HomeMy WebLinkAbout498 Salem St-Title 5-PASS - Title V Inspection Report - 498 SALEM STREET 7/15/2025 %,ommonwealth of Massachusetts
Tl"tle 5 Off" I Inspect"ion Form
ici,a
4 ... ..
Subsurface Sewage Disposal System Form
m It for Voluntary Assessments
;r498 SALEM STREET
property Address
Owner Owner's Larne
information is N, T AN DOVE R
required for every MA 01845 d U LY 11, 2025
page, City/Town State Zip Code Date of Inspection
Inspection results rust a submitted on tl�h f me . Ire ct on form r %1wo In a
ny
ay. Please see completeness checklist at the end oft11 foryNwn 00a,
Important:1J When
fillingout forms
A. Inspector Information
on the computer, JUL NZ5
use,only the tab Todd dames at son
key to move your Name_of Inspector
cursor-ado not Bateson Enterprises Inc.,
use the return
Ivey, Company Marne
111 Arg i l la Road
10 tab company address
:AndoverMA 1
--
City/Town State Zip Code
r 97 -475-4786 -16
S l
`telephone Number License Num er
B. Certification
I certify that'... I am a DEP approved system inspector in full compliance with Section 15.340
of Title
3" ; I have
personally inspected the sewage di posa,l system at the propertyaddress
listed above; the information reported below is true
p � ���ur�t�and complete ��of tlrn� 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, � p p
� p �� After conducting this... inspection I have determined
that the system:
I. ' Passes
2. El Conditionally Passes
3. El Needs Further Evaluation by the local Approving Authority
4. Fails
JULY 15, 20215
Ins c or's Si nat re taste
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of health or E +within � days of completing y completing this inspection. If the system has a design flaw of
101,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the P". The original farm shcu�ld� he sent
to the system owner and copies sent to
the buyer, if applicable, and the approving authority.,
Please note: This report,only describes condition at the time of inspection cti+�r� under the
condltlon of use at that time. T i ins ect on does no t + ress how the system will perform
in the future under the same or,different conditions of use.
t In p.doc-rev,7/26/2018 Title 5 Official inspection Form.Subsufface Sewage Di pos�l System.Pace 1 of 1
Commonwealth Massachusetts
Title 5 u't't'i",ci'al Inspect"ion Form
'z
FA
Subsurface Sewage Disposal sal System Form - Not for Voluntary Assessments
Property Address ..._.._.
M
JAC�C DoNOVAN
Owner Owner's Name
information M
rebut NORTH AI"�DOV R MA o1 45 JUL 11 2025
"red for every w.
page. City/Town State Zip Cede Cate of Inspection
. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
System Passes
I have not found any information which indicates that any of the failure criteria described
in 310 CIVIR 15.303 or in 310 C IVIR 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" M, N, ND for the following statements. If"not.
determined," please explain.
The septic tank is metal and over 20 years olds` or the septic tank(whether metal or not) is structural!ly
unsound, exhibits substantial infiltration or exfiltratl`on or tank failure is imminent. System will pass
insp
ection ction i
If the existing tank s 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 F] N N (Explain below):
t insp.dcc rev.7/26/2018 Title 5 Official inspection Farm:Subsurface Sewage Disposal System.Page 2 of 18
µCommonwealth + f Massachusetts
tie 5 Otticial Inspectio� Form
. Subsurface Sewage Disposal System Form Not for voluntary Assessments
498 SALEM STREET
Property Address
Owner Owner's Name
inform
required for every _ _._
page. City/Town State Zip code date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally lasses (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 water legal in the distribution box due
to broken or obstructed pipes) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of health);
Ell broken pipe(s) are replaced Ej Y 0 N 0 NCB (Explain below).
obstruction is removed 0 Y F1 N 0 ND (Explain below);
distribution box is leveled or replaced [I Y E] N E] NCB (Explain below):
F1 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):
El broken pipe(s) are replaced DY 0 N EI ND (Explain below):
obstruction is, removed Y 0 N l (Explain below):
)
3 Further Evaluation is Required by the Board of Health;
El Conditions exist which require further evalulati�on 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 3101 CMR.
1 .303(1) h that the system is not functioning In a manner which will protect public health,
safety and the environment
t5 nsp.dac.rev.7/26/2018 Title 5 Official InspectionForm:Subsurface Sewage Disposal System• 'age 3 of 18
Commonwealth of Massachusetts
p itle 5 0 ection Form
Irl tticiai insp
Subsurface Sewage Disposal System Form of for Voluntary Assessments
498 SALEM STREET
.m
Property AddressOwner
lAC B DONOVAI
Owner's Name
information is N TH' AN DOVE R MA 01 45
requlired for every � � l Y 1'�, �
page. City own State Zip code Date of Inspection
C. Inspection u co t.
Cesspool or privy is within 50 feet of a surface water
[ cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
El 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"
El The system has a septic tank and SAS and the SAS is within 50 feat of a private water
supply"well.
[:1 The system has a septic tank and SAS and the SAS is less than 100 feat but 50 feet or
more from a private water supply well".
Method used to determine distance:
stem Dr
p
This system asses 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 n itrogen is equal
to or less an 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
he attached to this form.
c. Other:.
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
1 Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5inisp.doc w rear,7f26l 01 Title 5 official Inspection Form:Subsurface Sewage Disposal System«Page 4 of 18
Commonwealth of Massachusetts
-"tie 5 O"" I Inspecti"on Form
TTIcia
tw °
Subsurface Sewage Disposal System Former Not for Voluntary Assessments
ar
Property Address
JACOB Cho lOVAN
Owner owner's Name
information is NORTH' AI"ROVER MA o 45 J L 11 2025
required for every
page, City/Town State Zip Code Date of inspection
C. Inspection u co rat.
4) System Failure Criteria Applicable le to All Systems (cont.)
"es No
Stat
ic liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS" orcesspool
Liquid depth
q p in cesspool is less than 6" below invert or available volume is less
than 1/2 day flora
El E y gq or
Requiredpumpingmore than 4 times �n the last year�" "�due to clogged
obstructed pipes)" Dumber of tunes pumped.
El E 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 or
tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public water suppily
well
[ ( Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis, [This
system passes, if the well grater analysis, performed at al D,EP certified
laboratory,for fecal ooliform bacteria indicates absent and the presence
of amm nia nitrogen and nitrate nitrogen is equal to or less than 5 p"p"m,
provided that no, other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flog of Zo o qpd
10,00o qpd..
The system falls. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
Large Systems:g y To, be considered a large system the system must sears a facility with a
design flow of 10,000 gpd to 15,0100 gip .
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 N
the system is withlin 400 feet of a surface drinking water supply
the system is within Zoo feet of a tributary to a surface drinking water supply
ens �'��� the system located in a nitrogen sensitive area (Interim Wellhead Protection y
Area-- IV' PA) or a snapped ?one Il of a public water supply well
t insp.d've-rev.7/2612018 `title 5 OffMelel Inspection Farr;Subsurface Sewage Disposal System-Page 5 of 1
Commonwealth of Massachusetts
Ti 5 utficial Inspection Form
fA tie
03
Subsurface Sewage Disposal System Form Not for voluntary Assessments
4 SALFM STREET
Property Address
JACOB N ON ' AN
Owner
Owner's Name
information
n is NORTH AN VE R MA 1� 45 J LY 11 202
squired for every �.. .__ _ _.._ _.
page. ity/T'mwn State Zip Code Date of Inspection
C. Inspection Summary (coat.
If you have answered It yes" to any question in Section C.5 the system is considered a significant
threat, or answered It 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.
6. You must indicate "yes" or"no"' for each of the following for all linapect1orns.
'es No
Pumping information was provided by the owner, occupant, or Board of Health
Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two week period?
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 N/A
Was the facility or dwelling inspected for si ns of sewage back a
Was the site inspected for signs of break out?
E El Were all system components, excluding the SAS, located on site's
E El Were the septic tank manholes uncovered opened, and the interior of the tan'
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth, of liquid, depth of sludge and depth of scum'
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 determlined based on.
E D Existing information. For example, a plan at the Board of Health.
Determined in the field if any of the failure criteria re
lated elated to Dart C is at issue
approximation of distance is unacceptable) [310 C N 15.302(5)]
t5insp.dcc•rev.. /26/2,018 Title 5 Official InspectionForm:Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts,
ppr
"Itle 5 otticial Inswpo%ectimon Form
Subsurface Sewage Disposal System Forr - Not for Voluntary Assessments.
498 SALEM STREET
Property Address
JACOB DONOVAN
Owner Owner's Name
information is NORTH AN MA 01845 JULY 11 2025
required for every I
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 CIF 15,203 for example: 110 gpd x#of bedrooms).. 440 GPD
Description:
4
Number of current residents:
Does residence have a garbage grinder? E Yes El No
Does residence have a water treatment unit.? El Yes E No
If yes, discharges to.:
Is laundry on a separate sewage system? (Include laundry system inspection El Yes [E No
information in this report.)
Laundry system inspected? E Yes F No
Seasonal use? El Yes, E No
Water meter readings, if available (last,2 years usage (gpd)): SEE 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
uommonwealth of Mas,sach e ts
FA, Totle m" UAO�'T'Tiwcimal Inspection Form,
. Subsurface Sewage
1TM498 BALED STREET
Property Address
Owner
Owner's Name
information is NORTH AN I�o'1l E R MA 01845 J L �1�1 2025
required for every — _ 1 _____
page. City/Town Mate Zip cede Nate of Inspection
D. System Information (cone.
2. commercial/Indus rial Flow Conditions:
Type ofEstablishment: _.�.
Design flow(based on, 310 cI R 15.2o3).
Gallons per day gpd
Basis of design flow seats/persons/s Mft., etc.); _....... _
Grease trap present? El Yes No
Water treatment unit present" El Yes El No
If yes, discharges to
Industrial waste holding tank present? El Yes El No
Non-sanitary waste discharged to the Title 5 system' Yes No
Water meter readings, if available: .....
Last date of occupancy/use;
Cate
Other(describe below):
3. Pumping Records:
Source of information: OWNER AP IL 202
Was system pumped as peat of the inspection? El Yes E No
If yes, volume pumped:
gallons
How was quantity pumped determined __._._ _. .....
Reason for pumping: �__ .._.....
�.
t insP.d -rev,7/ /201 s Title 5 Official Inspection Perm:Subsurface Sewage disposal System Page of 18
Commonwealth of Massachusetts
Insw%ectio Form
UTTIcia
(t T n
_....
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
498 SALEM STREET
Property Address
JACOB I NO VAwN
Owner _ ......
Owner's Name
information Is NORTH AWN DOVE R M 1845 �U LY 11 2
required far every _ ..... __ ._ _ 5
page. City/Town State Zip code Date of Inspection
D. System I'niformiation (cont.)
4. Type of System
Septic tank, distribution box, sail absorption system
Single cesspool
Overflow cesspool
El Privy
�] Shared system (yes or no) (if yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
T'i ht tank. Attach a copy of the D ID approval.
EJ Other(describe
Approximate ague of all components, data installed (if known) and source of information:
�5 YEARS OLD, INSTALLED MARCH 2000, CERTIFICATE OF COMPLIANCE
Were sewage odors detected when arriving at the site? El Yes E No
5. Building Sewer(locate on site plan):
1 ww
Depth below grade:
feet
Material of construction:
E] cast iron 40 PVC other(explain):
Distance from private water supply well or suction lime; ....
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
JOINTS AND VENTING OK
NO EVIDENCE OF LEAKAGE
t insp.dcc.rev.7126/201 i Title,5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 9 of 18
Commonweal assachusetts
_r a
le 0'rArn a
t, I 't 5 Ttl'ci�ai inspection Foirm
W °
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
hr
J
wr 498 SALEM' STREET
Property Address
JACOE EEO VAN
Owner Owner's Name
information is NORTH AN 1r ER CIA 01
required for every _ _. _ �.._... '4'5 J.. L 1 1, 202 5
page, city/Town .Mete Zip Cede Clete of inspection
D. System Information (cont.
6. Septic Tank (locate on site plan):
Depth halos grade: 611
feet
Material of construction:
concrete El meta E] fiberglass El polyethylene El other explain
If tank is metal', list age:
years
Is age confirmed by a Certificate ofCompliance? (attach a copy of certificate) 0 Yes El No
Dimensions: -
Sludge depth: _- _...
Distance from top of sludge to bottom of outlet tee or baffle 34" _
211
Scum thickness _
611
Distance from top of Scum to top of outlet tee or baffle
Distance from bottom of scum to bottern of outlet tee or baffle 1.2111
Hew were dimensions determined SLUDGE CAGE AND TAPE
MEASURE
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc..):
RECOMMEND PUMPING OLDER SYSTEMS YEARLY
PLASTIC INLET OUTLET TEES OK
'TANK IS OK
LIQUID LEVELS AREA GOOD
NO EVIDENCE OF LEAFAGE
t5i'nsp.doc rev,7/26/2018 Title 5 Off iclal Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
M N 0
Fit utticial Insp
PA le 5 ection Form
Subsurface Sewage Disposal System Form, Not foir voluntary Assessments
Property Address
JAc B CEONO AI
Owner Marne �Owner's
information i
required for every llFI� Al"11L1/EF MA 4 b� 1�1, 20
2 _ _...._
page. City/Town State Zip Code Cate of Inspection
D. System Information (cont)
". Grease Trap (locate on site pilan):
Depth below grade: feet
Material of construction:
El concrete El metal El fiberglass El polyethylene other(explain):
Dimensions:
Scum thricknes _.
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: rate
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
. T ht or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depths below grades
Material of construction:
EJ concrete El metal fiberglass polyethylene El other(explain):
Dimensions: . _
Capacity- ._-.� �....._. .�.
gallons
Deign Flow:
al'lorns per dad/
t5in p.dcc.rev.7/26/ 018 Title 5 official Inspection Farris Subsurface Sewage disposal System.Pace 11 of 1
Q
Commonwealth of Massachusetts,
tie .5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�. 498 SALEM STREET
Property Address
... __..
JAC OB DONC VAN
Owner Owner's Name
information is NORTH� ANDOVI MA 1 45 DULY 11 2 25
required for every .. — I....
age. City/Town State lip Code Date of inspection
D. System Information cant.
. Tight or Holding Tarok(cunt.
Alarm present: EJ Yves EJ No
Alarm level: Alarm in working order: El Yes El NO
Date of last pumping;
Date
Comments, condition of alarm and float switches, etc.).-
Attach copy of current pumping contract(required). Is copy attached' Yes No
9. Distribution Box if present must he opened) (locate on site plan):
Depth of liquid level above Cutlet invert
Comments (note if box is level and distribution to Cutlets equal, any evidence of solids carryover, any
evidence of leakage into or out of boo, etc.):
D-BC C, IS LEVEL AND, DISTRIBUTION IS EQUAL
LIGHT EVIDENCE OF SOLIDS CAR YC VEF
NO EVIDENCE OF LEAKAGE
ROOTS IN -BC C. REMOVED ROOTS COMING FROM BUSH NEXT TO -BOX.
RECOMMEND REMOVING BUSK
t insp.dcc•rev,7/26/2018 Title 5 official Inspection Farm:Subsurface Sewage Disposal System.Page 12 of 18
Commonwealth of Massachusetts
le 5 UTTIciai inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessment
498 SAL M STREET
Property Address
AC B DONOVAN
Owner Owner's Name
information is NORTH AN' E' ER M 1 45 �J LY' 11 2025
required'for every __ ... ..
page. City/Town State fi pb ode Cate of Inspection,
D. System Information (cry
10. Pump Chamber locate on site p�len
Pumps, in working order: 0 Yes D No*
Alarms in working order: Ell Yes El No*
Comments (note condition of pump ehern er, condition of pumps and appurtenances, etc.):
If pumps or alarms are net in working order, system is ,e conditional pass.
I I. Soil Absorption System (SAS) locate on site plan, excavation net required)
If SAS net located, explain why;
-----------------
Type:
El leaching pits number:
11 leaching dchamhers number:
El leaching galleries number: -�
. �
leaching trenches number, length: 3' ' LNG 3 _
leaching fields number, ddimensiens: _.._.
El overflow cesspool numbers _.
innovative alternative system
"" pe/name of technology:
t5insp,de .rev. /26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 13 of 1
Commonwealth ach tt
N 5 tficiai i,nsp
tle 0 Alb Am 01 0 N 0 ect'dimon Form
ran
Iry >
{ I
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a,
498 SALEM STREET
Property Address
IAC OB D NC VAN
Owner Own1ers Name
information
In Cerra ICE n is NORTH AN DOVEF IAA 1 5 J L L " 11 2O25
required for every _ _ _...
page. City/Town State Zip Code Cate Cif Inspection
D. System Information (cont.
11, Soil Absorption System (SAS) cont.)
Comments......... (n+y�y,t N cc....ndcondition of si�I,. signs hydraulic......'.yd •�ulic fa level.ilr�,� �vcl +c p +�in , d..am.....p soil, ccconditionofvegetation,
' /y yam.
SOIL AND VEGETATION OK
NO EVIDENCE ENC E F HYDRAULIC FAILURE OFF PONDING
12. Cesspools cesspool must he pumped as part of inspection) (locate can 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 nets condition of soil, signs of hydraulic failure, level of pending, condition of vegetation,
etc
t5in p.doc w rev.7/ /018 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Y
uommonwealth of Massachusetts
--u-itle 5 Ottici ai inspection Form
FA
15
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
� 498 SALEM STREET
Property Address
JACOB DONOVAN
Owner
Owner's Name
information i inform NORTH AN DOVE IAA 1 45 DULY' 11 2025
required for every __ _
page. City/Town Mete Zip Cede [date of Inspection
D. System Information (coat.
13. Privy (locate can siite plan):
Materials of construction.
Dimensions
Depth of solids
Comments (note condition tion of soil, signs of hydraulic failure, level of pQndingf condition of vegetation,
etc,
t insp.dee w rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Doge 15 of 1
Commonwealth of Massachusetts
1 Inspecti"on Form
Totle 5 Offm
Subsurface Sewage Disposal Systern Form - Not for Voluntary Assessments
498 SALEM STREET
Property Address
JACOB DON OVA
N
Owner Owner's Name
information is, NORTH AN�DOVER
required for every MA 01845 JULY 11, 2025
page. City/Town State Zip Code Date of Inspection
D. Siystem Information (cont.)
14. Sketch Of Sewage Disposal, System,:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters,
the building,. Check one of the boxes below:
0 hand-skeitch in the area below
El drawing attached separately
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t5lnsp.doo-rev,7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
w��
Commonwealth Massachusetts
"tie Inspecti"on Form
J�trp T1 5 UTTIci
r.
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
' W ' 498 BALED STREET
Property Address
JACOB C ONOVAN'
Owner
Owner's Name
•
n nformatio Is NORTH AID o f F MA 01845 J LY" 11 2025
required for every
page City/Town State Zip Cede Cate of Inspection
D. System Information (coat.
15. Site Exam:
Check Slope
Surface water
Check cellar
0 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: MARCH 2000
Date
El Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health - explain:
FLANS, ON FILE
Checked with local excavators, installers-- (attach documentation)
Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
DESIGN LAN ON FILE
Before filing this Inspection Report, please see Report Completeness Checklist on next page,
t5insp,de .rev.7/'26/2018 Title 5 Official Inspection Perm:Subsurface Sewage Disposal,System.Page 17 of 18
Common�wealth of Massachusetts
11"tle 5 Off"ici"a"l 'Inspect'-imon Form
Subsurface war a Disposal System Form Not for Voluntary Assessments
Property Address
JAC�C D NOVAN
Owner r�er Owner's Name
information
equiredf r�i� NORTH AN DOD MA 01845 J U L. 1`1 2025
required far every _.......
page. City/Town State Zip Cede Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of
A. Inspector Information: Complete all fields in this, suction.
Z B. Certification: Signed & Gated and 1, 21 3, or 4 checked
C. inspectionSummary:
11 21 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
C . System Information:
For : Tig t/H old i n Tank— Pumping contract attached
For 14: Sketch of'Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5in ,de *rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
Summary Record Card generated on 7/3/2025 11,.08.64 AM by Karen Hanlon Page 1
h I
Town of lNjorth Andover
Tax Map # 210vaO38.0=0321,4000,0
Parcel ld 11198
498 SALEM STREET
KELLY MURPHY
498 SALEM' STREET
NORTH ANDOVER MA 01846
Class 101 Single Family Property Type I Residential
Size Total 1.57 Acres
FY 2025
UB
Iff Mail in-a-1 NeA
Name/Address Ivpq Loan Number Active/Inact. From Until
KELLY MURPHY Owner Active
498 SALEM STREET
NORTH ANDOVER MA 01845
IMPRESCIA,RICHARD Previous Customer I n a c ti V 10/30/2007'
498 SALEM STREET
NORTH ANDOVER,MA
01846
STERGIOUS,PA,PADOLOS Previous Customer 2,/12/2009
498 SALEM STREET'
NORTH ANDOV ER,MA 01845
BRYAN&IAA
NIELLE BRAZILL Previous Customer 611/2017
498 SALEM STREET
NORTH ANDOVER,MA 01845
UB Account Maint.
Account No Cycle Occupant Name Active/inactive
Bldg Id. 16467.0-498 SALEM STREET Last Billing Date 7/2/2025
3160.420 013 Cycle,03 Active
UB Se,rvices Maint,.
Account No.3160420
Service Code Rate Ctiarge Multi'plier/Users
MISCFEEADMIN FEE 1 1 9.18 1/
WTR WATER 01 ALL METER SIZE 49.40
UB Mete r.M, ainte nonce
Account No.3160420
Soriall No Status Location Brand Type Size YTD Cons
13240241 a Active 00 ERT HH METE METE w Water 1 1 425
Date Read'ing Code Consumption Posted Date Variance
6/4/2025 1994 a Actual 13 7/9/2026 -13%
3/5/2025 1981 a Actual 15 4/1 /2025 15%
12/4/2024 1966 a Actual 13 1/14/2026 -14%
9/4/2024 1953 a Actual 15 10/8/2024 3%
6/6/2024 1938 a Actual 15 7/22/2024 -8%
3/5/2024, 1923 a Actual 16 4/16/2 24 32%
12/512023 1907 a Actual 12 1/15/2024 -29%
9/6/2023 1895 a Actual 18 10/13/2023 23%
6/2/2023 1877 a Actual 14 7/14/2023 -5%
3/212023 1863 a Actual 14 4/12/2023 -28%
12/5/2 22 1849 a Actual 20 1/16/2023 -75%
9/6/2022 1829 a Actual 84 10/18/2022 3,03%
6/2/2022 1745 a Actual 20 7/18/2022 25%
3/2/2022 1725 a Actual '15 4/13/2022 -3%
12/6/2021 1710 a Actual 17 1/17/2022 -5�2%
9/212021 1693 a Actual 34 10/16/2021 6%
6/2/2021 1659: a Actual 32 7/27/2021 138%
3/2/2021 1627 a Actual 13 4/21/2021 -70%
121312020 1614 a Actual 46 1/13,/2021 50%