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HomeMy WebLinkAboutTitle V Inspection Report - Pass - 101 SHERWOOD DRIVE - 2025-02-03 - Title V Inspection Report - 101 SHERWOOD DRIVE 2/3/2025 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 SHERWOOD DRIVE Property Address REX Ll Owner Owner's Name information is ,H ANDOVER MA 01845 FEBRUARY 3 2025 required for every NORTH page. City/Town State Zip Code Date 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 ---Town of NOM A Mover filling out forms A. Inspector Information on the computer,use only the tab Todd James Bateson key to move your Name of Inspector - cursor-do not Bateson Enterprises Inc. use the return Company Name key, 111 Argilia Road Health Department rab Company Address -- i Andover MA 01810 Cityrrown state Zip Code « � 978-475-4786 SI-16 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 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-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails „ FEBRUARY 4, 2025 Ins tor's Signat a 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. Winsp.doc-rev.712612018 Title 5 Official Inspodon Form:Subsudoco Sewage Disposal System page 1 of 19 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form ;4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 SHERWOOD DRIVE Property Address REX LI Owner Owner's Name Information Is required for every NORTH ANDOVER MA 01845 FEBRUARY 3 2025 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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): f5lnsp.doc rev,1/26/2018 Title 5 Drliclai Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l 101 SHERWOOD DRIVE Property Address REX L.I Owner Owners Name information Is every NORTH ANDOVER required for eve MA 01845 FEBRUARY 3, 2025 i page. City/Town State zip Code pate of Inspection C. Inspection Summary (cont.) F 2) System Conditionally Passes (coat,): ❑ Pump Chamber pumps/alarms not operational, System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 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): ❑ 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): ❑ 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: tSEnSp.dOc•rev.7l2812616 Title 6 Otticlal Inspeclton Form;Subsurtace sewage Dispose;system•age 3 of 18 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1y� 101 SHERWOOD DRIVE Property Address REX Ll Owner Owner's Name information is required for every NORTH AN©OVER MA 01845 FEBRUARY 3, 2025 page. City/Town State Zip Code Date of Inspecflon C. Inspection Summary (conk) ❑ 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. ❑ 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 ❑ ® Backup of sewage into facility or system component due to overloaded or. clogged SAS or cesspool ® Discharge of ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Mnsp.doc-rev.712812Q18 Tide 5 Ofridal Inspodlon Form:Subsutlace Sewage Disposal System Page 4 of 10 Commonwealth of Massachusetts -_- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 101 SHERWOOD DRIVE Property Address REX LI Owner Owner's Nance Information Is R MA 01845 FEBRUARY 3 2025 required for every NORTH ANDOVE , page. City/Town state Zip Code Date of Inspection C. Inspection Summary (cant) 4) System Failure Criteria Applicable to All Systems: (cant.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth In cesspool is less than 6" 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 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 1 of a public water supply 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 2000 gpd- 10,000 gpd. El ® 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 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 fallowing, 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 ❑ ❑ 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 tsinsp.doc•rev.7/2 612 0 1 8 Tile 5 otffool Inspection Form:Subsurface Sewage Disposal system,Page 5 of is c` Commonwealth of Massachusetts --�� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments g 101 SHERWOOD DRIVE Property Address REX LI Owner Owner's Name information Is NORTH ANDOVER MA 01845 FEBRUARY 3 2025 required for every , page. Cityfrown State Zip 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 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 16.304. 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 ❑ ® 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 this inspection? ® ElWere as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ElDetermined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15302(5)) 151nsp.doc rev.712612018 Title 6 Ofricdal Inspection Form;Subsurface Sewage Disposal System-Pago 6 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 SHERWOOD DRIVE Property Address REX Ll Owner Owner's Name information is NORTH ANDOVER MA 01845 FEBRUARY 3 2025 required for every , page, Clty/Town State Zip Code Date of Inspectlon � D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 GPD Description: Number of current residents: 3 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 years usage (gpd)): SEE ATTACHED Detail: Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date 45insp.doo rev.7/26/2018 Tlie 5 OfffcMl fnspecUon Form;Subsurface Sewage Ofsposal System Page 7 of 18 a Commonwealth of Massachusetts _A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 3. y. 101 SHERWOOD DRIVE Property Address REX LI Owner Owner's Name Information is NORTH ANDOVER required for every MA 01845 FEBRUARY 3, 2025 page. City/Town State zip Code Cate of Inspection D. System Information (cont.) 2. Commerciallindustrial Flow Conditions. Type of Establishment: Design flow (based on 310 C M R 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft,, etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: — Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: BATESON ENTERPRISES INC 2022 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 36insp.doo•rev.7/2 612 0 1 8 Title 6 Official lnspecllon Form;Subsurface Sewage Disposal System•page a of I Commonwealth of Massachusetts Title 5 Official Inspection Form ` i Subsurface Sewage Disposal System Porte -Not for Voluntary Assessments ` � '✓% 101 SHERWOOD DRIVE Property Address REX LI Owner Owner's Name Information for every on Is required NORTH ANDOVER MA 01845 FEBRUARY 3 2026 _ page. City/Town Slate Zip Code Date or Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: DESIGN PLAN MARCH 1996 INSTALLED JULY 2000 BOARD OF HEALTH Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan); 2' Depth below grade: Feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: reef Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS AND VENTING OK NO EVIDENCE OF LEAKAGE Wnsp.dac•rev.712W2010 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 0 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form t _ b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments o 101 SHERWOOD DRIVE Property Address REX Ll Owner Owner's Name Information 1s required for every NORTH ANDOVER MA 01845 FEBRUARY 3, 2026 page. City/Town State Zip Code Dale of Inspection D. System Information (cunt.) 6. Septic Tank (locate on site plan): 10" Depth below grade: feet 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: 10'X 5r X 4' 41F Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3411 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" 1381 Distance from bottom of scum to bottom of outlet tee or baffle — -- - - -- How 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.): TANK IN GOOD CONDITION NO EVIDENCE OF LEAKAGE PLASTIC INLET AND OUTLET TEES OK LIQUID LEVELS OK Mnsp.doc rev.7/2812018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 10 or 18 A� Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , ' 101 SHERWOOD DRIVE Property Address REX LI Owner owner's Name information is NORTH ANDOVER MA 01845 FEBRUARY 3, 2025 required for every page, City/Town State Zip Code Date of Inspection D. System Information (cons.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ 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: 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: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - Capacity: gallons Design Flow: gallons per day 151nsp.dac-rev.712612018 Title 5 Official Inspectfon Form:Subsurface Sewaga olsposnl Systam Page 11 of 48 i �.� Commonwealth of Massachusetts Title 5 official Inspection Form y Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° I 101 SHERWOOD DRIVE Property Address REX LI Owner Owner's Name information is requited for every NORTH ANDOVER MA 01845 FEBRUARY 3, 2025 page City/Town State Zip Code Late of Inspection D. System Information (cont.) 8. Tight or Holding Tank(coat,) Alarm present: ❑ Yes ❑ No Alarm level: -- Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc,): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 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 AND DISTRIBUTION IS EQUAL EVIDENCE OF LIGHT SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGE SLIGHT CORROSION IN D-BOX t5lnsp.doc rev,7126/2016 Tlile 5 Dr{Iclal Inspection Form:Subsurface Sawago Disposal System•Page 12 or 1e 1 c ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 SHERWOOD DRIVE F'raperty Address REX L.I Owner Owner's Name Informrequire for is NORTH ANDOVER MA 01845 FEBRUARY 3, 2025 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: ❑ Yes ❑ Nv* 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: ® leaching trenches number, length: 2' 50 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ Innovative/alternative system Typetname of technology: 15insp.dcc-rev.7126120118 Title 6 Dlficlal Inspection Form:subsurface Sewage nispossl System-Pago 13 of 1t) Commonwealth of Massachusetts Tale 5 Official inspection Form �# Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 SHERWOOD DRIVE Property Address REX LI Owner Owner's Name information Is required for every NORTH ANDOVER MA 01845 FEBRUARY 3, 2025 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) 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 PONDING OR HYDRAULIC FAILURE 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 ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc-rev.712U12018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of W Commonwealth of Massachusetts r _= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 SHERWOOD DRIVE Properly Address REX Ll Owner Owner's Name information is NORTH ANDOVER MA 01845 FEBRUARY 3, 2025 required for every pale, City(fown Slate Zip Code Dale of Inspection 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 failure, level of ponding, condition of vegetation, etc.): 15in5pAcc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslom-Page 15 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments n 101 SHERWOOD DRIVE Property Address RFX Ll Owner Owner's Name Information is NORTH ANDOVER MA 01846 FFBRUARY 3, 2026 required for every page, Cityrrown State Zip Code Date of Inspection D. System Information (cons.) i 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 (a 1 J►le,viood Dhi V ro �- Jhe,� tar 5+1 A- Box - � e13 0 4le 41 D- box a ' • 50� TreNc�es t5lnsp.doo-rov.712012018 Title 6 Official Inspection Form:Subsurface Sewage oispoW System-Page 1t3 of 18 Commonwealth of Massachusetts =,? Title 5 Official Inspection Form z Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 SHERWOOD DRIVE Property Address REX LI Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 FEBRUARY 3, 2025 page• City/Town State Zip Code Date of Inspection D. System Information (coat.) 16. Site Exam: ® Check Slope ® Surface water ® 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: MARCH 1996 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: PLANS ON FILE ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: DESIGN PLAN ON FILE MARCH 1996 Before filing this Inspection Report, please see Report Completeness Checklist on next page. Winsp.cfoe rev.712612018 7itfe 5 official Inspection Form:Subsurface Sewage UisposW System•Page 17 of i Commonwealth of Massachusetts Title 5 Official inspection Form �s Subsurface Sewage Disposal System Form Not for Voluntary Assessments c ,!� 101 SHERWOOD DRIVE Property Address REX LI Owner Owner's Name Information is required for every NORTH ANDOVER MA 01845 FEBRUARY 3, 2025 required page. CitylTown State Tp Code Date of Inspectlon 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 16lnsp.doo•rev.7/2 6120 4 8 Ve 5 official inspection Form:Subsurface Sewage Disposal Sysmom•Page 18 of 18 Summary Rneord Card oanaraletl on 21412026 2:13:22 PM by Karon Hanlon Page 1 Town of North Andover Tax Map # 210-10 . a0069-0000.0 Parcel Id 1698E 101 SHERWOOD DRIVE REX LI 101 SHERWOOD DRIVE NORTH ANDOVER MA 01845 Class 101 Single Family Property Type 1 Residentlal Size Total 0.69 Acres PY 2026 s Index Name/Address 7jrpe Loan Number AcUvellnact. From Until REX LI Owner Active 101 SHERWOOD DRIVE NORTH ANDOVER MA 01845 PAI,GURUDUTT&BEENA Previous Customer lovctivo Offi/2014 101 SHERWOOD DRIVE NORTH ANDOVER,MA 01845 BRITTANY D FLORA-SUN Previous Customer inactiu7 5/31/2022 101 SHERWOOD DRIVE NORTHANDOVER MA 01845 UB Account Maint. Account No Cycle Occupant Name Activelinaotive Bldg Id,17902.0-101 SHERWOOD DRIVE Last Billing Date 1/712026 3170558 03 Cycle 03 Active UB Services Maint. Account No.3170568 Service Code Rate Charge Multiplier/Users MISCI'E,EADMIN FEE 0.63518 7.82 11 WTR WATER 01 ALL METER SIZE 41.80 /1 UB Meter Maintenance Account No.3170668 Serial No Status Location Brand 'type Size YTD Cons 16372382 a Active ERT METE METE w Water 0.626 0.626 189 Date Reading Code Consumption Posted Date Variance 12/10/2024 2928 a Actual 11 1/14/2025 .48% 9/10/2024 2917 a Actual 21 10/8/2024 72% 6/12/2024 2896 a Actual 13 7122/2024 99% 318/2024 2883 a Actual 6 4/16/2024 98% 12111/2023 2877 aActual 3 1/46/2024 -85% 9/15/2023 2874 a Actual 22 10/13/2023 49% 6/9/2023 2852 a Actual 14 7/44/2023 69% 3/812023 2838 a Actual 8 4/12/2023 53% 12/8/2022 2830 a Actual 5 1116/2023 -20% 9/13/2022 2825 aActual 7 10/18/2022 -100% 6/9/2022 2818 a Actual 0 7/18/2022 -100% 5/25/2022 2818 f Final Bill 2 51125/2022 -62% 318/2022 2816 a Actual 6 4/13/2022 -53% 12/0/2021 2810 a Actual 13 1/17/2022 -22% 9/9/2021 2797 a Actual 17 10/15/2021 16% 6/8/2021 2780 a Actual 15 7/27/2021 13% 3/5/2021 2765 a Actual 12 4/21/2021 ge/a 12/9/2020 2763 aActual 14 1/13/2021 -67% 9/9/2020 2739 aActual 45 10/14/2020 59% 6/5/2020 2694 a Actual 26 7/15/2020 46% 3/912020 2668 a Actual 18 4/8/2020 -49% 12/11/2019 2660 aActual 34 1/16/2020 -27%, 9/1 N2019 2616 a Actual 54 10/10/2019 81%