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Home My WebLink AboutCertificate of Compliance - 15 FOREST STREET 12/9/1999 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 12/09/99 This is to certify that the individual subsurface disposal system constructed () or repaired (X) by Ben Osgood, Jr. at 15 Forest Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit# 1077 dated 7/1/99. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 12/09/99 This is to certify that the individual subsurface disposal system constructed () or repaired (X) by Ben Osgood, Jr. at 15 Forest Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit# 1077 dated 7/1/99. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATION & DENEENSTONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES & DWELL NiG, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/TN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D-BOX STAMP & SIGNATURE EMPERVIOUS,AREAS - DRIVEWAYS, ETC, NORTH ARROW FINAL CONTOURS LOCATION &, ELEVATION OF BE-i\q'CI-E\/tARX USED LOCUS PLAIN vp .✓,.+:-"-r.ny' Si,riC^rr^J'.s C�•.,`w .n7. y P .:;S'" .:=.f'''G':-�"7, ', .dCy r'Rt.,',y�.'�,,"�:..N✓^,'k`•.,, `r.,��^�X%,."•. .�.:r±,a"' j ' t TOWN' 0F ,NOR.!TH AND 0VER SE`s AGE DISPO,S.II: SYSTEA4 1`\,STA.Z LA'FION CERTIFICATION The under-slimed here:-v c-erilry that the `ewaf?? Disposal System. (K.) repaired. bv i—_— located at_ 1 , .. j--t cr,,,yd°was installed in confc.-mance with the North Andover Board of"Health a::provec plan, Svstem Design ?e; it i dated J-I—el _• wim an approved desi�12n flow of #1/ gailons per day. The matei7iajis usea were in corirormar..e w those speuved on the apprc,,-ed plan; the syster:, was installed in accordar.cc -,,,ith the C revisions of 10 C,'vfR l; 000, Title 5 and local reEnalatior,s, and the anal Ezradlr', aryrees substantially with the approved plan. .-ail work as accurateiy represented ,)c the A.S-built which has been sub-pitted to the Board c-?-ealth Led inspection date l!0 1 FnCineer R;pr��.e:;.�tive Final inspection cate / + Nei —_—_ Ell4ire°r ltepreser.rir:.e _-- Installer: _ L;c m Date: Deswr, Encincer: �- - __.— _-- ----- -- Date �_ .�_------ , .a NEW ENGLAND NG wow uu uuu SERVICES December 7, 1999 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 15 Forest Street septic system installation Dear Sandra: Enclosed is the as built plan and the engineers certification for 15 Forest Street. When the certificate of compliance is issued would you kindly fax a copy to this office at 978-685-1099. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, Benja m C. Osgood;Tr., EIT President 60 BEEC3&°3wC)OD DRIVE -N0131 H ANDOVER, MA 01845 - (975)686-1768-(ESA'8)3597645-FAX(!78)685.8099 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property: 15 FORE,ST STREET,NORTH ANDOVER Owner's name: JEFFREY& KARE N PC,ARL Date of Inspection: MARCH 2s, 1995 PART A- CHECKLIST Check if the following have been done, V Pumping information was requested of owner, occupant and the Board of Health. Y None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. • As-built plans have been obtained and examined. Note if they are not available. • The facility or dwelling was inspected for signs of sewage back-up. • The site was inspected for signs of breakout. • All system components, excluding the SAS, have been located on the site. • The septic tank manholes were uncovered, opened and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum. Y The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. Y The facility owner(and occupants if different from owner) were provided with information on the proper maintenance of SSDS. Depth to Groundwater: Groundwater not encountered. Method of Determination of Groundwater Depth: Test pits conducted by C.T.Assoc.in 1989 (Data on file at the North Andover BOH)recorded no groundwater at depths of tell feet(10') beneath grade.No other evidence indicates that this information is inaccurate.In fact,surface water/seasonal pond located approx. 1/4 mile from site estimated to be well below 10' of existing grade; Building site sits on the top of a rise-the high point of this subdivision. 2. SUBSURFACE DISPOSAL SYSTEM INSPECTION FORM PART B - SYSTEM INFORMATION FLOW CONDITIONS 3 Number of bedrooms 3 Number of cut-rent residents Garbage grinder(Y/N) * Laundry connected to system (Y/N) * Seasonal Use(Y/N) If residential, calculated flow: 3 Bedrooms x 110 gal/day/bedroom=330 gal/day Water meter readings if available: N/A Last date of occupancy: Presently Occupied GENERAL INFORMATION Pumping records and source of information: Statement from owner-Pumped four(4)weeks ago and two(2)years before that. Y System pumped as part of inspection? (Y/N) Volume Pumped:Approx. 1,000 gal. Reason for pumping:M.P.H. Public& Etivit-onmentalHealth policy, Type of system: Septic tank,D-box, soil absorption system Single cesspool Overflow cesspool Privy —Shared System (Attach previous inspection records, if any.) Other: 3. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B - SYSTEM INFORMATION (Cont'd.) Approximate age of all components; Date installed; source of information:According to records provided by the Real Estate Agent and a statement by the owner,the house was built in 1991. N Sewage odors detected when arriving at site? (Y/N) SEPTIC TANK : See attached As-Built Plan and Cross Section of the Septic Tank for the following data- -Location -Dimensions -Depth below grade: - Sludge Depth: -Distance from top of sludge to bottom of tee or baffle: - 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: Material of construction: –X—concrete; metal; FRP; other(explain) Comments: (Recommendations for repairs; condition of inlet/outlet tees or baffles; depth of liquid in relation to outlet invert; structural integrity; evidence of leaking, etc.)- Because the house had a previous offer which may have caused the transfer of title prior to the March 31 implementation date of the revised Title 5,the tank was completely pumped about four weeks ago. Just the same,the tank was pumped again to thoroughly observe its condition.No defects were observed and the tank appeared to properly operating at the time of inspection. DISTRIBUTION BOX -location: See attached Site Plan o" Depth of liquid level above outlet invert. Comments: (Note if distribution is equal, evidence of solids carryover, evidence of leaking, recommendations for repairs, etc.)-The inlet pipe in the D-Box appeared to be cocked slightly upward and a recessed area running across the yard from the septic tank to the D-box indicates a possible settling of this pipe.Also,the unsigned As-Built Plan on file at the BOH shows three(3)leaching pits.In reality,only one line was observed exiting the D-box apparently feeding a single pit.None-the-less,the absence of effluent build-up in the tank or D-box indicates to me that the system does not fail to protect public health. r , �y C/) ~ I V r ,y Cn a r C7 r Z CD O - r 0 0 CD r CD 00 00 00 n -0 y ly \v • 00 00 00 IL 3 33 1 0 00 0 y �y '^ h ^� cn k CD 0 � r N CD CD m C: y Iy d � r y I� r con CD � N � cn � ' CD � C =3 cf) � C�- a (� �} �■ ' cn o 0 C/)B < CD CD ,,_f_ w N C�)'7 CO C" C) v0 CQ C�j O U) C n 1 V co N N Cc °o - 4. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B - SYSTEM CONDITION (Cont'd.) SOIL ABSORPTION SYSTEM(SAS) *See Site Plan for location if possible. Excavation not required, but may be approximated by non-intrusive methods. Determined type: -Leaching pits & number: Most probably,a single leaching pit. -Leaching chambers &number -Leaching galleries &number -Leaching trenches &number -Leaching field& dimensions Comments: (Note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.)-No signs of any type of failure were evident at the time of inspection. CESSPOOLS *See Site Plan for:N/A -Location -Dimensions -Number& configuration -Depth from the top of liquid to the inlet invert -Depth of scum layer -Depth of solids layer -Materials of construction - Indication of groundwater Cesspools must be pumped as part of inspection. Was inflow noted? (Y/N) Comments: (Note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,recommendations for maintenance or repair, etc.) PRIVY *See Site Plan for location, materials of construction, dimensions, depth of solids. Comments: N/A 5. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C-FAILURE CRITERIA Indicate yes, no or not determined(Y,N,ND). Describe basis of determination in all instances. If"not determined", explain why.) _A_Backup of sewage into the facility or dwelling? N Discharge or ponding of effluent to the surface of the ground or surface waters? N Static liquid level in the distribution box above outlet invert? • Liquid depth in cesspool <6"below invert, or available volume<1/2 day flow? • Required pumping 4 times or more within the last year?Number of times pumped?_0 N Septic tank is metal, cracked, structurally unsound, substantial infiltration or exfiltration, tank failure imminent? Is any portion of the SAS, cesspool or privy: • Below the high groundwater elevation? • Within 50 feet of a surface water? N Within 100 feet of a surface water supply or tributary to a surface water supply? • Within a Zone I of a public well. N Within 50 feet of a bordering vegetated wetland or salt marsh? (Cesspools and privies only, not the SAS.) • Within 50 feet of a private well? • Less than 100 feet, but greater than 50 feet from a private water supply well with no acceptable water quality analyses?If the well has been analyzed to be acceptable, attach a copy of the well analyses for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 6. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D - CERTIFICATION Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Check one: X I have not found any information which indicates that the system fails to adequately protect public health or the environment defined in 310 CMR 15.303 Any failure criteria not evaluated are as stated in PART C - FAILURE CRITERIA. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in PART C- FAILURE CRITERIA, March 25, 1995 Pefer M. Mirandi, R.S., MY.H. Date M.P.H. Public& Environmental Health 30 Washington Street Danvers, MA 01923 508/774-3001 Original to system owner; Copies to: Buyer; Board of Health f - W c o o z s a o J O LL W 0 J (n, _ W "=3 Z a 3 m p c o Z .J W a) Cl. ; 2 U oL Q ce a .� L W N o c o z Q bn -o c O OU a Mid Y Q L- VI t �/ N o O O z m o 3 0 O o o � 3 Q i N z N V) O OOJER *** O Q. 0 to ! NMOl ,s a* Q to a. to LL