HomeMy WebLinkAboutTitle V Inspection Report - 20 BRIDGES LANE 8/16/1997 (2) r SERVICOES
�j
November 7, 1997
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 passes our
inspection. This is a system that had a conditional pass dated 8/16/97 our File# 97-44. We re-
inspected after repairs were made.
If there are any questions please call me at my office, 686-1.768.
Yours truly, /r )
?jamin C. Ojood Jr., J.
resident
33 WALKER surrE 22 - NORTH ANDOVER, MA 01845 - (508) 68(3-1768
Ve
CO'vIT.4ONWTALTH OF MASSACHUSETTS
�y EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
j DEPARTMENT OF ENN11RONMENTAL PROTECTION
ONE WINTER STREET. BOSTON. 1,1A 02109 61:-292-5500
. i
wlLUA�t F WELD TRUDY COXE
Sccrctsn
Goycmo: -
ARGEO PAUL CELLUCCI E N D DAVID 13.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address: 2,0, I-0,-J0, 11/0 &,000E-✓L Address of Owner:
D'atc of Inspection: s(1��11� (if different)
Name of Inspector. BERJAMIN 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 SARVICES, INC.
Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA 01845
Telephone Number: 508-686-1768 i
i
CERTIFICATION STATEAENT
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 I
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date:
The System !nspector shall submit a copy of this inspection report to the Approving Authority,within thirty (30) days of completing this
inspection. I(the system is a shared system or has a design flow of 10,000 gpd or greater, (he inspector and the system owner shall submit
the report to the appropriate regional off(cc of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the bgyer, if applicable. and the approving authority I
INSPECTION SUMMARY: Check A, B, C, or D'
Al SYSTEM PASSES:
1 have not found any information which indicates that the system violates any of the failure c:itc:is as definer in 310 iR 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 replacenscnt 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. (f-not determined", explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system rnspcctdr with a copy of 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 no( metal, is cracked, structurally unsound, shows substantial infiltration or ex(iltration, or tank
failure is imminent. The system will pass inspection i(the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued) ;
Property Address: 20 gRt OGr s h a/, w. Aw pOt�C/Z
Owner: Rrz it&,W
Date of Inspection: iN�s
/f/h'ly-7
B) SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to brokers or obstructed
pipe(s) of due to a broken, settled or uneven distribution box. The system will pass inspection if•(with approval of the
Board of Healihi. Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled-or replaced
The system required pumping more than (our times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health)
f broken pipets) are replacec
obstruction is removed I I I
i t
t t t
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which reouve iunhe( evaluation by the Board of Health in order to determine if the system,is failing to protect the
public health, sa(eq•and the environment.
1) SYSTEM WILL,PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTFIM IS NOT FUNCTIONING IN A MANNER
t WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: i
Cesspool or privy is within So 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
tribu(ary to a surface water supply, I
The system has a septic lank 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 of 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
Tw. 2 or 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 20 WILD reS i Al, N, 4,v ,0ov F1z_
Owner: 2t c kj are o Ni r S e +
Date of Inspection:
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 f6llowing 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'o(the ground or surface waters due to an overloaded or clogged SAS or
cesspool
l _ Static liquid level in the distribution box above)outlet invert due to an overloaded or clogged SAS or cesspool. I
_
Liquid depth in cesspool is less than 6- below invert or available volume is less than 112 day flog..
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets).
Number of trines pumped _.
Ant-portion of the Soil Absorption Svstem, cesspool or privy is below the high groundwater elevation
Anv portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a suriace water supply.
t An%, pon,on of a cesspool or privy is within a Zone I of a public well )
Am pon,on of a cesspool or privy is within 50 feet of a private water supply well
Am• 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
cohiorm bactgria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS: I I
You must indicate either -Yes- or -No-as to each of the followin&:
iThe iollow,ng criteria apply to large systems in addition to the criteria above:
The system serves a (a6lity with a design (low 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 more of the following conditions exist:
Yes No
the system is within 460 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 11 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 progrim
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(rwia..d 04/15/77) faq• 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 20 9(4t D 6-t:s L-ti a/iF NV v p o v E.-
Owner: R1 41 KARp
Dale of Inspection: -
10HIli -7
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 provided by the owner, occupant, or Board of Health.
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
I As built plans have been obtained and examined. Note d then ere not available with N/A. I
The facility or dwelling was inspected for signs of sewage back-up.
i
! i
The system does not receive non-sanitary or industrial waste flow.
i
The site was inspected for signs of breakout
All system components, excluding the Soil Absorption System, have been located on the site.
,/ i The septic tank manholets were uncovered, opened. and the interior of the septic tank was in?peoed fotr 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:
_✓ _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
i
�• _ Existing information. Ex.iPlan at B.O.H. i
_✓ _ Determined in the field(if anv of the failure criteria related to Pan C is at issue, approximation of distance is
unacceptable) (15.301(3)(6)) I
(r.vf..d o4/21/17) T.y. 4 or 10
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM
PART C
SYSTEM INFORMATION
Property Address: Zo 132i 0 6,C5 L_Ail
Owner: 9%Ct1c.2 p Mrs e-
Date of Inspection:
IiNq7
FLOW CONDITIONS
RESIDENTIAL:
Design (low: R.p.dJbedreom (or S.A.S
Number o(bedrooms: il
Number of current residents: 1/
Garbage grnr der (yes or no!:
Laundry connected to system Ty es or no):
Seasonal use (yes or no):IV
Water meter readings, if available (last two (2) year usage (gpd):
Sump Pump (yes or.not:
Last date of occupancyj<f tai% i
COMMERCIAUINDUSTRIAL:
Type of establishment: ,
Design (low: !p_allons/dav
Grease trap present: (yes or not
Industrial Waste Holding Tank present: tees or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings, if available
Last date of o�cupanc\'A
i t i 1
OTHER: (Describe!
Last date of occupancy.
GENERAL INFORMATION
PUMPING RECORDS and source of in(ormation
i t
P(r.r•/k CK �.., t'c 6(J 9 o ti..� C,�„ ��•,• �, L t r7,1 ;,e
System pumped as pan of inspection: (yes or no) L/
If yes, volume pumped: gallo�s '
Reason for,purnping
TYPE OF SYSTEM
V— 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)
VA Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (i(known) and source of in(orrnation:
Sewage odors detected when arriving a( the site: (yes or no) ��
r.o. 5 or 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Properly Address: AC. E,/Z I 6-i s L--
Owner: (Z r c l7" AA rs c
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
i
Depth below grade: Z
Material of construction: cast iron_40 PVC _other (explain)
Distance from private water supply well or suction I,rt
r,
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
6-aoKS I< F/lo M INS/Or Q/4Sc u�✓i --
SEPTICI TANK:_
(locate on site plane
Depth below grade:_
Material of construction: _concrete _metal _Fiberglas] _Polyethylene _other(expla,n)
If tank is metal, list age _ Is age confirmed by Ceridicate of Compliance _(Yes/No)
Dimensions / 5-oo jf /6i-L`A)
Sludge,depth- C"
Distance from top of sludge to botltom of outlet tee or baffle:33 t
)
Scum thickness C"
Distance from top of scum to top of outlet tee or bafile;-W�
Distance from bottom of scum to bottom of outlet tee or battle:Z 0
How dimensions Here determined: , Efts✓ 77Y -51-;7c K
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.) 7�34)K /j �'L/fiCt 2
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.)
(rwi—d 04/7)/17) r-9- 4 or 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: ?0 13 21 n&C, i.-A,/
, /VV
Owner: (Z'LL 11"A-2Q rv. r5 ;
Date of Inspection:
I r/ Ylq I
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:
Capacm: gallons ,
Design floe . gallonJda%
Alarm level Alarm in working drderl_ Yes. _ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm aria float switches, etc.) '
i
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert
Comments:
' (note if level and distribution is equal, evidence of solids C/a�rryLoLer, evidence of leakage into or out of box, etc.) '
I I I
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order: (Yes or Not
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(ar—i—d 04/35/17) r.o. —f 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: -2 C Q it I C'-1= 5 t-Av. /V' / /0 p o v vt
Owner: 2 t C i-((+aZ q e
Date of Inspection: I q y 1 e
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If no(determined to be present, explain:
Type.
leaching pits, number:_
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number.length:
leaching fields, number.1dimensions: (c e(o0 sa_ n l
overflow cesspool, number.
Alternative system:
Name of Technology:
Comments
(note condition of soil, signs of hydraulic failure, level of ponding, conditions of vegetation, etc.) /
U C .S r— 9 5 Or �� r
i,
i
CESSPOOLS: _
(locate on site plan)
Number and configuration. '..
Depth-top of liquid to inlet invert:
Dpp(h_o(solids layer:
Depth of scum laver:
Dimensions of cesspoo!:
Materials of construction: I I
Indication of groundwater.
inflow (cesspool must be pumped as pan of Inspectibn)
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:
(rio(e condition of soil. signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(r- lL .d 04/2S/)7) P.qe of 10 ''..
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION {continued)
Property Address: 0,:_— )3 Q t.6 G L t ,j ti�_ i�}w 19 ove?.�
Owner: R\c t-(A 2 D
Dale of Inspection:
I
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)
• t
uv�S�
5
i
(� 151- 0
t,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Addre-ss: 20 g�[t/� v ` v ✓ 2
Owner: Rtc�nv
Dale of Inspection:
tN ( 7
Depth to Groundwater Z Feet
Please indicate all (he methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Aborting propertl•, observation hole. basement sump e(c.)
Determine (t from local conditions
( r
Check r.,(th !oca! Board of health
Checi. FEMA Maps
Check pumping records i
Check local excavators, installers
Use USGS Data
Descnbe .n vaSr own %vords how you established the High Ground,-- ter Elevation.!(Must be comple(ed)
ski >1�•�
i (
ce re CL 2 -ia 3 a�o�� o r (.-�(
P.9. 10 0( 10