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HomeMy WebLinkAboutTitle V Inspection Report - 20 BRIDGES LANE 8/16/1997 NEW ENGLAND ENGINEERING SERVICES August 20, 19971 North Andover Board of Health Town Hall Annex School Street North Andover,MA 01845 RE; TITLE V REPORT 20 Bridges Lane Enclosed is the Title V report for 20 Bridges Lane,North Andover,MA. The system conditionally passes our inspection. If there are any questions please call me at my office,686-1768. Yours truly, e amin C. Osg Jr.,E.I.T. 7P sident 4, 33 WI WAL..o KE RD. .-_ SUITE E . — NOR ...Fi ANDOVER, MA 01845 — (508) 686.1-1768 CO\4MON\I'EALTH OF MASSACHUSETTS �F EXECL:TIVE OFFICE OF ENVIRONMENTAL AFFAIRS r r_t DEPARTMENT OF ENVIRO'N'MENTAL PROTECTION �) ONE WINTER STREET. BOSTON. NIA 02108 61 -292-5500 j WILLIAM WELD TRUDY CORE Sccrctar� Govcmo: ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: old It3e"D�'IBS (/}Wl , �v ' A�0bV ems--Address of Owner: Dale of Inspection: $ 1 101 9� (If different) Name of Inspector: BENJAMIN C. OSGOOD JR. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: NEW ENGLAND ENGINEERING SERVICES, INC. Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA_01845 Telephone Number: 508-686-1768 CERTIFICATION STATEMENT 1 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 11�condit tonal l\ Passes _ heeds Further Evaluation By the Local Approving Authority _ Fails l f�0 Inspector's Signature: Date:f The Svstem !nspector shall ubmrt a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C, or D: AJ SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as dzfined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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. 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 J Compliance (attached) indicating that the tank was installed within twen (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, sh w substantial nfiltration o x(iltration or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (r w i—d 04/25/97) P•sr. l o C 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: � 3 e 4 q>c,-,,F !.t!}A3 tz) IVv k't,&✓V rc.r Owner: e i c,*h M I 1�.0 ` Date of Inspection: 6 /10 15 BJ SYSTEM CONDITIONALLY PASSES (continued) /V 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). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled 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 pipets) are replaces 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 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 prik-�• 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) 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 (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a sun ace 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 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 valid). 3) OTHER (r•vir•d 04/35/97) Pay. 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: cP0 00 A_1t&)V P K_ Owner: VM 1 �L 1 Date of Inspection: kpIcitn DJ 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 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 Amy 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. Am portion of a cesspool or privy is within 50 feet of a private water supply well Anv 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, anach copy of well water analysis for cohiorm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El 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 above: The system serves a facility with a design flow of 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 morg 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 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 for further information. (revised 04/25/97) Pago 3 of 10 qy SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ')O Owner: M 1 5 G k Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No jef _ Pumping information was provided by the owner, occupant, or Board of Health. V _ 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 pan of this inspection. M _ As built plans have been obtained and examined. Note if they dre not available with N/A. 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. r The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owners were provided with information on the proper maintenance of Sub-Surface Disposal System. C — Existing information. Ex. Plan at B.O.H. _✓ _ Determined in the field (if anv of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)J r. (r.vix.d 04/25/97) Paq. 4 Of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1 SYSTEM INFORMATION Property Address: c�p hi�0 C9 fZs h tr}�O lZ) N q. ,&00 v.q— Owner: nth SL Date of Inspection: it. q-1 FLOW CONDITIONS RESIDENTIAL: Design flow: Q.p.d./bedroom for S.A.S Number of bedrooms: Number of current residents: Garbage gnr der (yes or no): V Laundry connected to system (yes or no):4- Seasonal use (yes or no):_JV Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no): Al Last date of occupant),: L(j eeo l COMM ERCI.AUINDUSTRIAL: Type of establishment: Design flow: t allons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (ves or no)_ Non-sanitary• waste discharged to the Title 5 system (yes or no)_ Water meter readings, if available Last date of occupancy: OTHER: (Describe) Last date of occupancy GENERAL INFORMATION PUMPING RECORDS and source of information "—PtZO a V ekP—'. System pumped as part of inspection: a or no)— If yes, volume pumped: Qallons Reason for pumping TO T-11 .5 Po c TVv I t TYPE OF SYSTEM v'*�Septic tank/distribution box/soil absorption system Single cesspool r Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: /,D y e �S C PPeox Sewage odors detected when arriving at the site: (yes or no)—VO (revised 01/25/97) Pape 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �O �2� G cx�S �w}r �1 U YJ✓Lr/E?l2 Owner: Yl! i S C Dale of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grader 6 e Material of construction: ✓•cast iron _ 40 PVC _other (explain) Distance from private water supply well or suction lire- Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan( Depth below grade: Material of construction: koncrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: / .5 00 6r4 Sludge depth © � Dislance from top of sludge to bottom of outlet tee or baffle VV jj ,j S Scum thickness: 1 Distance from top of scum to top of outlet tee or baffle: I I� rn �5 U�HL ems" S Distance from bottom of scum to bottom of outlet tee or baffle: N How dimensions were determined: 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.) 1►rt K Ajd?e b S BTU � 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, e(c-) (rwi—d 04/25/97) Paga 6 o! 10 ',, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: '!>O D �r its � yob PO 4­tl J2 )2 Owner: e SL Date of Inspection: TIGHT OR HOLDING TANK: iTank 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 floes — gallonJdak 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) 11 Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) T) -- "2 I� 4 S Iy o-1 �3 LH tz ru C ;z V,y"`'�t.G- ['� r3 � � �S(F © r= 1 Vtr+t le- t'14.` 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.) (raviaad 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM``INFORMATION (continued) Property Address: 90 i 4 G e�5 LA) NO p"Lo veez- Owner: SL Date of Inspection' 8A&' SOIL ABSORPTION SYSTEM (SAS):_ (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, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: Onl �.`►��9 / 00 overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) e ot2 fry Le S. 6-0 s �� s lvt�T t3rrr vu CESSPOOLS: _ (locate on site plant Number and configuration. Depth-top of liquid to inlet invert: Depth,of solids layer: Depth of scum laver: Dimensions of cesspoo!: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) T 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.) i (ravlssd 04/25/97) P.9e a of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:aD 3P i 0 W-S. {-�� i�10 `�CLO Ut `2^ Owner: i1'�1tSG; Date of Inspection: 81/(.1 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) SON P—O0 w\ k Iy (r•viv•d 04/25/97) Page 9 of 10 ',...... X17 �Y� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: du 'e'-9 Cs(�z S b �r �7v 4't 'ov4Q Owner: &V SC Date of Inspection: Depth to Groundwater 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.) ✓ Determine it from local conditions Check w,th !oca! Board of health Che6 FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words ho%v you established the High Groundwater Elevation (Must be completed) {� d oc a vcA e, �-✓ S i2 t 2 :1 — 3 ` 1. tz VV% , •iS r ?S r (r—iaed 04/25/97) Paq• 10 of 10