HomeMy WebLinkAboutPASS - Title V Inspection Report - 14 PURITAN AVENUE 6/23/2026 Commonwealth of Massachusetts Town of Nod Andover
Title 5 i I Inspect' or ' 'Z cia ion
Subsurface Sewage Disposal System Form Not for Voluntary Assessments JUN 2 3 2026
14 PURITAN AVE
Property Address Neelitri uepartment
TONY NEVES
Owner Owner's Name
information is NORTH ANC OVET R MA 01845 6/11/26
required for every
page. city awn State Zip Code Date of Inspection
Inspection results must be submitted can this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the farm.
Important:When A. Inspector I nform atio n
filling out forms
on the computer, JAM ES CURRIER 11
use only the tab
key to move your Name of Inspector
cursor-do not
use the return JS SEPTIC & DRA,11N
key. Company Name
131 FOREST STREET
Company Address
tabCA MIDDLETON MA 01949
City/Town State Zip Code
978-774-6685
Telephone Number License Number
B. Certification
I certify that: I am a CEP approved:system inspector in full compliance with Section 115.340 of Title 5
(310 CMR 15.000))-1 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training 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. 0 Passes
2. 0 Conditionally Passes
3. 0 Needs Further Evaluation by the Local Approving Authority
4. 0 Fail
6/11/26
l4pector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If'the system has a design flow of
101000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DER. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that t,i'me. This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
Title 5 OffiCIaInspection ]rl'Y1
N
T Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
� ,mow'°y 14 PURITAN AVE
Property Address
TONY NEVES
Owner Owner's Name
information is NORTH AN DOVER MA 01845 6/11/26
required for every
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 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:
SYSTEM WORKING PROPERLY
2) System Conditionally Passes:
El One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
El Y ❑ N ❑ ND (Explain below):
t5insp.doc-rev.7/26/201 S Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
z"6N.,
Commonwealth of Massachusetts
Title 5 OfficiaI Forrri
�a Subsurface Sewage disposal System Form - Not for Voluntary Assessments
, yVb`~tr4 14 PURITAN AVE
Property Address
TONY NEVES
Owner Owner's Name
information is NORTH AN DOVER MA 0 845 5l 1/25
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cunt.)
2) System Conditionally Passes (coat.):
E:1 Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
El broken pipe(s) are replaced El Y ❑ N F ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
Ej 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):
El broken pipe(s) are replaced [:1 Y Ej N [:1 ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N 0 ND (Explain below):
f.
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doe-rev.7/26/2018 Title 5 Official inspection Form.Subsurface Sewage Disposal System■Page 3 of 18
Commonwealth of Massachusetts
Officia
m
Title 5
r
I Inspection Form
a
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
14 PURITAN AVE
Property Address
TONY NEVES
Owner owner's Name
information is NORTH ANDOVER MA 01845 6/11/26
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cunt.)
❑ cesspool or privy is within 54 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:
El The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
[:] The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
El The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ 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
Ej ® clogged SAS or cesspool
gg p
Discharge or ponding of effluent to the surface of the ground or surface waters
El ® due to an overloaded or clogged SAS or cesspool
gg p
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
uTitle 5 Official Forr�
0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
14 PURITAN AVE
Property Address
TONY NEVES
Owner owner's Name
information is NORTH AN DOVE R MA 01845 6/11/26
required for every
page. CitylTown State Zip Code Date of Inspection
C. Inspection Summary (coat.)
4) System Failure Criteria Applicable to All Systems: (cant.)
Yes No
Static liquid level in the distribution box above outlet invert due to an overloaded
® or clogged SAS or cesspool
gg p
Liquid depth in cesspool is less than 6" below invert or available volume is less
El than 1/2 daY flow
Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pi e s . Number of times pumped:
❑ Any portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or
® tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public water supply
❑ � well.
El N 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 DER certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flow of 2000 gpd-
❑ ® 10 000 gpd.
The system fails. 1 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 16,000 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
El N the system is within 400 feet of a surface drinking water supply
El z 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
El N Area—IWPA) or a mapped Zone 11 of a public water supply well
pp
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
u �r r Title 5 Off
icia n� a ionForm
a Subsurface Sewage Disposal System Forme _ Not for Voluntary Assessments
14 PURITAN AVE
Property Address
TONY NEVES
Owner owner's Name
information is NORTH ANDOVER MA 01845 6/11/26
required for every
page, City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes" to any question in Section C.5 the system is considered a significant
threat, or answered "yes" to any question in Section 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.
6. You must indicate "yes" or"no"for each of the following for a!f inspections:
Yes No
® El Pumping information was provided by the owner, occupant, or Board of Health
El N Were any of the system components pumped out in the previous two weeks?
M El Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
❑ this inspection?
Were as built plans of the system obtained and examined? (if they were not
® available note as N/A)
❑ Was the facility or dwelling inspected for signs of sewage back up?
N El Was the site inspected for signs of break out?
N El Were all system components, excluding the SAS, located on site?
N El Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner) provided with
N El information on the maintenance of subsurface sewage disposal systems?
proper g p Y
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
�j ❑ 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
❑ N approximation of distance is unacceptable) 310 CMR 15.30� 5 pp p } [ � }]
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Farm.Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Title 1c1al Inspection Forrr�
4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
to t
_, �`s~ 14 PURITAN AVE
Property Address
TONY NEVES
Owner owner's Name
information is NORTH ANDOVER MA 01845 5111125
required for every
page. City/Town State Zip Code Date of inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 for example: 110 d x#of bedrooms): 440 OPD
� p gp }
Description:
Number of current residents: 4
Does residence have a garbage grinder? El Yes E No
Does residence have a water treatment unit? Yes ® No
If yes, discharges to: H.O. REMOVED DISPOSAL
Y
Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected? El Yes E No
Seasonal use? El Yes E No
Water meter readings, if available (last 2 years usage (gpd)}:
425.10 GPD
Detail:
Sump pump? ❑ Yes E No
of occu anc : CURRENT
Last date p y Date
t5insp.doe-rev.7/2 612 0 1 8 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
r Title ICIIspectionn or rr1
�7 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
,q
IN 14 PURITAN AVE
Property Address
TONY NEVES
Owner Owner's Name
information is NORTH AN DOVE R MA 01845 6/11/26
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 316 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seatslpersonslsq.ft., etc.):
Grease trap present? El Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? El Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? El Yes El No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information:
LP2o15 & 6112l26
Was system pumped as part of the inspection? ® Yes ❑ No
If es volume pumped'. 1500
Y p um p gallons
How was Yp pumped um ed determined? TRUCK GAUGE
q
Reason for MAINTENANCE & INSPECTION
pumping:
t5insp,doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
Title 5 Officia For1�1
a Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4
14 PURITAN AVE
Property Address
TONY NEVES
Owner Owner's Name
information is NORTH AN DOVER MA 01845 6/11/26
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
❑J Septic tank, distribution box, soil absorption system
❑ Single cesspool
[] Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
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:
PLAN APPROVED 1997, DBOX REPLACED 2016
Were sewage odors detected when arriving at the site? El Yes H No
5. Building Sewer(locate on site plan):
1`
Depth below grade: feet
Material of construction:
EI cast iron H 40 PVC El other(explain):
Distance from private water supply well or suction line: NA PUBLIC H2O
p pp y feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
PLUMBING APPEARS TO BE IN GOOD CONDITION, NO EVIDENCE OF LEAKAGE.
t5insp.doc•rev.7/25f2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
M
±, Title 5 Off Form
0 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
J 4
14 PURITAN AVE
Property Address
TONY NEVES
Owner owner's Name
information is NORTH AN DOVER MA 01 845 51 1 1 l20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
0. Septic Tank(locate on site plan):
Er'
Depth below grade: feet
Material of construction:
® concrete ❑ metal El fiberglass El polyethylene ❑ other(explain)
CAST IRON COVER TO GRADE OVER MIDDLE COVER.
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: 1500 GALLONS
Sludge depth: 1 0r,_1 2rr
p
r�r�r r
Distance from top of sludge to bottom of outlet tee or baffle LL
611
Scum thickness
6,r
Distance from top of scum to top of outlet tee or baffle
8,r
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? SLUDGE JUDGE
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
TANK HAS BEEN PUMPED AS PART OF INSPECTION, LIQUID LEVEL CORRECT, PVC TEE'S IN
PLACE.
t5insp.doc•rev.7/25f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
± 4 Title iciInspectionForm
a Subsurface Sewage Disposal System Form Not for Voluntary Assessments
q f.
rf� ,�ti~4V 14 PURITAN AVE
Property Address
TONY NEVES
Owner Owner's Name
information is NORTH AN DOVE R MA 01845 511112E
required for every
page. City/Town State Zip Code Date of Inspection
D. System information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
F] concrete ❑ metal El fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
El concrete El metal ❑ fiberglass El polyethylene El other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
ZI'N
Commonwealth of Massachusetts
Title 5 Official Forr�r�
a
Subsurface Sewage Disposal System Form .. Not for Voluntary Assessments
lJ /�
14 PURITAN AVE
Property Address
TONY NEVES
Owner owner's Name
information is NORTH AN DOVE R MA 01845 6/11/2B
required for every
page. City/Town State Zip code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cost.)
Alarm present: Ej Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes D No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? El Yes El No
9. Distribution Box (if present must be opened) (locate on site plan):
q
Depth of liquid level above outlet invert g
p
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
BOX WORDING PROPERLY, LIQUID LEVEL CORRECT, NO EVIDENCE OF SOLIDS
CARRYOVER. BOX IS 1 B" BELOW GRADE.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusetts
ti W
Title 1c1al Inspection Form
in Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r �
f V 14 PURITAN AVE
Property Address
TONY NEVES
Owner owner's Name
information is NORTH ANDOVER MA 01846 6/11/26
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: EJ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
El leaching pits number:
El leaching chambers number:
❑ leaching galleries number:
0 leaching trenches number, length: (8) 201
❑ leaching fields number, dimensions.-
El overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rev.7/25/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System■Page 13 of 18
Commonwealth of Massachusetts
itle InspectionForm
" w
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
14 PURITAN AVE
Property Address
TONY NEVES
Owner owner's Name
information is NORTH AN DOVER MA 61845 6/11/26
required for every
page. CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cost.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SOILS DRY, NO SIGNS OF HYDRAULIC FAILURE, VEGETATION NORMAL.
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 ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
f5insp.doc■rev.7/26/201 S Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
z"6N=M
Commonwealth of Massachusetts
G ±<< Title 5 Off Form
Subsurface Sewage Disposal System Form W Not for Voluntary Assessments
w
,r
ra ° 14 PURITAN AVE
Property Address
TONY NEVES
Owner Owner's Name
information is NORTH AN DOVE R MA 01845 6/1 /26
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cant.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
Title 5 Offic"ial Form
M1
4.1
� Subsurface Sewage Disposal System Form Not for Voluntary Assessments
14 PURITAN AVE
Property Address
TONY NEVES
Owner Owner's Name
information is NORTH ANDOVER MA 01845 6/11125
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
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:
El hand-sketch in the area below
® drawing attached separately
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Forrn
` w
0 Subsurface Sewage Disposal System Form _ Not for Voluntary Assessments
mu
�0 SZOV 14 PURITAN AVE
Property Address
TONY NEVES
Owner Owner's Name
information is NORTH ANDOVER MA 01845 6/11/26
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cant.)
15. Site Exam:
�] Check Slope
❑ Surface water
® Check cellar
F] Shallow wells
Estimated depth to high ground water: 5$" ESHGW
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked date of design Ian reviewed: 1997
' g p Date
�] observed site (abutting property/observation hole within 150 feet of SAS)
[� Checked with local Board of Health - explain:
❑ Checked with local excavators, installers-- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
TEST PIT DATA ON FILE WITH THE B.O.H., TEST PITS PERFORMED 1997
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
u g 4Title 5 Off Forrl'1
w
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
• L
r� 14 PURITAN AVE
Property Address
TONY NEVES
Owner owner's Name
information is NORTH AN DOVE R MA 01845 6/11/26
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
Z A. Inspector Information: Complete all fields in this section.
Z B. Certification: Signed & Dated and 1, 21 3, or 4 checked
Z C. Inspection Summary:
11 21 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
Z D. System Information:
For 8: Tight/Holding Tank— Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
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Summary Record Card generated on 611712026 8:64:14 AM by Susan Correale Page 1
Town Of North Andover
Tax Map # 210-107.13-0133-0000.0
Parcel Id 18246
14 PURITAN AVENUE
ANTONIO NEVES Since Jan 2018
ALLISON NEVES
14 PUTITAN AVENUE
NORTH ANDOVER MA 01845
Class 101 Single Family Property Type Residential
Size Total 0.69 Acres
FY 2026
UB Mi
Nan q ,: , Loan Number Activellnact, From Until
ANTCNI ° R.. r Active
14 PURI' ' {
NORTH
LUZZO )us Customer Inactive 6/12/2007
.... ......
14 PUR[ (.
3 i j
NORTH
01845 ,. ,..
JASON' pus Customer Inactive 9/28/2012
14 PURI l,- d r ,.
NORTH
RONG f cT �: •, aus Customer Inactive 1/11/2013
ZHIYU F ..� �._ �
i
14PUR 1
NORTH
SCOTT ous Customer Inactive 7/31/2017
14 PUR
NORTH
I
UB A{
Accour Occupant Name Active/Inactive
Bldg 1d. ry Last Billing Date 614/2026
210002 Active
UB S W -
C
Accour
Servlci f... ;te a Charge Multiplier/Users
M1SCF 7.82 11
WTR U IETER SIZE 103.75 11
...........
ip 0
UB Me�v,. ...p.
P:
Account No.2100027
Serial No Status Location Brand Type Size YTD Cons
3360�590 a Active ERT HH b Badger w water 0.625 0.625 1145
Date Reading Code Consumption Posted Date Variance
51512026 3300 a Actual 25 6/11/2026 -11%
21312026 3275 a Actual 28 311212026 W34%
1114/2025 3247 a Actual 44 12/12/2025 -20%
8/112025 3203 a Actual 53 9/12/2025 55°/0
5/1/2025 3150 a Actual 32 - 6/12/2025 7%
2/412025 3118 a Actual 33 3113/2025 -61°/°
111112024 3085 a Actual 83 12/12/2024 -9%
811/2024 3002 a Actual 91 9/12/2024 230°/0
511r2024 2911 a Actual 27 6/13/2024
�8��"
28T
a c ua 30 3/14/2024 `76°I�
11/1/2023 2854 a Actual 125 12/13/2023 w41%
8/112023 2729 a Actual 204 9/18/2023
859%
22 6/14/2023 -12°/�
5/4/2023 2525 a Actual
Summary Record Card generated on 6/17/2026 8:6414 AM by Susan Correale Page 2
Town of-North Andover
Tax Map ## 210-107.B-0 33-0000.0
Parcel Id 18245
14 PURITAN AVENUE
ANTONIO NEVES Since Jan 2818
ALLISON NEVES
14 PUTITAN AVENUE
NORTH ANDOVER I'ItIA 81845
Class 101 Single Family Property Type 1 Residential
Size Total 0.59 Acres
FY 2026
2/112023 2503 a Actual 25 3/14/2023 -67%
11/1/2022 2478 a Actual 75 12/19/2022 13%
8/2/2022 2403 a Actual 67 9/20/2022 245%
512120'22 2336 a Actual 19 612112022 W19°Io
21112022 2317 a Actual 24 3/15/2022 -38%
11/1/2021 2293 a Actual 38 12/7/2021 -14%
812/2021 2255 a Actual 44 9/21/2021 59%
5/3/2021 2211 a Actual 27 6/1512021 -3°Io
213/2021 2184 a Actual 29 3/16/2021 -47%
11/2/2020 2155 a Actual 54 12/1612020 -34°/°
8/312020 2101 a Actual 84 9/912020 171%
51112020 2017 a Actual 29 611 D12U20 11°Io
2/312020 1988 a Actual 28 3/16/2020 -45%
1111/2019 1960 a Actual 50 12/23/2019 -4%
8/112019 1910 a Actual 52 9/26/2019 86%
5/112019 1858 a Actual 27 6113/2019 0°/°
2/1/2019 1831 a Actual 28 3/19/2019 -40%
11/1/2018 1803 a Actual 47 12/12/2018 -34% .
8/1/2018 1756 a Actual 71 9/20/2018 129°/°
511/2018 1685 a Actual 30 6/20/2018 .3%
2/1/2018 1655 a Actual 35 3/28/2018 -63%
10/23/2017 1620 a Actual 77 12/29/2017 -100%
8/1/2017 1543 a Actual 0 9/20/2017 100°/°
7125/2017 1643 f Final Bill 19 7125/2017 11°I°
5/1/2017 1524 a Actual 18 6/26/2017 24%
211/2017 1506 a Actual 15 3/14/2017 -89%
11/1/2016 1491 a Actual 142 12/19/2016 170%
811/2016 1349 a Actual 52 9/21/2016 174%
5/2/2016 1297 a Actual 19 6/2112016 15%
2/1/2016 1278 a Actual 17 3/28/2016 -75%
10/30/2015 1261 ` a Actual 64 12/30/2016 24%
8/3/2015 1197 a Actual 55 9114i2015 129°Io
511/2015 1142 a Actual 22 6/22/2015 18%
2/4/2015 1120 a Actual 20 3/2012015 -60°/0
11/4/2014 1100 a Actual 50 12/15/2014 46°/0
815/2014 1050 a Actual 32 9/11/2014 27%
5/12/2014 1018 a Actual 29 6/12/2014 32%
213/2014 989 a Actual 21 3/17/2014 1°/°
111112013 968 a Actual 19 1212012013 13%
8/7/2013 949 a Actual 18 9/18/2013 -14%
5/7/2013 931 a Actual 21 6/18/2013 -29%
2/4/2013 910 a Actual 8 3/13/2013 -100%
1/10/2013 902 f Final Bit! 0 1/10/2013 -100%
10/30/2012 902 a Actual 7 12/13/2012 w60°/°
AIR Inquiry
Sub System
Account No.2100027 Utility Billing
Install Billed Adjt Bill Int/Pen Fee(s) Refunded Adjt. Abated Paid Balance
1 st $18,359.53 $151.48 ($737,94) $17,663.35 $109.72
a
Entry Date Install Trans Type Amount Balance Due Amount Billed Posted Flag
4/23/2004 Billed $48.46 $48.46 $48.46 Pasted
5/18/2004 Payment ($48.46) $0.00 Posted
5/1612004 Billed $41.62 $41.62 $41.62 Posted
7/16/2004 Payment ($41.62) $0.00 Posted
9/20/2004 Billed $196.72 $196.72 $196.72 Posted
10/27/2004 Payment ($196.72) $0.00 Posted
12/17/2004 Billed $58.22 $58.22 $58.22 Posted
3