HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 445 SALEM STREET 8/13/2025 m m o n we I h of Massachusetts
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Subsurface Sewage Disposal System Form � filet for voluntary Assessments
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445 SALEM STREET
Property Address
ACAC IC BARROS
Owner _
Owner's Name
information is NORTH AN OVER MA 01 45 AUGUST 13 2025
required for every ...... _ _ I
page. C.itylTowrl State Zips Code Date of Inspection
Inspection results must he submitted on this form. Inspection forms may not he,altered in any
way. Please see completeness checklist at the end of the form.
Tmkin ot Noqn Avidov'Bf
Important:when InspectorInformation
filling out forms A.
on the computer,
use only the tab
ToddJamesate�an
key to move your Dame of Inspector
cursor-do not Bates on Enterprises Inc.
use the return
key. Company Dame
111 Ark i I la Road its
ealth [)epartme
Company Address
Andover MA 01810
10
City/Town State Zip Code
978-475-47 6 SI 16
Telepho
ne Number License Number
B. Certification
I certify that. I am a DEP approved' system inspector in full compliance,with Section 15.340 of Title
(310 CMR 1 . ; I 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 m
inspection; and the inspection was performed based Can 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
:., AUGUST 21 2 25
Ins for s Si gnat re Date
Th
e system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of hlealth or C EP)within 30, days of completing this inspection. If the system has a design flow of
101000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the D'EP. 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 ti�ae 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.
t8insp.doe-rev.7128/ 018 Title 5 Official Inspection Fora:Subsurface Sewage Disposal System•Page 1 of 18
f Commonwealth of Massachusetts
Title
Officialr 1W Form
� Subsurface Sewage Disposal System Form Not for Voluntary Assessments
445 SALEM STREET
Property Address
ACACIG BARROS
Owner owner's Name
information is N G RTH AN DOV E R MA 01845
required for every AUGUST 3, 2025
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 21 3, or 5 and all of 4 and 0.
1) System Passes:
Ej 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 El ND (Explain below):
t5lnsp.doc•rev.7126/2018 Title 5 official inspection Form:Subsurface Sewage Disposal System Page 2 of 18
Commonwealth of Massachusetts
�xTitle 5 Official Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
N
9 �
445 SALEM STREET
Property Address
ACACIO BARROS
Owner Owner's Name
information is NORTH ANDOVER MA 01845 AUGUST 13 2D
required for every _ _ t 5
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cant.):
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 El N El ND (Explain below):
D obstruction is removed Ej Y ❑ N El ND (Explain below):
® distribution box is leveled or replaced E Y [I 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):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed El Y Ej N [] ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
Ej 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,7/2612018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 3 of 18
{{ � Commonwealth of Massachusetts
•F f..
:f.. 11P Title 5 Official Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
445 SALEM STREET
Property Address
ACACIO BARROS
Owner owner's Name _.
information is NORTH AN DOVE R MA 41$
required for every _ 45 AUGUST 13, Q�5
page, City/Town State Zip Code Date of Inspection
C. Inspection Summary
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:
❑ 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.
Ej The system has a septic tank and SAS and the SAS is within 54 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 54 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
El N 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 Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
445 SALEM STREET
Property Address
ACACfO BARROS
Owner owner's Name
information is NORTH AN DOVE R MA 01845 AUGUST
required for every UST 13, 05
page, City/Town State Zip Code Date of Inspection
C. Inspection Summary (cost.)
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
El El Liquid depth in cesspool is less than 5" below invert or available volume is less
than 1/2 day flow
❑ ® Required pumping more than 4 times in the fast year NOT due to clogged or
obstructed pipes). Number of times pumped:
[� Any portion of the SAS, cesspool or privy is below high ground water elevation,
d 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,
❑ z 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.
❑ 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,
necessaryto 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 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 El 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
h p Title 5 Official Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
F
4 f.±
445 SALEM STREET
Property Address
ACACIo BARROS
Owner owner's Name
information is NORTH ANDOVER MA 01 845 AUGUST 3 2025
required for every
- I
page, City/Town State Zip Code Date of Inspection
C. Inspection Summary (cost)
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 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,
8. 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?
El 0 Have large volumes of water been introduced to the system recently or as part of
this inspection?
El ® Were as built plans of the system obtained and examined? (if they were not
available note as N/A)
® El Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
0 El Were all system components, excluding the SAS, located on site?
E 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;
Z El Existing information. For example, a plan at the Board of Health,
E ElDetermined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [3 0 CMR 15.302(5)]
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Farm:Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
0
_- 4}
Title 5 Offi
c'ial In Forrr�
1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
h
�q 6
k
445 SALEM STREET
Property Address
ACACIO BARRoS
Owner owner's Name
information is NORTH ANDOVER MA 0
required for every
page. Ci 845 AUGUST 3, 2025
tylTown State Zip Code Gate of inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): NA Number of bedrooms (actual): 3
� }
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): NA
Description:
Number of current residents: 0
Does residence have a garbage grinder? EJ Yes [E No
Does residence have a water treatment unit? ❑ Yes H No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.) ElYes N No
Laundry system inspected? E Yes ❑ No
Seasonal use? El Yes N No
Water meter readings, if available last ears usage d SEE ATTACHED
g t y g �gP }}�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 2023
Date
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 7 of 18
Commonwealth of Massachusetts
r
_ Title 5 Official Form
t'
h
Subsurface Sewage Disposal System Form w Not for VoluntaryAssessments
%v10 445 SALEM STREET
Property Address
ACA_Clo BARROS
Owner owner's Name
information is NORTH ANDOVER MA o1845 AUGUST required for every 3, 0�5
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 1 5.203): Gallons r da
y ay(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes El No
Water treatment unit present? El Yes El No
If yes, discharges to:
Industrial waste holding tank present? El Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? EJ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes ® 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
g r Commonwealth of Massachusetts
�h (: Title 5 Off
ici a Inspection Form
Subsurface Sewage D'Isposal System Form - Not for� Voluntary Assessments
445 SALEM STREET
Property Address
ACACIO BARROS
Owner owner's Name
information is NORTH AN DOVE R MA 0 84 5
required for every AUGUST 3, 2025
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
E Septic tank, distribution box, soil absorption system
El Single cesspool
❑ Overflow cesspool
❑ Privy
El 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:
59 YEARS OLD, INSTALLED 1966, OWNER
Were sewage odors detected when arriving at the site? El Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 28
feet
Material of construction:
M 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.):
JOINTS AND VENTING OK
EVIDENCE OF LEAKAGE
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Farm:Subsurface Sewage Disposal System■page 9 of 18
E Commonwealth of Massachusetts
�hTitle 5 Official Forio m
r � Subsurface Sewage Disposal System Form - Not for Voluntary:. y Assessments
7'�:a ,tb~16 445 SALEM STREET
Property Address
ACACIO BARROS
Owner owner's Name
information is NORTH ANDOVER MA o1 845
required for every AUGUST 3, �g25
page- City/Town State Zip Code Date of Inspection
D. System Information (cont.)
5. Septic Tank (locate on site plan):
{
Depth below grade: 15
feet
Material of construction:
® concrete ❑ metal El fiberglass El polyethylene other(explain)
If tank is metal, list age: Years
Is age confirmed by a Certificate of compliance? (attach a copy of certificate) El Yes El No
Dimensions: 5' x 8`X 4'
Sludge depth: 511
Distance from top of sludge to bottom of outlet tee or baffle
32"
Scum thickness
g
Distance from to of scum to to of outlet NA
p p t tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle NA
How were dimensions determined? SLUDGE JUDGE AND TAPE
MEASURE
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc,):
RECOMMEND PUMPING OLDER SYSTEMS YEARLY
CONCRETE INLET BAFFLE OK
PLASTIC OUTLET TEE OK
TANK OK
LIQUID LEVELS GOOD
NO EVIDENCE OF LEAKAGE
15insp,dcc-rev,7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
z .. wTitle 5 Official Fors
!ro >
Subsurface Sewage DisposalSystem Form - Not for Voluntary Assessments
6 445 SALEM STREET
Property Address
ACACIA BARROS
Owner owner's Name
information is NORTH ANDOVER MA 0
required for every $45 AUGUST 3, 05
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:
El concrete ❑ metal ❑ fiberglass ❑ 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 Folding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete D metal El fiberglass ❑ 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 I 1 of 18
Commonwealth of !Massachusetts
lwOfficial Foral
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
7•'J?1A tlC'4 �0� 445 SALE M STREET
Property Address
ACACIO BARROS
Owner Owner's Name
information is NORTH ANDOVER MA 0 845
required for every AUGUST 3, 025
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: EI 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
0. 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,):
D-BOX IS NOT LEVEL
DISTRIBUTION IS NOT EQUAL
HEAVY EVIDENCE OF SOLIDS CARRYOVER
EVIDENCE OF LEAFAGE
D-BOX ROTTED - NEEDS REPLACED
t5insp.doc-rev.7/2612018 Title 5 official Inspection Form;Subsurface Sewage Disposal System-Page 12 of 16
Al
commonwealth of Massachusetts
Title 5 Off For�1
u
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
a
445 SALEM STREET
Property Address
ACACIO BARROS
Owner Owner's Name
information is NORTH ANDOVER MA 01845 AUGUST �13 2025
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 El No*
Alarms in working order: El Yes EJ 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:
El leaching pits number:
❑ leaching chambers number:
El leaching galleries number:
El leaching trenches number, length:
® leaching fields number, dimensions:
1; 2 0' x 40'
❑ overflow cesspool number:
El inn ovativelalternative 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
�h Iu ic"ial I Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
9 I�
�V
-,`k�` 445 SALEM STREET
Property Address
ACACIO BARROS
Owner Owner's Name _.
information is NORTH AN DOVE R MA 01845 AUGUST 13 20�
required for every 5
page. City/Town State Zip Code Date of inspection
D. System Information (cont.)
11. 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 OK
NO SIGN OF HYDRAULIC FAILURE OR PONDING
RAN CAMERA DOWN TO END OF LINE To DETERMINE SIZE OF SYSTEM
PIPES ARE DRY
2. 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 0 No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp,doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
, Commonwealth of Massachusetts
: iciaInspect'ion Form
a
' n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
9 .
r'
445 SALEM STREET
Property Address �W W
ACAC 1 O BAR RO S
Owner owner's Name
information is NORTH ANDOVER MA 01845 AU
required for every GUST 13, �05
page. CitylTown 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
T*tle 5•' r Offi'cia
I Inspection For
Subsurface Sewage Disposal System Form - Not for Volun
tary ntary Assessments
. �. 445 SALEM STREET
Property Address
ACACI0 BARROS
Owner Owner's Name
information is NQRTH AN
required for every I�OVER IAA 845 AUGUST3, 05
page. City/Town State Zip Code Date of inspec#ian
D. stem Information
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: pp y
hand-sketch in the area below
El drawing attached separately
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t5insp,doc-rev.7/2612018 Title 6 Official Inspection Form:Subsurface'swage Disposal System Page 16 of 16
Commonwealth of Massachusetts
f
7t,� Title 5 Officia
Inspect'ionForm
la
a
Subsurface Sewage Disposal System Form w Not for Voluntary Assessments
445 SALEM STREET
Property Address
ACACIO BARROS
Owner Owner's Name - _
information is NORTH ANDOVER MA 01845
required for every AUGUST 13$ 20 5
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
Z Check Slope
Z Surface water
Z Check cellar
El Shallow wells
Estimated depth to high ground water; feet
Please indicate all methods used to determine the high ground water elevation:
z Obtained from system design plans on record
If checked, date of design plan reviewed: NA
g p Date
El Observed site (abutting property/observation hole within 150 feet of SAS)
z Checked with local Board of Health - explain:
NO PLANS ON FILE
❑ Checked with local excavators, installers --(attach documentation)
Accessed USGS database -explain:
ESS EX COUNTY SOIL MAP
You must describe how you established the high ground water elevation:
CANTON FINE SANDY LOAM
DEPTH TO WATER TABLE >80"
SYSTEM ABOVE WATER TABLE
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
12 Title 5 Official Fors
r � Subsurface Sewage Disposal System Form Not for Voluntary Assessments
5
445 SALEM STREET
Property Address
ACACIO BARROS
Owner Owner's Name
information is NORTH ANDOVER MA 01845 AUGUST '13, 2025
required for every _ W
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, 2, 3, or 4 checked
® C. Inspection Summary:
11 21 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 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 T8
Summary Record Card generated on 8/12/2025 11:39:41 AM by Tara Hurtey Page 1
Torn of North Andover
z
Tax Map # 210-038.0-0056-0000,0
Parcel Id 18854
445 SALEM STREET
KANE, BARBARA I Since Jan 2003
FRED W KANE
445 SALEM STREET
NORTH ANDOVER MA 01845
Class 101 Single Family Property Type 1 Residential
Size Total 1.36 Acres
FY 2026
UB Mailing index
Name/Address Type Loan Number Act€vellnact, From Until
IGOR ALMEIDA Owner Active
445 SALEM STREET
NORTH ANDOVER MA 01845
KANE,BARBARA Previous Customer Inactive 711 12025
445 SALEM STREET
N.ANDOVER,MA
01845
UB Account Maint.
Account No Cycle Y Occupant Name Active/Inactive
Bldg Id. 16082.0-445 SALEM STREET Last Billing Date 7/3/2025
3160123 03 Cycle 03 Active
UB Services Maint.
Account No.3160123
Servlce Code Rate Charge Multiplier/Users
SCFEE ADMIN FEE 0.63 518 7.82 11
WTR WATER 01 ALL METER SIZE 11
UB Meter Maintenance
Account No.3160123 {
Serial No Status Location Brand Type Size YTD Cons
M212 a Active 00 METE METE w Water 0.625 0.625 1063
Date Reading Code Consumption Posted Date Variance
71312025 2418 f Final Bill 0 71312025 -100%
6/20/2025 2418 a Actual 622 7/9/2025 4.3%
315I2025 1796 a Actual 371 4/16/2025 -100%
12/4/2024 1425 a Actual 0 1/14/2025 -100%
914/2024 1425 a Actual 0 10/8/2024 -100%
616/2024 1425 a Actual 0 7/22/2024 -100%
31512024 1425 a Actual 1 4/16/2024 -1%
121512023 1424 a Actual 1 1/15/2024 7%
9/6/2023 1423 a Actual 1 10/13/2023 -4%
612l2023 1422 a Actual 1 7/14/2023 -53%
312/2023 1421 a Actual 2 4/12/2023 107%
12/5/2022 1419 a Actual 1 1/16/2023 -64% ?
916/2022 1418 a Actual 3 10/18/2022 -42% t
61212022 1415 a Actual 5 7/18/2022 -48%
3f212022 1410 a Actual 9 4/13/2022 -1%
12/6/2021 1401 a Actual 10 1/17/2022 21%
91212021 1391 a Actual 8 10/15/2021 -20%
61212021 1383 a Actual 10 7/27/2021 7%
3/212021 1373 a Actual 9 4/2112021 3%
12/3/2020 1364 a Actual
9 1113/2021 -17%
9/212020 1355 a Actual 11 10/14/2020 -25/o 0
6/112020 1344 a Actual 14 7/15/2020 --6%
31412020 1330 a Actual 15 4f812020 polo
12/5/2019 1315 a Actual 14 1/15/2020 3%
9/12/2019 1301 a Actual 16 10/10/2019 -7%
6/5/2019 1285 a Actual 16 7/25/2019 -2%