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HomeMy WebLinkAboutMiscellaneous - 142 DUNCAN DRIVE 4/30/2018 142 DUNCAN DRIVE _ 210/104.B-017�p000,0 E i i i Of NORT:,� 6484 O Town of North Andover `+�'•�;,;o:r ,' HEALTH DEPARTMENT C14U CHECK#: '� ® DATE: ' LOCATION:] .49 H/0 NAME: CONTRACTOR NAME: ��h, Dsp�md 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) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $� -x Title 5 Report $ _ ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer J Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. Cityrrown 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: When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Benjamin C. Osgood, Jr. cursor-do not Name of Inspector use the return key. N/A Company Name 24 Julie Ave Company Address Salem NH 03079 rerun City/Town State Zip Code 603-458-2883 870 Telephone Number License Number B. Certification 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 ❑ ailsRECEIy►E® ❑ Needs Further Evaluation by the Local Approving Authority MAY 01 2013 TOWN OF NORTH ANDOVER 4-23-13 1 HEALTH DEPARTMENT Insp ctor's Si ature Date The system inspector sha1 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. i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Duncan Drive Property Address I Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. Cityrrown 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: i 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): i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments j I 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. Cityrrown 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: i D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No I Backup of sewage into facility or system component due to overloaded or ❑ ® clogged SAS or cesspool El ® 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 EJ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow I ' � � ` , - . . _ } , • � r I 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 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 j 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 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) ® ❑ 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): 4 Number of bedrooms(actual): 4 440 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): i Commonwealth of Massachusetts D. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1500 gallon tank to 1000 square foot leach field Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 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.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: April 5, 2013 per owner i Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 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): Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 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: Tank installed 1981, leach field installed 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Pipe looks good in basement Septic Tank(locate on site plan): Depth below grade: 6"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 Dimensions: Sludge depth: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is North Andover MA 01845 4-23-13 required for every page. Cityrrown 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 32" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 1" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Measure stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition. Cross baffle intact. Concrete tee coroded and missing to water level, recommend installation of sch 40 PVC tee. Tank pumped 18 days prior to inspection. Grease Trap (locate on site plan): Depth below grade: 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. CitylTown 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.): Tight or Holding Tank(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 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 *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. Citylrown 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.): Box in good condition. No evidence of leakage in or out, some carryover. Pronounced scum line at pipe inverts which indicates long term normal operating level. I 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. CityTTown 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- 1000 S.F. ❑ 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.): Area of system normal to very dry. No evidence of ponding or unusual vegetation. Probing into stone reveals that stone is clean and dry to bottom. Sand below system clean and dry. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 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.): Privy(locate on site plan): Materials of construction: Dimensions I Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. City/Town 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 wells 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 ��otr 1`{v L) 7 vj DoAIC aqAJ D2l�E Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >6feet 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: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: USSCS Maps You must describe how you established the high ground water elevation: Bottom of leach field located 2.5 feet below grade. USSCS maps indicate water table is >6 feet below grade. Basement is 5 feet below grade and is dry without a sum pump. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Duncan Drive Property Address Paul Fabiano Owner Owner's Name information is required for North Andover MA 01845 4-23-13 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 \ 1 V Commonwealth of Massachusetts City/Town of � V 6 y+k JAN 1 2009 System Pumping Record TO. •,'ORTH ANDOVER HE/,,, 1 DEPARTMENT Facility Information: System Location: I e� � b � Address �j o� � � l 5 City/Town State Zip Code System Owner: Name: Adress (if different from location of pump) City/Town State Zip Code Telephone Number Pumping Record Date of Pumping I U Quantity Pumped (!v gallons Type of System Septic Tank Grease Trap Other (what) System Pumped by: Op Company: ROOTER-MAN 12 East Dracut Rd., Methuen, MA 01844 Location where con t were disposed: Signature of Hauler Date U ` rocuA4tD 577VAI( S' © lhv6G mss!/ !/x,✓�ess'L CLSTi.t,G� 74!AM-' 009 4 ler-rl-WO oV-� 7Ztl 4AA�3 aur or *D 74r Wqs 6>4 i74 &,*y �r wrys De-leChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, April 13, 2010 1:55 PM To: DelleChiaie, Pamela Subject: FW: 142 Duncan Drive-Question Attachments: Title V Certificate(3).pdf From: fabiano.p@tbcam.com [mailto:fabiano.p@tbcam.com] Sent:Tuesday, April 13, 2010 12:30 PM To: Sawyer, Susan; peellechiaie@townofnorthandover.com Subject: RE: 142 Duncan Drive - Question Hello, Has the Title V inspection been filed? I'm still interested in obtaining the full report. Thanks,Paul From: Sawyer, Susan [ma iIto:ssawver@townofnorthandover.com] Sent: Tuesday, August 25, 2009 2:39 PM To: Fabiano Paul Subject: RE: 142 Duncan Drive- Question It's probably in a"to file"pile somewhere. Thankyou From: Fabiano Paul fmailto:fabiano.g(@tbcam.com] Sent: Tuesday, August 25, 2009 11:20 AM To: Sawyer, Susan Subject: RE: 142 Duncan Drive - Question Thanks for the quick response. Benjamin C. Osgood,Jr. of New England Engineering Services, Inc. performed the inspection on 11/13/08. Attached is the 1"page. I'll let you know about coming in to copy the information you have. Thanks. From: Sawyer, Susan [mai Ito:ssaMer0townofnorthandover.com] Sent: Tuesday, August 25, 2009 10:35 AM To: Fabiano Paul Subject: RE: 142 Duncan Drive - Question Hello Paul, I pulled your file. The tank appears to be from 1981 and the field appears to have been re-done in 1990,according to hand drawn documents. 1 You`are welcome to come to the Health Office during business hours to review or copy the information. We are located at 1600 Osgood Street,the old Lucent Tech. building.We can assist you from 8:30—4. 1 will leave your file out if you let me know when you will be coming. If you recently purchased the home,there should be a Title V inspection in the file, but I do not see one to date. Do you know who did the inspection for the seller?The inspection would give you additional information. Possibly it is here at the office, but has not been filed yet. Susan From: DelleChiaie, Pamela Sent: Monday, August 24, 2009 11:18 PM To: Sawyer, Susan Subject: FW: 142 Duncan Drive - Question From: Fabiano Paul [fabiano.p@tbcam.com] Sent: Monday, August 24, 2009 5:25 PM To: DelleChiaie, Pamela Subject: 142 Duncan Drive - Question Hello, Not sure if you could assist. If not, a point in the right direction would be appreciated. I recently purchased 142 Duncan Drive. I'm trying to find information on the septic tank which is of newer age. I was wondering if you had any documentation highlighting who the installer was? Thanks for your time. Paul Fabiano 2 ---- -- - - -•-• ••�• i�c L1N11VCCt[11YU PAUL 01/15 f Massachusetts I ficial Inspection Form Subsurface Sewage Disposal System form-Not jot Votitintafy AsseSSmerits 142 Duncan Drive P'ropedy,Address Estate of Joyce E.Ballard Owner ownoes Name Informationu' redfor No.Andover MA 01845 11/13/08 requitedfor -- - wary page. Cttyrrown State Zip Code Date of Inspection I Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Importatht: A General Information When fililnp out forms On U%4 nm he tab use eY 1 Inspector: �1 to move your Benjamin C. O?g000d,Jr. WWI•do 1101 Name of Inspector use the fetum key. New England.Engineering Services, Inc. Wo Company Name — — 1600 Osgood Street Suite 2-64 GA Company Addross No.Andover MA 01845 Citynown state Zip Code 078.686-1768 Toleptlonv Number License Number B. Certification 1 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 alto sewage disposal systems. l am a DEP approved system Inspector pursuant to Section 16.840 of Title 6(310 CMR 15.000).The system; Gt/Passes ❑ Conditionally Passes ❑ Foils Q Needs Further Evaluation by the Local Approving Authority Inspector SignaWre Date The system inspector shI 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 condldons of use. I ME 3 FORM MASTMOG•tM raa 5 040n Mepeolon Form;Sumurtmes ft"go OhpoM System#Pon 1 0115 f 02/06/2006 10:43 9783276138 NE ENGINEERING PAGE 01/15 —+� r f Massachusetts I ficial Inspection Form Subsurface Sewage Disposal System FOTtn-Not fo►11t)1>SMVt ASMSfften% 142 Duncan Drive Property Address Estate of Joyce E.Ballard Ownet owner's Name Information Is No.Andover MA 01845 11/13108 required for -- every page. CitylTovm State Lip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Imponsnt: A General Information When oiling out A. forms an" computer,use I Inspector: only the tab key SO move your Benjamin Q Osgood, Jr. cursor-do not Name of Inspector use the fetum key.�rNew England Engineering Services, Inc. _1� Company Name 1600 Osgood Street Suite 2-64 Company Address No,Andover MA 01845 6A Clty own state Zip Coda 978.886-1768 Telepfro»e Number License Number B. Certification 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.II am a DEP approved system inspector pursuant to Section 15.340 of This 5(310 CMR 15.000).The system: asses ❑ Conditionally Passes ❑ Fails El Needs Further Evaluation by the Local Approving Authority f 6 /3 O F, r'• s inspectoignature Date The system Inspector sh1 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 shell 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. TREES FORM M ASTER.00G-ona 1106 3 CAM01 Insp6pyon Form,SWourr6o6 Sn"ps olepwro system i Pap 1 d 13 97868,'-18476 HEAL'rH RSA C E IV ED A� E 02/0-, COMMon. wealth Of Massachusetts JAN 16 2007 City/Town Of NORTH ANDOVER MAR IR F—W%F]h System Pumping Record T �-.1. NI)OVER 04F�NATLT�l DEPARTKAENT Form 4 DEP has Provided this form for use by iocal Boards of Health. The System Pumping Record must be Submitted to the local Board of Health or other approving authority. A. acifity E ED E 'VE JAN 6 2 7 ! 7 ) -R _-A-S-S-A E ( . OVE- IVN P�V�rl�� T�_ 3� NT inkportant: When filfing out 1. Systurn Location: fQrM$on the computer;Ljso only the tab koy U 'c�rah —__ IO move you, 01.10or-do not uzoh the return key. state -70 Code .&*-- 2. SYStem Owner., Name 'ent 7�ron)10-0 T',Y7FoVjW oil$ umber --- ................. la- Date of Pumping -6 14- 2, Quantity Pumped: 3. Type of syslam: 11 CL-5.5pool(.S) 2/septic Tank ❑ Tight Tank El Other(de$Cribe); 4. Effluent Tee Filter present? 0 Yes Cj No S. Condition of System. If yeS,was it cleaned? ED Y88 El No 6- System PU111ped By., ROOTER-MAN7 e—hi c I SNumber, ---- 12 EAST DRACUT ROAD Company METHUEN,MA 01844 7. Location were Conterits were disposed: FS1 t,at rqt of Hau er - - -- __''� �t� (' http://Vvww.rT,@$$.� ov/deP/wateriaPPrOvelSItSforMs.htM#if)spect (5fOrm'00C-06/03 '5yStern Pumping Record•Page 1 of I ZN- Commonwealth of Mas/s�achu etts RIEG�! 93City/Town of k �g�c:f ! �� � DEC 2 0 2005 System Pumpmg`'Record Form 4 _ TOWN OF NC;STH ANDOVER HEALTH DE?A.RT(AENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority_ A. Facility information Important: When filling out 1- System Locatio : forms on the computer,use U/) 6L I yt, only the tab key Mare /I/�^I to move your �0 , r/'yo V j cursor-00not ss use the return C' /Town State Zip Code key. 2. System wn Name t, tl ' Address(if different from location) City/Town State Zip C Telephone Number B. Pumping Record 1. Date of Pumping ate 2. Quantity Pumped: Gali6nss 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,wad it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Rme Vehicle Lice Number Cbmpay 7. Location where contents were disposed: Signature of Hauler Date t5fornA.docr 06103 System Pumping Record•Page 1 of 1 Address /. .D� �c � Q ' Title of File Page o f Date File Open: Date file closed: Doc Document/Action Title Date of action Refer to other Purpose of Documernt/Action and notes Document/ document/ Num. Document/ Department Board of Appeals - Board of Health - Plannang Board - Conservation Commission- Building Department i Commonwealth of Massachusetts /A/, ",A�massachusetts System Pumping Record System Owner System Location L( C -� Date of Pumping: I �'' Quantity Pumped:4�gallons Cesspool: No�[�]/ Yes [] Septic Tank: No [] Yes System Pumped by: 64&44K. 46gavww License# Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: I I J t.+ I i i TOWN OF NORTH ANDOVER Q 25 2001 SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION "�f 16(j (example: left front of house) qz cQDf . DATE OF PUMPING: 16"IC-N QUANTITY PUMPED15'00 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES AZ NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: C� <� .�•U 1 � r i t - I 1 r�• , i i � 1 j i r ti I I ' I { I I I i eC71 ,7 I Loz l (A, QuAc.aw . • C. Meow.-� ,kard of Health 1.cr'`h r '�ier, ia,a SUBST FACE DISPOSAL !,,SIGN CHECK LIST LOT # ,&# APPROVED DATE DISAPPROVED DATE Provided: Reasons: s TitleW FAIL ja) Reg 2.5 a submitted plan must show as a ydnirwm: the lot to be served-area,dimensions lot # abutters location and log deep observationhoes-distance to ties location and results percolation tests-distance to ties design calculations & calculations showing required leaching area location and dimensions of system-including reserve area e fisting and proposed contours location any wet areas vithin 1001 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 eaeaments within 1001 of sai-age disposal system or discla.Ir.:r-Plmr.3ng Board files 3) krona sources of "ter supply within 2001 of m.-age disposal } system or disclaimer location of aq proposed well to serve lot-1001 from leaching facility Location of water lines on property-101 from leaching facility location of benchmark driveways f ) garbage disposals 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 Otter elevations _ r) maximum ground s-rater elevation in area sewage disposal system s) plan =st be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 S22tic Tanks a) capacities-150,% of flow, water table, tees, depth of tees, access, purping } cleanout Pd) 101 from cellar wall or inground su=ing pool 251 from subsurface drains Reg 10.2 Distribution Boxes slope greater 0.08 Reg 10.4 b} auamp i i V N1,11ir;'dace D`ffi.ga Check I.f at Pam.e 2 FAIL 0K Lachiag Pits Leaching pits are referred v3here the installation is possible Reg 11.2 a) calculation f leaching area-W-niram 500 aq ft 11.4 b) spacing 11.10 c surfa drainage 2% 11.11 d cov material e) x2 IA splash pad f tee at elbow no bends in pipe from d-box to pipe Leaching Fields Reg 15.1 no greater ME 20 minutes/inch area-mini=m 900 sq ft 15.4 } construction of field 15.8 surface drainage 2 % 3.7 e) 201 from cellar ia11 or inground MimaIng pool I.eachi.n Tenches Reg 14.1 a) calculations onMn�6ft ing area-min 500 sq ft 14.4 b spacing-4 with reserve betv3-en 14.6 d) c ction 14.7 e) no 14.10 surface drainage 2% z Douihill Aop e a) sopa x = to be shown) b) y/x 150 = (to be shown) s Reg 9.1 a) !app val 9.6 b) s d-by power :` as86W' ,m`sv.M+rW'r °iR4WbT.wry^.a,"ti—'.Tt4.O3N1°,�1R�.'Xk"PT:�47,SCVf�."•`1.Snis�ASti•._'"„ i t � ,F I t I IIA 1� to, T\ 1 � � k i I � ` � _ _1 �try• -- � 1 i' s, 1 1 p ' iia';. .:.iY..it9`,"'^'•3a,:," � c�� �'�Z� bL Blue Medicare PFFS (Blue Cross Blue Shield of MA) Fallon Senior Plan. (Fallon Community Health Plan) First Seniority Freedom (Harvard Pilgrim Health Care) Senior Whole Health Tufts Health Plan Medicare Pre' Tufts Health Plan i Medicare Card Number # 1 give permission to bill my ins (Signature of person to receive vac( X For Clinic/Office Use: Vaccine name: u-X-\�\ Injection site: D Vaccine manufacturer: Name and title of vaccine administrator Clinic/office address: Influenza Forms—MAHP/Masspro Plan Reimbu, \dTO: 1981, . ja,Av nF 'AaNL_T-" B10AIR D Off` .3"'ALTH FROM: V4tiK L, DESIGN ENGINEER Re : Soil Absorption Sewage Disposal System ` This is to certify that I have inspected the construction materials of said disposal system at L �) \-k Q G-A tj 'b(Li V Site Location North Andover, Mass. The grades and construction materials are as specified in my plans and specifications dated C l C) 19 S 1 and �0 V i 19 g 1 __ Recd. Prof . Engineer/Reg. Sanitarian Commonwealth of Massachusetts JMassachusetts V stem Putning Record System Owner System Location � �` ! � � �� ►�Com- ��= Date of Pumping: t a— 4 Quairiity Pumped: �R��C�gallvns Cesspool: No Yes Septic Tank: No U Yes System !lumped by: garejele grit'¢vmMed License# Contents transferrred to : Greater awrence sanitary District Date: - Inspector: 12 9 78 6 7 C. HEALTH E .2. 0 RECEIVED Cor'nmonwealth Of Massachusetts JAN 16 2007 P City/Town of NORTH ANDOVER MASSA HUSETTS SYSteumPing Record NDOVER Forrn 4 HEALTH DEPARTMENT Dep has provided this form for use by local Boards of Health The System Pumping Record must be submitted to the 10cal Board of Health or other approving authority, A. �aeufity Information VWlenfilifing out I. fQcompurtrl$QM the ter,Li8e 1 y� _ yr V only the tab key 4.d dress to move your do 110t ulo the retueh CA.,/Town kev. State 2. 8"Yste-rri Owner:---- -1 -sea_-E ?in Code Name Stale. timber S. Pu ................................ i. Date of Pumping Type Of system: 2. Quantity Pumped: a. cesspoolm 2/Septic Tank F] Tight Tank ❑ Other(describe): 4. Effjuent'TeeFilfej-present? ❑ Yes No S. Condition of System. If yes, was it Cleaned? Yes El No (3, System Pull)Ped By: Name. ROOTER-MAN Vehicle Licosa: - 12 EAST DRACUT ROAD timber (50 f I�Da i I y, METHUEN,MA 01844 7, Location w ere Contents we.,ee disposed; - �`/ --- ---._ Hau a' val-VtSforrins,htnIffinspect t5fo—i-iac-06103 Syq'-,M PUM0,19 Record,Page=1 of 1 WELL DATABASE ADDRESS: IJ�•►,✓r�,yl r a f' }-} AGE OF WTELL: J 5 WELL DRILLER: 1 WELL PERNIIT m: z WELL LOCATION: l ao ViELL PERMIT DATE: DEPTH OF WELL: TYPE OF WELL: a.. DRILLED _b. DUG c. LTNKv W 1 TYPE OF WATER BEARING ROCK: �- WATER ANALYSIS DATES 7 HIGH MANGANESE: Y N - HIGH IRON: Y N OTHER CONTAMINANTS: Y N - x