HomeMy WebLinkAboutPASS - Title V Inspection Report - 480 Boxford Street 5/26/2026 Commonwealth of Massachusetts
M
Subsurface Sewage 131sposal System Form Not for Voluntary Assessments
" T"tle 5 Official Inspecti*on Form
480 BOXFORDSTREET
Property Address
JAMES NEED
Owner 's Name
required for even
page. City/Town State Zip Code Date of Inspection
Inspection results must be subml"tted on this form. ton forms may not be altered
way. Please see completeness frost at the end of the form.
lmoortantv.When A. Inspector Information
filling out forms
on the computer, � � � "
use only the tab _. ..____. ._._. s Bate�
key to move your Name of Inspector
cursor-do not Bateson Enterprises Inc.
use the return rrr Company Name
........__ .._ .
key,
�... III Road
__...�.�. . . . �..._..___.. .�.� ._�.. �.__ .._��._..�._..� . ..._.._...._..� .....____.__.. .". _,.. _.__��.__ ..�.. �.�._.�___..�_ ._ . ... ._.. _._. ...._. .�
b r it Address
Andover MA 01810
ity/Town State Zip Code
9 ' '5- 8 I
-16
Telephone Number License Number
B. Certification
I card that: I am a DEP approvedr in full compliancet tTitle
1 have personally inspected the sewage disposal system at the property address
listedabove- the information reported below is true, accurate and complete as of the time of m
inspection; and the inspection was performed based on my training rid experience in the proper function
and maintenance of on-site sewage disposal systems. r conducting this inspection I have determined
e
that the system,
I- Passes
2. Conditionally Passes
3. El Needs Further Evaluation by the Local Approving Authority
4.. Fails
MAY 28, 2026
Inspector's S ign r � Date
The system inspector shall submit a copy of this inspection report to the Approving Authority oar
f Health or Ewithin 30 days of completing this inspection. if the system has a design flow of
101000 d or greater, the inspector and the system n r 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 t
the buyer, if applicable, and the approving authority.
Pleasenote: This report only descrlibescondiffilons at the time of iinspectlon andunder the
condlvtl*o,ns of uset that time.This iinspectlon does not address how the system w*111 perform
in the future under the same or diffferent cond*lt*lonsuse.
t5ins.d -rev,7/26/2018 Title5 Official inspection Form:Subsurface Sewage Disposal System.Page 1 of1
Commonwealth ssac setts
"tie 5 U't't'"1c"1a1 Ion For
o .. . Subsurface Sewage its oral System Farm Not for Voluntary Assessments
480 BOXFORD STREET
Property Address
JAMES C ' ONNEL
Owner owner s I" ame _
information is IORTH AI o I F MA 01845 MAY 26, 2026
required for every
page City/Town State ,dip Cade Cate 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 descr'ibed
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, ICI, 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 exfil ration 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.
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 IUD (Explain below):
t insp,doc.rev,7/26/2018 Title 5 Official Inspection rormi Subsurface Sewage Disposal System•Page 2 of 1
Commonwealth of Massachusetts
T"Itle 5 Off"Icl"al Inspecti"on Form
10 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
480 BOXFORD STREET
Property Address
JAMES O'D l NELL
OwnerOwner's . ..--._..__m_. __..w._ _.___ ..._.a.....__.....w._.�_._.IT_w__��____�____.�._.._______..__._.______
information is NORTH AI DOVE MA 01845 MAY 2 2026
required for every _
page city/Town State .Zip code Date of Inspection
C. Inspection Summary (coat.)
2 System Conditionally lasses (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 F1 Y N AID (Explain below):..
El obstruction is removed 7 Y El N El AID (Explain below):
distribution box is leveled or replaced Y N F1 IUD (Explain below):.
Ej 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):
El broken pipe(s) are replaced Y 0 N [] ND (Explain below):
obstruction is removed 0 Y El N 7 ND (Explain below):
3 Further Evaluation is Required by the Board of Health:
0 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 31 CM
1 .30 3(1)(b that the-system is not functioning in a manner which will protect public health,
safety and the environment:
t insp.doc•rev.7/26/2018 Tifle 5 official Inspection Form.-Subsurface Sewage Disposal System-Page 3 of 18
Commonwealth of Massachusetts
T"t1e 5 Off"ic*ial Form
Subsurface Sewage Dilsposal System Form - Not for Voluntary Assessments
480 BOXFORD STREET
Property Address
JAMES O'DONNELL
inforrtiation is NORTH ANDOVER MA
MAY 26 026
required for every
page, citl�r /r �t�_t� � �_._wd�� � fIn��p_�.-c._.t_i.o.._r_
C
_._. _..._.._.._...._._.._�._.µ�._.w
Inspection Summary (corrt.
[:1 Cesspool or privy is within 50 feet of a surface water
El Cesspool or priory is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will falill unless the o aar+ of Health (anus Public Water Sup pll r, 'it an
determines that the system is uruct oru ng in a manner that protects the pwuubllc health,
safety and environment,.,
[I 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,
E] The system has a septic tank and SAS and the SAS is within a Zone I of a public water
supply.
[I The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
0 The system has a septic tank and SAS and the SAS is loss than 100 feet but 50 feet or
more from a private water supply well .
Method used to determinedistance:
This system passes if the well gyrator analysis, performed at a DEP certified laboratory, for focal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or loss than 5 pp , provided that no other failure criteria are triggered. A,copy of the analysis must
e 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 aoall as sp►�ect aoa so.
Yes to
0 z Backup of sewage into facility or system component dine to overloaded or
clogged SAS or cesspool
El Z Discharge or pon ing of effluent to the surface of the gro�und or surface tors
due to an overloaded or clogged SAS or cesspool
t in .doc.rev,7126/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System.Page 4 of 1
commonwealth o Massachusetts
0"ff icia ion Form
qlfil 1�� T*tle 5 1 Inspect"
ho
Subsurface Sewage Disposal System Form Not for Voluntary ssess ents
Property Address
JAMES o' olL
Owner
information is NORTHANDOVER MA 01845
026
required for even _.._. �.._..._ ....� _
page, City/Town State Zip Code Date of Inspection
C. Inspection Summary (coat.)
System Failure Criteria Applicable to All Systems.- cont
Yes No
El Z Static liquid level in the distribution box above outlet invert due to are overloaded
or clogged SAS or cesspool
0 z Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1 day flow
1:1 z Required pumping more than 4 times in the last year NOT due to clogged or
obstructed i e s . Number of times, pumped-
0
Any portion of the SAS, cesspool or privy is below high ground water elevation.
0 z Any portion of cesspool or privy is within 100 feet of a surface grater supply or
tributary to a surface water supply.
1:1 z Any portion of a cesspool or privy is within a Zone 1 of a public grater supply
well.
1:1 z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
0 z Any portion of a cesspool or privy, is less than 100 feet but greater than 50 feet
from e private ureter supply well with no acceptable water quality analysis. [This
system passes It the well rater analysis, performed at a DEP certified
laboratory,r for fecal colitorrn bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
r i e that no ether failure criteria are triggered. copy of the analysis
and chain of custody mist be attached to this form.]
1:1 z The system is e cesspool serving e facility with e design flog of 2000 gpd
10,000 gpd,
The system fails. l 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) barge Systems: To be considered a large system the system must serve a facility with
design flow of 10,000 + to 15,000pd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section c . .
Yes 10
El 1:1 the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to e surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area - IWP or a mopped Zone 11 of o public water supply well
t 1ns . o .rev,7/26/2018 Title 5 official Inspection a¢'m Subsurface Sewage Disposal System•Page 5 of 1
Commonwealth of Massachusetts
T"tle 5 Off" I Inspect' Form
icia ion
10 Subsurface Sewage Disposal System Fora Not for Voluntary Assessments
Property Address
JAM ES C 'DON ELL
Owner
Owner's Name
information is O T�H AI DC VI ILIA o1345 MAY 2 202
required for every __..._._.._,_._._ _._. ._. W.
page, y State Zip Cade Date of inspection
C. Inspection Summary (coat.)
If you have answered "yea" 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.
You must indicate "yes" o "no"for each of the following for allinspections:
Yes No
Dumping information was provided by the owner, occupant, or Board of health
Were any of the system components pumped out in the previous two weeks?
0 Has the system received normal flows in the previous two week period?
0 z Have large volumes of water been introduced to the system recently or as part of
this inspection's
Were as built plans of the system obtained and examined? If they were not
available note as /A)
E El Was the facility or dwelling inspected for signs of sewage back up?
1:1 Was the site inspected for signs of break out?
z 1:1 Were all system components, excluding the SASS, located on site?
Z F-1 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?
z 1:1 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 7 Existing information. For example, a plan at the Board of Health.
Determined in the field if any of the failure criteria related to Fart C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)
t5insp.d c•rev.7/26/2018 Title 5 Official InspectionForm:Subsurface e Sewage Disposal System•Page 6 of 18
commonwealth of Massachusetts
TI'tle
ENV Inspect'ion
26
I Subsurface Sewage Disposal System Form Not for Voluntary Assessments
480 XFORD STREET
Property Address
JAMES O'DONNELL
__�—_�__.M.__._..____w.m�.._....,...�..�...._..µ.. ....�,,....,.�...._......,,..._......,....,_,.,.�....._.....�_�...._.,._..M__.__...._.._a._......_____._..,..._ ___,_.,_,_,,.........,rv__...._.._._,...�.....,..,...�� ...,w......,..__.......M�..u�.�..,..,�.,.,..,�....,_..,.�.._..w.._._.�._._.,_�. ._....._.._._..,.,.,w_._.,.....__.w._..u,.._�..__.,.rv.__...._,..._.__,,....................._,_._.._.,..�...,.._....__.�.�.w.......w
Owner Corner's Name
required for every
page. State Zip Code Cate of Inspection
D. System Information
1. Res'I'dential Flow Conditions,,,
4
Number of bedrooms (design)- _.' .._ __....._ umber of bedrooms (actual): 440
_� _.m......_
DESIGN flaw based on 31 CMR '15.2 3 for exa le: �1'1 d x of bedrooms):
G
Description.,
Number of current residents; 5
Does residence have a garbage grinder? El Yes Z No
Does residence have a water treatment unit' Yes E Nye
If yes, discharges to OUTSIDE
Is laundry on a separate sewage system? (include laundry system inspection El Yes Z N
information in this report.
Laundry system inspected? Yes No
Seasonal use? El YesZ No
WE
Water meter readings, if available last 2 years usage d l L
Detail:
Sump pump. 0 Yes No
CURRENT
Last date of occupancy: D._...�te..�.. __......._._....
t5insp.doc•rear.7/26/2018 Title Official Inspection Farm:Subsurface Sewage Disposal l System.Page 7 of 1
Aftk
"41 uommonwealth of Massachusetts
T1
"tie 5 0T'*T'1'ci*a ion Form
I Inspect*
Subsurface Sewage Disposal System Form Not for voluntary Assessments
w 480 BOXFORDSTREET
Property Address
JAMES
LL
Owner _.__._________.___"__.�._.�. ._�
i�er's J�rne.
information is NORTH AI" EI ILIA 1 4 MAY 2 2026
required for every �.._._.___m.._... . I
page. pity/T'ewr� __.._�._w _State
.�_._. Zip Code gate of Inspection
U. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment-
Design flaw (based can 310 CMR 15.2 3): Gallons per day(gpd�_��
)
Basis of design flow ($eats/persons/ p.f., etc.):
Grease trap present's D Yes o
Water treatment unit present? 7 Yes E] No
f yes, discharges to:
Industrial waste holding tank present? El Yes No
Non-sanitary waste discharged to the Title 5 system? Yes No
Water meter readings, if available.-
Last date of occupancy/use: ate
Other(describe below):
3. Pumping Records.-
Source of information: ATESON ENTERPRISES INC MARCH 2024
Was system pumped as part of the inspection's [ Yes Z No
If yes, volume pumped:
ilcrrs
How was quantity pumped determined? ___.__Mm._.__.
P e a s o n for pumping:
t5ins w.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
Form
k _ I>
Subsurface �►evvaesposal Syserr ►rr -iltr� TI't1e, 5 Q"t"t"'icial Inspect"ion
Not for Voluntary Assessments
:
-----------
Property Address
JA ES otl o l ELL
Owner Owner's ir>
information is NORTH ANDOVE MA 0184 MAY 2 � 02
required for emery City/Town/�c�wrt __.._ _...____ state__-_.._ _._____ _ _ _m.__..._.....
page �..� _._..__._...__ ..�_. .�..._�___ Zip Code Gate of Inspection
D. System Information (cont.)
4. Type of System.-
Septic tank, distribution boxy 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
El Tight tank. Attach a copy of the [ IMP approval.
El other (describe):
Approximate age of all components, data installed (if known) and source of information:
YEARS, INSTALLED JUKE 2021, AS BUILT PLAID
Were sewage odors detected when arriving at the site? El Yes Z No
5. Building Sewer(locate on site plan):
Depth below grade: 24'[_._______
p g feet
Material of construction:
El cast iron Z 40 PVC other(explain):
Distance from private water supply well or suction line: o
p pp y feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
JOINTS AND VENTING o
No EVIDENCE of LEAKAGE
t5irnsp.dc c-rev.7/2812018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 9 of 18
k;ommonweafth of Massachusetts
T*tle 5 Q' ff"ic"ia'1 'Insr%ecti* Form
Subsurface Sewage Disposal System Form Not for Voluntary ssess ents
Property Address
JAMES a ELL.
information is NORT NDOVE A 0184,5 MAY 26, 26
required for err �.. �... �[ o..I1°�s~ectio �_......w__�.�...�..�....w..._.."w... . .-__..
.... .. �.. ... .. ...mm ...."._.__... w.. ...____._�__........._.__._..._._.._.__.." _ ._._ .._.....__... .
page State Zip Code
D. System Information (coat.)
6. Septic Tank (locate on siteplan);
12 it
Depth below,grade: iw t
Material of construction:
concrete metal fiberglass polyethylene other(explain)
It tank is metal, list age: .._.._._ ...__. ... .w__-.._. __ _ _ _-__._....... __._.._...
years
Is age confirmed by a Certificate to of Compliance? (attach a copy of certificate) Yes No
Dimensions
6'
Sludge depth.-
�......_.W"._......._.... _ __.._..._____.. _.__... .. ._.......__._.....
Distance from top sludge t ttC of outlet tee or baffle 32m��__.___._..�...._.._...__.. .._ __.__m_..__._�._...�__. � .
Scum thick ness .5��._...._... __._.. �_.._. .._._M...n._ . ._._....._..�._..._ _..
Distance from top of scum to top of outlet tee or daffy ... _..�.. M_._..__.....__._ ____ �� .�_...M.. .....__..._.__._..........._._._.._..
Distance from bottom of scum to bottom of outlet tee or baffle 9�.w_...._ � ..���.. ......................_ .... mmw.._..._...._..........
How were dimensions determined? SLUDGE JUDGE
TAPS MEASURE
Comments n pumping recommendations, inlet and cutlet tee or baffle condition, structural integrity.,_
liquid levels as related to cutlet invert, evidence of leafage, etc.),-
PLASTIC STIC INLET AND OUTLET TEES O
TANK IS OK
LIQUID LEVELS ARE GOO
NOF LEAKAGE
RECOMMEND PUMPING TANK FOR MAINTENANCE
t in p. oc.rear.7/26/2018 Title Off icial Inspection Form:Subsurface Sewage Disposal System•Page 10 of 1
Tatle 5 u0%t&*t&v*ic*ia1K
nspection Form
C uommonwealth of Massachusetts
_. Subsurface Sewage Disposal System Form Not for Voluntary Assessments
480 XFOR STREET
Property Address
JAMES O'DONNELL
Owner er s Name ------- ................
irtt rmation is NORTH DOVES A 01845 MAY 26 2026
requiredfor ever/ ity cat _...__ _._... ._.. ,._ ....._.,...._,_ ,..,. m......_....__._ ._ _� __.__.__m....._ ._._ __. ...__........ ...._.._w Irs�..m.e�tic .._ ......__....___.._.__...._......W�
page. Town State Zip Code
D. System Informationcoat.
''. Grease Trap (locate on site plea):
Depthbelow grade: .... ,.. _ _.__.._... ...-____ ..._.._....... ,�......__.... _.._..._
Material of construction-
F1
concrete 0 metal 0 fiberglass El polyethylene El other(explain):
Dimensions-
Scum thickness .. w.._....mm_. ............ .._.. .__ _. . . ...__._.._.m....... ..._ .
Distance from top of scum to top of cutlet tee carbaffle
Distance from bottom of scum to bottom of cutlet tee or baffle _ ....__ ......,..._..w......_..w_.,_._..__.m.._._..... _. _.. .___.......�._.
Date
Comments (on pumping recommendations, inlet and cutlet tee or baffle condition, structural integrity,
liquid levels as related' to cutlet invert, evidence of leakage, etc,):
. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan)*
Depth e l o grade*
_... r ....__.._ ___. ._....._.. . . ........ ._..._�..........__._..
Material of construction:
El concrete El motel fiberglass polyethylene other (explain)-
Dimensions: __n_n....._n_.. ._._ _..... __..__.._.._.__....._..___._........ . .....__n..._.._ _.......
Capacity:
gallons
DesignFlow _ _.._.. _ _.. _,,.._„µ,...._ ..._, .Mw..._._.._... .._ _._....__..._.._w_...._-_.m_. .rv.... ______
gallons per day
t'0 p. w rev.7/26/2018 Title Official inspection Form Subsurface Sewage Disposal S st rn-page I i of 1
Commonwealth Massachusetts
. w � ic* s
Form
T*tle 5 'Off" ial Inpect'ion
._,. I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
480 BOXFORDSTREET
Property Address
JAMES 'D N I E L L
OwnerOwner's Name
information is
MA 01845 MAY 26, 2026
required for every _.
page. City/Town State Zip ate of inspection
D. System Infor i (cola.)
. Tight or Holding Tank c ry .
Alarm present: Yes No
Alarm level ___ .m_._ ....... _....... .. ..._.._. ..._........w....__...... Alarm rm in working order: Yes
c�
te
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached' Yes N o
9. s ribuflo►n Box (if present must he opened) (locate on site plan):
Depth of liquid level above outlet invert ._ .._ n............M _.... . _ .. .__ ___- ._n_ _._. _._. ._Ww_.__. .. ._ ......�. ....N..
Comments (note it box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leafage into or out of box, etc.):
-BOX IS LEVEL AND DISTRIBUTION IS EQUAL
LIGHT EVIDENCE OF SOLIDS CARRYOVER
-BOX HAS FLOW EQUALIZERS
NO EVIDENCE OF LEAKAGE
t5insp. as.ray!.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System»Page 12 of 1
k;ommonwealth of Massachusetts
.... n � Off"ici'al
mm Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4,80 BOXFORD STREET
Property Address
JAMES ' O NEL
Owner
information is
NqRTH ANDOVER MA
01845 MAY 26, 2026
required for�r��� C�� C�c� rt ���.r.. .. �� _m I�r��..�....��_��._..�.,�.�..__.....�,....____.__._____.m.w._..
page. Y cation
D. System Information (cunt.)
1 , Pump Chamber(locate on site plan)-
Pumps ps in working order. Yes
Alarms in working order. Yes E] No*
Comments (note condition of pump chamber,er, condition of pumps and appurtenances, etc,):
If pumps or alarms are not in working order, system is a conditional pass.
11 M. Soil Absorptlion System (SAS) locate on site plea, excavation not required):
If SAS not located, explain why:
Type:
11 leaching pits number-
0 _.._... . ........_..... ... ._....... _....
leaching chambers number: _._._M.._........._......._..._ ._ ___..__.._.
leaching galleries number: _........_ _....._ ... _ _..... ... ___._._
leaching trenches mum er, length: 2;.._.�5. 1.....__
leaching fields number, dimensions., _..w�....... _......._._._._.._.
overflow cesspool number:
innovative/alternative system
Type/name of technology: ......
t ins .d a -rev,7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 1
Commonwealth Massachusetts
�s T"Itle 5 Off"icialorm
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
480 BOXFORD STREET
Property Address
JAM ES ' ONNELL
Owner Owner's Name
informcition is NORTH ANC VE MA 01 '5 MAY 26, C
required for every ___..._..____ �_
C it /Town StateZipC Code
y wDate 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 AND VEGETATION N GOOD
No SIGN of HYDRAULIC FAILURE CAR PON ING
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 ___ ______..._ .__..____. __.._. .__n...._ ..........
Depth of scum layer
Dimensions of cesspool _v .__ _ w__ __..__._._..._. _____ ._..........
Materials of construction
Indication of groundwater inflow Yes No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t insP.doc•rev.7/ 6/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System«Pace 14 of 18
µ t.�ommonwea1 h of Massachusetts
.�..,.... a "«me...µ......... Title 'Official Inspecti*on
Subsurface Sewage Dlis osall System Form - Not for Voluntary Assessments
a„ 4,80X R STREET
. r __.�._.._, _._.w...._........_..._._._...__.........__.. ...__........_._.
Property Address
Owner _JAMES ' L
Owner's Name
information is NORTH OV R C 5 MAY 26, 2026
required for every _..._.µm .__ _ . _ .__.._... ........_._.......... ____..._a.____.
page. Y t� �w n i Code Cate of Inspection
D. System Information (cone.)
3. Privy (locate on site plan):
Materials construction', �....� .�...._.._��,..._.
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t aln p.do •rev.7/26/2018 "title 5 Official Inspection Form:Subsurface Sewage Disposal System.liege 15 of 1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
� Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4
480 BOXFORD STREET
Property Address
DAMES O'DONNELL
Owner Owner's Name
Information is NORTH ANDOVER MA 01845 MAY 26 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
� �QQ6 the building. Check one of the boxes below:
Q
hand-sketch in the area below
❑ drawing attached separately
Boxfor
0 0 '0_1 POPIA -I-MONO
Q.
1S00C ion
a
&1W 1 .. 0 . .
f tA
A Q 6
A 0
Uf�e� X 5� 5 I r
t5insp.dx•rev.7/26I2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 16 of 18
uommonwealth of Massachusetts
TI'tle 5 Ot"t'i"cial Inspect'ion Form
:µ Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
480 R D STREET
Property Address
JAMES O' O ' ELL
OwnerOwner's
.m.�., �....._.�.�..._w_�..._.,.�...._....
, ......�.._..m�.._._�_..._.......�_....__. ..�__v...._-�_.____w._ ._..__ .._...._.__M......�.�_.�.�..m......rv... ...._..._W. ...._........�__�.........._..�
information is NORTH ANDOVER C 1 45 MAY 26, 2026
requirefor ever .._.._......_.........._ � .�. ....__.___.n.._M._... .. ._.._. _.... ._._� _.._..... ........_.._..._
page. City/Town State Zip Code Date of Inspection
D. System Informati (cont.,)
15. Site Exam:
Check Slope
Surface water
Check cellar
El Shallow wells
Estimated depth to high groundwater: e... . ..� ._.�.._.M...��..... ..M._.... � ._ ._...._.µ. _ _._._.....__..
'lease 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 y 202.E
JU,ate LY""'
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of health - explain:
PLANS ON FILE
C hecked with local excavators, installers (attach documentation)
n
Accessed USES database -explain-
You must describe how you established the high ground rater elevation-
DESIGN PLAN
------
Before filing s Inspection Report, please see Report Completeness Checklist on next page.
t insp.doc-rev.7/26/2018 "title 5 Official inspection Fora:Subsurface Sewage Disposal System-Page 17 of 1
Commonwealth of Massachusetts
' icia
ion
T*tle 5 Off" I Inspect' Form
11,
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
Property Address
AMES 'DONNELL
Owner C r�rner'S I al
information is NORTHANDOVER ILIA 01845 MAY 2 02
required for every ,
� _ � �._...
page. State ,dip Cade Cate 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 { Tight/Holding Tank- Dumping 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
t insp.do -rear.7/26/2018 'Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 18 of 18
L:.,L jL L%. ;.AZA-&A AAAUa-A•'-LA-•,•u•...1.. STEPS,YOU CAN FOLLOW i.
What is a Sep t•ic System? �
o Pump your septic tank every 1 - 2 years.
A septic system is used to dispose and treat household Solids could be overflowing to the leaching facility right now, •,
sewage. it consists of a rectangular Winer--tight box causing damage that will require expensive repairs.
(the sept ec y.ic tank} and a lehing facilit
• o l.nves t igate signs of' failure immedia t ely.
• --Slow draining of toilets and sinks
CD - --Foul odor, patches of green grass, ponded water, or melting snow'
_ - near the leaching
system.
e e p c i e L a.ak
t o Minimi ze vater use in the home
distribution box-
The less era ter used, the longer the re tent ion period in the tank
leaching are8 and ehe more solids the bacteria can de�-. compose. Use water-saving
Wastewacer from the house flows directly into the septic showerheads and toilets.
tank. There, the larger solids settle 'to the boutom, o Da .not dispose the following• forming a layer of -sludge. The light
lighter particles -rise P l ing materials
--Garbage_ Use of disposals adds massive amounts of soLids to the
to the surface, forming a layer of scorn.. Bacteria in the tank.
t:�rik wank to decompose the solids in these lavers, ln -Sanitarynapkins, colored tole '
spite of this decomposition, however, both the sludge and p s 1 t Paper, disposable diapers , and
scum gradually accumulate and must be removed every i ? tissues do not decompose.
years to ensure proper operation of the system. --Cooking oil, fat, and grease can pass through the •septic tank
• dead clog Cite �,eaching field
. THE SF�''T'�'� TANK -Pesticides,, disinfectants acids med
air space 1C1ne, paint thinners, etc_ ,
sewage from house p
• will kill she helpful bacteria in the tank and eoncaminate the
r
acua build--up. groudvater.
1,liqtLid to
li aid lc a Do no C use cesspool cleaners
q vz1 leaching
fl area -
uaSCev$Lcr
There are no known chemicals, yeasts, bacteria, enzymes or ocher
. - _. ,. ,
substances capable of eliminating or reducing •the sludge and slum
sludge so that periodic cleaning is unnecessary. Many of these cleaners
The liquid portion of the sewage- flows form the septic contain highly concentrated organic solvents that• are rated toxic
tank to the leaching system, -which consists of a series and suspected to be cancer--causing by the EPA and National Cancer
of perforated pipes or a pre--cast pit placed in trenches Institute: They are not bio-degradable and pose a serious
or "beds" of washed stone. This system distributes the potential threat to private and public water suppl,y ,wells. The.
liquid sewage into the surrounding soil, where it is use of such products •is not necessary for the prover functioning
'filtered and treated. of a septic system and, in fact, can harm the system.
The Need for Maintenance For more information or assistance, contact- the Department of
Environmental duality_ Engineering Regional Office (435--2160) or,
The leaching system is .not. designed to receive solids. Vour local Board o r �
If solids are allowed to accumulate and oti,er►1.ow from the - f heal Lh. (4 f 0-3500 ext. -55) If your septic
System has been installed or repaired in the last 5--7 years, the
septic Cank, the leaching system becomes clogged and will w. most Tom, Health Dept. likely " -
no longer transmit the liquid sewage. This results in a p 1, ill be able co provide you with a
system location. Call the above number to
back--up of sewage into the house or a break-out through plot plan of your receive our co free of chartre.
the ground. When this occurs, the system can often only y copy
be renovated by abandonment (usually for S inon chs or more) '
TEL:(sos)4:5-14#74 .
or by complete replacement. Coscs for replacement of the
Ax:[508]45-5z1
.e
leaching system are high, ranging from 30S000 to��fDdo_
G��tn proper maintenance, these problems and expenses can - BATESON ENTERPRISES, INC. :
be avoided. Excavating-Warr 6 Srwrr Lines-Scpzic Sysrrrns&Purnping Servicc
]i 1 Argilla Rbad Andover,Mass. 01810