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Home My WebLink AboutPASS - Title V Inspection Report - 127 TUCKER FARM ROAD 7/1/2025 h uom,monwealthMassachusetts ion Tl"tle 5 Official Inspect" Form 1> Subsurface Sewage Disposal System FormNot for Voluntary Assessments 127 TUCKER FARM ROAD Property Address _. DON LI Owner Owner's Name information is required for every � ��All �� MA 01845, JUNE 2812,025 page. City/Town Mate Zip Cade Cate of inspection Inspection results must be submitted on this form. Inspection forms may not be altered: • ay. Please see completeness checklist �� any p" � � erg �' a�rr��. Important WhenIng out forms I i on the computer, use only the tab Todd ,James Bat,eson key to move your Name of Inspector cursor-do not ateson Enterprises Inc. use the return �` IT_ key. Company Nerve Argilla Road Company Address _ Andover MA 01810 Mate dip Code r r n 78-475-4786 S l-1 Telephone Number _ ..w_ License Number B. Certification I certify that: I am a DEP approved system inspector in full coo lia�r�oe�� (310 C ° �'.+ 1)y I here personallyi p` Section 1 .� "Title inspected the�ewa e disposal system at the property,address listed above; the information reported below is true, accurate and complete as inspection; ,end the inspection was p o�the time of my performed based on my training and experience in the proper function p p and maintenance e of on-site sewage disposal systems, After conducting this inspection I have d that the system: p determined 1. Passes 2. Conditionally Passes 3. El Deeds Further Evaluation by the Focal Approving Authority rity 4. Fails .01 lnspe is sic,�r�ature �_. J L 11 2 25 __. Date The system inspector shell submit e copy of this inspection report to the A , p Approving Authority (Board Health or DEP, within 3o days o completing this inspection.ection. It the s o p system has e design , + gpd or greater,: the inspector and the system � flow of nn owner�l�ell submit the repent to the appropriate re ionel office of the DEP. The original form should be sent to the system owner and' copies the buyer, if applicable, and the approving authority. p gent o Please note This report only esorles conditions4 at tl��time of inspection and user the conditions of use at that time. Thi's inspect,ion does not address how inthefuture under the��or different the system will �` rrr� conditions cat use. t 1nsp,doc.rev,7/2612018 "title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page i of 18 ., Commonwealth of Massachusetts Title 5 Offic"ial Fors rW ' }�> Subsurface Sewage Disposal System Form Not for Voluntary Assessments a- °4 127 TUCKER FARM ROAD Property Address DON LIU Owner owner's Name information is NORTH AN DOVE R [VIA 01845 J U N E 28 2025 required for every I 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 5. 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. El Y [:1 N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 official inspection Form:Subsurface Sewage[disposal System•Page 2 of 18 , Commonwealth of Massachusetts A- 6A Title 5 Official Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ry fhly'v 27 TUCKER FARM ROAD Property Address DON LIU Owner Owner's Name information is NORTH AN DOVE R MA 01845 845 J U N E 28 2025 required for every page, City/Town State Zip Code Date of Inspection C. inspection Summary (coat.) 2) System Conditionally Passes (cant.): El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired, ❑ 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): El broken pipe(s) are replaced ❑ Y Ej N ❑ ND (Explain below): ❑ obstruction is removed El Y El N El ND (Explain below): ❑ distribution box is leveled or replaced F-1 Y El N ❑ ND (Explain below): E:1 The system required pumping more than 4 times a year due to broken or obstructed pipes). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced El Y El N [I ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: EJ 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(l)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 official Inspection Farm:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Off ic'ial I Form ' a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 9 �l 127 TUCKER FARM ROAD Property Address W DON LIU Owner owner's Name information is NORTH AN DOVE R MA 01845 J U N E 28 2025 required for every , page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) El Cesspool or privy is within 50 feet of a surface water Ej 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: Ej 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. [:1 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. El The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. [:1 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"Noy'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 t5insp.doc•rev.7/26/201 S Title 5 official Inspection Form:Subsurface Sewage Disposal system-Page 4 of 18 }M Commonwealth of Massachusetts gpd _ g e �ci� ns ec ion corm i ' Subsurface Sewage Disposal System Form Not for Voluntary Assessments W ry 127 TUCKER FARM ROAD Property Address DON LIU Owner owner's Name information is NORTH AN DOVE R MA 01845 J U N E 28 2025 required for every , page. City/Town State Zip Code Date of inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) 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 E" 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 pipes). Number of times pumped: El 2 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ E 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 E 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- 101000 gpd. El E The system fails. 1 have determined that:one or more of the above failure criteria exist as described in 310 CM R 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`ono" to each of the following, in addition to the questions in Section C.4. Yes No 1:1 El the system is within 400 feet of a surface drinking water supply 1:1 1:1 the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Y u Title 5 Off ic"ial I Form �7 N Subsurface Sewage Disposal System Form Not for Voluntary Assessments 127 TUCKER FARM ROAD Property Address DON LIU Owner owner's Name information is NORTH ANDOVER MA 01845 JUNE 28 2025 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (coat.) 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 C.4 shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 5. You must indicate "yes' or"no" for each of the following for aC1 inspections: Yes No Z 1:1 Pumping information was provided by the owner, occupant, or Board of Health 1:1 Z Were any of the system components pumped out in the previous two weeks? Z 1:1 Has the system received normal flows in the previous two week period? Z Have large volumes of water been introduced to the system recently or as part of this inspection? Z 1:1 Were as built plans of the system obtained and examined? (If they were not available note as NIA) Z 1:1 Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? Z El Were all system components, excluding the SAS, located on site? Z 1:1 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? Z 1:1 Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Z El Existing information. For example, a plan at the Board of Health. Z 1:1 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)] t5insp.doc-rev.7126/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System■Page 6 of 18 Commonwealth of Massachusetts 1T"tle 5 Official Form i> Subsurface Sewage Disposal System Form - Not for Voluntary Assessments = g p Y Y h ,.AV °V 17 TUCKER FARM READ Property Address DON LI U Owner Owner's Name information is NORTH AN DOVE R MA 01845 J U N E 28 2025 required for every a 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): 4 t � DESIGN flow based on 310 CMR 15.203 (for gp 3 example: 110 d x#of bedrooms): 440 GPD p Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? El Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ElY es E No Laundry system inspected? Yes ❑ No Seasonal use? El Yes E No Water meter readings, if available (last 2 years �gp ��usage d : SEE ATTACHED Detail: Sump pump? ❑ Yes E No Last date of occupancy: CURRENT Date t5insp.doc-rev.7/26/2018 Title 5 official Inspection Farm:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts 3: y� 1�p Title 5 Officimal For'A , 1Q Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 127 TUCKER FARM ROAD Property Address DON LIU Owner owner's Name information is NORTH AN DOVE R MA 41845 J U N E 28 2025 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 2. Commercialllndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day� d gp ) Basis of design flow(seatslpersonslsq.ft., etc,): Grease trap present? El Yes El No Water treatment unit present? El Yes ❑ No If yes, discharges to: Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? El Yes El No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: 2019 OWNER Was system pumped as part of the inspection? El Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Y Offici'al�,p Title 5Forrr� 1+ '? 4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments md ^ bV 127 TUCKER FARM ROAD Property Address DON LI U Owner Owner's Name information is NORTH ANDOVER MA 01845 JUNE 28 2025 required for every a page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 8 YEARS, INSTALLED SEPTEBER 2017, AS BUILT PLAN Were sewage odors detected when arriving at the site? El Yes E No 5. Building Sewer(locate on site plan): Depth below grade: 2 2 F1feet Material of construction: ❑ cast iron E 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments icon condition of joints, venting, evidence of leakage, etc.): JOINTS AND VENTING OK NO EVIDENCE OF LEAKAGE t5insp.doc■rev,7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System■Page 9 of 18 Commonwealth of Massachusetts �M uTitle 5 Off Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M1 127 TUCKER FARM ROAD Property Address DON LIU Owner owner's Name information is NORTH AN DOVE R MA 01845 J U N E 28 2025 required for every page, City/Town State Zip Code Date of Inspection D. System Information (cant.) 6. Septic Tank (locate on site plan): Depth below grade: 10"feet Material of construction: Z concrete ❑ metal El fiberglass El polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes ❑ No Dimensions: 10'X5`X4' Sludge depth. 4" Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA 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 SYSTEM EVERY TWO YEARS PLASTIC INLET AND OUTLET TEES OK TANK IS OK LIQUID LEVELS GOOD NO EVIDENCE OF LEAKAGE t5insp.doc•rev.7/2612018 Title 5 official inspection Form:Subsurface Sewage disposal System•Page 10 of 18 Commonwealth of Massachusetts u Title 5 Off ici'al I ForiA l'1'1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° g p Y rY 127 TUCKER FARM ROAD Property Address DON LIU Owner owner's Name information is NORTH ANDOVER MA 01 845 JUNE 28 2025 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: Material of construction. El concrete El metal ❑ fiberglass El 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 El metal El fiberglass ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons erda g p y t5insp.doc-rev.7/26/201 S Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page'I 1 of 18 Commonwealth of Massachusetts 4 T itle iInspectionFor�'1� 'T Subsurface Sewage Disposal System Form Not for Voluntary Assessments r 127 TUCKER FARM ROAD Property Address DON LI U Owner Owner's Name information is NORTH AN DOVE R MA 91845 J U N E 28 2925 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) S. Tight or Holding Tank(cant.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: El Yes El 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 El No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert D Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-BOX IS LEVEL AND DISTRIBUTION IS EQUAL NO EVIDENCE OF SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGE D-BOX HAS FLOW EQUALIZERS t5insp.doc-rev.7/25/2018 Title 5 official Inspection Form;Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Offi c"ial Inspection o r inn + Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 127 TUCKER FARM ROAD Property Address DON LI U Owner Owner's Name information is NORTH AN DOVE 2 required for every , 0 5 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: El Yes El No* Alarms in working order: ❑ Yes D 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: El leaching chambers number: �] leaching galleries number: El leaching trenches number, length: H leaching fields number, dimensions: 1; 25' X 30' El overflow cesspool number: El innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 official inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Offi c'ial I Form ' � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 127 TUCKER FARM ROAD Property Address DON LIU Owner owner's Name information is NORTH AN DOVER MA 01845 J U N E 28 2025 required for every page. City/Town State Zip Code Date of inspection D. System Information (cant.) 11. Soil Absorption System (SAS) (cant.) 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 El Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts z i c"iaInspectionForm r i0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � � y ry 127 TUCKER FARM ROAD Property Address DON LIU Owner owner's Name information is NORTH AN DOVE R MA 01845 J U N E 28 2025 required for every , page, City/Town State Zip Code Date of inspection D. System Information (cont,) 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts i Title 5 Official Inspect"ion For rr� A Subsurface Sewage Disposal y g p sal System Form Not for Voluntary Assessments .� ,16 127 TUCKER FARM ROAD Property Address DON LIU Owner Owner's Name information is N o RTH AN DOVE R required for every MA 01845 J U N E 28, 2025 page. City/Town State Zip Code Date of inspection D. System Information (cont.) 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; Z hand-sketch in the area below El drawing attached separately 12-1 j4(.r%Fr- A I 0 0 0 4 .� 35' 5 N." �• gip. `� ,� �:, V-)a w� �- : \:,Y t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 18 � Commonwealth of Massachusetts ±� i e ii"Ac1a r1s eC 1or1 orI Subsurface Sewage Disposal System Form Not for Voluntary Assessments 6 w'°� 127 TUCKER FARM ROAD Property Address DON LIU Owner Owner's Name information is NORTH AN DOVE R MA g 1845 J U N required for every E 2$I �0 5 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: J U LY 2017 P 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. t5insp.doe-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Off"cial For1-3 P rl'1 8 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F L � ,,Alt 127 TUCKER FARM ROAD Property Address DON LIU Owner Owner's Name information is NORTH AN DOVE R MA 61845 J U N E 28 2025 required for every , 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, 21 3, or 4 checked ® C. Inspection Summary: 11 21 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 t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Summary Record Card generated'on 6/30/2025 10:26:00 AM by Karen Hanion Page 1 Town Of i\j h Andover Tax Map # 21 Owl 07#C"00961-00004,0 Parcel Id 18378 127 TUCKER FARM ROAD DON P L,IU 127 TUCKER FARM ROAD NORTH ANDOVER MA 01845 Class 101 Single Family Property Typo, I Residential Size Total 1.1 Acres, FY 2025 UB MiLfflng !ndex Nate/Address *[We Loan Number Active/Inact, From Until DON I'LIU Owner Active 127 TUCKER FARM ROAD NORTH ANDOVER MA 01845 MOSCARITOLA,SILVIO Previous Customer Irlactive 12/1'4/2017 127 TUCKER FARM ROAD N.ANDOVER,MA 01845 UB Account Maint. Account No cycle Occupant Name Active/Inactive Bldg Id.14331.0-127 TUCKER FARM ROAD Last BIlling Date 6/3/2025 2100335 02 Cycle 02 Active UB Services Maine. Account No.2100,335 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE, 1 1 9.18 WTR WATER 01 ALL METER SIZE 34.20 UB Meter Maintenance Account No.2100335 Serial No, Status Location Brand 34133272 a,Active ERT HH b Badger 7YP0 Size YTD Cons, Date Reading Code w Water 378 6/2/202,5 1626 a Actual Consumption Posted Date Variance 2/5/2025 1617' a Actual 9 6/12/20,25 7% 11/5/2024 9 3/13/2,025 -73% 1608 a Actual 34 12/1212024 .27% 8/2/2024 1574 a Actual 45 9/12/2024 5/2/2024 1529 a Actual 8 6/13/2024 450% 2/2/20,24 1521 a Actual 9 3/14/2024 -9% 11/2/2023 1512 a Actual' -18% 12/13/2023 8/2/2023 1501 a Actual 11 20 9/18/2023 -50% 5/11/2023 1481 a Actual 97% 2/2/2,023 12 6/14/2023 1469 a Actual 9 3/14/2023 25% 11/2/20212 1460, a Actual 41 12/19/2022 -78% 8/3/2022 1419 a Actual 101 9/20/2022 -59% 5/3/2022 1318 a Actual 91 6/21/2022 998% 2/2/2022 1309 a Actual -8% 10 3/1612022 11/2/2021 1299 a Actual 11 12/7/20112 -11% 8/4/2021 1288 a Actual -491% 22 9/21/2021 5/5/2021 1266 a Actual 142% 9 6/15/2021 3% 2/4/2021 1257 a Actual 9 3/16/2021 11/3/2020 1248 a,Actual 48 12/16/20,20 -82% 8/4/2020 1200 a Actual 82 9/9/2020 �-41% 5/4/2020 1118 a Actual 10 6/10/2020 702% 2/4/2020 1108 a Actual 2% 11/4/20119 1098 a Actual 10 3/16/2020 -79% 48 12/23/2019 8/2/20191 1050 a Actual 42 9/26/2019, 12% 5/2/201 9 1008 a Actual 206% 2/4/2019 995 a Actual 13 6/13/2019 40% 1 11/212018 986 a Actual 0 3/19/20,19 -78% 44 12/12/2018 134%