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HomeMy WebLinkAboutMiscellaneous - 130 HEATH ROAD 4/30/2018 UO HEATH ROAD _ I 2]0/.097 000.0 i NEW ENGLAND ENGINEERING SERVICES INC RECEIVED APR 2 0 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT April 19,2005 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover,MA 01845 RE: TITLE V REPORT: 130 Heath Road,North Andover, MA E Dear Sir or Madam: Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely C Benjamin C. Osgood, r.,P.E. Certified Title 5 inspector 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION y TITLE 5 -OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1.3o KEA771, 2cgD AZ o/L-/')! Aly D 00ca .n�} Owner's Name: D v itt jf94AI Ci S Owner's Address: 1-3o Next-Ty )2,D4-(D Date of Inspection: _ `/lojo.S Name of Inspector.(please print) Benjamin C. Osgood, Jr. CompanyName:New England Engineering Services Inc. MailingAddress:60 Beechwood Drive, North Andover, MA 01845 Telephone Number: 978-686-1768 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: a� The system inspector shall submit a copy of this'04ton 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 wilt perform in the future under the same or different conditions of use. � I II Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1-30 KeffiW 2oi9�D V o 2"7i Ani�c�e,2, Owner: PO&j ANGiS Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. .System Passes: 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: /W One or more system components as descn'bed in the"Conditional Pass"section need to be replaced or repaired The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y N ND)in the for the following.statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is strudurally 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. aA metal is tank will ion if it septi Pass inspect 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: Obser ahon 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 tunes a year due to broken or obs ructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /-3D 1-1,097W 12a H P O OL)UL rg Owner: DDA-) US Date of Inspection: C. Farther Evaluation is Required by the Board of Health. /VV 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)(6)that the system is not functioning in a manner which wM 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. em will fail unless � the Board of Health(and Public Water Supplier,if nay)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 fee_t of a surface water Supply or tn'butary 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 "Ibis system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. Page 4 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_/ J K&f��( (Lv►�}� o aTiy AN p o v ex- Owner: ALLS Date of Inspection: 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 ti below invert or available volume is less than%day flow 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. f 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 most be attached to this form.] /4/0. (YeS No)Toe system faits.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 1� You must indicate either"yes"or`no"to each of the following: (The following ern is apply to large systems in addition to the criteria above) yes no _ — the system is within 4 of a surface uff a water supply _ the system is within 200 f of a ' utary to a surface drinking water supply _ — the system-is located in a nitrogen sensitive ea(Interim Wellhead Protection Area-IWPA)or a mapped ZoneTI"of a public water supply well If you have answered"yes"to any question in Section E the syst -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 15304.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:_/3 D 14FIfl ( ao'lc-) Owner: Do�v �j2�J,vu S Date of Inspection: ©S Check if the following have been done.You must indicate`des"or`no"as to each of the following: Yes/No ✓ Pumping information was provided by the owner,occupant,or Board of Health , V--Were any of the system components pumped out in the previous two weeks? V — Has the system received normal flows in the previous two week period 7 ZHave 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) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? V _ 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 beet,determined based on: Yes/�no ✓ Existing information.For example,a plan at the Board of Health. / V Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 13 U e X —j ly t2o j}C> A)o"Z—H Alu % o o CIL- Owner: iLOwner: Date of Inspection: Tj c(��. s FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): ,—?_ Number of bedrooms(actual): 'Z. DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms): Number of current residents:_ I____ Does residence have a garbage grinder(yes or no): ,5 Is laundry on a separate sewage system(yes or no):U[if yes separate inspection required] Laundry system inspected(yes or no): — Seasonal use:(yes or no):ti/� Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):AVO Last date of occupancy c rr c•. — _--— COMMERCIAL JINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sg8,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):T Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: 4)THER(describe)-. GENERAL INFORMATION Pumping Records Source of information: ,V ev E ,pr M p E ID Was system pumped as part of the inspection(yes or no):AZO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pump: 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/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: /q&o PEAL 12S -9U/LT PL,441 Were sewage odors detected when arriving at the site(yes or no): Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: i3 o H C hil-e 2v A-D _N09TH Owner: pov s Date of Inspection: BULDING SEWER(locate on site plan) Depth below grade: Materials of construction iron _40 PVC other(explain): Distance from private water supply well or suction line: NM Comments(on condition of joints,venting,evidence of leakage,etc.): I O ti DEQ sC A SEPTIC TANK:_(locate on site plan) Depth below grade: 3 D f Material of construction: ✓concrete metal fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): certificate) _(attach a copy of Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thicmess, o" Distance from top of scum to top of outlet tee or baffie: Distance from bottom of scum to bottom of outlet tee or baffle: �z" 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.): Ti9nj v, t,.J o K CD A3,� 6— GREASE -GREASE TRAP:610(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 l 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 13o H c-#i11-t i2,,4,p ll2 Z�'9M4 A-rJ DOoe.I.. —/4 Owner: DD N LIQ A' C S Date of Inspection:-H q -5- TIGHT TIGHT or BOLDING TANK: t"' (tank must bepumped at time of inspectionxlocate on site plan) Depth below grade: Material of construction: oariaete metal fiberglass_polyethylene other(explain): Dimensions: CpacitY• aaLlons Design Flow: --gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: Of present must be opened)(tocate 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.): &�X 1ti r-c IJNPl1J✓i. 5;D Gft/Lll�IO�CG �J LZJ�D��tCe PUMP CHAMBFJ :IVA- (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,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: )-3p H6—A— Z Q NZ>91 H A N C> D-Jet ,tA v4 Owner: :a tgn,c1s Date of Inspection; SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: TA leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: 44—leaching fields,number,dimensions: 0(-) overflow cesspool,number: innovativetalternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): AREA OF F�7ELp �30KJ NO2.vtAL N� EyJc �cC vi— i OtiPiN C —DQM� So/L 02 t/,UUSvAL �)G(-CTJ4770itJ CFSSI'OOLS:2l� (cesspool must be pumped as part of inspectionxlocate 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.): i .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 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: 13 p , ; A i1 t 9-0 N� �� PcN D Ck.QA vl✓� Owner: -PO AJ Nc c s Date of Inspection: N �d SKETCIi 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. i Ho 0SC FA �� 3a L IL So' Page 11 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /3o Id; ftp 120 _40 Owner: �c�nJ F2ANG!5 Date of Inspection: y zg/o s SM EXAM Slope Surface water N Check cellar Ae 0 5,;,,,,j, I v rc y Shallow wells IVD.✓c- Estimated depth to ground water C, 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 /observation � (abutting property 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 must describe how you established the high ground water elevation: rs P e-s YfAtl> cra 725- .v r4 a o f s S s a v 3 Ce— >9 l3c) e U D OiZtCrr ., Rt. �-2 i✓ �vq,�Q 065z Feer $fLOw c72�rtN*q &-a,+0& . I I Oeaill Roselbef rg Rd. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEJWH DEPAIMUT--NORTH AIMOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Heath Ed. _ . I will install this system in accordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Trnin of North Andover. Further.. I will construct the house sewer of bell and spigot pipet the minimum diameter being 4 inches.. and will maintain a minimum grade of 2% until 10 feet preceding the septic tanks, where the grade shall not exceed 2%. I will install a concrete septic .tank of 7 Ogam 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 160 lineal (sem) 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 1/8'r to 1/4" (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 case, two lanes of tile will be installed. A minimum of 6 feet gill 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 further agree not to cover any ngdion of this installation until aooroved ja the inspection officer, as provided below.4 and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE �ij• Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as describ a 7 DATE � U Signatureo nspecting Officer Pereolation Test 2 min. Garbage Grinder (_-�� July 12, 1958 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 Heath Road building site of Mr. Herman Petzold. The subsoil in the area was of a sandy soil content and a 2-minute percolation test was conducted. The land iri general is high. It- is recommended that a 750 gallon concrete septic tank be installed together with 160 lineal feet of drain pipe. ° Very truly yours, William J. Coll 1 ( " BOARD OF HEATH TOWN OF NORd' H ANDOVER, MASS. t 1 ZZ 6 VO$4 gppric T4 711 rn 0 m 1. NAME Aux. .. . . DATE . 2. ADDRESS LOT LOT N0. . . . TEL. . . 3. NO. OF BEDROOMS .? . . . DEN YES ;�. . NO. . . . 4. GARBAGE GRINDER YES NO. . • . . . 5. SHOW DIR.ZEIZ IONS OF HOUSE 3 2 71 6, SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7, SHOW DII:'ENSIOIZ OF LOT 8, SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9, NOTE LOCATION AND DISTANCE OF WELL FROM SEffERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STPEA169 DITCHES., LEDGE OUTCROPS ETC. 11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULAT IOVS SHOULD BE READ CAREFULLY. v '� n � .� ' .--u � �' �' �"� ,.�.�t:`.:-cam• _.. �� 7 J ` Y ' ., � i f � . ♦ � � '1 1 � � t � • ` T .. 1