HomeMy WebLinkAboutPASS - Title V Inspection Report - 800 JOHNSON STREET 9/11/2026 Commonwealth asp us ,
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ic* I Inspect,4ion For�m,
Tl"tle 5� Off"O ia
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....
N� Subsurface Sewage Disposal System, Form Not for Voluntary Assessments,
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8,010 Johnson Street
Pr -------------.............................................................................. ..................... .........
rt Address
Stage leer W w w�� :..__w_ ..:
Owner Owner"s Name
information is North Andover 0 5 9 1 2 2
required for every .,u.� w _..._.. ._.._
page. CIk ff wry Inspection
w.
Ott Zip,C e f�r��spe i
Inspection results must be submftted on,this form. Inspection forms may not be,alteredin any
y. Please see completeness checklist at the end of the form.
m.
[important:Whenk Inspector Information
filling out forms
on the computer, Dean Dy.nan
key to,move your e of Inspector
cursor not
Dean,
�
use the return � � ,_ __._._� . ..w. ....... �,,.
Company fir
.......... Street
City/Town State Zip Code
Y .................... ...........-................
P h o,n e Number License Number
B C le rti�f i'lic,a t i o n
l certify that" I am a DEPapproved system inspector in full compliance w�, Section 15.340 of Title 5
(3,10 C R 15. , ); l have personally inspected the sewai e disposal system at the property address
listed, e,;, the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection ways performed based on my training and experience ln the proper function
and maintenance f on-site sewage disposal systems., After conducting this, inspection l have determined
that the system*
1. Passes.
2. El Conditionally Passes
1 El Asada Further Evaluation by the Local Approving Aut rity
4. Fails
���..w r..�_.�...,. .. _ ..�w.w� ����m � �.�.,w��...�� � ��
I tor s,Si nature
The system inspector shall submit a copy, of this inspection report to the,Approving Authority (Board':
f Health or E within 30 days of completing this inspection.. if the system has a design flow of
10,000 g! d or greater, the inspector and the systern owner shall submit it the report to the appropriate
regional office,of the DER The original fora should be seat to,the system l wner and copilles sent to,
the buyer,, if applicable,, and the approving ut rity.
Please notel.: This report only d,es,cribes conditions at the time of inspection and under the
conditions of use at that time.This 'Inspection does not ad ress how the system w1ill, perform
in the future under the same or different conditions use.
t5jn lac,-rev.7126,12018 Title 5 wciai 1Inspectlon Form'":Subsurf'ace Sewage Disposal,Systern-Page l of 1
.�L\ Commonwealth of Massachusetts
Tiotle 5 Offnicial Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,V
800 Johnson Street
Property Address
Steve Elbeery
Owner owner's Name
information is North Andover Ma 01845 9/11/2026
required for every
page, Cityfrown 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:
® l 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:
four bedroom septic system in working order
Filter on septic tank outlet pipe that requires regular maintenance/cast iron cover to grade
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5insp.doc•rev.712WO18 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
itle 5 Off Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
i
800 Johnson Street
Property Address
Steve Elbeery
Owner ^owner's Name
information is North Andover Ma 01845 9/11/2026
rewired for every
peke. City/Town State Zip Code Date of Inspection
C. inspection Summary (cunt.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
El 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 [:1 Y ❑ N El ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y El N Ej ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipes). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced E] 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 CMR
15,303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
15insp.doc-rev.7l2 M18 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Twitle 5 Official Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.r 800 Johnson Street
Property Address
Steve Elbeery
Owner owner's Name
information is North Andover Ma 01845 9/11/2026
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cunt.)
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.
❑ 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 mus..t.indicate `Yes"or"No"to each of the following for all inspections:
Yes No
El Backup of sewage into facility or system component due to overloaded or
z 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
g9 p
t5insp.doe•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
T"tie 5 Offi'ci*a InspectionForm
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
800 Johnson Street
Property Address
Steve Elbeery
Owner owner's Name
information is North Andover Ma 01845 9/11/2026
required for every
page. Citylfown 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
El z Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1z day flow
z Required pumping more than 4 times in the last year NOT due to clogged or
El obstructed i e s . Number of timespumped:
p p � � .�
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
0 S 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
1:1 z well.
El ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
El 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 form,]
The system is a cesspool serving a facility with a design flow of 2000 gpd-
❑ ® 10 000 gpd.
The system fails. I have determined that one or more of the above failure
❑ ® i exist as described in 310 CM 15.303 therefore the s
criteria e 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
El z the system is within 400 feet of a surface drinking water supply
El ® the system is within 200 feet of a tributary to a surface drinking water supply
El the system is located in a nitrogen sensitive area(interim Wellhead Protection
Z Area—IWPA)or a mapped Zone II of a public water supply well
t5insp.doe-rev.7/26=18 We 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
<L
Commonwealth of Massachusetts
T'Itle "ic"ial Inspect"ion Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
y
800 Johnson Street
Property Address
Steve Elbeery
Owner owner's Name
information is North Andover Ma 01845 9/11/2026
required for every
peke, 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 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 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
D Z this Inspection?
Were as built plans of the system obtained and examined? (If they were not
® available note as NIA
N ❑ Was the facility or dwelling inspected for signs of sewage back up?
Z ❑ Was the site inspected for signs of break out?
ED 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
® 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:
® 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 310 CMR 15.302(5)J
Pp of distance is unacceptable)[P
t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Official Inspect'
ive 5iion
...................................
Subsurf ce Sewage Disposal System Form Not for Voluntary Assessments
- $
� � X800 Johnson Street
Property Address
Steve Ele,ler
Owner Owner's Name
information is North Andover 11 2
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D. System Information
. ResildlenUal Flow Conditions:
4 4
Number of bedrooms es, _. umber of bedrooms (actual),:
DESIGN flow as ' on 310 CMR 15.,203 (for example: x#of bedrooms)- 4401
Description:
Bedroom, system with 1500 gallon teak and 792 sq ft,drainfield
Number current residents: . ��.mm.. . �� �.........� ... ......
Doles residience, have a garbage grinder'? Yes 0 No
Does residence have a water re ran unit? Yes No
If yes, discharges o _
Its launildry on a separate sewagie system? (Include laundry system inspection El Yes E No,
information in is report.
Laundry system it s 1? El Yes, N
Seasonal use? EJ Yes E N
Water imeter readings, if avail l (last 2 years s a. e g *
Detail,
town water
sump pumps El Yes E 1
current
Last date occupancy: "bate nnmm m ,...
t ire, u w,.rev.712,6)2018 Title 5 Official Inspectinn Form Subsurface Sewage Disposal Systern-Page 7 of 1
ts
Commonwealth of Massachuset
"tl'e 5 Otticial Insp ion
�......... Ti ect" Form
I ' ! � ts
;
S �bsrfac'e Sewage easel System of o tad s� � e
800 Johnson Street
Address
Steve Elbe
Owner. Ownerls Name
information is North Andover , 22
requiredf r eves . ..,,uN... .... .....page., pity/Tows ,Skate Zip Code Date of Inspection
D.:: nformation (cont.
2. Commerc*fail]nd ustrfal Flow Conditlonsm.
Type of Establishment W __.. _ ..�.µ u.....
.
Design flow(biased n 310 CIVIR 15.2 3 �w ,,,� m.,ry �.....- __..rv. m, _......._.
Gallons,per day d)
Bads, of design flows s ers ns s ft, etc. : _._ .
Grease trap presents El Yes
Ater treatment unit resent? El Yes, E] No
Instil waste holiding teak presents El Yes N
Non-sanitary Non-sanitary waste discharged to the Title, 5 system?' El Yes No
Water meter readings, if available,. _ �u.a .. �..,,,�_._ v.........Last date of occupancy/use,
Date
Other(describe below),
3. Pumpll,ng Records*.,
SOUrce _� irr� rr�i�tir�: Homeowner r Health
last pUrnped spring 2026
s system pumped as part of the inspection? El Yes N ol
If yes, volume pumped"
gallons
w was quantity pumped determined? �.�����....._-----.,,
tiro .do,c-rev.7/26/2018
Tille,51off i i i Inspection Four-Subsurface rf Sewage Disposal S,te -Page 8,of 1
CommonwealthofWassachusetts
T 1 5 nspect,10
atle !A= 0 1� 1� n F'o rm
i Subsurface Sewage Disposal Sysm arm Not,for Voluntary Assessments
800 Johnson Street
Steve E1 e!�
Owner Name
information is North Andover 1 4 9 2
required for eves ..._ ry __.. ..._.w..W..._._ _ _ „ ..
page, �itr- Mate Zip Code Date of Inspection
D., t Information (cont.)
4, hype s
Septic tank, distribution 'box, soil absorption system
El Single cesspool
Overflow cess, lI
Privy
E]
Shared system (yes or,no) (ifyies, attach previous inspection r c r st if any)
In nova t i ve/Alterniative technology. Attach a copy, the current ra ion and
maintenance contract obtained from system owner),and a copy of latest
inspection of the IIA system by system operator,under contract
Tight tank. Attach a copy of the DEP approval..
El Other (de�scribe).-
Approximate age of all comp entsa date installed' (i known), and source of information-
2018 as, per permit on file
Were sewage odors detected when arriving at thie site? El Yes E No
. Build*lnl Sewer,(locate on site plan):
121
Depth below grade: fees
Material of construction'.
El cast iron E 40 PVC other (explain)-
Distance fromprivate water supply well or suction fine- _... .........
t
Comments (ors condition t joints, venting,, evidence of leakage,, etc.
sewer pipe in good condition ' no evidence of leakage
Mnsp,doc rev,,7126/2018 Take 5 Offida]:Insplection v�Subsufface,Sewage Disposal System-Paige 9 of 11
a. Commonwealth ofW a p se s
-incia ,1 0" I' lInspecti
T1 ittle onForm
� a Sub,surface Sewage Disposal System Form Not for Voluntary Assessments
� a8,00 JohnsonStreet
Property Address
Steve �
information i North Andover a 2
required for ..,. ,.....,. m.. �.. �"� u.wu.
page. f Inspection
Di. System Informatilon (cont.
6. Septic Tank locate on site plea)-
19
Depth el ow grade- _.... ........w�
Material of construction:
c ncr El natal El fiberglass El pollyet.hyleneother(explain)
1500 gallon septic gunk located in grass area with cast iron cover to grade
If tank is metal,, list age; .. .. _..__r._r......__._ _ .._ rv..rn...
years
Is age confirmed by a Certificate of Compliance? attaic copy f certificate) EJ Yes El No,
6"1,
Sludge depth v ... .
Distance from top of sludge to bottom of outlet fee or baffle 2914
Scum thickness 0-3,1t
6,11
Distance -fr m top of scum to top of outlet tee or baffle ___ ._.. _....._..rr._.. __ .... �
1,4
Distance from bottom of scum to bottom of outlet tee or baffle '�u.,v
ape
H er dimensions frrir��e '"' in field with measure, stick� I t
Comments (ors pumping recommendations, inlet and outlet tee or baffle condition" structural integrity,
liquid levels as related to outlet invert' evidence f'leal , etc.),
1500 gallop concrete septic tank withVC inlet and outlet Tank in working inn r r with separation from
inlet to outlet no evidence of 1eake uge
cover to,9111
f grade
recommend pumping every two to,three years depending on usage and number of occupants,
Media filter on outlet T that, requires aninual service filter was serviced at time of inspection
Failure,to service could result in hack up to house
Tank does not need' pumping at this time
t5insp.doc, rev,7126,12,018 Tifle 5 Official Inspectioni F orm-1,Subsurface Sewage i po l System,Piage 10 of 1
Commonwealth as huse
TIT IC
81 t 1�e, !�5 01 Inspection Form,
�w
"M
r S s irface Sawa a Disposal System Form Not for Voluntary Assessments
8010 Johnson Street
erty Address
Steve Elbleery
Owner"s Name
infbrmatioin is
th
dover
Ma 01845 9111/2026
rewired for eves w,.""" w,„,� "."mm.m .-.-_-_...._..._.w.w...
City/Town State
Di. System, Information (
`, Grease'Trap (locate, n site plea)*
Depth e l w grade: ��,, �mn..............mn....nn .mm. . ...........
Material Materialof
construction-
concrete Ornetal fiberglass polyethylene El other(explain):
i e n s i ns r
Scums,thickness
Distance from top of'scums to,top,of outlet tee r baffle ___ w _._.w.w....__
Distance from m of scorn , bottom of outlet tee or baffle
Date of lastpumping*
Comments (ors pumping recommendations, inlet andoutlet tee o,r baffle condition„ structural integrity,
liquid level, s related t uu�tlet invert, evidence leakage,, c.
. T10t or Holding Tank (tank must be pumped at time of inspection) (locate on, site plan.,
Depth below grade'.
Material. of construction*
E concrete metal fibergilass El polyethylene El other(explain).
Design Flow, g I'll,a"I'll 1.11 o"I'll n"I'll s r
t i -rev,712612,018 Tifle5 officiai Inspectiori Form:Subsurface Sewage Disposal System Fade 11 of 1
Commonwealth of Massachusetts
I'Itle 5 Officia nspecti'on For�m
T 1� 1�
ace Sewage Dlspoza1l System, Form Not,for Voluntary Assessments,
A800 Johnson, Street
Property Address
Steve Elbe,,
Owner Owner"s Name
information is North Andover . 1 �1 2 2
rewire for eves __ w _� ,,,,.u�.� w_��..., __._ �. �w�,, —---------
page. City/Town State Zip Codle Date of Inspection
D. Syste Information (coney),
Tight8. ,lw1i Tank ci .
Alarm present: El Yes 0� No
Alarm level: Alarm inworking order, El Yes [:1 N o
Diate of last pum p i g -Da 11
te
Comments (condition of al rm and float switches, etc.):
Attach copy current pumping contract ('required). Is copy attached'? Yes
9., D s *11bution Box (if presentuse opened) (locate on site plan)-
D lii Ie el above outlet invert f� l abo v e
rt
---
Comments (note if box is level and distribution to,outlets equal, any evidence of solid's carryover, any
evidence leakage into r out of boxy etc.):1
10 outlet concrete 'box level with 4 outlet pipes in good condition little evidence ofsolids carryover
nd' nce lea,kage, into or out of box
outlet pipes, have levelers
Box cover is "" below grade
t in . -rev,7/26/2018 Title 5Official inspection Form'SUbsurface Sewage Disposal System-Bags 12 of 1
Commonwealth of Massachusetts
sip Twitle 5 Official Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
y
t
ti
800 Johnson Street
Property Address
Steve Elbeery
Owner owner's Name
information is North Andover Ma 01845 9/11/2026
required for every
page. Cityfrown State Zip code Date of Inspection
D. System Information (cunt.)
10. Pump Chamber(locate on site plan):
Pumps in working order: EI Yes ❑ Noy
Alarms in working order: El Yes El 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:
D leaching pits number:
El leaching chambers number:
D leaching galleries number:
❑ leaching trenches number, length:
number, dimensions: 1, 792 sq ft
® leaching fields 24 X 33
❑ overflow cesspool number:
El innovative/alternative system
Type/name of technology:
t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
%,ommonwealth of Massachusefts
r
Titile
Subs,urf'ace Sewagle Disposal System Form, NotforVI
8100 Johnson Street
............._`.............................................................................................................................................................................. .................................................................................................-—'"lr Address
Steve 1ee _v:�_ m......
Owner,
informationrequired is for e�veryN th Andover'
Ma 0 184 5 9/11/2026
....,... „u,µ uu _�........ .........
.. ..
............
..�,
page. to Zip Cote Date of Inspection
D1. System If Rio (coat®
Soil Absorp,blon System (SAS) (cone.)
C r iments (note condition of soil, signs of hydraulic failure, level of ponding, damp,,soil, condition of.
vegetation etc.
,)'-
Ir i iel n in green lawn area with sligl slopes hold, rain water s ils in condition
no signs ' ra lip failure no ponding/ no damp s it grass is, uniform in good condition
Drain field is s vc: pipe in stone conventional system in working order
2. Cesspools (cesspool must be pumpeds part inspection) (locate on site plan
Number and configuration .� .. mmm.....�.....
Depth ,of liquid inlet invert ......�..
Depth of sl'is 1y 'r _�.. u.0
Depth of scum layer, _._....ya _.,..... ..,.�.. ,
(Dimensions of cesspool ,u .....a - .. . ... .
Materials construction . ,
Indication of groundwater inflow El Yes 0 N
Comments ('note condition of soil, signs of hydraulic failure, legal of plonding, condition of vegetation,.
eta.)
t5insp..doc rev,7/2'6/2018 Title 5 Official Inspection Fw rtm Subsurface Sewage Disposal Sort -Pago,14 018,
Y
�xCommonwealth of Massachusetts
T lotle 5 f"Iff ion
icia,l I'nspect Forarn
Subsurface Sewage ils z 11 System Form Not for VoluntaryAssessments
800 Johnson Street
Property Address
S °e Elb,e......................,e ''....m...�___,.. . �....__ _. __..-., _..._..
Owner Owner's Nana
information i
North 0 9 202
required for 'e � w .m
page. City/Town State Zip Code Date Inspection
DI, System Information
3 rl ' (locates on, site plan)*
Materials construction: ,... . ......., ..
Dimensions
Depth of solids, wmnm..rv.. n,m,„n,„ . ...mrvmm _..__. .�. __...... m..m
Comments (note condition soil sips of hydraulic failure„ level of ponding, condition of vegetation,
etc.)*
t5insgdoc rev.7/2'6/2018 Title ffidai inspection orm Subsurface Sewage Disposal Systern-Page i 5 18I
Commonwealth of Massachusetts
■
M IOff'
ici'al Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
800 Johnson Street
Property Address
Steve Elbeery
Owner owner's Name '
information is North Andover Ma 01845 9/11/2026
required for every
page. Cityfrown 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
the building. Check one of the boxes below;
❑ hand-sketch in the area below
® drawing attached separately
t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Iw uommonwealth f Massachusetts
Tllle ,5 Official rr rrrrr�rirrrr,�i � �
1'nspect,i*�on
Subsurface Sewage D s sal y� �" 1 r � e
800 Johnson! Street
.a
Property Address
Steve El bier
..................
Owner Owner's Name
information is North Andover 1 /1�1 2 �2
required for even ....... ,,-,,, ,.nw.�..... .� m.� mod_ __r.- ---- m
City/Town � e ?I bode fe— „rym„ m n , ,,, ,., .....d
ofinspection
D. System Information (cont
15. SiteExam:
N, Check Slope
Surface water
Check cellar
El Shallow well
3O as per plan on, file
Estimated depth to high ground water-
Please, indicate all methods usedto determine the high ground water'elevation,
Obtained from system design pleas on record
20,18
If clue , date of design plan ra ne e . Date
Observed site (a,butting property/observation 'hole within 1510 feet of SAS
Checked with local Board of Healt1 explain.
Checked with focal excavators, installers - (attach documentation')
E] Accessed USES database -explains
You must describe how you established the high ground water,elevation.
Plans on file at 130Hdated 2,018 soil test Sullivan Eng
System is gravity mound
Before fflin,gl thils Inspection Report,, please see Report Completeness Checklist on next page.,
t5insp,doc rev,712,612018 Tifleofficial Inspection " rrnd Subsurface Sewage Disposal System Pale,17 of 18,
Commonwealth of Massachusefts
T i"t 1'e ff' Form,
RA 01 icial Inspection
alJ
Subsurface Disposal S st,em Forte Not for Voluntary Aseesaw s
. . 800,Johnson Street.
u w .u... . . �..,� ...... mm m ..... ....m . ... . ..... ....................... .. �.....
Property,Address
OwnerSteve EIe� "'..... . ..
�����...........e................r.rv.........�, , . .._..... ...._..._...__ _ .�__W_ .......... ------- .................................
info�rmation is North
required for eves --- w.. uu., a �...
pageCity[Townto Zip Code Date of Inspection
E. Report Checklist
Complete all ap Ii a le sections of this form inclusive
A. inspector Information- Complete all,field's in this sec Io .
Certification,,- Signed & Dated and 1, 2, 3 or 4 checked
C. Inspection Summar �
4 (Failure Criteria) 6 (Checklist) completed
. System Information,".,
For * Tigi H ldin Tank - Purnping contract attached
For : Sketch of sewage Disposal System drawn on pg. 16 or attached.
For 15, Explanation of estimated depth to high groundwater included
t5imp,doc rev,712612018 Title 5 Official Inspection Forte Subsurface S,ewage Disposal S t -Page 1 f 1
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Cominunity and Economic Development Division
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This i"Sto Certify that thcindtv Idual Subsurface disposa system rece,wed, a
SX.FISFACrI"0RY INSPECTION, of the:
Cons,tructi*on of ion�,Si*,,te Sewa, isp,os,a'l, System
BY* Tim Qui"n'lan,
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b �� ,�� _wf�tl!npw�i.... v�w,em,r � ..„I°�N ',�K�a,'P�'��MI�Y�NYr�'�WN"' ftd�lx ,. i" a�4�� �'4i��...Iwm, �r�aw�wr�w�nr.,a•�~pr�u�uYr��w���aY��.a��:� �wW'��!Wf�.. ,�,"��W�Ye�"M�Wv�:. q�. '�,�rw�r�r�wm�r� ,u�,�w��Rr�„�.d��A, 1N
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1 Main St,North Andover,Massachuselts 01845
Phone 978.688.9540 fax 978.688.9542 Web wwwnorthandoverma.golv
VVI111/two r►%*A%rV&%a yM.V%,VI nos%A%rY V11"m►W`Vr.I%o..".►v.M.►..j•.W/Vf •►►I..w
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Town of North Andover
Tax Map # 21 0m038.0=01 081-0000.0
Parcel Id 10409
800 JOHNSON STREET
GINA& STEPHEN ELBEERY
800 JOHNSON STREET
NORTH ANDOVER MA 01846
Class 101 Single Family Property Type 1 Residential
Size Total 1.26 Acres
FY 2026
UB Malling Index
Name/Address Type Loan Number Active/lnact. From Until
GINA&STEPHEN ELBEERY Owner Active
800 JOHNSON STREET
NORTH ANDOVER MA 01845
TKZ LLC Previous Customer Inactive 5/17/2018
4 HIGH STREET,SUITE 201
NORTH ANDOVER MA 01845
UB Account Maint
Account No Cycle Occupant Name Activelinactive
Bldg Id.28162.0-800 JOHNSON STREET Last Billing Date 9/412026
2101378 02 Cycle 02 Active
UB Services Taint.
Account No.2101378
Service Code Rate Charge MultipliedUsers
MISCFEE ADMIN FEE 0.63 5/8 7.82 1/1
WTR WATER 01 ALL METER SIZE 170.35 1/1
UB Meter Maintenance
Account No.2101378
Serial No Status Location Brand Type Size YTD Cons
49871505 a Active HH#800 b Badger w Water 0.625 0.625 482
Date Reading Code Consumption Posted Date variance
8/5/2026 883 a Actual 37 9/11/2026 185%
5/6/2026 846 a Actual 13 6111/2026 -13%
2/4/2026 833 a Actual 15 3/12/2026 -43%
11/5/2025 818 a Actual 26 12112/2025 7%
8/7/2025 792 a Actual 25 9/12/2025 102%
5/6/2025 767 a Actual 12 6/12/2025 -32%
2/5/2025 755 a Actual 18 3/13/2025 55%
1115/2024 737 a Actual 12 12/12/2024 -80%
8/2/2024 725 a Actual 58 9/12/2024 305%
5/2/2024 667 a Actual 14 6/13/2024 -4%
2/2/2024 653 a Actual 15 3/14/2024 12%
11/1/2023 638 a Actual 13 12/13/2023 -4%
8/3/2023 625 a Actual 14 9/18/2023 91%
5/2/2023 611 a Actual 7 6/14/2023 -52%
2/2/2023 604 a Actual 15 3/14/2023 -51%
11/212022 589 a Actual 30 12/19/2022 -18%
8/3/2022 559 a Actual 37 9/20/2022 503%
5/3/2022 522 a Actual 6 6/21/2022 -59%
2/2/2022 516 a Actual 15 3/15/2022 12%
1112/2021 501 a Actual 13 12113/2021 -67%
8/5/2021 488 a Actual 41 9/21/2021 82%
5/5/2021 447 a Actual 22 6/15/2021 -5%
2/4/2021 425 a Actual 24 3116/2021 -41%
11/3/2020 401 a Actual 40 12/16/2020 -58%
8/4/2020 361 a Actual 96 9/9/2020 248%
5/4/2020 265 a Actual 27 6/10/2020 10%
2/4/2020 238 a Actual 25 3/16/2020 4623%
11/4/2019 213 a Actual 33 12/23/2019 -34%
Caring, for your Septic System* A Reference Guide for
Homeowners
Car't'ng for Your Sept"Ic Systern, (Conventional Septic System, lii rev,a!,t ve
System, or Cesspool)
The accumulated solids in the blottom, ofthe septic tank should I)e p,umped out every hree years to
prolong the life of your, system. Septic systerns Must be niaintaine d regularly, to stay,working.
Neglect or rabuse of your system can cause It to fall. Failing systems can
causse a serious health t1ireaf to your mfly and nelighbors,
degrade the environment, especiiially, es, streams and groundwater,
reducle, the value ofr YOUJ_ property,
be very expensive to repair,
and, put thousand of water supply users at risk if you live in a plublIc water supply watershed
and fail to: it in your system.
Be alert to, tease warning signs, of a failing system.
a sewage surfacing over*the drainfield (ospecially after storms),
* sewage back-LIPS I'll the h0LJS,ef
* ILIS11,, green growtlii, over ti[i�e drainfield,
* slow draining toilets or,draltis,
* se)w age i odors
e#z 19
bN
ij
id
IFF
Tlps, to Av,o'ld Trouble,
DO have your tank pumped out and systern inspected every 3 to 5 years by a licensed septic
contractor (Hated in tl,,i,,e yellow pages).
ri ritfil 71
i
4-1002020 Caring for`your Septic��S`06m A Deference Guide for Homeowners
f
• DO keep a record of pumping, inspections, and other maintenance. Use the back page of this
brochure to record maintenance'dates.
• Do practice water conservation. Repair dripping faucets and leaking toilets, run washing
machines and dishwashers only when fall, avoid long showers, and use water-saving features
In faucets, shower heads and toilets.
• Do learn the location of your septic system and drainfield. Keep a sketch of it handy for
service visits, if your system has a flow diversion valve, learn its location} and turn it once a
year. Flow diverters can add many years to the life of your system.
• DO divert roof drains and surface water from driveways and hillsides away from the septic
system. Keep sump pumps and house footing drains away from the septic system as well.
• DO take leftover hazardous household chemicals to your approved hazardous waste
collection center for disposal. Use bleach, disinfectants, and drain and toilet bowl cleaners
sparingly and in accordance with product labels,
• DON'T allow anyone to drive or park over any part of the system. The area over the drainfield
should be left undisturbed with only a mowed grass cover. Moots from nearby trees or shrubs
may clog and damage your drain lines.
• DON'T make or allow repairs to your septic system without obtaining the required health
department ermit. Use professional licensed contractors when needed.
p pe
rmit,
DO se .
« DON'T use commercial tic tank additives.These products usually do not help and some
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may hurt your system in the long run.
your toilet as a trash can b dumping nondegradables down your toilet or drains.
• DON'T use yo Y
Also, don't poison your septicsystem
and the groundwater by pouring harmful chemicals
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down the dram, y
The can Will the beneficial bacteria that treat your wastewater. Keep the
following materials out of your system:
Nondegradables
grease disposable diapers, plastics, etc.
Poisons
gasoline, � p ,oil paint, paint thinner, pesticides, antifreeze, etc.
Septic System Explained
• wastewater treatment systems(conventional septic systems,
Septic systems are Individual .
• (I/A) cess cesspools)that use the soil to treat small wastewater flows,
alternatives sterns, or p )innovat�vel � lazed
• he are Icall used in rural or large lot settings where cents
usually from individual homes. They typ y
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wastewater treatment is impractical.
• today, While all Systems are individually designed for
re man es of septic systeMS in use , + Y
There a Y tYp
• most systems are based on the same principles.
each site, m Y
temporarily holding it in the septic tank
• rn treats our household wastewater by
Your septic system Y firam the waste water.Thin eparation
solids and lighter scum are allowed to separatebacteria
where heavy tank are decomposed b '
rims treatment.The solids stored in the
process�s known asp primary professional septic tank pumper.
d along with the lighter scum, by prof . p tes
and later remove , g �t flaws into a d�str�but�on box, which separates
treated wastewater leaves the tank,
After partially holes at the bottom of each line allow
a network of drainiield trenches. Drainage e s
this flow evenly into f storage* This effluent then slowly se p
o dram into gravel trenches for temporary g properly
the wastewater t • purified (secondary treatment).A prop y
into the subsurface soil whe
re it is further treated and P
'c system does not pollute the groundwater.
functioning septic y .. _. .�