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HomeMy WebLinkAboutMiscellaneous - 270 BRADFORD STREET 4/30/2018I - - �11 'I- C) 0) 03 n 0 1-01 x M m Commonwealth of Massachusetts RECEIVED City/Town of NORTH ANDOVER .10 2013 JUL System Pumping Record TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 2 System Location: -� 0 12,20 -ba Address NORTH ANDOVER Ma Cityrrown State Zip Code System Owner: PC) b -12 - Name Address (if different from location) City/Town B. Pumping Record State Telephone Number 1. Date of Pumping Date J�'n e- 19 2. Quantity Pumped: 3. Type of system: El Cesspool(s) D� Septic Tank El Tight Tank F-1 Other (describe): Zip Code 160() Gallons Ej Grease Trap 4. Effluent Tee Filter present? [j Yes [j No If yes, was it cleaned? E] Yes [] No 5. Condition of System: (;� 6. System Pumped By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Signature of Receiving Facility Date Date t5form4.doc- 03/06 System Pumping Record - Page 1 of 1 E P. h.s I P I Q y I d ;hl'J 10t(n f,�t (Q Ltl Q Q F a I —nf —on "JUN I H ANDOV— I LTH 0 1j': L4 04 rj"'M`;": (a rn 8wnj I.- T l'4v'",l tit 9111411fil I(QM "OQI)) iYmplu Ro'�,.ord� Q! Pvm'Plng,: '.. � , .. 1 0)4 - Typo 91 sx)(0m: EM�onl T�o* F116"' 0 p(qj o n r? y M. 77, 4c, it L Q Qn. Wh A C -H U S T -T S OFF P(!c TBn,, m up. mo, 4-. r-7 'Im T8�7, ye5 N L i r-) n S, Y's TF �A cx DATI OF PURpINQ,:_�2 'r y p ocrr FUK60t-1 Mml Cr" '-3 RECENED� RE RZAVY 0jt&,*,3B KOOT3 ---- 12 2005 L RAC p dXCUSIVE SOLIDS AUG L%N-TMENT $OL rD CA U Yo lay, j)O\JER -rOVVN OF NORT�j ANDOVER t4 0 N T T - p r mEN A HEALTH D�EPAR r�i TbYM OF NORTH -ANDOVER SYSTEM PUMPING RgCORD I) V 1 1-:: . 0 WN ER A D D RE SS IV 171 C CLy) 14n o 6f ve- -3 "" �YSTEM LOCATION (exMple: Icf( fron( of hou�t) i L)..\,I,c OF PUMPINC, QUANTITY PUMPCD L L NO V YES SEPTIC TANK: NO y E s %.7\ -\TURE'OF SERVICE: ROUTINE EMERCENCY uu-�FRY.:\TIONS: COOD CONDITION. FULL TO COYC, 1� HRAYY CREASE BAFFLES IN PLACP ROOTS LEACHFIELD RUNUACK...- CXCESSIVE SOLIDS FLOODED SOLIDS CARRYOYER pWHFR (EX%A.IN) �)..'s'l-cm PUMPEO BY: !'I A N S P C, I Z I � ED TO: 4- 0 a) 0) R 5 E U- 4-- 0 (1) 4-J z U) Ul W11 4-1 flu in CL 0 4--) F c v c c E S t! 0 = M 42 U CL C: o E CD 0 m 0 -2 ru 0 01 < 4-- 0 0 co 0 0 fa Z Alvwver i2.a 4. )-:)b Aoin STjjfmTlS SEPTIC TANK SERVICE A 47 RAILROAD SrREE:r B -ADFORD,, Mh 0.1835 P 14-im w I Lo f- I G1 jZb 14 :. . 978-372-7471 r) MONTH OF )ber 46)o,!�, MONTHu PmpORT pm wa OF NEW ENGLAND ENGINEERING SERVICES lk INC May 24, 2000 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 D RE: TITLE V REPORT: , M Bradford Street, North Andover Dear Sirs: Enclosed is a copy of the Title V report for the above referenced property. The system ppssed our inspection. If there are any questions please call me at my office, 686-1768. Sincerely Benja&n C. Osgood, J?/,.T. President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 Surry Corp. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION RI-adford Street HEALTH DEPARTMENT - NORTH ANDOVER, MASS. CI -5— I hereby make application for a permit for a sewage disposal installation at I will install this system in ac - To dance with all thd1laws of 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 grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. 1 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 " lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed 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 1/811 to 1/4), (dia.) will be placed over the course gravel or stone. The disposal field will be installed 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 paintained 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 aeree not to cover anv rortion of this installation until aDDroved bv the inspection officer, as provided bolow, and to incorporate any additional requirements that may be attached to the permit. Plot Plans mu e submitte!!with a i�)cation.. DATE tat) (,7 4 Signature of-ADDlicAnt I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Signefture of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Si nature of/114WIspecting Officer 9 Percolation Test Garbage Grinder 4 - BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL NAME OF APPLICANT Surrey Real Estate LOCATION— Lot #2, Bradford St. Address of lot no. BUILDING: Dwelling .. X -Other SYSTEM: New X GENERAL DESCRIPTION OF LAND Repair H i r- h DATE July 29, 1967 SUBSOIL: Clay X Gravel Sand PERCOLATION TEST 27 min.utes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 180 -lineal feet of drain pipe. PREA TO BE FILLED T!,.T VTD '3Y5TE'_"'_' !11TS'T_,%11ED I -1-T A.C,,',ORDXTC1E "�!TTH ATTACHED FLS& BY J. 3_ARB1kGAL_T,0 R.S ATFD hl ;467 J J.4 2 :Aa==:: William J. DA�i�coll, EngineV Board of Health f7i x) A L T tj S F F_�' C -7-o i o &_3 . 4 ( I q 6 7 I D I S / C�, 5 CL CA F RCI 4�1 /9/ �r S I C, 4 / B v /,- Al rb (X) tl,,IV tf5 r (Xj A? Vli r 1j-1,>.i.61)1-SfPr1C 7'fl.NX 8 7 YA,16 u I /-,,v 13,jl IMr s c a, Ik 'Ile S-0 /) /Y -3 R .49 -5 r A IvorZ- rx rr/v 0 C,*// Z3 ,Visll 6AI)CE pi rcg To It k/ FA 0 ZX rrA,(D 411 Jill, L t a E P I- 7- M F 5 "1/ A/ /V, 3 wfirrR rJIq b 1- 4, P, A v Ibl-A �qc4i41*rY E 5 3 6 ec 19 6,c t) G X,' re r ;r z - P 7 ;C 7 1� ^1 7- Alc, 6 r, .,Y / *,', 4) �� e,'l m 5 r IN' iv PA c, er b 44 /jF ( " I ck r r, i-> 5o, -5 c4 h j,�// A j -,g A S- I;v D I R E c /V P, f 'c o S'a /V 'o fi 3. Rc, 1*3r t L S VA Tl'o 1v a,6 42 v.F 6A 14,0,1- 66 z o i - ME CA /j Al I C A 1�/ C A r L) 5 & 40 5 6 Al P0,4 c,.A' N 4 ,0,6 LA )',4RFD -f* /,v 6,co 19RI�-A Ple-i S a .5'1. 19 Po,'7 le,,vyz R t q tA iAl f D o /v 3 5/�o S o ;r 0 L r Cc, ct s aA jvo TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS X/0 SYSTEM LOCATION (example: left front of house) gA C r, DATE OF PUMPING: QUANTITY PUMPED/WD GALLONS CESSPOOL: NO Y <ES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE Z�EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) I -fly ------------ C&MONWEALTH OF AWWHUSEM E�[ECOTMOFFICE OF ENVIRONMENTAL AFFAIRS. DF,PARTM= OF ENVIRONMENTAL PROTWTION ONE V4XTER STREET, BOSTON MA: 02108 (617) 292Z506 ARGEO PAUL CEL�UCCI Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM -WSPECTION FORM PART A CERTIFICATION DAVID 0. Co Property Addr&&z: Z Ics, 0 12 )�P F- e C> .5T -9W ----T_ Narne of Owner K%A.1k, /VI,CAJIJ'5 Al . A/J 6- Address Of Owner: 2.7 1� _!S-T"&4a6r/ A.7 -6-\OD Date of Inspection: Name of tnspector:'(Please Print) Beni amin C. Q'-'Zood, Jr. I . I am a DEP approved system inspector pursuard to Section 15.340 of 'Fide 5 (310 -CMR 15.0001 coffqmnyNwTie:New England -Enizine;Pering Services Inc. MaXngAddress: 60 Beechwood Drive, North Andover, MA TelephoneNurrgw: 978-686-1768 CER,nnCA'nomSTATEMENT 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 inspection. The Inspection was *Performed based on my training and experience In the proper function and maintenance of on-site sewage disposal systems. The system: _1z"passes Conditionally Passes Needs Furthertvalua6n By the Local Approving Authority Falls* Inspectoes sIgnatLie:- Date: The System Inspector shall submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)wkNn thirty (301 -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 sball subrrdt the report to the appropriate regional office of the Department ofEnvtronmental Protection. The original should *be sent to t1m system owper. and copies sent to the buyer. If applicable. and the approving authority. NOTES AND COMMENTS revised 9/2/98 r rw I of 11 '"o—URFACE SEWAGE DISPOSAL SYSTEM 11INSPECTION-foRM PART*A Property Address: 270 Bradford Street CER111FICAnOlif(continued). North Andover, MA Owner: Kim McGinnis Date of Inspection: 5/9/00 Vil�OVCTION SUMMARY: Check A, -ft, 0, or D: A; V71EM PASSES: 1 '303 exist have not found any*information wfilch Indicates that any of the failure conditions described In 310 CIVIR 15. Any failure' criteria not oval ated are Indicated below. COMMENTS: B. SYSTEM CONDMONALLY PASSES: One or more system components as described In the "Condiflonal Pass' section need to be'raplaced or repaired. The system, upon completion of the replacement or repair, as epproved by the Board of Health, will pass. Indicate yes, no. or not determined (Y. N. or ND). Describe basis of determination In all Instances. If "not determined'. explain why not.* The septic tank Is metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached) Indicating that the tank was Installed within twenty (20) years prior to the date of the Inspactloh; or the septic tank. w hether or not metal. Is cracked, structurally unsound, shows substantial Infiltration or exfiltration..or*tank failure Is Imminent, The system wit ' I pass Inspection If the existing septic tank Is replaced With a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed pipe(s) or due to a broken, sittled or uneven distribution box. The system will pass Inspection If (with approval of the Board of Health). broken pipe(s) are replaced obstruction Is removed distribution box Is levelled or replaced The system required pumphig-inM than-four-ftes -a yvardue to broVen orabsti cted pipets), The syst... Inspection If (with approval of the Board of -Health)- broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2 or 11 r -----tjRFACE SEWAGE IDISPO�AL SYSTEM INSPECTION FORM PART A Property Address: 270 Bradford Street CER1111FICATION (oofftinued) North Andover, MA Owner: Kim McGinnis Date of Inspection: 5/9/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: tion by the Board. of Health In order to determine If the system Is I I airing to prote dt th CoAditiohs exist which require further evalun a public health, safety and the environment. SYSTEM WILL PASS UNLESS BOARD OF HEALTH DE I M RIES IN ACCORDANCE WITI-I 310 CMR 15.363 (1)(b) -THAT THE SYS� IS NOT FUNCTIONING IN A MANNER WHIcHMILL MO.IECT THE PUBLIC LiEALTKAND SAFETY AN12 THE EWOaoNME&�L- Cesspool or privy Is within 60 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated w.etiand or a salt marsh. 21 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF ANY) DETERMINES -THAT THE SYSTEPA 9S. FUNCTIONING IN A MANNER THAT PROTEM THE PUBLIC HEALTH AND SAFOX AND THE ENVIRONMENT: The system he ' s a septic tank and soil absorption system (SAS) and the SAS Is within 100 fact of a surface water supply . or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a pubric water supply welts The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 feet or more from a private water supply well. unless a watt water analysis for cofiform 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 then 5 ppm. Method used to determine distance (approximation not valid). -- 31 OTHER 0 r r revised 9/2/98 pagt 3 or 11 SUBSUR CE -SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION fcorrumiadl Prqperty Address: 270 Bradford Street North Andoveri MA F.. Owner: Kim McGhinis Date of Inspection: 5/9/00 D. SYSTEM FAILS' You must incricate ei;her "Yes" or "No" to each of the following. I have determined that one or more of the following failure conditions exist as described In 310 CIVIR 15.303. The basis for this' determin3tion Is Identified below. The 8 ard of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of "Wage Intofacifity-or-aVtorn �,componenrdue tto an ovedoadedorcWgged -SAS��or.,cesspoo(.' Discharge or ponding of effluent to the surface of the ground or surface writers 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 112day flow. Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any po�rtlon of the Soil Absorption System. cesspool or privy Is below the high groundwater elevation. Any portion of a 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 pfty Is -within a Zone I of a public well. Any portion of a cesspool or privy �s within 60 feet of a private water supply well. Any portion of a cesspool or privy Is less -than 100 feet but greater than 60 fact from a private water supply well with no. _:cceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of wall water analysis for oriform bacteria. volatile organic- compounds. ammonia n1trogen-and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow;of T0.000 gpd or greater (Large System) and the system Is a significant threot to public health and safety and the environment because one or more of the following conditions exist: Yes No the systaints1withInJI06 f.,tof a surface drinking water supply the the system Is located In a nitrogen sensitive area (Interim Wellhead Protection Area -'CWPA) or a mapped Zone 11 of a public water supply well) r The owner or operator of any such system shall upgrade the dystem In accordance with 310 CIVIR 15.304(2). Please consult the local regional office of the Department for further Information. revised 9/2/98 Pate 4 of 11 .,Vf SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTI10.N FORM PXRT 13 CHECKLIST -4 Property Address: 270 Bradford.Striet North Andover, MA Owner: Kim McGinnis Date of Inspection: 5/9/00 h of the following: Check If the follov0ng have been dode: You must indicate either 'Yes" or 'No' as to eac Yes No Pu.1hping information was provided by the owner, occupant, or Board of Heelth. All' None of rates during that period. Large volumes of water have not be.en Introduced Into the system recently or -as part of -this inspection. As built plans have been obtained and examined,. Note If they are not available with NIA. The facility or dwelling was inspected for sighs of sewage back-up. V/ The. system does not receive n on -sanitary or Industrial waste flow. The site was Inspected for signsof breakout. All system components, excluding the Soil Absorption System. have been located on the site. The* septic tank manholes were uncovered. opened, and the Interior of the septic tank was Inspicted for condition of baffles or toes, miterial of construction, dimensions. depth of fiquid, depth of sludgle. depth of scum. The size and location of the Soil Absorption System orr the site has been delem-dried based on: - Existing information. For example, Plan at B.O.H. Datern-Jnad In the field (if any of the failure criteria related to Part C Is at Issue, approximation of distance Is unacteptable) .115.302(3)(b)l The facility owner (and.occupanuJi differaW ircim-owneirl.wariiprosAdarl Informitti, t.LDn thaptapar-maintanano"If SubSurface Disposal Systems. SUBSURF4CE SEWAGE DISPOSAq SYSTEM INSPECTION FORM PART C SYSTEM INFOhMATION Property Address: 270 Bradford Street Nort1f Andover, MA Owner: Kim McGinnis Date of Inspection: 5/9/00 FLOW CONDITIONS RESiDENTIAL: Desil;ln flow.-__�O.p.d.lbedroorn. Number of bedrooms 4desion)-d Number of dedrooms (acWall.--q Total DESIGN flow N' bar of current7asiden t v. Zrbage grinder (yes or no). V _ LC -,4 La * undry (separate system) (yesornol.-!�q if yes, ep.,atz.f.paction-re.quired Launilry system Inspected (yes or no) Seasonal use (yes or noj-_A�o Water meter readings, If available (last two year's usage (gpd): Sump Pump (yes or noj:_�� Last date of occupancy:Z(�, -T COMMERCIAL/WDUSTRIAL: Type of astabrishment: Desig� flow: qpd (Based on 16.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no).�-_ Non -sanitary waste discharged to the Tide 6 system: (yes or no)_ W,ater meter reacrings, If available: Last date of occupancy: OMER: (Describe) Lost date of occupancy: GENERAL INFORMATION. PUMPING RECORDS and source of Information: System pumped as part of Inspection: (yes or no)A,�p If yes. volume pumped: allons Reason for pumping: TYPE OF SYS71EM Septic tank/distribution boxisoll absorption system Single cesspool Ovirflow cesspool Privy Shaved system (yes br no) (if yes, attach previous lnspecdoq records. If any) IIA Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank _,_�Copy of DEP Approval Other APPRO)OMATE AGE of &A components. date installed4if known) -and source of4imiformation: P'O A.) CA/ r*%- V., r e -e 171,4 j-LAF j> r Sewage odors detected whowarriving at the ske: (yes Of nol.AV-0 revised 9/2/98 pap 6 or it 7" SU11SVRFACE SEWAGE 61SPOSAL SYSTEM INSPECTION FORM Wit c Property Address:. 270 Bradford Street SYSTEM wr-oRkATION (corttlnued) North Andover, MA Owner: Kim McGinnis bate of Inspection: 5/9/00 BUILDING SEWER: (Locate on site plan) Depth below grade:211,2 - I t Material of construction: Zcast Iron 40 PVC other (explain) Distance from private.water supply� well or su�tion lin Diameter Comments: (condition of foints, ver)ting,' evidinceof foakage,-etc.) . J?l V7 C-- t'\.) &-Oc' V -co �'-- Z> 171 CA—) 12 - SEPTIC TANK: (locate on site Tian) Depth below grade: 12 Material of constructfion: concrete —metal —Fiberglass _Polyethylene _other(explain) If tank Is [netal, list age _ Is.age.confirmed -by Certificate of Compliance (Yes/No) Dimensions: /�Oc>c-;> Aj Sludge depth: Distance from top of sludge to bottom of outlet teeortraffie- Z Scum thickness: t Distance from top of scum to top of outlet tee or baffle:'& Distance from bottom of scum to bottom of cAutlet tee or baffle: Zf" How dimensions were determined: 15" ; IZ67 f;,rV V - Comments: (recommendation for pumping, concrition of Inlet and outlet toes or -baffles, depth of r1quid level In relation to outlet Invert. - structur"tegrity. //U 6--c. Cj evidence of leakage, etc.) 71-7-1 1,� 1 &-0 (? (1b,-Jb 1 -1 "V) A.). r n a E7ZF 7Z-5- 17-7c�'Aj - f -C C VA N S -CA -4- V- A-TIZ> A-) C) r k -�' 2-% :j:U L,- I Aj'�Ap 1-47 &A -j .111 L -L- -f-� f7 L ---)z- J'r-, ^ FleAl I Al 6�1 GREASE TRAP: (locate an site plan) Depth below grade: Material of construction: —concrete —metal ­1171berglafts _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlettee or baffle*— Distance from bottom of scum to bottom of odtlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping. condition of Wet and outlet toes or baffles. depth of liquid.level In relation to outlet Invert, structural integrity. evidence of leakage. etc.) revised 9/2/98 Pate 7 of 11 SUaSURFACE SEWAGE 6ESPOSAL SYSTEM RjSPEMON FOfiM PART C Property Address: 270 Bradford Street SYSTEM tNFORMATION (contirlued) North Andover, MA owner: Vim McGinnis J! 9/00 Date of Inspection: 51 TIGHT OR HOLDING TANK- 9411"ank must bq pumped prior to, or at time of. inspection). (loca a on site plan) Depth below grade glass Polyethylene other(explain) Material of construction: —crncrete —metal -Fiber Dimensions: -77 Capacity:_ gallons Design flow:_ gallons/day Alarm present Alarnilevel: Alarm In working order: Yes No— Data of previous pumping: Comments: (condition of Inlet tee, condition of alarm and float switches. etc.) DLSTRIBUT16N BOX - (locate on site plan) Depth of liquid level above cl�tlet Invert: Comments: (note If level and distribution Is equal, evidence of solids carryover. evidence of leakage Into or out of box, etc.1 Oox I A) &-Coo C 0 t-' ID 0 A�) IVC� 1DEAJCC-- 0 F� 1, r�� A V, (5 —rT-. A�1,;' Jr, V A- I PUMP CHAIMIIER: &A (locate on site plan) Pumps In working order: lY*z or No)____:_ Alarms In working order (Yos or No) Comments: (note condition of pump chamber. condition of pumps and appurtenances, etc.) I revised 9/2/98 a pate I of 11 pEcnqN roRm URFACEsEWAGEDISPOSAL YSTEMtNS PART Bradford Street Property Address: 270 sySTEm wr-oRmATIONIcorttintmd) North Andover, MA Kim McGinnis Owner: Date of InspeCtion: 5/9/00 SOIL ABSORPTION SiSTEM (SAS): (locate on site plan, If �osslble: excavation not required, location may be approximated by non4nitrusive methods) If not located, explaln,� Ty�e: leaching pits'. number: leaching chambers, number: leaching galleries, number, leaching trenches. number, length: leaching fields, number, dimensions: r-1 ao 2, 0,- Y, A�,C, overflow cesspool, number: Alternative system: Nam e of Technology: Comments: (note condition of soil, signs of hydraulic failure. level of ponding, damp soil. condition of vegetation, etc.) F -JZC�* it Ai CESSPOOLS: (to cate on site plan) Number and configuration: D;pth-top of liquid to Inlet Invert: Depth of solid * t layer: Depth of scum layer: Dimensloh's of Cesspool: Materials of construction: indication of groundwater: Inflow (cesspool must be pumped as part of Insp . ectionj- Conunents: (note condition of soil. signs of hydrautic fallureelevel of Pending, condition of -vegetation. etc.) (locate on site plan) Miatedpts of constmcj!on: Dimensions; Depth of solids: Cornrnents: (note condition of soll, signs of hydraulic failure, level of ponding. condition of vegetation; etc.) f revised 9/2/98 Pate 9F.Or I I N, ON F;dRM SUJISURFACE 917�AGE DISPOSAL SYSTEM INS�PECTI PART C sysTEm wFORMATION (continued) Property Address: 270 Bradford Street North Andover, MA Owner: Kim McGinnis Date of Inspection: 5/9/60 ,SKETCH OF SEWAGE DISPOSAL PYSTEM: nce landmarks or t)enchmarks Include ties to at least uko permanent refere locate all wells within 100' (Locate where public water supply i:om�.s Into house) revised 9/2/98 Page 10 of 11 a revised 9/2/98 Patenorn SUBSURFACE SEWAGE DISPOSAL SYSTEM tNSPE=ON F7 RM PART 0 sysTEIM WFORMA*nON (cmtkweA Property Addres-s: a-70 Aj- AA)VC),-)C- R.- Owrw: X^: C, 'Date of kupec6w: NRCS Reportname 11A 6-s -5 Aj,�, �L-rH k��K�u Soil Type vuv&C- Typical depth to groundwater in USGS Date website visited Observation WeI4 checked Groundwater depth: Shallow --Mode.rate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells 17 Esfimated Depth to Groundwater Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site (Abt&ing property. observation hole, basement sump etc.) Determined from locat conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. Installers Used USGS Data Describe how you established the High Groundwater Elevation. &2g be completed) LA-) -_V _67 0 -fj 31 F V%— C11 c-�:, e y Vie a revised 9/2/98 Patenorn OCEIV50 TOWN OF NOR'rH AND VrEf"'E D 0 9 DA IT SYSTEM PUMPING REC RD AUG 0 9 2004 0 DOVER nPTH AN SYSTF'M OWNER & ADDRESS khe'is- '::� 76 '6raAq,�'ql Nor�b 01V,61ot1e-jC1 SYSTEM 1­047AI��'TH DATE OJ­'l-*`UMPIN(J: 7-f -0 Y __QUANTITY PUMPED: CESSPOOL: N0- ­',%'X -YES--- SepticTank: No YES N 1,1RE OF SERVICE: ROUTINE Al '_ __v***_/ EMERGENCY ---- OBSERVA FIONS GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLAC� ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER.11--,-- OTHER EXPLAIN System Pumpedby COMMENTS I 0 CL -t !L MCL - Please forward us as much of the foliow'Mig- information that is pc-ssi.ble; I.. Type of system I S - ZV)L-A- 2. A Q, e 3� Locat ion! - 4- Maintenance records and date Of I-Eist pilmping oiit. FJ- Tloat.m.),-nt��tion of repairs and reconstruction 6. Site conditions 7. Biillder of system C', 8. Enzineer who approved, — Site — S-Ystem )r - 21 - 9. Installation Procedure 1.0. Problems C H '4. .has PrQ'vl )ji,,f,o`r`m, "'for u8 e by local Soards of He I 0 oubmj�ed a (h. The system Pumpino Racc�:� b thQJOC4l'SQ&rd of Health or other approying authorir/, A.,-Facility.inforb)-aflon Un�QrtI4 L �,iYNA N1119 QVI 1 �Yswm WO� Of 1,&� �4)I d ,.� MOYO YQW . �Lw Uw,yl D'V Nivni lie t W, --;7 AW (I w lQc4UQn) p/7 Nn, T,1 honq Nvrn�v, Rt 'Pump ylv- L) 0 Quanfty PUMPed: , r1Q,1)4 P,Q 9 6ylterh:.... Coss 001(s) optIc Tank TIght Tank or Ye PO If Yes, W83 N c'lean'ed? Cl Yes Al V1% -1.7`�T . . . . . . . -dl�posed: Ou Qn,Wh r , J` h ttp) q ". - — "' " -�'Vv� Ivehido c4n+f NvftQ( SYOOM PUMP1j)q R$wrQ , P4,4