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Home My WebLink AboutTitle V Inspection Report - 224 CARLTON LANE 10/20/1997 COMMON% EALTH OF 1 ASSAC14USETTS ( EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRO.'tiMENTAL PROTECTION ONE WINTER STREET. BOSTO!:. NIA 02109 617-242-556() �t 60 TRUDY CORE wILLI.as.F WELD Seaetan Govcrno: DAVID B.STRUHS ARGEO PAUL CELLUCC1 Commissioner Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: /`� Address of Owner: Date of Inspection: /01,oxo/�� 7 (I( different) Name of Inspector: BENJAMIN C. OSGOOD JR. I am a DEP approved system inspector py rsuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: NEW ENGLAND ENGINEERING SLI'RVICES, INC. Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA 01845 Telephone Number: 508-686°1768 t t CERTIFICATION STATEMENT � I cenify 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 (unction and maintenance of on-site sewage disposal systems The system: L' Passes `onddtonalh Passes l _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature.` _ '.r Date: The Svstem !nspector sh41 ubmit a copy of this inspection report to the Approving Authority twithin 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, 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 btlyer, if applicable, and the approving authority INSPECTION SUMMARY: Check A, 8, C, or D! AI SYSTEM PASSES: VX1 have not found any information which indicates that the system violates any of the failure C"tesia as defined in 310 2MR 15.303. Any (allure criteria not evaluated are indicated below. COMMENTS: 81 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 NO). Describe buffs 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 (attachedl 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. The system will pass inspection i(the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. .._.._.... 9 2-y7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner. agQe� oGS� �T Date of Inspection: /O /_30 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 pipe(s) are replaces I obstruction is removed t I I t ' Cl 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 �jYSTEM IS NOT FUNCTIONING IN A MANNER t WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: i _ 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ' ENVIRONMENT: ' 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 surface water supply. I _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water sup,-)'v 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 irom 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.-i..d 04/25/77) T.g. 3 of 10 912 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A `/ CERTIFICATION (continued) Property Address: ��T C QF �A+ 1�r"1 , /uo Owner: Date of Inspection: ci D) SYSTEM FAILS: You must indicate either -Yes" or-No"as to each of the following: 1 have determined that the system violates one or more of the (61lowing failure criteria as defined in 310 CMR 15.303. The basis (or 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. i Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day (low. i Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). , Number of tiAies pumped_. Any portion of the Soil Absorption System, 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 surface water supply. � I 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 _ Am• portion of a cesspool or privy is less than 100 feet but greater than So feet from a private water supply well with no T acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copv of well water analysis for ' colnorm bactgria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. i El LARGE SYSTEM FAILS: I Ypu 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 (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 program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (r.vir.d 04/15/27) P.q. 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: l Oou e wNV Owner: 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 _ Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped (or at least two •-reeks 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 , As built plans have been obt6ined and examined. Note if then are not available with N/A. I ✓ The facility or dwelling was inspected (or signs of sewage back-up. i t — The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout All system components. excluding the Sod Absorption System, have been located on the site. _✓, i The septic tank rnanholets were uncovered, opened. and the ij)terior of the septic tank was in{peded 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: _V _ The facility owner (and occupants, if different from owners were provided with information on the proper maintenance of Sub-Surface Disposal System, ✓ — Existing information. Ex.iPlan at B.O.H. Determined in the field (if anv of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (r.v1s.d 04/25/171 4 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART C l i SYSTEM INFORMATION Property Address: Owner. Date of Inspection: / a �4 FLOW CONDITIONS RESIDENTIAL: Design flow: t.p.dJbedroom (or S.A.S Number of bedrooms: Number of current residents: Garbage gror.der (yes or no):_,OL) Laundry connected to system (yes or no): Seasonal use (yes or no):_Q,o Water meter readings, if available (last two (2) year usage (gpd): At /h,,Sump Pump Pump (yes or.no):4- Last date o(occupancy: •Lwlll�— I COMMERCIAUINDUSTRIAL: Type of establishment: Design (low: �allons/day Grease trap present: (yes or not_ 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 o•cuparl = i I OTHER: (Describe? Last date of occupancy. GENERAL INFORMATION PUMPING RECORDS and source of information T-ulx k C&I o? System pumped as pan of inspection: (yes or no) A D 1(yes, volume pumped: gallops ' Reason for,pumping TYPE OF SYSTEM '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 information: Sewage odors detected when arriving at the site: (yes or no) (revived 04/25/)7) >aq• 5 of 10 .,........... _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �� (�eo U l¢ti 6Z/ 1V O Q K �0 Owner: R IN3'Q! fv 0 C Dale of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade:L Material of construction: _cast iron &1/0 PVC _other (explain) Distance from private water supply well or suction hr, Diameter Comments: (condition of joints, venting, eviden f of leakage, etc.) Q(< 4S (1t (nq C°!�w (�(� Sf� la 00 r SEPTIC TANK:_ I (locate on site plane Depth below grader � Material of construction: i--"concrete _metal _Ffberglas� _Polyethylene _other(explain) If tank is metal. list age _ Is age confirmed by Cenificate of Compliance —(Yes/No) Dimensions: x( ° t 'T P�ac0 19 ►95 Sludge depth: fo " i heS� t Disldnce from top of sludge to botom of outlet tee or baffhe:36 Po O Loos""9e e G/1`'I, /� Scum thickness:_ > //% 7- �,e`/ Al G/ Distance from top of scum to top of outlet tee or baffle cg' /YIts�S°P vji e'r� � Distance from bottom of scum to bottom of outlet tee or baffle: 615 �ew �!/G lee How dimensions were determined: 4k erf5uea— ---tt— 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.) V f o f 7e e � /x'e'^' ' oe.F cc', h /Lc��t S wo PUG �P� �e t`d r`A.9 C e /I!r T►rt t K D S QA 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 bosom 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•vi••d Ol/75/77) p•4. 6 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1) N „�/( SYSTEM INFORMATION (continued) Property Address: dpi( aop/! K' /-'rme, de A e� Owner: eb&gef�OG�CSf�OT Date of Inspection: TIGHT OR HOLDING TANK: ifank 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: Capaan: gallons Design floes . gallonJda% Alarm level Alarm in working drder _IYes. _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm an'd float switches, etc.) DISTRIBUTION' BOX:_ b - t>cK (locate on site plan) PW 7-4,'S )�wr 4 < /)S Depth of liquid level above outlet invert: A „ — Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) ' bey— o)( l oreL Alu /2U D�'�1 D/zLrifl°�✓ O!/C�rZ 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.) (r.vi..d 0{/25/!7) P.q. 7 of 10 7 �- y7A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C I SYSTEM INFORMATION (continued) Property Address: a�t( Owe�V0 n it 4/ Owner: 1266aet Date of Inspection: 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:_ i leaching galleries, number: _ //.. leaching trenches, number,length: J C�pctG teS JO o ti G /Z vl leaching fields, nun>ber, dimensions:_ overflow cesspool, number: Alternative system: Name of Technology: i Comments: (note condition of soil, signs of hydraulic failure, level of ponding, co/di(ion of vegetation, etc.) i CESSPOOLS: _ (locate on site plan) Number and configuration Depth4op of liquid to inlet invert: ' Depth of solids layer: i Depth of scum layer: Dimensions of cesspool: Materials of construction: I 1 Indication of groundwater: inflow (cesspool must be pumped as pan of inspecttbn) ' 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: (riote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (r.via.d Ot/2S/f�I P�q� • oC to '...,. 92 v7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: as I N Q'V+0~' f V' �- Owner: Date of Inspection: — � moo/vA; 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) I 0C 0 SID ' ��Do 0 97=y7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address: a,3,y C e � .b N Owncr: r Date of Inspection: oQ,�21 [ r�G �C S t eaOT Depth to Groundwater N7 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 .v!th !o--a! Board of health I Checi FEMA Maps Check pumping records Check local excavators, installers r/ Use USGS Data Describe in woui own .words how you established the High Groundwater Elevation. (Must be completed) 5 �3- ��-� l� :1•�el� �� $l-l� �... : -�- ih; H �t-k � SY S�� e (�to ©� `? ` . , Soy , � 2 P- L�1 sQi?c� mow OIU Q C 'to m s 00-A 1 tZ 02 �- 3r �sC, -i- Ca+gS. gs Cep C - C� �l � e � �� Ni go+�, (rw1—d 0�/IS/9�1 P.9. ]0 or 10 _..... ........_w INC _.._.. .. . ..._._... .__ ..._.. ._._ _. ._ ..._..... ... .... ....-__..... _..... September 9, 1997 North Andover Board of Health Town Hall Annex School Street North Andover, MA 01845 RE: TITLE V REPORT 224 Carlton Lane Enclosed is the Title V report for 224 Carlton Lane,North Andover,MA. The system passes our inspection,there are however some noted repairs that should be made. If there are any questions please call me at my office, 686-1.768. Yours truly, �epj min C. Osgood E.13. President WALKER KER RD. SUITE 22 .._ NORT1.....1 ANDOVER, KAA 01845 (5 08) 6--'1....W