HomeMy WebLinkAboutTitle V Inspection Report - 815 JOHNSON STREET 3/16/1998 RAGGS, INC., P. O. Box 1027, CONCORD, MA 01742
(508) 369-1100
OFFICIAL CERTIFICATION
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION
IN ACCORDANCE WITH TITLE 5 (310 CMR 15.000)
CERTIFICATION PREPARED FOR: William and Claire Moody
ADDRESS OF PROPERTY: 815 Johnson Street
North Andover, MA 01845
DATE OF INSPECTION: March 16, 1998
RESULTS:
This property has PASSED the criteria set
forth in 310 CMR 15.000.
This property has CONDITIONALLY PASSED
the criteria set forth in 310 CMR 15.000.
This property has NEEDS FURTHER
EVALUATION BY THE BOARD OF HEALTH
according to the criteria set forth in
310 CMR 15.000.
This property has FAILED the criteria set
X forth in 310 CMR 15.000.
RAGGS, INC., P.O. BOX 1027, CONCORD, NIA 01742
(970369®1100
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
ADDRESS OF PROPERTY: 815 Johnson Street
North Andover, MA 01845
OWNER'S NAME: William and Claire Moody
DATE OF INSPECTION: March 16, 1998
PART A
CERTIFICATION
Name of Inspector: Garry A. Harmon - Certified Title 5 System Inspector
Company Name: Raggs, Inc.
Company Address: P. O. Box 1027, Concord, MA 01742
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 based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
PASSES NEEDS FURTHER EVALUATION BY
THE LOCAL APPROVING AUTHORITY
CONDITIONALLY PASSES X FAILS - per Sandra Starr B.O.H.
L/_�`
Inspector's Sig ature /Date
Garry A. Harm n - Certified Title 5 System Inspector
Raggs, Inc. certifies that all work performed on the aforementioned property was done in
accordance with the guidelines set forth in Title 5 (310 CMR 15.303).
Fred T. Fish, President Date
Raggs Septic Service, Inc. d/b/a E. A. Comeau
File No.: 98-17205/MOODYWILLI
Copies to: Payer of inspection
Local Board of Health or its agent
RAGGS, INC., S.O. BOX 1027,9 CONCORD, MA 01 1742 2 (9/®11 69`1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
INSPECTION SUMMARY
A. System passes:
I have not found any information which indicates that the system violates any of the
failure criteria as defined in 310CMR 15.303 Any failure criteria not evaluated are
indicated below.
B. System Conditionally Passes:
One or more system components need to be replaced or repaired. The system,
upon completion of the replacement or repair, passes inspection.
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
inspection; or the septic tank, whether or not metal, is cracked, structurally
unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.
Septic tank is:
Metal : Cracked: Structurally unsound:
Substantial infiltration: Substantial exfiltration:
Tank failure imminent: Tee(s) missing:
The system will pass inspection if the existing 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 a broken or obstructed pipe(s) or due to a broken, settled or uneven
distribution box. The system will pass inspection if (with the approval of the Board
of Health):
Broken pipe(s) are replaced:
Obstruction is removed:
Distribution box is leveled or replaced:
2
GGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY continued
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:
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, and the
environment.
1. System will pass unless the Board of Health determines 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:
3
GGS, INC., P.O. sox 1027, CONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
INSPECTION SUMMARY continued
2. System will fail unless the Board of Health (and Public Water Supplier, if
appropriate) determines that the system is functioning in a manner that will
protect public health, safety, 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 a soil absorption system and is within a Zone 1
of a public water supply well.:
The system has a septic tank and a 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 that 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:
4
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY continued
D. System Fails:
You must indicate either "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria
as defined in 310CMR 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.
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 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 four 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.:
5
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY continued
E. Large System Fails:
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to.large systems in addition to the criteria listed above:
The design flow of the system is 10,000 gpd or greater (Large System) and the
system is a significant threat to public health, safety and the environment because
one or more of the following conditions exist:
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 bring the system and facility into full compliance
with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please
consult the local regional office of the Department of Environmental Protection for additional
information.
6
RAGGS, INC., P.O. BOX 1027,, CONCORD, MA 01742 42 (9/813C9-11®®
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B CHECKLIST
The following have been done - You must indicate "Yes" or "No" as to each of the following:
1. Pumping information was requested of the owner, occupant, and Board of Health: Yes
2. 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: Yes
3. As-built plans have been obtained and examined (Note if they were not available with n/a.):
Yes
4. The facility or dwelling was inspected for signs of sewage back-up: Yes
5. The site was inspected for signs of breakout: Yes
6. All system components, excluding the SAS, have been located on the site: Yes
7. 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: Yes
8. The size and location of the SAS on the site has been determined based on: Yes
The facility owner (and occupants, if different from owner) were provided with information
the proper maintenance of Sub-Surface Disposal System: Yes
Existing information (example Plan at Board of Health): Yes
Determined in the field (if any of the failure criteria related to Part C is at issue,
approximation of distance is unacceptable) [15.305(3)(b)] Yes
7
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
FLOW CONDITIONS
Residential: design flow: gpd/bedroom for SAS
number of bedrooms: 4
number of current residents: 3 garbage grinder: Yes
laundry connected to system: No seasonal use: No
Has drywell that is under brick patio, whereabouts unknown as homeowner
does not want patio disturbed
Water meter readings, if available (last two (2) year usage:
private well: No sump pump: Yes
Last date of occupancy: Occupied
Commercial / Industrial: Type of Establishment: n/a
design flow: gallons/day grease trap:
industrial waste holding tank present:
non-sanitary waste discharged to the Title 5 system:
Water meter readings: Last date of occupancy:
Other: Last date of occupancy:
GENERAL INFORMATION
Pumping records and source of information: Every 2 - 3 years per homeowner
System pumped as part of inspection: Yes Volume pumped: 1500 gallons
Reason for pumping: Inspect structure
Type of system-
Septic tank/distribution box/soil absorption system: Yes
Single cesspool:
Overflow cesspool:
Privy:
Shared system:
I/A Technology etc. (Copy of up to date contract?):
Other:
8
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (9781369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
Approximate age of all components: 1982
Date installed: July, 1982
Source of information: As-Built plan prepared by Flynn Assoc. P.C.
Sewage odors detected when arriving at the site: No
BUILDING SEWER (locate on site plan)
Depth below grade: 21
Material of construction:
Cast Iron: 40 PVC: Other:
Distance from private water supply well or suction line:
Diameter: 4"
Comments:
Condition of joints:
Venting: Good
Evidence of leakage: No
SEPTIC TANK (locate on site plan) --
Depth below grade: 12" - cover built up to 4" below grade
Material of construction - Concrete: X Metal: Fiberglass:
Polyethylene: Other (explain):
If tank is metal list age: Is age confirmed by Certificate of Compliance:
Dimensions: 4.75 w X 10.50 1 X 4'd
Sludge depth: 10"
Distance from top of sludge to bottom of outlet tee or baffle: 18"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 7"
Distance from bottom of scum to bottom of outlet tee or baffle: 18"
How dimensions were determined: Tape measure
Recommendation for pumping: annually
Condition of inlet and outlet tees or baffles: Good
Depth of liquid level in relation to outlet invert: Good
Structural integrity: Good Evidence of leakage: No
Recommendation for repairs:
9
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
GREASE TRAP (locate on site plan) -- n/a
Depth below grade:
Material of construction - Concrete: Metal: Fiberglass:
Polyethylene: Other:
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:
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:
Recommendation for repairs:
TIGHT OR HOLDING TANK (locate on site plan) -- n/a
Must be pumped prior to or at time of inspection
Depth below grade:
Material of construction - Concrete: Metal: Fiberglass:
Polyethylene: Other:
Dimensions:
Capacity: gallons Design flow: gallons/day
Alarm level: Alarm in working order (Y/N):
Date of previous pumping:
Condition of inlet tee:
Condition of alarm and float switches:
Recommendations:
DISTRIBUTION BOX (locate on site plan) -- Yes
Depth of liquid level above outlet invert: 0"
Level and distribution are equal: Yes Evidence of solids carryover: Yes
Evidence of leakage into or out or box: No
Recommendation for repairs:
10
RAGGS, INC., P.O. BOX 1027, CONCORD, NIA 01742 (978)369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
PUMP CHAMBER (locate on site plan) -- n/a
Pumps in working order:
Alarms in working order:
Condition of pump chamber:
Condition of pumps and appurtenances:
Recommendation for maintenance or repairs:
SOIL ABSORPTION SYSTEM (SAS) -- Yes
(locate on site plan, if possible; excavation not required, but may be approximated by non-
intrusive methods).
If not determined to be present, explain:
Type:
Leaching pits and number:
Leaching chambers and number:
Leaching galleries and number:
Leaching trenches, number, length:
Leaching fields, number, dimensions 3 pipes leaving °d" box 25' x 40' - see sketch
Overflow cesspool, number:
Alternative system
Name of Technology:
Condition of soil: Gravel Signs of hydraulic failures: No
Level of ponding: None Condition of vegetation: Grass
Recommendations for maintenance or repairs:
Probed hole next to leach pipe and there is standing water 5" below bottom of pipe. Stone was
found to be clean next to the pipe
11
GGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
CESSPOOLS (locate on site plan) -- n/a
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:
Inflow (cesspool must be pumped as part of inspection):
Condition of soil: Signs of hydraulic failure:
Level of ponding: Condition of vegetation:
Recommendations for maintenance or repairs:
PRIVY(locate on site plan) -- n/a
Materials of construction:
Dimensions:
Depth of solids:
Condition of soil: Signs of hydraulic failure:
Level of ponding: Condition of vegetation:
Recommendations for maintenance or repairs:
12
`$GS, INC., P.O. BOX 1027,, `IONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
SKETCH OF SEWAGE DISPOSAL SYSTEM
* Include ties to at least two permanent references, landmarks or benchmarks
* Locate all wells within 100 ft.
* Locate where public water supply comes into house
THIS SKETCH IS NOT TO SCALE.
J town water
-- ----------------
0 #815
h
n
S A
0
n TANK
S
t 25' D- A B
TANK 28'3" 26'3'
N
D-B O 24'6 47'6'1
A o
n
d
0
V
e
r
DEPTH TO GROUNDWATER: 6+ feet
METHOD OF DETERMINATION OR APPROXIMATION: Observation of site, local
conditions and B.O. H. records
13
GGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
Please indicate all the methods used to determine High Groundwater Elevations:
Obtained from design plans on record:
Observation of Site (Abutting property, observation hole, basement sump etc.): Yes
Determine it from local conditions: Yes
Check with local Board of Health: Yes
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):
Basement 6' tall has sump pump, from ceiling of basement to outlet invert in "d" box
approximately 6'
14
RAGGS, INC., P.O. SOX 1027, CONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
APPENDIX A:
HISTORICAL
PUMPING RECORDS, REPAIR RECORDS
Home owner indicates pumping was done every 2 - 3 years.
15
GGS, INC., P.O. BOX 1027, CONCORD, MA 01742 42 (9/®)369°1100
98-17205/MOODYWILLI
APPENDIX B:
SITE PLAN / AS BUILT PLAN
Attached
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���}�r�'`}"��,��,��� l' -t -t .. Yi: '�`tC 'ti '•,� � i>. J -s.. .�}•QS�'r'�i _ �-( 1 1 ;p �,�_ '!:�
GGS, INC., P.O. BOX 1027, CONCORD, Mai 01742 (970369-1100
98-17205/MOODYWILLI
APPENDIX C:
LISTING SHEET
None available
17
GGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100
98-17205/MOODYWILLI
Appendix D:
Water Usage
Documentation
Attached
Mandatory Records Found (Y/N)
Applications, plans, and specifications Y
Approved system capacity
Soil Evaluation Data
Disposal construction permits
Certified As-Built Plan
Construction Inspection reports
Certificate of Compliance
System Pumping Records
Letters of Non-Compliance
Enforcement orders
Other Public Information Considered (Y/N)
FEMA Flood Maps
Soil Maps
Assessors Map Map Block Lot
USGS Topographical Map
Local Conservation Map
Builders Sketch
18