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HomeMy WebLinkAboutMiscellaneous - 145 BRADFORD STREET 4/30/2018 1 145 BRADFORD STREET 210/061.0-0003-0000.0 _ i i i i v North Andover Board of Assessors Public Access Page 1 of 1 W ,lOR7M TQM Of WcWth A.0dover 22 of �.e eryOL Of A , � � r F 9& cfi Property Record Card Return to the Home page click on loco Parcel ID:210/061.0-0003-0000.0 Community:North Andover SKETCH PHOTO New Search Click on Sketch to Enlarge Click on Photo to Enlarge Sales Summary Residence Detached Structure Condo Commercial Comparable Sales 1145BRADFORD STREET k' Location: 145 BRADFORD STREET Owner Name: GAUDETTE,TIMOTHY M MARJORIE B GAUDETTE Owner Address: 145 BRADFORD STREET City:NORTH ANDOVER State:MA ZIP:01845 Neighborhood:5-5 Land Area:0.93 acres Use Code:101-SNGL-FAM-RES Total Finished Area:2422 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 489,600 511,400 Building Value: 293,700 305,100 Land Value: 195,900 206,300 Market Land Value: 195,900 Chapter Land Value: LATESTSALE Sale Price:355,000 Sale Date:07/29/1.999 Arms Length Sale Code:N-NO-OTHER Grantor:P A F REALTY TR Cert Doc: Book:05512 Page:0292 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=1177434 5/1/2008 i j 284.00' - LOT A2E.& 40,Co 14 S.F.* ' i { 0' LEacwI1 JG TZEt-Cl 4 CTYPI GdL .9 Bg• tiEXfST. EL-L1►-1G Q` 1� ToPOF9-oUNDEL- 98.g ZOO , —, ISOO GAL . SEPTIG ZLS Q y �. �( '► fin? - 2 55.Oo ' - 1592AP -F012 V ' ST12EE T'• S IY ELEVATIONS description design as built INV. PIPE OUT OF HSE. 89.72 89.88 S • BUILT INV. PIPE INTO TANK 89.48 89.78 . INV. PIPE OUT OF TANK 89.23 89'72 SUB SURF/�CE DISPOSALINV. PIPE INTO DIST. BOX 89,10 89.37 INV. PIPE OUT OF DIST. BOX 88.93 89. 1Co SYSTEM- 2 M INV. END OF PIPE y" I 8 �o 8. S 8871 I I. 2 88.40 88.49 IN it 3 88.15 88.30 O t2T H AWDOVEP.I.-M A4 8-7.90 87..90 s 87.C,5 g7,(,8 FOR : A.tZTNul2 Lu.z Scale: I" = -4o' Date: JULY 22, 1985 RICHARD F. KAMINSKI AND ASSOCIATES , INC. ENGINEERS • 'ARCHITECT • SURVEYORS • LAND PLANNERS NORTH ANDOVER , MASS . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is North Andover MA 01845 2/29/2016 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information M` a�Y' filling out forms on the computer, MAR 0 8 2016 use only the tab 1. Inspector: key to move your cursor-do not Neil J. Bateson TOWN OF NORTH ANDOVER use the return Name of Inspector HEALTH DEPARTMENT key. Bateson Enterprises Inc. � Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 S 1 15 Telephone Number License Number B. Certification 1 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 e 2/29/2016 Inspectors S gnature 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. ""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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r / Commonwealth of Massachusetts t Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner Owner's Name Information is required for every North Andover MA 01845 2/29/2016 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3N3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is required for every North Andover MA 01845 2/29/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is North Andover MA 01845 2/29/2016 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 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'/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is required for every North Andover MA 01845 2/29/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont. Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pi�e(s). Number of times pumped: ❑ ® Any portion oi the SAS, cesspool or privy is below high ground water elevation. I ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. I ❑ ® 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 Icustody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system Vis. 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 I6orrect 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 I ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is ithin 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. t5lns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is North Andover MA 01845 2/29/2016 required for 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) Z ❑ 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)] 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): 600 thins•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is required for every North Andover MA 01845 2/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current 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: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Conimonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " 145 Bradford Street Property Address Robert Gruber Owner owner's Name information is required for every North Andover MA 01845 2/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2008,owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume"pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pepe 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 145 Bradford Street Property Address Robert Gruber Owner owner's Name information is North Andover MA 01845 2/29/2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 31 years old, 7/22/1985, as built plan. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 5 feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): finished velar uanable to see piping Septic Tank(locate on site plan): Depth below grade: 4 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed lay a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10' x 5'x 4' Sludge depth: 4" t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 Coffirtianwealtn of MaSSaChUSOM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is North Andover MA 01845 2/29/2016 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont,) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 11" Now were dimensions determined? Tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Center cover has riser 1' deep. 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 tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Cotrinionwaalth df MaSeachUSMS Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is North Andover MA 01845 2/29/2016 required for 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.): Tight or Holding Tank (tank must tie pumped at time of inspection) (locate on site plan); Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain); Dimensions: Capacity: gallons Design Flow: gallons per day 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is required for every North Andover MA 01845 2/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal. No evidence of leakage Evidence of light carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Cor>itnbnwelth of Masscf~uses Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is required for every North Andover MA 01845 2/29/2016 page. Cityfrown State Zip Code Date of Inspection Db System information (conn) Type: E] 9pits its number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 5 trenches 61' long ❑ leaching fields number, dimensions: ❑ 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.): Soil ok. Vegetation ok. No sign of ponding to surface. 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 c6mmonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner owner's Name information is North Andover MA 01845 2/29/2016 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): tSns•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal.System''Pepe 14 of 17 CottimnWeaIth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is required for every North Andover MA 01845 2/29/2016 page. City/Town State Zip Code Date of Inspection D. System) Information (cont;) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ driwing atta0h6d sapardtsly 3 36'5 I t5ins•3/13 Title 5 Officiel Inspecdon Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth 6f MaSSSChtJgLi Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 145 Bradford Street Property Address Robert Gruber Owner Owner's Name information is North Andover required for every MA 01845 2/29/2016 page. Cityrrown State Zip Code Date of Inspection D. SystemInformations (oQnt�) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: '4 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: 5/3/1984 ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Desi-an Plan_ ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 16 of 17 Cdthttl6hW661th of MaddadhUd s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 145 Bradford Street f�roperty Address Robert Gruber Owner owner's Name information is required for every North Andover MA 01845 2/29/2016 page. City/Town State Zip Code Date of Inspection E. Report- completeness checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file !Sin's+3713 TWO 5 Official Inspectlan Form.SUbsURad-0 Sewage`D16posal System:Page 17 of 17 • Summary Record Card generated on 2/23/2016 10:28:41 AM by Karen Hanlon Page 1 • Town of North Andover Tax Map # 210-061.0-0003-0000.0 Parcel Id 10541 145 BRADFORD STREET THERESE & ROBERT GRUBER 145 BRADFORD STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 0.93 Acres FY 2016 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until THERESE&ROBERT GRUBER Owner 145 BRADFORD STREET NORTH ANDOVER,MA 01845 GAUDETTE,TIMOTHY Previous Customer Inactive 7/9/2008 145 BRADFORD STREET N.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant.Name Active/Inactive Bldg Id. 15234.0-145 BRADFORD STREET Last Billing Date 12/15/2015 2120193 02 Cycle 02 Active UB Services Maint. Account No.2120193 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 214.75 /1 UB Meter Maintenance Account No.2120193 Serial No Status Location Brand Type Size YTD Cons 35078158 a Active ERT HH b Badger w Water 0.63 0.63 608 Date Reading Code Consumption Posted Date Variance 2/12/2016 635 a Actual 21 -57% 11/9/2015 614 aActual 45 12/30/2015 83% 8/14/2015 569 a Actual 26 9/14/2015 16% 5/14/2015 543 a Actual 22 6/22/2015 -3% 2/13/2015 521 a Actual 25 3/20/2015 -16% 11/6/2014 496 aActual 26 12/15/2014 8% 8/12/2014 470 aActual 25 9/11/2014 49% 5/15/2014 445 a Actual 17 6/12/2014 -21% 2/14/2014 428 a Actual 24 3/17/2014 -3% 11/6/2013 404 aActual 21 12/20/2013 18% 8/13/2013 383 a Actual 19 9/18/2013 3% 5/14/2013 364 a Actual 18 6/18/2013 -7% 2/14/2013 346 a Actual 22 3/13/2013 -1% 11/5/2012 324 aActual 18 12/13/2012 -4% 8/15/2012 306 a Actual 21 9/26/2012 4% 5/15/2012 285 a Actual 20 6/20/2012 9% 2/14/2012 265 a Actual 20 3/14/2012 -15% 11/7/2011 245 a Actual 20 12/15/2011 -14% 8/15/2011 225 a Actual 26 9/14/2011 22% 5/13/2011 199 a Actual 20 6/13/2011 1% 2/14/2011 179 a Actual 22 3/15/2011 10% 11/8/2010 157 aActual 18 12/13/2010 -2% 8/12/2010 139 a Actual 19 9/13/2010 -3% 5/13/2010 120 a Actual 20 6/9/2010 32% 2/9/2010 100 a Actual 15 3/11/2010 -16% 11/9/2009 85 aActual 17 12/11/2009 6% �. Commonwealth of Massachusetts Title 5 Official In u -- ---- ° specteon Fora _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 145 BRADFORD ST. Property Address - - MARJORIE GAUDETTE Owner Owner's Name —^ information is NO. ANDOVER MA 01845 4/7/08 required for _ _ 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 Expl ❑ The system requir pumping more than 4 times a year du to broken or obstructed pipe(s). The system will pass insp tion if (with approval of the Board f Health): ❑ broken pipe(s) a replaced ❑ obstruction is remove ND Explain: C) Further Evaluation is Required/by the Board f Health: ❑ Conditions exist which require/ urther evaluation by a Board of Health in order to determine if the system is failing to protect public health, safety or a environment. 1. System will pass unless Board of Health determin in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a man r which will protect public health, safety and the envirgnment: ❑ cesspool,&privy is within 50 feet of a surface water ❑ Cess of or privy is within 50 feet of a bordering vegetated we nd or a salt marsh 2. System/will fail unless the Board of Health (and Public Water Supplt r, if any) determines that the system is functioning in a manner that protects the p blic health, safety a`nd environment: ❑ f' The system has a septic tank and soil absorption system (SAS) and the SAS i 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 publi ater supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. TITLE V 2008.doc-03!08 Title 5 Official Inspection Foran:Subsurface Sewage Disposal System•Page 3 of 3