HomeMy WebLinkAboutTitle V Inspection Report - 37 CARLTON LANE 2/10/2000 A4 1
IN
NEW ENGLAND ENGINEERM":' SERVICES
_.... ............ I N C
",,
February 15, 2000
North Andover Board of Health.
Town Hall Annex
27 Charles Street
North Andover, MA 01.845
RE: TITLE V REPORT: 37 Carlton Lane,North Andover
Dear Sirs:
Enclosed is a copy of the Title V report for the above referenced property. The system ap sses our
inspection.
If there are any questions please call me at my office, 686-1768.
Sincerely
Benjarfiin C. Osgood ., .I.T.
President
60 IB EEC MOOD DRIVE-NORTH AN DOVER, 10A 01845-(978)686-1-768..(888);359-764 5-FAX(978)685-10799
(AMMONWEALTH OF MASSACHUSEM
EnCUTIVE•OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL P$OTECTION
ONE WINTER STREET,BOSTON MA 02108 (617)292-6600
TPiUM co
S
ARGEO PAUL CELLUCCI DAVID 03.sjnUHSyr'
Governor Commis'roner
SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM -
i PART A
CERTIFICATION
Property Address: (Z 01-Dr j_oj, -V. 14NOc�J( Name of Owner i c l(A(Lp J��7v�e
Address of Owner._3-2 (J n/D
Date of Inspection: 'Z) I J )0-z,
Name of Inspector:(Please Print) Beni amiri C. Os>?ood,Jr.
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310•CMR 15.000)
Company Narrie: New England -Engineering Services Inc.
MaXng Address: 60 Beechwood Drive North Andover, MA
Telephone Number: 9,78-686-1769
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 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:
ZPasses
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date: / 60
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEPlwhhin 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 oKnvIronmentA Protection. The original should'be sent to-"
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
revised 9/2/98 Page I of 11
��}Printed on Recycled Paper
'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION`ORM
PART'A
CERTIFICATION(continued) ;
Property Address:37 Carlton Lane
North Andover,MA a
Owner:Richard Dooley
Date of Inspection:2/10/00
INSPECTION SUMMARY: Check A, B, 0, or D:
F
Ap SYSTEM PASSES: i
have not found any information which indicates that any of the failure conditions described In 310 CMR 15:303 exist. Any failure'
criteria not eval'ated 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,asapproved by the Board of Health, will pass. -
Indicate yes, no, or not determined(Y, N,or NO). 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 inspectioh;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 if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
_ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
° The system required pumpfag-inore than•four-Umes n yeardue to broken or obst, cted pipe(s). The system will peas^
e inspection if(with approval of the Board of•Heafth):
broken pipes)are replaced
obstruction is removed
revised 9/2/98 Page 2ofIt
:d
-_
f
., stlttsURFACE SEWAGE DISPOSAL SY STEM INSPECTION FORM
•
PART A )
(continued)
TION(conn +.
Property Address:37 Carlton Lane CERTIFICA
North Andover,MA
Owner:Richard Dooley
k.
• Date of Inspection:2/10/00 ..,.�
3n�• r'
C. FURTHER EV/LUATiON IS REQUIRED BY THE BOARD OF HEALTH: sc.
CoAditiohs exist which require further evaluation by the Board-of Health in order to determine if•the system Is falling to protect`the t'
public health,safety and the environment. z,,
1) SYSTEM WiLL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WiTH 310 CMR 16.303(1)(b),TMT•THESYS: F"•`
IS NOT FUNCTIONING IN A MANNER WH,ICH.YM-PRQTECT,THE PUBLIC HEALTILAND SAFETY ANQ THE Et+L aoNMENL
Cesspool.or privy is within 60 feat of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
21 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM(S
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALT4-1 AND SAFETY AND THE 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 aseptic 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 60 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).--
31 OTHER
revised 9/2/98 Page)of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
i PART A
CERTIFICATION(continued)
Property Address:37•Cariton Lane
North Andover,MA ,
owner:Richard Dooley
Date of Inspection: 2/10/00
D. SYSTEM FAILS: j
You must Indicate either'Yes"or"No" to each of the following; 1
have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. The basis for this
determination is Identified below. The 8pard of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
"Backup of"4eWage Into 4acility, r-evte rn component-due ttoanovedoodedorcbggdd"S-or•cesspod. ��---�—
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.
Any 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. ;
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
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. If the well has been analyzed to be acceptable,attach copy of well water analysis for
»coliform bacteria,volatile organic compounds, ammonia nitrogen•and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
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:
The system serves a facility with a design flow of 1:0,000 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•200 teato Mary teasurtau d�r�kkzg water sur}ty••• — --
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 upgrade the system in accordance with 310 CMR 16.304(2). Please consult the local regional
office of the D*partment for further Information.
revised 9/2/98 Page 4ofII
i It H� f� •.'.f
SUBSURFACE SEWAGE DISPOSAL SYSTEM tNSPECnON FORM r
PART 0 -5
CHECKUST
Property Address:37 Carlton Lane
North Andover,MA '
Owner:Richard Dooley
Date of Inspection:2/10/00
i Check if the following have been done:Ybu must indicate either"Yes"or"No" as to each of the following:
Y, es No I �
� Pumping information was provided by the owner, occupant, or Board of Heath. �-�•
• ,_ '.None of the system.con*o,aanu.baya-haan pompodufor-atlaasttwo•aaaalis nr&the•system has6aecwceiaiwgwrwrtal flow s
rates during that period. Large volumes of water have not been introduced into the system recently or as part of'this
inspection.
_ As built plans have been obtained and examined. Note If they are 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.
A� _ 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.
The size and location of the Soil Absorption System orrthe site has been determined based on:
Existing information. For example,Plan at B.O.H.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
116.302(3)(b))
The facility owner(and.occr pants,Jf diNereni irnm osunat).t�tetepro�ridad.with lafama"on on tom;raps aaIntan`na"f
SubSurface Disposal Systems.
revised 9/2/98 Page 5of11
' SUBSURFACE SEWAGE DISPOSAI)SYSTEM INSPECTION FORM
PART
SYSTEM INFORMATION
Property Address:37 Carlton Lane
North Andover,MA s
Owner:Richard Dooley ,
Date of Inspection: 2/10/00 jryw
FLOW CONDITIONS
RESIDENTIAL: '
Design flow:' md g.p.d./bedroom.
a rsx
Number of bedroos!(design): ' Number of Bedrooms(actual)•_
Total DESIGN flow &00 ,p D-
2mbar of current residents: Z �.
rbage grinder(yes or no):•ALt7
Laundry(separate system) (yes or no): )L; If yes,sepamte.Inspection.required _
Laundry system Inspected (yes or no) ,
Seasonal use (yes or no): /VO
Water meter readings,0 available(last two year's usage(gpd):
Sump Pump(yes or no)-A,—'(2
Lost date of occupancy: 2- -;
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: qpd (Based on 15.203)
Basis of design flow
Grease trap present:(yes or no)_
Industrial Waste Holding Tank present:(yes or no)_
Non-sanitary waste discharged to the Title 6 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:
De,; /VOrt la!!!z Pe OtiAj 2
System pumped as part of inspection:(yes or no1QL0
If yes,volume pumped: gallons
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)
1/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
/9s 9011-7-
APPROXIMATE AGE of all components,date Installed-{if known)-and source of4ftformation: -•---- -
Sewage odors detected when arriving at the site:(yes or no)
revised 9/2/98 Page 6oflt
M
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
i
PART C
Property Address:37 Carlton Lane SYSTEM INFORMATION(continued) Sa
North Andover,MA
Owner:Richard Dooley �rl,,
Date of Inspection:2/10/00
BUILDING SEWER:
(Locate on site plan)
Depth below grade:,
Material of construction:_cast Iron Z0 PVC_other(explain)
Distance from private.water supply well or sU tion line
Diameter 1
Comments:(condition of foints,venting,evidenceoffaakage,-etc.)
DOSS �st�D /N j3 ,F-SENT
SEPTIC TANK:_
(locate on site plan)
!
Depth below grade:,
Material of construction: !%concrete_metal_Fiberglass _Polyethylene_other(explain)
If tank is Inetal,list age_ Is.age.confrmed by Certificate of Compliance_(Yes/No)
Dimensions: h6-00 LLOti�
Sludge depth:
Distance from top of sludge to bottom of outlet tee ortmffie:Z6�I
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: _
How dimensions were determined: 1mFASL;26- 5VCt4
Comments:
(recommendation for pumping,condition of Inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert,•structur"tegrity,
evidence of leakage,etc.) 3/9NK /N 6-o0,:> e o/0 D/T)o,t/, e-r)IJC(2 G77- 7—Z-6S /itl (-0or-)
_COIJ D iT) fzi&eers 7D
f/Nrs 17 (;7,VL 67 QE I ry 0i L C71 Al Pr_'C776�v 0ete
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.)
revised 9/2/98 Page 7of11
• sip i :
i
i S UBS
UR F A
C
E SEWA GE
DISPOSAL
SYSTEM
INSPECTION CTION PO M
PART C '
SYSTEM INFORMATION(continued) j
,j
Property Address:37 Carlton Lane
North Andover,MA
Owner:Richard Dooley a+x
Date of Inspection:2/10/00 a
/f
r
TIGHT OR HOLDING TANK• V IT (Tank must be pumped prior to, or at time of,inspection) a .
(locate on site plan)
Depth below grade:_ r e
Material of construction:_epncrete_•metal_Fiberglass_Polyethylene _other(explain)
I N
D(ntensions:
Capacity: gallons
Design flow: gallons/day
Alarm present
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:J60;1 -Cc e T 6e
(locate on site plan)
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.) — - —
opA /N O/'C ZJ,✓D myi✓ l yut=R 0 12t�<KED 9,Fft- 96�n ifs
)SpC IJ S7/z16u116.v 0 e9L it/J L 5 A AfiG-t t C)r2
Jam' 2ME SOLIDS C✓�Z(LS�UcJC.2 __-__
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.)
revised 9/2/98 Page a of 11
i
44
J
j ° RFACE SEWAGE DISPOSA
" L YSTEM iNSPEt:T10N FORM
PART
Property Address:37 Carlton Lane SYSTEM iNr-ORMATiON(contirnwd)
North Andover,MA ;
Owner:Richard Dooley t•y,� .c
Date of Inspection:2110/00
Vim• �.z
SOIL ABSORPTION SYSTEM(SAS)
(locate on site plan,if possible;excavation not required,location may be approximated by nom(ntrusive methods)
If not located, explain;
Ty e:
leaching pits,number:_
leaching chambers,number._
leaching galleries,number:_ '
leaching trenches,number,length: i
leaching fields,number,dimensions: 1 /�/L�� �/� x /L/7l)
overflow cesspool,number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.)
VS M N`
CESSPOOLS:
(locate on site plan)
1
Number and configuration: ,
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensiotfs of cesspool:
Materials of construction:
Indication of groundwater:
Inflow(cesspool must be pumped as part of Inspection)
Comments:
(note condition of soil, signs of hydraulic failure,•.level of ponding,condition of•vegetation,etc.)
(locate on site plan)
Materials of construction; Dimensionsc
Depth of solids:
Comments:
(note condition of soil,signs of-hydraulic failure,level of ponding,condition of vegetation,etc.)
revised 9/2/98 Page 9of11
SUBSURFACE SE1(1rAGE DISPOSAL SYSTEM WSPECTION FORM - i
III PART C i
SYSTEM INFORMATION(continued)
Property Address:37 Carlton Lane
North Andover,MA
Owner:Richard Dooley
Date of Inspection:2/10/00
:SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least t*o permanent reference landmarks or benchmarks 1
locate all wells within 100'(Locate where public water supply comes Into house)
• Goy��� •
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revised 9/2/98 Page 10 of II
i clod, I IJ �
° SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FgRM
PART C i �1
SYSTEM INFORMATION(contirwed) r '
Property Address:37 Carlton Lane (.i•"
i ry �
North Andover,MA
Owner:Richard Dooley
r
Date of Inspection:2/10/00
NRCS Report name 6o1 t- Qy E`e FssC x C,:k„v?-( /AI-T 5 E-T73 012 1-9 Eakl I��72
Soil Type_ C Z a oN
i Typical depth to groundwater
USGS Date website visit d
Observation Weil;checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope / °V.
Surface water N„r,e
Check Cellar N,_,
Shallow wells MJN�;
Estimated Depth to Groundwater 0 Feet 3 i 5do-- Lec�� jca�
Please Indicate all the methods used to determine High Groundwater Elevation:
�t Obtained from Design Plans on record
Observed.Site (Abutting property, observation hole, basement sump etc.)
Determined from local conditions
Checked with local 136ard of health
Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
1 Used USGS Data
Describe how you established the High Groundwater Groundwater Elevation. (Must be completed)
il. bes�v IGKS tY1/ ccl Wfi.
2j V5 (-/5 DA-rr4 I.v !> . !'W-iVS
�� 1�r{L� vt SyS�ern �ti1 �jec.. L9 Z 3�
revised 9/2/98 Page 11 of it