Loading...
HomeMy WebLinkAboutTitle V Inspection Report - 164 MILL ROAD 11/7/2003 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENvIRONMENITAL PROTECTION yo4 NOV 2 6 TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 164 Mill Road_ —North Andover--, Owner's Name: Derek Rhodes Owner's Address: 164 Mill Rod-- —North Andover,MA 01845 Date of Inspection: 11/8/2003 Name of Inspector: Neil J.Bateson_ CompanyName:_Bateson Enterprises Inc._ Mailing Address: 111 Argilla Road_ _Andover,Ma.01810 Telephone Number:j 978)475-4786_ 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 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 ------- Needs Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: 11/7/2003 VVU---V- 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: Septic Tank Riser Needs Replaced,Cover Broken. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 164 Milt Road_ North Andover_ Owner:_Rhodes_ _ Date of Inspection:_11/8/2003_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X l 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: 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes)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 obstruction is removed distribution box is leveled or replaced ND explain: _The system required pumping more than 4 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 ND explain: Page 3 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_164 Mill Road_ _North Andover Owner:_Rhodes_ Date of Inspection:_111812003_ 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 public health,safety or 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 public health,safety and the environment: Cesspool or privy is within 50 feet of a 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,safety and 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 SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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 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 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 must be attached to this form. 3. Other: Page 4 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_154 Mill Road_ North Andover— Owner:_Rhodes_ Date of Lrspection: 11/8/2003_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: Yes No _ —No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or _ cesspool _ _No Liquid depth in cesspool is less than 5"below invert or available volume is%z day flow, _No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). _Number of times pumped _ No Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No_ Any portion of a cesspool or privy is within a Zone I of a public well. No Any portion of cesspool or privy is within 50 feet of a private water supply well. No— 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 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 must be attached to this form.] No (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 now of 10,000 gpd to 15,000 gpd. 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) 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 I€you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR artment. 15.304.The system owner should contact the appropriate regional office of the Dep Page 5 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 164 Mill Road _North Andover — Owner:_Rhodes_ ^ — Date of Inspection: 11/8/2003 _ Check if the following have been done.You must indicate"Yes"or"no"as to each of the following: Yes No Yes_ — Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes Were as built plans of the system obtained and examined?(If they were not available note as NIA) Yes Was the facility or dwelling inspected for signs of sewage back up? Yes Was the site inspected for signs of break out? Yes Were all system components,excluding the SAS,located on site 7 Yes_ _ 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? _Yes_ _ 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 _Yes _ Existing information. No Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_164 Mill Road_ North Andover – owner:_Rhodes_ Date of Inspection:_11/812003_ FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design): 4_ Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_600_ Number of current residents:_4 Does residence have a garbage grinder(yes or no): No_ Is laundry on a separate sewage system(yes or no):_No Laundry system inspected(yes or no):_ Seasonal use: (yes or no): No Water meter readings:_Yes_ Sump pumps(yes or no): No_ Last date of occupancy:_Current CONMIERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): T gpd Basis of design flow(seats/persons/sgft,etc.): 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 o):Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Pumped last year,owner_ Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500_gallons--How was quantity pumped determined? Measured tank_ Reason for pumping: Inspect tank&tees TYPE OF SYSTEM X_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) —Tight tank Attach a copy of the DEP approval Other(describe):_ Approximate age of all components,date installed(if known)and source of information:_18 Years Old, 8/9/1985, As built plan Were sewage odors detected when arriving at the site(yes or no):_No Page 7 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:_164 Mill Road_ _North Andover — Owner:_Rhodes_ Date of Inspection:_11/8/2003_ BUILDING SEWER(locate on site plan)X Depth below grade:—4'_ Materials of construction: _cast iron —X-40 PVC_X_other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):_4"Cast iron thru wall. 3"PVC in house, no leaks._ SEPTIC TANK: X locate on site plan) Depth below grade: 31 _ Material of construction:—X—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:_10'x S'x 41 _ Sludge depth:_8"- Distance from top of sludge to bottom of outlet tee or baffle:—17"— Scum thickness:_10" 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 were dimensions determined:_Difference in sludge&scum depth to tee length_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.):_Pumped septic tank.Inlet tee ok.Outlet tee ok.Depth of liquid at outlet invert.No evidence of leakage. 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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 3 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_164 Mill Road_ _North Andover_ Owner•_Rhodes_ Date of Inspection:_111812003_ TIGHT or HOLDING TANK; (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: 2allons Design Flow: allons/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:_X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _011 1 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.):—D-Box level&distribution equal.No evidence of carryover.No evidence of leakage._ PUMP CHAMBER: X (locate on site plan) Pump in working order(yes or no): Yes_ Alarm in working order(yes or no):—Yes-- Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump cycled on then off. Alarm has both audible buzzer&visual light._ Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_164 Mill Road_ _North Andover— Owner:_Rhodes_ Date of Inspection:_11/8/2003_ SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: _X leaching trenches,number, length: S trenches 61'long_ leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil ok.Vegetation ok.No sign of ponding to surface._ CESSPOOLS: (cesspool must be pumped as part of inspection)(locate 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: (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.): Page 10 of L I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_164 Mill Road_ _North Andover_ Owner:_Rhodes_ Date of Inspection:_111812003_ 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. Driveway A to Septic Tank=13'7" A to Pump Tank=22'3" A to D-Bog=62'3" B to Septic Tank=60'6" B to Pump Tank=75'5" B to D-Bog=97'6" Water Meter House B A Porch Septic TankPum%Tank D-Bog 61' Page 11 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_164 Mill Road_ North Andover — Owner:_Rhodes_ — Date of Inspection:_1118/2003_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 49 — Please indicate(check)all methods used to determine the high ground water elevation: X_ Obtained from system design plans on record-If checked, date of design plan reviewed:_512311983_ _ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board ofHealth-explain:_ Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per design plan. ....-•[xJ7..._a-^=-.r•tJ,.J-`Y-...n.._.�_.:::, r:-'-i �_. h - - _ = Connect 'Edit Temina! Help A J o WATER BILLING HISTORY 2100320-DR. DEREK RHODES METER #1 : 2100320 p --------------------- ILL RD Microsoft # CYCLE SERVICE PRIOR SE WATER SEWER FEES TOTAL Gutfook � 1 2000-12 08/04/1999 768 833 65 177.45 0_00 0„00 177.45 2 2000-22 12/10/1999 833 865 32 87.36 0.00 0.00 87.36 3 2000-32 03/15/2000 865 886 21 57.33 0..00 0.00 57.33 or �s 4 2000-42 05/22/2000 885 912 26 70.98 0.09 0.00 70_98' 5.Q- - 5 2001-12 08/09/2000 912 947 35 95.55 0-09 11 .90 106.55cop =- � =' 6 2001-22 11/15/2000 947 980 33 90.09 0.40 11.00 101.09 . download.hdl v: _ 7 2001-32 02I20/2901 980 997 17 46-4157.41 11.00 57.41 8 2001-42 05/22/2001 997 1020 23 62.79 0-00 11.00 73.79 e- 9 2002-22 12/0b/2001 108b 1 !32 46 130.42 0.00 5.55 135.97 10 2002-32 03/19/2002 1132 1159 19 46-93 0.00 5.55 52_48 . ; 11 2002-42 05/21/2002 1151 1163 12 29.64 6.80 5.55 35_19: . �## : ,:12 2002-12A 08/09/2001 1020 1086 66 214.54 0-00 5.5S 220.09 13 2003-12 08/09/2002 1163 1188 25 66.60 0.00 5.97 72.57 =� .;14 2003-22 11/07/2002 1188 1206 18 42.84 0.00 5.97 48.81 rv� 115 2003-32 02/12/2003 1206 1222 16 38.08 0.00 5.97 44.05 overn32 16 2003-42 05/07/2003 1222 1237 95 35.70 0-00 5-97 41 -67 -; AVE 17 2004-12 08/94/2003 1237 1277 40 113-44 0-00 7.42 120-86 REVIEW CHOICE # or CENTER] MORE HISTORY: icrosofk �'' Word Mpft;4b Flu work ip erurces i vDocument.NtME [ 4. ® _ a"1; NON -.... -...._.- ry .._ ..._. ....--_ ...1.r. _ .. ...__ Ir r4 �' My Lloerrments Connect to theNet k Neighborhood iM'�f3rjefcase a f DelfnetSignup--:_ 9 . Internet •-s Mart ; Inbar - Microsoft O_.. Telnet- 10.1.71.55 i7 3:45 PM M 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: 164 Mill Road, North Andover Owner: Rhodes Date of Inspection: 11/8/2003 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. Ne' 1 B eson Bateson Enterprises, Inc.