HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 42 CROSSBOW LANE 10/11/2024 4w. Commonwealth of (Massachusetts
Title 5 Off dal Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
42 CROSSBOW LANE
Property Address
KAR L R ETI
Owner bwner`s Name
information is NORTH ANDCVER MA 01845 SEPTEMBER 25, 2024
reported for every
pace. CityfTown state Zip Code Date of Inspechon
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:out
when A. Inspector Information
fiWllne�out forms
on the computer, Todd James Bateson
use only the Cab
key to move your Name of Inspector
cursor-do riot Bateson Enterprises Inc,
use the return Company Name
key.
111 Argilla Road
Company Address _
—=— Andover MA 01810
6tyrrown state Zip Code
978-475-4786 SI-16
Telephone Number License Number
B. 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. F� Passes
2. Conditionally Passes
. Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
SPTEMBER 26, 2024
Inspe/s/. ature 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 systern has a design flow of
10„000 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.
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n'n Commonwealth of Massachusetts
Title 5 offrcial Inspection Form
r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,,: 42 CROSSBOW LANE
Property Address
KARL RETI
Owner Owner's Nanre
information is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every _ ... ..
page. it /Town __..... Mate__.._._,_ _ Zip Code Date of Inspection
as e. Y p p
C. Inspection Summary
Inspection Summary Complete 1, 2„ 3„ or 5 and all of 4 and B.
1) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.353 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally 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
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 odd* 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.
7 Y N F] ND (Explain below):
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Commonwealth of Massachusetts
io
Tide 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
� 42 CROSSBOW LANE
Oroperty Address
KARL RETI
Owner Owner's Name
inforregUi edfo is NORTH ANDOVER MA 01845 SEPTE BER 25, 2024
regaaired far every _
page. Cwty[Town State Zip Code gate of Inspection
_....._ ..... __ .w_._ ... _w_..._...._.. _v ... .. .._..._.._ .._. _.. .....v w ._...w__
C. Inspection Summary (cant.)
2) System Conditionally Passes (cant,):
[� Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
broken pipe(s) are replaced Fj Y F� N ND (Explain below):
❑ obstruction is removed Y 7 N M ND (Explain below):
distribution box is leveled or replaced El Y F� N F-1 ND (Explain below).
D-BOX IS DETERIORATING AND FULL OF ROOTS. NEEDS REPLACED
PIPE TO TANK NEEDS REPLACED
Q 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 El Y ❑ N [__I ND (Explain below):
El obstruction is removed [j Y ❑ N El ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
[-1 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:
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Commonwealth of Massachusetts
Title 5 Offii al Inspection Form
°I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
42 CROSSBOW LANE
F5roperty Address
KARL RETI
Owner owners Narre
information is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every _. _.
page. City/To n Mate Zip Code Date of lnspecfuon
C. Inspection Summary (coat.)
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.
El The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
E] 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
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
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Commonwealth of Massachusetts
i ) ,q Title offidal Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
, 42 CROSSBOW LANE
Property Address
KARL RETI
Owner Owner's Name
�nforrrequired for
is NORTH ANDOVER MA 01645 SEPTEMBER 25, 2024
repaired for every _
page. City/Town State Zip Code Gate of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: `cant.)
Yes No
El Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
E Z 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
rt obstructed pipe(s). Number of times pumped:
❑ r71 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.
z Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well,
El E Any portion of a cesspool or privy is within 50 feet of a private water supply well.
[Iz Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
frorn 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.]
El Z 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
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 CA.
Yes No
11 E] the system is within 400 feet of a surface drinking water supply
El 1:1 the system us within 200 feet of a tributary to a surface drinking water supply
El 1-1 the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone Il of a public water supply well
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��. Commonwealth of Massachusetts
I Tide 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
W 42 CROSSBOW LANE
Property Address
KARL RETI
Owner Owner's Name
infor
mation ed for every is
required NORTH ANDOVER MA 01545 SEPTEMBER 25, 2024
re '
page. CltylTown State Zip Code Date of Inspection
C. Insp��ti6n 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.
5. You must indicate"yes" or"no" for each of the following for all inspections:
Yes No
Z 0 Pumping information was provided by the owner, occupant, or Board of Health
0 E Were any of the system components pumped out in the previous two weeks?
Z EJ Has the system received normal flows in the previous two week period?
0 Z Have large volumes of water been introduced to the system recently or as part of
this inspection?
® Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up?
Z ❑ Was the site inspected for signs of break out?
Z 11 Were all system components, excluding the SAS, located on site?
0 ❑ 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?
1:1 Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
Z 1:1 Existing information. For example, a plan at the Board of Health.
Z 0 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)]
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Commonwealth of Massachusetts
Title Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4" 42 CROSSBOW LANE
Property Address
KARL RETI
Owner Owner's Nanre
information for every
is
regarired for CityfTown State Zip Code NORTH ANDOVER MA 01€�45 SEPTEMBER 25, 2024
_ _ _ __
page Date of Inspection
_... .... ........ _ ....._,...._... .... _ .. ......__, ........_..
D. System Information
1, Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (;actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x##of bedrooms): 600 GPD
Description:
Number of current residents:
Does residence have a garbage grinder? Yes No
Does residence have a water treatment unit? Yeses No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection (l Yes Z No
information in this report.)
Laundry system inspected? Z Yes n No
Seasonal use"? El Yes Z No
Water meter readings, if available last 2 ears usage d ATTACHED
g ( y g (gl� ))
Detail:
_ .....
Sump pump? 0 Yes Z No
Last date of occupancy: CURRENT
Date ...
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' ., Commonwealth of Massachusetts
Title 5 Offocial Inspection Form
d Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
42 CROSSBOW LANE _
Property Address
KARL RETI
Owner Owner's Name
required
for
is NORTH ANDOVER MA 01845, SEPTEMBER 25, 2024
re¢�rarred for every
page. City/Town State Zip Code gate of Inspection
D. System Information (colt.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203); Gallons per day(9pd)
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? 0 Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? 0 Yes ❑ No
Water meter readings, if available: _
Last date of occupancy/use: Crate _
Other(describe below):
3. Pumping Records:
Source of information: OWNER SEPTEMBER 2022
Was system pumped as part of the inspection? El Yes Z No
If yes„ volume pumped: gallons_
How was quantity pumped determined? _
Reason for pumping
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° Commonwealth of Massachusetts
'Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
42 CROSSBOW LANE
Property Address
ARL RETI
Owner Owner's Name
information is. NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every _ _ _
page ity_rown State Zip Code Date of Inspection
_.,......... _.. __ ..._. ...._ ._..w._._ ._.... _...w ....... ....__._.._.
D. System Information (cant.)
4. Type of System;
Septic tank, distribution box, soil absorption system
( ] Single cesspool
❑ Overflow cesspool
F1 Privy
0 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
[l Tight tank. Attach a copy of the DEP approval.
❑ Other (describe):
Approximate age of all components, date installed (if known) and source of information:
SYSTEM 41 YEARS OLD INSTALLED 1983 DESIGN PLAN
Were sewage odors detected when arriving at the site? Yes No
. Building Sewer(locate on site plan):
15"
Depth below grade: teed
Material of construction:
[ cast iron �40 PVC 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
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
" 42 CROSSBOW LANE
Property Address
KARL RETI
Owner Owner's Name
information is NORTH ANDOVER MA 01$45 SEPTEMBER 25, 2924
required for every ... _ _ _
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cant.)
6. Septic Tank(locate on site plan):
Depth below grade: 3°"
feet
Material of construction:
Z concrete F� metal El fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: yea
rs
is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 10' 5' X 4"
Sludge depth: 4
Distance from top of sludge to bottom of outlet tee or baffle
34°"
Scum thickness 1..
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle 13"
How were dimensions determined? SLUDGE NUDGE AND 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.):
RECOMMEND PUMPING OLDER SYSTEMS YEARLY
INLET AND OUTLET BAFFLES OK
TANK OK
NO EVIDENCE OF LEAKAGE
LIQUID LEVELS GOOD
PIPE LEAVING TANK HOLDING WATER. NEEDS REPLACED TO D-BOX
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Commonwealth of Massachusetts
=1 � Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w ay 42 CROSSBOW LANE
Property Address
KAf L. RETI
Owner Owner's Name
required on is NORTH ANDOVEC MA 011845 SEPTEMBE 25, 2024
required for every _
page. Cityrrown State Zip Code Date of Inspection
_.... ........ _...... . . . ...... ..._._... _ .... _ ....... ....,.._ . ... ... _......_._
D. System Information (cant.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
El concrete [-1 metal fiberglass ❑ polyethylenes E] other(explain);
Dirensions:
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:
EJ concrete El metal 0 fiberglass El polyethylene 0 other (explain);
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
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Commonwealth of Massachusetts
Title 5 Official l Inspection Farm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
42 CROSSBOW LANE
Property Address
KARL RETI
Owner Owner's Name
information Is
required f NORTH ANDOVER MA 01845 SEPTEMBER 25„ 2024
required _.
page. Chy/Town State Zip Code Date of Inspection
_. ._
D. System Information (cont.)
5. Tight or Holding Tank (cont.)
Alarm present: Yes No
Alarm level. Alarm in working order, [ ] Yes No
Date of last pumping. feats
Comments (condition of alarm and float switches, etc.)
Attach copy of current pumping contract(required). Is copy attached? [l Yes No
9, Distribution Box (if present must be opened) (locate on site plan),
Depth of liquid level above outlet invert
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 FULL OF ROOTS AND DETERIORATED. NEEDS REPLACED
PIPE TO TANK NEEDS REPLACED
DISTRIBUTION NOT EQUAL
LIGHT EVIDENCE OF SOLIDS CARRYOVER
EVIDENCE OF LEAKAGE
RAN CAMERA DOWN LEACH LINE, NO ROOTS DETECTED
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° Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm _ Not for Voluntary Assessments
, apy 42 CROSSBOW LANE
Property Address _
KARL RETI
Owner Owner's Larne
information Is NORTH ANDOVER MA 0184 SEPTEMBER 25„ 2024
required for every _ _. _ .. _
page. City/Town State Zip Cade Date of Inspection
.... .... ..... _.._m . .. ._._.. �_ ..__....,_ _ _a.....__.._.... _... ._.,,. ._.,, .___ .... _..........__.m.. _ ._
D. System Information (cant.)
10. Pump Chamber(locate on site plan):
Pumps in working order: El Yes ❑ Noy"
Alarms in working order. El Yes ❑ Now
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:
11 leaching pits number:
EJ leaching chambers number:
E] leaching galleries number:
El leaching trenches number, length:
Ej leaching fields number„ dimensions: 1; 20'X 45"
El overflow cesspool number:
[ innovative/alternative system
Type/name of technology:
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Commonwealth of Massachusetts
Tide 5 Official Inspection Form
}I Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
42 CROSSBOW LANE
Property Address
KARL RETI
Owner Owner's Dame
information is required for everyNORTH ANDOVER MA 01845 SEPTEMBER 25„ 2024
_ .... _
page. CttyfTown State Zip Cade Date of Inspection
D. System Information (cunt.)
11. Sail 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 GOOD
NO SIGN OF HYDRAULIC FAILURE OR PONDING
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 No
Comments (note condition of soil, signs of hydraulic failure, level of ponding„ condition of vegetation,
etc,):
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Commonwealth of Massachusetts
Tide 5 Official Inspection Farm
re
3 Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments
42 CROSSBOW LANE
Property Address
KARL RETI
Owner Owner's dame
inforregUir dfo is NORTH ANDOVER MA 01845 SEPT-EMBER 25, 2024
required for every _
page. City/Town State Zip Code Gate of Inspectuon
D. System Information (cant.)
13, Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure„ level of ponding„ condition of vegetation,
etc.):
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Commonwealth of Massachusetts
Title 5 Official Inspect-Ion Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
42 CROSSBOW LANE
...........
KARL RETI
Owner dwn(Wi7Name' '
information is
required for every NORTH ANDOVER MA 01845 SEPTEMBER"25, 2024
State Zip Code Date of Inspection
page, 'bii 6w,"n, —---------___,
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,
Z hand-sketch in the area below
F� drawing attached separately
L air,,
�.j S
157()() Gaf(u I'l
A
_30 ' 2-'
0 4
LN"
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ar � °Irf Tale 5 Official Inspection Form
� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
� � . 42 CROSSBOW LANE
15roperty Address
KARL RETI
Owner Owner's Name _
information is reqUired for every NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
page. Crty/Town S ate Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
Check Slope
Surface water
( Check cellar
E] Shallow wells
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
Obtained from system design plans on record
If checked, date of design plan reviewed: AUGUST 1 g83
Date
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health - explain:
PLANS ON FILE
0 Checked with local excavators,. installers - (attach documentation)
❑ Accessed USGS database- explain:
You must describe how you established the high ground water elevation:
DESIGN PLAN ON FILE
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
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Commonwealth of Massachusetts
�� Iw Tale 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
42 CROSSBOW LANE
Property Address
KARL RETI
Owner Owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every
page 6ty'fTown State Zap 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, 2, 3, or 4 checked
Z C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
Z D. System Information:
For 8: Tight/Holding Tank— Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
15insp ck)c•rev.7r26We!08 'htfe 5 o6fhr.ml 8nspection Fo�rrm.Subrossta ce Sewage Q")mposw Sworn•F"ne 18 of ie
Summary Record Card gerpm nd on 913W2024 W 31 41 AM by Kwon Hankm Pago I
4 Town of North Andover
Tax Map # 210-106,.B-0197-0000.0
Parcel Id 17692
42 CROSSBOW LANE
RETI, KARL
42 CROSSBOW LANE
N. ANDOVER, MA
01845
Class 101 Single Fwnfly Property Type 1 Resdential
Size Total 1 Acres
FY 2025
UB Mailing Index
Name/Address Type Loan Nuinber Activollrmct, From Until
RETI, KARL. Payer Achv�""=
42 CROSSBOW LANE
N,ANDOVER,MA
01845
UB Account Maint,
Account No Cycle Occupant Name Activeftactive
Bldg Id. t 7565,0-42 CROSSBOW LANE Last Billing Date 7/15/2024
3170235 03 Cycle 03 Active
UB Services Maint,
Account No 3170235
Service Code Rate Charge MuffiplierlUsers,
MISCFEEADMIN FEE 0,635/8 782 1/
VVrR WATER 01 ALL.ME'rER SIZE 1140
UB Meter Maintenance
Account No,31702,35
Serial No Status Locatiion Brarid Type Sizo Y'rD Cons
35445475 a Active ERT11H b Badger w Water 0M5 0,625 133
Dat!e Readlnf4 Code Consumption Posted Date Variance
9/10/2024 805 a Actual 10 248%
6/1112024 795 aActual 13 7122/2024 -43%
318/2024 792 a Actual 5 411612024 -42%
1218/2023 787 aActual 8 1/15�2024 -29%
9/1412023 779 a Actual 13 10/13/2023 t 134%
6/8/2023 766 a Actual 1 7114/2023 -88%
3/7/2023 '765 aActual 8 4/1212023 68"/o
12t7/2022 757 aActual 5 1/1612023 -67%
9/9/2022 752 aActual 16 10/1812022 129%
6/8/2022 736 aActual 7 7/1812022 •16%
3/7/2022 729 a Actual 8 4/13/2022 18%
1218/2021 721 aActual 10 1/17/2022 2%
9/8/2021 711 aActual 10 10/15/2021 1%
6f7/2021 701 a Actua 1 10 7)2712021 -29%
3/5/2021 691 a Actual 13 4/21/2021 -15 0/01
1121812020 678 aActual 16 1/11/2021 -16%
91812020 662 a Actual 20 10114/2020 47%
6/5/2020 642 aActual 13 7/15/2020 54%
3/6/2020 629 a Actual 8 4/8/2020 .8�41
12111/2019 621 aActual 9 1/15/2020 -26%
9/13120,19 612 a Actual 13 10110/2019 7%
6/10/2019 599 aActual 12 7/25/2019 -6%
3/8/2019 587 a Actual 12 4/16/2019 .,8%
12/1012018 575 a Actual 13 1/22/2019 -1 0'Yo
911312018 562 aActual 16 10/15/2018 -4"d"o
6/8/2018 546 a Actual 16 71231201 8 19%
317/2018 530 as Actual 13 412312018 14%
t 21712017 517 aActual 11 1/2512018 -14%
9/1112017 506 aActual 14 10/1812017 1311/10
6/812017 492 a Acl!ua 1 12 7/25/2017 -171%,
SEPTIC SYSTEMS MA-1-N'T F_\AN C'E ST-PS YOU C,Eih' FOLLOW
What is a Septic System? 0 Pump your septic tank every I - 2 vears.
A septic system is used to dispose and treat household Solids could be overflowing to the leaching facility rig-tit now,
sewage. It consists of a rectangular W.,Ler__Jght box causing damage that will require expensive repairs.
(the septic tank) and a leaching facility. 0 Investigate signs of failure immediately.
-Slow draining of toilets and sinks
10 -Foul odor, Patches of green grass, ponded water, or melting snow
near leaching e aching system.
septic tank o Minim4ize water use in the home
a The less water used, the longer the retention period in the tank
distribution box leaching are
and the more solids the bacteria car, decompose Use water-saving
Wastewater from the house flows directly into the septic showerheads and toilers.
tank- There, the larger solids settle to the bottom,
0 Do not dispose the following materials
forming a laver of sludge. The lighter particles rise G
to the surface, forming a layer of scum.. Bacteria in the - arbage- Use of disposals adds massive amounts of solids to the
tank work to decompose the solids in these lavers. in tank.
-Sanitat napkins, colored toile, paper, disposable diapers, and
spite of this decomposition, however, both the sludge and
tissues do not decompose.
scum gradually accumulate and must be removed every 1 2
years to ensure proper operation of the system. -Cooking oil, fat, andd
grease car, pass through the septic tank
THE qFP71C. TANK snotli clog , e leaching field.
sewage from house air space -Pesticides, disinfectants, acids, medicine, paint thinners, etc. ,
will kill rbe helpful bacteria in the ta
nk and contaminate the
scum build
_UPL groudwater.
liquid to
.liquid level to leaching Do nor use cesspool cleaners
area There are no known chemicals, yeasts, bacteria, en_z}mes or other
Wastewater
substances capable of eliminating or reducing the sludge and scum
sludge so that periodic cleaning is unnecessary. Many of these cleaners
The liquid portion of the sewage- flows form the septic contain highly concentrated organic solvents that are rated toxic
tank to the leaching system, which consists of a series and suspected to be cancer-causing by the EIPA and National Cancer
of perforated pipes or a pre-cast pit placed in trenches Institute. They are not bio-degradable and pose a serious
or "beds" of washed stone. This system distributes the potential-
threat to private and public water supply wel, S. The
liquid sewage into the surrounding soil, where it is use of such products is not necessary for the proper functioning
filtered and treated. of a septic system and, in fact, can harm the systez.
The Need for maintenance For more itif orma-lion or assistance , contact thin Department of
Environmental Oua--' ,'- -
Engineering Regional- Office (935-2160) or
The leaching system is not designed to receive solids.
your local Board of Health. (470-3800 ext. 255) If your septic
If solids are allowed to accumulate and, over471ow from the
septic tank, the leaching system becomes clogged and will system has been installed or repaired in the last 5-7 years, the
Town Health Dept. most likely will be able - you with a
no longer transmit the liquid sewage. This results in a to provide
your system location. Call the above number to
back-up of sewage into the house or a break-out through plot plan of
receive your copy free ol;:
charge.
the ground. When this occurs, the system can often only
be renovated by abandonment (usually for 6 months or morel
TEL: �508Z_75-1
l- FAX-608'475-54i
or by complete replacement. Costs for rel) acemen- of the
leaching hing system are high, ranging from 000 to,�6,000.
With proper maintenance, these problems and expenses can BATESON ENTERPRISES, INC.
De avoided. Fa,atirlZ,-Wat&S1 L_-S..Oric 5,1!s&P1g
Si
I Argilla Road Anoover Ma-,s_0 18 10