Loading...
HomeMy WebLinkAboutTitle V Inspection Report - 145 BRADFORD STREET 4/7/2008 (2) f` x, Coiinnionw ealth of Massachusetts "T 'Itle ,5 Official Inspection Form ' "Juhsurfrace Sewage Disposal S yste rr l°airrar w. Not for Voluntary Assessrrrents tv. 145 BRADFORD ST. t � Property A MARJORIE GAUDF f f k. Owner Owner's Name - information is 110. ANDOVER MA 0'184 5 4/7/08 required for every page. City/Town State lip Code Date of Inspection - - Inspection results rnu st be submitted can this form, Ins ec.trean forrns may not be altered in any way. EC ,'1 Jt. ,m Important:When filling out A. General Inforo'°t" ation er forms on the 1'lJ"'R r 3 20(18 computer,use '1. Irispector: only the tab key OWN OF N )qf I @j ANH irk E cursor-do notAYMCSnlspecto�tlIFIM II to move your P-EA `N 0 use the return - - key. J's SEPTIC & DRAIN r -- Company Name 131 FOREST ST. Company Address MIDDLETON MA 01049 nm City/Town State _ Zip Cade 0'78-774-6685 Telephone Number - License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the inforrriation reported below is true, accurate and complete as of the time of the irispectiori. The inspection was perforrrred based on my training and experience in the proper i'Mictiori and friainterlarice of on site sewage disposal systems. l am a DEP approved system inspector pursuant to Section 15,340 of Titles 5 (310 CIVIR 15.000). The systerri: Lasses ❑ conditionally Lasses (_ ] f=ails El Needs Further Evaluation by the Local Approvirig Authority ru 4/7/08 n ctor s Signat e Bate The system inspector shall submit a copy of this inspection report to the Approvirig Authority (Board of Health or DEP) withiri 30 days of completing this inspection. If the system is a shared system of- has a design flow of 10,000 gpd or greater, the inspector acrd the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "'This report only describes conditions at the time of inspection acrd under the conditions of use at that time. This inspection does not address how tl'ie systein will performs in the future under the sarrie or different conditions of r.rse„ THIE V 2008.doc•03/08 Title 5 Offic'61 Insp ction Fear[.Subswf ar.L Suvmqu Disposal System.Palle,1 of 1 (,1(-)v orh ve 1t1°a of Mas acli u ett; k L0 !� Official � { r' Inspection nd trface Sewage Disposal ystenrptrm Not for Voluntary Assessments uas t 145 BRADFORD a'T. Property Address - IVIARJOR IE GAUDETTC Owner's _ wrlcl's PVame information is required for NO. ANDOVER IVIA 01345 4/7/08 every page, city/Down state Zip Code _ Date of Inspection B. Certification (cant.) Inspection Currarrtary: Check A,B,C,D or F 1 always complete all of Section D A) System Basses: FA I have not found any inforrrration which Indicates that any of the failure criteria described in 310 CIVIL 15.303 or in 310 CMR 15.304 exist, Any failure criteria not evaluated are indicated below. w Comments.- f ) syst:er%or ditionally Basses: El One �re system components as described in the "Co ditional Vass" section need to be replaced oi,repaired. The systen•a, upon eorripletion tat�k�e replacerrietat or repair`, as approved by floe Board of %nt lth, will pass. fr' Answer yes, na or idetermined (Y, N, ND) in flee ❑for tale following statements. If"not determined," please c plain. ❑ 'The septic tank is meta] and over 10 yearn old* or the septic tal7kr (whether metal or not) is Structurally urasaund, exht its st.rtsstantipi'infiltration or extiltration or tank failure is inirninent. Systerrr will pass inspection 'f the exuding tank is replaced with a comgalying septic tank as approved by the ward of I--lei the "' A metal septic frank will pass �slaction if it is structurally sound, not leaking and if a Certificate of Compliance indicating th the t€arikc is less than 20 years aid is available. ND Explain: ,F f ❑ Observatiitii of sewage backup or break attt or high static titer level in the distribution box due to brol ti aI-obstructed pipe(s) or due to a broken, settled or never distribution box. Cysterrt will bass spectiort if(with approval of Board of Health): broken pipe(s) are replaced ❑ obstruction is removed TITLE V 2008,dot,•03/08 Title:. Offirial InsPvlfi on Frnm;S11h"L1'f 1(r S`W`dr C)ispns l 4SYMM)r 8191?1 of 2 A i <� t:R rairvaonweaith of M ssae-htisetts 1 _ � SubSur,face Sewage disposal System Form Not for Voluntary Assessments _,. <�.. ' 145 BRADFORD ST. - ..... Property Address - MARJORIE GAUDETT Owner Owner's Name information is NO. ANDOVER reeauired for -. _ _ IVIA 01£345 4/1i05 every page. City/Town State Zip Cade Date of Inspection - B. G"erfification (cont.) 13) System Conditionally passes (coat.). _ distribution box is leveled or replaced ND Exp6n: t ❑ The system regr.ti'60,pumping more than 4 times ca year due'to broken or olastructed pipe(s). The system will pass inspbction if (with approval of the Boarc9.ti1 Health): ❑ broken pipe(s) are replaced w ❑ olastruction is rernove r° ND Explain: ° l ) f=urther Evaluation is eguirerl/by the toarrt"` f\,iealth. FA Conditions exist which require Urther evaluation [y"t�ie Board of f-lealth it) order to determine if the system is failing to protect public health, safety or-tie environment. 1. System will pass unleess Board of Health deterrnir in accordance ante witty 310 CIVIf 15.303(1)(b)that the system is not furrctiorairarg in a Manl yr which will protect public health, safety and the environment: ❑ Cesspool or privy Is within 50 feet of a surface water \� ❑ Cesspool or privy is within 50 feet of a bordering vegetated we, land or a salt marsh . System Will fail unless the Board of Health (and Public Mater Sup pl\ch ally) determines that the system is functioning in a manner that protects tyr , safety and environment: 'The system has a septic tank and soil absorption systerrr (SAS) and n 100 feet of a surface water supply or tributar y to a Surface water supThe systern has a septic tank and SAS and the SAS is within a ;done ater. supply. ❑ The systems has a septic tank and SAS and the SAS is within 50 feet of a private water, supply well. TITLE V 2008 doc-0:310H 11110 5 CJf IGMI Inspection Funn Subs wfiaf re SLW' Igu Disposal`isyst,rm-flags 3 of s G"ornmormealfh cA Massachusetts f � T„, e Official Subsurface Sewage Disposal System Form Not for Voluntary Assessments '145 BRADFORD ST. r >- Property Address _ MARJORIE GAl.1Cw7ETT E Owner Q -- wne1 s Narrro information is required for NO. ANDOVER 114A 01845 4/7/08 every page. city/Town State Zip Code — Date of Inspection _ B. Certification (cont.) C) Further Eval tioll is Required by the Board o,F Health (coat): /'.°� El The system ha. a;eIL,ptic tank and SAS and the SAS is less than 10, feet but 50 feet or more front a priv wat er supply well". Method used to defern�aine 1istance: � asses This stem if the well Y p I wafer a\nalysrs at a DF' certified laboratory, for coliform bacteria indicates absent and the present a , monia nitrogen and nitrate nitrogen is equal to or, less than 5 ppm, provided that no other fail r criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: F r' D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for.all inspections: Yes No ❑ EXI Backup of sewage into facility or System component due to overloaded or clogged SAS or cesspool ❑ FX-) Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El FJ Static;liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ❑�j� Liquid depth in cesspool is less than C" below invert or available volun-re is less than "/2 day flow El 1 Required purTrping rrrore than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pun-7ped: ❑ Iz Any portion of the SAS, cesspool or privy is below high ground water elevation. E-j ❑X114 Any portion of cesspool or privy is within 100 feet of a Surface water supply or tributary to a surface water supply. 11TLE V 2oGti,dac 6310F.� TitIL 5 Offioial Inspection Farm:v'iUbSUrfD(;t!SI-WEI90[:'7ispa rrl Systr'm.Papr,.4 or 4 om or eAaffli of Massachusetts _ Vr Subsurface Sewage Disposal System Form - bot forVoluntary Assess "ritle V f As Inspection Form '145 BRADFORD ST". Property Address MARJORIE GAaUD T...l_E Owner - C7wner's NalYlo -- _ information is required for NO. ANDOVL.I IVI 01 f345 4/7/08 every page. City[Town state Zip code Date of Inspection B. Certification (coot.) D) System Failure Criteria Applicable to All Systems (coat): Yes No 11 ❑ I ll� Any portion of a cesspool or,privy is within a Zone 'I of a public well. L] I_] pl� Any portion of a cesspool or privy is within 50 feet of a private water supply well. C1 ❑ kN, 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 Wqtern Passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliforrn bacteria indicates absent and tkae presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppn'i, 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 systern is a cesspool serving a facility with a design flow of 2000gpd- '10,OOOgpd. EI fa The system fails. I have determined that one or more of the alcove failure criteria exist as described in 310 CIVIL 15.303, therefore the system fails. The system owner should contact the Board of Health to deterrrrine what will be necessary to correct tine failure. Large Systems: To be consis �d a lame system the systern rust serve a facility with a design flow of 10,000 gpd to 16,010-7 d, For large systems, you must indicate either " es" or",no"to each of tkae f owing, in addition to the questions in Section D. Yes No (� �J the systern is within 400 feet of a pace drinking water supply the system is within X00 feselof a tribrrtar o a surface drinking water strpply the systern is located 'f1 a nitrogen sensitive a a (Interim Wellhead Protection Area — VIA/PA) or a spiced Zone ii of a public w r supply well If you have answered "yes'"to any c,wTe;stion is Section F: the system is consic 'ed a significant threat, or answered "yes" in Section D cave the large system has failed. The owner or ->erator-of any large system considered a significa� threat under Section or failed under:3ection D s I upgrade the system it') accordance with lG CMR 15.304. The system owner should contact the a Wpriate regional office of the De. rtment. TITLE V 2008.dnc•03lGfi '''...... -ritle a Official Inspection Form,SutrsnrtYacAa SLw;arin Dispomil Systl7rn F'at7r�s of 5 Covywirionwealth of Massachusetts Title Official N till°".11 1 Si,ibsorface Sewat e i° posat System °'arra foottor Voluitatr AssossrTror7l r 145 BRADFORD S'I-, Property Addres.> MARJORIE GAUD TTF Owner rl _ .. Owner's Nale _ information is NO. ANDOVER required for MA 0"185 4/7/Ot3 every page. city/Town State Zip Gad,e Date of inspection C. Checklist Chock if the following have been done. You Must indicate "yes" or"no" as to each of rile following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ EX) Were any of the system components ptrmped out it-) 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 systern recently or as part of this inspection? Were as built plans of the systern obtained and examined? (If they were not available mote as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was file site inspected for signs of break out? ❑X El Were all systern components, excluding the SAC, located oil site? m ❑ Were tide 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 scurn? C� Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systerTas? Tile Baize and location of the Soil Absorption System (SAS) on file site has been determined based oil: ❑ Existing information. For-exarraple, 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) (310 CMR 15.302(5)] T11 LE V 2008,doc 0311)b Title S Official InIpuction Farm:Subsurface suW au DIS gas al 7 4� 'y.=lam•Page 6 of 6 Subsurface Sewage Disposal System Form Not for Voluntary Asses;yrnents 145 BRADFORD ST, Property Address MARJORIE GAUDE`ITE Owner Owner's Name information is required for IVO. AND R OVC: _ MA 01845 4/7/Oft every pane. City/gown C - State - - Li r Corse Date or hispection D. System Inforrriation Residential plow Conditions: Number of bedrooms (design): Number of bedrOOms (actual): 4 DI~SIGN flow based Ora 310 CIVIL 15.203 for exarn ale: Y 600 GPD ( C g facl ,�, Of bectrcaOms): Number of current residents.- 4 Does residence Dave a garbage grinder? E-1 Yes � Na Is laundry On a separate sewage system? [if yes separate inspection required) ❑ Yes ❑i No Laundry system inspected'? h[l Yes Cl No Seasonal use? Yes M No Water meter readings, if available (last 2 years usage (glad)): 427.05 GILD Sump purrtla? jJ Yes ❑ No Last date Of Occupancy: CURRENT Date C orninercial/lt1 strial Flow Conditions: Type of stablishment:\ _ Design flow (based oil 310�'Rj5.203): Caallop er day(gpd) Basis of design flow (seats/persons/SC).(t., etc.): Grease trap present? ❑ Yes ❑ NO Industrial waste holding tank present? � � ❑ Yes ❑ No Nora-sanitary waste discharged to the T,jt1b 5 system? El Yes ❑ NO Water ureter readings, if availabl �` Last date Of Occupancy/use' _ r Date Other (describe): f' nn.E u 2006.dor-rstoa Tine 5 Official If'Spoctfon Form:Sotiatfrfaou SPW irrn Dis'PVStal syrtirn flaw,,7 of 7 I 1�01'11monweafth of hilassach setts L Title �',l Substuface Sewage Disposal ys ter m oCyt - Not for VoIltt1taI"v Ass rticsr7 caa 4� 145 BRADFORD ST __ Properly Address MAF'JORIE GAUDCTf Owner _ Ownel°s Name information is regrY pre NCB. ANDOVER dar . MA 01845 4/"7108 ever age. City/Town state Zip Code: Date of Inspection _ D. System Information (cont.) General lnfa nmtion PUMP419 RecoMs; SOM-ce of information: LAST PUMP DATE - 3/23/06 Was system pumped as part of the inspection? Yes ❑ No It yes, volume pumped: gallons _ I-low was quantity pumped determined? TAPE M-EASt.)-RE Reason for purj,rping: TO INSPECT TANK & BAFFLES Type of System: >' Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool El privy ❑ Strayed system (yes or,no) (if yes, attach previous inspection recor(:ls, if arty) ❑ Innovative/Alternative technology. Attach a copy of tyre current operation and maintenance contract (to be obtained from systerri owl-jer) and a copy of latest inspection of the I/A systern by systern operator Under contract ❑ Tight tank. Attach a copy of the DFf' approval. (.D Other, (describe): Approximate acre of all components, date installed (if known) and source of iriforri-Cation: '1985 ASBUII T Were sewage odors detected when arriving at the site? ❑ Yes ❑ No TI"I'LE V 2a08,rloc•r)iJM) rim.,5 Official lwxpzcharr 1=arm SuGsurfacin suwagc Disposal "ysattnna•Page 8 of 8 Goo'romonweallth of Massachusetts Y S 4' ry efp Inspection (1 Title Off i � _ .. � SUbsr.ai e t a�aw��rrte Disl: osral stem For�a�a Not for Vb c � Assessments ' ! rntary 145 BRADFORD ST. Property Address MARJORIE GAUt:7L:.I_.t.l: Owner Owner's Name regUit�edfo is 1\10. ANDOVER r requlrec!for _ _ AIIA U1 Es4 i 4/7/0 every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) BiAilding Sewer (locate on site Mara): 1'44, 1�,�* 41+1 Depth below feet Material of construction: cast if-oil ❑ 40 PVC:; ❑ other(explain): Distance from private water supply well or sUction line: 24' FROM TOWN WATER feet._....... Corrrrnents (on condition of,joints, venting, evidence of leakage, et.c.): Septic 'raralc (locate or) site plan): " 411 Depth below grade: feet Material of construc;tiort: concrete ❑ metal El fiberglass ❑ polyethylene other(explain) It tank is metal, list age: years Is age confirrned by a Certificate of Compliance? (attach a copy of certificate) EJ Yes ❑ No Dirrrensions: 10' X 5' X 4' - 1500 COALS. Sludge depth: 5rr 19" Distance frorTr �tol'7 of sludge to bottorrr of outlet tee or k�al��l�le Scum thickness 911 Distance from top of scurT) to top of nutlet tee or baffle 7 Distance frorn bottom of scurn to bottom of outlet tee or-baffle l£"' [low were dimensions determined' � � � STEEL TAF� S_ DG JUDGE & STC°._ TITLE V 200l:i19uc•031016' Title 5 Official Int,pl5ction Frnrn`,`i;W.,reurPerr:r,Srvwwc7e[)ispo:;.�I Syq 11•Faye 9 of 9 Ccarnn'aonw alth of assac r, setts Title 5 mi , — o� t i4 SruO. surface Sewage, Disposal Systati in Form - Not fOr VO � ss Irrntary A�,>essrraents '-% 145 BRADFORD ST. Property Address - MAI JORI LAUDE-I` E Owner C7 — - wner's Name information is regtaired for NCB. ANDOVLvR MA 01845 4/7/08 every page. City/Town State Zip Cade Date of Irrsraectian —----- D. Systelryll Information (cont.) COnrrierits (ore pupping recorrimendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to Outlet invert, evidence of leakage, etc.): MIDDLE COVER R HAS RISER 1'o wrrf-m 14" OF GRADE. TANK PUMPED AS PART OF INSPEc—riON.. Grup lY e ' f I-rap (locate on rite plan): De 7tla bbl(,)w grade: feet _ - material of GO"' IlStrUctran: r'+ CI CC)11Cfete ❑ rraetal fiberglass . � ether(explain):'`ett lens Dimensions: F Scum thickness Distance frorn 'top of scurf, to top of Orrt.let,tee eyr,,kaaffle -- Distance from bOttarar Of SCUrn to bottoirr of Outlet feu`ar baffle Date of last pumping: Date Comments (on pumping recorrinlendations, inlet and outlet tee err,baffle condition, structural integrity, liquid levels as related to outlet invert., evidence of leaks etc.):"`\ Tight or Hra9ct ing 'rank (tank must be pumped at tine of iraspectian) (locate Ori site Ian): Depth below grade: Mgtbrial of construction: ff, ❑ concrete ❑ nletal - fiber-glass ❑ Polyethylene ❑ ether(explain): - TITIC V 2008.dm=09/)3 '1"ills L Official Inst"reactirin Form:Subsurf,ri 'SuWap Disposal System•Pauu 10 of'10 t ornawnweaftli of Massacliu setts (� al iPl 3.'.rz Y l 1A l ra1,PP�`il) U4c.i i r a i Title w inspect-Ion lubsUrMce SOMYe Disposal System Forrn - Not for\/oPunt pry Assessrrlorlt 145 BRADFORD S'I". Property Address MARJORIE GAUDE TTE Owner Own er's Name information is rer{uired for NO. ANDOVEF MA 01 F34 4/7/0£3 every page. City/Town - State Zip Code Date of Irlspeetian D. System Inforniatioll (Cont.) Tight a Holdin( Tank (cone.) Dimensions: `\ Capacity: gallons Design Flow: gallons per dWrf' Alarm preserit: ❑,- 7 EI No Alarrri level: Alarm in working arcter. [� Yes � No Date of last Pumping: Cate Comments (condition of alarrri andr�atrswrtclres, etc.): '"Attach copy of cW ert �t purrrpillg contract ( e1 uired). Is co py attached? - El Yes ❑ No Distribution Box (if present [Trust be opened) (locate oil site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, ainy evidence of solids carryover, ally evidence of leakage into or out of box, etc.): :30" BELOW GLADE, LIQUID DUNNING AT CO RECT ELEVATION, NO EVIDENCE OF LEAKAGE. ALL PIPES EQUAL. Pump K Chamber (locate site fan): Pur"ps in working order: f CJ Yes D No Alarms in working : Cl Yes EJ No TI71E V 2008.dor.,03/08 ''.... f itle 5 Official Ins,piechun Form Suaaturfncu Sr:wap Dispogal System-Page 11 of 1'1 Coffirnonwealui of Massachusetts . Tim 5 Official mm i Form S urface Sewage, Disposal ysta�rn i"orm _ Not for VoluMmy Asse ssr7te ms t 145 BRA1-7EC�RD S"I`. Property/address MARJORIE Owner -- Owner's Nam_ —_e information is required for NO.-ANDOVER VIA 01845 4/7/0 _.- every page. City/Town State Zip Code [late of Inspection D. Systern Information (cont) Cormilents (note condition of pump chambe condition of pumps and appurtenances, etc.): Soil Absorption Systern (SAS) (locate on site plan, excavation not required): If SAS riot located, expltaira wily: Type: leaching pits nun"tber: _ C� leachirig chambers number: - - -- ❑ leaching galleries number•: - _ - ❑ leaching trenches number, length: ') ' 12" ❑ leaching fields I'll-ember, dimensions: - ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (mote condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): TRENCHES APPEAR TO BE WORKING WELL. NO EVIDENCE OF HYDRAULIC FAILURE. ......__........._.................. .. .......................... Tlrt_rs V 2008,don;^0:1,108 T"itle:r OffiCkil In,peee;tion Fww SubFurP'rcu Suwa19�2 Dispav€ul Syn;ten; p�u0e'1.?of 1Z 'N Counnicn,nivealth of Massaahusetts Jar fart ff Pl1r17U1 r (rJl�r rU!<<, �t� alR :931trf ad * Sewage t 'sposm system Form Not for Voluntary Ass ossr reltts '145 BRADFORD ST. Property Address MARJORIE GAUL ETTE Owner Owner's Name _ information is required for NO. ANDOVER MA 0,1845 every page. City/Town State Zip Cade Date of Inspection D. System Information (cont.) ice%-S POOIIS (Cesspool must be pur-rlped as part of ins ection (locate o site M ) ( Ia w7ite plan): Nurrlber`"tfad c011figuratior7 Depth --'top of,1iquid to inlet invert Depth of solids laj qr Depth of scurry, layer sf' Dimensions of cesspool Materials of construction Indication of grot.Indwater inflow `', ✓ ❑ Yes No C;ormnents (note condition of soil, signg',of hydratIlic failures, level of ponding, condition of vegetation, etc.): r" A ` Privy (locate on site Materials of construc'tip _ w Dimensions r Depth of solids/' C;ornn-tents (n'ote condition of soil, signs of hydraulic failure, level of pondira condition of vegetation, etc.): / ,A TI rLE V 2008.dot•f,'3lU8 Title a Nflea`arl II)IM1,0ion Form Sub:wrffar e SLewap t)ispos;ra1 Sy5•laa71 Page'13 of'13 Gonnnonweafth of Massachusetts 1. , or(,;t street r �r tvli3af>L.h 10'I',I, (,/)A 019/19 SU1bS rrfaCP Sewage Disposal System Form - Not for Voluntary Assessments 145 BRADFORD ST. Property Andress MARJORIE OAI.JDE T'TE Owner Owner's Narne regUiriaticrr NO. ,.NDIOIVl-f: MA 01845 4/!/0$ required far ___. ___.. --_._.._ _-------..__. ----.._... every page. CityfTown State Zip Cade Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: provide a sketch of the sewage disposal systern including ties to at least two lien-nartent reference landi-narks or benchmarks. Locate call welds within 100 feet. Locate where public water supply enters the building. R _ Nt . - 0)( .o U _ • T Trn.E V:008.doc-03/08 Title 5 official Inspection Form:Subsurfaco Sewage Disposal Syslern Page 14 of 14 taaao�uealth ' Massaclusefts, u & DRAIN r , ' 131 oi-est Street Ofq, MA ll4 cvlia)Ll I Official (978) 774-6685 faL'e Sewage Disposal Systen,i Fomi - Not for Voluntary Assessrrrents 145 BRADFORD ST. Property llctcrress MARJORIE: GAUDETf'i:H Owner _ Owner's Name requir don is NO. ANDOVEl required For -- -- MA 01845 4/7/08 every page. City/Town State Zip Cade Date of Inspection D. System Informatlion (cont.) Site Exam: [9) Check Slope,?X, Surface water ~7-ic Check cellar iC) Shallow wells-110,1 Estimated depth to high ground water: feet Please indicate all methods used to determine the high around water,elevation: © Obtained from system design plans on record If checked, date of design plan reviewed: _ Date E Observed site (abutting properly/observation (role within 150 feet of SAS) [ Checked with local Board of Health - explain: Checked with local excavators, installers - (attach docurrientation) Accessed USGS database - explain: You must describe how you established the high ground water.elevation: SYSTEM DESIGN AT 4' ABOVE GROUND WATER.WT. ASBUILT DATED 1985, FI I LE V 2008_dor..0,31019 Tillr=S C�rfirieal Inspe=ction Porin Sub5L1r1 rr.0 tSewago Di.pos aI Sy.,ILDI^PagD'15 D(15