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Home My WebLink AboutPass - Title V Inspection Report - 224 HAY MEADOW ROAD 2/26/2025 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 224 HAY MEADOW ROAD property Address MARK SAMSE Owner Owner's Name information Is MA 01846 FEBRUARY 26 2025 required for every NORTH ANDOVER , page, Cilyfrown State Zip Code Date of Inspection Inspection results must be submitted on this faun. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:when ailing A. Inspector information out forms on the computer,use only the tab Todd James Bateson key to move your Name of Inspector cursor-do not Bateson Enterprises Inc, use the return Company Name key. 111 Ar Ilia Road r� Company Address Andover MA 01810 Cityrrown state Zip Code 978-476-4786 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. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4, ❑ Fails MARCH 2, 2025 Inspector'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. t5insp.doo rev.7126=18 Title 5 Official Inspection Form:Subsurface Sewage disposal System Page 1 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 224 HAY MEADOW ROAD u Property Address MARK SAMSE _ Owner Owner's Name information is NORTH ANDOVER MA 01845 FEBRUARY 26, 2025 required for every page. CityfTown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6• 1) System Passes: ® 1 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): Mnsp.dao rev.712IU2010 TMe 6 Offidal€nspectlon Form:Subsurface Sawage D€sposal System Page 2 of 98 i ' Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 224 HAY MEADOW ROAD Property Address MARK SAMSE Owner owner's Name ion Is requirequiredd for every NORTH ANDOVER MA 01845 FEBRUARY 26 2025 page. Clty/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (coat.): ❑ 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): ❑ 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: Mnsp.cloc rev.712612018 Title 5 Off3clal Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts hs Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments z 224 HAY MEADOW ROAD Property Address MARK SAMSE Owner Owner's Name Information to ER MA 01845 F'EBRUARY 26, 2025 required for every NORTH ANDOV page. City/Town State Zip Code Date of Inspection C. Inspection Summary (coat) ❑ 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: 4) System Failure Criteria Applicable to All Systems: You must 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 clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc rev.7/2612010 Title 5 official Inspection Form:Subsurface Sewage Disposal System Pago 4 of 18 I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 224 HAY MEADOW ROAD PropertyAddress MARK SAMSE Owner Owner's Name information Is required for every NORTH ANDOVER MA 01846 FEBRUARY 26, 2025 page. City/Town State Zip Code Date of inspection C. Inspection Summary (cont) 4) System Failure Criteria Applicable to All Systems: (coat.) Yes No El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth In cesspool is less than 6" below invert or available volume is less than day flow El ® 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. ❑ ® 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 form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system falls. 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 ❑ ❑ 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 El Elthe system is located in a nitrogen sensitive area (interim Wellhead Protection Area--IWPA) or a mapped Zone 11 of a public water supply well 15insp.doe-rev.712612016 Title 5 Official Inspection Form!Su6surfaco Sewage Disposal Syslem-Page 6 of 18 ' Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System norm -Not for Voluntary Assessments 7' -, 224 HAY MEADOW ROAD Property Address MARK SAMSE Owner Owner's Name Informarequired Is NORTH ANDOVER MA 01845 FEBRUARY 26 2025 required for every page. City/Town State ,Zip Code Date of Inspection C. Inspection Summary (coat.) 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.6 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 NIA) ® ❑ 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. ® ElDetermined in the field (if any of the failure criteria related to Part C is at Issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doe•rev.712812 0 1 8 Title 5 0fticlal Inspection Form:subsurface Sewage Disposal System-Page,6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments z 224 HAY MEADOW ROAD Property Address MARK SAMSE Owner Owner's Name requiedfoation Is NORTH ANDOVER MA 01845 FEBRUARY 26 2025 required for every � page, Cityrrown State Zip Code Date of Inspection D. System information 1. Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): NA Description: Number of current residents: 2 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: CURRENT Date l5losp,dco rev.712612M Tilts 5 afficfal Inspection Form:Subsurface Sewage Disposal System•Page 7 of 10 1 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 224 HAY MEADOW ROAD Property Address MARK SAMSE Owner Owner's Name Information is required for every NORTH ANDOVER MA 01845 FEBRUARY 26 2025 page. CItyTrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial 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: 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 occupancyluse: Date Other(describe below): 3. Pumping Records: Source of information: BATESON ENTERPRISES INC 2024 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5lnsp.doc•ray.7/26/2018 Tiilo 5 Official Inspection Form:Subsurface Sewage Disposal Syslem Page 8 of 18 f! i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 224 HAY MEADOW ROAD Property Address MARK SAMSE Owner Owner's Name information Is required for every NORTH ANDOVER MA 01845 FEBRUARY 26, 2025 page. CityrTown State ZIP Code Date of Inspection D. System Information (cons.) 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 [/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: 41 YEARS, INSTALLED MARCH 1984, AS BUILT PLAN Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 4' Depth below grade: feet Material of construction: ®cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10 feel Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS ARE NOT VISIBLE, UNDER FLOOR VENTING OK- NO ODORS DETECTED NOT ABLE TO VISUALLY INSPECT FOR LEAKAGE t5inspAoc•rov.712612018 Title 5 Official Inspection Form;Subsurfnoe Sewage Disposal System-Page 9 of 46 c � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 224 HAY MEADOW ROAD Properly Address MARK SAMSE Owner Owner's Name information is NORTH ANDOVER MA 01845 FEBRUARY 26 2025 required for every page. CitylTown State Zip Code Date of Inspection D. System information (cont.) 6. Septic Tank(locate on site plan): 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 5'X 4' 4" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 34" 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 OK TANK IN GOOD CONDITION LIQUID LEVELS GOOD NO EVIDENCE OF LEAKAGE Onsp.doc ray.712612018 TWe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V3/ 224 HAY MEADOW ROAD Property Address MARK SAMSE Owner Owner's Name Information is required for every NORTH ANDOVER MA 01845 FESRUARY 26 2025 page. City[rown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 15insp.doc-rev.712612018 Title 5 Ofriclet inspection Form:Subsurface Sewege Disposal System•Page 14 of 18 Commonwealth of Massachusetts ,s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 224 HAY MEADOW ROAD Property Address MARK SAMSE Owner Owner's Name Information is required for every NORTH ANDOVER MA 01845 FEBRUARY 26, 2025 page. City/Town State Zip code Date of Inspection D. System information (cant.) 8. Fight or Holding Tank (cont.) 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 UNDER CONCRETE PATIO POOL. DECK, UNABLE TO ACCESS l5lnsp,doc rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage O€sposal System-Page 12 of 18 ell Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 f 224 HAY MEADOW ROAD Property Address MARK SAMSE Owner Owner's Name atl is requir fo ed for every NORTH ANDOVER MA 01845 FEBRUARY 26 2025 requir page. Cityrrown State Zip Code Date of Inspection D. System Information (cons) 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: ® leaching fields number, dimensions: 1, 20'X 45 ❑ overflow cesspool number: ❑ innovativetalternative system Type/name of technology: 16insp,doe rev.712612016 Title 5 Official Inspection Form:Subsurfece Sewage Disposal System page 13 of 18 1 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � I 224 HAY MEADOW ROAD Property Address MARK SAMSE Owner Owner's Name Information is NORTH ANDOVER MA 01845 FERRUARY 26, 2025 required for every page. CitylTown 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,): i SOIL AND VEGETATION OK NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING DUG TEST PIT 4' DEEP TO LOCATE LEACH LINE FOUND LEACH LINE DRY STONE DRY AND CLEAN 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 ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.); t5insp.doo rev.7f2612a18 Title 5 official Inspection Fow Subsurfeca Sewage Disposal System Page 14 or 18 i Commonwealth of Massachusetts M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �� 224 HAY MEADOW ROAD � Propefty Address MARK SAMSE Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 FEBRUARY 26 2025 page. City/Town State Zip Code Dale of Inspeetton 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,doo-rev.7/2612 01 8 Title 5 Official Inspection Form!Subsurface Sewage Disposal System Page 16 of 16 ' Commonwealth of Massachusetts a achusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. f 224 HAY MEADOW ROAD Property Address = MARK SAMSE �I Owner Owner's Name Information Is NORTH ANDOVER MA 01845 FEBRUARY 26 2026 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 a, ❑ drawing attached separately A- �t ARAR, of VJ�.S r. m(i rig T�� 3 � v "�11�11f� •�iSew �1 _41- 26) s1 ' 15lnsp.doe•rev.7I2812018 Title 6 Orlin€al Inspection Form:Subsurface Sewage Disposal System Page 16 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 224 HAY MEADOW ROAD Property Address MARK SAMSE _ Owner Owner's Name Information is required for every NORTH ANDOVER MA 01845 FEBRUARY 26 2026 page. City/Town State Zip Code Date of Inspection D. System Information (cunt) 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: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: AS BUILT PLAN ONLY ON FILE ❑ Checked with local excavators, Installers - (attach documentation) ® Accessed LISGS database -explain: ESSEX COUNTY SOIL MAP You must describe how you established the high ground water elevation: CANTON SOIL DEPTH TO WATER TABLE > 6' BACKYARD FILLED SYSTEM RAISED ABOVE ORIGINAL GROUND SYSTEM ABOVE WATER TABLE Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5lnsp.doc-rev.712612018 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Pago 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 224 HAY MEADOW ROAD Property Address MARKSAMSE Owner Owner's Name Information Is required for every NORTH ANDOVER MA 01845 FEBRUARY 26 2026 page. City/Town State Z(p 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 ® 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 Winsp.doc rev.712612018 Title 5 Oificlal inspection Form:Subsurfece Sewsge Disposal System-Page 18 of 18 SEPTIC SYSTEM MAINTZNAlr'CE" STEPS,YOU CAN FOLLOW what is a Sept-ic System? a Pump your septic tank every 1 - 2 years. A septic system is used to dispose and treat household Solids could be overflowing to the leaching facility right now, sewage. It consists of a rectangular WaLer--tight box causing damage that will require expensive repairs. (the septic tank) and a leaching facility, o Investigate signs of failure immediately. -Sloe draining of toilets and sinks -Foul odor, patches of green grass, ponded water, or smelting snow near the leaching system. septic tank _ ~ o Minimize water use in the home The less eater used, the longer the retention period in the tank distribution box- leaching area _ and the more solids the bacteria can decoipose_ Use water--saving 'Wastewater from the house flows directly into the septic showertzeads and toilets_ tank- There, the larger solids settle to the bottom, o Do not dispose the following materials f orming a layer of "sludge_ The lighter particles rise Garbage_ Use of disposals adds massive amounts of solids to the to the surface, forming a layer of scum.. Bacteria in the tank work to decompose the solids in these lavers. In tank -Sanitary napkins, colored toilet "paper, disposable diapers, and spite of this decomposition, however, both the sludge and tissues do not decomDase. scum gradually accumulate and must be removed every 1 - ? -Cooking oil, fat, and grease can pass through the septic tank years to ensure proper operation of the system_ Co clog the leac"fat, and field_ THE SF.. 'CTC TANK -Pesticides, disinfectants, acids, medicine, "paint thinners; EtG- , field- sewage from House rr air space will kill the helpful bacteria in the tank and contaminate the scxm bu"lid—up groudwater. liquid to o Do not use cesspool cleaners ]squid level j� leaching area There are no known chemicals, yeasts, bacteria, enzymes or oche; wastewater substances capable of eliminaiing_ 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 EPA and National Dancer 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 "wells. The liquid sewage into the surrounding soil; where it is use of such products is not necessary for the prover functioning filtered and traated. of a septic system and; in fact, can harm the system- The bleed for Maintenance For more information or assistance, contac� the Deparrment of Environmental Quality Engineering Regional Office (935-2160) or, The leaching system is .not. designed to receive solids. your local Board of Health. (47/0-3800 east. 255) If your septic If solids are allowed to accumulate and arerfl"ow from the system has been installed or repaired in the Ias> 5-7 years, the sep>=ic tank, the leaching system becomes clogged and will Town Health Dept. most likely will be able to provide you with a no larger transmit the liquid sewage. This results in a plot plan of your system Location. Call the above number to back-up of sewage into the house or a break--out through receive your copy free of charge. the ground_ When this occurs, the system can often only be renovated by abandonment (usually for 6 months or more) TEL:1508f a,'S-ia;a or by complete replacement_ Costs for replacement. of the :f FAX:[508)475-5451 leaching system are nigh, ranging from 30;000 to�d,0o0. BATESON ENTERPRISES, INC. With proper maintenance, these problems and expenses can De a V o 1a ed- Excavating-Waicr&Sc tins-Scpric Sysrcm;6 Pumping Service 111 Argilla Road Andovttr,Mass.0 18 10 i summary Record Card generated on 3/512025 8:58:34 AM By Nancy Viens Pago 1 Town of North Andover Tax Map # 210-104.B-007 -0000d Parcel Irk 16401 224 HAY MEADOW ROAD SAMSE, LORI 224 HAYMEADOW ROAD NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Resldentlal SIZE)Total 1,009 Acres F Y 2025 UB Mailing Index Name/Address 'type Loan Number Activelinact. From Until SAMSE,LORI Payor Active 224 HAYMEADOW ROAD NORTH ANDOVER,MA 018,45 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id.18112.0-224 HAY MEADOW ROAD Last Billing Date 117/2026 3180140 03 Cycle 03 Active UB Services Maint. Account No.3180140 Service Corte Rate Charge MultipliedUsers MISCFEE ADMIN FEE 0.63618 7.82 11 WTR WATER 01 ALL METER SIZE 109.30 /1 UB Meter Maintenance Account No.3180140 SE)rial No Status Location Brand Type Size YtD Cons 13242294 a Active 00 METE METE W Water 0.626 0.626 482 Date Reading Code Consumption Posted Date Variance 12111/2024 3149 a Actual 26 1/14/2026 -71% 9/11/2024 3123 a Actual 88 10/8/2024 291% 6/13/2024 3035 a Actual 23 7/22/2024 107% 3/13/2024 3012 a Actual 11 4/16/2024 -20% 12113/2023 3001 aActual 13 1/15/2024 22% 9/18/2023 2988 a Actual 12 10/13/2023 -2% 6/13/2023 2976 aActual 12 7/14/2023 4% 3/10/2023 2964 a Actual 11 4/12/2023 .36% 12/9/2022 2953 a Actual 16 1/16/2023 -83% 9/14/2022 2937 a Actual 105 10/18/2022 619% 6/10/2022 2832 a Actual 14 7/18/2022 5% 3/10/2022 2018 aActual 13 4/13/2022 14% 12/10/2021 2805 a Actual 11 1/17/2022 -80% 9/14/2021 2794 a Actual 60 10/1512021 213% 6/9/2021 2734 a Actual 18 7/27/2021 -19% 3/10/2021 2716 a Actual 22 4/21/2021 -18% 12/10/2020 2694 a Actual 27 1/13/2021 -76% 9/10/2020 2667 a Actual 111 10/14/2020 202% 6/9/2020 2556 a Actual 36 7/15/2020 193% 3/10/2020 2520 a Actual 12 4/812020 -3% 12/12/2019 2508 aActual 12 1/15/2020 -49% 9/17/2010 2496 a Actual 26 10/10/2019 61% 6/14/2019 2470 aActual 16 7/26/2019 9% 3/12/2019 2454 a Actual 14 4/16/2019 16% 12/12/2018 2440 a Actual 12 1/22/2019 -62% 9/14/2018 2428 a Actual 33 10/15/2018 47% 6/12/2018 2395 a Actual 22 7/23/2018 .7% 3/12/2018 2373 a Actual 23 4/23/2018 -10% 12/13/2017 2350 a Actual 26 1/25/2018 -49% 9/13/2017 2324 a Actual 52 10/18/2017 133% i