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Pass - Title V Inspection Report - 135 ACADEMY ROAD 7/23/2024
Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 ACADEMY ROAD Prouerky Address __ . ..... ...... ..... ...._ JENNIFER AND DAVID ROBERTS Corner ... .._......... .. .......... . . .. . owner"s Name information is required for every NORTH ANDOVER MA 01845 JULY 11, 2024 .. _.. _.. _.. rtyCTowrnAN^ State Zip Co de page, __._ ... ......,.. __...._.....�_...�._......�._a._..�.. _-___.w.�_.. ._.__ Cla1'�Crflnsp�c.4rCrn ��. � , C Inspection results must be submitted on this form. Inspection farms m yi4" altered in any way. Please see completeness checklist at the end of the fornn '�'t�� Important:Men A. Inspector Information _. use one ne tab` Todd James �ateson _ ._ _ __w _ ...__ .0 .__ d filling out forms f, ......_. key to move your Nameof Inspector o , cursor-do riot Bateson Enterprises Inc use the return _.. __......... .... ..._...._.... ..... . ........_....._. _.. . key. Company Nate.. 111 Ar9illa Road Company Address _.._ Andover MA 01810 City/Town State Zip Code 978 476 4736 SI-16 te, ephcrne Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title ( 10 C MR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-side sewage disposal systems. After conducting this inspection I have determined that the system: 1. Z Passes 2. El Conditionally Passes 3. FNeeds Further Evaluation by the Local Approving Authority 4, Fails /rs�srg JULY 11, 2024 nsp ture Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater„ the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable„ and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.drsc•rev,7/26/2018 TWe 5 off al Inspedion I mm.SUbsur4ece Sewage Dr4possl System-gage 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form Not for Voluntary Assessments 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner Owner's Name 2024 required is NORTH ANDOVER MA 01845 JUL:Y 11, co information for every _. ... ate _ g Cdty�owrn State zip Cade g of Inspectdon C. Inspection Summary .........w. ..____........... . ................._____ _...._ _...._ ._........._._.....�.. ........_...... ...... Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 5. t) 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: [l one or more system components as described in the"Conditional puss" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or "not determined" (Y„ N, ND) for the following statements. if"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound„ not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. El Y ❑ N ND (Explain below). tram'r+sg,¢.u.daw„-rear '7/:2612018 TA e 5 g;YCRoroaf IrMmp(x'flda n Form:Sutasu dace Sewage r7mposW System-Page 2 of 16 " °, Commonwealth of Massachusetts ,1 � Ti l 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner bwner's Name information is NORTH ANDOVER MA 01845 JURY 11, 2024 required for every - page. CitylTown State Zip Code Date of Inspection C, Inspection Summary (cant.) 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. El 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): F-1 broken pipe(s) are replaced ❑ Y ❑ N F ND (Explain below): obstruction is removed ❑ Y ❑ N ® ND (Explain below): distribution box is leveled or replaced ❑ Y ❑ N F� 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): Ej broken pipe(s) are replaced ❑ Y ❑ N [] ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t insip,doc.rev.7/26/2018 Title 5 Offic4 InsperAion Form,SUbsurfacex Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts �. 'mn T 'E Me 5 Official In ►perirn Form Subsurface Sewage Disposal System Farm Not for Voluntary Assessments 135 ACADEMY ROAD Property Address JENNiFER AND DAVID ROBERTS Owner Owner's Nanne information is NORTH ANDOVER MA 01845 JULY 11, 2024 required for every page. City/Town State Zip Code Date of Inspection _.. . _...._.,.,__............_._ ._ _ ....... ...a...._. ._._ _... ...._... C. Inspection Summary (cant.) [� Cesspool or privy is within 50 feet of a surface water [ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will 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: E] The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. [] The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. D 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 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 1:1 z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5ff mp dric•rnv 702612018 ritlla°x ofriui.v insiroa.:4 tM FOMI:"SL1bau.erfr,Ce S'.wa r,?oarMr.sW„Siptem w Page 4 of 18 Commonwealth of Massachusetts UE Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner Owner's Name o Is required fo NORTH ANDOVER MA 01845 JULY 11 2024 page City/Town State Zip Code Date of Inspection _,_....... ......m .. ..._.._,._._.. _.._ _..,........ _..................._.......... _......,_...._,.._.....w. C. Inspection Summary (coat.) 4) System Failure Criteria Applicable to All Systems: (cant.) Yes No El E Static liquid level in the distribution box above cutlet invert due to an overloaded or clogged SAS or cesspool El E Liquid depth in cesspool is less than 6" below invert or available volume is less than '12 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El 71 Any portion of the SAS, cesspool or privy is below high ground water elevation. El Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El E Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. �] © Any portion of a cesspool or privy is within 50 feet of a private water supply well. 0 Ej Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this forma L1 E The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 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 n n the system is within 400 feet of a surface drinking water supply 0 0 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 11 of a public water supply well t5musp doc-revr.71'&2018 5kaW 5 k"'ffjaan Vnattgam;aC:Bvon Fonrn:Subsurface Sewage Cimpwosa[Systern•Page 5 of 18 w Commonwealth of Massachusetts Titie 5 Official Inspection Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JU1LY 11, 2024 _ page. Cltyrrown State Zip Code Date of Inspection _.__....____.........__...___.___ ___._...__.e._...._........ _..__W_W.__........._.._....._........._..... C. Inspection Summary (cant.) If you have answered"yes" to any question in Section C,5 the system is considered a significant threat„ or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No Z ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Z Were any of the system components pumped out in the previous two weeks? 0 ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Z ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Z ❑ Was the facility or dwelling inspected for signs of sewage back up? Z ❑ Was the site inspected for signs of break out? Z ❑ Were all system components, excluding the SAS, located on site? Z ❑ 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: 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 approximation of distance is unacceptable) [310 CMR 15.302(5)) t5osp doc rev.7/26/2018 'rifle 5 officlal inspection Form SUbSUrface Sewage Disposal System-Page 6 of T8 _.-----._ ° Commonwealth of Massachusetts OW, Tile ❑ Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 ACADEMY ROAD Property Address _.. JENNIFER AND DAVID ROBERTS Owner --------- ------.. ---.-..- Owner's Name information is NORTH ANDOVER MA 01845 JULY 11, 2024 required for every page Clty/Town State Zip Code Date of Inspection .......... .........._._...............__.__......__....__.................__..._..._....._.._.__.__-------- _...._..._ D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): IVA Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): NA Description: ........ Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ❑ No If yes„ discharges to.- 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 ears usage d SEE ATTACHED g ( Y g (gp )) - --- . -----------ED Detail: Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date _ _ t5insp.doc-rev 712612.018 TiVe 5 Official Inspection Form,Su6Surface Sewage Disposal Systems•Page 7 of 18 ° Commonwealth of Massachusetts q, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M. P 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner Owner's Name information is NORTH ANDOVER MA 51845 JULY 11„ 2024 required for every _ page. City[Town _state Zip Code sate of Inspection D. System Information (font.) 2. Commercial/industrial Flow Conditions; Type of Establishment: Design flow (based on 310 CMV1R 15103): GaIIIo 11 ns per day E9pol Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes E] 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? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: bate Other(describe below): 3. Pumping Records; Source of information; OWNER DULY 2023 Was system pumped as part of the inspection? ❑ Yes Z No If yes, volume pumped: gallons _ How was quantity pumped determined? _ Reason for pumping: f.17nsp,doc•r'ev.7126 2018 TOW 5 G,DftW€m%p&,,tcxn Form substaf ace Se w&g e E"7urvpamM System;-Page 8 of'18 < „w Commonwealth of Massachusetts Title ❑ Official Inspection Farm `} Subsurface Sewage Disposal System Form Not for Voluntary Assessments 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner Owner's Name information is NORTH ANDOVER MA 01845 JULY 11 2024 required for every -- _--- _... page. cityitown State Zip code Date of Inspection D. System Information (cant.) 4. Type of System: z 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 I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. E] Other(describe): Approximate age of all components, date installed (if known) and source of information: TANK ORIGINAL, LEACH LINES 1970, NEW D-BOX 2019, JULY 1970 AS BUILT Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 5 feet Material of construction: ❑ cast iron ❑ 40 PVC ❑other(explain): Distance from private water supply well or suction line: - -------- �eet Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS THAT I CAN SEE ARE OK. MOST GO UNDER FLOOR TO TANK VENTING IN WALL- NO SMELLS DETECTED NO EVIDENCE OF LEAKAGE t6insp doc•rev 7/26/2018 Title 5 Official inspection Norm Subsurface Sewage Disposal System-Page 9 of 18 a Commonwealth of Massachusetts I5 Tide 5 Official Inspection Form Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments f 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner Owner's Name information is NORTH ANDOVER MA 01845 JULY 11, 024 required for every page. City/Town State Zip Code Date of Inspection _._..........._._ __.._____.,...m.m...._a,._,_..__.__._._._...____..__�__ _ _____.m_m.....................__. ....... ...... D. 'System Information (cant.) 6. Septic Tank (locate on site plan): 4' Depth below grade: feet Material of construction: ® concrete El metal ©fiberglass ❑ polyethylene ❑ other(explain) If tank is metal„ list age: Y ears Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 6' X 4' ROUND TANK 5'' Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 33" 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 12" Haw were dimensions determined? SLUDGE JUDGE AND TAPE MEASURE Comments (on pumping recommendations, inlet and outlet tee or baffle condition structural integrity, liquid levels as related to outlet invert, evidence of leakage„ etc.): RECOMMEND PUMPING OLDER SYSTEMS YEARLY CONCRETE INLET AND OUTLET BAFFLES OK TANK IN GOOD CONDITION NO EVIDENCE OF LEAKAGE NORMAL LIQUID LEVELS TANK HAS PLASTIC RISER COVER ON TANK .........--_. ...... t5insp doc-rev 7/26/2018 Tale 5 Official Inspection Farrar.Subsurface Sewage Disposal Sy^stern•Page 10 of 18 Commonwealth of Massachusetts I Title 5 Official Inspection Farm Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 138 ACADEMY ROAD 77 • ,,f Property Address JENNIFER AND DAVID ROBERTS Owner Owwner"s Name information Is NORTH ANDOVER MA 01845 JULY 11, 2024 required for every page. C1tylfown State Zip Code Date of Inspection _................ _ ................ .._............__ _ .... D. System Information (coat.) 7. Grease Trap (locate on site plan): Depth below grade: t _ Material of construction: ❑ concrete D 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 last pumping: bate 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 [l metal E] fiberglass ❑ polyethylene ❑ other (explain). Dimensions; Capacity: gallons Design "low: _ .. gaVlons per day tEan apx doc•rev ?V2612018 1`€e 6 0ftg,rmaV BamaWrertm Fomm.5uabsarkare SowNjo CaViaposM Sg, esm-Page 11 of'1 S 1 .� Commonwealth of Massachusetts x, T'itle 5 Official Inspection Farm ti I Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 135 ACADEMY ROAD Property Address _ JENNIFER AND DAVID ROBERTS Owner d er°s Name information is required for every NORTH ANDOVER MA 01845 DULY 11, 2024 page. city/Town State Zip Code Date of inspection _......_........... v.._...._.,__._., __...__...__„__.___.__,,.w,._._..._. ,..w..._.._......_......_ ___.___ D. System Information (cant,) 8. Tight or Holding Tank (cant.) Alarm present: ❑ Yes Ej No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: _Da__te ............ Comments (condition of alarm and float switches,. etc.): ..._.... ..._._... -------- -------- -------------------- ........_ Attach copy of current pumping contract(required). Is copy attached? ❑ Yes 0 No 9. Distribution Box (if present must be opened) (locate on site plan): 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.): D-BOX LEVEL AND HAS SPEED LEVELERS DISTRIBUTION IS EQUAL. LIGHT SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGE D-BOX WAS REPLACED IN 2019 _.._..... .. t5insp.dor,-cev 7/26120 8 'rifle 5 0fl'ic iial Inspection Form.Subsurface Sewage Disposal Systerm-Page'12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Farm a; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 JULY 11, 2(724 _ ........ ......_ ... _ page. City/Town .... . State Zip Code Date of Inspection ..............__................_-_....... .._..__......_........._.....,,,,,...._a_,._,a........._............__----... D. System Information (cant.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ 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: ❑ leaching chambers number: ❑ leaching galleries number: z leaching trenches number, length; ; 33" LC7NG ❑ leaching fields number, dimensions: ❑ overflow cesspool number: �] innovative/alternative system Type/name of technology: i56nsp.edoc-rev.712612018 TSVe 5 OfrrcOl Inspection Farrar,Subsurface Sewage Disposal Systern-Page'13 of 18 Commonwealth of Massachusetts { Title 5 Official Inspection Farm Subsurface Sewage Disposal System Farm • Not for Voluntary Assessments 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner owner's Name ------- information Is NORTH ANDOVER IAA 01845 JULY 11„ 2024 required for every page. Crtyffowvn State Zip Code Crate of Inspection __. _. ......._ .._. ._. _..._.v..__.._.,,. _..--_ ___.w..n_ ..... _ _...�_..._. ._..... w ..w D. System Information (coat.) 11. Sall 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 EVIDENCE 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 Depth of solids layer Depth of scum layer Dimensions of cesspool _ Materials of construction Indication of groundwater inflow ❑ Yes E_j No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): P54'nsp doca-rraw.YCtik"nJdW B rAtar 5 Official Rnsper<k onn Form S ubsurfaoef Sewage C7iii%wosal System•Page 14 of 18 Commonwealth of Massachusetts �'m Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 ACADEMY ROAD I roperty Address JENNIFER AND DAVID ROBERTS Owner Owner's Name information is NORTH ANDOVER MA 01845 JULY 11, 2024 required for every page 6ity("own state Zip wade state of Inspection _._e__... . ........ ...._ .._._._....... _.. _...._._ ....... ............_ _... D. System Information (cant.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failures level of ponding, condition of vegetation, etc,): t rina¢a.doc•rev.'7`t26/201 N Palle 5 Moat Insl ctton Form:Subsu face Sewage CSrsposW Sysler'rm•Page'15 or 18 r Commonwealth of Massachusetts Title 5 Official l Inspection Form °a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 135 ACADEMY ROAD �'rcrperty�idres� JENNIFER AND DAVID ROBERTS Owner Crwner"s r_6anle information ie NOR�"N ANDOVER MA 0184�r JiUL`( 11 2024 required far every ...� _ . __.._. , . w.._.__ .__...__.. ..... ._.. _.__ _ ....__ ... ___...__. .._............_ page. CrtyfTown State Zip cotton Date of Inspection 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 water supply enters the building. Check one of the boxes below: hand-sketch in the area below �] drawing attached separately 0 £,v.f. ------------- t5insp.dm,,•rev.7r2512018 Title 5 Officinal inspection rorrn Subsurface Sewage Disposal System•Page 16 of 18 .. . Commonwealth of Massachusetts �a Title 5 t ffic cal Inspection Farm _ Subsurface Sewage Disposal System Form_Not for Voluntary Assessments 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner Owner's Nance onformation is NORTH ANDOVER MA 01845 JULY 11, 204 required for every page. City/Town State Zip Code Date of Inspection _.... _.._. ..,... _........ _.. ._.... _........... ... D. System Information (cunt.) 15. Site Exam: Q Check Slope El Surface water Z Check cellar Shallow wells Estimated depth to high ground water: feet _ Please indicate all methods used to determine the high ground water elevation.- Obtained from system design plans on record If checked, date of design plan reviewed: ratite Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board of Health - explain: TITLE 5 AND AS BUILT PLAN ON FILE [] Checked with local excavators, installers- (attach documentation) Accessed UGS database-explain: ESSEX COUNTY SOIL MAP You must describe how you established the high ground water elevation: WOODBRIDGE SOIL WATER TABLE 1.3- 3" LAND FILLED IN ABOVE WATER TABLE IN BACK YARD Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5dr sp.do c•rev "712fiY2018 1 We 5 G1r6PC4 Gnspc,^fion Form Sure%%face Sewage 9`mriosa6 S,ytr6ernn•Page 17 of 18 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System. Farm - Not for Voluntary Assessments 135 ACADEMY ROAD Property Address JENNIFER AND DAVID ROBERTS Owner Owner's Name information is NORTH ANDOVER MA 01845 JULY 11, 2024 required for every page Cetyll own State Zip Code Date of Inspection ---_..._.__ ... ...........____..._------------ ... . ........._. w ._._ , ...... ..........._________......_,....... . .....__.............._.Y._..._.. 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, 2, 3„ or 4 checked ' C. inspection Summary: 1, 2, 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 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included GSinsp.ckx. rerv."TF 612018 Title 5 CK is iW hapeertiane F orin &bseerlace Sewage Omposeai System•Page 18 04 16 Suirwnwy Record Cafd generated on 6/2CV2024 8 M51 AM by Karen Hanim Page I TOwn of North Andover Tax Map # 210-096.0-0039-0000.0 Parcel Id 15876 135 ACADEMY ROAD DAVID & JENNIFER ROBERTS 136 ACADEMY ROAD NORTH ANDOVER MA 01845 Class 101 Single Family Property Type I Residential Size Total 0,961 Acres FY 2024 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until DAVID&JENNIFER ROBERTS Owner Acbvq'a 136 ACADEMY ROAD NOR'rlA ANDOVER MA 01845 PICKUL,DAVID Previous Customer Inactive 7/1012020 135 ACADEMY ROAD N.ANDOVER, MA 01845 UB Account Maint, Account No Cycle Occupant Name Active/Inactive Bldg to, 18555.0- 135 ACADEMY ROAD Last Billing Date 4/9/2024 3180729 03 Cycle 03 Active UB Services Maint. Account No,3180729 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0,635/8 7.82 1 WTR WATER 01 ALI-METER SIZE 10335 11 UB Meter Maintenance Account No.3180729 Serial No Status Location Brand Type Size YTD Cons 3180729 a Active 00 HH#135 b Badger w Water 0,625 0,625 230 Date Reading Code Consumption Posted Date Variance 3/12/2024 285 a Actual 25 4116/2024 36% 1211212023 260 a Actual 17 1115/2024 32% 911912023 243 a Actual 15 10/13/2023 -14% 6/13/2023 228 a Actual 17 711412023 319/2023 211 a Actual 38 4/1212023 230% 12/912022 173 a Actual 11 1116/2023 2% 9/14/2022 162 a Actua 1 12 10/18/2022 -32% 6110/2022 150 a Actual 17 7/1812022 63% 3/912022 133 a Actual 10 4/1312022 -7% 12/10/2021 123 a Actual 11 1117f2022 -20% 9110/2021 IQ a Actual 14 10115/2021 15% 6/912021 98 a Actual 12 7/2712021 -2% 319/2021 86 a Actual 12 4/2112021 -.37% 12/912020 74 a Actual 19 111312021 -34% 9110/2020 55 a Actual 21 10/102020 16% 716/2020 34 f Final Bill 34 7/8/2020 -100% 3/4/2020 0 n New Meter 0 4/8/2020 -100% 3/4/2020 2261 s Reset meter 13 4/8/2020 73% 1/10/2020 2248 rn Manual estimate 16 1/15/2020 0% 9/17/2019 2232 a Actual -3 10/I0/2019 -111% 6/26/2019 2235 m Manual estimate 33 7/2512019 102% MSG 3/19/2019 2202 m Manual estimate 16 4/161'2019 _8% 1211212018 2186 a Actual 16 1/22f2019 -11% 9114/2018 2170 a Actual 19 10/15/2018 .44% 6112/2018 2151 a Actuat 33 7/23/2018 194% 3/12120I8 2118 m Manual estimate '10 4123/2018 -20% ..............