HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 68 CRICKET LANE 2/28/2025 Commonwealth of Massachusetts
eF _ : Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE
Property Address __. �...
BONACCORSO FAMILY TRUST
Owner Owner's Name
information is NORTH ANDOVER MA 01845 FEBRUARY 28 2025 required for every _
page. City/Town State Zip Code Date of inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out farms A. Inspector Information
on the computer, Town of North Andover
use only the tab Todd James Bateson
key to move your Name of Inspector
cursor-do not Bateson Enterprises Inc. �Q2
key.
use the return
Company Name __ ..... _.W
111 Argilla Road
rrD Company Address 2j m�+._.._, ht ....,....
Andover MA Health pep 01810
City/Town State
Cit _ ... __
Y Zip Cade
rd � 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 16.000); 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. ❑ Passes
2. ® Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
_ MARCH 4, 2025
insp or's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
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.
15insp.doc-rev.7/2612018 Title 5 Official inspection Foam:Subsurface Sewage DIsposel System•Page 1 of 18
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1
Commonwealth of Massachusetts
y:= Title 5 official inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name
Information Is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
page. Cityffown State Zip Code Cate of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
® One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years 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).
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Commonwealth of Massachusetts
: Wm Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE _
Property Address
BONACCORSO FAMILY TRUST
Owner __._..m...____�..............___..—. ....� __.._._
Owner's Name
Information is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
page, City/Town State zip Code Date of Inspection
C, Inspection Summary (cont.)
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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
® distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below):
D-BOX IS DETERIORATED AND LEAKING . NEEDS REPLACED
❑ 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):
❑ broken pipe(s) are replaced ❑ 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.
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner owner's Name m
information is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
��....._.._..�
page, City/Town State Zip Code Date of Inspection
C. Inspection Summary (cons.)
❑ 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.
❑ 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.
❑ 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:
SEPTIC TANK IS LEAKING, NEEDS REPLACED
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
l5insp.doc rev.7/2 8120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 4 of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name
Information is
required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
page. CitylTown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure criteria Applicable to All Systems: (cont.)
Yes No
El ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
ElLiquid depth in cesspool is less than 6" below invert or available volume is less
than 1/day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped;
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this forma
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 16.303, therefore the system falls. The
system owner should contact the Hoard of Health to determine what will be
necessary to correct the failure.
6) 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
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area -- IWPA) or a mapped Zone Il of a public water supply well
15Ensp.doc•rev.7126/2018 Titia 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
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Commonwealth of Massachusetts
. p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
9
68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name
information is NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
required for every _
page, CitylTown 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
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ 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?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ 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 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:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) 1310 CMR 15.302(5))
15insp.doc-rev.7126/2018 Tille 5 official Inspection Fomr Subsurface Sewage Disposal System•Page 6 of 10
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE _
Property Address
BONACCORSO FAMILY TRUST j
Owner Owner's Name
information is MA 01845 FEBRUARY 28, 2025 NORTH ANDOVER
required for every _ _
page. City/Town State zip Code 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: 0
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® 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? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)): SEE ATTACHED
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: D to 2O24
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Commonwealth of Massachusetts
H =`gip Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
3 f i
v
68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name
information is NORTH ANDOVER MA 018�45 F'EBRUARY 28, 2025
required far every _._....m _
page. Cliyllown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercialllndustrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd) —
Basis of design flow (seatslpersonslsq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to: -- - W
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: BATESON ENTERPRISES INC MARCH 2O22 T^
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons --....
How was quantity pumped determined?
Reason for pumping: -
15insp.doc rev.7l26MU0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
n
Commonwealth of Massachusetts
Title 5 Official Inspection Form
.w # Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name _ -... .
information is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
......_. �--
page. City/Town State Zip Code Dale of Inspection
D. System Information (cant.)
4. Type of System:
® 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:
45 YEARS OLD, INSTALLED AUGUST 1980, AS BUILT PLAN
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
DeDepth below grade: 15
p Meet
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
l5insp,doc-rev.7/2612018 Title 5 Offdal Inspeclion Form:Subsurface Sewage Disposal System Page 9 of 18
i
c Commonwealth of Massachusetts 1
Title 5 Official Inspection Form
m — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
I�
68 CRICKET LANE
r Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name
information Is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
--
page. City/Town State zip Code Date of Inspection
D. System Information (coat.)
6. Septic Tank (locate on site plan):
i
3"
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 10' X V X 4'
Sludge dep 0
th:
Distance from top of sludge to bottom of outlet tee or baffle NA
Scum thickness 0
Distance from top of scum to top of outlet tee or baffle NA
Distance from bottom of scum to bottom of outlet tee or baffle NA
How were dimensions determined? SLUDGE JUDGE 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
CONCRETE INLET AND OUTLET BAFFLES GOOD
TANK IS LEAKING AND NEEDS REPLACED
t5insp.doc rev.7126/2018 Tille 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 or 18
i
Commonwealth of Massachusetts
Y Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
y 88 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name
Information is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
-
page, Cltyffown State Zip Code Date of Inspection
D. System Information (cunt.)
7, Grease Trap (locate on site plan):
Depth below grade: feet ----
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness w-. -- -
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:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
15insp.doo•rev.7I2812018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
w� Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�t 68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
..--.
page. City/Town State —ZIp Code Cate o(Inspection
D. System Information (cont.)
8. Tight or Holding Tank(coat.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0 --
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 DETERIORATED AND LEAKING
DISTRIBUTION IS NOT EQUAL
LIGHT EVIDENCE OF SOLIDS CARRYOVER
EVIDENCE OF LEAKAGE
D-BOX AND TANK NEED REPLACED
t5insp.doc rev.712612018 Title 5 OffieW Inspection Form Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
x P Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name m
information is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
..—.-
page. City/Town State Zip Code r7ate of Inspection
D. System Information (cunt.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
" If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length: m
® leaching fields number, dimensions:
1, 20'X 45'
❑ overflow cesspool number:
❑ innovativelalternative system
Typetname of technology- — —
t5insp.doc rev.7/2612018 Title 6 OfficW Inspection Form,Subsurface Sewage Oisposal System-page 13 of 16
1
I
Commonwealth of Massachusetts
: Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments
68 CRICKET LANE _.
Property Address
BONACCORSO FAMILY TRUST
Owner owner's Name
information is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
._.._ ..— --
page, CIty[Town State zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SOIL AND VEGETATION OK
NO SIGN OF HYDRAULIC FAILURE OR PONDING
12, Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert --
i
Depth of solids layer --
Depth of scum layer
Dimensions of cesspool
Materials of construction -
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc,):
l5insp.doc•rev.7/2612018 Title 5 Official inspection Form:Subsurface Sawaga Disposal System•Page 14 of 18
g Commonwealth of Massachusetts
y� Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE _
Property Address
BONACCORSO FAMILY TRUST _
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
-_........___..�.___.. ._...m
page, City/Town State zip Code Date of inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction; -- — -
Dimensions -
Depth of solids —
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.712 8120 1 8 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRYST
Owner owner's Name
Information Is required for every NORTH ANDOVER MA 01845 FEBRUARY 28, 2026
page. CItyrrown State Zip Code Date of Inspection
D. System Information (cost.)
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
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t5inspAoc•rev.7/26/2018 Title 6 Official Inspection Form,Subsurface Sewago Disposal System Page 16 of 18
1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
V 68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 I"EBRUARY 28, 2025
_ ...._.._
page. cityrrown State Zip Code Date of Inspection
D. System Information (coat.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ 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: APRIi_ 1978Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
PLANS ON FILE
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
DESIGN PLAN
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5lnsp.doc-rev 7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 16
Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 CRICKET LANE
Property Address
BONACCORSO FAMILY TRUST
Owner Owner's Name
information is NORTH ANDOVER MA 01845 FEBRUARY 28, 2025
required for every
page. CityTrown State Zip Code Cate 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
® C, Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
® D. System information:
For 8: Tight/Holding Tank— Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg, 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp,doe•rev.7126/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Pago 18 of 18
Sunwaty Record Card generated on 31&20260:5W49AM by Nancy Vwns Pago 9
Town of North Andover
Tax Map # 210-107.A-0 16-0000.
Parcel Id 18046
68 CRICKET LANE
BONACCORSO, SANTO
68 CRICKET LANE
NORTH ANDOVER, MA
01845
Class 101 Single Family Property Type 1 Residential
Size Total 1.09 Acres
FY 2026
UB Mailing index
Name/Address Type Loan Number Activelinact. From Until
BONACCORSO,SANTO Payor Acdiva
68 CRICKET LANE
NORTH ANDOVER,MA
01845
UB Account Maint,
Account No Cycle Occupant Name Active/inactive
Stdg Id. 14273.0-68 CRICKET LANE; Last Billing Date 3/412026
2100269 02 Cycle 02 Active
UB Services Maint.
Account No.2100269
Service Code Rate Charge Multiplier/Users
MESCFEEADMIN FEE 0.63 5/8 7.82 1!
WTR WATER 01 ALL METER SIZE 11
UB Meter Maintenance
Account No.2100269
Serial No Status Location Brand Type Size YTD Colts
36388176 a Active ERT HH b Badger w Water 0.625 0.626 703
[late Reading Code Consumption Posted Date Variance
215/2026 2667 a Actual 0 3/13/2025 0%
11/6/2024 2657 aActual -19 12112/2024 -236%
8/20/2024 2676 m Manual estimate 20 9/12/2024 -100%
6/2/2024 2656 a Actual 0 6/13/2024 -100%
2/2/2024 2656 aActual 7 3/14/2024 -91%
11/1/2023 2649 aActual 80 12/13/2023 -31%
8/2/2023 2569 aActual 116 9/18/2023 1047%
6/3/2023 2453 a Actual 10 6/14/2023 15%
2/2/2023 2443 a Actual 9 3/14/2023 -90%
11/1/2022 2434 aActual 84 12/19/2022 -49%
8/3/2022 2350 a Actual 170 9120/2022 287%
6/3/2022 2180 a Actual 43 6121/2022 100%
212/2022 2137 aActual 22 3/16/2022 -31%
11/2/2021 2116 aActual 31 12/712021 -66%
814/2021 2084 a Actual 92 9121/2021 264%
6/6/2021 1992 a Actual 25 6115/2021 99%
214/2021 1967 aActual 13 3/1612021 -85%
11/3/2020 1054 aActual 83 12/16/2020 20%
8/4/2020 1871 aActual 70 9/9/2020 242%
6/412020 1801 aActual 20 6110/2020 14%
2/4/2020 1781 aActual 18 3/10/2020 -71%
11/4/2019 1763 aActual 64 12/2312019 69%
8/2/2019 1699 aActual 37 9/26/2010 119%
5/2/2019 1662 a Actual 16 6/13/2019 -4%
214/2019 1646 a Actual 18 3/10/2019 .43%
11/2/2018 1628 aActual 31 12112/2018 -52%
812/2018 1697 a Actual 64 9/20/2018 603%
5/3/2018 1533 a Actual 9 6/20/2018 •46%
2/2/2018 1624 a Actual 17 3/28/2018 -77%