The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 120 CANDLESTICK ROAD 4/30/2018 / 120 CANDLESTICK ROAD Zoad 2101106.A-0098-0000.0 4 -------.,_._-- __ --- METHYL, ALCHOHO L - (APPLICATIONS) t it �Of NORT.,N 6756 F Town of North Andover HEALTH DEPARTMENT '1ySACHUS<< CHECK#: TE: I LOCATION: nd r w H/0 NAME: CONTRACTOR NAME: ' P-d'fy' 1,[f Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ , ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ i ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Title 5 Report $ ❑ Other:(Indicate) $ I l� Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v�L 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 April 6 2014 required for p , every page. City/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: A. General Information When filling out forms on the computer, use 1. Inspector: only the tab key to move your Peter F. Reilly cursor-do not use the return Name of Inspector key. Peter F. Reilly Company Name 136 Andover Street Company Address Andover MA 01810 City/Town State Zip Code 978-375-3750 S11955 Telephone Number License Number B. Certification 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 Conditional) Passes Fails ❑ Y ❑ ❑ Needs er Evaluation by the Local Approving Authority RECEIVED APR 15 2014 April 6, 2014 OF NORTH AND I spector's Signature Date HEALTH DEPARTMENT 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. ****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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ' r Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is required for North Andover MA 01845 April 6, 2014 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 Aril 6 2014 required for p every page. CityTTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 Aril 6, 2014 required for p every 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 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 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 be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ❑ 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 ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 Aril 6, 2014 required for P every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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. ❑ ❑ 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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 flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts U W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 Aril 6, 2014 required for p every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ 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? ❑ ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) A//,� ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(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: ❑ ® 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): N/A Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 Aril 6, 2014 required for P every page. City/Town State Zip Code Date of Inspection D. System Information Description: 1,500 gallon septic tank, d-box and SAS (field). Original septic tank (1979), replacement d-box and SAS in 1991. Installer's"as-built" sketch was provided by the owner. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage (gpd)): 150 gpd avg. 9 ( Y 9 Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.)` I Grease trap present? ❑ Yes ❑ No i Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 April 6, 2014 required for p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: current Date Other(describe below): General Information Pumping Records: Source of information: owner said the tank was pumped in the fall of 2012 Was system pumped as part of the inspection? ❑ Yes ® No IfY es volume pumped:ed: 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) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 April 6, 2014 required for P every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Original tank was in stalled in 1979 when the house was built. Replacement d-box and SAS were installed in 1991 according to installer's"as-built" sketch that was provided by the owner. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12" - 16"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Building sewer was watertight and appeared sound at the foundation. Septic Tank(locate on site plan): Depth below grade: 10" - 12" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No i Dimensions: rectangular- 1,500 gallons Sludge depth: 1" -2.. t5ins•11/10 Title 5 Official Inspection Form: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 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 Aril 6, 2014 required for P every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 1211 - 14" 1"-2" Scum thickness 4 Distance from top of scum to top of outlet tee or baffle - 5 Distance from bottom of scum to bottom of outlet tee or baffle 6"-7" How were dimensions determined? measurement Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was watertight. Inlet and outlet baffles were intact. Grease Trap (locate on site plan): Depth below grade: N/A feet 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: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 April 6 2014 required for p every page. City/Town 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.): The tank appears to be structucturally and functionally sound. Pumping recommended. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): I I *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 April 6 2014 required for p , every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): Five lines accepting effluent unevenly as might be expected of a 23 year old SAS. All five lines settled at the inverts at static flow. Some solids caryover was evident. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Single field, 28' x 40' (1,120 square feet) according to the installer's"as-built" sketch that was provided by the owner. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 Aril 6, 2014 required for P every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 field 28' x 40' ❑ 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.): Soils in the area of the SAS appeared normal, no signs of breakout. 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 ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 required for April 6, 2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Soils in.area of system appeared to be normal, no signs of breakout. 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.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts ........... Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Candlestick Road ___.....-..._..__..._..__ �_ _---__........................ _..............__....__.___.._.-._--------......_-....__..._......._----------__----_.__ Property Address Kent Andiorio Owner's Name Owner __-._.....__._ -..-.._----- __---.------.._-__......... information is North Andover MA 01$45 Aril f 2014 required for ....._.._............................._............_........._......._..... ....._......._.._.._...__.. _State___- __._._.__......___..__ at _f 1____do�_._.___ .--..._..---.--.. every page. CitytTown 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 well`s 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 Approx. Water E t �€ 2 ' t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 Aril 6, 2014 required for P every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells >1' below bottom of SAS 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: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: no information on file. ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: USGS data not specific to site. You must describe how you established the high ground water elevation: There is no design plan for the current SAS. Soils, grade changes, indicates adequate groundwater separation. However, the precise ground water elevation cannot be determined for certain without a soil evaluation. NOTE: Soil evaulation is the recognized method for determining or establishing the high groundwater elevation. Since I am not a licensed or certified soil evaulator, I am not qualified to determine or establish the high groundwater elevation beyond the public information available, such as recent design plans of the site or the nearby area. My estimation of the high groundwater elevation is based on a due diligence effort to obtain all available information both on and off the site and my experience as a certified septic system inspector. (see attached Disclaimer Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts a W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 120 Candlestick Road Property Address Kent Andiorio Owner Owner's Name information is North Andover MA 01845 Aril 6, 2014 required for p 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 0 DISCLAIMER This passing septic inspection under Massachusetts Title V is in no way a guaranty or warranty of the inspected septic system. The inspection is a "snapshot in time" and does not constitute a complete assessment of theualit potential longevity q Y or 9 Y of the septic system. The pass/fail criteria are specific and outlined in detail in this report. Under the limited criteria of a Title V inspection, it is impossible to determine how long any septic system will last. The inspector made a diligent effort to certify the septic system based on the criteria required under Title V. Under Massachusetts Title V, soil evaluation is the accepted method of determining the high groundwater elevation. This inspector is not a certified soil evaluator and is therefore not qualified under Title V to determine or establish the high groundwater elevation. The method used to estimate the high groundwater for this inspection was based on the public records and methods of observation described on the previous page. Groundwater levels can vary greatly from season to season, year to year and soil evaluation is considered the most reliable method of groundwater determination under Title V. Peter F. Reilly Inspector April 6, 2014 Page No. of Pages Proposal FRANCIS P. REILLY 149 Andover Street ANDOVER, MASSACHUSETTS 01810 Phone 475.1237 PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME w v t W1 CITY, STATE AND ZIP CODE JOB LOCA ON ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: .... ........ .......... ........... - .................................. . ........... .. ........ .... ...... t .. ....... ... ... . ... ... .._ ................_. ..._.. ...... .... ................ ........._. . , ........ ............ ................ ..... ..... ...... . .._. .......... ........... ......... . ...... ...... ......... ........... .......... ........:.... ........... ................. .............. .......... ........�-. ...... ......... ...... ........_.._.. ........... ... .... ...... .............. ..................fir :.�� ......... ...........-._.... .... ... TAW-, ..... ... ..... i ............. .... .. ...... .......... ... ..._..._... ..._. ..f.._.... ......... ........ _....__.f...... . . .........................._.. .......... i=...... %....... �1 Q P propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: dollars($ ) Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifica- Authorized tionsinvolving extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. , rrr #ttnrpfrnosttl- p The above rices, specifications and conditions are'satisfactory and are hereby accepted. You are authorized Signature fto do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature FORM 118-3 COPYRIGHT 1960- Available from �Inc.,Groton,Mass.01450 _ i � t c. � __ - � , r . . ,. y � � e�� , `-�� L `� �� M 1 e �11' 1 1 ;, I ' � _� _ _ ►- � J;� Address �o��-V C-,4-MA1V-� S 7ec] k0 b Title of File Page of Date File Open: Date file closed: Doc Document/'Action Title Date of Refer to other Purpose of Docurnennt/Action and notes action Document/ document/ Num. Action Department --------------- Board of Appeals — Board of Health Planning Board — Conservation Commission — Building Department i 4`of Health th Andover,Mase. S_PTIC STSTEM { IIS STALLATICK CHECK LISP LOT WED DAT_ DISAPPROVED AQATICH OK FAIL f' e� t �. - " • ._7- OK 1. Distance Tot" a. - Wetlands 51 b. Drains c. Well 2. Water Line Location 3• No PVC Pipe 40 Septic Tank� s- a. _Tess -_Length & To Clean Out Covers.•:°- b. Cement Pipe to Tank -- On Both Sides of Tank ` . 3 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Bcqu 'Amclmts c. No Back Flow 60 - Leach -Field or Trench a._ Dimensions, ` b. Stone Depth { c: Capped Inds - 4� _ d. Clean Double Washed Stone' �. ?. Leach Pits r i a. On �. b. ne Depth 1 . Splash Pads d. Tees e. Ceraent Pipe to Pit - Both Sides f. Clean Double Washed Stone No Garbage Disposal '' 9• Anal. Grading Inspection 10. Barricading Covered System I. 11. As Built Submitted-- -- -- -- - _ a. Lot Location-- ,-:-_-- .- __— _ b. Dimensions of System - - - v c. Location With Regard-to Perc Test d. Flevations e: Water Table ,A\\� - -- - /� ---- _ ___ � v. ---- ----- - _i �r `T��r��_---w��`_ __-----_ SUBSURFACE DISPOSAL SYSTEM CHECK LIST NORTH ANDOVER BOARD OF HEALTH APP VED DATE PROVIDED DISAPPROVED DATE TIME REASON s — TAle 5 Reqs. 2. 5 Fail OK The submitted plan must show as a minumum: the lot to be served (area,dimensions ,l,ot ##,abutte.r,$) (Planning Board files) location and log of deep observation holes-distance to ties ) location and results of percolation tests-distance to ties design calculations & calculations showing required leaching area location and dimensions of system (including reserve t area) i existing and proposed contours i location of any wet areas within 100' of the sewage disposal system or disclaimer (check wetlands mapping) surface and subsurface drains within 100' of sewage disposal system or disclaimer ' ) location of any drainage easements within 100' of sewage disposal system or disclaimer (planning board files) I — known sources of water supply within 200' of sewage disposal system or disclaimer k location of any proposed well to serve the lot (100' from leaching facility) location of water lines on property (10' from leaching facilities) location of benchmark driveways garbage disposers no PVC is to be used in construction a profile of the system (elevations of basement , plumbers pipe septic tank, distribution box inlets and outlets, distribution field piping and any other elevations) maximum ground water elevation in area of sewage disposal system plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Septic Tanks Reg. 6 (a) Cap sties - 150% of flow, water table , tees, depth o tees , access, pumping, (b) eanout c 10' from cellar wall or inground swimming pool 25' from subsurface drains Y North- Andover Subsurface disposal system check list - Page 2 Fail OK Distributi=on Boxes Reg.10.2 (a ope greater than 0.08 Reg.10.4 (b Sump Leaching Pits Leaching pits are preferred where the installation is possible Reg.11 .2 (a Calculations of leaching area (minimum 500 S.F. ) Reg.11 .4 (b Spacing Reg.11 .1 (c Surface drainage 2% Reg.11 .11 d Cover material 2 42" task � ( P p I, _V_achin �Fi eel ds Reg.15.1 (a) N?Gr ater than 20 minutes/inch Reg 15.1 (b rea (minimum 900 S.F.) Reg.15.4 (c Construction of field Reg.15.8 Surface drainage 2% Reg. 3.7 ('e 20' from- cellar wall or inground swimming pool Leaching Trenches G Reg.14.1 (a Calculations of leaching.14 3 (b Spacing area (min. 500 S.F.) Re g.14-3 p g (4 ft. min. 6 ft. with reserve between) Reg.14.4 (c Dimensions 14.5 Reg.14.6 (d Construction Reg.14.7 Stone Reg.14.10 (f) Surface drainage 2% Downhill Slope I { Slope y/x = (to be shown) 14-b y/x X 150 = (to be shown) f Pum-pp i Reg. 9.1 (a Approval Reg. 9.6 (b� Stand-by power i i SOIL PROFILE & PERCOLATION TEST DATA Town/City. No.&Street Lo No._� Q I Loc./Subdiv. ✓ ,' ,-, �, Gv"ice/Plan Owner h Investigator �/; r Observer r ° SOIL PROFILES-DATE v 1. 2. . 4. ° E ev.� Elev. 3 � - ' Elev. --Elev. 77 p l0 0 0 d \ 2 2 2 l� 3 3 3 3 4a4 - 4 4 S 5 � - S S v _ V �6 6 6 7 7 . 7 . 7 a � _ 3 8 8 8 Ki 9 � 9 9 9 10 .1010 10 Benchmark - Location -- Elevation Datum Percolation Tests-Date Pit Number 1 2 3 4 S Start Saturation Soak-Mins. -- Start Test-Time :3s3 Drop of 3"-Time 3 U Drop of 6"-Time -� S Mans. lst 3"Dro Mit' ns.2nd 3"Dro Notes & Sketches on Back Frank C. Gelinas & Associates, -North And. 1-177 ,1/9/77 QQ t