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HomeMy WebLinkAboutTitle V Inspection Report - 1024 TURNPIKE STREET 7/22/2017 C4,)mmonweaith of Massachusetts Title 5 Official Inspection [Form t Subsurface Sewage Disposal-System Form-Not for Voluntary Assessments - �� a � 1 i � , -- Pra Addrbuy Owrrier Miners N information is "L:qz required for ayn;ry page. Cftylrown State lip Code Date of Inspection i Inspection results must be submitted on this form.Inspection forms may not be altered In any w,iky. Please see completeness checklist at the end of the form. '"'p°"ant' A. General Information — When filling out forms on the computer,use 1, Inspector: only the tab Ivey y to move your r` �eT -- cursor-do not Name of Inspector use the return r, key. Company Name Company Address State Zip Coda Teleph ne Number Liconae Number EL Certification 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's signature Date 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 tate approving authority. ""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. TWe 5 t0dal 4nspedtron poM Subsurface S&awage Dlspo-14 System•Palle 1 Of 17 t5ins OJN3 Commonwealth of Massachusetts Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 Property Address f — — Qwnet Owner's Name Information is required for every page. CitylTown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E7 1 always complete all of Section D A) System Passes: Ff 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: Ua �JU r4 {� C b YVI G �—c`1) � eW`eV1 g) 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 Xforfollowing r repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"br"not determined"(Y, N, statyements, if"not determined, " please explain. The septic tank is metal and over 20 years old"or the. otic tank(whether metal or not) is structurally unsound, exhibits substantial Infiltration "filtration or tank failure is imminent. System will pass inspection if the existing tank is replace ith a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection ''it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is I s than 20 years old is available. ❑ Y ❑ N ❑ (Explain below): Title 5Official Inspection Form Subswface Sewage olsposal System page 2 of 17 �5ins•[33715 Commonwealth of Massachusetts Title 5 Official Inspections Four Subsurface Sewage Disposal System Form- Not for Voluntary Assessments a D v 4 Property Address Owner — Information is owner's Name --- required for every page. cityl7own State Ilp Code Date of Inspection �T B. Certification (cont.) B) System Conditionally Passes (cont.); ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced Cl Y ❑ N ❑ ND (E=xplain below): ❑ obstruction is removed Cl Y ❑ N ❑ ND plain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ND (Explain below): _ — ❑ 7- The System required pumping more th��rraa 4 ti` mes a year due to broken or obstructed pipe(s). The system will pass inspection if(with appfoval of the Board of Health): ❑ broken pipe(s)are replayed El El El ND (Explain below): ❑ obstruction is remo d ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation bytf�e Board of Health in order to determine if the system is failing to protect public health, safety (the environment. I. System will pass unless Board of Healt et.1 In accordance with 310 CMR 15.303(1)(b)that the system is not functip Ing In a mariner which will protect public health, safety and the environment: / ❑ Cesspool or privy is withi 0 feet of a surface water ❑ Cesspool or privy is v(,4 in 50 feet of a bordering vegetated wetland or a salt march t5ins-03113 Title 5 Official Inspection Form Subsurface Sewage Dsposak Syslem•Page 3 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments OLUr fC C Property Ad8ress Owner Owner's Name Information is required for -Zip-Code Date of Inspection every page, City/To vn Stat® B. Certification (cont.) 2. System will fall unless the Board of Health (and Public Water Supplier, if any) deterimes that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)an3A9 SAS is within 100 feet of a surface water supply or tributary to a surface water Apply. El The system has a septic tank and SAS and the SAS is within Zone I of a public water supply. ❑ The system has a septic tank and SAS and the SAS is (thin 50 feet of a private water supply well. El The system has a septic tank and SAS and the SAS' is less than 100 feet but 50 feet or more from a private water supply well** Method used to determine distance: This system passes if the well water anal is, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presen �;of��ammonia mmonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no othep allure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: System Failure Criteria Appiicablo to All Systems; You must,indicate"Yes"or"No" to each of the following for all inspections: Yes No El E � Backup of sewage into facility or system component dUE1 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 ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool �IA El Liquid depth in cesspool is less than 6"below invert or available volume is less than % day flow t5inS-03113 Title 5 official inspection Form Subsurface Sewage Disposal System-Palle 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Ice- ����rvp� Property Address Owner Information is Owner's Name required for every page. Cityffown State ZipCadeDate of Inspection B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El 12' Any portion of the SAS, Cesspool or privy is below high ground water elevation. El 2 Any portion of cesspool or privy is within 100 feet of a surface water Supply or tributary to a surface water supply. El EJ"' Any portion of a cesspool or privy is within a Zone 1 of a public well. El E3 Any portion of a cesspool or privy is within 50 feet of a private water supply well. El 2 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] El 2r This system is a cesspool serving a facility with a design flow of 2000gpd- I 0,000gpd. ❑ � The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system falls. 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 gpd. For large systems, you must indicate either"yes"or"no"tR4ach of the following, in addition to the questions in Section D. Yes No El Cl the system is within 400 f t/ofa surface drinkiing water supply 0 El the system is within Zoleet of a tributary to a surface drinking water supply El El the system is locA(ed in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA ora mapped Zone 11 of a public water supply well If you have answered "yes"to a question in Section E the system is condidered a significant threat, or answered "yes" in Sectiog,,D above the large system has failed. The owner or operator of any large system considered a signif(cant threat under Section E or failed under Section 1) shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Officlai Inspection Form Subsurface Sewage Disposal System-Page 5 of V Commonwealth of Massachusetts - -- Title 5 Official Inspection Fora " = Subsurface Sewage disposal System Form - Not for Voluntary Assessments y Property A dressy - -�--�— - Owner -- inform,fiion is Owner's Name -- -- - - requireri for every page. c€ty1rown State Zip Code Date of Inspection C Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No Z" ❑ 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? ❑ E� Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built pians of the system obtained and examined? (If they were not available note as NIA) ❑ Was the facility or dwelling inspected for signs of sewage back up? ET ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located an site? 19'/ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ❑ Was the facility owner(arid occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? This size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. LIZ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information -- Residential Flow Conditions: Number of bedrooms (design); Number of bedrooms (actual): 25 DESIGN flow based on 310 CMR 15.203 {for example: 110 gpd x#of bedrooms}: {0I] Title 5 official Inspection Formsubsurface sewage Disposal System•p11pe 6 of 17 15ifi5•0:1113 Commonwealth of Massachusetts a Title 5 Official Inspection Foram Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner InformGltion Is Owner's Name ---� required for every page. City/Town State Zip Code Date of Inspection i D. System Information Description: e Number of current residents: '-3 Does residence have a garbage grinder? ❑ Yes 13 No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ❑' No Laundry system inspected? 10A ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No a Water meter readings, if available(last 2 years usage(gpd)): Gt1 / 0('4)"oj C',P-e-,C Detail: Sump pump? ❑ Yes 13No Last date of occupancy: p�,�e�r Commercial/Industrial Flow Cohditions:. Type of Establishment: Design flow(based on 310 CMR 15.203): _ Basis of design flow(sea#s/persons/sq.ft., Gallons per-day(gpd) ✓e�t .): Crease trap present? °` ❑ Yes I:1 No Industrial waste holding tank preser(7 El Yes E] No Non-sanitary waste discharged to�the Title 5 system? El Yes E] No Water meter readings, ifs ailable: Bins.03113 Tule 5 Official Mspecuon Foray Subsurface sewage olsposal syalemy-page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Information IS Owner's Name required for _ every pate. c€tylrown State Tip Code Date of inspection D. System Information (cont.) Last date of occupancy/use: Date —� Other(describe below): General Information Pumping Records: Source of information: 41cjJ V -e_ it Was system pumped as part of the inspection? ❑ Yes C3/No If yes, volume pumped: gallons How was quantity pumped determined? 14 _ f 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) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval, ❑ Other(describe): Title 5 Official Inspection Norm Subsurface:3ewage OTsposal System•Nage 8 of 17 Bins•D3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Information Is Owner's - requtred for every page. C1tylTown State Zip Code [)ate of Inspection D. System Information (cont.) — Approximate age of all components, dale installed (if known)and source of information: Were sewage odors detected when arriving at the site;' ❑ Yes No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: cast iron ❑ 40 IVC ❑ other(explain) Distance from private water supply well or suction line: feet — Comments (on condition of joints,venting, evidence of leakage, etc.): Septic Tank(locate on site plan): r i � c) `' Depth below grade: feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene! ❑ other(explain) If tank is metal, list age: years "'• -- __.....� Is age confirmed by a Certificate of Compliance? (altach a copy of certificate) ❑ Yes No Dimensions: Sludge depth t5hos•03!53 Tllle 5 Official Inspection Fomn Subsurface Selvage Disposal System•Page 9 of 17 Commonwealth of Massachusetts 'Title 5 Official F= Commonwealth of Massachusetts Tale 5 Official Inspection Form Subsurface Sewage disposal System Form _Not for Voluntary Assessments Property Address Owner Owner's Name Information is required for _ every page. City/Town Stale Zip Code bale of Inspectlon D. System Information (cont.) u Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Yank (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 per day _ - — Alarm present: ❑ Yes ❑ No j" Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date — Comments (condition of alarm and float switches, etc.): i` ,l *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No lslris•03113 Tule 5 01TICI 3 Inspection Form Subsurface Sewage Disposal Splem•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r it kf Property Address Owner — — Information is Owner's Name -- required for _ every page. CityfTown State Zip Code Date of lrlapectkon D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): V t ___ �trr1�J r �p S ' y P v ):.•� Pump Chamber(locate on site plan): Pumps in working order: d Yes ❑ No Alarms in working order: LJ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i r^ Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Titte 6 oHlclat Inspection Form Subsurface Sewage olsposal System•Palle 12 or 17 tSins-a�7t3 '.. Commonwealth of Massachusetts Title 5 Official Inspection Form _ = Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - L6 d-55r_ � 5 Property Address P Y Owner Owner's Name -- Informallon Is required for _.-- every page. City/Town State lip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: _ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: _ ❑ innovativelalternative system Typeln-arie of-technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): ��t�•lh� �� a �-_��/�lrct�1 ► � ��� � ��r� ��i�Y� l��k Cesspools (cesspool must be pumped as part of inspection) db/ate on site plan): Number and configuration W Depth -top of liquid to inlet/ow Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater i ❑ Yes ❑ No Title 5 Official€nspecilon Form Subsurface Sewage Disposal System•Page 13 of 17 (Sins-43113 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form Not for Voluntary Assessments r ° — 4rty Address Owner ---- -- Information lOwner's Name IS, required for every Page. C€ty[T'own State Z€p Code Date of In.spectlon c D. System Wolrmation (cont.) 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 (note condition of soil, signs of draulic failure, level of ponding, condition of vegetation, etc.): Bins-03113 Title 5 official Inspection Form Subsurface$swage Disposal System•Pape 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments r party Address Owner Information Is Owner's Name required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: E� hand-sketch in the area below drawing attached separately )-7 Ra V �-( J -31 Mfle 5 Official Inspection Form Subsurfeco S[Wage DISPOU1 System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form lipSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 4-rA CA IDI 1C.-F _ krollperty-Address Owner Information is Owner's Name required for every page. City/Town State Zip Code hate Df Inspectlon — D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: — f feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: r aide"""'"""•' �-3 ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USG$database-explain: You must describe how you established the high ground water elevation: CA (— ~ Before filling this inspection Report,please see Report Completeness Checklist on next page. Title 5 Official Inspection Form Subsurface sewage Disposal System.Pape Isat f7 15ins•x3713 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Add4s—s ' Owner Owner's Name Information is required for every page, CityfTown State 'Zip Code Date of Inspection E. Report Completeness Checklist 2' Inspection Summary: A, B, C. D, or E chocked Inspection Summary D (System Failure Criteria Applicable to All Systems)completed System Information - Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Title 5 Offidal inspection Form Subsurface Sewage Disposal System-Page 17 of 17 Mns-OW13 Town of North Andover Tax Map # 210-107.0-0007-0000.0 Parcel Id '18273 1024 TURNPIKE STREEt YONGJIANYU 1024 TURNPIKE STREET NORTH ANDOVER, MA 01846 Ghias llt�l Sin le Family Property Type I Rmidtmtla: 1 Rosldapbal Zonlri93 5izp Total 3,31 Ames 1:Y 29'17 USP11SL1�1t101 index Name)Addre-u, ryl)a Loan Number AcIlvelina(;t, From Untl! YONW[AN YU Owfler 1024 TURNPIKE STREET WC)R'nqAJrqt'>OVFR,MA 01845 jP'Na Previous Gusionlef Inactive 12122/20041 XIN,FRANK 1024 TURNPIKE',iTREFT NORTH ANDOVER.MA 0945 UB Age u7ltLMYint. ANounl:No Cycia Occupant Name ACbV&JIriact1Vrj el�Id. 1370'3,0- 1024 TORNPIKE STRU'r !_ail 1301 i OvIv,-5912017 1090472 01 CY&a 01 Art!vQ Aumum No. 1090472 SerYlar CoC#s Rate MISCFEEADVIIN FEE I 1 9.18 VVTR VNIATE"R !l1 ALL NIIV'�R SIZE 50,80 IL. B k�qter Mantun ,kcc,oun.No 1090472 Sorl�i No $otus 7yl>& Slzv YTD Cons 132402101 a Active 00 METE METE w Waler 1 1 101-i DtilF Rmadijig Code (;O11sumption Pasted©ate Variance Ar-612017 i Do! a Autuol 16 5/1;12017 1!'..912017 985 a Actual 18 2/16,02017 1WIV2015 .907 a AcWal 71 1111E12016 334 946 a Actual 7121f2olb 46 811612016 4/2112Q C j341 a ACA0,91 21 51'25!3016 aji/4 9121120!6 009 a Actual 20 211 G120 I b 10121/20115 689 a A(atlal 21 1112014,015 9% 712212016 868 a Actual 19 F/1412015 4/23/7016 849 a Actoal 23 6/19/2015 4/2212015 826 a Actual 22 2/2012015 1% JO/2$t2QQ 804 ia Ac1u21 22 1111412014 6% 71Z312014 782 a Adual 21 U113W14 2 Yd 4/1212W4 761 a Actual 20 611512014 2°/a IPWDi 4 741 a Actual 21 2/1412014 41.0 10/2312013 720 a Actual 22 11118/2013 8% 7122/2013 696 8 Adtfal 20 6/1501013 -2% 4t2212013 676 a Arktal 2.1 5/20/2013 13% 1/16/2013 667 a Actual 12013 -101.4 16119012 639 a AduM 20 11191202 1112 7120/Z012 Oig a Ar"sual IS 4/14/2012 4t=2012 60! a Aolual 17 ndq,1202 664 a AGWI 20 2!5312012.312012 1 C, 11012012011 564 as ADIUEO 1Y W-14120111 7121/20111 547 a Actual 15 811512011 21% 4/21/2011 532 a Aclus' 18 511612011 -3%