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HomeMy WebLinkAboutTitle V Inspection Report - 224 CARLTON LANE 8/28/1997 C6MMON\ EALTH OF IVMASSACI 1:SETTS (�? EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 4� ONE WINTER STREET. BOSTON. h1A0'"j.Ug 61; 293•titiOU WILLIAM F WELD TRUDY COXE Govcrno: Sccrctxn f� ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP GlO'K FORM Commissioner PART A CERTIFICATION Property Address:,V �+��/ �d/V ��Aa, /V 0, /J`4a®d1V dress of Owner:' Date of Inspection: / (If different) Name of Inspector: BEN AMIN C. OSGOOD JR. I 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. t Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA 01$45 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 inspecuon. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems The system: t R Passes _ Condrtronal!v Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails �+ Inspector's Signatu I C• a Date: 21-2-2-, ' The Svstem !nspector s II submit 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 t, B, C, or D: AI SYSTEM PASSES: r I have not found any information which indicates that the system violates any of the failure c:ite:Ea as defined in 310 CN4R 1 5.303. 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 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 aacked, structurally unsound, shows substantial infiltration or exfiltration, 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: Owner: W oee2�- Date of Inspection: P/a9/�17 B) SYSTEM CONDITIONALLY PASSES (continued) 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 cbstruction is removed t t r � 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 IUNLESS 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 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 SUPPLIED, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: I I 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 suriace 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.vie.d 04/15/9'7) Pay• 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: ��i5/tip 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 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 svaters due to an overloaded or clogged SAS or cesspool I I 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 112 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. Ah%- 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 belacceptable, attach copv'oi well water analysis for cohiorm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. I I 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 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 more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 100 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. (r•vix-d 04/35/97) Paq• 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: p9p9)1 (�el 0n Owner: aPa B�� JoLo c. Date of Inspection: 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. _Y 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 b,-en introduced into the system recently or as pan of this inspection. _ As built plans have been obtained and examined. Note ii they are not available with N/A. ►z _ The facility or dwelling was inspected for signs of swage back-up. v e 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. i I 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: The facility owner(and occupants, if different from pwner) were provided with information on the proper maintenance of, Sub-Surface Disposal System. t t _ Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable) (I 5.302(3)(b)) i (r.vi..d 04/25/97) PAg. 4 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:o?�� '/ pV//1 l � �� /Uv Aldawe"ei � Owner: 'eo6etP f �C ST OP Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: Q.p.d./bedroom for S.A.S Number of bedrooms: Number of current residents: Garbage gror.der (yes or no):—&o Laundry connected to system (yes or no): Seasonal use (yes or no):—C/0 / /_ Water meter readings, if available (last two (2) year usage (gpd): �(/J 1 Ads,`l"Ie- Sump Pump (yes or no): Last date of occupancy: COMMERCIAUINQUSTRIAL: Type of establishment: Design flow: ' Aallons/dav Grease trap present: Ives or no)_ Industrial Waste Holding Tank present: Ives or no)_ Non-sanitary waste discharged to the Title 5- system (yes or no)_ Water meter readings, if available Last date of o• cupancy: OTHER: (Describe) Last date of occupancy GENERAL INFORMATION PUMPING RECORDS and source of Informatl n ?ew k u,as �� /�*o yeses o �S.oc/eL�Z 0w07025 System pumped as part of inspection: (yes or(D- If yes, volume pumped: gallons Reason for pumping TYPE O�.SYSTEM r/ 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 (if known) and source of information: ✓1!eoo6 Sewage odors detected when arriving at the site: (yes or no) A (revimod 04/25/57) Dag. 5 of 10 F7-y7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �l SYSTEM INFORMATION (continued) Property Address: �a y C��2� '" 0� Owner: 2o/j�/2/� //,c St9 DT Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grader Material of construction: _cast iron 40 PVC _other (explain) Distance from private water supply well or suction lee /L. Diameter 3L' Comments: (condition of joints, venting, evidence of leakage, etc.) G3v,�D��'.oa o� CTo,`•,fs ,� �,`P, �� D/G �s � Cc.h.F � G/cfzr R� S�/�,y. SEPTIC TANK:_ (locate on site plant t t !ice/� •• Depth below grade: t Material of construction: ,"concrete _metal _Fiberglass _Polvethylene _other(explain) If tank is metal, list age _ Is age coniumed by Cenihcate of Compliance _(Yes/No) Dimensions: .5—X /0 ' Sludge depth " I I ,S' Distance from top of sludge to bottom of outlet tee or baffle:/yo 94F/'X!Z- Scum thickness:/". Distance from top of scum to top of outlet tee or baffle:NJ Distance from bottom of scum to bottom of outlet tee or baffle:PD How dimensions were detqrmtned: Comments: I t (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.) [,JnG?L>7`/7 �h`f'F. S !dell�2u/l/l,� ©.clZ��u.9/�� tu�r o e 7W-K E' dl-befu.Se O I l�COnsIlZv/Q ,� P�l1Gl1�e� f- u/s Ti�lZS u ' !i Sc aOoLl D G Zck O'- Te Q,r�uSfZS Q/J2ey o lee T:A VU D iR ox tu,:G� it 7,'-#?-'Z w '�G /�f hoc fy�f* o ot��dlfi`�4 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.) (r—i—d 04/75/97) of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C f I SYSTEM INFORMATION (continued) Property Address:c9d ��e�T°� ��h�Zi AV d l6`l tntDi/e4el Owner: eo6aet DGk,&ot o7- Date of Inspection: /l g/ - 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) .s Dimensions: Capacity: gallons Design f!o\.\ . gallon/da\ I Alarm level. Alarm in working order _ Yes; _ No Dale of previous pumping: Comments: ) (condition of inlet tee, condition of alarm and float switches, etc.) i ) ! DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert, Comments: 1 (note ii level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) I)- box Zs &ant-V Dee-ee,,O)ap o, w; �, 2 ou l�� {-a</;r� oplilu 40 Z>.`e,zcAoW�Z w if?e 4F4 e i lzGo nii,f O /Pa,P 6-4Te-1Z.as1 © D - ox 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.) (revioad 04/75/97) page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addres :��'7 &'g'e"Z rU 9 m v i A10 A l do v'-4 � Owner: P6,6 f /�o C Date of Inspection: b y/9 7 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: e , leaching trenches, number,length: TvlGllrs 7 l0/�G yZ r1 leaching fields, number, dimensions:_ overflow cesspool, number: Alternative system:. i Name of Technology: r � Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc. Tha,ed is ko S`��-r o� 11ypellill,'c �,¢:L��� Y/see eel-#-f7-7 is po CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet inven: Depth,o(solids layer: Depth of scum layer: Dimensions of cesspoo�: i Materials of construction: Indication of groundwater: ' inflow (cesspool must be pumped as pan of inspection) 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.) (r.vip•d 04/75/97) p.9. B of 10 9710 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /1 SYSTEM INFORMATION (continued) Propertv Address: a� y l� (� �I1�o Aj �r N tZ O (�14 1 a e-1—t Owner; pQ 2� b+�G k S t ft1tDT Date of Inspection; g � 17 Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record s Observation of Site (Abusing property, observation hole, basement sump etc.) Determine it from local conditions Check %v!th !oca! Buard of health ! I Che6 FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in vour owr words ho%v you established the High Groundwater Elevation. (Musl'be completed) (rSsc2G � ���� �C6�GiD 19�TS ` 4•Ve%p -ta 3 L t� u In ti -�k Sys l-tsP(3c� �aw ol� l SDI �i�( � �- . ©Tfntz e PK oPi e}`� t},: Soot ofL l± L J 5 Ci S --r/l D,`t✓to �l�S h s C 2�_) G 'L R v;h G- �} �� �1. WA- � 2 Tiih j�f Z_ (r.vi..d 04/25/97) P.g. 10 of 10 _.__... _. .. INC October 30, 1997 North Andover Board of Health Town Hall Annex School Street North Andover, MA 01845 RE: TITLE V REPORT 224 Carlton Lane,North Andover, MA. Enclosed is the Title V report for 224 Carlton Lane,North Andover, MA. The system passes our inspection. This is a revised inspection from our inspection dated 8/29/97. The d-box and pipe from tank to d-box, and the outlet tee has been replaced. If there are any questions please call me at my office, 686-1768. Yours truly, y/ Be in C. OsgoZr,, E.IJ. Pre;ident 3 WALK EEP R D flT 22 ..... ORTI-.n ANDOVER, KAA 0184 ..... (508) 686....'11