HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 76 TUCKER FARM ROAD 3/24/2026 Town of Wit Andover
Commonwealth of massachusetts
MAR 3 0 2026--i'llp Tintle 5 Off'icial Inspection F'orm
ire I
i ubsurface Sewage Disposal System Form Not for Voluntary Assessments
KEN HUBBELL Health De)partment
................ .........
Property Address
76 TUCKER FARM ROAD
Owner, Owner's Name .......
information is NORTH AN MA 01 84�5 MARCH 21
required for every ..... ,
page. City/T'own 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 fora.
Important:When A. Inspector I nformation
filling out forms
on the computer, Todd James Bateson
use only the tab
key to move your Name of Inspector,
cursor-do not Bateson Enterprises Inc.
use the return Company Name
key.
111 Argilla Road
Company Address
Andover MA 01810
City/Town State Zip Code
978-475-4786 SI-16
Tel ephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340, of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of'on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. D Passes
2. E Conditionally Passes
3. Ej Needs Further Evaluation by the Local Approving Authority
4. Fails
ooeo�I"
�70 MARCH' 24, 2026
-�n—sp is Signature Gate-.
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
101000 gpdl or greater, the inspector and the system owner shall submit the report to the appro�priate
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.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
r.�3 Commonwealth of Massachusetts
�r Title 5 Officnial Inspection Form
' I > Subsurface Sewage Disposal System Form Not for Voluntary Assessments
KEN HUBBELL
Property Address
76 TUCKER FARM ROAD
Owner Owner's Name
information is NORTH ANDOVER MA 01845 MARCH 21, 2026
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 21 3, or 5 and all of 4 and 6.
1) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
® one or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N El 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
Title 5 Off
ici"al Inspectin Form
�10 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
9 p Y rY
M1
KEN HUBBELL
Property Address
76 TUCKER FARM ROAD
Owner owner's Name
information is NORTH ANDOVER MA 01845 MARCH 21 2025
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.);
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
El observation of sewage backup or break out or high static wafer 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):
0 broken pipe(s) are replaced E Y El N ❑ ND (Explain below):
El obstruction is removed El Y El N ❑ ND (Explain below):
distribution box is leveled or replaced E Y 0 N ❑ ND (Explain below):
OUTLET BAFFLE ROTTED OFF, NEEDS REPLACED
D-BOX IS RUTTED AND NEEDS REPLACED
PIPE FROM TANK TO D-BOX HAS A COLLAPSED SECTION THAT NEEDS REPAIRED
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed El Y ❑ N El ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
El 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.7/25/2018 Title 5 official Inspection Farm:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
�z I Title 5 Official Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
� p y v
h
KEN HUBBELL
Property Address
7E TUCKER FARM ROAD
Owner owner's Name
information is NORTH AN DOVE R MA 0 1 845 MARCH 2 1 2025
required for every I
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
El 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:
[:1 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.
El 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.
El The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. other:
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑] ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
Title 5 Officoial Inspection For
N I
�� Subsurface Sewage Disposal System Form Not for Voluntary Assessments
} g p Y Y
19 �1
J� KEN HUBBELL
� ` ��=
Property Address
70 TUCKER FARM ROAD
Owner Owner's Name
information is NORTH AN DOVE R MA 01845 MARCH 21 2025
required for every 1
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 C" below invert or available volume is less
® 1
than day flow
Required pumping more than 4 times in the last year NOT due to clogged or
� ® obstructed
t ucted pipes). Number of times pumped.
El N Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ N 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.
E ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
El N 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 ❑EP 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 forma
® The system is a cesspool serving a facility with a design flow of 2000 gpd-
101000 gpd.
❑ ® The system fails. I 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"no" 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 El the system is within 200 feet of a tributary to a surface drinking water supply
1:1 El 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
�WTitle 5 Official Form
h W
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
y �
�r
° KEN HUBBELL
Property Address
75 TUCKER FARM ROAD
Owner owner's Name
information is NORTH ANDOVER MA 01845 MARCH 21, 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 all inspections;
Yes No
E EJ Pumping information was provided by the owner, occupant, or Board of Health
El ® Were any of the system components pumped out in the previous two weeks?
❑ Has the system received normal flows in the previous two week period?
® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as NIA)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
E El 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)}
t5insp.doc•rev,7/26/2018 Title 5 official Inspection Form;Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
�f yTitle 5 Off Form
00 Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
R
9 �
KEN HUBBELL
Property Address
78 TUCKER FARM ROAD
Owner owner's Name
information is NORTH ANDOVER MA 01845 MARCH 21 2026
required for every
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
DESIGN flow based on 310 CMR 15.203 (for gp }example: 110 d x#of bedrooms): 500 GPD
p
Description:
Number of current residents: 2
Does residence have a garbage grinder? El Yes E No
Does residence have a water treatment unit? D Yes E No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.)
ElYes E No
Laundry system inspected? ® Yes C] No
Seasonal use? El Yes E No
Water meter readings, if available (last 2 years �gp }}usage d : ATTACHED
Detail:
Sump pump? El Yes E No
Last date of occupancy: CURRENT
Date
t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
....................
p Title 5 Off
ici"al I Form
'� ��e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a
KEN HUBBELL
Property Address
76 TUCKER FARM ROAD
Owner owner's Name w
information is NORTH AN DOVER MA 01845 MARCH 21, 2026
required for every
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 CM R 15.203):
Gallons per day(gpd)
Basis of design flow(seatslpersonslsq.ft., etc.):
Grease trap present? El Yes F] 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: BATESON ENTERPRISES INC OCTOBER 2022
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.7/28/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
WTitle 5 Off Form
is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
KEN HUBBELL
Property Address
70 TUCKER FARM ROAD
Owner owner's Name
information is NORTH ANDOVER MA 01845 MARCH 21 2020
required for every }
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)
❑ I nnovative/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.
El other(describe):
Approximate age of all components, date installed (if known) and source of information:
38 YEARS, INSTALLED APRI L 1988, 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: 16
feet
Material of construction:
E cast iron E140 PVC El 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
t5insp,doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System■Page 9 of 18
Commonwealth of Massachusetts
Title 5 O Forrlrl
17 y
� Subsurface Sewage Disposal System Form Not for Voluntary Assessments
KEN HUBBELL
Property Address
78 TUCKER FARM ROAD
Owner owner's Name
information is NORTH AN DOVE R MA 01845 MARCH 21 2025
required for every ,
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Septic Tank(locate on site plan):
8,
Depth below grade: feet
Material of construction:
concrete El 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) El Yes El No
Dimensions:
10' x5' x4'
Sludge depth:
4"
Distance from top g of sludge to bottom of outlet tee or baffle NA
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
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 SYSTEM YEARLY
CONCRETE INLET BAFFLE OK
CONCRETE OUTLET BAFFLE ROTTED OFF
TANK IS GOOD
LIQUID LEVELS GOOD
NO EVIDENCE OF LEAKAGE
PIPE FROM TANK TO D-BOX HAS A COLLAPSED SECTION WHICH NEEDS REPLACED
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form,Subsurface Sewage DisposaI System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Form
h
_ 8 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
7 �N
KEN HUBBELL
Property Address
78 TUCKER FARM ROAD
Owner Owner's Name
information is NORTH AN DOVE R MA o 1848 MARCH 21 2026
required for every f
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
El concrete EJ metal El fiberglass ❑ polyethylene El 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 per day
t5insp,doc-rev.7/28/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
17 > Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
zf� h `°V KEN HUBBELL
Property Address
76 TUCKER FARM ROAD
Owner owner's Name
information is NORTH AN DOVE R MA 9 1 845 MARCH 2 1
required for every , � �
page. City/Town State Zip Code Date of Inspection
D. Systems Information (cont.)
8. Tight or Holding Tank (cont.)
Alarm present: ❑ Yes ❑ No
Alarm level. Alarm in working order: ❑ Yes D No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? El 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 NOT LEVEL AND DISTRIBUTION IS NOT EQUAL
DWBOX IS ROTTED AND NEEDS REPLACED
LIGHT EVIDENCE OF SOLIDS CARRYOVER
EVIDENCE OF LEAKAGE
t5insp.doe•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
` Commonwealth of Massachusetts
ci"al Inspection For
Title 5 Offi
d Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�W
III
ff - ~ KEN HUBBELL
Property Address
70 TUCKER FARM ROAD
Owner Owner's Name
information is NORTH AN DOVE R MA 01845 MARCH 21 2025
required for every a
page. City/Town State Zip Cade Date of inspection
D. Systems Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: El Yes El No*
Alarms in working order: D Yes El 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:
El leaching pits number:
El leaching chambers number:
El leaching galleries number:
® leaching,trenches number, length:
4; 59' LONG
❑ leaching fields number, dimensions:
El overflow cesspool number:
El innovative/alternative system
Type/name of technology:
t5insp.doc■rev.7r25r2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System■Page 13 of 18
Commonwealth of Massachusetts
GTitle 5 Official Form
� M
:.x
M
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
KEN HUBBELL
Property Address
76 TUCKER FARM ROAD
Owner owner's Name
information is NORTH AN DOVER MA 01845 MARCH 21 2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (coat.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SOIL AND VEGETATION GOOD
No SIGN 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 El No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/25/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
f Title 5 Official For
'R Subsurface Sewage Disposal System Form Not for Voluntary Assessments
h
1'
KEN HUBBELL
Property Address
76 TUCKER FARM ROAD
Owner owner's Name
information is NORTH AN DOVE R MA 01845 MARCH 21 2020
required for every r
page. City/Town State Zip Code Date of Inspection
D. System Information (cant.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp,doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
FA T'Itle 5 Offi"cial Form
Q Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
KEN HUBBELL
Property Address
76 TUCKER FARM ROAD
Owner Owner's Name
information is NORTH ANDOVER MA O1845 MARCH
required for every g�6
Page. City/Town 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
El drawing attached separately
3, 13
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7
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44,0'o Wfs
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t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal 8ystem Page 16 of 18
Commonwealth of Massachusetts
x Ti e i
c"iaInspectionForm
4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
g p Y y
KEN HUBBELL
Property Address
75 TUCKER FARM ROAD
Owner Owner's Name
information is NORTH AN DOVE R MA 01845 MARCH 21 2025
required for every
page. City/Town State Zip Code Date of Inspection
Dr System Information (cunt.)
15. Site Exam:
® Check Slope
Z Surface water
® Check cellar
F, 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 N E 1985
g 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)
El Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
DESIGN PLAN
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.712612018 Titre 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
Commonwealth of Massachusetts
r c"ial Inspection Form
Title 5 Offi
7+
is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
ti
KEN HUBBELL
Property Address
75 TUCKER FARM ROAD
Owner owner's Name
information is NORTH AN DOVE R MA 01845 MARCH 21 2026
required for every a
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, 21 3, or 5 completed as appropriate
4 (Failure Criteria) and 5 (Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank-- Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 15 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 3/18/2026 7:22:03 AM by Nancy Mans Page I
Town Of North Andover
Tay Map # 210-107.C-0091-0000.0
Parcel Id 18371
76 TUCKER FARM ROAD
HUBBELL, KENNETH
76 TUCKER FARM ROAD
N. AN DOVE R, MA
01846
Class 101 Single Family Property Type 1 Residential
Size Total 1 Acres
FY 2026
UB Haring Index
Name/Address Type Loan Number Activellnact. From Until
HUBBELL,KENNETH Payor !Active
76 TUCKER FARM ROAD
N.ANDOVER,MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id.22561.0-76 TUCKER FARM ROAD Last Billing Date 3/412026
2100339 02 Cycle 02 Active
UB Services Maint,
Account No.2100339
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.63 518 7.82 11
WTR WATER 01 ALL METER SIZE 34.20 11
UB Deter Maintenance
Account No.2100339
Serial No Status Location Brand Type Size YTD Cons
36207123 a Active ERT HH#76 b Badger w Water 0.625 0,625 656
Date Reading Code Consumption Posted Date Variance
214/2026 19 a Actual 9 3/12/2026 -44%
11/5/2025 10 a Actual 10 12/12/2025 -64%
91912025 0 n New Meter 0 12/12/2025 -100%
9/912025 2293 s Reset meter 31 12/12/2025 251%
8/22/2025 2262 m Manual estimate 55 9/12/2025 135%
5/2/2025 2207 a Actual 18 6/12/2025 13%
2/5/2025 2189 a Actual 17 3/13/2025 -70%
11/512024 2172 a Actual 59 12/12/2024 -45%
8/212024 2113 a Actual 103 9/12/2024 572%
5/2/2024 2010 a Actual 15 6/13/2024 -33%
212/2024 1995 a Actual 23 3/14/2024 -4%
111212023 1972 a Actual 24 12/13/2023 -14%
81212023 1948 a Actual 28 9/18/2023 108%
5/2/2023 1920 a Actual 13 6/14/2023 -29%
212/2023 1907 a Actual 19 3/14/2023 -22%
111212022 1888 a Actual 24 12/19/2022 -49%
8/312022 1864 a Actual 48 9/20/2022 235%
5/3/2022 1816 a Actual 14 6/21/2022 -35%
21212022 1802 a Actual 22 3/1512022 -35%
11/212021 1780 a Actual 33 12/13/2021 -43%
8/4/2021 1747 a Actual 59 9/21/2021 143%
615/2021 1688 a Actual 24 6/15/2021 38%
2/412021 1664 a Actual 18 3/16/2021 -84%
11/312020 1646 a Actual 112 12/16/2020 32%
8i412020 1534 a Actual 86 91912020 367%
51412020 1448 a Actual 18 6/10/2020 53%
2/4/2020 1430 a Actual 12 3/16/2020 -58%
11/4/2019 1418 a Actual 29 12/23/2019 -19%
8/2/2019 1389 a Actual 35 9/26/2019 121%