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HomeMy WebLinkAboutFAILS - Title V Inspection Report - 23 BRADFORD STREET 8/27/2026 t No�hCommonwealth of Massa�chuseTown of Andover SEP 2 2026 q subsurface sewage Disposal System Form Not for Voluntary Assessments ' 23 Bradford Street Property Address Ron Cambell Owner owner's Name information is N Andover MA 01845 8/27/26 required for every page. Cityrrown 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. Irnporint:when A. Inspector information filling out forms on the computer, Pau[Gouveia use only the tab ley to move your Name of Inspector cursor-do not Paul's Title V services use the return Company Name fey. 86 Danforth Street Company Address Rehoboth MA 02769 City/Town State Zip code Y 508-360-5880 SI-13726 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. Passes ti 2. n Conditionally Passes 3. El Needs Further Evaluation by the Local Approving Authority 4. ® Fails 8/27/26 Ins eet s nat. Date 1 system i e or shall submit a copy of this inspection report to the Approving Authority(Board o ealth 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 DER The original fora 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. t5insp.doc-rev 3112/2026 TiNe 5 Official inspection Form Subsurface Sewage Disposal System•Page 1 of 18 4 Commonwealth of Massachusetts ion Form Toltle 5 Off � Subsurface Sewage Disposal System Form �Not for Voluntary Assessments g p y' f 23 Bradford Street Property Address Ron Cambell Owner owner's Name information is N Andover MA 01845 8/27/26 required for every page. CitylTown State Zip code Date of inspection C. Inspection Summary Inspection Summary: Complete 1, 21 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: El 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`ayes", "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. El Y N ❑ ND (Explain below): t5lnsp.doc•rev.3172r2f326 Title 5 Waal Inspection Form.Subsurface Sewage©isposel System•Page 2 of 18 _ w Commonwealth of Massachusetts Twitle d Subsurface Sewage Disposal System Form Not for voluntary Assessments 23 Bradford Street Property Address - Ron Cambell Owner owner's Name ......... information is o 1845 1�71�6 N Andover MA $ required for every _ ____ _,.._ - __....._.. ., page. CitylTown State Zip Code Date of inspection C. -Inspection Summary (cost.) 2) System Conditionally passes (cont.) ❑ 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 El Y El N ❑ ND (Explain below): [] obstruction is removed El Y ❑ N ❑ ND (Explain below): El 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 pipes). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced D Y El N ❑ ND (Explain below): [] obstruction is removed El Y M 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(l)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doo•rev.3/1212026 Title 6 Official Inspection Form-Subsurface Sewage Disposal System*Pago 3 of 18 Commonwealth of Massachusetts T mtle 5 Offn w I Inspectnion For icia -- per Subsurface Sewage[disposal System Form Not for Voluntary Assessments 23 Bradford Street Property Address Ron Cambell Owner owner's Name information is N Andover MA 01 845 8127/26 required for every page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont,) [� 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 fall 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: El The system has a septic tank and soil absorption system (SAS) and the SAS is within Boa 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. [j The system has a septic tank and SAS and the SAS is less than too feet but 50 feet or more from a primate 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 pprn, 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 mmsf 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 gg p Discharge or pondng of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Mnsp.doc•ray.3/1212026 Title 6 Official lnspoction Form.Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts .... 'r .:,.. � 'tle 5' Off'ic'ia'i inspection i�orm a. . .... 0 Subsurface Sewage Disposal System Form Not for voluntary Assessments � p � 23 Bradford Street Property Address __.._._.... Ron Cambell Owner owner's Name information is N Andover MA 01845 8/27/26 required for every page. C1ty/Tewn State Zip Code Date of inspection c. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No Static liquid lavel in the distribution box above outlet invert due to an overloaded ® ❑ AS or cesspool or clogged 5 Liquid depth in cesspool is less than 6" below invert or available volume is less El than ' a flow d Y Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes}. Number of times pumped: Eli s ❑ R1 Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 1 00 feet of a surface water supply or ❑ tributary to a surface water supply. El X) Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. El K) 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 DIP 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 forma The system is a cesspool serving a facility with a design flow of 2000 gpd- ❑ 10 000 gpd. The system fails, l have determined that one or more of the above failure ❑ - i 1 o CMR 15.303 therefore the system fails. The criteria exist as described n 3 Y system owner should contact the Board of Health to determine ghat will be necessary to correct the failure. 5) Lame 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. 'des No El El 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 ❑ mapped Zone 11 of a public water supply well Area�Ivi1PA3 0r a pp p pp Y t5imp doe rBVr 3/12/22026 Title 6 Official InspecUon Form SubsurfaFco Sewage Disposal system•Pages 6 of Is k Commonwealth of Massachusetts . ................ Icy al Inspectmion Form Subsurface sewage Disposal system Form Not for Voluntary Assessments 23 Bradford Street Property Address Owner Owner's Name Ran Cambell information is N Andover MA 01845 $12?'125 required for every page. CityTrown State Zip Dade Date of Inspection C. Inspection Summary (cont.) 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 C.4 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 C.4 shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate`dyes" or"no"for each of the following for aft inspections: Yes No El 0 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? E] 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? KI Ej were all system components, excluding the SAS, located on site? E@ El 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 ® ❑ e subsurface sewage disposal systems? Information on the proper maintenance of g p y The size and location of the soil Absorption system (SAS) on the site has been determined based on: [55 ❑ Existing information. For example, a plan at the Board of Health. Ud Determined in the field (if any of the failure criteria related to Part C is at issue 1:1 approximation of distance is unacceptable) CMR 15.30� 5appro p � � 3 Mnsp.doc rev.3I3212026 Title 5 official Inspection Form-Subsurface Sowage Disposal System•Pago 6 of 18 Commonwealth of Massachusetts iTintle 5 Offmicuial f• subsurface Sewage Disposal System For Not for Voluntary Assessments . ;� 23 Bradford Street .. ...................._ -- Property Address Ron Cambell Owner owners Name information is N Andover MA 01845 $127126 required for every a page. Citylfown state Zip code Date of inspection D. System Information 1. residential Flow Conditions: 4 Number of bedrooms(design): Number of bedrooms(actual): 440 DESIGN flow based on 310 CM R 15.203(for example: 110 g pd x##of bedrooms): Description: 0 Number of current residents: Does residence have a garbage grinder? El Yes R] No Does residence have a water treatment unit? D Yes Q No If yes, discharges to: _..........................................- . .........,-- ..........._.-. A............_..................... . Is laundry on a separate sewage system?(Include laundry system inspection ❑ information in this report.) Yes No laundry system inspected? El Yes No Seasonal use? El Yes [:1 No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: 7/1/2026 Date t5insp.doo rev.3//212026 Title 5 Offidai Inspection Form-Subsurface Sewage Disposal System■Page 7 of 18 II � Commonwealth of Massachusetts Title 5 Off nal Inspection Form Subsurface Sewage Disposal system Forte[ -Not for Voluntary Assessments r 23 Bradford Street Property Address Ron Cambell Owner .. ... Owner's Name Information is N Andover MA 01845 8/27/26 required for every page, Cityrrouwn State Zip code Date of Inspectlon D. system Information (cant.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 1 5,203): Ga[�ans per day(gpd) Basis of design flow(seatslpersonslsq.ft,, etc.): Grease trap present? El Yes [] No Water treatment unit present? El Yes ❑ No If yes, discharges to: -- -_ Industrial waste holding tank present? EJ Yes El No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: [date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? El Yes E] No If yes, volume pumped: .��._-.._.�__... � _-____._--___ _....... ..___.-,_.-._--_-_ gallons How was quantity pumped determined? - --- -- -- _. Reason for pumping: _�w _.. t5insp.doe-rear-3112/2026 Titio 5 Official tnspaction Form,Subsurface Sewage Disposal 5y&tem■Pafle 0 of 18 commonwealth of Massachusetts ■A 0q ■ ive 5 Officiai inspection Form Subsurface � Sewage Disposal stem Form �Not for voluntary Assessments � p 23 Bradford Street Property Address Ron Cambell Owner owner's Name information is N Andover MA 61845 8/27/26 required for every page. CitylTown State Zip code date of Inspection D. System Information (cont.) 4. Type of System: Septic tank, distribution box, Solt 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 11A system by system operator under contract [� 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: house built 1961 homeowner Were sewage odors detected when arriving at the site? Yes No 5. Building Sewer(locate on site plan): 19" Depth below grade: feed .. Material of construction: R1 cast iron [3 40 PVC E]other(explain): Distance from private water supply well or suction line: feet Comments(on condition of Joints, venting, evidence of leakage, etc.): no evidence of leakage t6insp,daa•rev.3192I2028 Title 6 Offoml Inapoction Form,Subsurface Sewaga Diaposa!System■P890 0 of#8 1�a�N Commonw ealth of Massachusetts ................. T'Itle 5 Official inspect'imon Form 4 Subsurface Sewage Disposal System Form Not for voluntary Assessments 23 Bradford Street Property address Ron cambell Owner Owner's Name information is N Andover MA 01845 8/27/26 required for every page. City/Town State Zip code Date of inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 12 Depth below grade: feet Material of construction: [N concrete El metal El fiberglass E] polyethylene ® other(explain) If tank is metal, list age: years _ .. Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) [:3 Yes EJ No 6'x5' cylindrical Dimensions: __...... _ F 20 Sludge depth: - 811 Distance from top of sludge to bottom of outlet tee or baffle (]1i Scum thickness ......--. yP 211 Distance from top of scum to top of outlet tee or baffle 14" Distance from bottom of scum to bottom of outlet tee or baffle tape measure sludge judge How were dimenrsions determined Comments ion pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): outlet tee in place septic tank at proper working level no evidence of leakage t5inap doe-rev 3/1212026 Tate 5 Official Inspection Form Subsurface Sewage Disposal System•Page 10 of 1S Commonwealth of Massachusetts P._...._. ■ . ■ .. � Title Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 23 Bradford Street Property Address Owner Ron Dambell �_.... ..��a ............ owner's Name information is N Andover MA 01845 8/27/26 required for every _ ..... _. page. City/Town State Zip Code Date of Inspection D. system Information (cont.) 7. Grease"Trap (locate on site plan): Depth below grade: feet_.. Material of construction: El concrete ❑ metal [I fiberglass ® polyethylene El other(explain): Dimensions: __ Scum thickness Distance from top of scum to top of outlet tee or baffle __ Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leafage, etc.): 8. "Tight or Holding"Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: W -- Material of construction: El concrete 0 metal ❑ fiberglass ❑ polyethylene F] other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day � r tSinsp.doc•rev.3112/2028 Title 6 Official inspection Farm Subsurface Sewage Dleposat System■Page 1 t of 18 . Commonwealth of Massachusetts Isa T"Itle 5 Official Inspect'ion For y Subsurface sewage Disposal system Form Not for voluntary Assessments ►-� 23 Bradford Street Property Address Ron Dambell -__.. Owner Ownees Name information is N Andover MA 01845 8/27/26 required for every page, City/Town State Zip Code Date of Inspection D. System Information (cant.) 8. Tight or Holding Tank(cost.) Alarm present: El Yes [:1 No Alarm level: Alarm in working order: D 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? EI Yes El No 9. Distribution Box (if present Dust be opened) (locate on site plan): 311 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.): solid carryover presant tainsp doc•rev.311212026 Title 5 Official inspection Farm,Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts T"Itle 5 % Subsurface Sewage Disposal stem Form Not for Voluntary Assessments � p � rY y , 23 Bradford Street Property Address Owner Ran Cambell owner's Name information is N Andover MA 01845 8/27/26 required for every _---- page, City/Town State Zip Code Date of Inspection D. System Information (cant.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: El Yes Ej No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): ' if pumps or alarms are not in working orders system is a conditional pass. 11. Soil Absorption System (SAS){locate on site plan, excavation not required}; If SAS not located, explain why: Type: ❑ leaching pits number: [� leaching chambers number: El leaching galleries number: ❑ leaching trenches number, length: 1-1 5'x3O' estimated leaching fields number, dimensions: overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5rsp doc•rev 31/2/2026 Title 5 Off"I inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 e Commonwealth of Massachusetts 6,a Tnitle it Subsurface Sewage Disposal System Form _Not for Voluntary Assessments 23 Bradford Street Property Address Ron Dambell Owner _ ____ _. .._.. Information is owner's Name 01845....................................... 51�71�5 required for every N Andover M ._..._.-_......--- - _................._.......... _. . page, City/Town State Zip Code Date of inspection M System Information (cant.) 11. Soil Absorption System (SAS) (cant.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): hydraulic failure obderved 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Y Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): (Sinap.doc•rev.3/12/2029 Title 5 Official Inspection Form-Subsurface Seviage Disposal System•Page 14 of 10 x � Commonwealth of Massachusetts . _........._ Itle 5 Offni ciai inspectnion Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments . ;' 23 Bradford Street Property Address Ron Carnbell owner .__-. -... --- ___-_- _ information is ovuner's Name 01$45 8127126 required for eve N Andover MA page. City/Town State Zip Code Date of inspection D. System Information (cont.) 13. Priory(locate on site plan): _._ Materials of construction: ..._.._..... --- _._W .�_.--4- ..._--..... Dimensions _ Depth of solids _.............. Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t6lnsp.doa-rev.3/12/2026 Title 6 Official Inspection Farm-Subsurface Sewage Disposal System Page 16 of 18 v .. T Commonwealth of Massachusetts T"Itle Off'ic'ia'i 'inspect'ion For 4 Subsurface Sewage Disposal System Form Not for Voluntary Assessments �. 23 Bradford Street Property Address - � _Ron Cambell Owner owner's Name information is N Andover MA 01845 8/27/26 required for every ........._. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 t6insp.doc ray.3i1712428 Title 5 Official inspection Form-Subsurface Sewage Disposed System-Page 16 of 18 k C Commonwealth of Massachuseft 'al Ins ection Form TI'tle 5 Off Subsurface Sewage Disposal System Form Not for Voluntary Assessments 23 Bradford Street Property Address Ron Cambell Owner .... .. .. . D1$45 owner's Name Information is N Andover MA $�2712� required for every page. Cityf town state Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® check Slope ® Surface water Check cellar Shallow wells 32" 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: 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 USCS database-explain: You must describe how you established the high ground water elevation: test pit 21 7/24/98 provided by andover board of health see attached Before filing this Inspection Report, please see Report Completeness Checklist on next page. Mnsp.doo-rev.3/1212026 Title 6 Official lnspeotion Form,Subsurface Sewage Disposal system•Page 17 of 18 Commonwealth of Massachusetts Toltle 5 Off micilani ninspection Form Subsurface Sewage Disposal System Form -Not for voluntary Assessments x 23 Bradford Streetµ Property Address Ron Cambell __.._ - _ Owner owner's Name Information is N Andover MA 01845 8/27/26 required for every ,........... _........._. page, CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this fora inclusive of: A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 21 3, or 4 checked C. Inspection Summary: 11 21 3, or 5 completed as appropriate 4(Failure Criteria) and 6 (Checklist)completed D. System Information: For S: Tight/Holding Tank—Pumping 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 t5insp.doc►rev.3112/2026 Title 5 Officie!Inspection Form Subsurface Sewage Disposal System■Page 18 of 18 t P BOARD HEALTH TEL. 666-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SO TESTS GATE: 20119 LOCATI ON OF SOIL TESTS: Assessor's map & parcel number: baf 67, 13 A,. OWNER: TEL. NO.: 9 i7i jl"� j gi��L ADDRESS. Atapove" VIA A 0 "I ENGINEER: TEL. NO.:�� - ?�I_ro CERTIFIED SOIL EVALUATOR: Intended use of land: residential subdivision,Csing7le�family home, commercial Repair testing Undeveloped lot testing L,.--' THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of$275,00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only certified soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the EOH representative. 5. Full payment will be required for all additional tests within two weeps of testing. 6. Within 45 days of testing, a scaled plan (no smaller than I"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. �A JA_ . l i Frank Verreccha Bradf ord St APPLICATION FOR SEWAGE DISPOSAL ZSlAG ATION HEALTH DEPA RTMNT � NORTH ANDOVER, MSS. _ hereby make application cation for a permit for a sewage d"spos al installation at 6radf ord 6t �. , } r , I will install this s ys t'9m inaC;•a.IM 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 to feet pree ceding the septic tank, where the grade shall not exceed 21. 1 will install a con cre to septic tank of ,®,,. .7„ -O I ,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 /+ inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will prodw vide a minimum of --Zoo lineal. (eWjUWb) 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 3A 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 1/01 (dia. ) will be placed over the course gravel or s tone. The disposal, field will be installed at a grade of 4 to 6 inches/100 feet. No single the line will. exceed 100 feet in length and in any case, two lines of the will be installed. A minimum of 6 feet will be maintained between the center lines of the dis osal field trenches and the average depth of trench shall not exceed 36 inches. p 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 aLiy rtion of this installation unti roved. y the ins action officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE Signature of Applicant 1 hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DA 1ELZ sms r' mom Signature of Health Agent I have insp e c ted the uncovered system indicated above and find everything done as described. DA TE .. _. .. .j • S } 1 °kwmewi Qf Signature of _ nspecting Officer ' Percolation Test Soil sandy-clay 6 m n e Garbage Grinder July 8., 1961 Miss Mary Sheridan Ho No Health Agent Board of Health North Andover.9 Mass* Dear Miss Sheridano. An oxamination was roade as requested In order to do-tormine, the 9 ul itability of tho soil for the subsurface disposal of sovmge on the proposed Bradford Stveet building site of Frank A. Verrecchia The land in general is high'a 'rho subsoil in the area was of mandy c lay content and a 6-nd-nute percolation test was conducted. Ib is recommended that a 75O gallon concrote soptic tcq,,nk be in- stalled together with P.00 lineal feet of drain pipe. Very tmly yotirs, 14j,11jam J. Dr- scoal WJDshd z 330ARD OF HEALTH TOWN OF NORTH ANDOVERV MASS leyell t k 3 i3 4 i 4 2 ADDRESS4 � or"N. + v �.- . 30 Me OF BEDROOM � � a 0 a DEN YES .� GARBAGE GRINDER YS a 0 0N09 SHOW DID +'NS IONB Cry HOUSE 6 e SHOW D rSTANCES OF HOUSE TO ALL PROPERTY LINTS 7,0 SHOW DIDISM1014 CF LOT 8 o SHOW LOOAT ION AND SIZE OF SEPTIC TANK OR CESSPOOL go NOTE L40AT ION AND DISTANCE Or' WELL FROM SEMRAGE SYSTEn4 10 SUGW LOCATION OF BROOKS, STR AMS 9 DITCHOS p LEDGE CUT CROP O BTC 9 Ile SHOW DISTANCE Cr' SERT TC TAM OR CESSPOOL FROM UCUSI4; NUTS: LOCAL REGULATIONS SHOUTD BE READ CAREFULLY. r a 1 �, .. DATE: LOCATION* �NGIN E - _ - BONS VVITNES.D. PERCOLATION PrLr � �t BOTTOM DEPT r# OF FERC TEST. D (AtL minutes cna) TIME OF SOAK. �. ..�_ TIME AT 1? 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