HomeMy WebLinkAboutPASS - Title V Inspection Report - 89 BRUIN HILL ROAD 5/12/2025 Commonwealth of Massachusetts Town of Noah Andover
Title 5 Official Inspection Form
l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments MAY 2025
89 BRUIN WILL ROAD _
Property Address I leat[ eepartment
MARY ROBINSON
Owner Owner's Name
Information is MA 01845 MAY 12 2026
required for every NORTH ANDOVER ,
page. Cityrrown State Zip Code Bate 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 forms
on the computer,
use only the tab Todd ,lames Bateson
key to move your Name of Inspector
cursor-do not Bateson Enterprises Inc.
use the return Company Name
key.
111 Argilla Road
r� Company Address
Andover MA 01810
City/Town State Zip Code
rerun 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 16.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-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
MAY 13, 2025
Insped or's Signatu 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.
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Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r�
89 BRUIN HILL ROAD
Property Address
MARY ROBINSON
Owner Owner's Name
information is NORTH ANDOVER MA 01845 MAY 12, 2025 required for every — ��... _. ._.... _. _..
page. City/Town State zip Code Date of Inspection
C. inspection Summary
0
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and S.
1) System Passes.
® 1 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.7/2612018 Titie 5 Official inspection Form:Subsurface Selvage Dlsposal System Page 2 of 16
Commonwealth of Massachusetts
h Title 5 official Inspection Form
~ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL ROAD
Property Address _
MARY ROBINSON
Owner Owner's Name m.. _.. ..__
information is required for every NORTH ANDOVBR MA 01845 MAY 12, 2025
page. City/Town State zip Code Date of Inspection
C. Inspection Summary (cons.)
2) System Conditionally Passes (cont,):
❑ 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:
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Commonwealth of Massachusetts
-_ Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL ROAD
Property Address
MARY_ROBINSON
Owner Owner's Name m. _....__
information is NORTH ANDOVER MAW 01845 MAY 12, 2025
required for every __... m_
page. City/Town 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
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
El ® 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
l5insp,doc•rev.70612016 Title 5 Official Inspection Form:Subsurface Setrage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL ROAD
Property Address —�._.._....
MARY ROBINSON
Owner _ ......._..... _
Owner's Name
information is required for eery NORTH ANDOVER MA 01845 MAY 12 2025
page, Cityfrown mm ._ State Zip Code bate of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cant.)
Yes No
El ® 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:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
El ® 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.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 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
t5insp.doc•rev.7120=18 Title 5 Officlal Inspectlon Form:Subsurface Sewage Usposal System•Page 5 of 18
E
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL ROAD
Property Address
MARY ROBINSON
Owner _..
Owner's Name
information is required for every NORTH ANDOVER __.w MA 01845 MAY 12, 2025
page, City/Town 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 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?
El ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® El available
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?
® 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)]
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Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL ROAD
Property Address
MARY ROBINSON
Owner owner's Name
information Is required for evrrry NORTH ANDOVER MA 01845 MAY 12, 2025
._ .._. m.._ _..___.. __....
page, City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15,203 (for example: 110 gpd x#of bedrooms): 660 GPD�
Description:
Number of current residents: 0
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 El Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage SEE ATTACHED
( Y g (gpd))� ......
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: APRIL 7 2025
bate
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Commonwealth of Massachusetts
Title 5 Official inspection Form
C Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL_ ROAD
Property Address
MARY ROBINSON
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 12, 2025
� m.�...m.. _ ...._._ ... i
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commerciallindustrial Flow Conditions:
Type of Establishment:
i
Design flow(based on 310 CMR 15,203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.). - —
Grease trap present? ❑ Yes ❑ No
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 occupancyluse: Date --
Other(describe below):
3. Pumping Records:
Source of information: OWNER 2022
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: - -.
gallons
How was quantity pumped determined? — - -
Reason for pumping:
151nsp.doe-rev.712 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page a of 18
ti Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL ROAD
Property Address
MARY ROBINSON
Owner —.._._ _.
Owner''ss Name
information is MA 01845 MAY 12 2025
required for every NORTH ANDOVER ,
page. City/Town State Zip Code Date of 4nspection
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 IIA 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:
32 YEARS OLD, INSTALLED JULY 1993, AS BUILT PLAN
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 30"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
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r Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
I
.
89 BRUIN HILL ROAD _
Property Address
MARY ROBINSON
Owner — _._.... ..._ _..
Owner's Name m_._...
information is required for every NORTH ANDOVER MA 01845 MAY 12, 2025
_._.�.
page. Cttyrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
1 811
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
10' X 5' X 4'
Dimensions: ---- m-
4"
Sludge depth: ........
Distance from top of sludge to bottom of outlet tee or baffle
3411
.}11
Scum thickness F
611
Distance from top of scum to top of outlet tee or baffle --.
Distance from bottom of scum to bottom of outlet tee or baffle
13"
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
CONCRETE INLET AND OUTLET BAFFLES OK
TANK IS GOOD
LIQUID LEVELS ARE GOOD
NO EVIDENCE OF LEAKAGE
CENTER COVER HAS RISER
t5insp.dac-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 18
i
Commonwealth of Massachusetts
I
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL ROAD
Property Address _....__
MARY ROBINSON {
Owner Owner's Name
information
is
required for every NORTH ANDOVER MA � 01845 MAY 12, 2025
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: feet W
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 1=10W, gallons per day
15insp,doc•rev.7/26/2010 Title 6 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_-F t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
0
r
89 BRUIN HILL ROAD
Property Address
MARY ROBINSON
Owner
Owner's Name m ._�..._.
Information is required For every NORTH ANDOVER MA _ 01845 MAY 12, 2025
_.__..
page. City/Town State Zip Code bate of Inspection
D. System Information (cant.)
i
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 EQUAL
LIGHT EVIDENCE OF SOLIDS CARRYOVER
NO EVIDENCE OF LEAKAGE
SLIGHT CORROSION IN D-BOX
t5insp.doc-rev.7126f2£118 Title 5 official Inspection Forw Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
p� Title 5 Official inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL ROAD
Property Address
MARY ROBINSON
Owner
Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 12, 2025
_._. _. � _ _
page. City/Town State Zip Code Date of Inspection
D. System Information (cons.)
10. Pump Chamber(locate on site plan):
Rumps 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!
® leaching fields number, dimensions: ' 20 X 50
❑ overflow cesspool number: - —
❑ innovative/alternative system
Type/name of technology:
t5lnsp.doo rev.M612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
'w T I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r i
89 BRUIN HILL ROAD
Property Address
MARY ROBINSON
Owner ....
Owner's Name
information is NORTH ANDOVER MA 01845 MAY 12, 2025 required for every .. ..� �...� _— _ .... ._.
page. City/Town State Zip Code Rate._of Inspection
D. System Information (cont)
11. Soil 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.):
t5insp.doc-rev.712612016 Title 5 Ofricfal inspection Form;Subsurface Sewage Disposal System•Pape 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I.a o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r�
89 BRUIN HILL ROAD
Property Address
MARY ROBINSON
Owner
Owner's Name ..- �.
information is
required
fo
ed for every NORTH ANDOVER MA 01845 MAY 12, 2025
requir _ _._.u. __.
page, CItyrFown State Zip Code Date of Inspection
D. System Information (cunt.)
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.):
t5insp.doc•rev.712612018 Title 5 Official Inspectian Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
w Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
89 BRUIN HILL ROAD
Property Address
MARY ROBINSON
Owner Owner's Name
Information Is required for every NORTH ANDOVRR MA 01845 MAY 12 2025
page. cityr'rown State Zip Code Date of Inspection
D. System Information (cunt.)
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
4 1
/ O �
b, boy.
z;r;_7
dF t
f•�f
t5lnspAcc•rev.712 6128 10 Tilde 5 offclal Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
c � Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL ROAD
Property Address
MARY ROBINSON
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 MAY 12, 2025
—._
page. Cityfrown State Zip Code Date of Inspection m..__._...
D. System Information (cant.)
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
MARCH 1990
If checked, date of design plan reviewed: - -
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
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
l5insp.cloo-rev.712612018 Title 5 Official Inspection Form:Subsurface Sawage Disposal System Page 17 of 18
Commonwealth of Massachusetts j
F m p Title 5 Official Inspection Form
^ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 BRUIN HILL ROAD m.. __...
Property Address
MARY ROBINSON
Owner
Owner's Name .._�. ..
information is required for every NORTH ANDOVER __ MA 01845 MAY 12, 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System rage 18 of 18
i
Summary Record Card ganerased on 6/221202510.37:48 AM by Tara Hurley
Page I
Town of North Andover
Tax Map # 210-104-A-0100-0000.0
Parcel Id 16327
89 BRUIN HILL. ROAD
ROBINSON, STEVEN R Since Jan 2003
89 BRUIN HILL ROAD
NORTH ANDOVER MA 01845
Class 101 Single Family Property Type 1 Residential
Size Total 2.02Acres
FY 2025
UB Mailing Index
Name/Address Type Loan Number Activelinact, From Until
STEVEN&MARY ROBINSON Owner Active
90 SHERWOOD DRIVE
METHUEN MA 01844
ROBINSON,STEVEN Payor Inactive 4/24/2026
89 BRUIN HILL.ROAD
N.ANDOVER,MA
01848
US Account Maint.
Account No Cycle Occupant Name Activellnactive
Bldg Id,18169.0-89 BRUIN HILL ROAD Last Billing Date 418/2026
3180187 03 Cycle 03 Active
UB Services Maint.
Account No,3180187
Service Code Rate Charge MuitlpllerlUsers
MISCFEE ADMIN FEE 0.63518 7.82 1l
WTR WATER 01 ALL METER SIZE 34.20 11
UB Meter Maintenance
Account No.3180187 `
Serial No Status Location Brand Type Size YTD Cons
41689706 a Active 00 ERT HH b Badger w Water 0.625 0.625 177
Date Reading Coda Consumption Pasted Date Variance
3/12/2026 822 a Actual 9 4/1612025 -26%
12/11/2024 813 a Actual 12 1/14/2025 Oojo
0/12/2024 801 aActual 12 10/8/2024 77%
6114/2024 789 a Actual 7 7/22/2024 -2%
3/13/2024 782 a Actual 7 4/18/2024 32%
12/13/2023 776 a Actual 6 1/16/2024 .49%
9/18/2023 770 a Actual 11 10/13/2023 „2%
6/13/2023 759 a Actual 11 7/14/2023 76%
3/1012023 748 aActual 6 4/12/2023 13%
12/9/2022 742 aActual 6 1/16/2023 -44%
9114/2022 737 a Actual 10 10/18/2022 6%
6/10/2022 727 a Actual 9 7/16/2022 26%
3/10/2022 718 aActual 7 4113/2022 1%
12/10/2021 711 a Actual 7 1/17/2022 •40%
9/10/2021 704 aActual 12 10116/2021 6%
6/9/2021 692 aActual 11 7/2712021 -21%
3111/2021 081 a Actual 14 4/21/2021 -36°%
12/1012020 667 aActual 22 1/13/2021 60%
9/10/2020 645 a Actual 16 10/14/2020 5%
6/9/2020 630 aActual 14 7/16/2020 24%
3/1012Q20 618 a Actual 11 410/2020 -3%
12/1212019 606 a Actual 11 1/15/2020 -7%
9/17/2019 694 a Actual 13 10/10/2019 -14%
6114/2019 681 a Actual 16 7/26/2019 _10%
3/12/2019 660 a Actual 16 4/16/2019 43%
12/1212018 660 a Actual 14 1/22/2019 9114/2018 14%
538 a Actual 13 10/1612018 .4%