Loading...
HomeMy WebLinkAboutMiscellaneous - 1300 SALEM STREET 4/30/2018 (2) 1300 SALEM STREET 21O/1O6.A=0159-0000.0 CER TIRED FOUNDATION PLAN LOCATED IN Q O?—r44 ANDo vez SCALE.'/"_ ` DATE.' S.L.GILES R.L.S. L AWRENCE a NORTH ANDOVER d 0 0 d 35'1 1;'l4 o Sk C 2 tl.o6 � 138.94 ZEST M . (JF / CERT/FY THAT THE OFFSETS SHOWN ARE FOR THE USE OF OFFSETS SHOWN THE BUILDING INSPECTOR ONL Y, B SUCH CONFORM TO THE USE IS FOR DETERMINATION OFZO/VING ZONINGS Y L A W OF CONFORMITY OR NON CONFORMITY •l f `. (\ -277-1 At1>0y-a Z.. WHEN TAKEN. IL 7 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO I Address of property Owner ' s name Date of Inspection PART A CHECKLIST Check if the following have been done: Pumping 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 . ivfI�/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 site was inspected for, signs of breakout. All system components , excluding the SAS , 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. ✓ The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants , if different .from owner) were provided with information on the proper maintenance of SSDS . ` 6 -� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLAW CONDITIONS If -esidential number of bedrooms ___,__—numb_e.rof current residents _garbage grinder, yes or no laundry connected to system, yes or no (1v seasonal use, yes or no If nonresidential , calculated flow: Water meter readings , if available: Last date of occupancy GENERAL INFORMATION Pumping records and source of information: � c System pumped as part of inspection, yes or no if yes , volume pumped 1.5o o 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) Other (explain) Approximate age of all components. Date installed, if known. Source of information : -v_ Sewage odors detected when arriving at the site, yes or no 9 1.5.-- 1 8 SUBSURFACE .SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site pian) depth belori grade :_ material of construction: _concrete metal FRP other(explain) dimensions:_-_- l4 -6 n g x sludge depth $„ distance from top of sludge to bottom of outlet tee or baffle d 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 Comments : ( recommendation for pumping , condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, e,,'idence of leakage, recommendations for repairs, etc. ) 719 N A rJA t �3 o c ro.v it/ �'il�Pfivc Ud- DISTRIBUTION BOX:—t.,— ( locate OX: ,.,.( locate on site plan) _(1 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, recommendation for repairs, etc. ) —i2isT. k1ECQ ndi�lyc' t+12 D'AlGv PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments : (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible ; excavation not .required , but may be approximated by ncn-intrusive methods) If not determined to be present, explain: Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions / 'r/C'- n do, Y 60 overflow cesspool , number F2cAl _ jj-ul '._j Comments : (note condition of soil , signs of hydraulic failure, level of ponding , condition of vegetation, recommendations for maintenance or repairs , etc. ) i R CESSPOOLS ( 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 (cesspool must be pumped as part of inspection) Comments : (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) PPIVY : ( Locate on site plan) i materials of construction dimensions depth of solids Comments : (note condition of soil , signs of hydraulic failure, revel of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) ll SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART B . SYSTEM INFORMATION Continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within. 100 ' i I � DEPTH TO GROUNDWATER / 0` depth to groundwater method of determination or approximation: 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes , no, or not determined (Y, N, or ND) . Describe basis of det.erminaticcn in all instances . If "not determined" , explain why not) /V_ Backup of sewage into facility? t'V Discharge or ponding of effluent to the surface of the ground or surface waters? ^,;�' Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <b" below invert or available volume< 1/2 day flow? _Z Required pumping 4 times or more in the last year? number of times pumped A/ Septic tank is metal-, cracked? structurally unsound? substantial infiltraticn? substantial exfiltration? tank failure imminent? Is any portion of the SAS , cesspool or privy : below the high groundwater elevation? I within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? A within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? __IV within 50 feet of a private water supply well? -t-Z less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis } for coliform bacteria , volatile organic compounds, ammonia nitrogen and nitrate nitrogen . 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Company Name U vv G,VG c-r9.✓a t om/ G-!:u t c'2rn1 G- S Rv�c t� Z7A,/C, Company Address 33 w,��i� R ��t� ✓. yv � �✓e'/7� A, J Certification Statement I certify that I have personally inspected the sewage disposal system at this .address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems . Check -one : z have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 3310 CMR 15 . 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15 . 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form, Inspector ' s Signature ' Pate Original to syste:� owner Copies to: Buyer (if applicable) Approving authority Board of Health SEPTIC SISTEli R �� North Anpyerit"�as. « INSrAMATICK CMK LIST LOT 'S , APPRcv5 DATE DISAPPt�Ok ED EX AVATICN Ob FXIZ 55 i /JO IPS Tb yV /JN , i FAIL OK 1. Distance Tot a. Vet1 ands b. Drains c.. Well 'f 2. Water Line Location 3- No PPC Pipe fit. Sepii.c Tank - a. -Tees -_Length & To Clean Oat Cove,rs. b. Cement Pipe to Tank Gla Both S! les 'of Tank 5. Dir tribution Box a. Covers & Box - No Cracks b. A11 Lines Flowing Equal Amourts, c. No Back Flow ' 6. ' Leach Field or Trench a. Dimensions b. Stone Depth c: Capped Inds d. Clean Double Washed Stone' ?. Leach Pits a. Dimensions b. Stone Depth c. Splash Pads d.. Tees e. Cement Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Abal Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard-to Pere Test d. Elevations e.' Water Table R 1 Board of Health Ncrtr :Andover..MaB6 c SUBSURFACE DISPOSAL DESIGN CHECK LIST JDf"1/1�5�/v LOT # APPROVED DATE •I{ DISAPPROVED DATE_^ Provided: Reasons: Title V FAIL 09 Reg 2.5 The submitted plan must show as a : a) the lot to be served-area,dimensions lot #jabutters b locon and ocation and lresultss percoladeep t on tests-di.stancetion eto s to ties c d design calculations & calculations showing required leaching area (e) location and dimensions of system-including reserve area f) existing and proposed contours (g) location any wet areas within 100' of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 1001 of sewage disposal system or disclaimer-Planning Board files (j) knovu sources of water supply within 2001 of sewage disposal e aystem or disclaimer (k) location of any proposed well to serve lot-1001 from leaching facilit3 (1) location of water lines on property-101 from leaching facility (m) location of benchmark (n) -driveways (ogarbage disposals . (p� no PVC to be used in construction (q) profile of system-elevations' of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and other elevations (r) maximum ground water elevation in area sewage disposal system (s) plan must be prepared by a Professional Engineer or other professional authorized by lax to prepare such plans Reg 6 Septic Tanks (a) capacities-150;6 of flow, water table, tees, depth of tees, access, pumping IN cleanout (c) 10, from cellar wall: or inground swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes Ljb) a) slope greater 0.08 Reg 10.4 sump Suubsurf ce Design Check List Pae 2 FAIL OK Leaching Pits Leaching pits Tire preferred where the installation is possible Reg 11.2 a) calculations of leaching area-ml.nimum 500 eq ft 11.4 b) spacing 11.10 c) surface drainage 2% :"_1.11 d) cover material e) Vx2 sx4" splash pad f) tee at elbow g) no bends in pipe from d-box to pipe Le aching Fields Reg 15.1 a no greater t 20 minutes/inch b area-ffinimun 900 eq ft 15.4 c construction of field 15.8 d) surface drainage 2 % 3.7 e) 20t from cellar tall or ingxound sAmming pool Leaching Trenches Reg 14.1 a) calculations or leaching area-ndn 500 sq ft 14.3 b) spacing-4 ft min 6 ft with reserve between 14.1 c) dimensions 14.6 d) construction 14.7 e) stone 14.10 f) surface drainage 2% Downhill Slope a) s oTpe y x = rto be shown) b) y/x x 150 ._ (to be shown) Reg 9.1 a) approval 9.6 b) stand-by; ppwex . CERT/F/ED FOUNDATION PLAN LOCATED /N Q z p-r-t AjDo vet SCALE/"= 4c,' DATE: ,-sl�- S.L.G/LES R.L.S. L AWRENCE a NORTH ANDOVER d 0 y.g,tZ-q;S,F p 0 r d 3�it G I d� t dam. z It.ob � X38.94- ,1 SALEr--� S�R-EET OF / CERT/FY THAT THE OFFSETS SHOWN ARE FOR THE USE OF �'`�" � OFFSETS SHOWN THE SU/LDING INSPECTOR ONL Y, & SUCH CONFORM TO THE USE IS FOR DETERMINATION OFZOIV/NG Is ZONING SY LAW OF CONFORMITY OR NON CONFORMITY '"S7rP� �o A�a�avErz WHEN TAKEN.