HomeMy WebLinkAboutMiscellaneous - 31 BRADFORD STREET 4/30/2018 (2) 31 BRADFORD STREET t
210/061.0-0031-0000.0
I
' Commonwealth of Massachusetts G��� ®
Title 5 Official Inspection Form �� Ck2®1l
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ����� d
°t 31 Bradford St. 10F DEPP�
Property Address
Caroline &Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
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
filling out forms A. General Information
on the computer, r
use only the tab 1. Inspector:
key to move your
cursor do not Anthony G. Campano
use the return Name of Inspector
key.
Campano Engineering and Title 5 Inspections
VQ Company Name
30A Elm St.
Company Address
» Pepperell MA 01463
City/Town State Zip Code
978-433-2212 3602
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. 1 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
r` J 06/04/2017
Inspector's Signature -date-
The
ateThe system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M s 31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
page. Citylrown 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.
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):
I
t5ins.doc•rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
page. City/Town 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):
i
❑ 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�,M ,•'� 31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
page. Citylfown 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 %day flow
t5ins.doc•rev.6/16 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
31 Bradford St.
Property Address
Caroline &Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
page. Cityrrown 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 pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 11 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.
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
,mono=
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
page. Cityrrown 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?
❑ Z 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): no plan Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330
t5ins.doc-rev.6116 Title 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
M , 31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 3
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
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage 42.5gpd
9 ( Y 9 (gpd)):
Detail:
4,142 x 7.48gal/728 days=42.5 gpd
Sump pump? ® Yes ❑ No
Last date of occupancy: occupied
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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
page. Cityrrown 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: 2014 per owner
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)
I
❑ Innovative/Altemative 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.
i
❑ Other(describe):
i
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owners Name
information is
required for every North Andover MA 01845 6/1/2017
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
Per the as biult 7-12-1993
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 16"feet
Material of construction:
® cast iron ❑40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 25
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
All exposed joints were in good condition with no evidence of leakage or venting problems.
Septic Tank(locate on site plan):
Depth below grade: 3"feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
Tank was in good condition, liquid level was at the outlet pipe invert. Both inlet and outlet baffles
were in place and composed of concrete.
i
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: TL x 5'5'W x 5'D
Sludge depth:
3"
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
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
34"
Scum thickness
2"
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
16"
How 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.):
Tank is in good condition. Liquid level was at the outlet pipe invert. Both inlet and outlet baffles were
composed of concrete, in place and in good condition.(SEE ATTACHED PHOTOS)
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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
u Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
°r 31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
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.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
i
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
I
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.doc•rev.6116 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
,•' 31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
page. CityrFown 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.):
The D-box is level with three lines all are receiving equal flow. No evidence leakage into or out of the
box and no sign of solids carryover.(SEE ATTACHED PHOTOS)
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:
i
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑
leaching trenches number, length:
® leaching fields number, dimensions: one, 20'X 43'
I ❑ 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.):
There is no sign of hydraulic failure, ponding or damp soil. vegetation is mowed lawn.
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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
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.):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is
required for every North Andover MA 01845 6/1/2017
page. Cityrrown 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
® drawing attached separately
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
GSM e�' 31 Bradford St.
Property Address
Caroline&Amine Hannache
Owner Owner's Name
information is North Andover MA 01845 6/1/2017
required for every
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 7
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
The sump pump was dry and the bottom of the sump was two feet bellow the basement floor, and the
floor is 5ft. below grade.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Bradford St.
Property Address
Caroline &Amine Hannache
Owner Owner's Name
information is North Andover MA 01845 6/1/2017
required for every
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
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
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Summary Record Card generated on 6/212017 9:29:09 AM by Karen Hanlon Page i
Town of North Andover
Tax Map # 210-061.0-0031-0000.0
Parcel Id 11805
31 BRADFORD STREET
AMINE & CAROLINE HANNACHE
31 BRADFORD STREET
NORTH ANDOVER MA 01845
Class 101 Single Family Property Type 1 Residential
Zoning2 1 Residential Zoning3 1 Residential
Size Total 1.05Acres
FY 2017
UB Mailing Index
Name/Address Type Loan Number Active/lnact. From Until
AMINE&CAROLINE HANNACHE Owner
31 BRADFORD STREET
NORTH ANDOVER MA 01845
ULIANO,ALBERT Previous Customer Inactive 6/30/2014
31 BRADFORD STREET
N.ANDOVER,MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id.15295.0-31 BRADFORD STREET Last Billing Date 3/6/2017
2120166 02 Cycle 02 Active
UB Services Maint.
Account No.2120166
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.635/8 7.82 11
WTR WATER 01 ALL METER SIZE 38.00 11
UB Meter Maintenance
I
Account No.2120166 j
Serial No Status Location Brand Type Size YTD Cons
36207147 a Active ERT HH b Badger w Water 0.63 0.63 509
Date Reading Code Consumption Posted Date Variance
5/9/2017 513 a Actual 11 17%
2/10/2017 502 a Actual 10 3/14/2017 -73%
11/8/2016 492 aActual 35 12/19/2016 -29% j
8/12/2016 457 aActual 52 9/21/2016 255%
5/11/2016 405 aActual 14 6/21/2016 7%
2/12/2016 391 a Actual 14 3/28/2016 -60%
11/9/2015 377 a Actual 32 12/30/2015 -35%
8/14/2015 345 a 52 9/14/2015 112%
-VT4 2015 293 a Actual 24 6/22/2015 230% !
2/13/2015 269 aActual 1-/f 4 Z 8 3/20/2015 -82%
11/6/2014 261 a Actual 39 12/15/2014 113%
8/12/2014 222 aActual 10 9/11/2014 357%
6/26/2014 212 f Final Bill 2 6/26/2014 41%
5/14/2014 210 aActual 7 6/12/2014 12% i
2/14/2014 203 a Actual 7 3/17/2014 4%
11/6/2013 196 a Actual 6 12/20/2013 7%
8/13/2013 190 a Actual 6 9/18/2013 -35%
5/14/2013 184 a Actual 9 6/18/2013 .40%
2/14/2013 175 a Actual 17 3/13/2013 25P
11/5/2012 158 a Actual 11 12/13/2012 -12%
8/15/2012 147 a Actual 14 9/26/2012 26% €
5/15/2012 133 a Actual 11 6/20/2012
2/14/2012 122 aActual 13 3/14/2012 5% i
11/7/2011 109 aActual 11 12/15/2011 -20% E
8/11/2011 98 a Actual 14 9/14/2011 5%
5/13/2011 84 aActual 13 6/13/2011 11%
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y SCOTT L. GILES, R.P.L.S.
50 Deer Meadow Road
_ o North Andover,MA 01845
683-2645
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Town of North Andover
HEALTH DEPARTMENT
SSACHUsf
CHECK#: 7733 DATE: 6-S oZ O }
LOCATION:
H/O NAME: h'Cc nI�Q,Cl1�,
CONTRACTOR NAME: Ca-lnd ro
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 $
❑ TrashlSolid 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 $
Title 5 Report ?1%
$
❑ Other. (Indicate) $
"'D
H 'Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
/address ^..l ST .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 - Building Department
G}
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y i I
Uliano,
11� )) B radford St.
APPLICATION FOR SEWAGE DISPOSAL IM TALIATIdN n a 7
HEALTH DEPARTMENT MA
NORTH ANDOVER, MSS. V�� Z3
I hereby make application for a permit for a sewage disposal installation at
RLndfnrd at. . I will install this system in ac-
cordance with all the laws 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%. I will install a con-
crete septic tank of 750 gal. 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 180 —lineal XIkffJkEb) 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 1/8" 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 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.
Seperate Dry Well and / 100 Lineal ft. drain om 't,►
DATE �,a-u�m
Sig
of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE
Siffiiature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DA TE__�a�4�- .� ..`
JLL
Signature of4nspecting Officer
Percolation Test 2 min. soil: Clay
Garbage Grinder No
I
BOARD OF HE4;.TH
TOWN OF NORTH ANDOVER, MASS.
� I
04.
i
1
1. NAME . DATE .
2. ADDRESS .. LOT N0. * ,a TEL. . . . . .
3. NO. OF BEDROOMS . .. DEN YES o NO. .
4. GARBAGE GRINDER YES . . . . . N0. . . . . .
5. SHOW DIIVEATSIONS OF HOUSE
b. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIlvENSIONS OF LOT
$. 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.
November 4, 1961
Miss Mary Sheridan R. N.
Health Agent
Board of Health
North Andover, Mass .
Dear Miss Sheridan:
An examination was made as requested in order to determine
the suitability of the soil for -the subsurface disposal of sewage
on the proposed Bradford Street building site of Mr. Uliano.
The land in general is high.
The subsoil in the area was of sand content and a 2-minute
percolation test was conducted.
It is recommended that a 750 gallon concrete septic tank
be installed together with 180 lineal feet of drain pipe.
Very truly yours,
GtLA
`tel
William J. riscoll
WJD:hd
c 3PrIG STEM A5-BU(LT RE PA I R
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�1tS ASR�SPa-S`�STE�NI���
31d C.M.Q. lS'CL'�
Commonwealth of Massachusetts F
City/Town of NORTH ANDOVER MASSACHUE
System Pumping Record
Y p 9 .vim E min
Form 4
DEP has provided this form for use by local Boards of Health. The Sy e
be submitted to the local Board of Health or other approving authority.
A. Facility Information
Important:
When filling out 1. System Location:
forms on the / c�
computer,use 3 l fZA4;7441 Cl` J�
only the tab key Address l
to move your
cursor-do not
use the return City/Town State Zip Code
key.. 2 System Owner:
/ -- `► f yo
Name
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping �� ��ly- ® 2. Quantity Pumped:
Date Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes Ej--`No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of Sys m:
Sys m:
6. System Pumped By:
61- S-'ep-r — I P 6;1?7 V&
Name Vehicle License Number
Company
7. Location where contents were disposed:
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
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