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Home My WebLink AboutMiscellaneous - 134 OLYMPIC LANE 4/30/2018 .9 134 OLYMPIC LANE 210/106.6-0123-0000.0 1 TOWN OF NORTH ANDOV,E'R � SYSTEM PUMPING PECOR_D V - 2 2003 �TEM OWNER & ADD RESS SYSTEM LOCATION- /�� 11C (exRmple; lef( front of house) e��rr1 �W , t✓,.Tc OF PUMPINC: Zp QUANTITY PUMPED—6 C .SI'UUL: NO YES SEPTIC TANK: NO YES � ATURE OF SERVICE: ROUTINE EMERGENCY �lil.>rRV.:\T10NS; GOOD CONDITION. FULL TO COVER HFAVY CREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK CXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER :O�HFR (EXPLAIN) /,� PUMPED 0Y: CU);Iklf:NTS. TRANSFIERRED TO: �. 1 NEW ENGLAND ENGINEERING SERVICES INC March 18, 2003 North Andover Board of Health Town Hall Annex 27 Charles Street 7F, s ' ;" North Andover,MA 01845 r . MAR 19 200 RE: TITLE V REPORT: 134 Olympic,North Andover, MA N Dear Sirs: 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 O-Ji . Benjamin C. Osgood, J . 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 d 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION _. t6ra-CP A`si9t:2U�..- ,� MAR 19 2003 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY A-SSESSNIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 13 Y d 14 m4%c- 1-Acv E 1V00Y LAND DJ&lL Owner's Name: 7 r$o 2 AA-( F C L11-0 V t C Owner's Address:-1-�y Ol.yM p/c I-PAic- Date of Inspection: l/i o3 r Name of Inspector:(please print)_� 8r1,ce wvi^ C_ 0S6-0Jo cJ�- Company Name: A2 6yN&I21 A 7(a- Mailing Address: (,_c2 EGN t pro o t�R.l Ul` ►moo gZ Pry a �t�2- 1vt./t Telephone Number: j7 g- 68&/7Ag 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: 3 �?L6 The system inspector shall submit a copy of this inspec 4nr ort 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 now 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: 13.11 Ola.n,�•c L��r Nc)271/ AL V 6L)4F� Owner: 12EBV EAU 6�L:M V l(, Date of Inspection: 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.An failure criteria not of 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 aired The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no not determined(Y,N,ND)in the for the following.statements.I of determined"please explain. The septic tank is m _ and over 20 years old*or the septic tank( er metal or not)is structurally unsound,exhibits substantial tration or exfiltration or tank failure is' inent.System will pass inspection if the existing tank is replaced with a lying septic tank as approved b e Board of Health. *A metal septic tank will pass ins if it is structurally not leaking and if a Certificate of Compliance indicating that the tank is less than 20 y s old is available. ND explain: Observation of sewage backup or br out or ' static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settl or uneven ibution box. System will pass inspection if(with approval of Board of Health): roken pipe(s)are reply obstruction is removed distribution box is leveled or reply ND explain: The em required pumping more than 4 times a year due to broken or o ed pipe(s).The system will pass ins p ion 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: 13,V Dlu pop->c l-un e 1yy 4--nY AL n cjEa- Owner: 9 C-1k,RAF-1 FE�Tovic� Date of Inspection: 3))710 3 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. tem will pass unless Board of Health determines in accordance with 0 CMR 15.303(l)(b)that the sys is not functioning in a manner which will protect public heal ,safety and the environment: Cessp 1 or privy is within 50 feet of a surface water — Cesspoo privy is within 50 feet of a bordering vegetat etland or a salt marsh 2. System will fail unless the B of Health a d eal ( Public Water Supplier,if an determines that the PP � Y) em is functioning mg in a manner t protec a public health,safety and environment: I _ The system has a septic tank and absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a water supply. _ The system has a septic tank d SAS and a SAS is within a Zone 1 of a public water supply. _ The system has a septic and SAS and the S is within 50 feet of a private water supply well. - The system has a s tic tank and SAS and the SAS is 1 than 100 feet but 50 feet or more from a private water supply w 1**.Method used to determine distan **This system patif the well water analysis,performed a DEP ified laboratory,for coliform bacteria and vol ile organic compounds indicates that the well is free fr pollution from that facility and the presence ammonia nitrogen and nitrate nitrogen is equal to or less th 5 ppm,provided that no other failure crit a are triggered.A copy of the analysis must be attached to this fo 3. ther: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: A4 �c p,Ie Aloil- H "p ave Mr4 Owner:_ ac-609h4 fC-LTU VV_ Date of Inspection: 3%Z/0 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 v" Liquid depth in cesspool is less than 6"below invert or available volume is less than%z day flow Required pumpingmore than 4 times in the last year y NOT due to clogged or obstructedpipe(s).Number of times pumped t� _ AnY Pio n of the SAS cesspool or privy is below high ground water elevation. LO' 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. r 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 forma (Yes/No)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 1;Pd• You must irabate either"yes"or"no?'to each of the following: (The following cri is apply to large systems in addition to the criteria e yes no _ the system is within feet of a surface dr' ' g water supply the system is within 200 feet o utary to a surface drinking water supply _ — the system is located' a nitrogen sens ' e area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a p 'c water supply well If you have veered"yes"to any question in Section E the tem is considered a significant threat,or answered "yes"' ection D above the large system has failed.The owner operator of any large system considered a significant threat under Section E or failed under Section D shall up a the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 13f Qym?ic Lan Owner: b e f az* Date of Inspection: 3 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) 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: 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)[3 10 CMR 15.302(3)(b)] 1 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1311_ 0ti n,D,c LAA.;e No(L1N 62—eweQ.. 4104 Owner: a,2� ERZ)V tL Date of Inspection: 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):� ( gn): Number of bedrooms(actual):� DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: I _ Does residence have a garbage grinder(yes or no): Q Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no).— Seasonal use:(yes or no):M Water meta readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):AI-0 < Last date of occupancy: c r rc n?r COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203 : d Basis of design flow(seats/persons/sgft,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 meta readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Z � M Qe cQ 2�-S Was system pumped asp fo—'the inspection(yes or no):AI If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYP,R 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) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: ZZ Were sewage odors detected when arriving at the site(yes or no):Wo Page 7 of 11. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: L A&/97 iv t9 Owner: f�cc-7owc, Date of Inspection: 31)7 o, BUILDING SEWER(locate on site plan) Depth below grade: " Materials of construction: cast iron 40 PVC other(explain): Distance from private water supply well or suction line: At�4 Comments(on condition of joints,venting,evidence of leakage,etc.): f WfQ llmnO 4 0 01 6 el SEPTIC TANK: _ 1 locate on site plan) � Depth below grade: 9-t Material of construction:j/concrete metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: JaVO Com}Ll o,v s Sludge depth: Z N Distance from top of sludge to bottom of outlet tee or baffle: ley Scum thickness: z Distance from top of scum to top of outlet tee or baffle: G� Distance from bottom of scum to bottom of outlet tee or baffle: 16 How were dimensions determined: ^„EA sJ 2.E SZr-9.Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): iN &cop cvrtP jTlosl CD;vcreT GREASE TRAPA/Jbocate 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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of etc.leakage, : ) I'� Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /3 l ,G Lc.,-- N Owner: O E�o2Aµ FFA-ToQt C Date of Inspection: T7/oma---- TIGHT or HOLDING TANK:VA(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons 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: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): _)5�In 1#4 OK cOA a 1-170n. ZC),)Oe, c-e&14 err ftAJ O C,F7D 17th E,,1j p c.'. C i PUMP CHAMBER:e&(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 ofum s and appurtenances, P Petc.): Page 9 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: L �►r v}N� Owner:- n e&purr t Fc�Tav�c. Date of Inspection: — t7Z D'5 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not reqnired) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: teaching fields,number,dimensions: -_I �—�Ec,p overflow cesspool,number: innovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc. 0AJ 1&1 Tan r 3�2 �2 P s � CESSPOOLS: (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.): 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 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /3 y bl _1J1D 2T /� Owner: b 2A K PC LLT 0J L CC Date of Inspection: 1710 T2 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. D fL�v E 14 vSC- A f L ti�•3 4 L + Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 61 No RNl-f A D 01JE 2 11,A Owner: DFJ36 24H Fwm V IC. Date of Inspection: -3),7 o3 SITE EXAM Slope Surface water f=ir Check cellar Shallow wells Estimated depth to ground water 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 ISO 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: 0-iL� ✓hAfS INS �� WA-1 2 >(� ` Bccow CT2i/oc %M C Ao J Su l — wr T Aju Al2U g2 OF 4-JT 6' r3 r'4-a T-F w e-('6-ytlyc�lU I I . I I i Vim/ VJ/1JJr VV.JV JV VJf JV V11 JIG4Vfif',I/HI'YUV NCf? 1-Hl7C, CJ4- AV,hDVer 12.a4.- 1-36 o,r, St '$ SEPTIC Tat sun(z Ni o'lk, A 47 RIIF"D grpnT MW 01833 tn,C 1 Le- 978.372-7471 cip v csd MOWS I LY arm PM Mo (1p ADoRM acs I5oo 5d5 t'c S� +r elG l wasr� Mob t 6-- 13q Q ,� 60 Board of Health North Andover.,Nass. SEPTIC SISTEN . INSTALLATION CHECK LIST LOT # APPROVED DATE DI PROOED AVATI�+tOK FAIL Reasans _' OK 1. Distance To: a. Wetlands b. Drains c. Well JO VZ 2. Water Line Location 3. No PVC Pipe 4. Septic Tank a. Tees - Length & To Clean Out Covers b. Cement Pipe to Tank - On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c- No Back Flow Leach Fieldcor T ch a. Dimensions b. Stone c. Cappe ds d. Cle Double Washed Stone 7. Leach Pits Xees s e to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Brading 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 • �, NORTH ANDOVER EAR) OF HEALTH APPROVED DATE PROVIDED DISAPPROVED DATE TIME REASON - - ---------------------------- Title 5 Reg. 2. 5 Fail OK The submitted plan must show as a minumum: �(a) -.-the lot to be served (area,dimensions ,l,ot #,abutters) (Planning Board -files) (b . . location and log of deep observation holes-distance to ties (•c) location and results of percolation tests-distance to ties (d) design calculations & calculations showing required leaching area (e) location and dimensions sf system (including reserve area) f existing and proposed contours J'g� location of any wet areas within 100' of the sewage disposal system ot- disclaimer (check wetlands mapping) (h) surface and subsurface drains within 100' of sewage disposal system of disclaimer �(i) location of any drainage easements within 100 of sel.age disposal system or disclaimer (planning board files) (j ) known_-sources_ of_-water supply- within- 200' - of sewage disposal-.system= or disclaimer- (k) locationofany proposed-well to serve the lot (100' from leaching facility) (1�) location of water lines on property (10' from. leachin� facilities) 60 (m location of benchmark �n� driveways �o) garbage disposers " ) no PVC is to be used in construction �q) a profile of the system (elevations of basement , pluM pipe septic tank, distribution box inlets and outlet=s , distribution. -field piping and any other elevations) )� maximum ground water elevation in area of sewage disp( system F Vr/ (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Se tic Tanks Reg. 6 U w'--capacities - 150% of flow, water table , tees , depth of tees , access , pumping, Cleanout c 10' from cellar wall or inground swimming pool d) 25' from subsurface drains Ci;'�il IiiU() vLl' :�t1.:ou_ xt.cv . ..:ZJ'.. , •i . � . v ,iU VZ1t;�th ..1J� —�cvc c Tail OK, Distribution Boxes c;g.10.2Slope greater than 9.08 eg.10.4 L-VrR Sump Leaching Pits Leaching pits, are p - erred where the installation -is possible .eg.11 .2 (a) CaT.G6 ations of leaching area (minimum 500 S.F. ) eg.11 .4 b Spacing eg.11 -1C Surface drainage 2% eg.11 .11 �''` d Cgver material I nfee gar e,lbo Leaching Fields J / .eg.15.1 -- (,,a) RoGreater than 20 minutes/inch .eg.15.1 1.r(e ('� Area (minimum_900 S.F. ) '.eg.15.4 Construction of field '.eg.15.8Surface , drainage 2% .eg. 3.`] 20' from, cellar wall or inground swimming pool Leaching Trenches eg.14.1 (a Calculations of leaching area (min. 500 S.F.) '.eg.14. 3 (b Spacing (4 ft. min. 6 ft. with reserve between) . 'eg.14.4 (c Dimensions 14:5 (d -Construction-. 'eg:14:6` 'eg.14.'] a (eStorie 'eg.14.1 (f) Surface drainage 2% Downhill Slope �a� Slope y/x to be shownby/x X 150 = �to be shown Pum-Pa leg. 9.1 (a) Approval leg. 9.6 . (b) Stand-by power i i