HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 770 BOXFORD STREET 7/17/2026 Commonwealth of Massachusetts
Town 'Of N10fth Andover
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tle 5 Official Inspecto Form
Subsurface Sewn �e Disposal System orr Not for Voluntary Assessments
AUG 4 2026
Property Address Health D �D P4
Owner n, r's,Name
information is NORTH ANDOVER MA 011845 7/1 /
reu��re for qui. �d ►ityfTown, State Zip Code Date of Inspection
pagInspection 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.
Importanit:When A. Inspector Information,
filling out forms
on the compuiter� JAM ES CURRIER Iluse only the tab
key to move your Name of Inspector
cursor_do not J'S SEPTIC & DRAIN
use the return
key. Company Marne
131 FOREST STET
Company AIdress
MIDDLETON MA 0119491
Cityffown State Zip Code
Telephone Number License Number
B. Cedification
I certify that I am a DEP approved system inspector In fuill compliance with Section 15.3 of Title 5
(310,C R 15.000)w I have personally inspected the sewage disposal systems 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. El Passes
2. Conditionally Passes
3. Needs Further Evaluation by the Local Approving Authority
4. Falls
ell
4p
7/1 /26
lns ature rate
The system inspector shalll submit a copy of this inspection report to,the Approving Authority (board'
of Health or E P)within 30 days of compl�etin this inspection. If the system has a design flog of
10170001 gpd or greater, the inspector,and the system owner 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 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 inspection does not address how the system will perform
in the future under,the same or different conditions, of'use.
t5in p.doc.rev, /26/201 e title 5 Officii ul inspection,Form:Subsurface S wage(Disposal System•Page 1i of 18
Commonwealth ofWassachusetts
on Title 5 Offici,al� Insr%ect' Form
!>
Subsurface Sewage Disposa! System, For Not,for,Voluntary Assessments
770, BOXF'ORD RD
Property Address
NELSA EST ELL
Owner Owner's Name
information is NiORTH ANDOVER MA Oil 8451 7/17/26
requi red for every
page. CityfTolwn State Zip,Code Date of Inspection
C spection Summary
Inspection Summary: Comipilete 1, 2, 3, or 51 and all of 4 and 6.
1) Ss Wm Passes:
I have not found any information which, indicates that any of the failure criteria described
in 310 CMIR 151.,303 or in 3,10 CMR 15.304,exist., Any failure criteria not evaluated are
i I i
ndicated below.
Comments-
2) System Condilt ion ally Passes:
Z 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
i will p the Board of Health, ass.
Chieck the box for It yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," pilease explain.
The septic tank is metal andl over 20 years old* or the septic tank(whether metal or not) is structurally
uinsound, exhibits,substantial infiltration or exfiltrat,ion or tank failure is immilinenit. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health�.,
A mietal septic tank will pass inspection if it is s,tructurallly sound, not leaking and if a Certificate of
Compliance indicatingi, that the tank is less than 20 years old is available.
Ej N ND (Explain below):
t5insp.doc-rev.7/26/2018 Title 5 Official,Inspection FoIrm,Subsurface Sewage Disposal System-Page 2 of 18
Commonwealth of Massachusetts
Title ieial Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
770 BOXFORD RD
Property Address
NELSA ESTRELLA
Owner Owners Name
information is NORTH ANDOVER MA 01845 7/17/26
required for every
page. Cityfrown State Zip Code Date of inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
Ej Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y El N ❑ ND (Explain below):
SEPTIC TANK IS HALF FULL, TANK NEEDS TO BE REPLACED.
El 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):
[:1 broken pipe(s)are replaced Ej Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ 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 CHAR
15.303(1)(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
Isn f
T*Itle 5 Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
, y r
770 BOXFORD RD
Property Address
NELSA ESTRELLA
Owner owner's Name
information is NORTH ANDOVER MA 01845 7117/26
required for every
page. CitylTown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
Ej Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
[-] The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
[:1 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
Ej The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or
❑ ® clogged SAS or cesspool
99 P
El
Discharge or ponding of effluent to the surface of the ground or surface waters
® due to an overloaded or clogged SAS or cesspool
99 P
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
'Z~
Toltle 5 Official Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
pV 770 BOXFORD RD
Property Address
N ELSA ESTRELLA
Owner Owner's Name
information is NORTH ANDOVER MA 01845 7/17/26
required for every
page. City/Town State Zip Code Date of inspection
C. Inspection Summary (cont.)
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
z or clogged SAS or cesspool
g9 p
Liquid depth in cesspool is less than 6" below invert or available volume is less
El Z than %daY flow
Required pumping more than 4 times in the last year NOT due to clogged or
z obstructed i e s . Number of times pumped:
b pp � } p P
1:1 z 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
z tributaryto a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public water supply
1:1 z well.
1:1 z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this forma
The system is a cesspool serving a facility with a design flow of 2000 gpd-
❑ z 10 000 gpd.
The system fails. I have determined that one or more of the above failure
El z scribed in 310 CMR 15.303 therefore the s
criteria exist as de stem fails. The y
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
❑ z the system is within 400 feet of a surface drinking water supply
❑ ED 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
1:1 z Area—1WPA)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
Title 5 Official Form
' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
y r
770 BOxFORD RD
Property Address
NELSA ESTRELLA
Owner owner's Name
information is NORTH ANDOVER MA 01845 7/17/26
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 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
N El 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
El ® his inspection?
t p
Were as built plans of the system obtained and examined? (if they were not
® ❑ available note as N/A)
Z El Was the facility or dwelling inspected for signs of sewage back up?
Z El Was the site inspected for signs of break out?
® 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
® El information on the maintenance of subsurface sewage disposal systems?
proper 9 p Y
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on:
Z El Existing information. For example, a plan at the Board of Health.
Determined in the field (if any of the failure criteria related to Part C is at issue
El N approximation of distance is unacceptable) �10 CMR 15.302(5)]
PP � } �3
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
a
Commonwealth of Massachusetts
�
IOffoiciaI Inspectuion Form
•a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
770 BOXFORD RD
Property Address
NELSA ESTRELLA
Owner owner's Name
information is NORTH ANDOVER MA 01845 7/17/26
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 9p }
Description:
Number of current residents:
0
* 4
Does residence have a garbage grinder? El Yes ® No
Does residence have a water treatment unit? El Yes Z No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No
information in this report.)
Laundry system inspected? El Yes E No
Seasonal use? El Yes ® No
l s 2 ears usage d 145.31 GPD
Water meter readings, if available (last y g (gp }}
Detail:
SEE ATTACHED WATER RECORDS
Sump pump? El Yes Z No
1 MONTH
Last date of occupancy: PRIOR
t5insp.doc•rev.7I2612018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
� Commonwealth of Massachusetts
Title 5 Off Form
{
' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
My` 770 BOXFORD RD
Property Address
NELSA ESTRELLA
Owner owner's Name
information 1s NORTH ANDOVER MA 01845 7/17/26
required for every
page, City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CM R 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: LPD 11/13/25
Was system pumped as part of the inspection? ❑ Yes Z No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
a
t Commonwealth of Massachusetts
Tlutle 5 Official Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Ic
■ Tyr
°4 770 BOXFORD RD
Property Address
NELSA ESTRELLA
Owner owner's Name
information is NORTH ANDOVER MA 01845 7/17/25
required for every
page, CitylTown State Zip Code Date of Inspection
D. System Information (coat.)
4. Type of System:
N 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
❑ Tight tank. Attach a copy of the DEP approval.
❑ other(describe):
Approximate age of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
55T!
Depth below grade: feet
Material of construction:
El cast iron ®40 PVC ❑ 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 LEAFAGE.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 9 of 18
Commonwealthl a d e
'T
T"tie 5.- - 01T"ici,al
� 1 Subsurface Sewage Disposal o; System Form iot for Voluntary Assessments
7' 1 EXF
Property Address
MELBA ESTRELLA
Owner owner's Name
informat,ion is NORTH TH N + VE R MA 0 184,5 /1 "/26
requirid for
�� �i���d �_��_. gut �Inspection
.
page City/Town. ._�_._ .._ State
D. System Information (conyt.
6
Septic Teak locate on site lan .
34
Depth below g�rade.- feet
Material of construction.
0 concrete El meta,l fiberglass l� ethylene other(explain)
TANK HAS A CONCRETE BLOCK EXTENSION TO,WITHIN HIN 2" OF GRACE OVER MIDDLE
COVER.
If tank is metal, list age: � r w-.. _._._...._. ._. _� __.-._..._.
Is age confirmed by a Certificate of Colm liance? (attach a copy of certificate), R "Yes o
1000 GALLONS
11_1 11
Sludgedepth:
Distance from top,of sludge to bottom of outlet tee or baffle l
"turn thickness /2
Distance from top of scum to,top,of outlet tee oir baffle l
H
Distance from bottom of scum to, bottom of outlet,tee or baffle _..._..._..__..__�_ �_..._..mm....�� ..._mm. �...
SLUDGE JUDGE
How were dimensions determined?
Comments on pumping recommendations, inlet andi outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of'leakage, etc.):
TANK ILEAKING, ONLY HALF
F FULL, NEEDS TO E REPLACED WITH 15 LLON TANK
t5 ire .dcc.rev.7/26/2018 Title 5 Official Inspection Fora:Subsurface Sewage Disposal System.Page 10 of 1
s
Commonwealth of Massachusetts
gip itle iiaInspectionForm
-- a "c
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
770 BOXFORD RD
ti
1V
Property Address
NELSA ESTRELLA
Owner owner's Name
information is NORTH ANDOVER MA 01845 7/17/26
required for every
page. GitylTown State Zip Code Date of inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
El concrete ❑ metal 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:
D concrete El metal El fiberglass El polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Suhsteaee Sewage Disposal System•Papa 11 of 18
t
Commonwealth of Massachusetts
Title 5 O Forl'�1
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
.a by r
770 BOXFORD RD
Property Address
N ELSA ESTRE LLA
Owner owner's Name
information is NORTH ANDOVER MA 01845 7/17/26
required for every
page. CitylTown State Zip Code Date of inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Y
Alarm level: 40orAlarm in working order: El Yes ❑ No
r 4
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
g. Distribution Box(if present must be opened) (locate on site plan):
q
Depth of liquid level above outlet invert 0
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 IS WORKING PROPERLY, LIQUID LEVEL CORRECT, No EVIDENCE OF SOLIDS
CARRYOVER. BOX IS 30" BELOW GRADE WITH A 1' EXTENSION To WITHIN I' OF GRADE.
t5insp.doc•rev.7/25/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
FEB
te
Title 5 O Form
E� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
■ yy tl
770 BOXFORD RD
Property Address
NELSA ESTRELLA
Owner owner's Name
information is NORTH AN DOVER MA 01845 7/17120
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": " El Yes No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
V/
` 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:
gp® leaching its number: 2
e
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
r
Commonwealth of Massachusetts
■ w
itle 5 Official I Form
Zia 8 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,. 770 BOXFORD RD
Property Address
NELSA ESTRELLA
Owner owner's Name
information is NORTH ANDOVER MA 01845 7/17/26
required for every
page. CitylTown State Zip Code Date of Inspection
D. System Information (cant.)
11. Soil Absorption System (SAS) (cant.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SOILS DRY, No SIGNS,QF HYDRAULIC FAILURE, VEGETATION NORMAL.
3
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow El Yes [:1 No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26 2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Toltil�e 5 Officiallect'ion orm
JA Subsurface Sewage Dilsposal, System Form Not for Voluntary Assessments
770, X O
Property Address
ELSE► E TRELLA
Owner Owner's Name ...
iniformation is
NORTH ANDOVER A 01845 6
required for eve __....W . ._.._._...._...._. '�7 '
page. CutyfTown ;state Zips Cade Date of Inspection
D. Systems Information
13. Privy (Iodate on site plan)-
Materials of construction. _.
Dimensions
Depith of solids
Comments, note condition of soil, signs of hydraulliic t ilurel level of Po iding! condition: of vegetat%ors,
etc.):
t5in p.d •rev. /26/2,18 Title 5 Official inspection Foam:,Subsurface Sewage,Disposal System Page 15 at 18
Commonwealth of Massachusetts
Title 5 Offmicia
Inspectolon
µ Subsurface Sewage Disposal System Form Not for Voluntary Assessments
770 SaXFORD RD
Property Address
N ELSA ESTRELLA
Owne Owner's Name
infor atiori's NORTH ANDOVER MA 01845 7/17/26
requirr-ri nor ewery State Zip Code Date of Inspection
pale. �itytTown
D. System Information (cont.)
14. sketch of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at feast two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Chic one of the bones below:
[Q harAk-sletc �m tf area below
drawiN affadled crate
Y
IRK
_ A
WINNOW WMM
00
i
0 L eat h +
t5insp coc rev,7W2018 Tithe 5 official Inspection Form:sweurface Sewage Disposal system•Page 16 of 18
Commonwealth of Massachusetts
TTitle 5 Official Form
I' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
770 BOXFORD RD
Property Address
N ELSA ESTRELLA
Owner owner's Name
information is NORTH ANDOVER MA 01845 7/17/26
required for every
peke, Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water Y
® Check cellar
❑ Shallow wells
"
Estimated depth to high ground water: 78
feet
Please indicate all methods used to determine the high ground water elevation:
a F
z Obtained from system design plans on record
vi wed:
If checked, date of design plan re PREVIOUS TITLE-V DATED 2021 a 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 USOS database-explain:
You must describe how you established the high ground water elevation:
TEST PIT DATA ON FILE WITH THE B.O.H.
h
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t51nsp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
5 t-
wip a
Commonwealth of Massachusetts
-- f, Title 5 Off Form
n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
y
'y 770 BOXFORD RD
Property Address
N ELSA ESTRELLA
Owner owner's Name
information is NORTH ANDOVER MA 01845 7/17/26
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:
® A. Inspector Inforrrfation: Complete all fields in this section.
t
® B. Certification: Signed & Dated and 1, 21 3, or 4 checked
® C. Inspection Summary:
1, 21 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist)completed
® D. System Information:
y i
For 8: Tight/Holding Tank-- Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
r
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
}
jo Summery Rocord Card generaled on 6125/2026 1:42:52 PM by Susan Correele Page 1
i Town of North Andover
41
i;w
Tax Map # 210-1 OSoA-0002-0000,0
Parcel Id 16878 -
770 BOXFORD STREET
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'BREEN, PETER Since Jan 2003
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FERRY BREEN
770 BOXFORD STREET
NORTH ANDOVER MIA 01846
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Class 101 Single Family Property Type 1 Residential
Size Total 1.57 Acres i
FY 2026
UB Mailing Index
1
Name/Address Type Loan Number Activelinact. From Until
ZACHARY GREEN Owner Active
NELSA ESTRELLA
770 BOXFORD STREET
NORTH ANDOVER MA 01846 ,
BREEN,PETER Previous Customer Inactive 51312021
KERRY BREEN
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770 BOXFORD STREET
NORTH ANDOVER MA 01845
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UB Account Mlai nt■ ,
Account No Cycle Occupant Name Active/Inactive r
Bldg Id.27894.0-770 BOXFORD STREET Last Billing Date 417/2026 }
3170695 03 Cycle 03 Active
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UB Services Maint,
Account No.3170695
Service Code Rate Charge Multiplier/Users }
MISCFEE ADMIN FEE 0.63 5l8 7.82 111
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WTR WATER 01 ALL METER SIZE 49.40 ill
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UB Meter Maintenance
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Account No.3170695 - 1 6 ., o +
Serial No Status id Type Size YTD Cons ,
201108969 a Active 1 5 * 0 0 + dger��16 w Water 0.625 0.625 325
Date Re Consump ion Posted Date Variance
6/10/2026 1 7 0 4 12/o
3/12/2026 13 4/1412026 -5%
12/8/2025 1 $ 0 13 1/12/2026 -25%
9/10/2025 18 0 �- 18 10/10/2025 -1% �
6/10/2025 18 7/9/2025 0%
3/11/2025 1 8 0 0 + 18 4/16/2025 6%
12/10/2024 17 1/14/2025 12%
9/10/2024 3 ` 0 0
} 15 101812024 - -3/o
6/12/2024 16 Z=024
8
3/11/2024
17 4116/2024 8% i
12/11/2023 ] 4 • o o + 15 1/15/2024 •-20%
9/1512023 21 10/13/2023 17% �
6/9/2023 009 17 7/14/2023 -28%
318/2023 1 4 2 0 0 23 4/1212023 69%
12/8/2022 �` 13 1/16/2023 -37/o
9113/2022 23 10/1812022 59%
61912022 14
7/18/2022 -16%
318/2022 1 4 2 * 0 0 X 16 4/13/2022 2% i
12/9/2021 16 1/1712022 -3% i
919/2021 7 4 8 10 10/15/2021 23% �
7/16/2021 12 7/27/2021 152%
106 2 16 * 00
4/2612021 ' 1 4/26/2021
419/2021 4/26/2021
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i 069 21 6 * 00 w
7 3 1 ■ i
145 ' 1
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