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HomeMy WebLinkAboutPass - Title V Inspection Report - 50 BOXFORD STREET 3/5/2026 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms on the computer, Israel Berl use only the tab key to move your Name of Inspector cursor-do not Berl Engineering use the return Company Name key. 26 Nutter Road tab Company Address North Reading Massachusetts 01864 City/Town State Zip Code 351-201-2210 SI 14923 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 3 7 2026 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): El 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): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ 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(1)(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 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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: ❑ 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. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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 supply well. El H 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 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 form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No El ❑ 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 ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 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 CA 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. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes 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? H ❑ 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? H ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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: H ❑ Existing information. For example, a plan at the Board of Health. H El Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms 3 - see Number of bedrooms (actual): 4 (design): below ( ) DESIGN flow based on 310 CMR 15.203 for example: 110 : 330 (see ( p gpd x#of bedrooms): below) Description: Design plan dated 1974 shows proposed house being a 3 bedroom house. It is assumed that the septic system was designed for 3 bedrooms. Number of current residents: 2 Does residence have a garbage grinder? H Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d : 82 GPD g ( y g (gp )) Detail: See attached Sump pump? H Yes ❑ No Last date of occupancy: Current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 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? El Yes ❑ No If yes, discharges to: Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped day after Title 5 Inspection 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ 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 ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: Installed in 1974 Were sewage odors detected when arriving at the site? El Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 6 p g feet Material of construction: ® cast iron ❑ 40 PVC El other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Plumbing is in good condition t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete El metal El fiberglass El polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes H No Dimensions: 5'x 8'x 4' 6" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank was pumped following inspection. Outlet tee was repaired as part of inspection. Tank appears structurally sound and shows no signs of leakage. Outlet tee filter must be cleaned annually. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete El metal El fiberglass El polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete El metal El fiberglass El polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ 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 ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): Distribution box is in good condition. There is no evidence of solids carryover. No signs of leakage. All 3 outlets have flow equalizers. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every 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: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: (1)-20'x45' ❑ 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 {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 absorbtion system shows no signs of hydraulic failure. No ponding is present. All 3 laterals took water after testing for 10 minutes. 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every 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 {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts {{ Title 5 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells >1' 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 Ian reviewed: 1974 g p Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database - explain: NRCS Websoil survey You must describe how you established the high ground water elevation: Design plan has 2 test pits that showed no groundwater to the bottom of the pits (82"+). NRCS websoil survey states that depth to water table is more than 8011 . 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 Official Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,J $„ 50 Boxford Street Property Address Avelar Delima Owner Owner's Name information is North Andover MA 01845 3-5-2026 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 21 3, or 4 checked ® C. Inspection Summary: 17 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 �r,�I �. �V s „ ' rc .I r r . 44 • r ., .,,....,,.y"..i.,,, r,. i Its CS ....,.... .....� fwr .'..uRwx••....- +r�1s' '11''i... ,,.....r.,.,,i,,,.., ...... .. .,„.,w,Nw, .,w,..,. � .. ........ .. .." �. �. IN.... ..,.. IwEt . I IWk 'nlq. '�. 010 •4.,. ,yN.p. AI11M k �rI" y4P 1 ,^..N...,., f76.00 '� ..,.,.r...<....,.,. ..nr,.. ...,.,.,r.,......��.,,,,.r.,,r,r .,..,m,...,.,,,.n.,,,n..u•curmifr;:nYri•;r,r,.,„,. .,. „ ,,,, ,w^ r " p Lc Fr 4.0 too, r, io 00"0" WON ................ r fkk � n . Ll $��f•N �.'�iwv`',,: gifi� n iwwn�''.MI�d.'7ryL d,,,„ a ..... .,wwr•,..w..c..^,ww, I p� 1I vwuw" Summary Record Card generated on 3/9/2026 8:22:07 AM by Susan Correale Page 1 Town of North Andover Tax Map # 210-104.D-0003-0000.0 Parcel Id 16701 50 BOXFORD STREET NANCY G. SALEMME REV TRUST Since Jan 2018 50 BOXFORD STREET NORTH ANDOVER MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.039 Acres FY 2026 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until AVELAR DELIMA Owner Ac'live 50 BOXFORD STREET NORTH ANDOVER MA 01845 SALEMME, ROBERT Payor Inactive 2/4/2014 50 BOXFORD STREET N.ANDOVER, MA 01845 PER REMITTANCE SLIP NANCY SALEMME Previous Customer Inactive 8/9/2024 50 BOXFORD STREET NORTH ANDOVER MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17693.0-50 BOXFORD STREET Last Billing Date 1/5/2026 3170364 03 Cycle 03 Active UB Services Maint. Account No.3170364 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63 5/8 7.82 1/ WTR WATER 01 ALL METER SIZE 159.25 /1 UB Meter Maintenance Account No.3170364 Serial No Status Location Brand Type Size YTD Cons 36393538 a Active ERT HH b Badger w Water 0.625 0.625 561 Date Reading Code Consumption Posted Date Variance 12/8/2025 1540 a Actual 35 1/12/2026 -79% 9/10/2025 1505 a Actual 174 10/10/2025 39% 6/10/2025 1331 a Actual 125 7/9/2025 664% 3/10/2025 1206 a Actual 16 4/16/2025 -75% 12/10/2024 1190 a Actual 66 1/14/2025 45% 9/10/2024 1124 a Actual 17 10/8/2024 -100% 8/7/2024 1107 f Final Bill 0 8/7/2024 -100% 6/12/2024 1107 a Actual 7 7/22/2024 -42% 3/8/2024 1100 a Actual 11 4/16/2024 55% 12/11/2023 1089 a Actual 7 1/15/2024 1% 9/15/2023 1082 a Actual 8 10/13/2023 4% 6/7/2023 1074 a Actual 7 7/14/2023 -1% 3/8/2023 1067 a Actual 7 4/12/2023 11% 12/8/2022 1060 a Actual 6 1/16/2023 -4% 9/13/2022 1054 a Actual 7 10/18/2022 -15% 6/9/2022 1047 a Actual 8 7/18/2022 -15% 3/8/2022 1039 a Actual 9 4/13/2022 2% 12/9/2021 1030 a Actual 9 1/17/2022 3% 9/9/2021 1021 a Actual 9 10/15/2021 -10% 6/7/2021 1012 a Actual 10 7/27/2021 2% 3/5/2021 1002 a Actual 9 4/21/2021 -31% 12/9/2020 993 a Actual 14 1/13/2021 -24% 9/8/2020 979 a Actual 19 10/14/2020 65% 6/5/2020 960 a Actual 11 7/15/2020 18% 3/6/2020 949 a Actual 9 4/8/2020 -1% Summary Record Card generated on 3/9/2026 8:22:07 AM by Susan Correale Page 2 Town of North Andover Tax Map # 210=104.D=0003=0000.0 Parcel Id 16701 50 BOXFORD STREET NANCY G. SALEMME REV TRUST Since Jan 2018 50 BOXFORD STREET NORTH ANDOVER MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.039 Acres FY 2026 12/9/2019 940 a Actual 9 1/15/2020 -2% 9/13/2019 931 a Actual 10 10/10/2019 10% 6/10/2019 921 a Actual 9 7/25/2019 -6% 3/8/2019 912 a Actual 9 4/16/2019 -9% 12/10/2018 903 a Actual 10 1/22/2019 4% 9/12/2018 893 a Actual 10 10/15/2018 -6% 6/11/2018 883 a Actual 11 7/23/2018 15% 3/7/2018 872 a Actual 9 4/23/2018 -22% 12/7/2017 863 a Actual 11 1/25/2018 -32% 9/12/2017 852 a Actual 18 10/18/2017 71% 6/8/2017 834 a Actual 10 7/25/2017 0% 3/9/2017 824 a Actual 10 4/12/2017 -47% 12/8/2016 814 a Actual 19 1/23/2017 -62% 9/7/2016 795 a Actual 47 10/24/2016 -23% 6/13/2016 748 a Actual 67 8/2/2016 556% 3/11/2016 681 a Actual 10 4/22/2016 -9% 12/10/2015 671 a Actual 11 1/20/2016 -60% 9/9/2015 660 a Actual 27 10/16/2015 57% 6/10/2015 633 a Actual 17 7/24/2015 91% 3/12/2015 616 a Actual 9 4/28/2015 -74% 12/11/2014 607 a Actual 34 1/15/2015 -17% 9/11/2014 573 a Actual 42 10/15/2014 242% 6/10/2014 531 a Actual 12 7/16/2014 19% 3/11/2014 519 a Actual 10 4/11/2014 -17% 12/11/2013 509 a Actual 12 1/17/2014 -77% 9/12/2013 497 a Actual 53 10/15/2013 29% 6/13/2013 444 a Actual 41 7/24/2013 277% 3/14/2013 403 a Actual 11 4/22/2013 -17% 12/12/2012 392 a Actual 13 1/9/2013 -75% 9/13/2012 379 a Actual 53 10/15/2012 170%