HomeMy WebLinkAboutTitle V Inspection Report - 67 CRICKET LANE 3/31/2000 COMMONWEALTH OF MASSACHUSETTS
g EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
o DEPARTME NT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET,BOSTON,MA 02109 617-292-5500
a
y
ARGEO PAUL CELLUCCI TRUDY COXE
Governor Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address:67 Cricket Lane, North Andover Name of Owner: Walnut Ridge Development LLC
Address of Owner:Same
Date of Inspection:3/29/00
Name of inspector: Richard A. Briscoe
am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: R. A. Briscoe,'Inc.
Mailing Address: 61 Garrison St., Groveland MA 01834
Telephone Number: (9781372-2200
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 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 Furth Evaluation By the Local Approving Authority
Fails
Inspector's Signature: m Date: - .31. co
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer,if applicable and,the approving authority.
NOTES AND COMMENTS
(revised 9/2/98)
Page I of 12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:67 Cricket Lane, North Andover
Owner: Walnut Ridge Development LLC
Date of Inspection: 3/29/00
INSPECTION SUMMARY: Check A, 8, C, or D:
A.SYSTEM PASSES:
X_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
evaluated are indicated below.
COMMENTS:
B.SYSTEM CONDITIONALLY PASSES: /I/Y+
One or more system components as described in the"Conditional Pass"section needs to be replaced or repaired. The system,upon
completion of the replacement or repair,as approved by the Board of Health,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 inspection;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 septic tank is replaced with a conforming 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
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 leveled or replaced
The system required pumping more than four 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
(revised 9/2/98)
Page 2 of 12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 67 Cricket Lane, North Andover
Owner: Walnut Ridge Development LLC
Date of Inspection: 3/29/00
C.FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: 41,4
Conditions exist which require further evaluation 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 IN ACCORDANCE WITH 310 CMR 15.303(1)(b)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 ANY)DETERMINES THAT THE
SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system(SAS)and the SAS 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 the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private 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 analysis for collform 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 valid)
3) OTHER
(revised 9/2/98)
Page 3 of 12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 67 Cricket Lane, North Andover
Owner: Walnut Ridge Development LLC
Date of Inspection: 3/29/00
D.SYSTEM FAILS: *14
You must indicate"Yes"or"No"to each of the following:
I have determined that one or more of the following failure conditions exist as described 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.
Yes No
Backup 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.
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 is 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 50 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 analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E.LARGE SYSTEM FAILS: PA
You must indicate"Yes"or"No"as to each of the following:
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 health and safety and the environment because one or more of the following conditions exist:
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.
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office
of the Department for further information.
(revised 9/2/98)
Page 4 of 12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 67 Cricket Lane, North Andover
owner: Walnut Ridge Development LLC
Date of Inspection: 3/29/00
Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following:
Yes No
Pumping information was requested of the owner,occupant,and Board of Health.
X 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 with
The facility or dwelling was inspected for signs of sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow
_ 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 tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_ Existing Information. Ex.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
unacceptable) [15.302(3)(b)]
_ The facility owner and occupants,(if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal System.
rl.
(revised 9/2/98)
Page 5 of 12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 67 Cricket Lane, North Andover
owner: Walnut Ridge Development LLC
Date of Inspection: 3/29/00
FLOW CONDITIONS
RESIDENTIAL:
Design flow: !'50 g.p.d./bedroom.
Number of bedrooms(design): y Number of bedrooms(actual)--y
Total DESIGN flow: 00 &P.O
Number of current residents: 2
Garbage grinder(yes or no):-11,95
Laundry(separate syatem)(yds or no):_Ao If yes,separate inspection required.
Laundry system inspected(yes or no):,
Seasonal use(yes or no):_/4/
Water meter readings,if available(last two year's usage(gpd):
Sump Pump(yes or no) M
Last date of occupancy:_ (-Up/�D
COMMERCIAL/INDUSTRIAL: r .
Type of establishment:
Design flow: gallons/day (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 5 system:(yes or no)
Water meter readings,if vailable:
Last date of occupancy
OTHER:(Describe)
Last date of occupancy:_
GENERAL INFORMATION
PUMPING RECORDS and source of information: //f, 7
System pumped as part of inspection:(yes or no) /W 7
If yes,volume pumped gallons
Reason for pumping:
TYPE QF SYSTEM
_A 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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract.
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date installed(if known)and source of information: 7
Sewage odors detected when arriving at the site:(yes or no)
(revised 9/2/98)
Page 6 of 12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 67 Cricket Lane, North Andover
Owner: Walnut Ridge Development LLC
Date of Inspection: 3/29/00
BUILDING SEWER:
(Locate on site plan)
Depth below grade:_
Material of construction:_cast iron 40 PVC_other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK:--ye S
(locate on site plan)
Depth below grade:
f ,
Material of construction: ncrete_metal_Fiberglass_Polyethylene other(explain)
If tank is metal,list age=Is age certified by Certificate of Compliance_(Yes/No)
Dimensions: 1000 q&4
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: 1.3
Scum thickness: 0 3
Distance from top of scum to top of outlet tee or baffle;,��
Distance from bottom of scum to bottom of outlet tee or baffle: /,2
How dimensions were determined: GUTSY,�
Comments: t '+I �Y$ /v/�'RCq'
(recommendation for pumping,con ion of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural
integrity,evidence of leakage,etc.)
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:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence
of leakage etc.)
(revised 9/2/98)
Page 7 of 12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 67 Cricket Lane, North Andover
Owner: Walnut Ridge Development LLC
Date of Inspection: 3/29/00
TIGHT OR HOLDING TANK:(Tank must be pumped prior to,or 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:
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 liquid level above outlet invert:. 0
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box
etc.)
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(Yes or No)_
Alarms in working order:(Yes or No)_
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
(revised 9/2/98)
Page 8 of 12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 67 Cricket Lane, North Andover
owner: Walnut Ridge Development LLC
Date of Inspection: 3/29/00
SOIL ABSORPTION SYSTEM(SAS):�not-
(locate on site plan,if possible;excavation required,but may be approximated by non-intrusive methods)
If not located,explain:
Type:
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions: l y7� 2 ail
overflow cesspool,number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
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 cesspool:
Materials of construction:
Indication of groundwater:
Inflow(cesspool must be pumped as part of inspection)
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
PRIVY:—A10
(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.)
(revised 9/2/98)
Page 9 of 12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 67 Cricket Lane, North Andover
owner: Walnut Ridge Development LLC
Date of Inspection: 3/29/00
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'(locate where public water supply comes Into house)
revised 9/2/98
Page 10 of 12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 67 Cricket Lane, North Andover
owner: Walnut Ridge Development LLC
Date of Inspection: 3/29/00
NRCS Report
name
Soil
Type
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow: Moderate: Deep:
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater 4 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Check with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators,installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
Sd�L C o S �ti es f�
y �
(revised 9/2/98)
Page 11 of 12
R. N
61 GARRISON ST.
GROVELAND,MA 01834
TEL.(978)372-2200 FAX(978)372-2450
SEPTIC SYSTEMS.-DESIGNED,BUILT, REPAIRED AND PUMPED
Title V Inspections
Title V Inspection Report
3/29/00
Property Address: 67 Cricket Lane, North Andover
Owner. Walnut Ridge Development LLC
Date of Inspection: 3/29/00
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.
R. A. Briscoe
Page 12 of 12
r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 67 Cricket Lane, North Andover
Owner: Amy J. Channen
Date of Inspection: 8/23/97
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'(locate where public water supply comes Into house)
PC
L 431
O Lt
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bol -
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4 _ 0 - 3Z• 6
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(revised 04/25/97)
Page 9 of 11