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HomeMy WebLinkAboutMiscellaneous - 128 BRADFORD STREET 4/30/2018 i - 128 BRADFORD STREET �t - / 210/061.0-0060-0000.0 r • North Andover Board of Assessors Public Access Page 1 of 1 X11 � W f r�TA�,� q�� NOR1H Town,c) 1�I.VZ th—l3i,idpwr' a o Ek0 Q 'ASSE!SSOI S„ F - � 4 , S` y �Sn�Nuse Property Return to the Home page click on logo Record Card Parcel ID:210/061.0-0060-0000.0 Community: North Andover. SKETCH PHOTO New Search Sales Click on Sketch to Enlarge Click on Photo to Enlarge r 1p Summary Residence Detached Structure Condo Commercial Comparable Sales 128 BRADFORD STREET I Location: 128 BRADFORD STREET Owner Name: LAYNE,FELIX C SUSAN FOLEY-LAYNE Owner Address: 128 BRADFORD STREET City:NORTH ANDOVER State:MA ZIP: 01845 Neighborhood: 5-5 Land Area: 0.34 acres Use Code: 101 -SNGL-FAM-RES Total Finished Area: 1725 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 424,800 402,500 Building Value: 234,600 239,400 Land Value: 190,200 163,100 Market Land Value: 190,200 Chapter Land Value: LATEST SALE Sale Price: 100 Sale Date: 12/23/1998 Arms Length Sale Code:F-NO-CONVNIENT Grantor:FELIX LAYNE Cert Doc: Book:05287 Page:0299 i http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=987333 2/27/2007 Residential Property Record Card PARCEL_ID:210/061.0-0060-0000.0 MAP:061.0 BLOCK:0060 LOT:0000.0 PARCEL ADDRESS:128 BRADFORD STREET PARCEL INFORMATION Use-Code`. 1-01--- - Sale Price: 100' Book: �- 05287_ -Road Type:- T Inspect Date: 06/11%2002 Owner: Tax Class: T Sale Date: 12/23/1998 Page: 0299 Rd Condition: P Meas Date:' 06/11/2002 LAYNE,FELIX C Tot Fin Area: 1725 Sale'Type-: P Cert/Doc- Traffic: M Entrance:- - '-X SUSAN FOLEY-LAYNE Tot Land Area: 0.34 Sale Valid: F Water: Collect Id: RRC Address: - Grantor: --FELIX LAYNE - - _ -Sewer: - Inspect Reas: C m 128 BRADFORD STREET Exempt-B/L% 0/0 Resid-B/L% 100/100 Comm-B/LM Indust-B/L% 0/0 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: RR Tot Rooms: 7 Main Fn Area: 1725 Attic:- NBHD CODE: 5 NBHD CLASS: 5 ZONE: R2 Story Height: 1 Bedrooms: 4 Up Fn Area: Bsmt Area: 1686 Seg Type Code Method Sq-Ft Ades Influ-Y/N Value Class --._ 1 P ' 101 S 14665 0.34 190,199 Roof: - 0 Full Baths: 2 Add Fn Area: - 'Fn'Bsmt Area: 984 - Ext Wall: FB Half Baths.- ` Unfin Area - Bsmt Grade: DETACHED STRUCTURE INFORMATION Masonry Trim: 28 Ext Bath Fix: Tot Fin Area _ 1725 Sty Unit_ Mir-1 Msr=2 E-YR-Blt Grade Cond%oGood P/F/E/R Cost Class Foundation: CN Bath Qual. T RCNLD. 218248 PV S 800 1981 A ' A 50///50 14,600 Witch Qua!: T Eff Y�'Built: __1975 Mkt Adj: PT S 360 1981 A A ///84 1,800 Heat Type: HW Ext Kitch: Year Built: 1970 Sound Value: Fuel Type: -O Grade': A _Cost Bldg: 218;200 VALUATION INFORMATION Fireplace: 1 Bsmt Gar Cap. Condition_ A Att Str Val 1: Current Total: 424,800 Bldg: 234,600 Land: 190,200 MktLnd: 190,200 Central AC' N Bsmt Gar SF: 600 Pct Complete: Att Str Val2Prior Total: 402,500 Bldg: 239,400 Land: 163,100 MktLnd: 163,100 Att Gar SF: %Good P/F/E/R: } /100/100/79 Porch Type Porch Area Porch Grade Factor E 110 W 260 SKETCH PHOTO 20 13 260 Sq.R. 13 12 P-4 Q 1 U6 Sq.ft. i 20 24 w . 74 3 `� �. 1 24 sq.ft. .. <� ... 128 BRADFORD STREET Parcel ID:210/061.0-0060-0000.0 as of 2/27/07 Page 1 Of 1 Septic System Information 128 BRADFORD STREET Printed On: Tuesday, February 27, 200 System ID: BHS-2002-0252 General System Information Latest Permit Information Calcaluted Design Flow. Test Pits Septic Tank Disposal Trench , Design Flow: One Two Capacity. Number: s Design Flow Provided: Minutes per inch: Width: Width: =" Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter. Leaching: Grinder: No No Soil Type: Depth: Laundry: No No Hauling/Pumping Listing Quantity Tvpe System Type Pumped Pumped By Transferred To Disposed At Date Pumped (gallons) Routine Pump chamber STEWARTS SEPTIC 10/29/2004 1000 Inspections: Inspected: Expires: Inspector. Status: 02/20/2007 Joseph Delahunty Fails Comments: Title 5 12/18/2006 John Soucy Fails Comments: Title 5 10/29/2004 John Soucy Passes Comments: TITLE 5 ® _ D Y 'z GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 Septic System Information , 128 BRADFORD STREET Printed On:Monday,March 12, 2007 System ID: BHS-2002-0252 General System Information Latest Permit Information Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity: Number: Design Flow Provided. Minutes per inch: Width: Width: Total Flow. Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder: No No Soil Type: Depth: Laundry: No No Hauling/Pumping Listing Quantity Type System Type Pumped Pumped By Transferred To Disposed At Date Pumped allons Routine Pump chamber STEWARTS SEPTIC 10/29/2004 1000 Inspections: t Inspected: Expires: Inspector: Status: 02/20/2007 Joseph Delahunty Fails Comments: Title 5 12/18/2006 John Soucy Fails Comments: Title 5 10/29/2004 John Soucy Passes Comments: TITLE 5 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 Commonwbalth of Massachusetts RECEIVED Title 5 Official Inspection Form MAR 0 9 2007 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments TOWN OF NORTH ANDOVER hIEALT'H �M 128 Bradford St. North Andover DEPARTMENT Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 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. ImpoWhen filling A. General Information When filling out forms on the computer, use 1. Inspector: only the tab key to move your Joseph Delahunty cursor-do not Name of Inspector use the return key. Delahunty Septic Company Name r� 248 Danville Rd. Company Address Fremont, NH 03044 NH 03044 City(rown State Zip Code 603 895 6305 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority ll� y\ 3/6/07 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 is a shared system or has a design flow f 1 0 0 000 dor rester, the inspector n 9 9P 9 p and the system owner shall submit the report p 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 apProvin 9 authority. ****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. I I Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) 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: B) 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: ❑ 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 ❑ obstruction is removed Title 5 computer form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The i system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) 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. 1. 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: ❑ 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 2. 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. Title 5 computer form.doc•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 5 Y p 0 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 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. 3. Other: I I D) 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 ® ❑ 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 '/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or El ® 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. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 2000gpd- 10,000gpd. ® ❑ 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. I E) 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. I For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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 Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 computer form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: 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? ® El Were as built plans of the system obtained and examined? (If they were not I 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? ® El information the facility owner(and occupants if different from owner) provided with information on theY ro er maintenance of subsurface sewagedisposal osal s stems? P P 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) [310 CMR 15.302(5)] Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage(gpd)): Attached 9 ( Y 9 i Sump pump? ❑ Yes ® No current Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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): Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: BOH, Owner, Bateson Septic Service Niel Bateson Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): i Approximate age of all components, date installed (if known) and source of information: j June 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No Title 5 computer form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Q° 128 Bradford St. North Andover GSM Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): ' Depth below grade: 17 inchesfeet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town H2O feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: finches 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 -------------------------------------------------------------------------------------------------------------------------- I I Dimensions: 4'8"x 68" Sludge depth: 10 inches Distance from top of sludge to bottom of outlet tee or baffle 28 inches Scum thickness 2 inches Distance from top of scum to top of outlet tee or baffle 3 inches Distance from bottom of scum to bottom of outlet tee or baffle 9 inches How were dimensions determined? sludge judge, calibrated ron and tape Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 I l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is North Andover MA 01845 2/13/07 required for Ni every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet 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 to r e o 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.): 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): Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design es gn Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Commentscondition of alarm and float switches,s etc. *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ® No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 1 inch above invert of outlet lines. Heavy solids and sludge in the d-box. 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title 5 computer form.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 128 Bradford St. North Andover Property Address Felix Layne Owner Owners Name information is North Andover required for MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 20 x 40 ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): saturation is prominent on the pool side of field due to d-box not being level for extended period. Speed leveler found but not equalized to give equal flow. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): Title 5 computer form,doe•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 I � RADF- JD STR :ET I � i j q � /23 00 0 I h b' PprC t i 1000 &cel. TAN D. I30,'C � POO i- 46i i i {� i -ZO' PLAN SHO'. ! N6 NEW SUBSURFACE DATse T���.1 S, r 7a nlof Commonwealth of Massachusetts W Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 128 Bradford St. North Andover Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 4-6 feet 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: attached Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: BOH on fileand previous title 5 on file. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Calle Bateson Ent. and spoke with Niel the installer of the system. Title 5 computer form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Summary Racord Card gene`ated on 12/1/2006 9:22:19 AM by Lisa Warren Page 1 Town of North Andover Tax Map # 10-061 .0-0060-0000.0 128 8 BRADFORD STREET LYNE, FELIX 128 BRADFORD STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 0.34 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number Active/lnact. from until LAYNE, FELIX Payor 128 BRADFORD STREET N.ANDOVER, MA 01845 UB Account Maint. Active/Inactive Account No Cycle Occupant Name Bldg Id. 15215.0- 128 BRADFORD STREET Last Billing Date 9/7/2006 2120191 02 Cycle 02 Active UB Services Maint. Service Code Rate Charge Multipfierllfsers MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 173.92 /1 UB Meter Maintenance YTD Cons Serial No Status Location Brand Type Size w Water 0.63 0.63 0 16337190 a Active ERT METE METE Date Reading Code Consumption Posted Date Variance 11!6/2006 901 a Actual 29 23% 8/24/2006 872 a Actual 43 9/13/2006 91% 6/1/2006 829 m Manual estimate 30 6/20/2006 6% 2/9/2006 799 a Actual 30 3/13/2006 -6%6% 33% 11/17/2005 769 a Actual 35 12/14/2005 % 8/17/2005 734 a Actual 56 9!12/2005 5/11/2005 678 a Actual 24 6/8/2005 -1122% 3/7/2005 654 a Actual 43 3/15/2005 18% 11/24/2004 611 a Actual 34 12/17/2004 -9% 8/20/2004 577 a Actual 36 9/20/2004 -7% 5/20/2004 541 a Actual 29 6/14/2004 36% 3/12/2004 512 a Actual 37 4/16/2004 0% I I Of NORTN, 0 y Town of North Andover HEALTH DEPARTMENT SAC NUSf CHECK#: A DATE: LOCATIO H/O NA . CONTRACTOR NAMED: G Type of Permit or License:(Check box ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Tit e 5 Inspector $ Title 5 Report $ ❑ Other:(Indicate) $ 2323 ' Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusett -1 W Title 5 Official Inspection FormE® Subsurface Sewage Disposal System Form - Not for Voluntary Assessm nts FEB 2 7 2007 �<8 Bradford St. North Andover, MA roperty Address TOWl1; ;JAY} t Felix Layne r'``:'` IyrpRTMENT Owner Owner's Name information is required for North Andover MA 01845 2/13/07 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. ImpoWhen filling A. General Information When filling out forms on the computer, use 1. Inspector: only the tab key to move your Joseph Delahunty cursor-do not Name of Inspector use the return key. Delahunty Septic Company Name rQ 248 Danville Rd. Fremont, NH 03044 City/Town State Zip Code 603 895 6305 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Furth valuation by the Local proving Authority 2/20/07 spect s S ature Date e 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 is a shared system or 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 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 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. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) 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: B) 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: ❑ 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 ❑ obstruction is removed Title 5 computer form.doc•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 • f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments cM 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: C) 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. 1. 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: ❑ 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 2. 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. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required,for North Andover MA 01845 2/13/07 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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. 3. Other: D) 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 ® ❑ 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 '/2 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. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 2000gpd- 10,000gpd. ® ❑ 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. E) 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 D. 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 II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth'& Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: 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) [310 CMR 15.302(5)] Title 5 computer form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 r , Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: V 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Attached 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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): Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth'of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: BOH, Owner, Bateson Septic Service Niel Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Measure tank and Niel Bateson Reason for pumping: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Juune1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 17 inches feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town H2O feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 9 Inches 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: 4'8"x 6'8" Sludge depth: 10 inches Distance from top of sludge to bottom of outlet tee or baffle 28 inches Scum thickness 2 inches Distance from top of scum to top of outlet tee or baffle 3 inches Distance from bottom of scum to bottom of outlet tee or baffle 9 inches How were dimensions determined? sludge judge, calibrrated rod and tape measure Title 5 computer form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): outlet baffle is rotted and does not extend deep enough into tank. Outlet baffle appears to have allowed solids to migrate to field as when the distribution box was uncovered it was very sludgey and solids had migrrated to the field. The field may have been in good working condiotn at the time of inspection if attention to the outlet baffle was given in the past and a new pvc tee baffle installed. Grease Trap (locate on site plan): 9 Depth below rade: p feet 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.): 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): Title 5 computer form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth °of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 1 inch above invert of outlet lines. Heavy solids and sludge in the distribution box. 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.): It appears that the distribution box may have favored the pool side of the field this side of the field is in the worst condition and many of the solids are located in this section of the field as seen bu a cameara in the outlet lines. Speed levelers found in outlet lines; however they have been removed. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title 5 computer form.doc-08/06 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 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: 20 x 40 ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): saturation heavy to the pool side of the field. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): i Title 5 computer form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts N - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. i• Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 14 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 168 Bradford St. North Andover, MA Property Address Felix Layne Owner Owner's Name information is required for North Andover MA 01845 2/13/07 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 4-6 feet 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: attached Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: plans on file and previous title 5 ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Spoke with Niel Bateson the installer and BOH plans on file. Title 5 computer form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 r � i I l jL h 3S i' /28 '��• POrcF� f 1000 c��zl. TANS I 1 j i + s U FA ! BATESON J I,� [ ENTERPRISES, 111 ARGILLA RD l2a ANDOVER Qf�'i- r T NIA o1810 OWE K /`I .;a r TE _ ;vimo I Summary Record Card generated on 12/1/2006 9:22:19 AM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-061 .0-0060-0000.0 128 BRADFORD STREET LAYNE, FELIX 128 BRADFORD STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residentiai Size Total 0.34 Acres FY 2007 US Mailing Index Name/Address Type Loan Number Active/lnact. From Until LAYNE, FELIX Payor 128 BRADFORD STREET N.ANDOVER, MA 01845 US Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 15215.0- 128 BRADFORD STREET Last Billing Date 9/7/2006 2120191 02 Cycle 02 Active US Services Maint. Service Code Rate Charge Muhiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 173.92 /1 US Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 3 16337190 a Active ERT METE METE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 1 11/6/2006 901 a Actual 29 23% ! 8/24/2006 872 a Actual 43 9/13/2006 91% l 6/1/2006 829 m Manual estimate 30 6/20/2006 -25% q 2/9/2006 799 a Actual 30 3/13/2006 6% 11/17/2005 769 a Actual 35 12/14/2005 33`0 1 8/17/2005 734 a Actual 56 9/12/2005 55% 678 a Actual 24 6/8/2005 -12% 5/11/2005 y 3/1/1205 654 a Actual 43 3/15/2005 18% 34 12/17/2004 -9% 11/24/2004 611 a Actual -7% 8/20/2004 577 a Actual 36 9/20/2004 5/20/2004 541 a Actual 29 6/14/2004 36% 3/12/2004 512 a Actual 37 4/16/2004 0% J ,J 'l I 1 t } i i T Summary Record Card generated on 12/1/2006 9:22:19 AM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-061 .0-0060-0000.0 128 BRADFORD STREET LAYNE, FELIX 128 BRADFORD STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 0.34 Acres FY 2007 US Mailing Index Name/Address Type Loan Number Active/Inact. From Until LAYNE, FELIX Payor 128 BRADFORD STREET N. ANDOVER, MA 01845 US Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 15215.0- 128 BRADFORD STREET Last Billing Date 9/7/2006 2120191 02 Cycle 02 Active US Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 173.92 /1 US Meter Maintenance Serial No Status Location Brand Type Size YTD Cons i 16337190 a Active ERT METE METE w Water 0.63 0.63 0 } Date Reading Code Consumption Posted Date Variance 11/6/2006 901 a Actual 29 -23% 8/24/2006 872 a Actual 43 9/13/2006 91% 6/1/2006 829 m Manual estimate 30 6/20/2006 -25% j 219/2006 799 a Actual 30 3/13/2006 -6% 11/17/2005 769 a Actual 35 12/14/2005 -33% 8/17/2005 734 a Actual 56 9/12/2005 55% 5/11/2005 678 a Actual 24 6/8/2005 -12% 3/7/2005 654 a Actual 43 3/15/2005 18% 11/24/2004 611 a Actual 34 12/17/2004 - 8/20/2004 577 a Actual 36 9/20/2004 -7% 5/20/2004 541 a Actual 29 6/14/2004 36% ` 3/12/2004 512 a Actual 37 4/16/2004 0% •a 1 { '•i J a 1 1 1 i i '.Xo7 f vc I h Ci Qj ` � � e 0 0 s" - �4�ts$ 0 0 � "J Po c r7 •-. /000 — cral 1, ,SOX ti I Poov 4o' I 1 t PLAN] SHO'w pj6 1`I EW DATE -S G SON ENTERPRISES INC.. r:1 J��� 171 ARGILLA RD. /28 i;? Septic System Information r 128 BRADFORD STREET Printed On: Thursday,January 11, 200 System ID: BHS-2002-0252 s. General System Information Latest Permit Information i Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench i Design Flow: One Two Capacity: Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder: No No Soil Type: Depth: Laundry: No No Hauling/Pumping Listin QuantitV Tvpe System Type Pumped Pumped By Transferred To Disposed At Date Pumped (gallons) Routine Pump chamber STEWARTS SEPTIC 10/29/2004 1000 Inspections: Inspected: Expires: Inspector: Status: 12/18/2006 John Soucy Fails Comments: Title 5 GSC G� GeoTMS®2007 Des Lauriers Muicipal Solutions, Inc. Page 1 of 1 � w I Of Town of North Andover HEALTH DEPARTMENT �S-SAC t� CHECK#: /���f DATE: i'lle O 7 l LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ 2.,Tif1 R5 eport $ uC1 ❑ Other. (Indicate) $ 2278 Health Agent Initials i White-Applicant Yellow-Health Pink-Treasurer COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS j d DEPARTMENT OF ENVIRONMENTAL PROTECTION a` TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 128 Bradford Street RECEIVED North Andover,MA 01845 Owner's Name: Felix Layne JAN 10 2007 Owner's Address: Same TOWN OF NORTH ANDOVER Date of Inspection: 12-18-2006 HEALTH DEPARTMENT Name of Inspector: (please print)John Soucy Company Name: Soucy Sewer Service,Inc. Mailing Address: 830 Livingston Street Tewksbury,MA 01876 Telephone Number: 978-851-8839 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority r V ° Fails Inspectors 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 is a shared system or has a design flow of 10,000 d or eater,the inspector and the system o gP S�' P y weer shall submit the report to' appropriate Pregional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving provin g authority. Notes and Comments ****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. NOTE: This Title 5 is NOT a guarantee/warranty of the future function of the septic system. Page2ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 128 Bradford Street North Andover,MA 01845 Owner's Name: Felix Layne Date of Inspection: 12-18-2006 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D A. 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: B. 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. Answer yes,no or not determined(Y,N,ND)in the 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 p to will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 ears old is available. g y a able. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 128 Bradford Street North Andover,MA 01845 Owner's Name: Felix Layne Date of Inspection: 12-18-2006 C. 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. 1. 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: _Cesspool or privy is within 50 feet of surface water _Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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. 3. Other: -Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 128 Bradford Street North Andover,MA 01845 Owner's Name: Felix Layne Date of Inspection: 12-18-2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X _Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool — X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow — X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped — X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. T 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] YES (Yes/NO)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. I E. 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. •Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 128 Bradford Street North Andover,MA 01845 Owner's Name: Felix Layne Date of Inspection: 12-18-2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No x — Pumping information was provided by the owner,occupant,or Board of Health x Were any of the system components pumped out in the previous two weeks? x _ Has the system received normal flows in the previous two week period ? x Have large volumes of water been introduced to the system recently or as part of this inspection? x Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? x _ Was the site inspected for signs of break out? x _ Were all system components,excluding the SAS,located on site? x _ 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 i scum? x _ 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: Yes No x Existing information.For example, plan at the Board of Health. P a P ea th. x Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable) 310 CMR 15.302(3)(b)] •Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 128 Bradford Street North Andover,MA 01845 Owner's Name: Felix Layne Date of Inspection: 12-18-2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: 4 Does residence have a garbage grinder(yes or no):no Is laundry on a separate sewage system(yes or no): no [if yes separate inspection required] Laundry system inspected(yes or no): no Seasonal use:(yes or no): no Water meter readings,if available(last 2 years usage(gpd)): See Attached. Sump pump(yes or no): no Last date of occupancy: recent COMMERCIAL/INDUSTRIAL N/A Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Home Owner Was system pumped as part of the inspection(yes or no): no If yes,volume pumped: 1000 gallons--How was quantity pumped determined?N/A Reason for pumping:N/A TYPE OF SYSTEM X 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) _Tight tank _Attach a copy of the DEP approval j —Other(describe): Approximate age of all components,date installed(if known)and source of information: Built 1987 Were sewage odors detected when arriving at the site(yes or no):No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 128 Bradford Street North Andover,MA 01845 Owner's Name: Felix Layne Date of Inspection: 12-18-2006 BUILDING SEWER(locate on site plan) Depth below grade: 30" Materials of construction: X cast iron _40 PVC other(explain): Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: x (locate on site plan) Depth below grade: 18" Material of construction: X concrete_metal_fiberglass_polyethylene other (explain) If tank is metal list age:_Is age confirmed by a Certificate of Compliance(yes or no):,(attach a copy of certificate) Dimensions: 4'8"x6'8" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or battle: 38" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: Tape&Sludge Tool Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): NOTE: Outlet Baffle needs replacement due to longevity signs of corrosion on Lop portion of baffle. GREASE TRAP:_(locate on site plan) N/A 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): I Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 128 Bradford Street North Andover,MA 01845 Owner's Name: Felix Layne Date of Inspection: 12-18-2006 TIGHT or HOLDING TANK:_(tank must be pumped at time of inspection)(locate on site plan)N/A Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 2" 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.): PUMP CHAMBER:_(locate on site plan)N/A Pumps in working order(yes or no): Alarms in working order(yes or no):_ Comments(note condition of pump chamber,condition of pumps and appurtenances,etc) Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 128 Bradford Street North Andover,MA 01845 Owner's Name: Felix Layne Date of Inspection: 12-18-2006 SOIL ABSORPTION SYSTEM(SAS): X (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:40'x 20' overflow cesspool,.number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Hydraulic Failure CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)N/A 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan)N/A Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): a Page 1 @ of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 128 Bradford Street North Andover,MA 01845 Owner's Name: Felix Layne Date of Inspection: 12-18-2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. L a I 3 �I a 4t: /z8 jos" 000 W o � 1000 &a1. TA1YK____1 A 1pX � Popp f ' j 1 i i Page 1 Y of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 128 Bradford Street North Andover,MA 01845 Owner's Name: Felix Layne Date of Inspection:. 12-18-2006 SITE EXAM Slope Surface water Check cellar x Shallow wells Estimated depth to ground water 4' Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: x Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Dug Hole with Auger in low drop off area rear. Summary Record Card generated on 12/1/2006 9:22:19 AM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-061 .0-0060-0000.0 128 BRADFORD STREET LAYNE, FELIX 128 BRADFORD STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 0.34 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until LAYNE, FELIX Payor 128 BRADFORD STREET N. ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 15215.0- 128 BRADFORD STREET Last Billing Date 9/7/2006 2120191 02 Cycle 02 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63 5/8 7.82 1/ WTR WATER 01 ALL METER SIZE 173.92 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 16337190 a Active ERT METE METE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 11/6/2006 901 a Actual 29 -23% 8/24/2006 872 a Actual 43 9/13/2006 91% 6/1/2006 829 m Manual estimate 30 6/20/2006 -25% 2/9/2006 799 a Actual 30 3/13/2006 -6% 11/17/2005 769 a Actual 35 12/14/2005 -33% 8/17/2005 734 a Actual 56 9/12/2005 55% 5/11/2005 678 a Actual 24 6/8/2005 -12% 3/7/2005 654 a Actual 43 3/15/2005 18% 11/24/2004 611 a Actual 34 12/17/2004 -9% 8/20/2004 577 a Actual 36 9/20/2004 -7% 5/20/2004 541 a Actual 29 6/14/2004 36% 3/12/2004 512 a Actual 37 4/16/2004 0% I i I I COMMONWEALTH OF MAS CHUSETTS EXECUTIVE OFFICE OF NVIRONMENTAL AFFAIRS a DEPARTMENT OF E RONMENT PROTECTION RRECEIVED NOV - 3 2004 [HEA WN OF NQR T H ANDOVER LTH DEPARTMENT T E5 OFFICIAL INSPECTION FORM— �T FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWA E DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: /UUP �edav�,? Owner's Name: +Yyra Owner's Address: ra® 412- Ayltz S G1� —4--f Date of Inspection: /0I a q Q Name of Inspector: (please print) 914r-t w Company Name: /u;'i 7—J�;VUd Mailing Address: �tc��STtprf�51�' Telephone Number: 27k-74G—S-YO5 Cc) CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails 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 is a shared system or 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 should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: -57— Owner: fii¢}✓�l/�' Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: <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: B. 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. Answer yes,no or not determined(Y,N,ND) in the 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 I obstruction is removed I` ND explain: r 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 12'V' iLA� le`p 5' AlB�1?d-1�?y00 i/€1L Owner: Date of Inspection: y� C. 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. 1. 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: _ 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 2. 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1A6 ,8/157— �? i Z Owner:Z Date of Inspection: tZ 24 Qr D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ _ ackup 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 — to gged SAS or cesspool ,/ tic 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 ''/z day flow _✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped y 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 "ny portion of a cesspool or privy is within a Zone 1 of a public well. _ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] (Yes/ c fhe 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. E. 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 II of a public water supply well .Z If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B l CHECKLIST Property Address: /? /�4�'JF�i2dJ q— Owner• Date of Inspection: /o d Check if the following have been done. You must indicate"yes"or"no"as to each of the following: 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? i/ 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) e/ 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: Yes ono 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) [3 10 CMR 15.3 02(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 12-8 10e-4dAbdZ 5; N1' AIVOave-je-AtA Owner: 21&0w Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):_ [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use: (yes or no):_ Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no):_ Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):_ gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): _ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes, volume pumped: gallons--How was quantityPum ed determined? Reason for pumping: 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) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): I 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) %OwneProperty Address: />6 MAOF012-0 57— Owner: r: Date of Inspection: /O Z9 0 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron `�40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): 6"0,9P &00AV/l"ZOy SEPTIC TANK: (locate on site plan) I Depth below grade: /. 7--$- f/" Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) ) Dimensions: 3! Sr S Sludge depth: IT Distance from top of sludge to bottom of outlet tee or baffle: Z. Z S ` Scum thickness: Z,% If 4-1 Distance from top of scum to top of outlet tee or baffle: _I/ Distance from bottom of scum to bottom of outlet tee or baffle: 6 How were dimensions determined: 6a554 VA-770A/ Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 6tiVAt,/r 1' 0/- A -Fr�v�ryT 000b �Uf sa��OS 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Zg' )97pX49 $% Owner: 46+ iU Date of Inspection: 10Z O 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIB •Z(ifUTION BOX. sent must be opened)(locate on site plan) Depth of liquid level above outlet invert: 67 r1 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.): A409:D 5;a-9z -Le"Zi 7-0 Ty PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): 8 Page 9 of 11 0 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 124 d/2Wy4i5,M S% - 1f�C�.4�""7'f/90zX1 Owner: Z-4 f/vim. Date of Inspection: 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: aching fields,number,dimensions: / yd 1A'2D overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspect 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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 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.): 9 Page 1,0 of 11 OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFO 'TION(continued) Property Address: p }' Owner: I—A YNA Date of Inspection: ' V SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. 3 fz8 � � 4 0)- 1,)l r%f . 86x 4o' G i i INC. I IN6 LATE-SO" ZVERMSES, � J �•' ARG11_LA fi1B. ANDOVER. MA 0,810 /{ �'I?; f Page l l of 1 l a OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ZXt )44020'O-57- Owner: Date of Inspection: SITE EXAM Slope 6>-3 ep Surface water 7 yo®° Check cellar PvmP Shallow wells 7S • a Estimated depth to ground water) feet Please indicate(check)all methods used to determine the high ground water elevation: " Obtained from system design plans on record-If checked,date of design plan reviewed:_07�S_ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked.with local excavators,installers-(attach documentation) Accessed USGS database-explain: !JS 194 Ack, You must describe how you established the high ground water elevation: SE"'77c- DE516AJ 11 7RECE"' TOWN OF NO TM ANDOVE �.DA VE SYSTEM PUMPINQ RECORD SYSTEM OWNER.& ADDRESS SYSTEM LOCATION /'C/`"� DATE OF PUMPING: -- IJANTITY PUMPED: C 0SPWL: NO­.... . YES.. ,. . _.... Sap(jc Tank: NU, YES NA WRE OF SERVICE: RourINE Y EMI RUI NC'1' obsFIRVATIONS: GOOD CONDITION PULL. 'W COVER HEAVY OREASE ___ BAFFLES IN PLACE. ROOTS LBACKKELD RUNBACK "CESSIVE SOLIDS.._.___ FLOODED SOLID CARRYOVER, _ _O'V'ER EXPLAIN Jyrtern Pwnpcd by C'' ,C3ra�i2-� 177a. �'UMMENTS. CUN I f:N I'S f KANS,FbK D 11) Address .f S -7- Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date.of Refer to other Purpose of Document/Action and notes: action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Binding Department i w.,...r�r_s..a.wo_«o-....«...aw.....o-c�,.u..snrw.r.w[4z.Cr.r.•fi�� y� .... ♦. .. .. ^....•.—`..�_ 1rfiL4`t,ih "t S�'•c1; A r�a.4' f t+btl rf 1 r rt ""t 4 "f, �` �,�+1t � '� f � r r 1rtt.. 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FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. , This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: L_C�V ti G Phone SCS - G- -(,--2Yo LOCATION: Assessor's Map Number Parcel DD 6 Subdivision Lot(s) Street r1d c : iee_�- St. Number ************************Official Use Only************************ RECOP9EZN1 PATIONS OF TOWN AGENTS: :�bd Date Approved -"/ S Conservation Adminis rator Date Rejected Comments ri- to 0 ys Date Approved Town Planner Date Rejected Comments / Food Inspector-Health Date Approved Date Rejected Date Approved 9 Septic Inspector-Health Date Rejected Comments i Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date �D of H ,-�-1 '. - rZ v6d pd S :. NoI�TN� -,�iu�OVEi�, Nl,d, ApFu cAti I, (� SER, S�Pt 7 "rbwnl ❑ WELL AP�oucD C c SS - St- rlc SY STS VE'SI6,k) ��PPr{cav�� D,clrt' �P�viN� /urho►��ry PLAA) V651 6A-)Q:Z, PG41U 9,4 TC :DI�QPPKUVEp Co�p(T�o�s 1AT6 R�QSOr�s y 0 y ��`'� St pr1 SYSTEr� t J STALL, Tl(DAJ EXc./JV/JT(o� 1tiSP�G►�otiJ D/JYC Q I�/JSS Q FAIL- 1-10 nj AIL1-10nj i Q PPj�d�E� QUC CEM T- l ' DiS,CiPP�ov�D FI)AL APPIROVAL PArC 7-7--�-7 APPS wW6 4 u-mogi -ty 9 , � 5 f t E f { BRAT O s T,Q ` I 3 L I Q 8 woo , 1000 Gal. TANK D, 3oX i I POO C 4o* i PLAN SHOWING NEW SUSSURFACE SEWAGE 5'rSTEP tATESON ENTERPRISES, INC.. O�- +/ { 'v� 111 I � , k,4rFop ST ARGILLA RD. N09T H A N Do V/ — ANDOVER, MA 01810 O WN E-R. : 'H U j T D�AT� .T UN; 2 / _ lt3 7No -�o 's ca r APPLICATION FOR SEWAGE DISPOSAL INSTALLATION �-y HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make app 'cation for permit for a sewage disposal installation at will install this system in ac- cordance with all he laws 6f the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum rade of 1% until 10 feet pr e - ceding the septic tank, where the .grade shall not exceed 290. I will install a con- crete septic tank of ' in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of � o---c.) lineal (square) feet o • q f effective absorption area. The pipes will be laid on a-6inch layer of washed P y gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone. The disposal field field will be installed a led at a grade of 4 to 6 inches/100 feet. No single. tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application, DATE 7 f Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE- .�� 7 6 Signat/4reAf Aalth Agent I have inspected the uncovered system indicated above and find everything done as describe . 1 DATE 3 /70 Signature of Ins ting Officer Percolation Test Garbage Grinder A BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. / F 1 N CC AME � rr ,� ITX -r1f l.!&7- DATE_e�/ol/ 2. ADDRESS le->O fl/�AFp/f 0 �r LOT NO. TEL. 3. NO. OF BEDROOMS J DEN YES t� NO 4. GARBAGE GRINDER YES NO l� 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER , MASSACHUSETTS SEWAGE DISPOSAL DATE 5,17/70 NAME OF APPLICANT Scott Realty no_ i LOCATION Lot 913-B Bradford Sty Address of lot no. BUILDING: Dwelling X Other SYSTEM: New Y Repair I GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay__ Gravel Sand PERCOLATION TEST 10 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1_0000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipe. i I � William J. Dr' s oll , Engineer Board of Healt _ Commonwealth of Massachusetts City/Town of NORTH ANDOVER, \\\j MASSACHUSETTS - System Pumping Record • Form 4 v DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving RECEIV A. Facility Information Important: APR U 7 2008 When filling out 1. System Location: forms on the TOWN OF NORTH ANDOVER computer,use HEALTH DEPARTMENT only the tab key Address to move your &)C)6\-) GGLI cursor-do not o� p L+ use the return City/Town State Zip Code key. 2. System Owner: Felix I_Un Name — — Address(if different from location) City/Town State Zip Code qT -621, ba�+o Telephone Number B. Pumping Record 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes YNo if yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: _ NGyi ()! nem �yslem_`l (CA 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed. G.L.S.®. Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1