HomeMy WebLinkAboutTitle V Inspection Report - 41 CEDAR LANE 5/31/2000 NEW I ERI G SEI VICES
....
INC
June 9, 2000
North Andover Board of Health
Town Hall Annex
27 Charles Street
North Andover, MA 01845
RE: TITLE V REPORT: 41 Cedar Lane, North Andover
Dear Sirs:
Enclosed is a copy of the Title V report for the above referenced property. The system ap ssed our
inspection.
If there are any questions please call me at my office, 686-1768.
Sincerely
Benjamin C. Osgood Jr.; I.T.
President
60 BE ECH WC7OD DRIVE..NOR"Hq ANDOVER, MA 01845-(978)55E1-17615-(888)559.75451-FAX(978)685-1099
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C&MONWEALTH OF MASSACHUSE'd"I'S
` EXECUTIVE'OFFICE OF ENVIRONMVNTAL AFFAIRS ';ti '
DEPARTMENT OF EN MONMENTAL PROTECTION
r ONE WINTER STREET,BOSTON MA 02108 (617)29M500
y.4
Secretary,,,:
ARGEO PAUL CELLUCCI DAVID 0 STFtUIiB;
' Governor Comui)sr�oper:i:�
SUBSURFACE SEWAGE DISPOSAL SYSTEM.WSPECTiON FORM
PART A
CERTIFICATION
Property Address:Z/I SPA(AV JA , N,A.v Ao v e(" Name of owner/—A e e >7„C 14 ee'
Address of Owner:y I.(e,,�AJC LN,
Date of kupection: 00 No c T rl' AA)Ao v0('
Name of inspector:(Please Print) Benjamin C. Osgood,Jr.
I am a DEP approved system Inspector pursuant to Section 15.340 of Tide 5(310•CMR 15.000)
company Narnie: New .England {EnIzineering Services Inc.
Mailing Address: 60 Beechwood Drive North Andover, MA
Telephone Number: 978-686-1768
CERTIFICATION STATEMENT
I certify that 1 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 Inspection was performed based on my training and experience In the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails-
inspectors Signature: Date:
The System inspector shall s mit a copy of t s Inspection report to the Approving Authority(Board of Health or DEP)whhin thirty(301-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 Department atrEnvironmental Protection. The original should'be sent to t1m
system owner•and copies sent to the buyer,If applicable,and the approving authority.,
NOTES AND COMMENTS
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revised 9/2/98 Pate t of 11
_..-
! cr inc'rRFACE SEWAGE DISPOSAL SYSTEM INSPECTION- ORM r{
Property Address: 41 Cedar Ln. PART'A ! '
CERTIFICATION'(contintiod) r,
North Andover
Owner:Larry Durkee
F.
Date of Inspection: 5/26/00
INSPECTION SUMMARY: Check A, •B, or D:
A; SYSTEM SYSTEM PASSES:
/ j
V I have not found any Information which Indicates that any of the failure conditions described in 310 CMR 15:303 exist. Any failure'
criteria not oval ated 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 Hei%4,will pass.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all Instances. If'not determined",explain why not:
_ The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of
Compliance(attached)Indicating that the tank was installed within twenty(20)years prior to the date of the inspectioh;or
the septic tank,whether or not metal,is cracked,structurally unsound, shows substantial Infiltration or exfiltration,or tank
failure is imminent., The system will pass inspection If the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
_ Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pipes)
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
- The system required pumphtMM than•four•times n yerardae to broken or obstructed pipe(s). The vyrtcm v7*t-pass"
inspection If(with approval of the Board of-Health):
broken pipe(s)are replaced
obstruction Is removed
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1 S
revised 9/2/98 Page 2ofII
'ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
'Property Address: ,41 Cedar Ln. PART A
:t J�
i North Andover CERTIFICATION(continued)
i.
Owner:Larry Durkee '
Date of Inspection: 5/26/00
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Corididohs exist which require further evaluation by the Board of Health in order(o determine If the system is faring to protect the
public health,safety and the environment.
1) SYSTEM WiLL PASS UNLESS BOARD OF HEALTH DETERMNES IN ACCORDANCE WiTH 310 CMR 1.6.303(1)(b)- HAT THE SYSTIDJ
IS NOT FUNCTIONING IN A MANNER WH•ICHA yIL PRQTECT•THE PUBLIC HEALTFLAND SAFETY.AND THE ENMIRONMEN1.
_ Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a sell 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 AND SAFETY AND THE ENVIRONMENT:
_ The system has a septic tank and soil absorption system(SASI 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 soil absorption system and the SAS is within a Zone I of a public water supply welli
_ The system has a septic tank and soil absorption system and the SAS is within So feet of a�prlvate water supply well.
_ The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysts 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. Method used to determine distance (approximation not vafid).
31 OTHER
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revised 9/2/98 Psge3ofIt
►A
• 4
SUBSURF CESEWAGE DISPOSAL SYSTEM INSPECTION FORM i L•
r PART A i :+;
CERTIFICATION(continued)
Property Address: 41 Cedar Ln.
North Andover ,
Owner:Larry Durkee
I Date of Inspection: 5/26/00
D. SYSTEM FAILS:
You must indicate either"Yes"or"No", to each of the following; l ,
I have determined that one or more of the following failure conditions exist as described In 310 CMR 16.303. The basis for this
determination is identified below. The Bperd of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of"Wage late ieciR"r-rT3temcomponent•due Ko en overloaded orcioggedSASor,cesspool.• "s?A•-
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool
Static liquid level In the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" 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).
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(s-within a Zone I of a public well. ,
— Any portion of a,cesspool or privy is within 50 feet of a'private water supply well.
_ Any portion of a cesspool or privy Is less than 100 feet but greater than 60 feet from a private water supply well with no,
acceptable water quality analysis. if the well has been analyzed to be acceptable,attach copy of well water analysts for
»coliform bacteria,volatile organic-compounds,ammonia.nitrogen•and nitrate nitrogen. -
E.: LARGE SYSTEM FAILS:
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:
The system serves a facility with a design flow V 1:0,000 gpd or greater(Large System)and the system is a significant thra§t to public
health and safety and the environment because one or more of the following conditions exist:
r r
Yes No
the system is within 400 feet of a surface drinking water supply
the system-le-within200 teetof�trilr�tary le��urlaoe drinkiwy water strry�ly•.. • '_ -
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area:IWPAi or a mapped Zone li of a public
water supply welt) r r r
The owner or operator of any such system shall upgrade the fystem in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further Information.
revised 9/2/98 rege4of11
.urn
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIQ,N FORM t<
PART B
CHECKLIST
ON
Property Address: 41 Cedar Ln. it4 �
,t
North Andover
Owner:Larry Durkee
Date of Inspection: 5/26/00
Check If the following have been dome:You must Indicate either"Yes" or"No" as to each of the following: �• ;
V No
VV
_ _ Pulping information was provided'by the owner,occupant,or Board of Health.
v None of the jystemcon oaanu.ha --beon pumped+for-etlsait tvto•wP�ks aruf•the'+ystam haz6asaascalaiwgw�acal ftow
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 with N/A.
_J _ -The,
facility or dwelling was inspected for sighs of sewage back-up.
Z _ The system does not receive non-sanitary or industrial waste flow.
v _ The site was inspected for signs of breakout.
_ All system components,excluding the Soil Absorption System,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 toes,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System orrthe site has been determined based on:
Existing information.For example, Plan at B.O.H.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance Is unact:eptable)
11 5.302(3)(b))
Thq fac(Gty owaar(and-oc=paau,Jf different tram nwnerl.ware p urlded.wtth 1„four f:„aan rhm prApAr gInten• ^°^_f
SubSurface Disposal Systems.
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revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSA i SYSTEM INSPECTION FORM
..iti
PART r i4
Property Address: 41 Cedar Ln. SYSTEM tt1FOhMAT10N
North Andover
Owner:Larry Durkee 1ka �s
Date of Inspection: 5/26/00
FLOW CONDITIONS
RESIDENTIAL: '
Deslpn flow: g.p.d./bedroorn. 31 9fy r
Number of bedrooms{design):_ ' Number of Bedrooms(actual):
Total DESIGN flow D/iJ 1 yyEGi FICI� t�1J DE�f�N f�wNS yf
G62mber of current residents:,
rbage grinder(yes or no):tVo
Laundry(separate system) (yes or no):_: If yes,separate.Inspectiomroquired-
• Laundry system Inspected (yes or no) ,
Seasonal use (yes or no):_
Water meter readings,if available(last two year's usage(gpd): 1.11 eLL
Sump Pump(yes or no): /o-
Lest date of occupancy:CL2C
COMM ERCIALfINDUSTRIAL:'
i
Type of establishment:
Design flow: qpd (Based on 15.203)
Basis of design flow
Grease trap present:(yes or no)_
Industrial Waste Holding Tank present:(yes or no)_
Non-sanitary waste discharged to the Title b system:(yes or no)_
Water meter readings,if available: -
Last date of occupancy:
OjHER:(Describe) ,
Lest date of occupancy:
GENERAL INFORMATION.
PUMPING RECORDS and source of information:
System pumped as part of inspection:(yes or no)&Jj
If yes,volume pumped: gallons
Reason for pumping:
STYPE O YSTEIM
eptic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool :.
Privy
Shaved system(yes or no) (if yes,attach previous(nspeption records,If any)
I/A Technology etc:Attach copy of up to date operation and maintenance contract
s Tight Tank Copy of DEP Approval 6
f
Other -}- 1 �}
APPROXIMATE AGE of all components,date Installed4if-known)-and source otdnformation: -•--�- J t'l3�,L �`Q '` -`
Sewage odors detected when•artiving at the site:(yes or no) f
revised 9/2/98 pate 6orit
• r y
' SUBSPRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
Property Address: 41 Cedar Ln. SYSTEM INFORMAT1oN(continued)_ J.
North Andover
Owner:Larry Durkee
Date of inspection: 5/26/00
r"
BUILDING SEWER:
i (Locate on site plant
U
Depth below grade.-Ii I ,
Materiel of construction: _cast Iron_40 PVC_other(explain)
Distance from private.water supply well or su Lion line
Diameter
Comments:(condition of Points,vegting,evidence offoak-"e,-etc.)
Foj',SHed 5AS6m& vi A)o�v V•SAP,46
SEPTIC TANK:_
(locate on site plan)
Depth'below grade, I Z
Material of construction: X concrete_metal_Fiberglass _Polyethylene_other explain)
If tank Is metal,list age_ 1s.age.confumed by Certificate of Compliance_(Yes/No)
Dimensions: I OOO GAUOn)S .
Sludge depth:„.
Distance from top of sludge to bottom of outlet tee vrimffle:•1'0 1 ”'
Scum thickness: ,, '
Distance from top of scum to top of outlet tee or baffle:. f7 ,
Distance from bottom of scum to bottom of outlet tee or baffle: b
How dimensions were determined: MCA51wi 6AI& 5T%CK .
Comments:
(recommendation for pumping,condition of inlet and outlet tees or•baftles,de th of liquid level in relation to outlet invert,•structur"tQgrity,
evidence of leakage,etc.) T/1.tJ f( 1 nl (,Q r)d L•nJ d iT,O, V C - , F 1� � 'U (� Lb,tJd i f,ON,
/Aev6 I TA I I A (= Sec TO W iTf-I,nl '+ eq fr
GREASE TRAP-=1
(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: i
Date of last pumping:
Comments:
(recommendation for pumping,condition of inlat and outlet tees or baffles,depth of tiquid.level In relation to outlet Invert,structural integrity,
evidence of leakage,etc.)
revised 9/2/98 P&Zc7of 11
t •
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1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOi,M fr
PART C a
Property Address: 41 Cedar Ln.
SYSTEM INFORMATION(contiquad)
North Andover
Owner:Larry Durkee �' {
Date of Inspection: 5/26/00 a '
TIGHT OR HOLDING TANK;/tTank must b4 pumped prior to,or at time of,Inspection). i t
(locate on site plan)
Depth below grade:_
Material of construction:•_cPncrete_metal Fiber lass_Polyethylene other(explain)
lain)
g YI p
Dimensions: -
Capacity: gallons
Design flow: gallons/day
Alarm present
Alarm level: Alarm in working order:Yes_ No
Date of previous pumping:
Comments:
(condition of Inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:—
(locate on site plan)
Depth of Uquid level above outlet invert:
Comments:
(note If level and distribution is equal,evidenoa of solids carryover,evidence of leakage Into or out of box,etc.) — '—
Ro� avA M r,ati nyo ca':jiveeo LeA *itn t° ut; o
A10 E�, .A Q,t!L,e O F G n I A C�i mo o✓ec,.
PUMP CHAMBER:,A/1A
(locate on site plan)
Pumps in working order:(Yes or No) -
Alarms In working order(Yos or No)
Comments: I.
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
t 1
revised 9/2/98 Page 8oftt
' \CE SEWAGE DISPOSALeYSTi]rt•pYSPECTIO,N FORM 'err
• Property Address: 41 Cedar Ln. PART
North Andover
SYSTEM tNFoRMAT1ON(c"rt i d) <
Owner:Larry Durkee
Date of Inspection: 5/26/00 r,
SOIL ABSORPTION SYSTEM(SAS);_
(locate on site,plan,if possible;excavation not required,location may be approximated by non4ntrusive methods)
H Y
If not located,explain;
1.41t• t
Ty e, 74 P T
leaching pits',number:
leaching chambers,number:_
leaching galleries,number:_
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:_
Alternative system:
Name of Technology;
Comments:
(note condition of soil,signs of hydraulic failure,level of ending, damp soil,condition of vegetation,etc.)
A�C'� of PITS Loo KS ,..CMAr App pa.u�,N6 nA,,l So f
Q� UV OcSuA 1 Ue(9PTAr_ON, 6 NG PIT Cn/i-_Q
CFSSPoOLS•
(locate on site plan) '
Number and configuration: ;
Depth•top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensioh's of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection)
Comments:
(note condition of soil,signs of hydraulic faliura,devei of ponding,condition of•vegetation,etc.)
PRIVY:w(A
(locate on site plan)
f f
Matetjeis of construction: Dimenslons:
Depth of solids•
Comments:
(note condition of soft,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
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revised 9/2/98 Pate 9 of 11
h
SUBSURFACE SErGE DISPOSAL SYSTEM INSPECTION FORM
PART C
Property Address: 41 Cedar Ln. SYSTEM INFORMATION(contu►uedl
North Andover �t
Owner:Larry Durkee
Date of Inspection: 5/26/00
F
.SKETCH OF SEWAGE DISPOSAL SYSTEM: `
Include ties to at least WJ o permanent reference landmarks or benchmarks I '
locate all wells within 100'(Locate where.public"water supply comes Into house) '
CEDAR LANE
WELL
12
41 CEDAR LANE
30'
46' 4 '
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revised 9/2/98 Page 10a11
-1C
j SUBSURFACE SEWAGE DISPOSkL SYSTEM INSPECT ION F�RM
PART l:
a
-Property Address: 41 Cedar Ln. SYSTEM CNFORMATION(co�tirwod) Zw f
North Andover '
Owner:Larry Durkee
j 1
Date of Inspection: 5/26/00 �; • I
NRCS .Report name `job ��-yr ey ; �sse> ��� /�� ` �tQA
Sol[Type_
Typical depth to groundwater
USGS Date wabslte visit d
Observation Wollf chacked
'Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater Feet
Please Indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed.Site (Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps-
Checked pumping records
Checked local excavators,Installers
Used USGS Data
Describer how you established the High Groundwater Elevation.(Must be completed),1 (/1/
(�, tiles i�n �I—Cr(hs i r��cc,�c-- w cr� y cC5` b C-�w �7��'r✓
2) U S-S.0 5. pG}dq tvtS,cc, } (a ` be to„
revised 9/2/98 P.<<uertt