HomeMy WebLinkAboutTitle V Inspection Report - 1491 TURNPIKE STREET 7/27/2007 Tel: (978) 475-4786
Fax: (978) 475-5451
BATESON ENTERPRISES, INC.
Excavating-Water& Sewer Lines-Septic Systems &Pumping Service
111 Argilla Road Andover, Mass. 01810
Title 5 Inspection Report
Property Address: 1491 Turnpike Street, North Andover
Owner: Kiesel
Date of Inspection: 7/27/2007
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.
t�
Neil J. Bateson
Bateson Enterprises, Inc.
COMMONWEALTH OF MASSACHUSETTS 1
g EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
9 d
DEPARTMENT OF ENVIRONMENTAL i -y„w� j�
TITLE 1✓E
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:_1491 Turnpike Street
North Andover_
Owner's Dame:_Diana Kiesel _
Owner's Address:_44 Cricket Lane
_North Andover,MA 01845_ �
Date of Inspection: 7/27/2007
i t
Name of Inspector:_Neil 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 CdIR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signatures C- -m--- Date: _7/27/2007_
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 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:_1491 Turnpike Street-
-North Andover_
Owner•_Kiesel_
Date of Inspection:_7/27/2007_
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:_1491 Turnpike Street-
-North Andover-
Owner:_Kiesel_
Date of Inspection:_7/27/2007_
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 I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_1491 Turnpike Street-
-North Andover-
Owner:_Kiesel_
Date of Inspection:_7/27/2007_
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
No Backup of sewage into facility or system 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'/2 day flow.
_No_ 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 I 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 be attached to this form.]
_No_(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
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
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:_1491 Turnpike Street
_North Andover_
Owner:_Kiesel_
Date of Inspection:_7/27/2007_
Check if the following have been done.You must indicate"yes"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?
_No 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?
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.
_Yes_ _ 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:_1491 Turnpike Street-
-North Andover_
Owner:_Viesel_
Date of Inspection:_7/27/2007_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_3_ Number of bedrooms(actual):_3_
DESIGN flow based on 310 CMR 15.203_330_
Number of current residents:_0_
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 reading:_Yes_
Sump pump(yes or no):_No_
Last date of occupancy:_Vacant on June 21,2007_
C OMDIERCIALANDUSTRIAL
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: Never pumped_
Was system pumped as part of the inspection(yes or no):_Yes_
If yes,volume pumped:_1500_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 2 Years old,7/5/2005,as
built plan._
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:_1491 Turnpike Street_
_North Andover_
Owner:_Kiesel_
Date of Inspection:_7/27/2007
BUILDING SEWER_X_ (locate on site plan)
Depth below grade:_27"_
Materials of construction: _X_cast iron _40 PVC X other
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.) _4"cast iron thru floor,2"Copper in
house,no leaks visible _
SEPTIC TANK: X
Depth below grade:_18"_
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:_101 x 5'x 4'
Sludge depth 2"_
Distance from top of sludge to bottom of outlet tee or baffle: 25"_
Scum thickness:_3"
Distance from top of scum to top of outlet tee or baffle:_811
_
Distance from bottom of scum to bottom of outlet tee or baffle: 19"_
How were dimensions determined:_Tape Measure_
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.Depth of
liquid at outlet invert.No evidence of septic tank leaking.Outlet cover has riser 6"deep_
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:_1491 Turnpike Street-
-North Andover_
Owner:_Kiesel_
Date of Inspection:_7/27/2007
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 (locate on site plan)
Depth below grade 6"_
Depth of liquid level above outlet invert: 0_
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.No evidence of
carryover._
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 ok.Cycled on
then off. Alarm has both audible&visual alarm.
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:_1491 Turnpike Street_
_North Andover-
Owner:_Kiesel_
Date of Inspection:_7/27/2007_
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
_ leaching pits,number: _
_X leaching chambers,number:_4 rows of eight infiltrators_
leaching galleries,number:
leaching trench,number,length:
leaching field,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.Opened up inspection ports no standing water._
CESSPOOLS:
Number and configuration:_
Depth—top of liquid to inlet invert:_
Depth of sludge 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
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:_1491 Turnpike Street_
_North Andover-
Owner:_Kiesel_
Date of Inspection:_7/27/2007_
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
House Septic
Driveway Tank
C
Water Meter
A B
Pump
Tank
Po t#1
O
D-
Box
O
Port#2
A to D-Box=43110"
Ato Port#1=15'9"
Ato Port#2=24'10"'
B to D-Box=15' 1"
B to Septic Tank=15'
B to Pump Tank=816"
B to Port#1 =54'
B to Port#2=5716"
C to Septic Tank=13'25'
C to Pump Tank=2116"
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_1491 Turnpike Street_
_North Andover-
Owner:_Kiesel_
Date of Inspection:_7/27/2007_
SITE EXAM
Slope_No_
Surface water_No_
Check cellar _Dry_
Shallow wells_No_
Estimated depth to ground water_41
_
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:_10/28/2004_
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: As per design plan_
Page 1
Summary Record Card yeneraled on 8/2/2007 2:42:58 PM by Lisa Warren
Town of North Andover
Tax Map # 210-107.8-0068-0000.0
1491 TURNPIKE STREET
KIESEL, ALEX V
P0 BOX 1894
ANDOVER, MA
01810
Class 101 Single Family Property Type 1 Residential
Size Total 1.15 Acres
FY 2007 -
UB Mailing Index
Name/Address Type Loan Number Activellnact. From Until
KIESEL,ALEX V Payor
P O BOX 1894
ANDOVER,MA
01810
UB Account Maint.
Account No Cycle Occupant Name Active/inactive
Bldg Id. 13225.0-1491 TURNPIKE STREET Last Billing Date 6/15/2007
2100010 02 Cycle 02 Active
UB Services Maint.
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.635/8 7.82 1/
WTR WATER 01 ALL METER SIZE 37.56 /1
UB Meter Maintenance
Serial No Status Location Brand Type Size YTD Con'
13242631 a Active ERT HH METE METE w Water 0.63 0.63 I
Date Reading Code Consumption Posted Date Variance
5/2/2007 265 a Actual 12 6/22/2007 60i
2/16/2007 253 a Actual 16 3/23/2007 00/
11/2/2006 237 a Actual 11 12/22/2006 -590i
8/21/2006 226 a Actual 32 9/13/2006 680i
5/25/2006 194 a Actual 23 6/20/2006 320i
2/8/2006 171 a Actual 16 3/13/2006 -330
11/3/2005 155 a Actual 21 12/14/2005 -439
8/10/2005 134 a Actual 43 9/12/2005 1130
5/2/2005 91 a Actual 18 6/8/2005 559
2/2/2005 73 a Actual 12 3/15/2005 -239
11/2/2004 61 a Actual 15 12/1712004 -269
8/5/2004 46 a Actual 19 9/20/2004 219
5/14/2004 27 a Actual 18 6/1412004 419
2/9/2004 9 c Correction 13 4/16/2004 00,
C/O 4+ERT 9=13
11/4/2003 953 n New Meter 0 11/4/2003 V
Commonwealth of Massachusetts
City/Town of
System Pumping Record
y` Form 4
DEP has provided this form for use by local Boards of Health.Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form,check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
Important: (,
When filling out 1. System Location:
forms on the
computer, use �7
o move tab key Address C 14 '?
not
cursor-do n
use the return City/Town State Zip Code
key.
VQ 2. System Owner:
Name
Address(if different from location)
Cityrrown State t� Zip Code
Telephone Number
B. Pumping Record '?
1. Date of Pumping Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) B-19-e-ptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes 9-90' If yes, was it cleaned? ❑ Yes ❑ No
5. Condi 'on of S stem:
v�,
6. Syster Pumped By:
Name Vehicle License Number
V1
Company
7. Location re ont ere sed:
Sign re uler Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1