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Home My WebLink AboutPASS - Title V Inspection Report - 212 HAY MEADOW ROAD 6/11/2025 Massachusetts%.pommionwealth of _ U N o 11, 2 itle 5 Official Inspect"ion Form Subsurface, Sewage, rsp ws 1 System Form 1- Not for Volluntary Assessment ti 212 HAY MEADOW ROAD Property Address ON MAL0,LEPSZY Owner vier"s Name �,,,:.�w� ��: ��:�� ......_. It" rm� tion as NORTHre ir+ for even '"�� 018,45 JUNE 11 2025 page. City/Town Stets Zip Cod's Date of Inspection ibspection results rust be submittedthis form. Inspection forms may not be altered in any way., Please see completeness checklist at the end of the form. Important When A'tilling ! firmsector Information orl the computer, use only the tab Todd James Bateson key to moire your Name of Inspector cursor-do not, Bates Enterprises 1 ck use the return m Company Name 111 A,rgillaRoad I'd, Complany Address �.�. �. .w ��.. Andover MA CIt ................ 01810 rT+ r State Zip Code 9718-475-4786 Telephone u s er License I r l er B. Certification certify that: I am a DEP approvedsystlem Inspector in full compliance with Section .3 _itle (3`10 CMR 11 - ; 1 have personally, inspected th sewage disposal,system at the property address listed above; the information reported below 's true, accurate and complete as ofthe time of ray inspection; and theinspection was, performed beau' on my training and experience In the! proper function and maintenance of '-site sewage disposal systems. After conducting this inspection 1 have determined that the system,: 1� N P b, El Conditionally Passes . EJ Needs Further Evaluation y the Local Approving Authionty 4. Veils ,r lit rn IN E IZI 2025 5 Irrs, for's Signature Date The system inspector shall submit a copy of this inspection report lto the Approving Authority (Board of 1 ea,1t11 or DEP) within 310 days completing this inspection,, If the system has a design flow of 1011000 gpd or greater t ie inspector and the,system owner sb ll submit the r pl in to the appropriate regional the DEP. The original form should ant to,the systern owrier and cis sent t the buyer, if applicable, and they approving th rity Please notel This report my describesconditions at the time of inspection and! under the conditions of use, t that time. This inspection does not address how the system will perform to the future cinder the same or different conditions, of use. t5i ns p., -rev,7/2612,01 B Me 5 Official Inspection Form:Subsurface Sewlagel Disposal System-Page I of 1 Commonwealth of Massachusetts, 11i,t1e 5 Offi,,cial Inspect' Form ion Subsurface Sewage Disposal System Form Not for Voluntary Assessment 212 HAY MEADOW ROAD Property Address JOHN MLES , _ . ... Owner 's Name Information NORTH ANDOVER M 5 E 1 2 , 5 required for eves �, ...�_ page. Itown State Gode Dateof Inspection C. Inspection, Summary Inspection Summary.,mar . Complete 1 a 2, 3, or 5 and all of 4 and6. se asses l have not found any information which indicates that any of the failure criteria,described in 310, CMR 15.303 or in 310 CMR 15.3,014exist, Any failure criteria not evaluated ar+ indicated be1 .. 2 System Conditi l asses. El one,or more system components mponents s, described in the "Conditional ease section need to be replaced or repaired. The system, upon completion of the replacement or repair, as appr ed time Board f'l e lth will pass. Check the box for yes", "no r"not t rminield (Y,, INI, N' for the following statements. if not etermirm w" please explain,, septic tank is metal l n over 20 years old* or the septic tan (whether metal tali r not) is structurally unsound,, exhibits substantial 'infiltration or exfiltration or tank failure is imminent.t. System will pass inspection if the existing tan is replaced with a complying septic tank as approv 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 2 ears old is available. El Y �N E:] xlaim 'below). t5in .d -re w 7/26120118 Title Official Inspectlon Forn SubWrfate Sewage Di l System&Page 2 of.1 Commonwealth, of Massachusetts T"tle 5 Official InsForm ;A _I Subsurface Sewage Disposal System Form Not for Voluntary Assessiments 212 HAY MEADOW ROAD ................. ........... ............--- Property Address JOHN MALOLEPSZY Owner ner's Name information,is NORTH ANDOVER MA 01845 JUKE 11 1 2025 requiredfor every - ...................................... m. . ................................................ ................. page. City/Town Mate Zip Code Date of InspeGtion C., Inspection, Summary (corit.) 2), Systeam Condiltionally Passes (cont,,),, Pump,Chamber pumps/alarms, not operational. System will pass with Board of'Health, approvalif pumps/alarms are repaired. El Observation of sewage backup or break i or high, static water level in the distribution box d1ule to, broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass [Inspection if(w,ith approval of Board of Health): broken pipe(s)are replaced' El Y r-I N El Ni (Explain bellow).: obstruction is removed [:1 Y 0 N [:1 ND (Explain below): distribution box is leveled or replaced E] Y [:1 N El AND (Explain below)- ............................................................................................ ..................................................... I.................. .................... ......................... .............. E] Thy,system required ,pumping more than 4 times a year due,to broken, or obstructed pipei(s). The system will pass inspection if(with approval olf the Board of Health): broken pipe(s) are replaced El Y E:1 N E:1 N'D (Ex plain below), obstruction is removed Ej Y [:1 NEI ND (Explain below)- ....... ......................1-............ ............ .......... .............. ........................................................... -...................................._.'.-......................................................_'111.1-...... ............- 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 falling to protect public health, safety or the environment. a. System will pass unless Board of Health determines in aclicordance with 310 CMR 15.303(l)(b)that the system is not,functioning in a manner which will protect publilc health,, safety and the envi iron me,nt: t5iinsp.doc rev.71261,2018 Title 5 Official Inspection Foirm:Subsurface Slewaige,Disposal System,-Page 3 of 18 Commonwealth, of Massachusetts lrli,tle 5 Officiai inspection, Form .............. Subsurface Sewage Disposal System Form Not for Volunta�ry Assessments, Al 6. 212 HAY MEADOW ROAD roperty Address JOHN E SZY Owner Owner's Name information NORTH ANDOVER MA 01845 E 1 20�25 required for eves ".n. M.m _.: . i /Town State ZIP Code, Date Inspection .__.. C. Inspection Summary E] Cesspool or privy is,within 50,feet f'a surface water Cesspool or privy "I's within 50 feet of a bordering 'vegetated wetland or a salt marsh System will fall unease the Board of Heart i (and Public Water Supplier, if any) determi,nes that the system is functioning, in a manner that protects,the public health, safety and environment: E] The,system has septic tan tankr 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 astern has a, septictank and SAS and the SAS as within a Zone I of a public water supply. El The system has a septic tank and SAS and the SAS is within 50 feet of a privatewater supply well., El The system, has a septic tank andSAS and the SAS is less than 100 feet,but 50 feet or more from a private to water supply ll . Method used to,determinedistance: This system passes if the well water anatysis, performed at a DEP certified laboratory, for fecal c llf rn bacteria indicates absent and the presence of ammoni(a 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. cX Other: 1) Systern Failure Criteria Applicable to All Systems: You must indicate "Yes" r" " to each of the following ,for all inspections. Yes N Backup f sewage into facility, r system component ue to overloaded or E] E c,logg,ed SAS or cesspool El 2 Discharge r pondingi, of effluent to the surface of the ground or surface waters due to an overloadedr cl e ' SAS or cesspool t j=ri p, -rev.7/2612018 TRIe 5 official Inspection Form,:Subsurface Sewage Disposal System-Page of 18, Commonwealth Massachusetts 'Icia Tiltle OR U'T'T'* I Inspect"ton Form ..i SubsuTface Sewage Disposal System Form Not for Voluntary,Assessments 212 HAY MEADOWROAD property Address JOHN,MALO,L,EPSZY Owner Owner's Name Information is NORTH AN OV AMA 01845 J U� I 11, 2025 requiredfor v �. m M � .... � ...�......... _ .. _ w... page. 6If w State Zip Code Date of Inspection C. Inspection Summary (ct 4) System F'allure CriteriaNicol All, Systems: (coat.) Yes, Nio Static liquid level in the distribution box above outlet invert due to n overloaded or clogged SAS or cesspool Liquid depth in cesspool is less th in 6" below invert or available volume is, less than %day f'low Required rein , snore,than,4, times in the lust year NOT due to clogged or obstructed i e(s).. Number of times u . Any portion of the SAS cesspool or privy is below high, ground water elevation., Any portion of cesspool or privy is within 100 feet of a surface water supply r tributary to a surface water supply., Any portion of a cesspool or privy is within a Zone 1 'a public water supply well. El E Any portiona cesspool or privy is within 50 feet of a private water supply well. El M 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 acceptably water quality analysis. is system passes i"u the well water analysis, armed at a D,EP certified laboratory, for ec id colifform bacteria ria indicates, absent,and the presence of ammonia nitrogen and, nitrate, nitrogen is equal to or less than 5 p,pmi,. provided that, no other failure criteria are triggered. A copy of the anallysis and claims of custody must be attached to this rm.,] El 0 ' e system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. El 0 The,system fall's. I have determined that one or more of the above falture criteria exist as described in 310 CMR 15.,3 3, therefore the!system fails. The system owner shou Id contact the Board of Health to determine what will. necessary to correct the failure.. 5 Large Systems To be cons,idered a large system the system must serve a facility with s1li n flow of 10,000gpd to 15,000 gpd. For large systems, you must indicate anther es"'or no" to each of the following, in addition to the, questions, in, Section C* w Yes N El F1 the system is within,400 feat of a surface drinking water supply, El El 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 Pr tecti n Are I r a, mapped Zone 11 of a public water supply well t5insp.d,ocw rev.7126/2018 Tile 5 Official Inspection Form,Subsurface Sewage Disposal Systern.Page 5 of 18 a}, uomwionwealth of Massachusetts ltl�e 10A :m Subsurface Sewage Disposal System Form Not for Voluntary Assessments da 212 HAY MEADOW ROAD Property 'ire , JOHN L 1 SAY ..... . Owner Owner's Name information is 5 JUNE 111 2025 �r ui�r for eves W. page.. City/Tows State Zap Code Date of Inspection C., Inspecti cont.), If you have answered es" 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 tailed. The owner or operator,of any large system considered a significant threat under Section C.5 or,failed under Section CAS shall upgrade the system in accordance with 3110, CIVIR. 15.304. The system owner should contact the appropriate regional office of the Department. 6. You meat indi a e "yes" r"no" for each of the Following for all t s i s Yes No Pumping information was provided by thie owner, occ,upant, or Board of Health Were any of the system components pumpe out in the previous two weeks? E El Has the system received n rr al flows inn the, re i n k 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 NI 'Was the facility or dwelling inspected for signs of sewage back E F1 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 thie interior of the tank inspected for the,condition of the baffles or tees, material of construction, n, dimensions, depth of liquid, depot of'sludge and depth of scu Was, the facility, owner(and occupants, if different fromowner) provided with information on the proper maintenance of subsurface sewage disposal systems? e size and location of the Soil Absorption System (SAS) on the site has been determined based n Existing information. For example, a plan at the Board of Health. Determined ine in the field i any of the failure criteria related'! to fart C is at issue approximation ustan is unacceptable) [310 CMR, 1 t in p, oc-rev.712612018 Titre 5 Official InspectionForm:Subsurface Sewage Disposal Systern.'Page 6 of 1 Commonwealth off' Massaco husetts "kill X itle 51m Official Ins ect"ioln Form T P nil Subsurface, Sewage Disposal System Form Not for Voluntary Assessments 212 HAY MEADOW ROAD Property Address JOHN MALOLEPSZY ............ Owner er's Name information is required for every NORTH ANDOVER ....M. A............. ..J• N E 11 �2025 ................... page. fit f Ti --- ..................................................................................... State Zip Code „bpi-"o,f'I ns p',e-,",c t i"o",............n..................... D. System Information 1. Res,idential Flow Conditions: 4, 4 Number of bedrooms (design): Number of bedrooms (actual DESIGN flow based on 310 CMR, 15.203 for exams plew 1110, gpd x#of bedrolloms),# Description.: .............. .................... -.."............ ........... ....... .............. ..........-...................... ............................. ....................... .......................... 5 Number of current residents: Does residenicle have a garbage girincler? Yes No Does, residenice have a water treatment unit? El Yes 0 No If yes, discharges to: .......................... Is laundry on a separate sewage system? (Includ e laundry system 'Inspection El Yes M No information in this reportf , ., Laundry system inspected? Yes Seasonal use? El Yes 0 No SE E ATTACHED Water meter readings, if a,vai'la,ble (last 2 years usage (,gpd)),,, Detail: ......................... ....... .................... .......................... ..........-"ll........... ............ .........................-.-........... ............. .....................................-",................................. ......... ............ Sump Pump?. El Yes 0 No Last date of occupancy: C Ul R R E N T' Date t5insp.doc-rev,7126/2018 Title:5 Official Inspection Forrn:Subsurface Sewage Disposal System-'Page 7 of 18 P� Commonwealt of Massachusetts, or,m Tiltle U0%TrTrN1ci'a1 1ns,&pqN&ectm,'i0on Subsurface Sewage Disposal System Form - Not-for Volunt ary Assessments bf 212 HAY M EA,DOW ROAD ........... .......... ......................... ................... ............................ ........................ Property Address JOHN IVIALOLEPSZY ................ ......................_................................................._"................................... Owner Ownerli s Name inform�ation is required for every NORTH ANDOVER MA 01845 JUNE 111 2025 ................... page. City owe State Zip Code Date of Inspection D. System I nformation (cant) 2., Commercial/Industrial Flow Conditions: Type of Establishment: ................. Design flow (based on 310 CMR 15.203),* Gallons ple�r day(gpd) Basis of design flow(seats/persons/sq.ft., etc.Y .ry .m.. mmGrease trap present? El Yes El No Water treatment unit present? El Yes F] No If yes, discharges to,, .........._'_.........a____....... Industrial waste holding to present? E] Yes, No Non-sanitary waste discharged to the Title 5 system.? 'Yes Water meter reading�s, if ail lei Last,date of occupancy/use: t I e ........— O I then(describe below): ....................... .......... ...................... ........... .................... ........................................... .......... ............. ....................... ............ .............. ........................... 3. Pumping Records: information: BATESON ENTERPRISES INC APRI'L 2025 Source of ........................... Was,system pumped as part of the Inspection? El Yes 0 No If yes, volurne pumped- ... ........ ............. gallons, ................................... How was quantity, pumped determined? Reason for pumping: ........................... ............ t5insp.doc-rev.7/26/2018 Tifle 5 Off iciall Inspection Forte:Subsudace,sewage Disposal System-Page,8 of 18 %.Pommonwealth of Massa c h usefts i Form I BrA T�ultle 5, Ot"t"imcnial Insoolec Slubsurfaice Sewage Disposal System Foirm Not for,Volluntary Assessments 212 HAY' MEADOW ROAD ......................... ................... ............. .............................. .1........ Property Address JOHN A ML0LEP'SZY ................."' -' ..... ...................... ....................................................................................................................... ............................ Owne�r 6-wner's Name information is NORTH ANDOVER MA 01845 JUNE 11 2 25 .............. ........... required for every, City[Town State Zip Code, Date of inspection page. Di. System I nformation (cont.) Type,of System: z Septic tank, distribution box, soil absorption system El Single cesspool E] Overflow cesspool El Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Inn ovati've/Alt ernative 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. F-1 Other(describe): ........... ....................--'-.......... Approximate age of all components, date installed, (i'f known)and source of informatiom 24 YEARS, INSTALLED AUGUST 2,001 t AS BUILT ........... Were sewage odors detected when arriving at the site?. El Yes 0 No, 5, Building Sewer(locate,on, site plan). Depthbelow grade- 531-I-'-- ..................... ................................................................................................................................................................................................feet Material of construction,,. 0 cast iron El 40 PVC Ej other(explain)- Distancefrom private water,supply well or suction line: t....................................................................................................................................................................... ....................................................................... Comments (on condition of joints, venting, evidence of leakage, etc.),-, JOINTS ARE SOT VISISBLE IN WALL 'VENTING OK- NO ODORS DETECTED NO, EVIDENCE OF LEAKAGE ................. .......... .................-................... .................... t5 urn sp.doc rev,7126/2018 Tille 5 Offi ial Inspection Form:Su su oe Sewage Disposal System-Page of 18 Commonwealth `fficiai ins"',,ection Form 2 r IL :,p 11ne 5 u Subsurface Sewage Diisposal System Form - Not for Voluntary Assessments 212 HAY MEADOWROAD, Property Address JOHN ALOE 1 SZ Owner Owner's Name information is required�for every �NORTH ANDOVER ............................. MIA Oil 845 JUNE 111 2025 page. Cii own State Zip Code Date of Inspection D. System Information (cont. e Septic Tank (locate our site plan),. ,Depth below r � "Ve t............ m.. ...,, .... f Material of construction: 0 concrete El metal fiberglass _] polyethylene El offer(explain If tank is metal, list age* .rv....ww. yearn Is age confirmed by a Certificate f Compliance'? (attach a,copy ofcertificate) Yes __ No 1 "X5"X " Dimensions: -........................ 1I Sludge depth 34" Distance from top f sludge to, bottom of outlet.fee or baffleNA .M�. . Distance from top of scum to top,of'outlet fee r baffle Distance from bottom of scum to of f outlet fey r baffle N SLUDHow were dimension �f�rrin� G � � �l ! P Comments (our pumping recommendations, inleit and outlet tee or baffle condition, structural integrity, liquid levels as related to u tl f invert, evidence of leafage, etc.),-. REC0,MMEND PUMPINGOLDER SYSTEMS YEARLY CONCRETE INLETAND OUTLET BAFFLES OK TANK IS OK LIQUID EVELS GOOD O EVIDENCE LEAKAGE Mn,p, oc rev..7/2612018 TitleOfficial inspection Form subsurface Sewage Disposal System Page 10 of 1 uommionweafth of Massachusetts, T MAIL" itle 5 i'c"i n ion Form > Subsurface Sewage Disposal System Form Not for Voluntary Assessments ' 212 MEADOW ROAD ............Property Address JOHN MALOLEPSZY ............ ........ Owner Owner's,Name information is NORTH ANDOVER MA 01845 JUKE 11 20,25 required for every ........................ .................. page. City/Town State Zip Code! Date of Inspection D. System Information (cont) T Grease Trap (locate on site plan): Depth below grade. ......................... ......... Material, of construction: El concrete El metal E:1 fiberglass Ej polyethylene Ej other(explain): ...........,---—----------- Dimensions, .............. Scum thickness, ................................................... Distanc from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle .m Date of last,pumping* b,a-1: 111.111.1111.1�l.-I'll,�.11,11�,,�ll,�,,�,�1.11.111,11,�'ll-I'll�'ll""'ll",Ill".--,,--"-�l---- Comments,(ors pumping recommendations, inlet anid outlet tee or baffle condition, structural integrity, lliquid levels as related to outlet invert; evidence of leakage, etc,.): ....................................................... ..........111111111............... ................................................. 8. Tight or Holding 'Tank (tank must be pumped at time of inspection) (locate on site plan).: Depth below grade: Material of construction-.1, El concrete El metal fiberglass El polyethylene El other(explailn):' ................... .................... ..............111,.........._11.1.111111111111111................. Dimensions: ...........-.1111-111......................."I'll.............. ............ .............. Capacity ........................ gallons Design Flow" ........................................................ ..........,"..".......... gallons per day t5insp,doc-rev.7'121612018 'Title,5 Offidal Inspection Form,Subsurface Sewage Disposal System-Page I of 18 Commonwealth of Massachusetts ............. ........... . Subsurface Sewage Dig Form Not for Voluntary nta Assessments 12,n HAY MEADOW ROAD Property Address Owner JOHN 1" LL SZY Owner's me information is NORTH A VER M 1 JUKE 1, 2025 required for every page., City/Town City/Town State Zip Code Date of Inspection D. System Information (con't,.) 8. Tight or Holding caw Alarm present, Yes No Alarm, level: Marm,in working order. El Yes l Date last rn i * ate--- ....................� .... . ,u... ............. . . ......... ..... .., ..... Comments (condition of alarm,and float switches, etc. Attach copy of current:pumping contract (required). Is copy attached? Yes 0 No Distribution Box if present must be opened) (locate n site plan. Depth f liquid i levell above outlet invert Comments (noteff box is level and, istrib ti n to outlets equal, any evidence of solids,carryover, any evidence f leakage into or out of box, etc.),: -BOX IS LEVEL AND DISTRIBUTIONIS, EQUAL NO EVIDENCE SOLIDS CARRYOVER NO EVIDENCE OF LEAKAGE t6insp.doc rep.7126,120118 TitleOfficial Inspection,Form,Subsufface,Sewage Disposal System-Fags 12 of 1 ts Commonwealth of Massachuset (7� TI-Id-,le, 5 uo"",ffilmcial Inspectimon Form Subsurface Sewage Disposal System Form ,- Not for Voluntary Assessments 212 HAY MEADOWROAD ............... Property Address JOHN MALOLEPS,ZY Owner Owner's Name information is required for every NORTH ANDOVER MA, 018451 JUNE 111 20,25 page. Cityffown, State Zip Code Date of Inspection System Information (cont.) 10. Pump Chamber(locate on site plan,):, Pumps in working order: E Yes, El No* Alarms 'in working order- E Yes, El No* Comments (note condition of pump chamber, condition of s and appurtenances, etc.,): PUMP CYCLED ON THEN OFF FLOATS OK ALARM PANEL IN GARAGE OK .................. ............................ ............. ..................................................................................... ................. If pumps or alarms,are riot in working order, system is a conditional pass. 11 Soil',Absorpflon System (SAS) (locate on site plan, excavation not required).- If SAS not located, explain why .................... ....... ... ............. ........................................... ..................-'....................... ........ ......... ............................. ............................................................................................... ................ Type: El leaching pits n=ber, .................. leaching chambers number: El leaching galleries number: .................. leaching trenches number, length: . ... 1; 15',X 60' leachinig fields number, dimensions: .......... ............. overflow cesspool number-' ....... El innovative/all,ternative,system Type/name of technology.: t5insp,ldoc-rev.7112612.018 Title 6 Official Inspection Form,Subsurfaiee Sewage Disposal System-Page,13,of 18 uommoriweatth of Massachusetts tip% 5 u'ff'" I Inswobect" icia ion Form - . Subsurfaces Sewage Disposall System Fo,rm Not for Voluntary Assessments ..- 212 HAY MEADOW ROAD ..... Aioperty,Address JOHN 1ESZY Owner n r& e iinfrrutln i required for every NORTH ANDOVERw r.. n, MA 01845.. ..,,........ „.m page. Cit wn State Zip bode Date of Inspectl r D. System Information 11. Soil Absorption System ('SAS,) (coat.) Comments (rote condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of egietati n, etc..): SOIL.AND VEGETATION O,I NO EVIDENCE OF HYDRAULIC FAILURE, OR PONDING 2. Cesspools (cesspool rust be pumped as part of inspection) (locate on site, l n)�. Depth. topof'liquid to inlet.invert �.... ..u�,.. Depth f solids layer . Depth f scum layer ......... ................ Dimensions f cesspool _ �.. �. Materials f construction, .. ..... Indication of groundwater inflow Ye s Com,me its (note condition of soil, signs of hydraulic failure, level of ponding, condition f vegetation,, etc.): Minsp,doc rev.7/26/2018 TitleOfficial Inspection Form"Subsurface Sewage 1 o l Systemi-Page 14 01 Commonwealth o�f Massachuseft,s T NA- itle 5 Off'oicoial Inspect"i,on Form Subsurface Sewage s s lI System Form Not for Voluntary Asses meets, 212 KAYMEADOW ROAD .......... ...... .......... ........... Property Address JOHN MALOLEPSZY ..................... n e"-r"-s--N-...........-a m-e-----—------................ information is NORTH,ANDOVER MA 01845 JUNE 1111 2025 required for every .................. page. t y-/To w n' State Zip Code Date of Inspection, Di. System Information (cont.) 13., Pr*ffy (locate on site plan)* Materials of construction: ............. Dimensions ............... Depthof solids ..................................... ....................... Comments (note condition of soil, signs of hydraulic failure, level of ponding, condifion of vegetation, .............................. .......................................... .......... ......... ....... ... ....... ............ ........... t5insp.doa-rev.7/26/2018 Titte 5 Official Inspection,Foci:Subsurface Sewage Disposal System-1 Page 15 of 18 uommonwealthMassachusetts Tolitle :on, Form Off'mici"al Inspecti'' �s Subsurface Sewage D'I'sposa] r Not for Voluntary Assessments 212 HAY MEADOW ROAD Property Address H N, MALO,LEPSZY Owner Owner's Nam; information s NORTH A VE JUNK 2 26 required for � � � .�„ ��... page. City/Town State Zip Code date ofit e ti n D., System Information (cont.) u ,, Skertch 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 well's within, 100 feet. Locate where public water supply eaters, the building. Check one of the foxes below. hand sketch I the area below El drawing attached separately rj 0 10 Ill 9i. I � � �� r.�mm�rsmm��ai..n.�nmG iimmrwnnre�,.. .d�.a.�.m mm��+.®.�..�•--......+s-.mmm+-�..- yyWr✓,'vrvu axon r I h. "e"",1101"Oele"'01 I 060 w �ll�r�IlAlln�SY��Nr wM�w,.i� jjjjjj¢�Yrxx� ou rc 'A''/ wi s: 0i,io�99/7Ti, Jl7Y%'l'•ir,GsIT� DPI YYl?.'fmy^^6!?'c0'r^P.r�. g D flw a rim r s:,u�yy um nr urn n ii r;Y m mr r�iryr,,,2,,;rr,r t5insp,,doc rev.7/2612018 TRIa 5 Official inspeation Form,Subsurface S la' DI P S1 S,ystem"Fags'16,of,18 Commonwealth of Massachusetts ................ Title 5 Official Inspect0ion Form iR Subs,u,rface S�ewage Disposal System Form Not for Voluntary Assessments f16 212 HAY MEADOW ROAD .................................................... ...... ..................... .............................................. .................................................................................................... .......................... Property Address Owner JOHN, MiA,LOLEPS�ZY Owner's Name information is NORTH In MA 01845 JUNE 11 2025 required:for every .......... .................................................. ............... .......... ...................... - page. City/T'own State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope Surface water Check cellar El Shallow wells Estimateddepth to high ground water- ............................................................................................................. Please indicate all methods used to,determine the high ground,water elevation,, z Obtained from sysrl design plans on record NOV EMBER 2000 If checked, date ' siI lan 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) I Accessed USES database, -explain: ......... ..................... You must describe how you established the high, ground water elevation* DESIGN PLAN ON FILE ..................................................-.................... ........... ............... ............ ........... ............................................................ .............................. ......................... .......... ...................................... ......................... ..................... .......................... Before filing this Inspection Report, p1ease see Report Completeness, Checklist on next page. 15insp.do,c-rev.7/26/2018 Tithe 6 O'fill Inspection Form:,Subsuirface Sewage Disposal System-Page 17 of 18 uommanwealth of Massachusetts _.v le 5 Official Inspect"ion Form „.y ,siw „,. rrrrrrrr�« ® r Subsurface Sewage Disposal System Form Not for Voluntary Assessments, � ^ 212 HAY MEADOW ROAD roperty Address O'HN MALOLEPSZY information isr,equired for every NORTH'ANDOVERU N,E 11 2 025 page. City[Town State Zip Code Date of IIns,pection E. Report Completeness Complete all applicable sections of this dorm *I clusiv of,., A. Inspector Information: CompIete all fie l' s in this section. B. Certification- Signed 1& Dated and 1� .21 3,, or 4 checked C. inspection Summary- 1 21 ' , or 5 completed as appropriate (Failure Criteria)and 6 (,Checklist) completed D. System Information', For, w Tit 'lire " nk— Pumping, contract attached Fir 14:1 Skate, Selwage Disposal System,drawn on pg,. 16 or attached For 1 :1 Explanation estimated depth to 'high groundwater Included t5hs . -rev.712612018, Title 5 Official Inspection Form,Subsurface urf Sewage IDisposal System Page,18 of 1 Summary Record C!a,(,d generated on 611212025 Z;36,22 PM by Tat a Kirley Pago I A Town North Andover, 'Tax Map # 210,4043-007T,0000,120 Parcel Id 16400 212 HAY MEADOW ROAD MALOLEPSZY, JOHN Since Jan 2012 MALOLEPSZY, MA 212 HAY MEADOWROAD NORTH ANDOVER, MA 01845 Class, 101 Slagle Family Property Type 1 Residential Size Total 1.09 Acres FY 2025 UB Vr MailinpL,jndex Name/Address, 1we Loan Number Actilve/Inact. From Until JOHN MALOEPSZY Owner Active 212 HAY MEADOW ROAD NORTH AND OVER,,MA 01845 MAC RIDES',STEPHEN Previous,Customer Inactive 6/3,0/2005 212 HAY MEADOW ROAD N.ANDOVER,MA 01845, UB Account Maint, Account No Cycle Occupant Name Active/Inactive Bldg Id. 1811110-212 HAY MEADOW ROAD Last Billing Data 4/ 2025 3180141 03 cycle:03 Active UB Services Maint Account No.3180141 Service Code Rate, Charge MultIpIleriUears MIISCFEE ADMIN FEE 0,63518 7.82 1/ WTR WATER 01 ALL METER SIZE 49.40 /11 UB, Meter Maintenance Account,No.3180141 S'eria,l No Status Location Brand Type size YTD Cons 13242668 a Active 00 METE,METE w Water 0.6250.625 210, Date ma in e Consumption Posted IDate Variance 3112/20,26, 3131 a,Actual 13 4116/2 02 5 0% 12/11,/2024 3118 a Actual 13 1/1412025 167% 9/11/2024 3105 a,Actual 5 10/812024 -36% 6/1312024 3100, a Actual 8 7/2212024 -34%, 3/13/2,024 3092 a Actual 12 4/16,12024, 42%, 12/131/2023 3080 a Actual 8 1/1,` 24 0% 9/118/2023 3,072 aActual 9 10/13/2,023 -1 2% 6/13/2023 3063 3 Actual 10, 7/14/2023 -4% 10/'2023 3053 a Actual 10 4/12,12023 18% 12/9/2022 3043 a Actual 8 1/16/2023 28% 9/1412022 3035 aActual 7' 10/18/2,022 ",58:% 6/10/2022 30218 a Actual 16 7/18/20212 4% 3/110/2022 30112 a Actual 15 4/13/2022 21% 12/10/202 1 2997 a Act,ual 12 1/117/2022 -16% 9/1412021 2985 a Actual 16 10/15/2021 0% 6/9/20,21 2969 a Actual 15 7/27/2021, -18% 3/1012021 2954 a Actual 18 4/21/20211 21% 12/10/2020 2936, a Actual 15, 1/'131202 1 -10% 9/10/2020 2921 a,Actual 17 10/14/20,210 -17% 6/912,020 2904 a Actual 20 7/16/2,020 30% 3/1012020 2,884 a Actual 16 4/8/2020 -3% 12/12120,19 211869 a Actual 15 1/15/2020 -13% 9117/20,19 21854 a Actual 1 9 10/10/2019 -1% 6/14/2019 2835 aActual 19 7/25/2019 1% 3/12/2019 2816 a Actual 18 4/16/210,19 -116% 12/12/2018 2798 a Actual 21 1/22/2'019! 48%