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HomeMy WebLinkAboutMiscellaneous - 1028 Salem Street (5)DATE: LOCATION: l D �- ENGINEER: -_ ( ,) mow( BOH WITNESS: z S� PERCOLATION TEST # TIME OF SOAK: 3 (At least 15 minutes long) TIME AT 12" TIME AT 9" TIME AT 6 ct ._ OVERNIGHT SOAK lE STARTED _ InaS' DATE: LOCATION: ENGi,%'F TIME AT 12;' TIME AT 9" TIME AT 6" minutes lora.,) 7 OVERNIGHT SOAK TIME STARTED 0 C3ff NEXT DAY SOAK: (At least 15 minutes) TIME AT 12" TIME AT 9" TIME AT 6" I WILLIAM J. SCOTT Director Town of North Andover Ree OFFICE OF - JOY011Q COMMUNITY DEVELOPMENT AND SERVICES TO.N NQRT� � 146 Main Street North Andover, Massachusetts 01845 APR 17 1 NOTICE OF DECISION Any appeal shall be filled within (20) days after the date of filling this Notice in the Office of the Town Clerk. ,.sem .j�-'� `•� +. e � ppR Date April 16, 1997 Date of Hearing April 15, 1997 Petition of 1028 Salem Street - Repetitive Petition Premises affected 1028 Salem Street Referring to the above petition for a special permit from the requirements of the North Andover Zoning Bylaw Section 10.8 - n - SO aS tO allOW_ a repetitive petition within the two year prohibition After a public hearing given on the above date, the Planning Board voted to -Approve the repetitive petition based upon the following conditions: CC: Director of Public Works Building Inspector Natural Resource/Land Use Planner ,Health Sanitarian Assessors Police Chief Fire Chief Applicant Engineer File Interested Parties Signed Joseph V. Mahoney, Chairman Richard Rowen, Vice Chairman Alison Lescarbeau, Clerk Richard Nardella John Simons Planning Board BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 e Town of North Andover , N OFFICE OF 3r; 50 •`'``p COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street, North Andover, Massachusetts 01845 t WILLIAM J. SCOTT Director April 16, 1997 Ms. Joyce Bradshaw Town Clerk 120 Main Street North Andover, MA 01845 Re: Repetitive Petition - 1028 Salem Street Dear Ms. Bradshaw, The North Andover Planning Board held a public hearing on Tuesday evening, April 15, 1997 at 7:30 p.m. in the Senior Center behind the Town Building on the application'of Albert P. Manzi Jr., Pacific Realty Trust, 1028 Salem Street, North Andover, MA 01845 requesting a repetitive petition under Section 10.8 of the North Andover Zoning Bylaw. The legal notice was properly advertised in the North Andover Citizen on March 26 and April 2, 1997 and all parties of interest were duly notified. The following members were present: Joseph V. Mahoney, Chairman, Richard Rowen, Vice Chairman, Alison Lescarbeau, Clerk, Alberto Angles and John Simons. Richard Nardella was absent. Kathleen Bradley Colwell, Town Planner, was present. The petitioner sought the consent of the Planning Board to re -petition the Zoning Board of Appeals. The premises affected is land numbered 1028 Salem Street, in the Residential -1 (R-1) Zoning District. Atty. Scott Masse was present to represent the applicants for 1028 Salem Street. Mr. Masse sent a letter to the Board outlining the issue. Mr. Masse stated that the ZBA is in favor of the repetitive petition. Ms. Colwell explained that Section 10. 8, of the Zoning Bylaw states that when the ZBA denies a petition for a variance no application for the same matter may be heard and acted upon for two years unless: Four or five members of the ZBA find that there are specific and material changes in the conditions, and Only after a public hearing held by the Planning Board at which consent to allow the petitioner to re -petition the ZBA will be considered. BOARD OF APPEALS 688-9541 RUIIDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 68&9535 The ZBA met and determined that there are specific and material changes. The Planning Board is supposed to hear any abutter concerns and make a decision as to whether there is material changes. Mr. Masse explained that in 1996 the ZBA denied a variance request for relief from the lot dimension requirements in order to create 3one acre lots. The lots are located on the corner of Salem Street and Foster Street in the R-1 (2 acre) zone. The applicant sought to create 3 one acre lots. The current plan shows 1 one acre lot, one 19,000 SF 50' strip to create access to a back parcel of land, and a 1.7 acre lot. Therefore this plan is different from the original plan. Mr. Simons stated that he does not like this plan. The zoning in this area requires 2 acre lots, one acre lots should not be allowed. Mr. Mahoney stated that the applicant has the right to request a variance from ZBA, that is not the issue before the Planning Board. Mr. Nardella stated that some members have concerns and would like Ms. Colwell to write a letter to the ZBA stating the Boards concerns Mr. Mahoney does not share those concerns. Al'Manzi Jr. stated that the ZBA meeting all abutters were in favor of the petition. The Board agreed to uphold the ZBA's determination that the new plan has specific and material changes. On a motion by Mr. Nardella seconded by Mr. Rowen the board voted to close the public hearing. Ms. Colwell had prepared a draft decision for the Boards review. On a motion by Mr. Nardella seconded by Mr. Rowen the board voted 4-1 that the Planning Board find the plan dated 2/13/97 is materially different from the original plan and consented to allow the applicant to re -petition the ZBA. Mr. Simons was opposed. Attached are the conditions. Sincerely, Joseph V. Mahoney,, Chairman North Andover Planning Board 1028 Salem Street Repetitive Petition The Planning Board herein consents to allow the petitioner as set forth below to re -petition the Zoning Board of Appeals. The petitioner is Albert P. Manzi, Jr., Pacific realty Trust, 1028 Salem Street, North Andover, MA 01845: The petition was submitted on March 14, 1997. The Planning Board makes the following findings as required by Section 10.8 of the Zoning Bylaw: FINDINGS OF FACT: 1. In September of 1996, Foscar Realty Trust filed a Petition with the North Andover Board of Appeals for a Variance from the requirements of Section 7.1 and Table 2 of the Zoning Bylaw requesting relief from the lot dimension in order to create three one acre lots. 2. On December 24, 1996 the Board of Appeals voted to deny the petition. 3. On January 3, 1997, Pacific Realty Trust purchased the subject property. 4. On February 18, 1997, Pacific filed. a new petition with the Board of Appeals for a Variance from the requirements of Section 7.1 and Table 2 of the Zoning Bylaw seeking relief from the lot dimension. This petition would allow the creation of a 1.0 acre lot, a 1.7 acre lot and a 19,089 SF parcel to provide access to land owned by the petitioner to the rear of this lot. 5. Pursuant to Section 10.8 of the North Andover Zoning Bylaw and MGL Ch. 40A, Sec. 16 the - applicant was required to appear before the Zoning Board- of Appeals for a determination that there are specific and material changes in the conditions upon which the previous unfavorable action was based due to the fact that the Board had denied the plan less than two years ago. 6. On March 11, 1997, the Zoning Board of Appeals voted to allow the petition due to specific and material changes in this application from the prior application namely the fact that two lots and one parcel will be created as opposed to three lots. 7. On April 15, 1997, the Planning Board held a public hearing to discuss the request for a repetitive petition. The Planning Board voted to allow the petitioner to re -petition the Zoning Board of Appeals. The Planning Board deferred to the Zoning Board of Appeals determination that specific and material changes were present in this application from the prior application. DECISION: The Planning Board herein consents to allow the petitioner to re -petition the Zoning Board of Appeals. r TO: FORM L DEPARTMENTAL REFERRAL FORM Building Inspector \000" Conservation Administrator Director of Community Development Director, Public Works Fire Chief Heaath_Agent. Police Chief FROM: Town Planner and/or Clerk, Planning Office RE: Preliminary Plan Definitive Subdivision Special Permit Sitf�e, Pllan� Review 7 Date: 1 + 1� 1 cc Public lean has been scheduled for p.m. on to discuss the plans checked above. (Preliminary plans do not require public hearings.) The Technical Review Committee Meeting is scheduled for: Thank You. �r ,I '_TE` Li EP' HONE (508) 532-8400 March 143997 North Andover Town of North Town Hall North Andover, SCOTT L. MASSE ATTORNEY AT LAW 12 PEABODY SQUARE PEABODY, MA 01960-5654 Planning Board Andover MA 01845 Attn: Joseph V. Mahoney, Chairman RE: PACIFIC REALTY TRUST REQUEST FOR CONSENT TO ALLOW PETITIONER TO RE -PETITION ZONING BOARD OF APPEALS 1028 SALEM STREET Dear Chairman Mahoney: FA 508) 532-8410 j408) 532-8410 N0 M44 1 q 247 PP. IS7 Please be advised that Pacific Realty Trust hereby requests to appear before the North Andover Planning Board on Tuesday, April 15, 1997 for..the purpose of securing the consent of said Planning Board to allow Pacific Realty Trust to Re - Petition the North Andover Board of Appeals for a Variance within two years from the date of unfavorable action as set forth pursuant to Section 10.8 of the North Andover Zoning Bylaw and Massachusetts General Laws Chapter 40A Section 16. (see attached) A h' torical background will be helpful in allowing -you to understand the mature of this request. In September of 1996, Foscor Feaitr Trv&t (hereinafter referred to as "Foscor") filed a tion (Application) with the North Andover Board of Appeals for a Variance from the requirements of Section 7, Paragraph 7.1 and 9aE32 2 of the Zvn�ing_ B.y Law, specifically relief from the lot dimdnsion area in�brAer'to subdivide and develop three lots from the paieel known -go Q28 Salem Street. On December, 24, 1996 the Board o� A�'eals after a hearing, voted to accept the' Guest of the pe�tioner, Foscor to deny the petition iliew--of a withdrawal. On January 3, 1997, Pacific Rsalty TriLst, Albert P. Manzi, Jr. and Albert P. Manzi, III, (hereinafter referred to as "Pacific") purchastl the aforestated property and immediately sought to mat ialfy alter the Foscor plan. On February 18, 1997, Pacific 'led a new Petition with the North Andover Board of Appeals for a Variance from the requirements of Section 7, Paragraph 7.1 and Table 2 of the North Andover Zoning By Law, specifically seeking relief from the lot dimension area. However, unlike the Foscor proposal, this plan called for the subdividing of this parcel into only two lots, one to be owned and occupied by Albert P. Manzi, III, a trustee of Pacific and a fifty foot right of way. Pursuant to the provisions of Section 10.8 of the North Andover Zoning By Law and Massachusetts General Laws, Chapter 40A, Section 16, because Pacific's request for a variance was made within the two year restriction period following the denial of the Foscor petition in December of 1996, Pacific initially was required to appear before the Board of Appeals to establish that the changes made in its proposal were specific and material. Om March 11, 1997, Pacific appeared before the Board of Appeals specifically for this purpose. After a hearing, the Board unanimously voted that the Pacific proposal was in fact specifically and materially changed from that of Foscar, and allowed Pacific's request to withdraw its petition for a variance without prejudice to secure the consent of the North Andover Planning Board. (see attached) Thank you for your consideration in this matter. Sincerely, PACIFIC REALTY TRUST By I vCRattorney Cott L. Masse SLM/ham Enclosures cc: Albert P. Manzi, Jr. Albert P. Manzi, III j A&1F,��+� NOR7N N�SV.F:�Oy_ 4AJA{� pF �t�ec �° �s9 Q°A,TEo �PP`ty DEC 21 AN 96 FIVSSACHUSES n� �I �I TOWN OF NORTH ANDOVER 9 MASSACHUSETTS BOARD OF APPEALS --- "" Any Appeal shall be filed within (20) days after the date of filing this notice in the Office of the Town Clerk NOTICE OF DECISION Property: 1028 Salem Street Fos or Realty Trust Date: December 24, 1996 1028 Salem Street Petition: 036-96 North Andover MA 01845 Date of Hearing: The Board of Appeals held a special meeting on Tuesday evening, December 17, 1996 upon the petition of Foscor Realty Trust requesting a Variance under Section 7, Paragraph 7.1, seeking relief of lot dimension area. The following members were present and voting: William Sullivan, Raymond Vivenzio, John Pallone, Joseph Faris & Ellen McIntyre. The hearing was advertised in the Lawrence Eagle Tribune on September 24, 1996 & October 1, 1996 all abutter were notified by regular mail. Upon a motion by Raymond Vivenzio, seconded by Joseph Faris the Board voted to accept the request to deny the petition in lieu of a withdrawal. The following members vote unanimously to deny the petition: William Sullivan, Raymond Vivenzio, John Pallone, Joseph Faris and Ellen McIntyre. 0 Board of Appeals William Sullivan, Chairman NEW E GLAND ENGINEERING SERVICES INC RECD eJED JAN 12 2005 TOWN OF P:^A,NUO�✓ER HEALTi" t, _ �I�� i 'HENT January 11, 2004 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 1028 Salem Street, North Andover, MA Dear Sir or Madam: Enclosed is a copy of the Title V report for the above referenced property. The system FAILED our inspection. This inspection was done a while ago and the home has since been tied in to the municipal sewer system. If there are any questions please call me at my office, 686-1768. Sincerely Benjamin C. Osg Jr. Certified Title 5 inspector 60 BEECHWOOD DRIVE -.NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 t/ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: I0 oZ o SAt C.r. Owner's Name: is L 1�C2T 14 H - ,-• _ a4' - Owner's Address• Date of Inspection:JAN 1 2 2005 Name of Inspector. (please print) Benjamin C. Osgood, Jr. Tp�;ty pF t:�.,-i; f.: CompanyName:New England Engineering Services Inc. �: - MaGingAddress:60 Beechwood Drive, North Andover,MA 01845 Telephone Number. 978-686-1768 CERTIFICATION STATEMENT I certify that I have pully 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 _X Fails Inspector's Signature: C ( Date: i o 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. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /oz Pa n4 !g;—, A,� 0 o o,jej- Owner: Ac -YC -/t - 4 u Date of Inspection: i o/ ZyLpy Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: Mii 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: ALJ 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 `hot 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 septictank 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 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 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: Pagel of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: / cs .. sca �C ,14 j Owner:�–�- Date of Inspection: C 12- LO y G Farther Evaluation is Required by the Board of Health: / Q 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(l)(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 environments _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 fee_ t of a surfaoe 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 colifoM 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 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address; _ /,D z° 6A L M �s/ 1,� Owner: Date of Inspection:���/�c���y D. System Failure Criteria applicable to all systems: You must indicate `jres" or "no;" to each of the following for aIl inspections: Yes No v 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 _ V Static liquid level in the distdlmtion 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 'h day flow L/ 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 SAS, cesspool or privy is below high ground water elevation. 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 well. L 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 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.] (YM No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15303, 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 gpd- You must indicate either "yes" or `ono" 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 II of a public water supply well If 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 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _ I ORO Owner: A(.-6, 2 ^AA.1a1 Date of Inspection: /o/a9/DY Check if the following have been done. You must indicate `)res" or "no" as to each of the Mowing: 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 ? — Z 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 7 Was the site inspected for signs of break out ? Were all system components, excluding the SAS, located on site ? _ Were flue septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition o'f the baffies or tees, material of construction, dimensions, depth of liquid, doth of sludge and depth of swim ?. ✓ 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 C is at issue approximation of distance is unacceptable) [310 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: -_- iy 2 P �1 -[ rti s; c r� NL2TH AAJpaJ(A_ Owner: Date of Inspection: °lam y FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example* 110 gpd x # of bedrooms): Number of current residents: Z Does residence have a garbage grinder (yes or no): Is laundry on a separate sewage system (yes or no): VD (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): nr 0 Last date of occupancy: L, COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persoos/sq%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 meter readings, if available Last date of occupancy/use: bTHER (descdbe): GENERAL INFORMATION Pumping Records Source of information: v, ti oar 4, Was system pumped as part of the inspection (yes or no): ,ti o 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 — Privy Shared system (yes or no) Of yes, attach previous inspection records, if any) _ Innovative/Altemative 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): 15,(; -?72C ; yAj I'L, Z u ^j V, rv6 Approximate age of all components, date installed (if Imown) and source of information: Were sewage odors detected when arriving at the site (yes or no): _VC, Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Na Owner: Pru -1364: A,%6AJzt L Date of Inspection: i a ISgLi BUILDING SEWER (locate on site plan) Depth,below grade: z i Materials of construction• ✓cast iron 40 PVC other (explain): Distance from private water supply well or suction line: AIA Comments (on condition of joints, venting, evidence of leakage, etc.): _ i %I% i N r7 1 LUN i it % ✓1 SEPTIC TANK: _ (locate on site plan) Depth below grade: t £ " Material of carstrudion:t/oarcxete meal fiberglass _polyethylene other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a Dopy of certificate) Dimensions: ,, Iz Sludge depth: Distance from top of sludge to bottom of outlet tee or baffie- 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: How were dimensions determined: D L) t= ,,A Comments (or' pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Z! 2A.) Y_ AAJA } nJ 2 ej?L .A -t 6 n! i GREASE TRAP: A/`A 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 umpingComments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: / o z� y; _,i1o2r 7f i�J A c�� ,vcA Owner: Ac �3 Etii M. 2, y Date of Inspection: TIGHT or HOLDING TANK: ,^ (tank must be pumped at time of kgxdion)(locate on site plan) Depth below grade: Material of 0onstruction: concrete metal fiberglass _polyethyleneother(explain): Dimensions: capacity. RaLlons Design Flow: aallons(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.): DLS'TRiBUTION BOX: (if present must be opened)(locate on site plan) Depth Iliquidlevelabove outletinCommts (nose if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): PUMP CHAMBER: !P;4— (locate on site plan) . Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump diamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address• 102�^sem` v /Z Re Owner: 41-b« �n,IN a_ Date of Inspection: _ , �Z?-0?/0 E/ SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Trne leaching pits, number: _ leaching chambers, number: leaching galleries„ number: leaching trenches, number, length: 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.): 412 C. n'i- S Ns i ��rt iy i� �lfl ir .J CESSPOOIS: A10- (cesspool must be pumped as part of inspection)0ocate 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: / iftocate 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 Page 10 of 11 OFFICIAL INSPECTION FORM = NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: lo z-3 Owner: Date of Inspection: ivy 7 �N 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. Nj t. 0 Page 11 of 11 OFFICIAL INSPECTION FORM _ NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (,continued) Property Address: /a2� �?f P", P Ove Owner: A%t3ca;-A rN Hfv?, Date of Inspection: zc//a,i SITE EXAM Slope Surface water /V ,, f - Check cellar Shallow wells Estimated depth to ground water -3 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 most describe how you established the high ground water elevation: 3 / / q (Low