HomeMy WebLinkAboutMiscellaneous - 145 CARLTON LANE 4/30/2018 (3) 1 D
I
NEW EN2 AND ENGINEERING SERVICES
INC
RECEIVED
JUN U 3 2005
June 1, 2005T�HEALOTH DEPARTMENT
OER
North Andover Board of Health
400 Osgood Street
North Andover,MA 01845
RE: TITLE V REPORT: RE: 145 Carlton Lane North Andover, MA 01845
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,
Benj C. Osgood, Jr.
Certified Title 5 inspector
I
60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
................. .....................
CC NWONWEALTH OF MASSACHUSEITS
EXEC OFFICE OF ENVROMMENrAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE
SEWAGE DISPOSAL SYSTEM FORM
PART A CERTIFICATION
Property Address: 145 Carlton Lane North Andover,MA 01845 RECEIVED
Owner's Name: Patricia Schwanbeck
JUN U 3 2005
Owner's Address: 145 Carlton Lane North Andover MA 0184
TOWN OF NORTH ANDOVER
Date of Inspection; 05/31/05 - HEALTH DEPARTMENT-
Name of Inspector; (please print) Benjamin C. Osgood Jr., Certified Title 5 Inspector
Company Name: New England Engineering Services Inc.
Mailing Address: 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 15340 of Title 5 (3 10 CMR 15.000).
The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: (� Date: ,5.3i oS
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of
Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design
flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if
applicable,and the approving authority.
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 V0LMARYASSFSSNffakffS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(ewrtnr i4
Property Address: 145 Carlton Lane North Andover,MA 01845
Owner's Name: Patricia Schwanbeck
Date of Inspection: 05/31/05
Inspection Summary:Check A,BCD or E/ALWAYS complete all US of Section D
A. System Passes:
y ES I have not farA any information which indicates that any ofthe 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:
Ny One or more system components as desanbed in the"Conditional Pass"section need to be replaced or repaired.
The system upon completion of Bic replacement or repair,as approved by the Board ofHealth,will pass.
Answer yes,no or not determined(YNND)in the=for the following statemetrts.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 iron or filtration or tank fiilure is imminent.System will pass inspection if the
odstim 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.
ND explain:
Observation of wNzige backup or break out orhigh static water level in the distnbutionbox 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
distribufion box is leveled or replaced
ND explain:
The system required pumping morethan 4 times ayear due to broken or obstructed pipe(s).The system will
pass inspection if(with approval ofthe Board offlealth):
broken pipe(s)are replaced
obstruction is removed
ND explain:
i
•Page 3 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE
SEWAGE DISPOSAL SYSTEM INSPECITON FORM
PART A
CERTIFICATION(continued)
Property Address: 145 Carlton Lane North Andover,MA 01845
Owner's Name: Patricia Schwanbeck
Owner's Address: 145 Carlton Lane North Andover MA 01845
Date of Inspection: 05/31/05
C. Further Evaluation is Required by the Board of Health:
D. Conditions east which require further evaluation by the Board ofHealth in order to mine ifthe system is
failing to protect public health,safty or the environment
1. System will pass unless Board of Health determines in accordance with 310 CMR 15303(M)that the
system is not functioning m a manner which w M 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. System will fail unless the Board of Health(and Public Water Suppler,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 ofa,suffice
water supply ortnbutary to asurface water supply
The system has a septic tank and SAS and the SAS is within a Zone 1 of apublic water supply.
The system has a septic tank and SAS andthe SAS is within 50 feet of aprivatewater supply well
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from aprivate
water supply well**.Method used to determine distance
**Ibis system passes if the well water analysis,pufonned at aDEP certified laboratory,for ooliforrn bacteria and
volatile organic compounds 6dicates did the well is fine from pollution from that facility aid the presence of
ammaniantirpgan andniliale n0ogm is equal to or less man 5 pptn,provided that noother fiilure a to is are
triggered A copy of the analysis must be attached to this form
3. Other:
Page 4of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTSSUBSURFACE SEWAGE
DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 145 Carlton Lane North Andover,MA 01845
Owners Name: Patricia Schwanbeck
Owner's Address: 145 Carlton Lane North Andover MA 01845
Date of Inspection: 05/31/05
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 S AS 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 man 6"below invert or available volume bless than 1/2 day flow
Required pumping more man 4 times in the last year NOT due to clogged or obstructed pipc(s).Number
of times pumped_.
Any portion of me SAS,cesspool or privy is below high ground water elevation
U 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 astable water quality m>alysis.[This system passes tithe 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.]
AJ O (YeslNo)The system fails.I have cletemtined that one or more ofthe above farbn criteria exist as
described in 310 CMR 15.303,therdm the system&1s.The system owvw should oorsact the Board of caltr O determine what
will benecessarytothe
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
You nhist indicate ' "or'bd'to each ofth following:~
(The following ataia apply systerms in addition both
Yes No
the system is within 400 of a surface drinking water supply
the system is 200 feet tnbutary to a surface d mkmg water supply of public water supply well
the is located rbb a nitrogen itive area(Interim Wellhead Protection Area IWPA)
or a ne 11 of public water supply well
If you have answered)es"to any question in Section E the system is ions a sigai cant throat,ararmored"y"in Section D above the
large system has fm7ed The owner or operator of any Large system considered a 'grrifirarrt threat under Section E or fa<W wider Section
M weak the system inaccordance with 310 CMR 15.304.The system owner should coiW the ante regio d office of the
Page 5 of 1 l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY SSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PARTB
CHECKLIST
Property Address: 145 Carlton Lane North Andover,MA 01845
Owners Name: Patricia Schwanbeck
Owner's Address: 145 Carlton Lane North Andover MA 01845
Date of Inspection: 05/31/05
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 7
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?
i/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?
V Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the
v"— 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 theme Board of Health.
Detennined in the field(if any of the failure criteria relaxed to Part C is at issue approximation of
distance is unacceptable)[310 CMR 15.302(3)(b)]
Page b of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DE POSAI.
SYS'L11 AINSPECMNFORM
PARK
SYSTEM INFORMATION
Property Address: 145 Carlton Lane North Andover,MA 01845
Owner's Name: Patricia Schwanbeck
OwWsAddtin 145 Carlton Lane North Andover MA 01845
DateofLt4pection: OS/3Lg5
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4—Number of bedrooms(actual)"
DESIGN flow based on 310 CMR 15.203(for example:110 gpdx#of bedrooms):
Number of current residents: 3
Does residence have a garbage grinder(yes or no):
Is laundryon a separate sewage system(yes orno): NO (if yes separate inspection required)
Laundry system inspected(yes or no):
Seasonal use:(yes or no):
Water meter readings,if available(last 2 years usage(gpd)
Sump pump(yes or no) /L0
Last date of occupancy. C r
COMMERCIAIAMUSTRIAL
Type of establisbmen
Design flow(based on 310 CMR 15.203): apd
Basis of design flow(seats/persons/sq ketc.):
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 meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERALIlO-ORMATION
Pumping Record
Source of information: 196(c( J,c
Was system pumped as part of the inspection(yes or no): /N0
If yes,volume pumped:`gallons How was quantity pumped determined?
Reason for pumping:
TYPEOF SYmm
__7y__Septic Tank,distribution boat,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: ��2_ l L s (,
Page 7of 11
OFFICIAL INSPECTIONFORM—NOTFORVOLUNTARY ASSESSMENTS
SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 145 Carlton Lane North Andover,MA 01845
Owner's Name: Patricia Schwanbeck
Owner's Address: 145 Carlton Lane North Andover MA 01845
Date of Inspection: 05/31/05
BUILDING SEWER(locate on site plan)
Depth below grade
Materials of construction cast iron ,,40 PVC other(explain)
Distance fi+om private water supply well or suction line:
Continents(on condition ofjoims,venting evidence ofleakaM etc): _
Ill
SEPTIC TANK_(locate on site plan)
Depth below grade:
Material of construchon: L, _Concrete metal fiberglass polyethylene
o"explain)
Iftank is metal list age: Is age confirmed by a Catfic&of Compliance(yes or no):_(atm a copy of
certificate)
Dinoisions: 1-5-c-0 Crr'}G�.oti S
Slue depth 42
Distance from top of sludge to bottom of outlet tee or baffle: 3 c�
Scum thickness. /- �-
Distance firm top of scum to top of oudet tee or baffle:
Distance frombottom of yam to bottom ofoutlet tee or baffle* Z9 —
How
9 "flow were dimensioris determmed: M e f}s u R r
Continents(on putapmg recomutendaticM inlet and autlettee orbaffle eondmor4 stnrcftual mtegrdy,hquid levels as related
W Outlet invest,evidence of leakage,etc)-,
I9 6ell tto P0( lti Cr7 p
GREASE TRAP: &A (locate on site plan)
Depth below grade:_
Material of construction: ooncrete 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 re mune nda tons,inlet and cutlet tee or bate condition,stnxt►aal mtcg*,liquid levels
as related to outlet invert,evidence of leakage,etc):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE
SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 145 Carlton Lane North Andover,MA 01845
Owner's Name: Patricia Schwanbeck
Owner's Address: 145 Carlton Lane North Andover MA 01845
Date of Inspection: 05/31/05
TIGHT or HOLDING TANK: /l, (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:_
Material of construction: concrete metal _ fiberglass polyethylene
ofl*explain):
Dimensions:
Capacity: gallons
Design Flow mallons/day.
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments (condition of alann and float switches,etc.):
DISTRIBUTION BOX: (if present must be (locate on site plan)
Depth of liquid level above outlet invert-
Comments(note Tbox is level and distribution to outlets equal,airy evidence ofsolids canyover,any evidence of
leakage into or out of box,etc.): kq-e S,
e,1-TC-
PUMP
fl-TPUMP CHAM BER:ju!! -(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.):
Page9of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE
DISPOSAL SYSTEMINSPECTION FORM
PART C SYSTEM INFORMATION(continued)
Property Address: 145 Carlton Lane North Andover,MA 01845
Owner's Name: Patricia Schwanbeck
Owner's Address: 145 Carlton Lane North Andover MA 01845
Date of Inspection: 05/31/05
SOIL ABSORPTION SYSTEM(SAS):_(locate on site plan,excavation not required}
If SAS not located explain why.
Type
leaching pits,number
leaching chambers,number:
leaching galleries,number
,X—leaching trenches, number length: oZ S�? ` i- c s
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/ahemative system Type/name of technology:
Comments(note condition of soil,Was of hydraulic failure,level of ponding damp soil,condition ofvegetation,
etc.):
F__ -rtes L_' l io jx't 0 02A,C.
CESSPOOI.At/ (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 or no):
Comments(nate condition of soil,signs ofhydraulic failure,level of ponding,cmdition ofvegetatioA etc.):
PRIVY: k1,4' (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids
Co mengs(note clition of soil,signs of hydraulic failure level of ponding condition of vegetation,
Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PARK
SYSTEM DiFORMATION(continued)
Property Address: 145 Carlton Lane North Andover,MA 01845
Owner's Name: Patricia Schwanbeck
Owner's Address: 145 Carlton Lane North Andover MA 01845
Date of Inspection: 05/31/05
SIC=OF SEWAGE DISPOSAL SYSTEM
Provide a sketch ofthe sewage disposal system includmg ties to at least two permanent refenmce
WAmarks or benchmariss.Locate all wells within 100 fed.Locate whae public water supply ettm the
building
a q,3
4 \
- I
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PARTC
SYSTEM INFORMATION(continued)
Property Address: 145 Carlton Lane North Andover,M.A.01845
Owner's Name: Patricia Schwanbeck
Owner's Address: 145 Carlton Lane North Andover MA 01845
Date of Inspection: 05/31/05
SITE EXAM
Slope
Surface water �,�
Check cellar
Shallow wells
Estimated depth to ground waterG 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 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach dwmw4ation)
.Accessed USGS database-explain:
You nnust desmbe how you established the high ground water elevation:
i
Fax
To: North Andover Board of Health From: Benjamin Osgood.Jr,
Company: Date: June 1,2005
Fax: 978-688-9542 Pages: 12 including this sheet
Re: 145 Carlton Lane,Title 5 CC:
0 Urgent x For Review 0 Please Comment 0 Please Reply 0 Please Recycle
If you have any questions please don't hesitate to call,
Thank You
Benjamin C.Osgood,Jr.,P.E.
New England Engineering
978-686-1768
" TRANSMISSION VERIFICATION REPORT
TIME 06/01/2005 14:55
NAME NEW ENG ENG
FAX 9786851099
TEL 9786861768
DATEJIME 06101 14:52
FAX NO./NAME 19786889542
DURATION 00:03:16
PAGE(S) 12
RESULT OK
MODE STANDARD
ECM