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HomeMy WebLinkAboutPass - Title V Inspection Report - 100 TUCKER FARM ROAD 2/24/2025 Commonwealth of Massachusetts down 01 �a AndOve� Title 5 official Inspection dorm Subsurface Sewage Disposal System Form Not for Voluntary AssessmentsAR 3 � Property Address a „} e ealfih ® p 1 Owner Owner's Name Information Is required for every A� �� � aL4 a 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 filling out farms p on the computer, use only the tab key to move your Name of Inspe Cursor-do not use the return J ' key. Company Name Comppan��y,,Address Cityl7��,� +-� State Zip Code LEA O Telephone Number License Number B. Certification 1 certify that: 1 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: Passes 2. ❑ Conditionally Passes 3• ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Falls Inspecto s 5lgnature 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. t5fnsp.doc•rev.71261201E Title 6 Official Inspection Form:Subsurface sewage olsposal splem•page 1 of 18 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Information Is Owner's Name required for every 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: 00"11 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 deed 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): Wnsp.doc•rev.7/2GRO10 Title 5 Official Inspacdon Form:Subsurface Sewage Disposal system•page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner h `U 1`lddlkUC7� Information is Owners Name required for every " t ( Y _, page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cons.) 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 hoard 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 Hoard of Health: ❑ Conditions exist which require further evaluation by the Board of Health is 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 45.303(1)(b) that the system Is not functioning in a manner which will protect public health, safety and the environment: t5fnsp.doc•rev.712612038 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of Is i Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Ji.j Property Address Owner Owner's Nutria i Information is required for every — (Y0111 page. it own State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 i 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's*. 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 ❑ Qom' Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2016 Title 5 pfllclal Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner T~(A-�e) information is Owner's Name -- required for every page. Cityfiown State Zip Code Date of Inspection C. Inspection Summary (cont.) 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 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or _/ obstructed pipe(s). Number of times pumped: El53 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ L`_t 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. El IT Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Q/ 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. ❑ The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 16.303, 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 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 it of a public water supply well l5tnsp.doc•rev.712612016 Title 5 Official lospection Form:Subsurface Sewage Disposal system•Page s of 18 Commonwealth of Massachusetts Title 5 official Inspection Form 8 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address T C Owner `s rVame informatian is Owner required for every -� _ MA D� ^1 ������.-- page, CitylTawn State Zip Code Date of Inspection C. Inspection Summary (cunt.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section C.4 above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section 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 ❑ 9---, Were any of the system components pumped out In the previous two weeks? ig' ❑ 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? lK ❑ 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? ❑ 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. ❑ 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)] 15insp.dop•rev.112612018 Tide 5 olfidal Inspection Form:subsurface Sewage Dlspossf System•Page a of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form JSubsurface Sewage Disposal System Form - Not for Voluntary Assessments -" on Property Address 1, Owner information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection D. System Information 1, Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): � DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes [!)'No Does residence have a water treatment unit? ❑ Yes 21"'No If yes, discharges to: — Is laundry on a separate sewage system? (include laundry system inspection information in this report.) ❑ Yes ©'No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes EVNo Water meter readings, if available (last 2 years usage (gpd)): __ '�i'� Detail: .P� Sump pump? ❑ Yes ED' No Last date of occupancy: Date i t5rnsp.doe•rev.7/26/2018 Title 6 0mclal Inspection Farm:Subsurface sewage Disposal Syslem Page 7 of 18 911LooHours TOWN OF NORTH ANDOVER Mon.Wed.Thur.8:00 AM-4:30 PM 120 MAIN STREET Tues.8:00 AM-6:00 PM NORTH ANDOVER MA 01845 Fri.8:00 AM-12:00 PM QQ—N-Ql MAIL CASH MakQ Check ftable and Mall To: Town of North Andover Department 2850 MOVING?PLEASE CALL 978-688-9570 IN ADVANCE. P.O.Box 986500 Boston,MA 02298-6600 Telephone Numbers: Talc Office:(978)688-9550 Water Dept.:(978)688-9570 T4 P1 1378 �,y aline: KOKKOTOS,FOTIOS&BAR BARA 1 The Town now has a new Online Bill Payment 100 TUCKER FARM ROAD System.To ensure we receive your payments NORTH ANDOVER MA 01845-5535 online please visit IIIII)I�rrrrllrlrEllllEll,r,lillll�llul�il�l�l�llll�fllf�l,rllll www.norlhandoverma.gov/pay to setup your account. 2100002 TAXPAYER'S COPY AT E ilri .. _2100002 02/02/2_ 100 TUCKER FARM ROAD 05'/02 2 4/G 20 20 20 3 06/1 0 07/14/ 23 -i° 7jE =Vl�ln r` Sd(Y�i SJ#sp s I'!f„1ojt).�,.,.. �s Lf.1i.� It).°S 1 �) 34 eke ,' �\! �- .` �1'�..,' 11 1[i.2• 02/02/2023 1641 06/02/2023 1652 11 ,F A 89 WATER USAGE 11 $41.80 ADMINISTRATIVE FEE $7.82 F$38.22 ! 17 , —, �i �.S • i -$38.22 $0.00 $0.00 $0,00 $49.62 $45.62 MESSAGE: WATER RATE: FIRST 20 UNITS$3.80 OVER 20 UNITS$5.55 SEWER RATE:FIRST 20 UNITS$5.95 OVER 20 UNITS$9.24 BYPASS METER WATER RATE:ALL UNITS$5.55 Pay online at DETACH AND RETURN THE PORTION BELOW WITH yoUR PAYMENT www•northandoverma.gov TOWN OF NORTH ANDOVER - - PAYMENT COPY 120 MAIN STREET Any amount which Is not paid by due date will be subject to Interest charge of 14%per annum. NORTH ANDOVER MA 01845 978-688-9550 07/14/2023 $49 62 3 100 TUCKER FARM ROAD 2100002 KOKKOTOS, FOTIOS& BARBARA Make Check P bleit 100 TUCKER FARM ROAD TOWN OF NORTH ANDOVER NORTH ANDOVER MA 01845-5535 DEPARTMENT 2850 PO BOX 986500 BOSTON,MA 02298-6500 041,67044372023ElE1O0000©000002100002040210 ]002000000 04962006 Office Hours TOWN OF NORTH ANDOVER Mon.Wed.Thur.8:00 AM-4.30 PM 120 MAIN STREET Tues.8:00 AM-6:00 PM NORTH ANDOVER MA 01845 Fri.a:oo AM-y 2:Oa PM 00 NOT MAIL CASH, l Ake Check Payable and M,all To: Town of North Andover Department 2850 MOVING?PLEASE CALL 978-688-9570 IN ADVANCE, Po.Box 986500 Boston,MA02298-6500 leLeRhone Numbers- Tax Office;(978)688-9550 T4 P1 Water Dept.:(978)688-9570 1423 Pay OnNne: KOKKOTOS, FOTIOS&BARBARA 1 The Town now has a new Online Bill Payment 100 TUCKER FARM ROAD System.To ensure we receive your payments NORTH ANDOVER MA 01845-5535 online please visit IIEI�I�III��IIIIIt�IIIII�FIi�I�I�II�II�FInI�I�IIII�ilill�lll�li www.northandoverrna.gov/pay to setup your account. 2100002 TAXPAYERS /� OPY 1 a0 TUCKER FARM ROAD , 21 QOQa2 05/a2/2Q23 a8/02/2023 09/18/2023 10/18/2023 ts:!1,;� WATER { ; 06/02/2023 1652 08/02/2023 '-�1709 57 A 92 USAGE 67 $280.97 ADMINISTRATIVE FEE $7.82 $49.62 -$49.62 $0.00 $0.00 $a.ao $2ss.79 $288.79a= MESSAGE: WATER RATE: FIRST 20 UNITS$3.80 OVER 20 UNITS$5.55 SEWER RATE:FIRST 20 UNITS$5.95 OVER 20 UNITS$9.24 BYPASS METER WATER RATE:ALL UNITS$5,55 Pay online at DETACH AND REnM THE PORMN BELOW Wr-M yours PANr=NT www.northandoverma.gov TOWN OF NORTH ANDOVER � PAYMENT COPY 120 MAIN STREET Any amount which Is not paid by due date will be NORTH ANDOVER MA 01845 subject to Interest charge of 14%per annum. 978-688-9550 10/18/2023 $288.79 EE '�i E #Rt 1_:, K�#,�I�a! ���2�10000�2 100 TUCKER FARM ROAD KOKKOTOS, FOTIOS&BARBARA Make CheckI l T 100 TUCKER FARM ROAD TOWN OF NORTH ANDOVER NORTH ANDOVER MA 01845-5535 DEPARTMENT 2M PO BOX 986600 BOSTON,MA 02298-6500 0416704g3720240 000000000DO210000204021DooD2000000028879000 •:""pr,a Offtoe Hours • TOWN OF NORTH ANDOVER Mon.Wed.Thur.8:00 AM-4:30 PM 120 MAIN STREET Tues.8:00 AM-6:00 PM ° Fri.8:00 AM-12:00 PM NORTH ANDOVER MA 01845 DO NOT MAIL CASH � ill�ke Gheak Payable and"mail TO: Town of North Andover ' Department 2850 MOVING?PLEASE CALL 978-688-9570 IN ADVANCE. PO.Box 986500 (Roston,MA42298-8500 Telephone Numbers: Tax Office:(978)688-9650 Water Dept.,(978)688-9570 T2 P1 693 ]?By Onfing: KOKKOTOS, FOTIOS&BARBARA 1 The Town now has a new Online Bill Payment 100 TUCKER FARM ROAD System.To ensure we receive your payments NORTH ANDOVER MA 01845-5535 online please visit `IItI' '� I�II�r�� l�lrr�llll�itll �r�L�1�1IrrI���II �i�,I��rI� www.northandoverma.gov/pay to setup your account. 2100002 TAXPAYER'S COPY l t ✓'.I 1 1, i,`��1, J E.1 I;"�i ] y! 4 t , s DUE:PATE s 100 TUCKER FARM ROAD 2100002 08/02/2023 11/02/2023 12/13/2023 1 01/12/2024 08/02/ 2023 1709 11/02/2023 1744 35 A 92 WATER USAGE ADMINISTRATIVE FEE 35 $1$7.8.82 TOTAL PUE F y1 l -$288.79 $0.00 $0.00 $0.00 $166.69 $166.69 MESSAGE: WATER RATE:FIRST 20 UNITS$3.80 OVER 20 UNITS$5.55 SEWER RATE:FIRST 20 UNITS$5,95 OVER 20 UNITS$9.24 BYPASS METER WATER RATE:ALL UNITS$5.65 Pay online at DETACH AND RETURN THE PORTION BELOW WITH YOUR PAYMENT www.northandoverma.gov TOWN OF NORTH ANDOVER — PAYMENT COPY 120 MAIN STREET Any amount which Is not paid by due state will be subject to Interest charge of 14%per Bnnum.NORTH I ANDOVER MA Q 1845 978-688-9550 r e o Ij 01/12/2024 $166.69 FA Le 100 FUCKER FARM ROAD 2100002 KOKKOTOS, FOTIOS a BARBARA Make Check Payable and Mail To• 100 TUCKER FARM ROAD TOWN OF NORTH ANDOVER NORTH ANDOVER MA 01845-5535 DEPARTMENT 28W PO BOX 986600 BOSTON,MA 02298-6500 0416704437202400000000000002100002E 402100002DO0000016669002 •,,s�,.,., Ofte Hours TOWN OF NORTH ANDOVER Mon.Wed.Thur 8:00 AM-4:30 PM 120 MAIN STREET Tues.8:00 AM-6:00 PM NORTH ANDOVER MA 01845 Fri.8:00 AM-12:00 PM I70 NOT MAIL„QASH MUM QftQAk—PffiwbIQ and Mall T Town of North Andover Department 2850 MOVING?PLEASE CALL 978-688-9670 IN ADVANCE, P.O.Box 986500 $aston,MA 02298-6600 Telephone Numbers: Tax Office:(978)688-9550 Water Dept.:(978)688-9570 T2 P1 727 Pay Online: KOKKOTOS, FOTIOS 8, BARBARA 1 The Town now has a new online Bill Payment 100 TUCKER FARM ROAD System.To ensure we receive your payments NORTH ANDOVER MA 01845-5535 online please visit www•northandoverma.gov/pay I �I �IIIII !I nl 111 II�II I lilll I1� I�III� to setup your account. 2100002 TAXPAYE'R'S COPY 100 TUCKER FARM ROAD 2100002 11/02/2023 02/02/2024 03/14/2024 04/15/2024 11/02/2023 1744 02/02/2024 1753 9 A 92 WATER USAGE 9 $34.20 ADMINISTRATIVE FEE $7 82 Z .:. 9 -$166.69 $0.00 P $0.00 $0.00 $42.02 $42.t32 MESSAGE: WATER RATE. FIRS`f 20 UNITS$3.80 OVER 20 UNITS$5.55 SEWER RATE: FIRST 20 UNITS$5.95 OVER 20 UNITS$9.24 BYPASS METER WATER RATE:ALL UNITS$5.55 Pay online at -- -- Ai EETACI4 AND AETIN THE POAIIQN RELOW WI'T'H YOUR PAYMENT www.narthantloverma.gov TOWN OF NORTH ANDOVER PAYMENT COPY 120 MAIN STREET Any amount which Is not paid by due date will be NORTH ANDOVER MA 01845 subject to Interest charge of 114%per annum, 978-688-9550 04/15/2024 $42.02 100 TUCKER FARM ROAD 2100002 KOKKOTOS,FOTIOS 8,BARBARA Make Check Pay t l@ and Mell Ta; 100 TUCKER FARM ROAD TOWN OF NORTH ANDOVER ANDOVER MA 01845-5535 DEPARTMENT 2850 PO BOX 986500 BOSTON,MA 02298-6500 04167044072024000000000D0OO2lODDO2D1021000020000 0004202002 ""°•k OFflce"ours • TOWN OF NORTH ANDOVER Mon.Wed.Thur.8:00 AM-4:30 PM 120 MAIN STREET Tues.8:00 AM-6:00 PM NORTH ANDOVER MA 01845 F .8:00 AM-12:00 PM P_Q NOT MAIL CASH MakoChockfta1J1 an Mall To: Town of North Andover Department 2860 MOVING? PLEASE CALL978-685-0950 IN ADVANCE PO.Box 986600 Roston,NIA 02288-6500 T n m Tax Office:(978)686-9550 Water Dept,:(978)685-0950 T2 Pi 690 Pay 0—aline`, KOKKOTOS,FOTIOS& BARBARA 1 The Town now has a new Online Bill Payment 100 TUCKER FARM ROAD System.To ensure we receive your payments NORTH ANDOVER MA 01845-5535 online please visit www.northandoverTna.gov/pay to setup your account. 2100002 7 7 / Imo(+ PAR C COPY 1 Il YY} � 100 TUCKER FARM ROAD 2100002 02/02/2 .. �: 024-05/02I2024 06I13/2024...� ..: 07115 202 Y�:.r 02/02/2024 1753 05/02/2024 1763 10 A 90 WATER USAGE 10 $38.00 ADMINISTRATIVE FEE $7.82 ToTALDU { .: .. .:.' I 42.02 3 -$42.02 $0.00 $0.00 $0.00 45 82 $45.8z MESSAGIE' WATER RATE:FIRST 20 UNITS$3.80 OVER 20 UNITS$5.55 SEWER RATE: FIRST 20 UNITS$5.95 OVER 20 UNITS$9.24 BYPASS METER WATER RATE:ALL UNITS$5.55 Pay online at -- -- OEFACH AND RETURN THE PORTION BELOW 1MfFH yOUR PAYMENT www.northandoverma.gov TOWN OF NORTH ANDOVER PAYMENT-60Py 120 MAIN STREET Any amount which is not paid by due date will be x NORTH ANDOVER MA 01845 subject to Interest charge of 140%per annum. 978-688-9550 p p • f p� '. 07/15/2024 $45.82 Ing 100 TUCKER FARM ROAD 2100002 KOKKOT05, FOTIOS$ BARBARA Pay&o and Mail T - 1DD TUCKER FARM ROAD TOWN OF NORTH ANDOVER NORTH ANDOVER MA 01845-5535 DEPARTMENT 2850 PO BOX 986500 BOSTON,MA 02298-6500 . 1tlYYlrl M1 . 9111ce„Hours TOWN OF NORTH ANDOVER Mon.Wed.Thur.8:OD AM-4:30 PM 120 MAIN STREET Tues.8:00 AM-6:00 PM NORTH ANDOVER MA 01845 Fri.a:a0 AM-12:a0 PM NOT MAIL CASH ' Mett�'r ieck PaY..abig pnd Mall To. Town of North Andover Department 2850 MOVING?PLEASE CALL 978-685-0950 IN ADVANCE. P.O.Box 986600 Boston,MA 02298-6500 Tef h 2ne Numbers- Tax Office:(978)688-9550 Water Dept.:(978)685-0950 T2 PtP-iW Online-, KOKKOTOS, FOTIOS& BARBARA 886 The Town now has a new Online 13111 Payment 100 TUCKER FARM ROAD System.To ensure we receive your payments NORTH ANDOVER MA 01845-5535 online please visit IIIIIIIi�IjI��IIIIII�I��I�I�IIIIIIIIII�IIII�IIITi141IIIIIIIIuII www.northandoverma.gov/pay to setup your account. 2100002 TAXPAYERf + 1 1 Y 'S COPY m 11 v �... ✓, ! ' 100 TUCKER FARM ROAD !A 2100002 05/02/2024 08/02/2024 09/12/2024 i t°llYl� r i i i 10/14/2024 11763�Yr � .. ._, r�E,._,.��..1�4 _i w. ,_,;qr'✓ -,=` ,-, 1 1n. a 7�e..� < -er - �' �,�!! 11a �(iJ i�r S }ll 06/02/2024 60 A 92 .a) ustt4) i I 08/a2/2024 1823 WATER USAGE - �� ADMINISTRATIVE FEE Ba $297.62 $7.82 x x DUE I It i �1 J l 11 ! f„rv,{�j 4 $Q. $45.82 -$45.82 $0.00 $305.44 $305.44 MESSAGE: WATER RATE: FIRST 20 UNITS$3.80 OVER 20 UNITS$5,55 SEWER RATE.FIRST 20 UNITS$5.95 OVER 20 UNITS$9.24 BYPASS METER WATER RATE:ALL UNITS$5.55 Pay online at ^— DETAGH AND RETURN THE PORTION WOW WITH YOUR PAYMENT www.n"andoverma.gov "'' •b TOWN OF NORTH ANDOVER PAYMENT COPY 120 MAIN STREET Any amount which Is not paid by due date will be NORTH ANDOVER MA 01845 subject to Interest charge of 14%per annum. 978-688-9550 DUE DATE TOTAL DUE 10/14/2024 1 $305.44 x011V lij 100 TUCKER FARM ROAD 2100002 KOKKOTOS,FOTIOS 8, BARBARA I , 100 TUCKER FARM ROAD NORTH ANDOVER MA 01845-5535 TOWN OF NORTH ANDOVER DEPARTMENT 2850 PO BOX 986500 BOSTON,MA 02298-6500 0416704437202400000000000002100002040210000E000000000544006 .,s,tiu„4' OffiCB HQI1�R I' TOWN OF NORTH ANDOVER Mon.Wed.Thur.8:00 AM-4.30 PM 120 MAIN STREET Tues.8:00 AM-6:00 PM NORTH ANDOVER MA 01845 Fri.a:�AM-12:00 PM DO NOT MAIL CASH �x Make CChgck Payable an,d Mail To: Town of North Andover Department 2850 MOVING?PLEASE CALL 978-685-0950 IN ADVANCE. PO.Box 986500 Roston,MA 02298-650p To-tephone Numbers: Tax Office:(978)688-9550 Water Dept.:(978)685-0950 12 P1 691 Fay Online: KOKKOTOS,FOTIOS&BARBARA 1 The Town now has a new Online Bill Payment 100 TUCKER FARM ROAD System.To ensure we receive your payments NORTH ANDOVER MA 01845-5535 online please visit www.northandoverTna.gov/pay to setup your account. 2100002 Y'I1 I ; i 1 I I f T�� Si� COPY 1 � i r � 100 TUCKER FARM ROAD 21QQpQ2 SIMQ8/02/2Q24 11/05/2024 12/12/2024 01/13/2025 .It �I ",yule .[•1 r)nf 1,h. ,I Jfx [e�. '"`' I! fY[ . ; ,o1 s. �' 1,e tiE r it elf�a� �-+, ���1 IDS 08/02/2024 1823 11/05/2024 1864 41 A 95 WATER USAGE 41 $191.01 ADMINISTRATIVE FEE $7 82 3i l $305.44 -$305.44,.., $Q.OQ $QA0 $0.00 $198.83 $198.83 MESSAGE: WATER RATE: FIRST 20 UNITS$3.80 OVER 20 UNITS$5.65 SEWER RATE: FIRST 20 UNITS$5,95 OVER 20 UNITS$9.24 BYPASS METER WATER RATE:ALL UNITS$5.55 Pay online at DETACH AND RETURN THE PORTION BELOW WITH YOUR PAYMENT www.northandoverrna.gov ,..�r..,' , TOWN OF NORTH ANDOVER ANDOVER - - PAYMENT COPY 120 MAIN STREET Any amount which Is not paid by due date will be NORTH ANDOVER MA 01845 subject to Interest charge of 14%per annum. 978-688-9550 01/13/2025 $198.83 � II 'i t I;i I 100 TUCKER FARM ROAD 2100002 KOKKOTOS,FOTIOS& BARBARA MaM heok Pa0ble and MallT 100 TUCKER FARM ROAD TOWN OF NORTH ANDOVER NORTH ANDOVER MA 01845-5535 DEPARTMENT 2850 PO BOX 986500 BOSTON,MA 02298-650o 04lk7D44372025000000000000021000020402100002000000019883002 1 Ofte Hours TOWN OF NORTH ANDOVER Mon.Wad.Thur.8:00 AM-4:30 PM 120 MAIN STREET Tues.8:00 AM-6:00 PM NORTH ANDOVER MA 01845 Fri.8:00 AM-12:00 PM DO NOT MAIL,CASH i; Make Cheqk PMble and Mall Tn: Town of North Andover Department 2850 MOVING?PLEASE CALL 978-6M-9570 IN ADVANCE. P.O.Box 986500 Barton,MA 02298-6500 Iblephone,Numbers: Tax Office:(978)688-9650 Water Dept.:(978)688-9570 T5 131 KOKKOTOS,FOTIOS&BAR13ARA 1895 The Town now has a�new Online 13111 Payment 1 100 TUCKER FARM ROAD System.To ensure we receive your payments NORTH ANDOVER MA 01845-5535 online please visit lI11IIIIII��'ICI"III"I"I��IIIIII'�'II�IIIIj"+�I�I„ll�"11,11" www.northandoverma.gov/pay to setup your account. 2100002 TAXPAYER'S COPY . . 100 TUCKER FARM ROAD " 2100002 11/02/2022 02/02/2023 03/14/2023 04/13/2023 11/02/2022 1633 02/02/2023 1641 8 A 92 WATER USAGE ADMINISTRATIVE FEE 8 $$7.82. t177 (,F 1J i " d t I $155.97 $0.00 $0.0 t -$155.97 $0.00 0 $38.22 MESSAGE: WATER RATE: FIRST 20 UNITS$3.80 OVER 20 UNITS$5.55 SEWER RATE.,FIRST 20 UNITS$5.95 OVER 20 UNITS$9.24 BYPASS METER WATER RATE:ALL UNITS$5.55 Pay online at DkTACFf AND RETURN THE PORMN BELOW Wmi yoUR pAVMMT www.northandoverma.gov TOWN OF NORTH ANDOVER PAYMENT COPY 120 MAIN STREET Any amount which Is not paid by due date Will be subject to Interest charge of 14%per annum.NORTH ANDOVER MA 01845 978-688-9550 � r • • e I'i 04/13/2023g,22 100 TUCKER FARM ROAD 2100002 KOKKOTOS, FOTIOS& BARBARA Make C-h-aQkPayable i : 100 T ND FARM ROAD TOWN OF NORTH ANDOVER NORTHH ANDOVER MA 01845 5535 DEPARTMENT 2850 PO BOX 986500 BOSTON,MA 02298-B500 04167044372023000000000000021000020402100002000000003822008 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments property Addrres.`s Owner Owner's Name information is required for every ( a�T a Le � _ page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 2, Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/personsfsq,ft., etc.): Grease trap present? ❑ Yes ❑ 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 occupancyfuse: Date Other(describe below): 3. Pumping Records: Source of information: c 1 0 f , ( , 7 ,/ Was system pumped as part of the inspection? Owes ❑ No If yes, volume pumped: f' gallons How was quantity ? q y pumped determined. r Reason for pumping: iSlnsp.doc•rev.7r2are018 Title 5 official Inspection Form:Subsurface Sewage ofsposai system•page 8 of fa Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form , Not for Voluntary Assessments �,�� l o � c�.•es "�c�.�c� �p Property Address Owner Owner's Name required fo information is `��° � far every _ page page, CltyfTown _ State Zip Code Date of inspection D. System Information (cunt.) 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: t �.�? I c� Were sewage odors detected when arriving at the site? ❑ Yes OR'-�No 5. Building Sewer(locate on site plan): y t' Depth below grade: feet Material of construction: cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feel Comments (on condition of joints, venting, evidence of leakage, etc,): 151nsp.40c•(OV,712612018 Me 5 Mow Insp Oon Form:Subsurface sewage Disposal System Page 9 of 18 !I Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is rl required for every page, GtylTown State Zip Code Date of Inspection D. System Information (cant.) 6. Septic Tank (locate on site plan): ' Depth below grade: feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle r e ri Scum thickness ' Distance from tap of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle r( — How were dimensions determined? r� Cvr;�.. ,l i<! Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): . Wnsp,doo•rev.7l2r12018 Me 5 Orfidat Inspection Form:Subsurface sewage oispow system•Page I of 18 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface stem Sewage Disposal S � p y Form Not for Voluntary Assessments bd -TUC, PropeilLAd�dr-e�sl Owner , information is Owner's Name required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cant.) 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 El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp,dac rev.712612018 Title 6 ofRdal Inspection Form:subsurface Sewage Disposal Syslem•page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner information is Owner's Name — required for every page. City/Town ate Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont,) 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 � '= 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,): ' ?' �t 7 ) \ i t5insp,doc-rev.72612e18 Tore 5 olficlal Inspe0on Form:Subsurface Sewage Disposal system•page Q of 18 '', r - Ja 3 �� t, � ��5�� fz.!• { Ali 1 x�" i `E 7 I IY rly�7�, } r��m ;?➢4rdit,`q� ' l:�y�gt��tva� ��"�n�7, �: - '--y� d.. n� r r f Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments too Property Address Owner Owner's Name information Is required for every n page. GliylTown State Zip Code Date of Inspection D. System Information (cons.) 10. Pump Chamber(locate on site plan): Pumps in working order: R- Yes ❑ No* Alarms in working order: Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): r * 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): y e� If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: leaching trenches number, length: ❑ leaching fields number, dimensions: - tt}P-L( ❑ overflow cesspool number: ❑ inn ovativelalternative system Type/name of technology: t6igsp.doc•rev.712612018 71ge 6 Official Inspecfioq Form:subsurface sewage olspesal system•Page 13 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L Property Address C Owner U�l U hC��ti Information Is Owner's Name required for every �' r page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11, Soil Absorption System (SAS) (coat.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): J 12. Cesspoals (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.): i { i t5in$p,dua my.7126r2018 7i110 5 04ficiai Inspection Form:Subsurface Sewage Disposal System•page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form n Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments s Property Address Owner L .. � �, information Is Owner's Name required for every page. City/Town� Si— ate Zip Code pate of Inspection D. System Information (cons.) i 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.): tbinsp.doc•rev.712612018 Title 5 olfidal Inspection Form'Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ry Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f ry Property Address ` Owner Owner's Name information is required for every page, City/Town State Zip Code Cate of Inspection D. System Information (coat.) 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: 19/'hand-sketch in the area below ❑ drawing attached separately Fn� 6� F(( l VIA �l- ?W0 �V,m 6f r t , c t5in5p,doc•rev.7/2612018 Title 5 ofriGa€Inspection Form:Subsurface Sewago Disposal System•Page 160113 Commonwealth of Massachusetts r Title 5 official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner information is Owner's Name required for every page, City/Town State Zip Code Date of Inspection D. System Information (coat.) 15. Site Exam: ❑ Check Slope W ❑ Surface water 9 U ❑ Check cellar ❑ Shallow wells10 t} Estimated depth to high ground water: 1 = feet Please indicate all methods used to determine the high ground water elevation: L�J Obtained from system design plans on record If checked, date of design plan reviewed: Date ? ;r ❑ Observed site (abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page, 151nsp.doc•fev.7126/2018 Title 8 Official laspecdon Form:Subsurface Sewage Disposal System•Page 17 of 1a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •� -- �t u Properly Address Owner 1_C) Information Is owner's Name required for every City/Town own �')A page. State ZipCode F bale of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ®"A. Inspector information: Complete all fields in this section. [rB. Certification: Signed & Dated and 1, 2, 3, or 4 checked Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed 11'0. 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 ISlnsp.doc rev.7/2612018 Tide 5 officia€Inspection Form:Subsurrace sewage€?isposal Syslem page 18 of 1a O f•V.0 .. fob ' 00, 5043�"VO 491" �1 M/t 7191'i�NU 1, la/( UE3-5D1 1lJ (�1L. 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