HomeMy WebLinkAboutPass - Title V Inspection Report - 15 BRADFORD STREET 10/11/2024 � Commonwealth of Massachusetts
ram.
Title 5 Official Inspection Farm
v} Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 BRADFORD STREET
Property Address
VICTOR ANDREOLI
Owner Owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every __.. . .... _---- _.. __.......__._. ..._ .... __...__..... --
page. City/Town State u Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not`60 altered in any
way. Please see completeness checklist at the end of the form.
Important:when A. Inspector Information
filling out forms
on the computer, Todd James Bateson
use only the tab —...... ........_, ... . ....._......
__ _...... _ _..., _.-....._ _ .._..._. . .
key to move your Name of Inspector
cursor-do not Bateson Enterprises Inc.
use the return _.-
_...
key.
Company Fame
111 Argilla Road
ran Company Address
Andover MA 0181
City/Town State Zip Code
1 978-475-4786 SI 16
Telephone Number License Number
_...__. __...._.._-.._-......._ _ .......... __...
B. Certification
I certify that- I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection- and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1, El Passes
2. F-1 Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. El Fails
SEPTEMBER 26, 2024
inspe ors 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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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,
t5atsp.doc-rev.712612018 1`itie 5 Official inspecwn Form:'Subswfare Sewage Disposal System•Pepe 1 0 18
Commonwealth of Massachusetts
V � Ti le 5 Official Inspection Form, nts
4 Subsurface Sewage Disposal System Form - Not for Voluntary Assess
15 BRADFORD STREET
Property Address
VICTOR ANDREOI I
Owner Ov�ner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required far every
page cetyrrow n State Zip Cade Date of Inspection
.......... ........._... _.... . .. _._ _............. .._.,_. .w............ ..._.......
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) 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:
2) 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 infiftration 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.
El Y ❑ N 0 ND (Explain below):
V5nar doc.rev t2l'W2018 i me 5 offw a6 tl¢aweciian Forms 54.4 nurdace Sewage C)o traaaSW SyMenii•Page 2 r:ilf 18
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 BRADFORD STREET
Property Address
VICTOR ANDREOLI
Owner Owners Name
required fo is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every _
page Clty/Town _._.._.... _ State Zip Code Date of Inspection
_._........-_.._.... __........ ...... .............. _.......
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
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):
-------- ......-.
3) 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.
a. 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:
tainsp.doc-rev.712612018 'Title 5 Official Inspection Farm.Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Farm
oY Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
t ,r
15 BRADFORD STREET
Property Address
VICTOR ANDREJI_I
Owner Owner's Name
rerequis�w�tiorr 6s NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every
page. City/Town State Zip Code bate of Inspection
..... _ ._...... _ .. ....... ..
C. Inspection Summary (cant,)
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
b. System will fail unless the Board of Wealth (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.
El The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
El 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,
c. Other:
_.....
4) System Failure Criteria Applicable to All Systems..
You must indicate"Yes„' or"No„'to each of the following for all inspections
Yes No
Ej Backup of sewage into facility or system component due to overloaded or
-� clogged SAS or cesspool
El E Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
Ckbn%p do,.-rev 71264'M 18 riw 5 o„ fwt of tlnR)er8 on Form Sa.rZzsr.ud�e,�,, Sewage Dmpn&M System•Page 4&18
Commonwealth of Massachusetts
Ti-le 5 Officlel Inspection Form
w, 1!i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 BRADFORD STREET
Property Address
VICTOR ANDREOU
Owner Owner's Name
required
is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
rectuired for every
page. Coty.JTown State Zip Cade gate cf Inspection
C. Inspection Summary (cant.)
4) System Failure Criteria Applicable to All Systems; (cant.)
Yes No
l Z Static liquid level in the distribution box above outlet invert due to an overloaded
�. or clogged SAS or cesspool
El Z liquid depth in cesspool is less than 6", below invert or available volume is less
than 1/2.day flow
z Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
0 z Any portion of the SAS„ cesspool or privy is below high ground water elevation.
El Z Any portion of cesspo6 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 water supply
well.
El 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well.
�.I z 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 2000 gpd-
E.1 z 10,000 gpd.
El Z The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.30 , therefore the system fails. The
systern owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) 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 C.4.
Yes No
El ® the system is within 400 feet of a surface drinking water supply
D' El the system is within 200 feet of a tributary to a surface drinking water supply
El 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
Y5n4N r'oc•¢ey 7f25120'18 1 fit,5 Cgfi°4 hsped,on Form 54abs,zfazcxiro Sewage[N",sal Systwn•Page 5 0 18
�� " Commonwealth of Massachusetts
Title 5 Official Inspection Form
"y A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address
VICTOR ANDREOU
Owner Owner's fame
requi�r�required
Is NORTH ANDOVER MA 01845 SEPTEMBER 25,, 2024
rea�inlred for every
page. City/Town State Zip Code Date of Inspection
_.. __.._...... _., .................__,..._ _,_.... __... . . _._...... ...,., .........._.....,...__ .. ..... .,..,......
C. Inspection Summary (cant.)
If you have answered"yes" to any question in Section C.5 the system is considered a significant
threat, or answered "yes" to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15,304. The system owner
should contact the appropriate regional office of the Department.
8. You must indicate "yes" or"no" for each of the following for all inspections:
Yes No
Z El Pumping information was provided by the owner, occupant, or Board of Health
1:1 Z Were any of the system components pumped out in the previous two weeks?
Z 0 Has the system received normal flows in the previous two week period?
Z Have large volumes of water been introduced to the system recently or as part of
this inspection?
Z 1:1 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?
Z 1:1 Was the site inspected for signs of break out?
[l Were all system components, excluding the SAS, located on site?
Z ❑ 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 1:1 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 Park C is at issue
❑ approximation of distance is unacceptable) [310 CMR 15.302(5)�]
t5ii,4a a.'oc-i ev.70512018 rh"�h 5D`r7i�"@ Enutiplawa�.9["aer 6°cwrrpr Sr„bswface Sewage 0,sposa1 System-Page 6 cf 18
Commonwealth of Massachusetts
Tale 5 Official Inspection Form
a) Subsurface Sewage Disposal System Form Not for Voluntary Assessments
.. F✓'
15 BRADFQRD STREET
Property address
VICTOR ANDREOLI
Owner Owner's Name
required
is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every _
page City/Town State Zip Cade Date of Inspection
D. System Information
1, Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD
Description:.
Number of current residents: 2
110y
Does residence have a garbage grinder? [ Yes No
Does residence have a water treatment unit? ❑ Yes Ej No
If yes„ discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.) El Yes �; No
Laundry system inspected? Z Yes ❑ No
Seasonal use? 0 Yes Z No
Water meter readings, if available last 2 ears usage d SEE ATTACHED
g f Y g (gp ))
Detail:
Sump pump? D Yes El No
Last date of occupancy: CURRENT
Date
t5mspr.doc•rev.7/2612018 'PTtRw,5()dtiu iai 4nspectjon Form Sutfisuiface Sewage Disposal System•Page"7 of 18
° Commonwealth of Massachusetts
F I:y
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
77
15 BRADFORD STREET
Property Address
VICTOR ANDREtOLI
Owner Owner's Name
inforniation is NORTH ANDOVER MA 01545 SEPTEMBER 25, 2024
required for every
page. CltyfTown State Zip Cade Date of Inspection
...... _..., ............ ....... .. ............__. .... ........ ...._...,
D. System Information (cant.)
2. Commercial/Industrial Flaw Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203). GaIHons per day igpd
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? 0 Yes E] No
If yes, discharges to:
Industrial waste holding tank present? 0 Yes �_ No
Non-sanitary waste discharged to the Title 5 system? 0 Yes No
Water meter readings, if available:
Last date of occupancy/use: crate
Other(describe below):
3. Pumping Records:
Source of information: AUGUST 2024 BATESON ENTERPRISES INC
Was system pumped as part of the inspection? (l Yes Z No
If yes, volume pumped:
galVans
How was quantity pumped determined?
Reason for pumping:
fl5m,p doc•rev 7/261 018 r'iflo 5 Ofi'rrial lns+p(wtion I:o"n SUbskxfacaaSewage GrsposM System-Page 8 of 18
Commonwealth of Massachusetts
� Title 5 Official Inspection Form
} Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 BRADFORD STREET
Property Address
VICTOR ANDREW
Owner Owner's Name
information is required for every NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
_
page. City(Town State Zip Cade Date of Inspection
D. System Information (coat.)
4. Type of System:
11 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)
El 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
El Tight tank. Attach a copy of the DEP approval.
El Other(describe):
Approximate age of all components, date installed (if known)and source of information:
32 YEARS„ INSTALLED OCTOBER 1992 AS BUILT
Were sewage odors detected when arriving at the site"? 0 Yes No
5. Building Sewer(locate on site plan):
Depth below grade: 1 '
feet _.
Material of construction:
El oast iron E 40 PVC other(explain):
Distance from private water supply well or suction line: fee
Comments (on condition of joints, venting, evidence of leakage, etc.):
JOINTS AND VENTING OK
NO EVIDENCE OF LEAKING
t`i msp doc»rex.'r d2612018 tl ifle 5 offoua;al Ilrrspecbo n F oln Subsu+f'acm Sewage Dasposaf System•Page 9 of 18
� Commonwealth of Massachusetts
Title 5 Official Inspection Form
'> Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 BRADFORD STREET
Property Address
VICTOR ANDREQLI
Owner Owner's Name
information is NORTH ANDOVER, MA 01845 SEPTEMBER 25, 2024
required for every __ _
page. Cityrrown State Zip Code Date of Inspection
.....,.._ _. . .... ........ - - -- - ..._........ ... .. . . _._., .,_,... _ _...........
D. System Information (cant.)
& Septic Tank (locate on site plan):
Depth below grader feet
Material of construction:
Q concrete [ metal fiberglass polyethylene El other (explain)
If tank is metal, list age: year
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 5 - 4
`
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scurn 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 1
How were dimensions determined? SLUDGE JUDGE AND TAPE
MEASURE
Comments (on purnping recornmendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
RECOMMEND PUMPING OLDER SYSTEMS YEARLY
CONCRETE INLET AND OUTLET BAFFLES OK
TANK IS GOOD
LIQUID LEVELS GOOD
NO EVIDENCE OF LEAKAGE
6nsp doc•rev.[F26/2018 Rce 6 oBfia aw Viraspeawtnrwn luau Subsa,nlw*Sewage Msposua[Systw•Page 10 of 18
of °^ Commonwealth of Massachusetts
l) LL X Title 5 Official cial Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 BRADFORD STREET
Property Address
VICTOR ANDREOLI
Owner Owner's Narne
information is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every _
page City/Town Mate Zip Code Date of Inspection
D. System Information (cant.)
7. Grease Trap (locate on site plan).
Depth below grade:
Material of construction:
CJ concrete E metal E] fiberglass 17� polyethylene ❑ other (explain)
Dimensions: _
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scorn 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.)
5. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
El concrete D metal [] fiberglass ❑ polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
i5,nsp c7oc my 717612018 Tittle 5 O fioaSl Wf^!4)ec io n Form S uks&v ace Sewage fMsposaf Sy+,8em•Page 8 b r„ad 18
a Commonwealth of Massachusetts
_ - � � Ti'Llc 5 Offidal Insp cUon Form
yl Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 BRADFORD STREET
Property Address
VICTOR ANDREOLI
Owner Owner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every
(rage. Clt Il ow y n State Zip Code CDate of insfaect.on
D. System Information (coat.)
& Tight or Holding Tank (cant.)
Alarm present: El Yes ❑ No
Alarm lever Alai in working order: El Yes E"' No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract (required). Is copy attached? 0 Yes Ej No
9, Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
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 IS LEVEL AND DISTRIBUTION IS EQUAL
LIGHT EVIDENCE OF SOLIDS CARRYOVER
NO EVIDENCE OF LEAKAGE
fSinsp doc-rev 7116Y2018 1 aie 5 offaal Insgaection F"onn 9ub;nGartaw Sowage Di hpuu.A:,,ys[enr-Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
,. 15 BRADFORD STREET
_.r
Property Address
VICTOR ANDREOLI
Owner Owner's Name
informatIn is NORTH ANDOVER MA 01545 SEPTEMBER 25, 2024
page.
every _
e. City/Town State Zip Code Date of Bnspectlon
D. System Information (cont.)
10. bump Chamber(locate on site plan):
Pumps in working order: ❑ Yes 0 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.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
11 leaching pits number:
El leaching chambers number:
D leaching galleries number:
z leaching trenches number„ length: 2, 45' LONG
Q leaching fields number„ dimensions:
F-1 overflow cesspool number:
d innovative/alternative system
Type/name of technology:
t5m%p doc•rev.7626J2018 11110 CMfir,.OW If Ispe dVo n f-'ovrn.Subsurface Sewage Dispoa,W System•Page 13 of 16
<M Commonwealth of Massachusetts
Title 5 Official Inspection Form
'i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 BRADFORD STREET
Property Address
VICTOR ANDR OLI
OwnerOwner's Name
information is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every
page. cityffown state Zip Code Date of Inspection
_... ®.. ......... ...._..._ _ _ . _..... .... ........ _. .........._ .. . .... _. .._.._.. _ __......... ..... ......... .. .......... ._.....
D. System Information (cone.)
11. Soil Absorption System (SAS) (cant.)
Comments (note condition of soil„ signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation,: etc.):
SOIL AND VEGETATION OIL
NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING
12. 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 Ej Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation„
etc.):.
tR`fnsc°ctcn•rev.7t260:)9 B 'P"Me 5 Cffi.r4 In"Cl<x)F offn SubswPace&7w age IC:V*ps.mM System rr�m-Page 1 4 ce 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
"1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
15 BRADFORD STREET
Property Address
VICTOR ANDREQI I
Owner 6wner's dame
information is NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every
page City/Town State Zap Cod11 e Crate o.f inspection
D. System Information (cant.)
13. 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.):
taimsp d m,-rev.7/26/209 B 'raie 5 Oft cwa tnsr)ocfion Y onn Subsurfa cm Sewage Disposal System-Cure 15 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
e� Subsurface Sewage Dispersal System Farm - Not for Voluntary Assessments
15 BRAD `ORD STREET
F'rope t}r Ad dress
VICTOR ANDREW
Owner
C7uwner" CVaaTze
Information is NORTH ANDOVER MA 01845 SEPTEMBER 25 2024
required for every ,_... . ,� m...,, —
.. _..... _ _.. .._.........,. _. ... _ _' .......__._.....
page. Cltyfrown State Ip Code Gate o f In"speotuon
D. System Information (coat.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system„ including tiles 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
I ,
603
lIl
.. r
t ... m c p
O
50
Mnsapa dor-rev.T br?..01 a TAW 5 Offi ai InspecAron f rxrc'im Subs&Aace Sewage Dispouili Syme m-Page 16 of 18
Commonwealth of Massachusetts
x� q Title 5 Official Inspection Fora
M. Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
c
15 BRADFORD STREET
Property Address
VICTOR ANDREOLI _
Owner Owner's Name
infrequired
dfo ie NORTH ANDOVER MA 01845 SEPTEMBER 25, 2024
required for every _
page cityfrown State Lip Code Date of Inspection
......_ .._.__.......__._. . ........ ........._._.._..... ....___.. ____. ........._...,._...__ .�............ ....,.......... ....__.......... ....................... ...._.............._ ,._.__,_..._._ .._. ........._.__,.._,.._._....
D. System Information (cant.)
15. Site Exam:
-' Check Slope
Surface water
Check cellar
Shallow wells
Estimated depth to high ground water: 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: SEPTEMBER1992
Date
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health - explain:
PLANS ON FILE
[ Checked with local excavators, installers - (attach documentation)
Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
DESIGN PLAN
Before tiling this Inspection Report, please see Report Completeness Checklist on next page.
t5Inswzdoc•rev.7/2612018 1`Yw 5 offioa l Instaectuar�i Form Subsurfamrma Sewage Disposal System Fraage 17 of 18
Commonwealth of Massachusetts
i, �2�" - 'mr, Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,9 . 15 BRADFORD STREET
Property Address
VICTOR ANDREULV
Owner Owner's Name
info€rnatlwl is NORTH ANDC7VER CIA 01845 SEPTEMBER 25, 2024
required for every
page. City/Town State Zip Code Cate of Inspection
_..... ._..... .. ... ..................__.......... . ......
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
A inspector Information: Complete all fields in this section..
B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6 (Checklist) completed
D. System Information:
For 8: Tight/Holding Tank—Dumping contract attached
For 14. Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t?Frr sp rccx rev.7ti260018 Time°,l Offmm' Insr*cwun Form Subsur't";;aces Sewage Dr3posa� ESQ ston•Page 18 at 18
suinfm,my Recold Card genwMed on 9/191A)24 9 2:3 51 AM b,,p Kamn I iankm Page I
Town of North Andover
Tax Map # 210-061.0-0023-0000.0
Parcel Id 11182
16 BRADFORD STREET
VICTOR ANDREW
15 BRADFORD STREET
NORTH ANDOVER MA 01845
Class 101 Single Family Prc)perty Type I Resklerifial
Size ToiW 1.03 Acres
FY 2025
UB Mailing Index
NanmfA 'dress Type Loan Number Activoftact- From WIM
VI CTOR ANDRE 01-1 Payor /,kCfive
15 BRADFORD STREET
NORTH ANDOVER MA 01845
MACKOR,MICHAEL Payor Jnaclm,e W27/2013
15 BRADFORD STREET
N.ANDOVER,MA
01845
PER REMIT-TANCE SLIP,
UB Account Maint.
Account No Cyde Occupant Name AcUve/Inactive
Pld IId. 15243.0- 15 BRADFORD STREET Last Billing Date 9/5t2024
2120160 02 Cycle 02 Active
UB Services Maint.
Account No 2120160
Service Codo Rate Charge MuRiplier/Users
MISCFEE ADWN FEE 0 63 5/8 7W 1/
w"rR WATER 01 ALL METER SIZE 40T85 11
UB Meter Maintenance
Account No 2120,160
Sedat No SWUM Location Br mid Type SUe YTD Cons
16336648 a Active ERT METE METE w Water 0,625 O 625 647
Date, ReaWnq Code Consurnpfion Posted Date Vadance
8/12/2024 3758 aActual 80 9112/2024 335%
5/10/2024 3678 a ACtUal 18 611312024 -,17%
2/8/2024 3660 aAGtUaI 22 3114/2024 -45%
11/712023 3638 a Actual 39 12/13/2023 .40%
819/2023 3599 a Actual 66 9/18/2023 100%
5/10/2023 3533 a Actual 33 6/14/2023 45%
2/8/2023 3500 a Actual 23 3/14/2023 -620%
l 1 I812022 3477 a Actual 59 12/19/2022 -48%
811012022 3418 a Actual 117 912012022 387%
519/2022 3301 a Actual 23 612112022 4%
21912022 3278 a Actual 24 3/1512022 -42%
1114/2021 3254 a Actual 36 12/1312021 -37%
8111/2021 3218 a Actual 61 912112021 165%
511212021 3157 a Actual 23 6/15/2021
211012021 3134 a Actual 23 3/16/2021 .61%
11/6/2020 3111 a Actual 54 12/16/2020 -37,%
8/10/2020 3057 aActual 88 9/9/2020 300%
5/1112020 2969 a Actual 22 6/10/2020 21%
211012020 2947 a Actual '19 3/16/2020 -56%
111712019 2928 a Actual 42 12/2312019 -17%
8/7/2019 2886 a Actual 49 1,j/2612019 166%
5/10=19 2837 a Actual 18 6/1312019 01%
2/12/2019 2819 a Actual 20 3119/2019 -441/o
1117/2018 2799 aActual 33 12/12/2018 -36%
80012018 2766 a Actual 53 9/2012018 150%
5110/2018 2713 a Actual 21 6/2012018 1 91YU