HomeMy WebLinkAboutTitle V Inspection Report - 326 FOSTER STREET 11/9/1998 ° r
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November 30, 1998
North Andover Board of Health
Town Hall Annex
27 Charles Street
North Andover, MA 01845
RE: TITLE V REPORT 326 Foster Street.
Enclosed is a copy of the Title V report for 326 Foster Street,Noah Andover,MA. The systern.
apses our inspection.
If there are any questions please call me at my office, 686-1768.
Yours truly,
C
Benjai m C. Osgood Jr., I.T.
President
WALKER ROAD-SUITE 23-NORTH ANDOVER, MA 01845-(978)686-1768,.(888)359-7645-FAX(97 3)685-1099
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COMMONWEALTH OF MASSACHUSETiI'S
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617)'282-5500 ,r
Secrataiq
ARGEO MAUL CELLUCCI 1
DAVID B:STRUH9,
Governor Conttaiss�oner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A.
CERTIFICATION
I
Property Addkass: 2 c (� SfC1? f Name of Owner.Sy Mi c � rcc.1 ac7� ✓t
Al h �•ve0 Address of owner: ?„ ��7 �S� S I A)- r��^0 .
Date of Inspection: ! �� >
Name of Inspsctor:(Please Print) L' i GiVW a 1 lJ�
1 am a DEP approved system inspector purse to Section 15.3410 of Title 5(310 CMR 15.000)
Company Name: /�)[cn- G�,ti� � l"'�k;jj't.^Ir
Mang Address; 2 3 W t(t G� Kr� S� w N f}nJ d��/z, A
Telephone NurrAw: �Z78- LS C J"7 6 F3
CERTIFICATION STATEMENT
I certify that 1 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:
asses
_ 'Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_
Fails
Inspector's Signature: 17 (" - Date: Loo I be
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)wlthin 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*EnWonmental Protection. The original should'be sent to
system owner and copies sent to the buyer, if applicable,and the approving authority.
NOTES AND COMMENTS
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revised 9/2/98 Page of 11
01 Printed on Recycled Paper
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SUBSURFACESEWAGE DISPOSAL SYSTEM INSPECTION FORM
l PART A
CERTIFICATION(continued)
Property Address: a6 Fbs�cJL `s�; /V: f}v�tSL�✓�
Owner:
Date of Inspection:
INSPECTION SUMMARY: (heck A, B, C,:or D '
A. SY TEM PASSES:;
I have not found any information which indicates that anylof the failure conditions described in 310 CMR 1-5.303 exist. Any failure'
nteris not evaluated are indicated belgw
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,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 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 lathe distribution box is due to broken or obstructed pipe(s)
or due We 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 pumphig-more than tourtimes n yeardue to broken or obstructed pipets). The system WWI pass
Inspection if(with approval of the Board of Heaith):
broken pipe(s)are replaced
obstruction is removed
revised 9/2/98 Page 2oru
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
x
PART A
CERTIFICATION(continued)
Property Address: ,34 b ros tt- &-b A-), Iq ov UL
` fl�lb
Owner: r"vr: 7 �d�^ e-r
Date of Inspection:
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to deterlmine if the system is failing to proteathe •
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD 6F HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)16)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH_MLL PRO7FCT THE PUBLIC HEALTKAND SAFETY.AND THE EMOBONMEXT-
Cesspool of privy Is within 50 feet-of 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 ANY)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 of a surface water supply or
tributary to a surface water supply.
_ The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water suppiy.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 (appro)imation not valid).-
3) OTHER
revised 9/2/98 Page 3or11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I,
PART A
i
CERTIFICATION (continued)
R, _r aaaress: ti +. --,Q 0j &
Date of Inspection: 6s j vy% �fc r 0v 6C 4
D. SYSTEM FAILS:
You must indicate either"Yes" or"No" to each`of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health!should tie contacted to determine what will be necessary to correct the�ailure.
Yes No
— — Backup of sewage in*o4acili"r-s�component clue tto an overloaded orclaggedSAS-•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.
-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 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 200 feetofil3utery toeeurfaoa drinking water wpPly... — --- __
— — 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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 Page 4of11
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SUBSURFACE SEWAGE DISPOS#L SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 3 Z(o Fos T Cg_ S-b A) O i'ck
,Owner:
Date of Inspection: II i
Check if the following have been done:You must indicate either"Yes" or"No" as to each of the following:
Yew No
�✓// Pumping information was provided by the owner,ocoiupant, or Board of Health.
y _ - None of the system-con*oaants.WLuajwan pampadrforatJeast two-wasks and-the'system hast3oaouscWgiagmemw-f{ow
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.
3L The site was inspected for signs of breakout.
J _ 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 on-the 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)
I15.302(3)(b))
The facility owner(and.occupants,if different from-owner).were,pravidad,with iafwnm ioavn p.nT f
SubSurface Disposal Systems.
revised 9/2/98 Pagesortt
` ,.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION iFORM
PART C
SYSTEM INFORMATION
4
Property Addrass: 3Z'6 A ),e.L .
owner: S01,n�
Date of kupcction,
elg
FLOW CONDITIONS
x
RESIDENTIAL. _
4esign flow: g.p.d./bedroom.
Number of bedrooms(design): Number of bedrooms(actuaq& 11 r; 11
Total DESIGN flow
Number of current reside;Fts
Garbage grinder(yes or Ao):-&-
Laundry(separate system) (yes or no):W; If yes,sepamteins pection,required -
Laundry system Inspected (yes or no)
Seasonal use(yes or no):_
Water meter readings,if available (last two year's usage(gpd):
Sump Pump(yes or no):j0
Last date of occupancy: c. .;r e✓l
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: gpd ( 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 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:
System puYnped as part of n pection: (yes or no)_
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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other nn J
APPROXIMATE AGE of all components,date instaged4if known)-end source of4oformation:
Sewage odors detected when arriving at the site:(yes or noo O
revised 9/2/98 Page 6orIll
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 „
PART C
SYSTEM INFORMATION(continued) '
Property Address: sflree� /J- #qKb!d v cL n
owner: vw»i 'pPu.� Dolje�1
Date of Inspection: t
BUILDING SEWER: ll
(Locate on site plant
Depth below grader I '
Material of construction:•cast iron 40 PVC other(explain)
Distance from private %kater supply well or suction line /V'/r.
Diameter
ents: (condition of joints,ve ting,evidence
Co y� 1Aoffaakage,-eta)
�C5 Clf10(� i l CSCY37c'n�
SEPTIC TANK:_
(locate on site plan)
Depth below grader �
Material of construction: Vconcrete_metal_Fiberglass _Polyethylene_other(explain)
If tank is metal, list age_ ls.age.confirmed by Certificate of Compliance_(Yes/No)
Dimensions: 10490
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
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:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet-invert,•structure(-wits rity,
evidence of i kage,etc.) , .vK o C 7v/ �i %��/�. E' 1,t,/&– ���
�S b L'.'4;!s - 6-H,,-12- �s� ' . O
b n Co^c re curY+{ z1
SC 0 c
GREASE TRAP: Ll �4/ –
(locate on site plan)
Depth below grade:_
Materiel 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 7or11
' h
SUBSURFAC' SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART
SYSTEM INFORMATION(continued) 7, r .
t n
Property Address: a26 F�s1�ed_ S-f; N.
Owner:
Date of lnspection: a b e 611 :F
/ct8
TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or atjtime of, Inspection)
(locate on site plan) s
Depth below grade:_
Material of construction:_concrete_metal_Fib irg(ass_Polyethylene_other(explain)
Dimensions
Capacity: gallons
Design flow: gallons/day
Alarm present
Alarm level: Alarm in working order:Yes_ No_
Data of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert: Q
Comments:
in cif level and distrjbutjpn is equal,evidence f solids car yover, den a of leak ge into or out of box,etc.)
(.l V 0— l r✓ "-? /1,h'.:, 4e, if. lr+([1
o l i`S C c t9✓A. ? G l c �
PUMP CHAMBER-.Z i,g
(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.)
revised 9/2/98 Page 8of11
ry
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 3 z 6 ��is ��' N A•^�D��
Owner: Dec.., Ool be-11
Date of kupectilm: M
!SOIL ABSORPTION SYSTEM(SAS): ! _
;(locate on site plan,if possible;excavation not required,location may+beapproximated by non-intrusive methods),
If not located,explain: ,
Type:
leaching pits, number:_
leaching chambers,number._
leaching galleries,number:_
leaching trenches,number,length:
leaching fields,number,dimensions:� �r�X 6 r y ee c tai
overflow cesspool,number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil, igns of hydraulic failure,le el of ponding, damp soil,condition of vegetation, etc.)
,^ca sN s k,r r•s K
CESSPOOLS:.&fr .
(locate on site plant
Number and configuration: ;
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection)
4
Comments:
(note condition of soil, signs of hydraulic failurerlevel of ponding,condition of-vegetation, etc.) -;°-
PRIVY:
(locate on site plan)
Materjals of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation;etc.)
revised 9/2/98 Page 9ortt
i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM s
PART C
SYSTEM INFORMATION(continued) ? r�:
Property Address:
Owner:
Date of kupection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks I i.
locate all wells within 100' (Locate where public water supply comes into house)
N
�Q'4 q,3
o
revised 9/2/98 Page 10 of 11
f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
i PART C
i
SYSTEM INFORMATION(continued)
Propdrty Address: 3.2 6 AX,r JV, ✓�
O,ar,er: ota„ Wit!
Date of r
�J n
NRCS Report name � �/'✓c, a
Soil Type_ r'A,V 7-6 Al'
Typical depth to groundwater C)!,
'
USG Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate }P Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater (o Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
--'—Observed.Site(Abutting property,observation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
(Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
TO
revised 9/2/98 Page 11 of11