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HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 315 CANDLESTICK ROAD 11/15/2025 uommlonwealth of Massachusetts Title 5 Official Inspecti"on Form , 1Subsurface Sewage Disposal System Form Not for Voluntary Assessments aq � F ` 315 CANDLESTICK LEST IC l ROAD Property Address MARK GOTOBED Owner Owner's Name information is required for every NORTH Al AND OVER M I( 1 4� � VET � 15 2025 page. City/Town State Zip Code Cate of Inspection Inspection results must be submitted on fbls fora. Inspection forams may not be altered 'in any way. Please see completeness checklist at the end of the form. Important:When filling out forms Inspector Information on the computer, use only the tab � ����� E t��a key to move your Larne of Inspector cursor-do net atason Entarprisas Inc. use the return _ Company 111 A►rgilla Road tab Company Ac re,ss Andover MA 01810 City/Town State Zip Code Telephone Number License Number B. Certification 1 certify that; I am a DEP approved system inspector in full compliance with Section 1'5.3140 of Title 51 (310 CMR 1 . 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training andexperience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection l have determined that the system: 1. Passes 2. Conditionally lasses 3. Deeds Further Evaluation by the Local Approving Authority 4. El Fails Inspect s Signetur Cate The system inspector shall submit a copy of this inspection report to the Approving Authority Board pp y of Health or DEP within 30 days of completing this inspection. if the system has a design flow of 101000 gp or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER 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+onlydescribes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the,system will perform in the future under the same or different conditions of use, t5in p.dcc.rev,7/26/2018 Title 5 Official Inspection Feria;Subsurface Sewage,Disposal System page 1'of 18 Commonwealth of Massachusetts Title 5 Official For�n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - ` 315 CANDLESTICK ROAD Property Address MARK OOTOBED Owner owner's Name information is NORTH ANDOVER MA 01845 NOVEMBER 15, 2025 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: El I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. El Y [] N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Farm;Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts •13. Title 5 Offic"ial For � Subsurface Sewage Disposal System Form Not for Voluntary Assessments N 9 315 CANDLESTICK ROAD Property Address MARK GOTOBED Owner owner's Name information is NORTH ANDOVER MA 01845 NOVEMBER 15, 2025 required for every page City/Town State Zip Code Date of inspection C. Inspection Summary (cont.) 2} System Conditionally Passes (cont.): [] Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): El broken pipe(s) are replaced ❑ Y El N [] ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N El ND (Explain below): ® distribution box is leveled or replaced Y ❑ N ❑ ND (Explain below): D-Box ROTTED, NEEDS REPLACED �] 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): E:1 broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed F] Y Ej N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health: safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Ol Inspection Form ID Subsurface Sewage Disposal System Form Not for Voluntary Assessments 315 CANDLESTICK ROAD Property Address MARK GOTOBED Owner owner's Name information is NORTH ANDOVER MA 01845 NOVEMBER 15, 2025 required for every page. City/Town State Zip Code Date of inspection Cr Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: 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 feet of a private water supply well. El The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance; ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections; Yes No Backup of sewage into facility or system component due to overloaded or ® clogged SAS or cesspool gg p ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doe-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title icial Inspection Forl'Y1 � 7 y � 10 Subsurface Sewage Disposal System Form Not for Voluntary Assessments r�r na ya4 315 CANDLESTICK ROAD Property Address MARK OOTOBED Owner owner's Name information is NORTH ANDOVER MA 01845 NOVEMBER 15, 2025 required for every page. City/Town State Zip Cade Date of Inspection C., Inspection Summary (cont,) 4) System Failure criteria Applicable to All Systems: (cont.) Yes No ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 0" below invert or available volume is less than 1/day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes). Number of times pumped: El E Any portion of the SAS, cesspool or privy is below high ground water elevation. EJ E Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. El E Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis, [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this forma El E The system is a cesspool serving a facility with a design flow of 2000 gpd- 101000 gpd. ❑ E The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM R 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serge a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section C,4. Yes No 1:1 1:1 the system is within 400 feet of a surface drinking water supply El ❑ the system is within 200 feet of a tributary to a surface drinking water supply El 1:1 the system is located in a nitrogen sensitive area (interim Wellhead Protection Area-- IWPA) or a mapped Zone 11 of a public water supply well t5insp.doc-rev.7/25/2018 Title 5 official inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Y Title 5 Offic"ial Form 4 Subsurface Sewage Disposal System Form .. Not for Voluntary Assessments 315 CANDLESTICK ROAD Property Address MARK GOTOBED Owner owner's Name information is NORTH ANDOVER MA 01345 NOVEMBER 15, 2025 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (coat,) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section C.4 above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 5. You must indicate "yes" or"no"for each of the following for all inspections: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ N Were any of the system components pumped out in the previous two weeks? M ❑ 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 signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? N El Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? N El Was the facility owner(and occupants if different from owner) provided with Information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: N ❑ Existing information. For example, a plan at the Board of Health. S EJ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 R Commonwealth of Massachusetts Title 5 Official Forrn ' > Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M1 ° 315 CANDLESTICK ROAD Property Address MARK GOTOBED Owner owner's Name information is NORTH ANDOVER MA 01845 NOVEMBER 15, 2025 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 � } DESIGN flow based on 310 CMR 15.203 for example: 11 D d x#of bedrooms): 500 GPD t p gp } Description: Number of current residents: 2 Does residence have a garbage grinder? E Yes ❑ No Does residence have a water treatment unit? El Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (include laundry system inspection El Yes E No information in this report.) Laundry system inspected? Yes No Seasonal use? El Yes E No Water meter readings, if available last ears usage d : SEE ATTACHED g � � y g �gp }} Detail: Sump pump? ❑ Yes E No Last date of occupancy: CURRENT Date t5insp.doc-rev.7/26/2018 Title 5 Official inspection Farm.Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts tF Title 5 Official Form 10 Subsurface Sewage Disposal System Form • Not for Voluntary Assessments g p Y rY t Lgv`k 315 CANDLESTICK ROAD Property Address MARK GOTOBED Owner owner's Name information is required for every NORTH ANDOVER MA 01845 NOVEMBER 15, 2025 ..�.... page. City/Town State Zip Code Date of Inspection D. System Information (coat.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? El Yes No Non-sanitary waste discharged to the Title 5 system? El Yes El No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: BATESON ENTERPRISES INC OCTOBER 2025 Was system pumped as part of the inspection? El Yes H No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc rev,7/25/2018 Title 5 official Inspection!worm:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Form is Subsurface Sewage Disposal System Form -� Not for Voluntary Assessments g p Y Y 315 CANDLESTICK ROAD Property Address MARK GOTOBED Owner owner's Name information is NORTH AN DOVE R MA 01845 NOVE M B E R 15, 2025 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 4. Type of System: ® Septic tank, distribution box, soil 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 IIA 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: 34 YEARS, INSTALLED DECEMBER 1991, AS BUILT PLAN Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: cast iron E 49 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS AND VENTING OK No EVIDENCE OF LEAKAGE t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts _ 4 TitleOfficiaInspectionForr� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a g p Y y 315 CANDLESTICK ROAD Property Address MARK GOTOBED Owner owner's Name information is NORTH ANDOVER MA 01845 NOVEMBER 15 2025 required for every page. City Town State Zip Code Date of Inspection D. System Information (coat.) 6. Septic Tank (locate on site plan); 18 Depth below grade: feet Material of construction: E concrete El metal ❑ fiberglass polyethylene ❑ other(explain) If tank is metal, list age: ears Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions; 1o'x5'x4` Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness 0 Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? TAPE MEASURE AND SLUDGE JUDGE 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 CONCRETE INLET BAFFLE OK PLASTIC OUTLET TEE OK TANK IS OK LIQUID LEVELS GOOD NO EVIDENCE OF LEAKAGE t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts r� Title 5 O Fors ' o Subsurface Sewage Disposal System Form Not for Voluntary Assessments 315 CANDLESTICK ROAD Property Address MARK GOTOBED Owner owner's Name information is NORTH AN DOVE R MA o 1 845 required for every NOVEMBER '15, �g5 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: EJ concrete El metal El fiberglass El polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El concrete El metal El fiberglass El polyethylene El other(explain): y Dimensions: Capacity: gallons W Design Flow: gallons per da g p Y t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts ti (tp, Forr� ' , i0 Subsurface Sewage Disposal System Form Not for Voluntary Assessments . v 315 CANDLESTICK ROAD Property Address MARK G OTO B E D Owner Owner's Name information is NORTH ANDOVER MA required for every 9 $45 NOVEMBER 1 5, 205 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cant.) Alarm present: El Yes ❑ No Alarm level: Alarm in working order: El Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? El Yes El No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert o Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): ❑-BOX IS LEVEL DISTRIBUTION IS NOT EQUAL LIGHT EVIDENCE OF SOLIDS CARRYOVER EVIDENCE OF LEAKAGE D-BOX IS RUTTED AND NEEDS REPLACED t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts 14Title 5 Off Fors � ,A Subsurface Sewage Disposal System Form w Not for Voluntary Assessments �f' tik`°4 315 CANDLESTICK ROAD Property Address MARK GOTO B E D Owner owner's Name information is NORTH ANDOVER MA 1 required for every a 845 NOVEMBER 15, 0Z5 page. City/Town State Zip Code Date of Inspection D. System Information (cont,) 10. Pump Chamber(locate on site plan): Pumps in working order: El Yes ❑ No* Alarms in working order: El Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: 11 leaching pits number: El leaching chambers number: El leaching galleries number: leaching trenches number, length: 2; 50' LONG leaching fields number, dimensions: ❑ overflow cesspool number: [❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts x pt, T"tle 5 Official For�''Y1 W io Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w . ° 315 CANDLESTICK ROAD Property Address MARK GOTOBED Owner owner's Name information is NORTH ANDOVER MA 01845 NOVEMBER 15, 2025 required for every page. City/Town State Zip Code Date of inspection D. System Information (cent.) 11. Soil Absorption System (SAS) (cont,) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SOIL AND VEGETATION OK NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow El Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev,7125l2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 - -- Commonwealth of Massachusetts c"ial Inspection For 1A Title 5 Offi .r ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments by 315 CANDLESTICK ROAD Property Address MARK OOTOBED Owner Owner's Name information is NORTH AN DOVE R MA 01845 required for every NOVEMBER 15, 2025 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 �, Commonwealth of Massachusetts x....... ici"al ITitle 5 Off" Form Subsurface Sewage Disposal System Form Not for Voluntary a ry Assessments N Yr 315 CANDLESTICK ROAD Property Address MARK OOTOBED Owner owner's Name information is NORTH ANDOVER required for every MA 01845 NOVEMBER 15, 2025 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet, Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately . � �o 71 rx k o x 1 r+ a rss •T i !^js.0 fI T r it Vo3 W Ll r Ir x.: TTTT 111 f ll< F, t �s x •.4 '4 i 3, 1 `I f t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts �V icial I Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments n 315 CANDLESTICK ROAD Property Address MARK GOTOBED Owner owner's Name information is NORTH AN DOVE R MA o 1845 N OV required for every EMBER 15, 9�5 page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar El 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: APRIL 1989 g Date ❑ observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: PLANS ON FILE ❑ Checked with local excavators, installers - (attach documentation) [� Accessed USGS database -explain: You must describe how you established the high ground water elevation: DESIGN PLAN Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Offi cia 1 Inspection Form ' h Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 315 CANDLESTICK ROAD Property Address MARK OOTOBED Owner Owner's Name information is NORTH ANDOVER MA 01845 NOVEMBE required for every R 15, 025 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Z A. Inspector Information: Complete all fields in this section. Z B. Certification: Signed & Dated and 1, 2, 3, or 4 checked Z C. Inspection Summary: 11 21 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed Z D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Summary Record Card generated on 1117/2026 7:37:42 AM by Nancy Viens Page I Town of North And v r Tax Map # 210-406-4-0232,-00100.0 Parcel Id 17377 316 CANDLESTICK ROAD MARK& DANIELLE GO,TOBED 315 CANDLESTICK ROAD NORTH ANDOVER, MA 01845 Class 101 Single Family Property 1�pe I Residential Size Total 1 Acres FY 2026 UB Mailing Index Narne/Address Type Loan Number Active/Inact. From Until MARK&DANIELLE'GOTOBED Owner Active 315 CANDLESTIC K ROAD NORTH ANDOVER,MA 01845 SHERMAN' ,TONI Previous,Customer Ir lac tive 2/7/2005 315 CANDLESTICK RD NORTH ANDOVER,MA 01845 PATRIOT &DANA DININO Previous Customer Ifliactive 8/4/2008 315 CANDLESTICK ROAD NORTHANDOVER,MA 01845 ,UB Account Maint Account No Cycle Occupant Name Active/Inactive Bldg Id. 17640.0-315 CANDLESTICK ROAD Last Billing Date 10/2/2025 3170310 03 Cycle 03 Active UB Services Maint, Account No.3170310 Service Code at Charge Muftlpller/Users MISCIFEE ADMIN FEE 0.635/8 7.82 WTI WATER 01 ALL METER SIZE 41.80 UB Meter Maintenance Account No,3170310 Serial No Status Location Brand Type Size YT'D C,ons 299558�58 a Active ERT'HH b Badger w Water 0.626 0.625 265 Date Reading Code ConsumptIon Posted Date Variance 9/10/2025 1710 a Actual 11 10/10/2025 -17% 6/9/2025 1'699 a Actual 1'3 7/9/2026 -14% 3/10/2025 1686 a Actual 15 4/16/2025 17% 12/10/2024 1671 a Actual 13 1/14/2026 29% 9/10/2024 1 58 a Actual 10 10/8/2024 -1'4% 6/12/2,024 1648 a Actual 12 7/22/2024 1% 3/1112024 1636 a Actual 12 4/16/2024 19%12/8/2023 1624 a Actual 9 1/15/2024 -25% 9/15/2023 1615 a Actual 14 10/1 3/2023 _1,CD 6/9/2023 1601 a Actual 15 7/14/2023 20% 317/2023 158,6 a Actual 12 4/12/2023 -1% 12/7/2022 1574 a Actual 12 1/16/2023 -26% 9/9/2022 1562 a Actual 17 10/1812022 53% 6/8/2022 1546, a Actual 11 7/18/2022 -28% 3/8/2022 1634 a Actual 15 4/13/2022 69�% 12/8/2021 1519 a Actual 9 1/17/2022 -43% 9/8/2021 1510 a Actual 16 10/15/202 1 6/7/2021 1494 a Actual' 17 7/27/2021 -5% 3/5/20�21 1477 a Actual 17 4/21/2021 -7% 12/8/2020 1460 a Actual 19 15 111312021 % 918/2020 1445 a Actual 20 10/14/2020 -22% 6/5/2020 1425 a Actual 21 7/15/2020 -12% 3/9/2020i 1404 a Actual 17 4/8/2020 25%