HomeMy WebLinkAboutTitle V Inspection Report - 157 OLD CART WAY 3/7/2000 COIVMMONW MTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIMONMENTAL PROTECTION
ONE WINTER STREET,BOSTON MA 02108 (617)292-5500
TRUDY COXE
Semr9
ARGEO PAUL CELLUCCI DAVID B.STRUM
Gaveraor Commissioner
SUBSURFACE SEWAGE DISPOSAL SY'ST04 INSPECTION FORM
PART A
CEATIFICATWA
Property Address: 157 Old Cart Way,North Andover Name of Owner:Frazier Hamilton
Address of Owner:157 Old Cart Way,North Andover,MA. 09845
Date of Inspection:3/712000
Name of inspector:Neil J.Bateson
I am a DEP approved system inspector pursuant to Section i5.340 of Title 5(310 CMR 15.000)
Company Name:Bateson Enterprises Inc.
Mailing Address:911 Argilla Road Andover,MA 01810
Telephone Number:(978)475-4786
CERTIFICATION STATEN NT
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;
_X_Passes
Cond€tlonally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: j Date:317/2000
The System Inspector shall ub it a cop this inspection report to the Approving Authority(Board of Health or DEP)with€n 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.
NOTES AND COMMENTS
f
revised 912198 Page I of 11
Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 167 Old Cart Way,North Andover
Owner; Hamilton
Date of Inspection:31712000
INSPECTION SUMMARY: Check A, 8, C,orA.,
A.SYSTEM PASSES:
_X 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 evaluated are indicated below.
COMMENTS:
B.SYSTEM CONDITIONALLY PASSES:
One or move 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).Descr€be 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 Certificete 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 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).
broken pipe(s)are replaced
_obstruction is removed
_distribution box is leveled 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 replaced
obstruction is removed
revised 912198 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:107 Old Cart Way,North Andover
Owner:Hamilton
Date of Inspection: 31712000
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 UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)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 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 Zane 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
revised 9I2I98 Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 167 Old Cart Way,North Andover
Owner:Hamilton
Date of Inspection:31712000
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 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 Giogged 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.
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 900 feet of a surface water supply or tributary to a surface water supply,
Any portion of a cesspool or privy is within a Zorle 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
rt 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 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 upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional office of the
Department for further information.
revised 912198 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 157 Old Cart Way,North Andover
Owner:Hamilton
Date of Inspection:31712000
Check if the following have been done:You must indicate either"Yes"or"No'as to each of the following:
Yes No
_X Pumping information was provided by the owner,occupant, or Board of Health.
_X 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 been Introduced into the system recently or as part of this inspection.
X As built plans have been obtained and examined.Noti3 if they are not available with NIA,
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,
X All system components,excluding the Soil Absorption System,have been located on the site.
,_,_,X The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles
or tees, material pf 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:
_X— Existing information.For example,Plan at B.O.H.
_X Determined in the field(if any of the failure criteria related to Part C is at issue,approximatio6 of distance is unacceptable)
(i 5.302(3)(b)]
�X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 912198 Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address 167 Old Cart Way,North Andover
Owner: Hamilton
Date of Inspection:31712000
FLOW CONDITIONS
RESIDENTIAL,
Design flaw_165— .g.p.d.tbpdroom.
Number of bedrooms(design):_4_ Number of bedrooms(actual_,,,3,__-
Total DESIGN flow_660_
Number of current residents:2_
Garbage grinder(yes or no):_Yes_
Laundry(separate system)(yes or no): No_If yes,separate inspection required
Laundry system inspected(yes or no)
Seasonal use(yes or no):-No_
Water meter readings.97 to 99=28,900 ft'x 7.5=216,750 gals.!730 days=297 gals./day
Sump Pump(yes or no):-No-
Last date of occupancy:Cuneent
COM M ERCIALIIN I)USTRIAt_:
Type of establishment:
Design flow: gwd-(15ased 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: Never pumped,owner
System pumped as part of inspection: (yes or no)_Yes_
If yes,volume pumped:_1500_gallons
Reason for pumping;Never pumped,inspect tank&tees.
TYPE OF SYSTEM
_X Septic tankldlstribution boxlsoil 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
APPROXIMATE AGE of all components,date installed(if known)and source of information:4 years old.Oct.1 1996,as built plan.
Sewage odors detected when arriving at the site:(yes or no)_Na
revised 91219$ Page 6 of 11
r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 157 Old Cart Way,North Andover
Owner: Hamilton
Date of Inspection:31712000
BUILDING SEWER:X
(Locate on site plan)
Depth below grade:20"
Material of construction: cast Iron X 40 PVC other(explain)
Distance from private water supply well or suction line:
Diameter;4"
Comments:4"PVC thru wall to septic tank.X PVC in house.
$EPTIO TANK:X
(locate on site plan)
Depth below grade:8"
Material of construction:—X- concrete metal Fiberglass Polyethylene other(explain)
If tank is metal,list age,.,^.Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions: 10'x 5'x 4 x 7.5=1500 gallons.
Siudge depth:10"
Distance from top of sludge to bottom of outlet tee or baffle: 17"
Scum thickness;6"
Distance from top of scum to top of outlet tee or baffle:8"
Distance from bottom of scum to bottom of outlet tee or baffle: 15"
How dimensions were determined:Subtract scum&sludge depths to tee length.
Comments:Pumped septic tank,inlet tee&outlet tee ok.Depth of liquid at outlet Invert.No evidence of leakage.
GREASE TRAP. None
(locate on site plan)
Depth below grade:
Material of construction: concrete___Metal Fibergl ass__,._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:
revised 912/98 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 457 Old Cart Way,North Andover
Owner: Hamilton
Date of Inspection:317/2000
TIGHT OR HOLDING TANK:_None_ (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)
Dimensions:
Capacity: gallons
Design flow:�gallonslday
Alarm present
Alarm level: Alarm in working order:Yes No
Date of previous pumping:
Comments:
DISTRIBUTION BOX.:–X—
(locate on site plan)
Depth of liquid level above outlet invert:0
Comments; D-box level.Distribution equal.Evidence of solid carryover.Pumped d-box to clean,No evidence of leakage.
PUMP CHAMBER:_None,gravity system—
(locate on site plan)—
Pumps In working order:(Yes or No)
Alarms in working order(Yes or No)
Comments:
Revised 912198 Page 8 of 4I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued))
Property Address: 167 Old Cart Way,North Andover
Owner.Hamilton
Date of inspection:31712000
SOIL ABSORPTION SYSTEM(SAS):X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
Type:
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches, number,length:2 trenches 50'6'long.
leaching fields,number,dimensions:
overflow cesspool,number:
Altemative system:
Name of Technology:
Comments:Soil ok.Vegetation A No sign of pond€ng to surface.
CESSPOOLS:None
(locate on site plan)
Number and configuration:
Depth-tap 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)
Comments:
PRIVY:None
(locate on site plan)
Materials of constructipn: Dimensions:
Depth of solids:
Comments:
revised 912198 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:157 Old Cart Way,North Andover
Owner:Hamilton
Date of inspection:31712000
SKETCH OF SEWAGE DISPOSAL SYSTEM;
include ties to at least two permanent reference fendmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
House
Driveway Garage
Water
A Meter B
3 2 1
D-
Box
50'6"
•to 1 =38'3"
•to 2=357"
•to 3=32'4"
•to D-box=40'4"
•to 1 —35'8"
Bto2=39'3"
B to 3 =42'6"
B to D-box=61'6"
revised 912!98 Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:157 Old Cart Way,North Andover
owner.Hamilton
Date of Inspection:31712000
NRCS Report name
Soil Type
Typical depth to groundwater
USGS Date webske visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater 4 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
—X—Obtained from Design Plans on record
___X Observed Site(Abutting property,observation hole,basement sump etc.)
—X—Determined from local conditions
X 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)As per design plan.
revised 912198 Page 11 of 11
Tel: (978) 475-4786
Fax: (978) 475-5451
BATESON ENTERPRISES, INC.
Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service
111 Argilla Road Andover,Mass. 01810
Title 5 Inspection Report
Property Address: 157 Old Cart Way, North Andover
Owner: Hamilton
Date of Inspection: 3/7/2000
My report contained herein does not constitute a guarantee of future usage and the functionality of the existing
septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further
operation of your current septic system,
AU�`
Neil J. Bateson
Bateson Enterprises,Inc.
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