Loading...
HomeMy WebLinkAboutTitle V Inspection Report - 1020 SALEM STREET 12/17/2004 COMMONWEALTH OF MASSACHusEws EXECUTIVE C;U V OFFICE OF ENVIRONMENTAL AFFAIRS — G DEPARTMENT OF ENVIRONMENTAL PROTECTION K J� 4 5y5 hM1Ip! T'IT'LE OFFICIAL INSPECTION FCDRM —NOT FOR VOLUNTARY Y ASST+JSSIV ENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM 'OR PART" A CERTIFICATION Property Address:,_.1020 Salem Street North Andover° Clwner°'s Name: John machonis_ — Owner's Address:_1020 Salem Street, —North Andover,1 A 01845_ j 1, k 2, Date of Inspection:_12/17/2004 Name of Inspector:MNeil J.Batesorr� Company Name: Ilateson Enterprises Inc._ Mailing Address:_111 Argilla Load_ —Andover,Ma.01010._ Telephone Number:_(978)475-4786_ CERTIFICATION IO STATEMENT T 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.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 150000). The system; _ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F its Inspector's Signature: 6' ,. Vote. �12/17/2004� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments; ""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. Page,2 of I I OFFICIAL, INSPECTION I+`CDRM•-NOTFOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1020 Salem Street— �_North Andover— owner:_Machonisp Date of Inspection: 12/17/2004_ Inspection Summary: Check A,B,C,D or /AIL WAYS complete all of S tiott I9 A. System passes: X 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. Answer yes,no or not determined(Y,N,ND)in the 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 sttucturally 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. ND explain: _ 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Page 3 of 11 OFFICIAL INspEc'I iO FORM - NOT FOR VOLUNTARY' ARY A ESSMEN T SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAIN A CERTIFICATION (continued) Property Address: 1020 Salem Street_ �.North Andover Owner: Maehonis_ Date of&speetion;_12/17/2004_ 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 oi-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 wetlauid or a salt marsh 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'gone l 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 frorn 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 1]. OFFICIAL INSPECTION FO "-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DIS SAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1020 Salem Street North Andover— Owner:er: Machonis, Date of linspection:__12/1°7/2004_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or 1`no"to each of the following for all inspections: No Backup of sewage into facility or s!�stem component due to overloaded or clo ..ed SAS or cesspool Flo Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or — ^clogged SAS or cesspool No—Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ —No_Liquid depth in cesspool is less than 6"below invert or available volume is 1/2 day flow.__ io_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No Any portion of the SAS,cesspool or privy is below high ground water elevation. __ o_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a ssurface lrl water supply. _faro Any portion of a cesspool or privy is within a Zone I of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ado— 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 ICDEP certified laboratory,for coliforrn bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pprn,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this farm.) o (Yes/No)The system fails.I have determined drat one or more of the above failure criteria exist as described in 310 CMR 15503,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 gird, You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of l l OFFICIAL INSPECTION CIO I+`ORM —NOTFOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE ISPOS Lpry�SYSTEI INSPECTION IC+C�)C� PART B CHECKLIST KLIST Property Address: 1020 Salem Street_ North Andover O aer: Machonis� Date of inspection: 12/17/2004 Check if the followin have been done.You must indicate` es"or"no"as to each of the followin Yes No _Yes_ — Pumping information was provided by the owner,occupant,or Board of Health lido_ Were any of the system components pumped out in the previous two weeks?' _Yes_ " Has the system received nornnal flows in the previous two week period'? —No— Have large volumes of water been introduced to the system recently or as part of this inspection? Yes Were as built plans of the system obtained and examined? _Yes_ Was the facility or dwelling inspected for signs of sewage back up°? Yes Was the site inspected for signs of break out'? Yes Were all system components,excluding the SAS,located on site'! Yes _ 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 ".1 _Yes_ _ 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: Yes no _Yes Existing information. _Yes—_ Determined in the field(if any of the failure criteria related to fart Cis at issue approximation of distance is unacceptable) [3 10 C..M 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM _.,n NOTFOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1020 Salern Street_ North Andover Owner: Machonis- Date of Inspection: 12117/2004 I+I,fDW CONDITIONS RE SIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_4 DESIGN flow based on 310 CMR 15.203(for example: 11.0 gpd x H of bedrooms):_440 Number of current residents:_ _ Does residence have a garbage grinder(yes or no); Yes_ Is laundry on a separate sewage system(yes or no):_No- Laundry system inspected(yes or no): Seasonal use: (yes or no):_No Water meter readings:_Yes_ Sump pump(yes or no):_No_ Last date of occupancy:_Currrent CD RCIALANIDIIS" Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER R(describe): � ---—- GENE,RAL INFORMATION Pumping Records Source of information:Pumped this year,owner- Was system pumped as part of the inspection(yes or no):_No— If yes,volume pumped:___gallons--How was quantity pumped determined?_ Reason for pumping; PL OF SYSTEM _ _Septic tank,distribution box,soil absorption system Single cesspool____Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _�_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 'fight tank _Attach a copy of the DEP approval Other(describe):_ Approximate age of all components,date installed(if known)and source of information:..6 years old,5/9/1998,As built plan_ Were sewage odors detected when arriving at the site(yes or no):_No- Page 7 of I l OFFICIAL INSPECTION FO —NOT FOR VOLUNTARY ASS ;SS NTS SUBSURFACE SEWAGE DIS OSAL SYSTEM INSPECTION FOR PART SYSTEM INFORMATION(continued) Property Address: .1020 Selena Street_ _North Andover Owner: Machouls- Date of Inspection:�12/17/2004.� BUILDING SEWER_X_ (locate on site plan) Depth below grade:_24""_ Materials of construction: cast iron 40 PVC_,_other Distance from private water supply well or suction line: _ Comments(on condition of joints,venting,evidence of leakage,etc.): Unable to see piping leaving foundation, finished basement. 3"PVC in house,no leaks visible._ SEPTIC TANKS:-X.- Depth below grade: _12" Material of construction:-X—concrete____metal____fiberglass____polyethylene _other(explai.n) If tank is metal list age:____ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 10"x 5'x 41 _ Sludge depth:-2""- Distance from top of sludge to bottom of outlet tee or baffle:-2$"- Scum thickness:_29"_ Distance from top of scum to top of outlet tee or baffle:_S1'_ Distance from bottom of scum to bottom of outlet tee or baffle:-18"_ How were dimensions determined:_'Pape 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.)_Inlet tee ok4 Nutlet tee okm Depth of liquid at outlet invert. No evidence of lealmgem- G +GRE ASE TRAP: (locate on site plan) Depth below grade: Material of construction:____,.concrete_metal—fiberglass_polyethylene_____other (explain): _ - Dimensions: _ Scum thickness: _ Distance lrom 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FOR "-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM DART C SYSTEM INFORMATION(continued) Property Address: 1020 Salern Street_ wNorth Andover owner:inspection:of Inspection: _12/17/2004, TIGHT or HOLDE14G TANK:_,,,_(tank midst be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX:_X.._ Depth of liquid level above outlet invert: _0_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc,):_D®box level&distribution equal.No evidence of leafage.Light solid carryover.D-Box cover broken.Replaced cover. PUMP CHAMBER:___(locate on site plan) Pump in working order(yes or no): __ Alarm in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): _ Page 9 of I 1 FILIAL INSPECTION F —NOT FOR VOLUNTARY RY ASSESS EN TS SUBSURFACE SEWAGE DISPOSAL sys,rEM I SPEcrION FORM PART C SYSTEM INFORMATION (continued) Property Address:_1070 Salem Street_ _North Andover Owner: Machonk- Date of inspection:_].7/17/7004_ SOIL SD "T1DN SYSTEM(SAS):—X—(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number, length:_7 trenches 60' long_ leaching fields,number,dimensions: s overflow cesspool,number:__ innovative/alternative system Type/name of technology: _ Comments(note condition of soil,signs of hydraulic failure:,level of ponding,damp soil,condition of vegetation, etc.):–Soil ok.Vegetation oL No sign of ponding to surface._ CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration:__ Depth–top of liquid to inlet invert: Depth of sludge layer:_ Depth of scum layer:_ Dimensions of cesspool: Materials of construction: a Indication of groundwater inflow(yes or no):_ 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 pending,condition of vegetation,etc.): Page 10 of I 1 SUBSURFACE E SEW E DISPOSAL SYSTEM INSPECTION T IO FORM PA T SYSTEM INFORMATION (continuedd) Property Address:_1020 Salem Street_ North Andover— Owner: Machonis_ Date of 1lrrspection:—12/17t2004— SKETCH OF SEWAGE DISPOSAL 'L'S'D E,M Provide a sketch of the sewage disposal system including tics to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Driveway A House Septic Tank Water Meter i11 U A to Tank®2816" 60' A to D-Box=5118" B to Tank=151$" 11 to D®Box=25'l.1" Page 1.I of 11 OFFICIAL INSPECTION FO —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART SYSTEM INFORMATION ATION(continued) Property Address: 1020 Salem Street- North Andover Owner: 1Vlachonis� Date of Inspection:_12A 2004_ SITE EXAM Slope Surface water Check cellar Shallow wells L""^stitnated depth to ground water _4'_ Please indicate(check)all methods used to determine the high ground water elevation; Obtained from system design plans on record-If checked,date of design plan reviewed:_819/1997_ 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 mast describe how you established the high ground water elevation:_as per design plan, no water 4' below trenches ;;✓"'�d'I .,,!"r 1 r ,p;ll t,,, „�';° p� an .1 r s' ,1*h °?; G �, i ''r;, ,t,,n� �,,,..,:. ,"nF,fi'J^ e "� Gi j 6;4n{ '� N rr% r� Z, ,l �N 1 w V I d P/i< A /� Mw cn pia +. • •• �• �rl< t kqX MCI M7% �bYY W kM kM Mw F�Id//+1s1 r d .. Mw '+1 M., MCI Mw W19 Mi'^A M w%r`IY Mw Mw M^Y w 4. Mw r w: Mrvr 4w MZn MCr c»Mw MwM Mw ur Mw ww+ G uv Mw � � � L�`� w M5 Mn Y1 Mw to 4 MFM MA k MCI MCI 4 Mkt Mw M,MkI MA " 11 V I/ w M'A On � + t ON { F Mi II MIT I � �r + q ' o Ilia' C • M M M1 i M LfN ISM MCI �Mbl IC'1 M,AV � I Y/, 4 M1i! II a M ♦ , r.ar .r � �Gr I„ . My >tcv ��Oft MwwwM.w Mw .wM�aMw M.wMwasaMZaMwMwMry 6. d( � r 1174w� M4 wx whw w"a M"^I M�Mw Mw war Mw �_ Mw M,1 w%Mw 4 ayCa � Mw LcM Mfi MY MA 1o`�A MtY 1 !I �' viol � / N l9 Yo 1 r �r @ Ti wa 1 Y ryI f I fs, I A �f , i? 4 i �r s� six M r r a , tt i h,,m ?s 1�1" rye sus/�k i' � p�°� s=m�,n="m�mn�°��""`mmu��1u`xnw»vumw"�" Town of North Andover Tax Map # 210-104,D-0185-0000,0 � 1020 SALEM STREET K8ACHONIS^ JOHN & KELLY 1020 SALEM STREET NORTH ANDOVER, MA 01845 cha—s-S-1-01 Single Family report Type 1 Residential Size Total 1xomo � py zoos LIB Kai|inn-Mmdwx Name/Address Type Loan Number A d ve/|nmvt. From until MACHON|8' JOHN & KELLY Puvor 1o2O SALEM STREET NORTH ANDOVER, MA 01V^s LIB Account K0aint. Account No Cycle Occupant Name Active/Inactive | Bldg |d. 3649.0 1020 SALEM 8T Last Billing Date 10/8/2004 / Active ' 3180370 Vn Cycle 0n LIB Services 01aint' Service Code-------- nmo Charge K8"uipn*r/umem wi|SCFeeADM|N FEE 0.63 5/8 7.82 1/ VVTRVVATER 01 ALL METER SIZE 381.31 /1 UB Meter 88aimtenanme . geria|mo-------gtouuu---- Location Brand Type Size YrnCvns 43983597 aAutivo sNCFl. 7 wvVu*,r 0.630.03 0 Date Reading Code . consumption Posted Date Variance 12/8/2004 1739 aAotuu| 20 -68Y6 Trovb|eCvdeoa 9/15/2004 1713 aAuma\ 94 10/8/2004 3796 rmuh|000uo:Oa 6/9/2004 1618 aAvtum| 21 7/30/2004 '52% Tm^b|eCvdn:0S 5/10/2004 1598 oAutua| 218 5/17/2004 12/11/2003 1380 n New Meter 0 12/11/2003 0Y6 Tel: (978) 475-4780 Fax: (97 8) 475®5451 BATESON Sy Excavating-Water. : Sewer Lines-Septic Systems&Dumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property ty Addy ess: 1020 S ➢ Street, North Andover Owner: Machonis Date of Inspection: 12/17/2004 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil . Bateson 0� Bateson Enterprises, Inc.