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Home My WebLink AboutPass - Title V Inspection Report - 1881 GREAT POND ROAD 8/22/2026 Commonwealth of Massachusetts T*Itle 5 Offiecial Ins n _ Subsurface Sewage Disposal System Form - of for Voluntary Assessments rat 1881 treat Pond Road Property Address SS_i T. Marchand IrrevocableTrt. ..._...(Michelleis Owner w__. __. _. ._._._ ...M_....__._ _ ._.....__.. Oners Lane _... information is No. Andover /1A 01845 g /22/ re quired for every _______.___..__.__.__....._.._..._._...._.._. _.w.____________..___.__...__.�__...._...._.._._... _. ________.______._ _____._.__._.._.__. _w._.._.._....______________... .... . _.. _. ______.__.__._ _.............. page. City/Town State ,dip Cede Cate of Inspection Inspection results must be submitted on this form. Inspection forma may not be altered in any gray. Please see completeness checklist at the end of the form. TOWn Of Important:When A. Inspector Information filling out forms on the computer, use only the tan L. DiVincenzo li _...._:......�. key to move your Marne of Inspector curs or_do not J e elopme............. nt/St r 's Septic Service use the return .___.S_C___._..._w_.._ ____._m key, Company Name ..... ............... 58 So...................__._ __. .....Kimball fit. tab Company Address Bradford MA C 1 35 City/ 'own State ,dip Code ...._. _...._...a. . ._..... _._.__w __._....__ ...._.._.. . .__.._._. ___ _.._._._..._.._ _.._....... .... ...._. _.. .,.____...___._...._ .........w..._w ....._. __.. Telephone Number License Number B. Certification I Certify that: I am a DEP approved system Inspector,in full comphiancewith Section '15.34 ► of Title 31 o C R 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 ray training and experience in the proper function and maintenance of cry-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. Z Passes . El Conditionally Passes 3. Needs Further Evaluation by the Local Approving Authority 4. Pails 08/22/2026 _.... _.. eotor's Si re Date The system inspector shall sub . opy 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 flaw of 107000 gpd or greater, the inspector and the system owner shall subunit the report to the appropriate regional office of the CEP. 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 hoer the system Trill perform in the future under the same or different conditions of use. t5in p.doc.rev.7/26/2018 Title 5 Official InspectionForm:Subsurface Sewage Disposal System.Page 1 of 1 Oft L;ommonwe�alth of Massachusetts T_NW. eIcia - w- 1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments y 1881 Great Pond _._.. .w_._.._.. _ _..Road ._.....________ _. Property Address Simone T. Marchand Irrevocable Trust IVIic�h�ll� l�ichard� ___w___ m__..._._.....w._ .w____. __ �.___.__w._ _..rv .._.___..__ ._..._.. ___..__w. ._..... ... Owner Owner's Marne infoirmation is No Andover 01845 C 22/2026 required for every _-__............ _.�. _._.__._........�. _._._..__.._..._........mm...._..m _....._,w __._........_... . page city/Town State ,dip Conde Cate 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 15.3,03 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is old, but still working. To TitleV specs, there were farm roots in the pipes. We jetted the lines.._ _ _ _--___-_ _ ....._�_.._ .. roots and debris Flan grater for 2C minutes and the system took all the water.. to clean cut the...�__. ..____ _m_._..........._ _..w.._ ____..__._______ ....__._.._. .............._ __.______._._ .._._.M.__.._. .......__ . _w_______ ._. ... _........... __._ ..............-------- ................ ..........-1........................-------------- 2 System ondit"lo pally l a ses, one or more system components as described in the "Conditional Fuss" 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" `¢nog' or"net determined" , N, 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 net) 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. 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. D Y F-1 N F� N (Explain below)- t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System.Page 2 of 1 Commonwealth of Massachusetts ., . Title 5 utticial Inspection For 10 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 11 Great Pond Road .. Property Address Simone T. Marchand Irrevocable el le Richards Ownerm information is . Andover 1 5 '8/'22/2026 required for _ _._.____ _...... _. ..__._._ _._ �w�ry �Mt� �'"" n State �� w..�....� a......w.... ._ ode .. !��_.. . Inspection. . . _...................._.._. .. .._ _____--_.__ of C., Ieach Summary (coat.) Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fall unless the Beard of Halth (and Public lic ater Sub ller, If any) determl*nes that the system is funcUoniing ln a manner that protects the pubilic health, , safety and en vlr ent [:] The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply r tributary to a surface water supply. [I The system has a septic tank and SAS and the SAS is within a Zone 1 of a public grater supply. [] The system has a septic teak and SAS and the SAS is within 50 feet of a private water supply well. E] The system has a septic tank and SAS and the SAS is less'than 100 feet but 50 feet or ore from a private grater 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 pprn, providedthat no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other- ... System Falilure Cri erla Applicable to All Systems: You must i + ca a "Yes" or"No" o each the following for all iris ec r s: Yes No Backup of sewage into facility or system component due to overloadedr clogged SAS or cesspool D E Discharge:or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5ins ,doc.rev,7/26/2018 Title5 Officiai ins ton Form:Subsurface Sewage Disposal System.Page 4 of 1 ;Mtommonwealth of Massachusetts T*T"'Icial Inspection T'Itle 5 %^j' For -1^s Aft 1 SIu surf ce Sewage Disposal System Form Not for V l int ry Assessments ;a r r 1 Great on Road d . - _...............mm......... Property dress SimoneLL Marchand Irrevocable Trust � rchel'le RiIcI'�rar ---- .............. Owner Owner's Name inif rirnation is No Andover r q, i r .... id for ever L . _ mm...n_...__._.. .... w . mm.mm. _._ ..... . _ .mm . .M .__...._. . ...._..-. Cilt1'Ton State Zip o ate o Inspection C. Inspection, System Failure Criteria lica l o,All f ems.-I ref.) s NO Static liquid level' in the distriduaI I tioln box above oultlet invert due to an overloaded r clogged SAS or cess looll Liq,uild depth in cesspool is less than 6"' below invert or available vollume is less the 1/ day flow El E i g�� the last year NOTclogged" � rr� � �� rrr rnr�t � ti�w�� i obstructed r s . Number of times pumped, El E Any portion of the SAS, cesspool or rivy is belowi l ground' water elevation. El E Any portion of'c,esspiolol or privy is wit in100 feet of a surface water supply or tributary t a surface wat r supply. Any portion, cesspool or privy is within f a public water supply El zi well. El Z y portion of a cesspool or privy is,withi!nfeet of a private water supply well. 0i z Any portion of a cesspool or privy is less than 100,feet driven greater than 510 feet r ri° t t r supply well with no c, ta l�water analysis.n l systeml'f the well water analysis, performed of a DEP certified laboratory,for fecal colitform bacteria indicates absent,and the r c of ammonia nitrogien and nitrate nitrogen is equal to or less than 5 ppm, provided that r failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this for 1:1 Z, The system is a cesspool serving a, f ci l ity with a desig,n flow of 1 The system falls,. I have determined: that one or more of the above failure criteria exist as described in _ , therefore the system fails. 'The systemr r should con�tact the oar f Health to determinet will be necessary to correct the failure., Large ate be considered a large system the system must serve a facility with a designflow of 10, to , r large t , you must indicate eith r"yes)) or"no" to each, f the following, in addition to the questions in Section CA Yes No El El the system is within 4,00 feet of a surface drinkingwater sub l E] 1:1 the system is,within 2,00 feet of a tributary to,a, surfacedrinkin!g water lEl 0 the system ' is located i n nitrogen i r (interim llhProtection Area— I r a mappedone 11 of'a public wateir supply well t in p. o .rev.7/26/2018 Title ff 4 inspection,F'nrrn:Subsurface Sewage Disposal System.Page 5 of 1 c w y %,ommonwealth of Massachusefts Title 5 Icy . "al Insw%ect" .. v ion Form Subsurface Sewage Disposal System Form Not for Voluntary assessments kr Great Pond Road . ...�..._. _._.__ _........... . .... ......------_............._._.�... � ...�.� _._.. .__.- _ Property Address Simone Nw.....T...�.__...:archand Irrevocable Trust Michelle Richard �.........a Owner Owner's ae information is . Andover er 1 45 22 2C 26 requiredfor ever .._._..._._.... ....._........._.._._....__. _M......... _... ....._. ... .._...... _.. ........... w_..... ........._..._ __ _._........ _._........... ... . page. City/Town Mate Zip Code Cate of Inspection C., Inspection Summary (cont,.) If you have answered it yes" to any pulsation in Section C.5 the system is considered a significant threat, or answered �4 es" to any question in Section CA above the large system has faded. The owner or operator of any larc,.e system considered a significant threat under Section C .5 or tailed under Section CA shall upgrade the system in accordance with 310 CMR 15.3�04. The system owner should contact the appropriate regional office of the Department., . You rust i"n gate"Yes" r"no"for each of the followi*ng for all nspeotoo►ns Yes to Z El 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 eks Z EJ Has the system received normal flows in the previous o 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? la they were not available n Z El Was the facility or dwelling inspected for signs of sewage hack p" E El Was the site inspected for signs of break oat? E 1:1 Were all system components, excluding the SAS, located on site? Z El Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the battles or tees material of construction dimensions, depth of liquid, depth of sludge and depth of sou z 1:1 Was the facility owner(and occupants if different from ner) provided with information on the proper maintenance of subsurface sewage disposal systems? The s ze and ooa %or of the Soil Absorption System (SAS) on the site has been determined based on- z E] Existing information. For example, a plan at the Board of Health. z 1:1 Determined ino in the field if any, of the failure criteria related to part C is at issue approximation of distance is unacceptable) [310 C MR 15.302(5)] 5 Sins .c .rev.7/26/2018 Tifle5 Off�c4 Inspection Fora:Subsurface Sewage Disposal System*Page 6 of 1 aft ul LL_ O�ffi ion o ForArn m 1q �I Subsurface Di ' r of for Voluntary Assessments 18,81 Great Pond Road Property Address Simoine T._Marchand Irrevocable-Trust (MichelleRichards)_.. --- ---_._. Owner Owner"s N information is No oar r 1i 845 08/22/2026 required fired for every _...a. ----- ---� .....m...mm........_... page�. City/T'own State Zip,Cod�le Date of Inspection D. System Information Number of bedrooms (design): ..._...... ..�m......._.... Number of bedrooms (actual): I flo aced' on 1 R 1 1 t r x l : 11' i of e roa ' : _... - - - _. Description: No into)on, stem Number ofcurrent residents: ._._. .. . es, reslidlence have a garbage grinder E] Yes Z N Does residence have a water treatment unit' D Yes Z N If yes, discharges to- �� _ �_ _�_� -__�__�_��..�m mmm��._��_....�.. m w. ________---. Is laundry on parata sewage system? (Include laundry system inspection El Yes Z Noinformation in this report.) Laundryt inspected? El Yes 0 No Sea,sona,l u Yes 0 No Water meter readlings, if available (last 2 yearsusage (gpd)). ------ Detail: SUMP puimp:? 0 Yes Z N o Occupied Last to of occupancy: � w�__ ....Date . t ire i. .rep.7/26/2018 Tifle5 Official Inspection Forma.Subsurface Sewage Disposal l System,Page 7 of 1 icia T ion le 5 Off I pect" Form .._._ Commonwealth of Massachusetts lei Subsurface Sewage Dlisposal System m Not for Voluntary Assessments 1881 Great......._..._ and Road _.w_.._...�w._.... ._.. _...._.__ .�... ._.... _............. ... ....._.v.__. .... Property Address Simone T. Marchand Irrevocable l ......Richards) Owner Owner's Name information is . Andover 5 l22f2 26 required for eve _.._.__..._.. .. ._.....w..... _._M__ __._........._.m._..... __..._.._--- �t �"r"a...... w... _ �.._._. .._._.. _......m._..�._w_...._�.______ _........___..�.__..._... ..�....... State Zip Code Date of Inspection wn D. System Infa o (cont.) 2. Commercl"a 11/11nd ustralal Flew Co + fcrs Type of Establishment.- ...... . . ............._.... .. _ _.....a....._w..._m. Design flaw(based on 310 CMR 15�.2 3 - s_.. . pd .. ....__ . _�...... ._...._............. per day Basis of design flow, seats ersons/sq ft., etc. : _..._ m. . _ _...__ _...__....w....�...�........ _.._. ....__ ._._ Grease trap resent? El Yes No Water treatment unit resent? El Yes El No It yes, discharges to- Industrial waste holding tank present? El Yes El No Non sanitary waste discharged to the Title 5 system? Yes No Water raster readings, if available- Lastdate of ccu a nc se _._..._._...._._...__._. _.. _w._w___.__...._ ..._.. .w�........._ Date Other(describe below)- . . Pumping Records: Source of information- ------ _�._.. _ .._...._.. -------- Was system pumped as park of the inspection? Yes No volume �500 lt es u e ___ __w_...�..._........_..._w.....w..__.. ....... __w_.._....._._.m._._.._.. _... _ gallons How was quantity eterrnined Si �.,a_! .__�..n truck Reason for a %n : Inspect tank t5i p. o ,rev.7/26/2018 Tifle 5 Of i 4 Inspection Form Subsurface Sewage Disposal System.Fags 8 of 1 %,ommonwealth of Massachusetts tA 'Itw i"tle 5 Off"s ionForm f Subsurface Sewage Dispersal System Form Not for Voluntary Assessments 1 1 Great Pond Road ___-- Property Address Simone T. Marchand Irrevocable Trust Michelle Richards Owner r Owner's Name information is No. Andover M 1 45 c /22/2026 requiredfor every .__�__.__.___.__w_..__.__n_..._.._.__...._ _...._.µ.._.__...__._.______-._.___..__._._-_______._ ______.._.._.w_.__. _._M.M._.._.._......w._.__w____...w.._. �..__.__._._.___ page City/Town State Zip Code Date of Inspection D. Syste of r o (coat.) 4. Type e 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 they 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: apprirne' ° ears ....................... __._______.......... ..___.___-_.__-__. __._.__m_.._.... .. ..... .._. ....._. Were sewage e odors detected when arriving at the site? Yes Z No 5. BuIldilng Sewer(locate on site plane 2411 Dept feet below grade. .et ...._..... _. ____..------..._....__....... .__......... Material of construction. cast iron 40 PVC El other(explain): -.___._m_._.._ _..........._......_..ma.M.M..._._._.a......_._.._.v __.... .w... _._ ........_.. Distance from private water supply well or suction line: -e _________._.._._..._._._.__.m_...._...__.._.._._.....__._._...._w__._._._.�__..___._...... ._._.._...M.. et Comments ents (on condition of joints, venting, evidence of leakage, etc.). t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form.Subsurface Sewage Disposal System Page 9 of 1 Commonwealth of Massachusetts . :. Ot't"icial .. la Subsurface Sewage D11sposall System Form Not for Voluntary Assessments 1881......... -__. Pond Road Great _..._.__.._....._.....__..._. ._.a..... _...._ _....__....... ....__._._.... _. Property Address ..Simone T..__._.._Marchand Irrevocable Trust , Owner Owner's,Name information is o Andover A 01845 22 2 26 required for eve _...._.__. _ ... _.m....__..._..._......_ page. City/Town Mate Zip Code Cate of Inspection D. System Information (cont. 6. Septic Tan (locate on site lava Depth elm ride: _fee. �� .._.. ......�.._.�........_ ....... ..... _ .___._ ------ Material of construction- concrete El metal El fiberglass El polyethylene Queer (explain) It tank, is metal, list age: . . ....._.. _...... __...... ._____.._w_...._..._..... _.._.._ years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes No Dimensions.- Sludge w ... ..._ __..._..._ _.. _ry.._........ Distance from top of sludge to bottom of outlet tee or baffle 23�� ._._ _._...._..M._.._..w _..__..__..._. _w._..._.. __ _.......... Scumthickness ......._ ......_......_. __.__._. m_._.-___._..... _.....a... ........ ...._........... 6 Distance from top of scum to top of outlet tee or baffle _.._._. _.....................�........._........�. _-�____w____w__ _ _._.._.. .._. 20 Distance from ott m of'scum to bottom of outlet tee or baffle W W_. .................._...�............_...._... �_.._._..__._w _ _......._... How were dimensions s determined? Tape..... asure slu e...� _. . ........ . Comments (oar pumping recommendations, inlet and cutlet tee or baffle condition, structural integrity, liquid levels as related to cutlet invert, evidence of leakage, etc.)- Both affles are in ood shape No leak � lr uid level as t insp.doc.rev.7/2612018 Tifle 5 Off ic4 inspection rm Subsurface Sewage Disposal System.Page 10 of 1 t.�ommonwealth of Massachusetts 121k�1_1 11\ T oion'*tle 5, uOw""ro a N' Insp&ftecto' Form J, Subsurface Sewage Disposal Systern Form Not for Voluntary Assessments 18,81 Great Po__._nd Road, ............ .......... Property Address S,imone T. Marchand Irrevocabl Tr ust rust Owner Owner's Name (M,-i c h.,e, I.-Ile,R_i r'c h a d information is N_q., Andover MA 01845 08/22/2012�6 requ,i,red for every ........ ------- page. City/Town State Zip Code Date of Inspection D. System Informatio conic. ,) 7. Grease Trap; (locate on site plan): Depth below grade: f,e-e.t ................ ...... Material of construction: 0 concrete El metal El fiberglass El polyethylene El of r(explain)- ................ .............-1...................... —------- .......-.1-1.11-.11.1--....... 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 ......._111-..............._.______________.__............. Date of last plump,ing: Date Comments (on,, pumping recommendations,1 inlet and outlet to or baffle condition, structural integrity, liiquid levels as related to outlet invert, evidence of leakage, et1c.): ..........._111111.111--...... ...... ............. ......... .....................-.............. ........... ........ ................. .......... ................................. ........... 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site planl)': Depth below grade-, .........._........ ........... ...........................- Material of construction: E] concrete El metal 0 fiberglass E] polyethyle�ne, El other(explain).- Dimensions: .......... ............... Ca,parity: .................. —___-----_----------------------- gallons Design Flow ........ gallons per day t5ins,p.doc-rev,7/2,612018 Title 51 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 rCommonwealth c ico' I Insp-m-ect"ilon Form 1� Tutle 5 0""ffe' ia ................... ................ � 1 Subsurface Sewwage Disposal System Form Not for Voluntary Assessments 188,1 Pond Road Great .�... ...,.,,,..k. _.LL-..... --.. Iron rs Simone T Marchand ch.ard*_------....... ..................... Owner ............ .... .._._._.. ....`..v -.............. l mm........... i _..... _................_._.... _._.._._..m .-.... Owner's Name informiation is required'! or every � �� page. City/Town Stag Zip Code Date of Inspection D. System Information (con�t.,) Task c t, Alarm rep rat: Yes No Alarmlevel-, ...... ..._-- _._.................................. A,lIarm i olrking order-, El Yes No Date of It plumping: t CommentsIt t alar,m andt'l lat switches, etc.): -------- Attach copyof cure t pumping c (required). Is copy attached? 01 Y Sriblut*1on Box (if preselnt must be openield), (locate n gat n Depth of liquid level above outletiv (noteComments if is level andl tr ution to outlets u 1, any evidence of s,ollids carryover, any evidence of leakage into r t of boix, etc.): _q ldistribution, n littl soli Carr � r. u o � u w_r _ _mm_. ....... .. �_ mmm ....... M t5a .roe . /26/2 u l 5 Olffic4 Inspection Form:Subsurface Sewage D a sal System-Page 12 of 1 %.,ommonwealth of Massachusetts Tille 5 UTTIcial Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ~M 1881.G....�re_a.t...P..._ond cad ......_. Property Address Simone T. Marchand Irrevocable `rust...(.....is elle..Ricer...ward'§ __.._._......�.� Owner _.. .. ........_w_ m. .w._ _..____. Owner's Name information Is . Andover IAA 5 22/2 26 required for even _..- .___.....�.. _..... .. ......... ._.__-------- page. _m_......._ _ City/'Town State Zip Code Date of Inspection D. System Information (cont.) . Pump Chamber(locate on site plan)- Pumps in working order: El Yes 0 N'" Alarms in working order. El Yes 0 N 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. So ill Absorption System SAS (locate on site plan, excavation not required)- If SAS not located, explain wh �- Type* leaching pits nrbe�r, leaching chambers number: __..�._... ._MM._.._w�...��... leaching galleries number: ......._........_ _...w.��... 3 -401 leaching trenches number, length: leaching fields number, dimensions: _..... ..... ....._ ....._ . _w_.._.. .._. overflow cesspool number, ------ .................._. innovative/alternative system Type/name of technology: ...._ ._..._....._ ........-------- _... ... _ ..___.__ ._..mm.__.. t5ins .doc.rev.7/26/2018 rifle 5 Official Inspection Fora,Subsurface Sewage Disposal System•Page 13 of 1 . � TICI T Im t" I e 5� %4Jft'TfiN Arm! al Inspection, Foirm s" Subsurface Sewage 11311"s o y , ' ' l Not for Voluntary Assessments N � 1 Gireat Pond Road ._.... _.._. ..w....... .._... w............ Property Address Simone T Marchand Irrevocable Trust ds ____ _,_..w.._ m Owner Owner-s-1 Name information is No Andover M ! 1845 2 /2 26 required for every .�m�._ .. �� .m_... ._...��.... �_m.A.�m..�.�m.mm� �...- -. .. ......a�....�.. . , ...-_ ..........-.-.-.-. page City/Town State Zip Code Date of Inspection D., System Information (con 11. i'� s a r o' a ('cont.) Comments condition of soil, signs hydraulic failure, level' of pondling, damp,soil, condlition of vegetation, etc.): No ponding,, no damp soils, no hydraulic failure,. Stone still Tooke good, considering the age of the ____ . ... 12. Cess ls cesspool must be pumped as part of inspection (locate on site plea): N � er and configuration�� w__��.�mm��w-._._w.�__ __..... . ..... . ........................................... Depth th —top of liquid to inlet, invert ...... Depth of solids layer Depth f scum Layer .. .... ._..................�---- Dimensions of cesspool Materials of construction Indication of groundwater inflow Yes �� No Comments (note condition of soil, signs,of hydraulic fail re,1 level of pon,ding, condition of vegetation, etc. t5l ,pi.do .rev.7/ /2018 Title 5 Official Inspection,Form:Subsurface Sewage Di,spo I System-Page 14 of 1 Comm�oin� ialth oifMassachusetts tA -=.I.- 4a ici'al Inisp!ec,t,i"on Form W _..v , T"t,le 5 Offo fA Subsurface Sewage Disposal System Form Not for Vol rotary Assessments, �.e 1881 Great Pond Road Property Address i .. .....��._.._ Irrevocable ...� . V a ... Owner _-� ._.... _.. .......... ..mm................... ......... .............. information is MA Oil required for every wN.._... .-----..__._.�_. ... �__...... �� - City/Town gate Zip Code Date..of. w__Inspection D. System Information (cont) 131. rlivy (loca,te on site n : Materials f construction: Dirnensions ..... ---- m...- ........... ............................ .... _.._... Depth ' I .. Comments to condition ofsoil, signs of hydraulicfailure, level 'poi n �, condition of v t etc.), f5i s , w rev.7/26/2018 T"fle 5 Official Inspection Form:Subsurface sewage Dsposal Sylst m,.Page 15 of 1 Commonwealth of Massachusetts T1"t1e 5 Off'icial Forn7 Subsurface Sewage Disposal System Form Not for Voluntary Assessments � 1881 Great Pond Road Property Address Simone T. Marchand Irrevocable Trust Owner owner's Marne information is No. Andover MA o'184� required for every 08/11/2026 page. Cityffown 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 eaters the building. Check one of the boxes below: hand-sketch in the area below [� drawing attached separately P, Y }i i Y 1 t5insp.doe■rev.7128i2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 E AL O'k 1utficia Inspec ionFor k Subsurface Sewage Disposal System Forms Not for Voluntary Assessments 1881 Gireat Pond Road Property Address Simone T. Marchand Irrevocable Trust ds Owner Owner's Name information is o. Andover 01845 /2 / 6 required for every eta Zip ..�....� �t�� ..�... ...w...... .�..._...._ ....�__...._...�...._ w.�....._w.._. _._ ..__...__.._...._...Mm......_... . . ......�..._ ._.... ._ - - __. _._. __..._...._........ ..._._..._ _Mm_.._ .M._.Mm .... page. City/Town p nspection D. System Information (coat.) 15. Site Exam: Check Slope El Surface water E Check cellar El Shallow swells Estimated depth to high round rater. ' ..._..__._. ......__.___._.___.mm............ feet Please indicate all methods used to determine the high ground rater elevation.- Obtained from system design plans on record If checked, date of design plan reviewed. ... .. __u ......... _ ----------_. [date El Observed site (abutting property/observation hole within 150 feet of SAS) Checked with focal Board of Health -explain: No_p s on file for e ic s tem.__w__.k ------- Checked with local excavators, installers- (attach documentation) El Accessed USES database -explain: You must describe hew you established the high ground water elevation: Basement floor is approximately .5" below the bottom of the system. No sump pump in basement, floor,is d...r� ...._M.... _._._.__� ►efore filling this Inspection Report, please see Report Completeness Checklist on next page. t5in p,do •rev.7/ /015 Title 5 Official Inspection Farr:Subsurface Sewage7i pc l System•Fags 17 of 18 Commonwealth of Massachusetts T"tle 5 Off"icial Inspect"ion For mw° J� Subsurface Sewage Dlsposal System Farm Not for Voluntary Assessments r1881 Great Pored Road ______e_ -____w_.__w ..._._ _.__._-________--------------- wµ....._...�.__.._._..._.__�......_w..._._. ...__. ._..._. __ _. Property Address Simone T. Marchand Irrevocable Trust jMichelle I�� rd� _------ Owner _______._._._._.___.._.__._.._ ._.._ __.._. . ... _... . _......_......_..._........ Owner's Name..�....__._ information is o. Andover ILIA 01845 /22/2 2 � requiredfor every City/Town ��t�w._.__._ '_._.. ed�._�. _.._ __u__.__-...___... __....p__..�._.._.___..._.n......_.___...� ._._...__ .__. _.._.___._.�._�_.__....��..._..._._... � � of Inspection E. Repoft Completeness Checklist Complete a all appllicable sections of this form linclusive of A. inspector Information* Complete all fields in this section. . Certification- Signed & Gated and 1, 21 3, or 4 checked C. Inspection Summary: 11 27 , ter 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed D. System Information: For : Tight/Holding Tank-- Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 1 : Explanation of estimated depth to high groundwater included t in p.do •rev. /'26/2 18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 1