Loading...
HomeMy WebLinkAboutMiscellaneous - 111 REA STREET 4/30/2018 111 REA STREET - 210/098.B-0015-0000.0 1 i Shen..00d Homes, Inc. Rae St., Lot 13 APPLICATION FOR SEWAGE DISPOSAL IMSTALLATION HEALTH DEPARTP.WX--NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Rae St., hot 1 _ . I will install this system in accordance with all the lays of the Commonwealth of Massachusetts and regulations of the Board of Health of the Tann of North Andover. Furtherj. I gill construct the house sewer of bell and spigot pipep the minimum diameter being 4 inchess, and will maintain a minimum grade of 3,% until 10 feet preceding the septics tank# where the grade shall not exceed 2%. 1 will install a concrete septic tank of 1000 Gal, in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 Inches of the ground surface. I will provide subsurface disposal field with open jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a series of trenches, the bottom of which will provide a minimum of 20 0 lineal �) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench,, 2 inches of gravel or stone 1/80 to 1//+" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any easep two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the in- stallation will be less than 100 feet from any private water supply} 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I LiM"he agree not to cover any portion of this installation until anproved bythe,jnggection off ce j, as provided below$, and to incorporate any additional requirements that nay be attached to the permit. Plot Plans must be submitted with application. DATE gnature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE _ , ,A-71 Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Q Signature of Ir*P oting Officer Immolation Test , 5 min. Sandy-clay Garbage Grinder April 25, 1959 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Rea Street building site (Lot #13) of Sherwood Homes, Inc. The subsoil in the area was a sandy clay c ontent and a 5-minute percolation test was conducted . The land in general is high. It is recommended that a 1,000 gallon concrete septic tank be installed together with 200 lineal feet of drain pipe. Very truly yours, illi�amJ. i &o3r ,(a a.Y , BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. SS 2Co' t 0 1O'M1rN, Z�r MrA� t waaG,�t Cov . SLPT��Tq AJ t�_ I J r77s S 7 1. NAME s,!��:wn ed � s -z.G . . . . . . . . . . DATE 2. ADDRESS '�: :` ,�(�'a. S t,OP NO. . . . . TEL. 3. NO. OF BEDROOMS L. DEN YES NO. 4. GARBAGE GRINDER YES NO. .�. . 5. SHOW DIIIENSIONS OF HOUSE 6 X � 7 k/s-`� b. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIbEkZIONS OF LOT g. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROPS ETC. 11. SHOW DISTAAICE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULAT IOALS SHOULD BE READ CAREFULLY. . .—.....�,....,,�..a+,-,....,...,.,.�.+,e.. .«a....P. .........,..—.«...<..��.. ..,..........}Me..,.o-....w e..�.-.w..~r�..,..,,,�,,..w.......-......r<M...w.v..........�....,.....a..........�.ae...w....,.�.,.»,...ritw.u,v,...,.s..a.n+..:a........,.a.�{ i { s 4 T - 1 3 '- 9.3.S s jf 1 { s � 9 Q _ k 5 T. ;# f PZ- D 1V-D 1 /Vo. A /A/zD o vz-.4e 11,11,4 s s, Y � rt 4 Commonwealth of Massachusetts TOW N BOARD RTAND'aVER/ Executive Office of Environmental Affairs OF NF-A T-N Department of Environmental Protection "`A ' 191995 William F.Weld Governor Trudy Coxe' Secretary,EOE A, V David B:Sttuhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 1v /gyp/ZT!�- ^' Address of Owner: Date of Inspection: �� Rte41 , (if different) Name of Inspector: W N SCO T('- Company Name, Address and Telephone Number: 5co7r C.O PO 7-0>1- A10 okNv T 71--v O S L FF K C` �^J/F. 01 S-4s— 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sew disposal systems. The system: _ Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails ' Inspector's Signature: i� Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the s%-stem owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTE PASSES: bo 7I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDI NALLY PASSES: One or more syste com<elua be replace paired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determinedDescribe basis of determination in all instances. If"not determined", explain why not) The septic tank ' d, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. a inspection if the existing septic tank is replaced with a conforming septic tank as appro by theh. (revised 8/15/95) One Winter Street • Boston,Massachusetts 02108 • FAX(617)656-1049 • Telephone(617)292-5500 iJ Printed on Recycled Paper A 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pu ping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED B THE BOARD OF HEALTH: Conditions exist which require further valuation by the Board of He in order to determine if the system is failing to protect the public health, safety and the environme t. 1) SYSTEM WILL PASS UNLESS BOARD O HEALTH DETERM ES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC H LTH AND SAF AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surfac water Cesspool or privy is within 50 feet f a bor ring vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD O HE LTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MAN E THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ T ne sysiern nd� d NePt t- and Gli absurp',iuii s)stEiii and �o10.C. feet to a surface %vatc, sL'rpp!y or tributa^,' t0 2 surface water supply. _ The system has a septic tank d soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank nd soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tan and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a wel water anal is for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility a d the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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. (revised 8/15/95) 2 I 4 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D] SYSTEM FAILS(continued): Static liquid level in the distribution box above outlet invert d e to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or avai ble volume is less than 1/2 day flow. _ Required pumping more than times in the last year NO due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool o privy is below the high groundwater elevation. Any portion of a cesspool or privy i within 100 fe of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is ithin a Z e I of.a public well. Any portion of a cesspool or privy is wi in feet of a private water supply well. Any portion of a cesspool or privy is less an 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the II has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic com ou ds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large syste in additi to the criteria above: The design flow of system is 10,000 gpd r greater (La e System) and the system is a significant threat to public health and safety and the environment because one or mo a of the folio ing conditions exist: the system is within 400 feet a surface drin ing water supply the system is within 200 feet f a tributary to a surface drinking water supply the system is located in a ni ogen sensitive are (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. I (revised 8/15/95) 3 I Y li SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the following have been done: rpumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates :during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. IThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility o%,.•ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION i Property Address: Owner: Date of.Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 3-0­gallons Number of bedrooms: ''J Number of current residents: Garbage grinder (yes or no): /✓0 Laundry connected to system (yes or no):x Seasonal use (yes or no):Al© Water meter readings, if available: Last date of occupancy: COMMERCIAUINDUSTRI Type.of establishment: Design flow: eallA Grease trap present: (ye Industrial Waste Holdint: (yes or no)_ Non-sanitary waste disce Title 5 system: (yes or no)_ Water meter readings, i Last date of occupan OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: AJ D System pumped as part of inspection: (yes or no)_ If yes, volume pumped. Qallons Reason for pumping: TYPE OF YSTEM 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) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)Al (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: ^rz� 6-+9Z Sludge depth: Distance from top of psludge to bottom of outlet tee or baffler Scum thickness:_ 1 Distance from top of scum to top of outlet tee or baffle: f Distance from bottom of scum to bottom of outlet tee or baffle:_ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) I'g' GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _co /emetal _FRP_other(explain) Dimensions: Scum thickness: Distance from top of scu to to of outlet tee or baffle: Distance from bottom «u , t hottom of out!et tee or bartie: Comments: (recommendation for pumping, co dition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete m _FRP_other(ekplain) Dimensions: - Capacity: Design flow: gallons ay Alarm level: Comments: (conditio of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) 1"o-V-1 L" &,t-- Rd X Ore G"t 7 L PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: / leaching trenches, number,length: a — S v leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids Jaye Depth of scum layer: Dimensions of cesspo Materials of constructio Indication of groundly at inflow (cesspoo must be pumped as part of inspecti Comments: (note condition ofXSI, signs of hydr is failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of coristruction: A Dimensions: Depth of solids: Comments: (note conditio of soil, signs of hyd ulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8