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HomeMy WebLinkAboutTitle V Inspection Report - 890 JOHNSON STREET 4/8/2004 COMMONWEALTH OF MASSACHUSETTS x g EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 TITLE 5 OFFICIAL INSPECTION FORM ®NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FOAM PART A �e CERTIFICATION � Property Address:_890 Johnson Street_ _North Andover_ Owner's Name:_Craig Wilson_ Owner's Address:_890 Johnson Street_ _North Andover,A A 01845® Date of Inspection:— Name of Inspector:Veil J.Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,Ma.01810® Telephone Number:_(978)475-4786_ CERTIFICATION STATEMENT 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 CR 15.000). The system: ® Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: > 6� -13-D ate: _4/8/2004_ 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 DEP.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 I1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_890 Johnson Street_ _North Andover- Owner: Wilson_ Date of Inspectio_ n:_4/8/2004_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D 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 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. 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 INSPECTION FORM ® NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_890 Johnson Street_ _North Andover_ Owner:_Wilson_ Date of Inspection:_4/8/2004_ 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 or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance__ "This system passes if the well water analysis,performed at a DEP certified laboratory,for 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 11 OFFICIAL INSPECTION FO —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:—590 Johnson Street_ —North Andover_ Owner: Wilson— Date of Inspection:_4/5/2004_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ _No Backup of sewage into facility or s sy tem component due to overloaded or clogged SAS or cesspool No 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''/z day flow. —No7 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. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No_ 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 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 he attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• 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 T _ 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 _ T 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_890 Johnson Street_ _North Andover- Owner:_Wilson_ Date of Inspection:_4/8/2004_ Check if the following have been done You must indicate`des"or"no"as to each of the following. Yes No Yes_ — Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks? _Yes — Has the system received normal 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?(If they were not available note as N/A) 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? _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. —_ _No_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_890 Johnson Street_ _North Andover- Owner:_Wilson_ Date of Inspection:_4/8/2004_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_440_ Number of current residents: Does residence have a garbage grinder(yes or no): No_ 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): Yes_ Last date of occupancy:— Current-COMMERCIAL/INDUSTRIAL 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(describe): GENERAL INFORMATION Pumping Records Source of information:_Pumped 2001,owner_ Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1000_gallons--How was quantity pumped determined?_Measured Tank Reason for pumping: _Inspect Tank&Tees_ TYPE OF SYSTEM X_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) Tight tank _Attach a copy of the DEP approval _Other(describe):_ Approximate age of all components,date installed(if known)and source of information:Tank original,D-Bog& SAS installed 6//1996 Were sewage odors detected when arriving at the site(yes or no):_No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 890 Johnson Street_ ^_North Andover— Owner: Wilson Date of Inspection:_4/8/2004_ BUILDING SEWER_X_ (locate on site plan) Depth below grade:_20" Materials of construction: _X cast iron 40 PVC_other Distance from private water supply well or suction line Comments(on condition of joints,venting,evidence of leakage,etc.):_4"Cast Iron thru wall&in house,no leaks visible SEPTIC TANK: X_(locate on site plan) Depth below grade:_S" Material of construction: -X-concrete metal_fiberglass__polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:_7'x 5'x 4'_ Sludge depth:—311_ Distance from top of sludge to bottom of outlet tee or baffle: 24"_ Scum thickness: Distance from top of scum to top of outlet tee or baffle:_S"_ Distance from bottom of scum to bottom of outlet tee or baffle:_15"_ How were dimensions determined:__ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):_Pumped septic tank.Inlet tee ok.Outlet tee ok. No evidence of septic tank leaking. Depth of liquid at outlet invert. _ GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete metal fiberglass_polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: 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 FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_890 Johnson Street- -North Andover_ Owner:_Wilson_ Date of Inspection:_4/8/2004_ TIGHT or HOLDING TANK: (tank must 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_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _011 _ 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 leakage out of d-boat. Evidence of solid carryover,pumped d-box to clean_ PUMP CHAMBER: X (locate on site plan) Pump in working order(yes or no):_Yes_ Alarm in working order(yes or no):—Yes_ Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): _Pump&pump chamber ok.Alarm both audible&visual Page 9 of 11 OFFICIAL, INSPECTION FO —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_890 Johnson Street_ _North Andover_ Owner: Wilson_ Date of Inspectio_ n:_4/8/2004_ SOIL,ABSORPTION 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:_4 trenches 40'long_ — leaching fields,number,dimensions: 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 ok.No sign of ponding to surface_ CESSPOOLS: (cesspool must be pumped as part of inspectionXIocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes 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 ponding,condition of vegetation,etc.): Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_890 Johnson Street_ _North Andover_ Owner:_Wilson_ Date of Inspection:_4/8/2004_ SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch 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. Driveway Water Meter Garage House A Porch 1 Septic Tank D- -- Box A to Inlet=18'6" A to Outlet=2118" 2 A to Pump Tank=26'6" A to D-Box=2316" B to Inlet=8 B to Outlet=10'2" Pump B to Pump Tank=16'6" Tank B to D-Box=4314" Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_890 Johnson Street_ _North Andover- Owner:_Wilson_ Date of 1Gnspection:_4/8/2004_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _49— Please indicate(check)all methods used to determine the high ground water elevation: _X_ Obtained from system design plans on record-If checked,date of design plan reviewed:_6/11/1996_ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:_ Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: _ You must describe how you established the high ground water elevation: Design Plan_ r��''•�,, 4 riy, at{4R {p r "1.rtylUp�f ti Q}}� _3 =r,t - �■ n �: - tc H 1M p� t 0 � AM " �' 3 b i 10 7. t rn yf w 4 r� f Ip 1 j rTr / J4 CD rrfQc-v30v0^wN"N(M%CM 3MM 44WNr i x ti f± f �NNNNNNNNNNNNNNt+F+F+N C7 1 H a ttlmmNmmmmmmm616119m+0+0�0+0' •C m + � mwmcm0mm©©ml9f9mm�G+o�O�D g b • X` ;: 'WW -41-400000 41-+IDmm®® R'' � I M `W r Si+F+�AWN1pWNF+NfAWN1-•I�NF+M z� �t ; ONNNNNNNNNNNNNN�DO�Wm I t" .. k Eli,r �<kx€ r,t t�sfmf9mm�61mF+ml+mmh►mF►ml9Q 1 z " xi ,�"7•7• �y CDOOfJ1WNfJ1NF+ODh+Et1WN09NNfJ1y cc 1 C) rQZ fl: 1. ;,,, Y•""`"" 1"N. 1-I f'" $ Y o 1`N;o�r+m;ooftaNCn,ocn+oa►cnu7 rcf CO 3 " , NNNNNNNNNF+NNijrF•rrl-• C'� I f-1 _ _ • �y t ��;: ��'`�� F _ s�mma�mmmmm©+olsm�o•o.oa•o�a tsi i O . ,- , '�, • � ��� C 'ZN @NNimhm+�6ml��mm��q+�0�� j;K . 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L; l9@m @Q K Ct9 .p ,taAwww r = z l 9 I W A .µco G@ri N N ." 1 Czi Go RL NNW N x W W W w N . 1 K In om • r tJ7 N®OO fJ'1 W m � CDWwIaU t9 + W -�;� x p G�C17N@ar ZC.O l+COWW@ FiOZ K .x 'F fIDObCf a GWt cnmwW t on w y CM ho -•-�' �n t!7 U7 fJ1 th,1d•ti i Y•-� I i.{r' L } WN�O�Otip Coif N , x �a •Y NN��7�7 �� Y 3� =• WNti7W17 � i i M1 d. #t' iF t Tel: (978) 475-4786 Fax: (978) 475-5451 Excavating-Water.& Sewer Lines-Septic Systems &Pumping Service 111 Argilla Road Andover, Mass. 01 8 10 Title 5 Inspection Report Property Address: 890 Johnson Street Owner: Wilson Date of Inspection: 4/8/2004 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 J. Bateson Bateson Enterprises, Inc. Town of North Andover of f NORTH .1 OFFICE OF �? �'"• 4, COMMUNTTY DEVELOPMENT AND SERVICES ° . % 146 Main Street *, ° North Andover, Massachusetts 01845 - SSACHUSE� TOWN OF NORTH ANDOVER BOARD OF HEALTH June 18, 1996 CERTIFICATE OF COMPLIANCE This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by MICHAEL REILLY installer at 890 JOHNSON STREET been installed in accordance with the provisions of TITLE 5 of t-h-e State Sanitary Code and with Board of Health regulation-s as described in the Design Approval Permit # 839 dated 5/28/96 . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY. Board of Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535