HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 534 BOSTON STREET 4/9/2026 . '. uommonwealth fMassachusetts
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Subsurface Sewage Disposal Form Not far Vol a ntar Assessments
Systemy
Property Address
CLAN G JTIVIAN
Owner
Owner's Name
a it information NORTH ANDOVE ILIA 1848 APRIL 6, 2026
in�rrrt �
r �q u'e'd for every ..__ _M._ .
page. City/Town State Zip Code Cate of Inspection
Inspection results must be submitted on this form. Inspection forms may not he altered in any
dray. Please see completeness checklist at the end of the form.
Important When A. Inspector r�"n 1NV,,..
i, , Yer
filling out farms _ �,.
on the computer, Todd E atesen
use only the tab
key to move your Name of Inspector APR 13 2026
cursor-do not
E ateson Enterprises Inc.
use the return __... _..__�. ......._.._ �....._� ._�.. .._
Companykey. CompanyName..
11 Arg i lla Dead
Company Address _.
Andover IAA 0 1818
City/Town State Zip Code
r 978-475-4786 SI-16
Telephone Number License Number
B. Certification
I certify that: I am a CEP approved system inspector in full compliance with Section 15.34 of Title
(310 CAR 15. ; 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
8. El Needs further Evaluation by the Local Approving Authority
4. Fails
APIL. 9, 228
_.Ins e ct r Signature .... IT__._._.
Cute
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or CEP)within 8 days of completing this inspection. If the system has a deign flow of
1 0X0 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DER R 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
condit"I
ons of use at that time. This inspection does not address hover the system will perform
in the future under the same or different conditions of use.
t insp,doc.rev. /2 /2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts
w� Title 5 Official Forr�n
Subsurface Sewage [disposal System Form Not for Voluntary Assessments
N
N
i IR.t
534 BOSTON STREET
Property Address
DAN GUTMAN
Owner Owner's Name
information is required for every NORTH AN❑OVER MA 01845 AP R I L 6 2026
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:
❑ 1 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 H ea ith, 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.
0 Y ❑] N Ej 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
`h . . ..........l/p Title 5 Official Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
q �1
534 BOSTON STREET
Property Address mm
DAN GUTMAN
Owner owner's Name
information is NORTH AN DOVE R � MA
required for every 01845 APRIL 5, 2025
page, City/Town State Zip Code Date of inspection
C. Inspection Summary
2) System Conditionally Passes (cont.):
[� Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
Z 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):
Z broken pipe(s) are replaced Z Y ❑ N El' ND (Explain below):
[� obstruction is removed El Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced El Y Ej N ❑ ND (Explain below):
ROTTED CAST ]RON Y PIPE IN CELLAR 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}:
❑ broken pipe(s) are replaced El Y [1 N ❑ ND (Explain below):
El obstruction is removed Ej Y Ej N ❑ ND (Explain below):
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 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
ci"al Inspection Form
r,� Title 5 Offi
4
k"
7 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
534 BOSTON STREET
Property Address .__
DAN GUTMAN
Owner owner's Name
information is NORTH ANDOVER MA g1845 AP �j
required for every ..W. R I L �06
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cant.)
❑ 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:
[:1 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,
[:1 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
E:1 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.7/2612018 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
534 BOSTON STREET
Property Address
DAN GUTMAN
Owner Owner's Name
information is NORTH AN DOVE R MA 01845 AP R I L 6 2026
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cant.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
El N 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 5" below invert or available volume is less
than 1/2 day flow
❑ N Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipes). Number of times pumped:
El N 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 I of a public water supply
well.
❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
El N 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.]
❑ N The system is a cesspool serving a facility with a design flow of 2000 gpd-
1 0,000 g pd.
❑ ® 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 C.4.
Yes No
1:1 0 the system is within 400 feet of a surface drinking water supply
El F� 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
ci'al Inspection Form
Title 5 Offi
133
� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
534 BOSTON STREET
Property Address
DAN o UTMAN
Owner owner's Name
information is NORTH AN DOVE R MA
required for every 01845 APRIL 6, 2026
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 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 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 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?
❑ 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?
E El Were as built plans of the system obtained and examined? (If they were not
available note as NIA)
® EJ Was the facility or dwelling inspected for signs of sewage back up?
® El Was the site inspected for signs of break out?
N ❑ Were all system components, excluding the SAS, located on site?
Z El Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the 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:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ 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
T Title 5 Official Inspecti"on For
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
.r
534 BOSTON STREET
Property Address _.
DAN GUTMAN
Owner owner's Name
information is NORTH AN DOVE R MA
required for every 01845 APRI L 0, 2025
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: I 10 gpd x#of bedrooms): 440 GPD
Description:
Number of current residents: 3
Does residence have a garbage grinder? ❑ Yes No
Does residence have a water treatment unit?
® Yes Ej No
If yes, discharges to: YARD
Is laundry on a separate sewage system? {Include laundry system inspection
information in this report.) ElYes No
Laundry system inspected?
M Yes Ej No
Seasonal use? El Yes 0 No
Water meter readings, if available last 2 ears usage d WELL
� � v � {gyp ���
Detail:
Sump pump? 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
�h �fTitle 5 Offi Form
f Subsurface Sewage Disposal System Form Not for Voluntary Assessments
�a I
h
1
534 BOSTO N STREET
Property Address
DAN GUTMAN
Owner owner's Name
information is NORTH AN DOVE R MA 0 1 845 AP R I L 5 2025
required for every
page. CitylTown 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 dayd
9p )
Basis of design flow (seatslpersonslsq.ft., etc.):
Grease trap present? EI Yes [:1 No
Water treatment unit present? El Yes [:1 No
If yes, discharges to:
Industrial waste holding tank present? El Yes El No
Non-sanitary waste discharged to the Title 5 system? Ej 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 APRI L 2026
Was system pumped as part of the inspection? E Yes El No
If yes, volume pumped: PUMPED ALL THREE COVERS OF TANK AND
P PUMP CHAMBER 3,000 GALLONS
How was quantity pumped determined? TRUCK GAUGE
Reason for pumping: MAINTENANCE
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
� `;;� Commonwealth of Massachusetts
uTitle 5 Official Form
Subsurface Sewage Disposal System Form w Not for Voluntary
: y Assessments
534 BOSTON STREET
Property Address
DAN G UTMAN
Owner Owner's Name
information is NORTH ANDOVER MA 01845 APRIL 5 2026
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
4. Type of System:
Septic tank, distribution box, soil absorption system
El 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
El Tight tank. Attach a copy of the DEP approval,
El Other(describe):
Approximate age of all components, date installed (if known) and source of information:
9 YEARS, INSTALLED NOVEMBER 2007, AS-BUILT PLAN
Were sewage odors detected when arriving at the site? El Yes E No
5. Building Sewer(locate on site plan):
28
rr
Depth below grade: feet
Material of construction:
cast iron [140 PVC El other(explain):
301
Distance from private water supply well or suction line: W
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
JOINTS - THE Y THROUGH THE WALL NEEDS REPLACED
VENTING - OK- NO ODORS DETECTED
NO EVIDENCE OF LEAKAGE
t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
�YTitle 5 Official Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
534 BOSTON STREET
Property Address
DAN GUTMAN
Owner owner's Name w
information is NORTH AN DOVE R MA 01845 AP R I L
required for every _ 6, ��
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
Depth below grade: 6"feet
Material of construction:
® concrete EJ 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 [:1 No
Dimensions:
5' x 7.3' x 6.6'
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
20
Scum thickness 6
Distance from top of scum to top of outlet tee or baffle
6►
►
Distance from bottom of scum to bottom of outlet tee or baffle 8
How were dimensions determined? SLUDGE JUDGE
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.):
PLASTIC INLET AND OUTLET TEES GOOD
TANK IS OK
LIQUID LEVELS GOOD
TANK NEEDS PUMPED AND FILTER CLEANED AT INSPECTION
MAINTENANCE INSPECTIONS REQUIRED BY STATE FOR ALTERNATIVE SYSTEM IS
EVERY 2 YEARS BY CONTRACT
CURRENT CONTRACT HELD WITH ADVANCED ONSITE SOLUTIONS CANTERBURY, NH
603-369-4777.
SYSTEM WAS INSPECTED APRIL 6, 2026 ALONG WITH TITLE 5 INSPECTION
2600 GALLON TANK
t5insp.doc•rev.7/26/2018 Title 5 Official Ins pedion Form:Subsurface Sewage Disposal System-Page 10 of 18
Commonwealth of Massachusetts
=fTitle 5 Official Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
7 �
534 BOSTON STREET
Property Address
DAN GUTMAN
Owner Owner's Name W
information is NORTH AN DOVE R MA o 1845
required for every APR I L 5, �oC
page. Cityffown State Zip Code Date of inspection
D. Systems Information (cunt.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
El concrete E 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:
El concrete ❑ metal El fiberglass El polyethylene El other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per da
9 p Y
t5insp.doc-rev.7/2612018 P Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
�R Commonwealth of Massachusetts
n
` Title 5 Off
ici'al I Forrrl
j K 1>
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
N
534 BOSTON STREET
Property Address
DAN G UTMAN
Owner owner's Name
information is NORTH AN DOVE R MA
required for every o 845 APRIL�I 2026
page. City/Town State Zip Code Date of inspection
D. System Information (cont.)
8. Tight or Holding Tank (cont.)
Alarm present: ❑ Yes El 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 ❑ No
9, Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert NA PRESSURE MANIFOLD, NO D--BOX
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.):
LEACH FIELD HAS A PRESSURE MANIFOLD, NO D-BOX
OPENED UP 4 INSPECTION PORTS IN LEACH AREA
SYSTEM WORKING PROPERLY
t5insp.doc•rev.7/26/2018 Title 5 officiaf Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusetts
�n w e i aInspecti"onForm
10 Subsurface Sewage Disposal System Form w Not for Voluntary Assessments
534 BOSTON STREET
Property Address
DAN OUTMAN
Owner Owner's Name
information is NORTH ANDOVER MA 01845 AP
required for every RI L 6, 2025
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber (locate on site plan):
Pumps in working order: ® Yes El No*
Alarms in working order: ® Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
PUMP CYCLED ON THEN OFF
FLOATS IN WORKING ORDER
ALARM PANEL IN CELLAR OK
* 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;
44 Infiltrator
Chambers
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
cia
Title 5 Offi I Inspecti"on For
o Subsurface Sewage Disposal System Form W Not for Voluntary Assessments
534 BOSTON STREET
Property Address
DAN GUTMAN
Owner owner's Name
information is NORTH AN DOVE R MA 018
required for every �5 APRI L 6, �g5
page. City/Town State Zip code Date of Inspection
D. System Information (cont.)
. Soil Absorption System (SAS) (cant.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.): `
SOIL AND VEGETATION GOOD
NO SIGN 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 El 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
r
Title 5
w
Official Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
=`rl. .=4,b� 534 BOSTON STREET
Property Address m
DAN GUTMAN
Owner Owner's Name
information is NORTH AN DOVE R MA 0 8
required for every 45 APRI L 6, 2026
page. City/Town State Zip Code Date of Inspection
D. System nformation 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
luOff'icial Form
h
a Subsurface Sewage Disposal System Form - Not for Voluntary� ry Assessments
534 BOSTON STREET
Property Address
DAN OUTMAN
Owner owner's Name
information is NORTH AN DOVE R
required for every MA 01845 AP R I L 5, 2026
page, City/Town State Zip Code Date of inspection
D, System Information (cant.)
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;
�1 e
Z hand-sketch in the area below
❑ drawing attached separately—
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t5insp.doc rev.7/2-6/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System Page 16 of 18
1931, Commonwealth of Massachusetts
a
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
= Title 5 Official Inspection Form
v
534 BOSTON STREET
Property Address
DAN GUTMAN
Owner owner's Name
information is NORTH ANDOVER MA
required for every 01845 APR I L 6, 2026
page, City/Town State Zip Code Date of Inspection i
D. System Information (cunt.)
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: AUGUST 2007
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 M (attach documentation)
El Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
DESIGN PLAN
Before filing this inspection Report, please see Deport Completeness Checklist on next page,
t5insp.doc-rev.712E12018 Title 5 official inspection Farm:Subsurface Sewage disposal System-Page 17 of 18
Commonwealth of Massachusetts
r luTitle 5 Official For�1
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
534 BOSTON STREET
Property Address
DAN G UTMAN
Owner Owner's Name
information is NORTH AN DOVE R MA g 1845 APR IL L
required for every 6, g28
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:
11 21 3, or 5 completed as appropriate
4 (Failure Criteria) and 8 (Checklist) completed
D. System Information:
For 8: Tight/Holding Tank-- Pumping contract attached
For 1 4: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 1 5: 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
NOTICE
The property known as 534 Boston Street, North Andover, Essex County,
Massachusetts, referred to in a deed recorded with Essex North District Registry of Deeds
in Book 10796, Page 71 has been improved with a subsurface sewage disposal system
using an approved alternative technology known as a Clean Solution Alternative
Treatment System. Said alternative technology is approved by the Massachusetts
Department of Environmental Protection and shall be operated under the terms and
conditions of said approval dated June 20, 2006, including the provision that the owner
maintain an operations and maintenance contract for the system with a qualified person,
This Notice is given by the property seller:
Petra~r Fail
my y 1P �/;
_;` a Date:
T comas H, Petralia,-Trustee
COMMONWEALTH OF MA S SACHUSETTS
Essex, ss.
On this .��h day of January, 2008 before me the undersigned
� y ry, � notary public,
personally appeared Th9mas H. Petralia, Trustee of Petralia Family Trust, and proved to
me through satisfactory evidence of identification, which were Photo ID, to be the'
persons whose names are signed to this preceding document and acknowledged to me
that they signed it voluntarily for its stated purpose.
A� fie. W11114111
Notary Pu lie u9 L "',
My Commission expires: �q S10
+' n 0 c=+
Buyer and current owner acknowledgment of the within described Notice re ar on ��"" �a
ter ativ e reatm nt System located at 534 Boston Street, Forth Andover MAP, �` � h�e
_ C:(j
T1.1 0�
Y 0��m�"�
an i el W. Gutm a.n Cathy L Gi an
COMMONWEALTH OF MAS SACHUSETTS
r
Essex, ss,
On this aay'of January, 2008 before m e the undersigned notary public,
�' a g y p a
personally appeared Daniel W. Gutman and Cathy L. Gutman, and proved to me through
satisfactory evidence of identification, which were Photo ID, to be the persons whose
narnes are signed to this preceding document and acknowledged to me that they signed it
voluntarily for its stated purpose,
rotary b.�.-c
My Commission expires:
DANA S.COHEN
Notary Public
C,(im oiiwealth of Maq�,achuSells
may commission Expires
SEPTIC SYSTEM M-A-INTENANCE 5TEP5 Y0 �'
U CAN FOLLOW
What is a Sep do System? o Pump your s"Lic tank every I - 2 years_
A septic system is used to dispose and treat household Solids could be overfloyring to the leachin facilzt ri
g y gh t now,
sewage_ It consists of a rectangular u<jcer:-tight box causing damage that Will require expensive repairs-
(the septic tank) and a laaching facility. o Investiaa '-Le signs oz failure imiediately._
-slow draining of toilets and sinks
--Foul odor, patches of green grass, ponded water, or melting, snow,
near the leaching system,
eep:ic LJ.nk o Minimize eater use in the home
Tie less gazer used, the longer the retention period. in th
distributirnn box leaching area e tank .
and the more solids the bacteria can decompose. Use water--savin
Wastewater from the house flows directly into the septic showerheads and toilets. g
tank. There, the urger solids settle 'to the bottom,
f ormi_ng a layer of •sludge_ The lighter particles rise ° D.o •not dispose the following materials
to the surface, forting a layer of scum.. Bacteria in zhe -Garbage_ Use of disposals adds massive amounts of solids to the
:k work to decompose the solids in these layers_ Zn tank.
Spite o -5anicary napkins, colored zoilet 'paper,, disposable diapers, and
p r this decomposition, however, both the sludge and
scum gradually accumulate and must be removed even-y _ tissues ao not decompose-
gradually
years to ensure proper operation of the system_
-Cooking oil, fat, and grease can pass through the -sep tic tank
TN �FP'•I'C. TANK acid clog the 1eachInb field.
-Pesticides,, disinfectants
sewage frnm House air space acids,, medicine, pain•1W thinners,* etc. ,
will kill t1-1e helpful bacteria in the Lank and contaminate the
aczra build--�� groudwarer,.
`liquid to
quid beaching o Do not use cesspool cleaners
area .
va.stewa;`cr _ There are no known chemicals, _yeasts, bacteria, enzymes or or-her.
substances capable of elimina�ing or reducing •the sludge and scum
sludge so chal' periodic cleaning is unnecessary.. Many o.f these cleaner s
The liquid portion of the sewage- flows `arm the se tic canto- �-
p in highly concenz.L aced organic solvents that are rated toxic
tank to the leaching System., 4whzch consists of a series and susp
ected ted to be cancer--causing by the EPA and National Cancer
of perforated pipes or a pre-cast pit placed in trenches Znsciruze: They are no
or "beds" of Washed stone_ This system dirt � t bio--degradable and pose a Serious --
ributes the potential threat to private and public water supply .wells_ The
liq u.i d sewage into the surrounding sail; where it is use of such proauc is ?s nor
- necessary for the prover s r unc t ioning
filtered and tr2ated. of a 5epL1C 5v5teID and_ Jn tact, can harm the system.
The Need for Maintenance For more information or assistance, Contact• the Department of
The leaching systerr, is .not_ designed to receive solids. Environmental ual tv Engineering Regional office �G_)5--2160) or,
If solids are allowed to accumulate and over f low from the your local hoard of health_ (4 f d--3800 exz•, ?55) if your sep tic
sepcic tank, the leaching system becomes clogged and will system has been installed or repaired in the last -7 years, the
no longer transmit the liquid sewage. This results in a T°"n Health Dept_ most likely will be able to provide you wi Lh a
back-up of sewage in co the house. or a break-our through plot Plan of your system location. Call the above number co
the ground. When this occurs, the system can often only receive your copy `ree or charge_
be renovated by abandonment (usually for b 9nchs or more)
or by complete replacement_ Coscs for replaCeme��t of the TEL
[508] �5-� ;
leaching system are high, �-~
FAX:(508)4/ -54a1
g ranging �roru 31),000 t o f<3 1 DQO_ .
Wi zh : proper main cenance, these problems and expenses can
BATLESONoe avoiaed. , INC_ _
Excavating-Watcr&5cwcr Lines-Septic]Ystems S Purnpino SrrvEcc
1 1] Arpi ilia Road Andover mass. 0 18 d