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HomeMy WebLinkAboutPass - Title V Inspection Report - 61 GRANVILLE LANE 2/14/2025 X Commonwealth of Massachusetts Title 5 Official Inspection Form V� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 61 GRANVILLE LANE Property Address MARTHA TACY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 FEBRUARY 14, 2025 — -- 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 A. Inspector Information Town 0 N er filling out forms on the computer, Todd James Bateson use only the tab key to move your Name of Inspector FEB 1 2025 cursor-do not Bateson Enterprises Inc. use the return key. Company Name 111 Argilla Road Heath ®�1n r� Company Address Andover MA 01810 City/Town State Zip Code rztan 978-476-4786 SI-16 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 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 18, 2025 Insp��tor's Signatur 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. 15insp.doc•rev.712 612 01 8 TWo 5 Or 631 Inspection Form:Subsurface Sewage Disposal System Page 2 or 18 Commonwealth of Massachusetts �# Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments z <, 61 GRANVILLE LANE Property Address MARTHA TACY Owner Owner's Name Informatlon Is requined for every NORTH ANDOVER MA 01845 FEBRUARY 14, 2025 equ€re page. CitylTown 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): 15insp.doc rev.712612018 Title 5 Official InspecWn Farm:Subsurface Sewage Disposal System•Page 2 of 18 L Commonwealth of Massachusetts ti Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 GRANVIL.L.E LANE Property Address MARTHA TACY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 FEBRUARY 14 2025 page. CityfTown State Zip Code Date of inspection C. Inspection Summary (cons.) 2) System Conditionally Passes (cunt.); ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes) 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; tSlnsp,doe rev.712612018 Title 5 Official Inspection Form:Sobsurfeea Sewage Disposal System Pago 3 of 18 i Commonwealth of Massachusetts i rd Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 GRANVILLE LANE Property Address MARTHA TACY Owner - —. Owner's Name ._ __..._.. _.._. information is NORTH A_N_DOVER _ MA 01845 _ FEBRUARY 14 2025 required for every page, City/Town State Zip Code Date of Inspection C. Inspection Summary (coat,) ❑ 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 fail unless the Board of health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply, ❑ The system has a septic tank and SAS and the SAS is within a Zone 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 or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 15insp.doe-rev.712612a18 TMe 5 Official Inspection Form:Subsurface Sewage Oisposal System-Page 4 of 18 i i k Commonwealth of Massachusetts = 4 Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 c� 61 GRANVILLE LANE Property Address MARTHA TACY Owner Owner's Name information a NORTH ANDOVER MA 01845 FEBRUARY 14 2025 required for every page. Cityrrown State Zip Code Date of inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont,) Yes No El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Yz 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 16.303, therefore the system falls. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems. To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA, Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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 151nsp.doc•rev.712612018 Title 5 0111dal Inspection Form:Subsurface Sewage Disposal Systern Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form °, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 GRANVIL.L.E LANE Property Address MARTHA TACY Owner Owner's Name information is NORTH ANDOVER MA 01845 FEBRUARY 14, 2025 required for every - - page. CitylTown State zip Code Date of Inspection 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 ® ❑ 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? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ 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? ® ElWas 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. ® ❑ 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)] l5insp.doc rev.712812018 Title 5 Official tnspeclion Form:Subsurface Sewage Disposal System•Page 6 0118 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 �7 61 GRANVILLE LANE Property Address MARTHA TACY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 F_EBRUARY 14, 2025 __ .. ---- page, CltylTown State Zip Code Date of Inspection D. System Information 1• Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 — DESIGN flow based on 310 CMR 16.203 (for example: 110 gpd x#of bedrooms): 330 GPD Description: 1 Number of current residents: -- - 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d SEE ATTACHED g ( Y g {gp ))� Detail: Sump pump? ❑ Yes ® No CURRENT Last date of occupancy: Date t5insp.doc rev.71202018 Title 5 Official fnspecllon Form:Subsurface Sewage Disposal System•Page 7 of 1a I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 GRANVILLE LANE Property Address - MARTHA TACY Owner Owner's Name information is NORTH ANDOVER required for every _ MA 01845 FEBRUARY 14, 2025 page. Clty/Town State Zip Code Date of Inspection D. System Information (conk) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 16.203): 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 6 system? ❑ Yes ❑ No Water meter readings, if available: - Last date of occupancy/use: pate Other(describe below): 3. Pumping Records: Source of information: BATESON ENTERPRISES INC February 14, 2025 Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 GALLONS gallons How was quantity TRUCK GAUGE q y pumped determined? Reason for pumping: MAINTENANCE t5insp.doc rev.772612C118 Title 5 Official Inspection Form:Subsurface Sewage Disposal system Page 8 of 18 i i Commonwealth of Massachusetts = � Title 5 official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 GRANVILLE LANE _. Property Address MARTHA TACY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 FEBRUARY 14, 2025 page. CityfTown State Zip Code Date of Inspection D. System Information (cons.) 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) ❑ In nova tivefAlternative 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: 16 YEARS INSTALLED JUNE 2009 AS BUILT PLAN Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer (locate on site plan): 2411 Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ 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 t6insp.doc-rev.712612018 Title 6 Olficial Inspection Form:SubsuAace Sewage 61sposal System Page 9 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 GRANVILLE LANE Property Address -� MARTHA TACY Owner Owner's Name information is 01846 �EBRUARY 14, 2025 required for every NORTH ANDOVER MA_ I page, City/Town __ State Zip Code Date of Inspection D. System Information (cons.) 6. Septic Tank (locate on site plan): Depth below grade: 12"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 5' X 4' 4" Sludge depth: 34e Distance from top of sludge to bottom of outlet tee or baffle - Scum thickness 4" 6" Distance from top of scum to top of outlet tee or baffle --- 811 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.): RECOMMEND PUMPING OLDER SYSTEMS YEARLY PLASTIC INLET AND OUTLET TEES OK TANK IS IN GOOD CONDITION OUTLET COVER EXPOSED LIQUID LEVELS ARE GOOD NO EVIDENCE OF LEAKAGE t5tnsp,doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 18 i Commonwealth of Massachusetts j Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 GRANVILLE LANE Property Address MARTHA TACY Owner Owner's name information is NORTH ANDOVER MA 01845 FEBRUARY 14, 2025 rewired for every — page. City/Town State Zip Code Date of Inspection D. System Information (cunt,) 7, Grease 'Trap (locate on site plan), Depth below grade: 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 Molding 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 15insp.doc•rev.712612018 Title 5 Olficial Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 I Commonwealth of Massachusetts x - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 61 GRANVILLE LANE Property Address MARTHA TACY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 FEBRUARY 14, 2025 for page, City/Town State Zip Code Cate of inspection D. System Information (cons.) 8. Tight or Holding Tank (cant.) 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 IS LEVEL D-BOX HAS FLOW EQUALIZERS SLIGHT CORROSION IN D-BOX DISTRIBUTION IS EQUAL LIGHT EVIDENCE OF SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGE 151nsp,doc rev.7/2012018 Title 6 Official Inspection Form:Subsurface Sewage Disposal Systern•Page 12 of 18 �I Commonwealth of Massachusetts m- : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 GRANVILLE LANs; Property Address MARTHA TACY Owner Owner`s Name Information is required for every NORTH ANDOVER MA 01845 FEBRUARY 14, 2026 ----- -- page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Rump 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: ® leaching trenches number, length: 3; 32'— ❑ leaching fields number, dimensions: - ❑ overflow cesspool number: ❑ Innovative/alternative system Type/name of technology: - - t5insp.doc•rev.712612018 Title 5 alficlal Inspection Form:Subsurface Sewage Disposal System•Page 13 of 1 B c Commonwealth of Massachusetts Title 5 Official Inspection Form .._ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments S t!ll���JJJ 61 GRANVILLE LANE _ Property Address MARTHA TACY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 FEBRUARY 14 2025 page, City/Town State Zip Code bate of Inspection D. System Information (coat.) 11. Soli Absorption System (SAS) (cunt.) 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 ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15hsp.doc rev.7/26/2018 fille 5 OfficW inspection Form:Subsurface Sewage Disposal Syslem Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form . f Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e� W 61 GRANVILLE LANE Property Address MARTHA TACY Owner Owner's Name requinform r on is NORTH ANDOVER MA 01845 FEBRUARY 14, 2025 requiredd for every _ page, Cityrrown state Zip Code Date of Inspection D. System Information (cost,) 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,): 15lnsp.doe ray.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 GRANVILLE LANE Property Address MARTHA TACY Owner Owner's Name information is NORTH ANDOVER MA 01845 FEBRUARY 14 2025 required for every � page. CltylTown State Zip Code Gate of Inspection D. System Information (conQ 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 9�VP2-1 ! d t5insp.doc-rev.7/2612 0 1 8 Title 5 official Inspection form:Subsurface Sewage D]sposat Systern Page 16 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments J% 61 GRANVILLE LANE Property Address MARTHA TACY Owner Owner's Name information is NORTH ANDOVER MA 01845 FEBRUARY 14, 2025 required for every page. City/Town State Zip Code Date of Inspection D. System Information (coat.) 15. 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: NOVEMl3ER 2007 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 SYSTEM T ABOVE WATER TABLE Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15lnsp.doc•rev.712612M Tille 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 10 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 61 GRANVILLE LANE Property Address MARTHA TACY Owner _._. Owner's Name information is required for every NORTH ANDOVER MA 01845 FEBRUARY 14, 2025 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, 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 l5insp.doc rev.7/202018 Title 5 ptficial Inspection Form;Subsurface Sewage Disposal System•Page 18 of 18 Summary Record Card generated on 2/1112025 215C57 PM by Nancy Vtens Page i Town of North Andover Tax Map # 210-106.C-0062-0000.0 Parcel Id 17687 61 GRANVILLE LANE MARTHA TACY 61 GRANVILLE LANE NORTH ANDOVER MA 01845 Class 101 Single Family Property type 1 Residential Size Total 1.01 Acres FY 2025 UB Mailing Index Name/Address Type Loan Number Active/Inact, From Until MARTHA TACY Owner Act Ive 61 GRANVILLE LANE NORTH ANDOVER MA 01845 FARR BETTER HOMES Previous Customer Inactive 7/30/2010 C/O BUILT BEST CONSTRUCTION 262 WESTFORD STREET TYNGSRORO,MA 01879 SCOTT&SOOJIN E;RIKSEN Previous Customer InacE{vc5 6129/2015 61 GRANVILLE LANE NORTH ANDOVER,MA 01846 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id.22366.0-61 GRANVILLE LANE Last Billing Date 1/7/2025 3170666 03 Cycle 03 Active UB Services Malnt. Account No.3170666 Service Code Rate Charge Multlplier/Users MISCFEE ADMIN FEE 0.63 6/8 7,82 1/ WTR WATER 01 ALL METER SIZE 153.70 1/1 UB Meter Maintenance Account No.3170666 Serial No Status Location Brand Type Size YTD Cons 36186643 a Active ERT HH b Badger w Water 0.625 0.626 463 Date Reading Code Consumption Posted Date Varlance 12/6/2024 1688 aActual 34 1/14/2025 174% 9/6/2024 1654 a Actual 12 10/8/2024 -7% 6/10/2024 1642 aActual 14 7/22/2024 3% 3/7/2024 1628 aActual 13 4/16/2024 -8% 12/7/2023 1615 aActual 13 1/16/2024 .47% 9/14/2023 1602 a Aclual 29 10/13/2023 127% 6/7/2023 1573 a Actual 12 7/14/2023 -3% 3/6/2023 1661 a Actual 12 4/12/2023 8% 12/6/2022 1549 aActual 11 1/16/2023 -87% 9/812022 1538 a Actual 90 1011812022 241 6/7/2022 1448 a Actual 27 7/18/2022 90% 3/4/2022 1421 aActual 13 4/13/2022 _9% 12/7/2021 1408 aActual 15 1/17/2022 .80% 0/712021 1393 aActual 80 10/15/2021 61% 6/412021 1313 a Actual 48 7/27/2021 167% 3/42021 1265 a Actual 17 4/21/2021 -20% 12/7/2020 1248 aActual 23 1/13/2021 -82% 9/4/2020 1226 aActual 130 10/14/2020 260% 6/312020 1096 aActual 35 7/15/2020 142% 3/6/2020 1060 a Actual 14 4/8/2020 8% 12/9/2019 1046 a Actual 13 1/15/2020 -76% 9/13/2011 9 1033 a Actual 61 10/10/2019 341%