/2013 13% 12/1312012 535 a Actual 14 1/9/2013 -30% 9/1912012 521 a Actual 22 10/15/2012 -15% 6118/2012 499 a Actual 25 7116/2012 6% 3/20/2012 474 a Actual 24 4/1412012 11% 12/19/2011 460 a Actual 22 1/17/2012 -23% 9/16/2011 428 a Actual 29 10/1312011 72% 6/13/2011 399 a Actual 16 7/2012011 14% 311512011 363 a Actual 14 4/13/2011 27% 12/15/2010 369 a Actual 11 1/12/2011 -79% 9/1612010 358 a Actual 55 10115/2010 157% 6/14/2010 303 a Actual 20 7/15/2010 26% 3/18/2010 283 a Actual 17 4/14/2010 7% 12114/2009 266 a Actual 16 1/12/2010 -17% 9116Y2009 251 aActual 20 10/1512009 16% 6/1012009 231 a Actual 15 7/20/2009 25% 3/17/2009 216 a Actual 13 4/2912009 41% 12115/2008 203 a Actual 9 1/20Y2009 -30% 9116/2008 194 a Actual 14 10/10/2008 .26% 6/10/2008 180 a Actual 17 7/16/2008 21% 3114/2008 163 a Actual 14 4/11/2008 -17% c-, LL7Y\ 1 S- �--/A�