HomeMy WebLinkAboutTitle V Inspection Report - 66 MARIAN DRIVE 5/14/1997 Ccmmonweafth of Massachusetts
Executive office of Environmental affairs
Department of
Environmental Protection
Metre, Boston/Northeast Regional Office
WORem F. Weld
Trudy S. Q ,
Sea".ECEA DoWd IL Struhs
nor
STIBSURFACE SEWAGE D SYSTEM RMECTION FORM
PART A
CERTIFICATION
66 Marian Drive Address of
Dads oflnspactiozc N.Andover, MA (I . )
Ne,s,of 5/13/97
N jj . Jr.
R.J. Inspections x'308 )681 -8759
1 Osgood St. , Methuen, MA 01844
�TCATTOrr sTA
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 inspection. The inspec*.3on was performed based on my training and "
experience in the proper func don and
maintenance of on-site sewage disposal systems. The system;
5
® Passes
® Conditionally Passes
eeds Further Evaluation By the Local Approving Authority
Falls
Ins s S` Date:
The System
pec*.or shall submit a copy of this inspection report to the Approving Authorii' within t'sirvy(30) days Of completing this
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 Department of Environmental Protection.
The original should be sent to the system.owner and copies sent to the buyer, if applicable and the app roving authority.
INSPECTION SUICKARY.
Check A, B, C, or D:
A7 SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM. 15.303.
Any failure criteria not evaluated are indicated below.
B1 SYSTEM CONDITIONALLY PASSES:
One or Components to be replaced or repaired. The 3yst0m, upon p of the replacement or repair,
Indicate Yen, no, or not determined CY,Fl, or ). Des=ibe basis of determination in all i, axlras, If"not lain,why not)
imminent. The systean turally unsound,shows or is
will pass inxpectiou if the wdsting septic tank is rep with a confo septic as app
by the Board of °
(revised 3/15/95) 1
10 Commerce Way 0 Woburn,Mawachuseft 01801 a FAX o Telephone
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,`settled or uneven distribution,box. The system will pass inspection if(with approval of the
Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
' F
j
(revised 8/15/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(
PzapertyAddresw 66 Marian Drive, N. Andover, MA
Joseph L. & Gertrude A. Iannazzi
Data of 5/13/97
B]SYSTEM CONDITIONALLY PASSES(continued)
The system required pumping more than four times a year due to broksn 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
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH
Conditions wrist which require further evejuation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE)DETERM]NES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFI=AND THE _
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100•feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis 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.
DI SYSTEM FAII
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR. 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
SBacknp of sewage into facility or system component due to an overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool
Ll/Static liquid level in the distribution box above outlet invert due to an cimloaded or clogged SAS or cesspooL
Liquid depth in cesspool is less than P below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
(revised 8/15/95) 3
Number of times pumped
® Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool 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 I of a public well. "
r
(revised 8/15/95)
SIIBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
tooe:tvAddzaw- 66 Marian Drive, N. Andover, MA
Wner Joseph L. & Gertrude A. Iannazzi
stn of Ias2ee11' 5/13/97
I SYSTEM FAILS(hued):
Any portion of a 1 or privy is within 50 feet of a private water supply well.
Any porti f or privy is less than 100 feet but greater than 50 feet from.a private water supply well with no
acceptab analysis. If the well has been analyzed to be acceptable,attach copy of well`water analysis for
coliform latile organic compounds, ammonia nitrogen and nitrate nitrogen-
3 LARGE SYSTEM FAIIS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater(Large System) and the system is a significant threat to public
iealth and safety and the environment because one or more of the following conditions exist:
the system/sv 4 f f a surface drinking water supply
the system is wi 2 net of a tributary to a surface drinking water supply
the system is l ted in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA) or a mapped Zone II of a public
water supply well)
The 6wner or operator of any such system shall bring the system and facility into full compliance with the grau dwater treatment program
requirements of 314 CUR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
PART B
CHECKLIST
Check if the following have been done:
_Pulmping information was requested of the owner, occupant,and Board of Health.
L/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.
t plans have been obtained and examined. Note if they are not available with N/A
he facility or dweller was inspected for signs of sewage back-up.
�!The system does not receive non sanitary or industrial waste flow
fg:f�site was inspected for signs of breakout.
_AIL system components, excluding the Soil Absorption System,have been located on the site.
(revised 8/15/95) 5
n'septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected
condition of baffies or tees, material of construction, dimensions, de th of li p far
p quid, depth of sludge, depth of scum.
®The size and location of the Sail Absorption System on the site has been determined based on existing
information or approximated by non-intrusive methods.
facility.owner(and occupants, if different from owner)were provided with information on the proper
maintenance of Sub-.Surface Disposal System.
i
j
(revised 8/15/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
. 66 Marian Drive. N.Andover, MA
Joseph L. & Gertrude A. Iannazzi
Date of 5/13/97
FLOW CONDITIONS .
IRS=�iTIc�L:
Design flaw:�X- .: ,{
Number of bedrooms r
Number of current
Garbage grinder(yea or—): e
Laundry connected to system(Tes or no):"oVZf
Seasonal use(yes or no): f/of
Water meter readings,if available-
Last date of occupancy: y
CO IISTRLiL
Type of estaibHsnment•
Design flow: gallons/day
Grease trap present: (yes or )
Industrial Waste Ho S present: (yes or no)_
Non-sanitary a Title 5 system: (yes or no)_ ,
Water meter re if
Last date of cc-cup cy:
CT (Des )
Last data of o==anc;:
GMTMkL IAiz'OR'MATION
PUMPING RECORDS_Alid source of' ormadon- /
L' / 'l�i�C7 � e
System pumped as part of inspection: (yes or no'_
If yes,volume pumped. gallons
Reason for pumping:
TYPE OF SYSP-7-d
peptic tangy distzrilution box/soil adsorption system
Single cesspool
Overflow cesspool
Prrvy
Shared system(yes or no) (if yes, attach previous inspection records, if any)
Other(expiain)
APPWXIMA 'g AGE of all components, date installed(if!mown) and source of information:
Sewage cdaa detec=xd when arriving at the site: (yes or no)
(revised 8/15/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(wed)
PropwtyAddrees 66 Marian Drive. N.Andover, MA
Owner Joseph L. & Gertrude A. Iannazzi
Da"'Of ' 5/13/97
SEPTIC TANK
(locate on site plan) _
Depth below.grade:-L
Material of construction:L, icrete metal FRP cther(eaplainT
Dimensions: _
Sludge depth:
i
Distance from top of sludge to bottom of outlet tee or baffle: �2e
Scum tluclmess:
Distance from top of scum to top of outlet tee or i3qffle: S
Distance from bottom of scum to bottom of outlet tee or baffle: /,
Comments:
(recommendation for pumping, condition of inlet and out'_et tees or baffles,depth of liquid level in relation to outlet invert, st:zc:ural inte3r ty,
evidence of age,etc.) _ _
�c r /
GREASE TRAP:
(locate on site plan)
Dept's below grade:
Material of construction:_concrete_metal_FRP_at r(explain)
Dimensions:
SCu:m tS,irlmean•
Distance from p of 0 1 p of outlet tee or baffle:
Distance from o s to bottom of outlet tee or baffle:
Comments: .
( tion for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,stnrctural inter
evidence of leakage, etc.)
(revised 8/15/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAST C
SYSTEM INFORMATION
66 Marian Drive. N. Andover, MA
O-W-6- Joseph L. & Gertrude A. Iannazzi
I?ate of
TIGHT OR HOLDING TANS_ '
(locate on site plan)
Depth below grade:
Material of construction: ---co _metal_FRP_other(ezplain)
Dimensions:
Capacity: o
Design flow
Alarm level•
L'omments: s
(condition of inlet , condition of alarm and float switches,etc.)
DISTRIBUTION BOZ_
(locate on site plan)
Depth of liquid level above outlet invert:_
Comments:
(note "level and distribution is equal, evidence of solids er, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:
(locate on site plan)
Pumps in working order-(yes or no)
Comments
(note condition f condition of pumps and appurtenances, etc.)
(revised 8/15/95) 9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continned)
pnp,rty 66• Marian Drive, N. Andover, MA
Owner- Joseph L. & Gertrude A. Iannazzi
Dsbe of bwpeetioa: 5/13/9 7
SOIL ABSORPTION SYSTEM(.SAS):—
(locate on site plan, if pomlle;excavation not required,but may be approximated by non-intrusive methods)
f
If not determined to be present,explain:
Type:
leaching pits,number._
legAing chambers,number:_
leaching galleries,number. ,
leaching trenches,number,length:
leaching fields,number,dimensions:/+
overflow cesspool,number:
Comments: (nqte condition of soil, signs of hydraulic failure, el of nding,condition of vegetation,etc.)
42 /sue rX 1-5 /7/C' -7
CESSPOOLS:
(locate on site plan)
Number and configuration.
Depth-top of liquid to inlet invert:
Depth of solids layer.
Depth of scum layer.
Dimensions of
Materials of construction:
Indication of graundwa
inflow( 1 must be pumped as part of inspection)
Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,'etc.)
PRIVY /
(locate on site plan)
Materials of eonstruction: Dimensions:
Depth of solids:
Comments: (note n of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
(revised 8/15/95) 10
SUBSURFACE SEWAGE DISPOSAL SYSTEK SECTION FORM
PAST C
SYSTEM INFORMATION(
: 66 Marian Drive, N. Andover, MA
Owner_ Joseph L. & Gertrude A. Iannazzi
Dabs of InspeCtim- 5/13/97
SEW=OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks 8
locate all wells within 100'
a
(revised 8/15/95) 11
DEPTH TO GROUNDWATER
Depth to pnundwater.i i "f t
method of determination prarimation• z
d
(revised 8/15195) 12