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Home My WebLink AboutTitle V Inspection Report - 325 BERRY STREET 9/12/2017 Commonwealth of Massachusetts RECEIVED � Title 5 Official Inspection Form 2 2017 Subsurface Sewage Disposal System Form - Not for`voluntary Assessments . �� TOWN OF NORTH ANDO 325 Berry Street VER -HEALTH 1 EPARTMEI T-.. Property Address Sean M. Dunn Owner Owner's Name information is required for every North Andover MA 01845 08/10/2017 ----- _.------ -_ _. --- -- - --. .. page. Clty/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1 Inspector: key to move your cursor-do not Robert Herrick use the return key. Name of Inspector Wind River Environmental rab Company Name 163 Western Avenue - --- . _ -- — Company Address ern Gloucester MA 01930 City/Town State Zip Code (978) 282-7315 SI 13758 Telephone Number License Number B. 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 I _ _08/10/2(717 ... .._. spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board j of Health or DEP) within 30 days of completing this inspection. If the system 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. ****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. t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Fuge 1 of 17 i Commonwealth of Massachusetts IMP - F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 325 Berry Street _------------ m _...._ Property Address Sean M. Dunn Owner Owner's Name information is North Andover_ MA 01845 08/10/2017 required for every —........_ __.. _ __ _ -- ............... page. City/Town State Zip Code Date of Inspection B. Certification (cant.) Inspection Summary: Check A,B,C,D or E 1 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: 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): l51ns,doc-rev.6116 Title 5 Official Inspection Form:Subsur#aco Sewage Disposal System•Page 2 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 325Ber Street � Property Address � Sean K8. Dunn Owner Owner's Name � information is North Andover dovar W�A -- -0-1-8-4-5��—' -U08/10/2017-08/10/2017��O�1-7 required for every page. ��o�m S�me Zip Code Date r/Inspection - -----��---- B. Certification (cont.)E] Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (oont): -- �l 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 |f(with approval nfBoard ofHea|th): 0 broken pipe(s) are replaced El Y El N F-1 ND (Explain below): F1 obstruction isremoved E] Y F1 N El ND (Explain be|mw): F-1 distribution box isleveled or replaced E] Y 0 N NO (Explain Ueluw): El The system required pumping more than 4times o rduatobrokenurobotrucbydpipe(n). The system will pass inspection if(with approval ofthe Board ufHoo|th): [I broken pipa(a) are replaced 0 Y El N El ND (Explain bo|ovv): F-1 obstruction isremoved E] Y E] N Fl ND (Explain below): C) Further Evaluation iaRequired bythe Board ofHealth: �� Cond�onne�stwh�hrequirahu�hereva|um�unbytheBmamdufHee�hinordartodetennine � �� the system is failing to protect public health, safety nrthe environment. 1' System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health, safety and the environment, �l Cesspool or privy is within 5Ofeet nfa surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh ' «�^ Commonwealth of Massachusetts Title��N�� ^��'°��N N��"�� 0=�N� �� m°�� N Nmm��N��mm N��mmm� Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 325 Berry Street Property Address Sean M. Dunn Owner Owner's Name information|a 01845 �/1 O17 �quieumrewe� '`"'"' ='~`~~ —A page. City/Town State Zip Code Date of Inspection B Certification (cont.) 2' System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in m manner that protects the public health, safety and environment: F-1 The system has a septic tank and soil absorption aymhern (SAS) and the SAS is within 180feet ofasurface water supply ortributary toasurface water supply. F1 The system has o septic tank and SAS and the SAS is within a Zone 1 of public water supply. F-1 The system hone septic tank and SAS and the SAS is within 50 feet ofm private water supply well. � F 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 vve||°° Method used todetermine distance: 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 must beattached tothis form. 3. Other: � D System Failure Criteria Applicable toAll s: You must indicate "Yea" or"No" to each of the following for all inspections: Yea No �� Backup ofsewage into facility nrsystem component due hnovadoodednr �� .~ clogged SAS urcesspool Discharge or ponding of effluent to the surface ofthe ground orsurface waters [� [� ^� �~ due toanoverloaded orclogged SAS orcesspool Static liquid level in the distribution box above outlet invert due to an overloaded [� [� �^ n/clogged SAS orcesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2da flow Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 325 BerryGtrnet -_-----_��-______��______��________��___ � Prope nvAddress Sean N1. Dunn Owner Owner's Name information is North Andover MA 01845 08/10/2017 requ|nado/evuy -_--__-��-�_--_.'�� __-��- -__��_-- ��--------�� So�e zipCu�a Date mmopo�mo e City �o�n page. B. Certification (cont.) Yes No �� Required pumping more than 4 times in the last year NOT due to clogged or �~ �� obstructed pipe(s). Number oftimes pumpad� _____ El Z Any portion mfthe SAS, cesspool orprivy isbelow high ground water elevation. F� �� Any po�innnfcesspool nrprivy imwithin 1DOfeet nfaou�anevvmtersupply nr �� tributary toasurface water supply. E:] Z Any portion ufacesspool or privy is within a Zone 1 of public well. El Z Any portion of oeonpnn| o/privy is within OO feet of private water supply vve||. �l �� Any po�ionofacesspool orprivy ialess than 1OOfeet but greater than 5Ofeet -- from a private water supply well with no acceptable water quality analysis. [This system passes ifthe well water analysis, performed atmDEP certified laboratory,for fecal coliform bacteria indicates absent and the presence oYammonia nitrogen and nitrate nitrogen isequal to orless than 5ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain pfcustody must beattached tpthis fornm.] The system isucesspool serving afacility with adesign flow nf2OU0gpd [� y� �^ �� 10.000gpd. / The eystennfmUm' | have determined that one ormore ofthe above failure | El znritaria exist ----as described in 310 CMR 15.303. therefore the nyshynn fails. The system owner should contact the Board ufHealth tudetermine what will be necessary tocorrect the failure. E) Large Systems. To bsconsidered alarge system the system must serve afacility with m design flow uf1Q.00Q8p6 to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions inSection D. Yam No ' Fl El the system iswithin 408feet ufesurface drinking water supply El F the system is within 200 feet nfa tributary to m surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection El El Area- |VVPA) orgmapped Zone \| nfapublic water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat. nranswered ^yea" |nSection Dabove the large system has failed. The owner oroperator ofany large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office ofthe Department. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsu�aceSevvmgwDisposal SyetemnForrn ' No�fnrVo|unboryAauaommmn�s 325Berry Street Property Address Sean M. Dunn Owner Owner's Name information is North AndoverMA 01846 0EV10/2017 n,noi�4for every ------'-� ------ -------�� ------��------- � G�� Z�Cnun o��of|ovpam|on 0|4mnmvn � page. C. Checklist Check if the following have been done. You must indicate"yes" m°no" aotoeach ofthe following: Yes No H 0 Pumping information was provided by the ownar, occupant, or Board of Health El 0 Were any ofthe system components pumped out inthe previous two weeks? M El Has the system received normal flows inthe previous two week period? � El �� Havelarge volumes nfvvaterbeen introduced tothe system recently oranpaduf �� this inspection? �� [� VVeraanbuilt plans ofthe system obtained and examined? Ufthey vvaranot �� available note aeN/A) E El Was the facility ordwelling inspected for signs ofsewage back up? E Fl Was the site inspected for signs ofbreak out? E El Were all system components, excluding the SAS, located onsite? �� VVerethe septic tank manholes uncovered, opened, and the interior ofthe tank -- -- inspected for the condition of the baffles or tees, material of construction, dimensions, depth ofliquid, depth nfsludge and depth ofscum? 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 wfthe Soil Absorption System (SAS) onthe site has been determined based on. Z Existing information. For example, a plan at the Board of Health. Determined in the field (|f any nfthe failure criteria n*|mtad to Part is at issue El E approximation ufdistance isunacceptable) [D1OCMR 15.302(5)] D. System Information Residential Flow Conditions: 43 Number ofbedrooms (denign). Number ufbedrooms (actual )� '��------- 0 DEG|(�NOmwbased on31O (�K4R15,2U3 (for example 110gpdx#ofbmdrqomu): =�-~=�=�--- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 325 Berry Street Property Address Sean M. Dunn - Owner Owner's Name information is North Andover MA 01845 08/10/2017 required for every page. CItyrrown State Zip Code Date of Inspection D. System Information Description: This system is made up of a gaIIon_septic tank, distribution box and soil absorption system. 4 Number of current residents: _ Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Well Water Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: " u Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/personslsq. t., etc. : Grease trap present? El Yes El No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? El Yes E] No Water meter readings, if available: I t5ins.doc-rev-6116 Title 5 Ofb6al tnspection Form:Subsurface Sewage Disposal System-Page 7 of 37 u i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 325 Berry Street .................... Property Address Sean M. Dunn Owner Owner's Name information is required for every North Andover MA 01845 08/10/2017 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use.- Date Other(describe below): General Information Pumping Records: Wind River Environmental 1 Home Owner Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool El Privy El Shared system (yes or no) (if yes, attach previous inspection records, if any) El 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 F❑ Tight tank. Attach a copy of the DEP approval. El Other(describe): 151ns.doc-rev 6116 Title s official inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -x-11 yv a 3255 Berry Street Property Address Sean M. Dunn Owner Owner's Name information is North Andover MA 01845 08/10/2017 required for every - --...._._ _................ ... _ page. CltylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1990; Plans on File Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 30' Depth below grade: fee€ _.._ Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): 100'+ Distance from private water supply well or suction line: - feet Comments(on condition of joints, venting, evidence of leakage, etc.): All joints are solid. There are no stens of leakage and ventin rough the building's sewer. Septic Tank(locate on site plan): 24" Depth below grade: feet _ Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1' If tank is metal, list age: yea -� years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 10'10" x 6'8"x 5'8" Dimensions: --.. _..._.. 4" Sludge dept _.._..... 15ins,doc•rev_6116 Title 5 Official Inspection Furm-,Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 325 Berry Street Property Address Sean M. Dunn Owner Owner's Name information is required for every North Andover MA 01845 08/10/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 35" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 14" Distance from bottom of scum to bottom of outlet tee or baffle Tape Measure & Sludge Judge How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Recommend M"in Iv. The inlet and outlet baffles are solid. There are no signs of leakage _�y _p��1 - and the liquid level is OK in relation to the inverts,.,.__,,, Grease Trap (locate on site plan): Depth below grade: feet Material of construction: El concrete El metal F-1 fiberglass El polyethylene El 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: Date "._..., t5ins.doc-rev.6116 Title 5 Officlat Inspection Form:Subsurface Sewage Disposal System Page 10 of Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 325 Berry Street Property Address Sean M. Dunn Owner Owner's Name information is required for every North Andover MA 01845 08/10/2017 page. City/Tow,n State Zip Code Date of Inspection D. System Information (cont.) 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 Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El concrete El metal El fiberglass E] polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present-. El Yes E] No Alarm level: Alarm in working order: El Yes [_1 No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): .......... Attach copy of current pumping contract(required). Is copy attached? El Yes ❑ No l5ws doe-rev 8116 TRIL 5 Offic[al Inspection Form:Subsurface Sewage Disposal System•P898 ' »�^ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 325 Berry Street _.----_........ ��______��________�� Property Address Sean M. Dunn Owner Owner's Name information iv 01845 1 D17 �qui�d�rove� '`"'"' ~''~~`~ —� page. ~^°'`~^ State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must beopened) (locate onsite o|mn): Depof O � Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any � evidence ofleakage into orout ofbox, otcj:The distribution box is solid. There are no � siqns of carryover or leakage in 0rout ofthe box and the liquid level is OK in relation to the inverts. � PunnpChmnnbar(|000hyoneitnp|on)� Pumps inworking order: El Yeo El No* Alarms inworking order: D Yes El No~ Comments (note condition of pump chamber. condition of pumps and appurtenances etc.): �-----_—_��__--_- ° |fpumps oralarms are not inworking order, system |naconditional pass. Soil Absorption System (SA8) (locate on site plan, excavation not required): If SAS not |uoated, explain why: t5ins.doc-rev.611(3 Title 5 Official inspection Form:Subsurface sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 325 Berry Street —Property Address" Bean M. Dunn Owner Owner's Name information is required for every North Andover MA 01845 08/10/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: leaching pits number: 3 ❑ leaching chambers number: El leaching galleries number: E] leaching trenches number, length: El 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.): The soil is dry and there are no signs of hydraulic failure or ponding. The vegetation is normal for the area. 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 El Yes E] No 15ins doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 17 Commonwealth of Massachusetts - $ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _ 325 Berry Street Property Address Sean M. Dunn Owner Owner's Name information is North Andover MA 01845 08/10/2017 required for every page. City/Town State Zip Code hate of Inspection D. System Information (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 hydraulic failure, level of ponding, condition of vegetation, etc.): i t5ins_doc•rev.6116 Title 5 Official Inspection Form:subsurface Sewage Disposal system•Page 14 of 17 I i 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 326 Berry Street Property Address Sean M. Dunn Owner Owner's Name information is North Andover MA 01845 08/10/2017 required for every page. City1rown 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: hand-sketch in the area below ❑ drawing attached separately 7 Owe/ t5ins.duc-rev,6116 TRW 5 official Inspection Form:Subsurface Sewage Disposai System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 325 BerryStreet --- Property Address Sean M. Dunn Owner Owner's Name information is North Andover MA 01845 08/10/2017 required for every ------ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope Surface water Check cellar Shallow wells 94.57 Estimated depth to high ground water 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: 1990 ........-- Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ........... El Checked with local excavators, installers -(attach documentation) El Accessed USGS database -explain: You must describe how you established the high ground water elevation: Obtained the estimated ground water using the 1990 design plan on record with the Board of Health. The bottom of the leach chamber is at an elevation of 98.57 giving 4' of seperation between the .......... ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15[ns.dor-rev,6116 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'q 325 Berry Street ----------........... Property Address Sean M. Dunn Owner Owner's Name information is North Andover MA 01845 08/10/2017 required for every --...... -- ----.------ page. CIty]Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® 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 I i 15ins.doc•rev-6116 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 17 of 17