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Home My WebLink AboutTitle V Inspection Report - 75 SHERWOOD DRIVE 3/2/2002 NEW y@ I '5 .� aq OF a '1h1 Anti' 1, gal n4 � . MA . .alum urn c- em February 11, 2002 North.Andover Board of Health Town Hall Annex 27 Charles Street North.Andover, MA 01845 RE: TITLE V REPORT: 75 Sherwood Drive,North Andover, MA Dear Sirs:, Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely Benjamin C. O,8 od, Jr. 60 RER`.CF°IWOOD DRIVE-NOR Ili Ah1DdJl EFq , MA 01845-(978)686-1768 768-(888)3559-7645,. I'-AX(9.78)685-109 =f' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION s TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: `7._ SHE 2L43c )D fLt UF 1�o�2TN A JT3OJC2 �A Owner's Name: to -(+R 2E i,!_ Mo i-I/W(/K Owner's Address: -76-- - SK ERwoOD 2t l�\2) 0-TH l'tA)CAL)yZ e /Vi A Date of Inspection: 31 Zi o:2 Name of Inspector: (please print) Company Name: },�E w F no &W C-F 21N 6- Mailing Address: G� LAJ 00 Telephone Number: -7;7e- CERTIFICATION STATEMENT I certify that I have personally.inspected the sewage disposal.system atthis address and that the information reported bejow is true,accurate and complete as of the time of the:inspection::�e inspection was performed based on my ,training and eicperience in the proper.-function and maintenance of on`sitesewage disposal systems.I am a DEP ' -approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �� Date: 3/fOO 2- The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not:address how the system will perform in the future under the same or different conditions of use. sy Page 2 of 11 hryxx s� g OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_ 75 SHERWOOD DRIVE Owner: — NORTH ANDOVER,MA DARELL AND TRACEY T_ROFIMUK Date of Inspection:_ 3/2/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: `� I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System Conditionally Passes: e or more system=mponentsas described in the"Conditional Pass'.'section need tgbe replaced or, repaired. system,upon completib"f the'replacement or repair,as approved by the Bo of Health,will pass; Answer yes,no or no termined(Y,N;ND)in the for the following stat ts.If"not determined"please'. explain. 17he septic tank is metal:an ver 20:years old*or the septic (wteether metal or not)is structurally unsound,exhibits substantial'infiltrate =briexfiltration or tank fail is imminent.System will pass inspection'if the existing tank is.replaced with a complyin tic tank as approv by the Board of Health. *A metal septic tank will pass inspection if u ' structurally d,not leaking and if a Certificate of Compliance,; indicating that the tank is less than 20 years old a vailab . ND explain: Observation of sewage backup or br out or high static ter level in the distribution box due to broken or obstructed pipe(s)or due to a broken, ed or uneven distribution . System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: Th em required pumping more than 4 times a year due to broken or obstructed pipe(s). a system will pass in on if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:– 75 SHERWOOD DRIVE Owner: – NORTH ANDOVER,MA DARELL AND TRACEY TROFIMUK Date of Inspection:– 3/2/02 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 fail'n o protect public health,safety or the environment. 1. System '11 pass unless Board of Health determines in accordance with 310 15.303(1)(b)that the system is n functioning in a manner which will protect public health,s ety and the environment: — Cesspool or ivy is within 50 feet of a surface water _ Cesspool or pri is within 50 feet of a bordering vegetated we d or a salt marsh 2. System.will fail unless the Board of He th(and blic Water Supplier,.if any)determines that the system is functioning in a manner that pro tec th ublic health,safety and environment: The system has a septic tank and soil.a orp ' system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a s ce water s ply. The system has a septic tank SAS and the SAS is 'thin a Zone 1 of a public water supply. The system has a septic and SAS and the SAS is with' 0 feet of a private water supply well. The system has a tic tank and SAS and the SAS is less than 1 feet but 50 feet or more from a private water supply ell**.Method used to determine distance **This system ses if the well water analysis,performed at a DEP certified la ratory,for coliform bacteria an olatile organic compounds indicates that the well is free from poll ut! from that facility and the pres ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, ovided that no other fail criteria are triggered A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_ 75 SHERWOOD DRIVE Owner: — NORTH ANDOVER,MA Date of Inspection: DARELL AND TRACEY TROFIMUK pceh •_ 3/2/02 D. System Failure Criteria applicable to all systems: You must indicate`yes"or`ono"to each of the following for all inspections: Yes No +� Backup of sewage into facility or system component due to 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 0. _✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool V' Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow V' Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped v' Any portion of the SAS,cesspool or privy is below high ground water elevation. V' Any portion of 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 1 of a public wc11. Lt/ Any portion of a cesspool or privy is within 50 feet of a private water'supply well. _ y' 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria>and volatile organic compounds indicates that the well is free from pollution from that facility and the'presence of ammonia nit togen:and nitrate.nitrogen is equal.to or less than 5 ppm,-provided that;no other failure criteria are-triggered.A copy of the analysis must be attached to this form.] N D (Yes/No)_The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 You indicate either`yes"or`no"to each of the following: (The followm teria apply to large systems in addition to the criteria a yes no _ the system is within 400 feet o ce dr' ter supply _ — the system is within 200 feet of a tri to a s drinking water supply _ — the system is located in ogen sensitive area(Interim Wellh tection Area—IWPA)or a mapped Zone II of a public ter supply well If you have an "yes"to any question in Section E the system is considered a significant threat, wered "yes",in S a D above the large system has failed.The.owner or operator of';any large system considered a sigrYifi t threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CUR 15.3 .The system.owner should contact the appropriate regional office of the:Department. Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_ 75 SHERWOOD DRIVE NORTH ANDOVER,MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? _ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? v""_ Were as built'plans:of the system obtained and examined?(If they were not available note as N/A) - Was the facility or dwelling inspected for signs of sewage back up? v**- the site inspected for signs of break out? Were all system components,excluding the SAS, located on site? Were the septic.tank manholes uncovered;opened,and the interior of the tank inspected for the condition of the baffles br tees,material:of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ — Was the facility.-owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to*Part Cis at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:— 75 SHERWOOD DRIVE NORTH ANDOVER,MA Owner: DARFLL AND TRACEY TROFIMUK Date of Inspection: 3/2/0.2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):-L�- Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): (1 0 Number of current residents: a Does residence have a garbage grinder(yes or no):_W Is laundry on a separate sewage system(yes or no):Y[if yes separate inspection required] Laundry system inspected(yes or no): - Seasonal use:(yes or no): } Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):_LVJ Last date of occupancy: (o 2 2EN-T- COMMERCIAIA NDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): 2Dd Basis of design flow(seats/perssons/sgft,etd.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: /y Guc2 T'v„ti p ED Pup- 0 Was system pumped as part of the inspection(yes or no):_ If yes, volume pumped:______gallons-How was quantity pumped determined? Reason for pumping: TYKE 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) _Innovative/Altenative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 02 `�2 ti,2S �e2- D w n EYL Were sewage odors detected when arriving at the site(yes or no): 5 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS r k: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM "z PART C SYSTEM INFORMATION(continued) Property Address:_ 75 SHERWOOD DRIVE NORTH ANDOVER,MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 BUILDING SEWER(locate on site plan) u Depth below grade: 24 — � Materials of construction:_cast iron v/40 PVC_other(explain): Distance from private water supply well or suction line: --- Comments(on condition of joints,venting,evidence of leakage,etc.): _P%iE "0 us New I N 6ASci0F X1 T SEPTIC TANK:_(locate on site plan) Depth below grade: 12" Material of construction: ✓concrete metal_fiberglass__polyethylene- _other(explain) If tank'is:metal list age:_ Is age confirmed by a Certificate of.Compliance(yes or no):_(attach a copy of certificate) Dimensions: tS-oo &0 tJ s Sludge depth: Z" Distance from top of sludge to bottom of outlet tee or baffle: y 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:LL How were dimensions determined: Cry HSL)2 E s n e y Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Toy,4- In.i 6-o&y (o n 6 1 i>0M. .SCK Ny 40C 7U6- Iill 6-C c) C) C 0 4 D 670 0, lZec QA+END I T-79 L- DJv oi— Ri.s iPA- 7-v w T- I A,, 6 Dl- FINtSh URAOE 0/0 A-Ll- DPEASItiGS GREASE TRAP:N 4(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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 4 Page 8 of l l 3, }: OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 75 SHERWOOD DRIVE NORTH ANDOVER,MA + Owner: DARELL AND TRACEY TROFIM UK Date of Inspection:_ 3/2/02 TIGHT or HOLDING TANK:AM_(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 < Comments.(note if box is,level and:distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): - 00K ,n (7-600 L0,A 0 110 n15T(LtaylDiy E-Qy /I L No ro)DC,VC t? /-J F -'o w I n 5 C q-ao y P y e L 0 ,2 I-E A)-R(--P i.v O 2 PUMP CHAMBER:(1J tq(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.): Page 9 of 11 r `1, OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS K_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_ 75 SHERWOOD DRIVE NORTH ANDOVER,MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: -leaching galleries,number: =leaching trenches,number,length: a y P` k o n U T(LEN Cµe 5 leaching fields,number,dimensions: overflow cesspool,number: innovativelaltemative system Type/name of technology: Comments-(note condition of soil,signs of hydraulic failure;level of ponding- damp soil,condition of vegetation, . etc.): CESSPOOLS: IV (cesspool must be pumped as part of inspectionxlocate on site plan) 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(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: IM-(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.): 3 Page 10 of 11 `' , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:— 75 SHERWOOD DRIVE _ NORTH ANDOVEF MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. �lvQ,5r J� 37 4 T2ENCNPs • Riy Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:— 75 SHERWOOD DRIVE NORTH ANDOVER,MA Owner: DARELL AND TRACEY TROFIMUK Date of Inspection: 3/2/02 SITE EXAM Slope Surface water Check cellar Shallow wells n 6„e– Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: JrG ST'C!2n. 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