HomeMy WebLinkAboutSeptic - Title V Inspection Report - 437 SALEM STREET 7/18/2026 eliN, Commonwealth of Massachusetts
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fd T"tle 5 Off"ici"al' inspe,ction Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
6.
437 SALES STREET
Property Address
J EAN N E CAM MAR,ATA
Owner Owner's Marne
information is NORTH ANDOVER MA 01845 JULY 18, 2026
required for every
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on 'this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end' of the form.
Important:When
fil'ling out forms X Inspector Information iuwrr-d N,orin mmovor
on the computer, Todd James Bat,eson
use only the tab
Ivey to move your Name of Inspector JULAVI-M-6--
cursor-do not Bates on Enterprises Inc.
use the return Company Name
key.,
111 Argilila Road
LLA Da1tTM
— Healt
V'U Company Address
64 Andover MA 0!1810
A), .11,1111
City/Town State Zip Code
k
roan 978-475-47 6 SI-16
Telephone Number License Number
Bi, Certification
I certify that: I am a DEP approved system inspector in full', compliance with Section 15.340, of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have,determined
that the system:
1. 0 Passes
2. F-1 Conditionally Passes
3. E] Needs Further Evaluation by the Local Approving Authority
4. Z Fails
JULY 21 2026
Inspect 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 DEP. The original form shQ
uld
be sent to the system owner and copies sent to
the buyer, if applicable,, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time. This linspection does not address how the system will! perform
in the future under the are or different conditions of use,
t5in,sp.doc-rev,,7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 1 of 18
.� Commonwealth of Massachusetts
Title 5 Official
lnspect*ion ors
r+
a Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4 ;��
0�
�4 , �' 437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner owner's Name
information is NORTH AN DOVE R MA 0 1 845 J U LY 1 8 2025
required for every _ f
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain,
The septic tank is metal and over 20 years olds` 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.
D Y El N ❑ ND (Explain below):
t5insp.doc►rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System►Page 2 of 18
Commonwealth of Massachusetts
ci'al Inspection Form
t,� Title 5 Offi
µ Subsurface Sewage Disposal System Form Not for Voluntary Assessments
ti
tl 1
437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner Owner's Name
information is NORTH AN DOVE R MA 0 1 848 J U LY 1 8 2026
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Basses (cont.):
[� 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 ❑ Y El N ❑ ND (Explain below):
El obstruction is removed ❑ Y Ej N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y El N F� ND (Explain below):
El 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 ❑ N ❑ ND (Explain below):
D obstruction is removed ❑ Y El N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(l)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 3 of 18
Commonwealth of Massachusetts
Title 5 Offi
cial I Fors
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
h
•� : ~°4 437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner Owner's Name _
information is NORTH AN DOVE R MA 01845
required for every J U LY 8, 20�0
page, City/Town State Zip Code Date of inspection
C. Inspection Summary (cont.)
El 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;
Ej 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.
E:1 The system has a septic tank and SAS and the SAS is within 50 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 50 feet or
more from a private water supply.well .
Method used to determine distance.
* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
. . .
W u e 5 Official Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
437 SALEM STREET
Property Address
J EAN N E GAM MARATA
Owner owner's Name
information is NORTH AN DOVE R MA 01845 J U LY 18 2026
required for every f
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cunt.)
4) System Failure criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2 day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipes). 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.
❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this forma
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
101 000 gpd.
® ❑ The system fans. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure,
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section C,4.
Yes No
1:1 El the system is within 400 feet of a surface drinking water supply
El EJ the system is within 200 feet of a tributary to a surface drinking water supply
❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area--IWPA) or a mapped Zone II of a public water supply well
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
-Title 5 Offic'ial Inspect'ion For
} Subsurface Sewage Disposal System Form Not for Voluntary Assessments
G �
487 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner owner's Name
information is No RTH AN COVE R MA 01845 J U LY 18 2026
required for every }
page. City/Town State zip Code Date of Inspection
C. Inspection Summary (cont.)
f
If you have answered "yes" to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no" for each of the following for all inspections;
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
�] ® 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?
El ® Were as built plans of the system obtained and examined? (If they were not
available note as NIA)
E El Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® D Were all system components, excluding the SAS, located on site?
® 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?
® El 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:
E El Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/201 S Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
zOfficial ors
>
Q Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
h
r�r
437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner owner's Name
information is Na RTH AN DOVE R MA 01845 J U LY 18 2025
required for every
page. Cityffown State Zip Code date of inspection
D. System Information
1. Residential Flow conditions:
Number of bedrooms (design): NA Number of bedrooms (actual): 3
= 3
DESIGN flow based on 310 CMR 15.203 for example: 110 d x#of bedrooms): NA
� p gp }
Description:
Number of current residents: 0
Does residence have a garbage grinder? Z Yes ❑ No
Does residence have a water treatment unit? ❑ Yes Z No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report,)
ElYes Z No
Laundry system inspected? Z Yes ❑ No
Seasonal use? ❑ Yes Z No
Water meter readings, if available (last 2 (gpd)):usa e ears ATTACHED
y g
Detail:
Sump pump? EI Yes Z No
Last date of occupancy: JULY 2025
Date
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
Commonwealth of Massachusetts
x 'r I4Title 5 Official Form
a
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
437 SALEM STREET
r
Property Address
J EAN N E CAM MARATA
Owner Owner's Name -
information is NORTH AN DOVE R MA 01845 J U LY 18 2025
required for every
page. City/Town State Zip Code Date of Inspection
DM System Information (cont.)
2. Commercial/industrial Flow conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day d
p Y�gp )
Basis of design flow (seatslpersonslsq.ft,, etc.):
Grease trap present? El Yes El 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 Ej No
Water meter readings, if available:
Last date of occupancy/use: Date
Other (describe below):
3. Pumping Records:
Source of information: BATESON ENTERPRISES INC APRI L 2025
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 6 of 18
Commonwealth of Massachusetts
Title 5 Offic"al Inspect"ion Form
> Subsurface Sewage Disposal System Form Not for Voluntary Assessments
g p Y Y
^�4''y 437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner owner's Name
information is NORTH ANDOVER MA 01845 JULY 18 2026
required for every
page, City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
Septic tank, distribution box, soil absorption system
❑ Single cesspool
El Overflow cesspool
El Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the IIA 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:
62 YEAR. OLD SYSTEM, INSTALLED 1964, OWNER
Were sewage odors detected when arriving at the site? ❑ Yes No
5. Building Sewer(locate on site plan):
Depth below grade: 2211
feet
Material of construction:
® cast iron ❑ 40 PVC El other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
JOINTS AND VENTING OK
No EVIDENCE OF LEAKAGE
t5insp.doc-rev,7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
uTitle 5 Official
�a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner Owner's Name
information is NORTH ANDOVER MA 01
required for every $45 JULY 1 8, �06
Page. City/Town State Zip Code Date of Inspection
D. System Information (cont)
6. Septic Tank (locate on site plan):
ri
Depth below grade: feet
0
Material of construction:
® concrete El metal Ej fiberglass ❑ polyethylene ❑ other(explain)
TANK IS LEAKING
If tank is metal, list age; years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes [I No
Dimensions: I0'X 5'X 4'
#r r
Sludge depth: 1
37rr
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness 0
Distance from top of scum to top of outlet tee or baffle NA
Distance from bottom of scum to bottom of outlet tee or baffle NA
How were dimensions determined? SLUDGE JUDGE
TAPE MEASURE
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
CONCRETE INLET AND OUTLET BAFFLES OK
TANK IS LEAKING
LIQUID LEVELS ARE LOW
EVIDENCE OF LEAKAGE
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 10 of 18
Commonwealth of Massachusetts
v i eicial r�nr�
U
' a Subsurface Sewage Disposal System Form Not for Voluntary Assessments
.J
9 4�
437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner Owner's Name
information is NORTH AN DOVE R MA g 845 J U LY 18 2026
required for every f
page. City/Town State Zip Code Date of Inspection
D. System Information (cont)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete El metal El fiberglass El polyethylene El other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
El concrete El metal El fiberglass ❑ polyethylene El other(explain):
Dimensions:
Capacity: gailons
Design Flow; gallons per da
9 P Y
t5insp.doc rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
Commonwealth of Massachusetts
T"tler
n f lu 5 Offi cia I Inspect"ion Form
a � Subsurface Sewage Disposal System Form Not for Voluntary Assessments
h
437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner owner's Name
information is NORTH AN DOVE R MA o 1 845 J U LY 1 8
required for every , 2026
page, City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank (coat.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: El Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached? El Yes Ej No
9. Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert o
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 AND DISTRIBUTION IS NOT EQUAL
LIGHT EVIDENCE OF SOLIDS CARRYOVER
EVIDENCE OF LEAKAGE
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusetts
�x MTitle 5 Official For�1
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
9
437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner owner's Name
information is No RTH AN DOVE R MA 01845 J U LY 18 2026
required for every r
page. City/Town State Zip Code Date of inspection
D. System Information (cont.
0. Pump Chamber(locate on site plan):
Pumps in working order: D Yes D No*
Alarms in working order: F-] Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why.
Type:
❑ leaching pits number:
leaching chambers number:
El leaching galleries number:
E leaching trenches number, length:
4; 40' LCNG
El leaching fields number, dimensions:
El overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
T"tie 5 Off"
i ciaInspect"ion Foram
'n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r
437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner Owner's Name
information is NORTH ANDOVER MA 01845 JULY 18 2025
required for every
page. City/Town State Zip Code Date of Inspection
D. System nformlation (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 OK
NO SIGN OF HYDRAULIC FAILURE OR PONDING
PIPES HAVE ROOTS AND SLUDGE (ORIGINAL SYSTEM)
COULD ONLY GET CAMERA DOWN ONE PIPE
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 EJ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc,):
t5insp.cloc-rev,7/25/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
x
Commonwealth of Massachusetts
TiInspectionForrll
r
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
f,��Sh 437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner owner's Name
information is NORTH ANDOVER MA 01845 JULY '18 2026
required for every }
page. City[Town State zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
15insp.doc•rev.7/25f2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
Commonwealth of Massachusetts
�z p 1OfficiaInspection
N
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
�7 44
437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner Owner's Name
information is N�RTH AN DIVE R MA o�$45 J
required for every U LY 18, 2026
page, CitylTown State Zip Code Date of Inspection
m byst6m Illit6rmat!A -cent. .
j
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, includingties c to at least two permanent reference
landmarks or benchmarks. Locate ate all wells within 1 D6 feet. Locate where public water supply enter the building, Check one of the boxes below. pp Y s
0 hand-sketch in the area below
El drawing attached separately
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t5insp.doo-rev.7126f2018
Title 5 Official Inspection Form:Subsurface Sewage Disposal system Page 16 of 18
Commonwealth of Massachusetts
Title 5 Offici*al Inspection For
L7
0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
F
9 j
H
437 SALEM STREET
Property Address
J EAN N E CAM MARATA
Owner Owner's Name
information is NORTH ANDOVER MA 01845
required for every J U LY 18, �0�8
page, City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
Check cellar
El Shallow wells
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
El Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health - explain:
PREVIOUS TITLE 5 ON FILE
❑ Checked with local excavators, installers - (attach documentation)
Accessed USOS database - explain:
ESSEX 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
z wTitle 5 Official Form
' Subsurface Sewage Disposal System Form Not for Voluntary Assessments
K
V L
437 SALE M STREET
Property Address
J EAN N E CAM MARATA
Owner [owner's Name
information is NORTH AN DOVE R MA 0`1845 J U LY 18 2025
required for every I
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of;
® A. Inspector Information: Complete all fields in this section.
B. Certification: Signed & Dated and 1, 21 3, or 4 checked
® C. Inspection Summary:
11 Z, 3, or 5 completed as appropriate
4 (Failure Criteria) and 5 (Checklist) completed
D. System Information:
For 8: Tight/Holding Tank— Pumping contract attached
For 4: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 5: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
Summary Record Card generated on 7116/20:26 8:13:56 AM by Nancy Vie,ns, Page I
Town of North A ndover
210,4381001,40821,4000vO
Piallocel Id i000io11626
4317 SALEM STREET
CAMMARITA, JASPER
437 SALEM' STREET
N.ANDOVER, MA
01,846
clings, 101 Single Family Prop 1 Residential
Size,Total 1.24 Acres
FY 2026
UB j!j index
Name/Address Type Loan Ntimber Activellnect, From UFAII
CA NI JASPER Payer
437 BALED STREET
N.AND OVER,MA
UB Account Main
Account No Cycle OCCL,Ipant Name Active/Inactive
Bldg Id. 16080.0-437 SALE M STREET Last Billing Date 7/1/20126
3160121 03 Cycle 03 Active
UB Services Maint.
AccountNo.3160121
Service,Code, Rate Ctiarge Mulitiplier/User's
MISCF'EE ADMIN FEE 0,.636/8 7.82 1/
WTR WATER 01 ALL METER SIZE /1
UB Meter Maintenance
Account No.3160121
Serial No sta"tus Location Brand Type SIZID 'YTD Co,ns
13242593 a Active 00 METE METE, w Water 0,625 0.6215 247
Date Reading Code constAIT'lPtIon Posteld 0'.la,to Va riance
6/2/2026 1,613 a Actual 0 7/10/2026 -100%
3/4/2026 1613 a Actual 1 4/14/2026 -1%
12/3/2025 1612 a Actual 1 1/1 2/2026 -87%
9/4/2025 1611 a Actual 8 10/10/20,26 -21%
614/2025 1603 a Actual 10 7/9/2025 11%,
3/5/2026 1593 a Actual, 9 4/16/2025 -18%
12/4/2024 1584 a Actual 11 1/14/2025 9%
9/4/2024 15,73 a Actual 10 1018/2024 .6%
6/6/2024 1663 a Actual 11 7/2,212024 -10%
3/5/2024 165,2 a Actual 12 4/16/2024 .9%,
12/5/2023 1540 a Actual 13 1/1 5/2024 -11%
9/6/2023 1527 a Actual 14 10/13/2023 .4%
6/2/2023, 1513 a Actual 14 7/14/2023 20%
3/2/2,023 1499 a Actual 11 4/12/20,23 -29%
12/5/2022 1488 a Actual 16 1/'16/2,023 0%
9/6/2022 1472 a Actual 17 10/18/2022 25%
6/2/2022 1455 a Actual 13 7/18/2022 10%
3/2/2022 1442 a Actual 11 4/13/2022 -7%
1216/2021 1431 as Actual 13 1/17/2022 -10%
9/2/2021 1418 a Actual 14 10/15/2021 8%
6/2/2021 1404 a Actual 13 7/27/2021 5%
3/2/2021 1391 a Actual 12, 4/21/2021 -5%
12/312020 1379 a Actual 13 1/13/2021 -18%
9/2/2020 1366 a Actual 16 10/14/2020 39%
6/1/2020 1350 a Actual 11 7/15/2020 1%
3/4/2020 13,39 a Actual 11 4/8/2020 3%
12/6/20!19 1328 a Actual 10 1/15/2020 -9%
9/12/2019 1318 a Actual 13 10/10/2019 10%
615/2019 1305 a Actual 11 7/25/2019 -2%
316/2019 1294 a Actual 11 4/16/2019 -31:%