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HomeMy WebLinkAboutMiscellaneous - 146 RALEIGH TAVERN LANE 4/30/2018 (2) `146 RALEIGR"1 AVE- c-1 210/107.A-0017-0000.0 n Lane `9 4 V ` V j-L �':���� `i111�� x t� North Andover Board of Assessors Public Access Page 1 of 1 R t poR7M Town of NorthAndo-w-r- nko opSSeSSOY'S:. y� �y Property snc F+us Return to the Home page click on logo Record Card Parcel ID: 210/107.A-0017-0000.0 Community:North Andover New Search SKETCH PHOTO Click on Sketch to Enlarge - - - — Sales o P i u re Summary fl Residence �Mv " le Detached Structure Condo Commercial Comparable Sales Location: 146 RALEIGH TAVERN LANE Owner Name: RETHMAN,NICHOLAS L Owner Address: 146 RALEIGH TAVERN LANE City:NORTH ANDOVER State:MA ZIP: 01845 Neighborhood: 7-7 Land Area: 1.04 acres Use Code: 101 -SNGL-FAM-RES Total Finished Area: 2040 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 567,200 522,800 Building Value: 330,300 307,400 Land Value: 236,900 215,400 Market Land Value:236,900 Chapter Land Value: LATEST SALE Sale Price:338,000 Sale Date:03/29/1998 Arms Length Sale Code: Y-YES-VALID Grantor:JOSEPH L'ITALIEN Cert Doc: Book: 05005 Page: 0314 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=991436 4/10/2007 Residential Property Record Card PARCEL ID:210/107.A-0017-0000.0 MAP:107.A BLOCK:0017 LOT:0000.0 PARCEL ADDRESSA46 RALEIGH TAVERN LANE PARCEL INFORMATION Use=Code`: 101 Sale Price: 338,000 ` Book: - 05005 Road Type' T Inspect Date: 10/2812002 Tax Class: T Sale Date: 03/29/1998 Page: 0314 Rd Condition: P Meas Date: 10/21/2002 Owner: Tot Fin Area: 2040 Sale Type: P Cert/Doc: Traffic: M Entrance: C RETHMAN,NICHOLAS L Tot Land Area: 1.04 Sale Valid: Y - Water: Collect Id: RRC Address: Grantor: JOSEPH L'ITALIEN _ Sewer: Inspect Reas: C 146 RALEIGH TAVERN LANE NORTH ANDOVER MA 01845 Exempt-B/L% 0/0 Resid-B/L% 100/100 Comm-B/L010 Indust-B/L% 0/0 Open Sp-B/L% 0/0 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 7 Main Fn Area: 972 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R2 Story Height: 2 Bedrooms: 4 Up Fn Area: 1068 Bsmt Area: 972 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 756 1 P 101 S 43560 1 236,530 Ext Wall: WS Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0.04 320 Masonry Trim: Ext Bath Fix: Tot Fin Area: 2040 VALUATION INFORMATION Foundation: CN Bath Qua]: T RCNLD: 330342 Current Total: 567,200 Bldg: 330,300 Land: 236,900 MktLnd: 236,900 Kitch Qual: T Eff Yr Built: 1980 Mkt Adj: Prior Total: 522,800 Bldg: 307,400 Land: 215,400 MktLnd: 215,400 Heat Type: HW Ext Kitch: Year Built: 1970 Sound Value: Fuel Type: _ G Grade: G Cost Bldg: ' 330,30.0 Fireplace: 1 Bsmt Gar Cap: Condition: A Aft Str Val1: Centra_I AC: N Bsmt Gar SF: Pct Complete: Aft Str Val2: Aft Gar SF: 484%Good P/F/E/R /100/100/85 Porch Type Porch Area Porch Grade Factor E 450 M 374 SKETCH PHOTO 2c; 22 E M IL IL 18 450 Sq.R. 18 374 Sq.R, 17 N Picture 48 22 B FM B 756 2*964d&. 18 16 Sq � 48G4 Sq.R. 22 Available 3 Parcel ID:210/107.A-0017-0000.0 as of 4/10/07 Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping-Record Form 4 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 1. System Location: Left/Right front of housKe3/Rig rea of ho , Left/right side of house, Left/ Right side of building, Left/Right front of building, t/ ig rear of building, Under deck Address City/Town State Zip Code 2. System Owner. Name' Add ie ss(if,different from location) C41—own ,I� � 15 I State&� 'l Zip Code ; TOCt'i:c MW"",/ + Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Canons . 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yeas No If yes, was it cleaned? ❑ Yes ❑ Na 5. Condition of System: 6. System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location re contents were disposed: L S. Lowell Waste Water _ rL( Sign Haul Date F t5fomu4.doe-06/03 System Pumping Record•Page 1 of 1 w: Septic System Information 146 RALEIGH TAVERN LANE Printed On: Wednesday,January 02, 2 System ID: BHS-2002-1257 General System Information Latest Permit Information Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity: Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder. Yes No Soil Type: Depth: Laundry: No No Hauling/Pumping Listing Quantity Type System Type Pumped Pumped By Transferred To Disposed At Date Pumped (gallons) Routine Other Neil J. Bateson GLSD 12/11/2006 300 Comments: pumped out drywell&filled with sand Routine Septic Tank Neil J. Bateson GLSD 01/09/2007 1000 Comments: normal level in tank&d-box Inspections: Inspected: Expires: Inspector: Status: 11/30/2007 Neil J. Bateson Passes Comments: Title 5 11/17/2006 Neil J. Bateson Conditionally Passes Comments: Title 5-passed on 12/15/06. Will need another inspection in 6 months. GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 �f AOR 1 .. ' - 3082 - o - n Town of North Andover HEALTH DEPARTMENT CHUsft CHECK#: DATE: /.,-- t/ LOCATION: /-�// Ile- v H/O NAME: _ .5���-2 r CONTRACTOR NAME: `� - -L-���� 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 $ 3 ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ s SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ;i ❑ Septic Disposal Works Installers(DWI) $ ❑ Title �5Inspector $ Title 5 Report $ 3 ❑ Other. (Indicate) $ f Health Agent Initials] 9 y White-Applicant Yellow-Health Pink-Treasurer a I 7 ' COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS o d DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED �qM she DEC 1 12007 TOWN OF NORTH ANDOVER TITLE 5 HEALTH DEPARTMENT OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_146 Raleigh Tavern Lane_ North Andover Owner's Name:_Richard Servino_ Owner's Address:_146 Raleigh Tavern Lane_ _North Andover,MA 01845_ Date of Inspection:_11/30/2007 i Name of Inspector: Neil J.Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,MA 01810_ Telephone Number:_(978)475-4786_ CERTIFICATION STATEMENT I cern that I have personally inspected the sewage disposal system at this address and that the information reported certify P y 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails 4 _ ✓ ,.. Inspector's Signature: Date: _11/30/2007 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 VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_146 Raleigh tavern Lane_ _ North Andover— Owner:_Servino_ Date of Inspection:_11/30/2007_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: 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.Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain._ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 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:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Servino_ Date of Inspection:_11/30/2007_ 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Servino Date of Inspection:_11/30/2007_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: _ No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _No_ Liquid depth in cesspool is less than 6"below invert or available volume is''/z day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _No_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ 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 form.] _No_(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 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. • Page 5 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Servino_ Date of Inspection:_11/30/2007_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes _ Pumping information was provided by the owner,occupant, or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes_ _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes_ _ Were as built plans of the system obtained and examined? Yes_ _ Was the facility or dwelling inspected for signs of sewage back up? Yes_ _ Was the site inspected for signs of break out? _Yes _ Were all system components,excluding the SAS,located on site? _Yes_ _ 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? _Yes_ _ 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 _Yes_ — Existing information. _Yes_ _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_146 Raleigh Tavern Lane- -North Andover– Owner:_Servino Date of Inspection:_11/30/2007_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203_440 Number of current residents:_4 Does residence have a garbage grinder(yes or no):–No_ Is laundry on a separate sewage system(yes or no): No_ Laundry system inspected(yes or no): Seasonal use: (yes or no):_No_ Water meter reading: Yes_ Sump pump(yes or no):_No Last date of occupancy:_Current_ COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,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 meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 2006_ Was system pumped as part of the inspection(yes or no):_No If yes,volume pumped: gallons--How was quantity pumped determined?_ Reason for pumping: TYPE OF SYSTEM X 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_19 years old,4/21/1988, as built plan_ Were sewage odors detected when arriving at the site(yes or no):_No • `Page 7 of l l ° OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Servino_ Date of Inspection:_11/30/2007 BUILDING SEWER_X_ (locate on site plan) Depth below grade:_2011 _ Materials of construction: _X_cast iron _X_40 PVC_other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) _4"Cast iron thru wall, 3"PVC in house, no leaks visible SEPTIC TANK: X Depth below grade:_8"_ Material of construction: X 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:_7'x 5'x 4' Sludge depth: 111 _ Distance from top of sludge to bottom of outlet tee or baffle: 25"_ Scum thickness:_1" Distance from top of scum to top of outlet tee or baffle: 811_ Distance from bottom of scum to bottom of outlet tee or baffle: 21" How were dimensions determined:_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc_Inlet baffle ok.Outlet baffle ok.Outlet tee ok.Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): • Page 8 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Servino_ Date of Inspection:_11/30/2007 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/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 X Depth below grade _18"_ 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.)_D-box level&distribution equal.No carryover.No leakage._ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no): Alarm in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): • 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:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Servino_ Date of Inspection:_11/30/2007_ SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _ leaching chambers,number: leaching galleries,number: _ leaching trench,number,length: X_ leaching field,number,dimensions: _1 field 20'x 431 _ 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.).—Soil ok.Vegetation ok.No sign of ponding to surface._ CESSPOOLS: Number and configuration: Depth—top of liquid to inlet invert:— Depth of sludge 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 Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Servino_ Date of Inspection:_11/30/2007_ 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 Driveway House Garage Septic Tank Porch Covers B C AtoTank 1=16'10" A to Tank 2=19'8" B to Tank 1=10'9" B to Tank 2=913" B to D-Box=36' D-Box C to D-Box=35' Page 11 of ll . OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Servino_ Date of Inspection:_11/30/2007_ SITE EXAM Slope_No_ Surface water_No_ Check cellar _Dry_ Shallow wells_No_ Estimated depth to ground water_>4'_ Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed:_10/28/1980 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: _ You must describe how you established the high ground water elevation:_No water 7'deep,as per design plan info Summary Record Card generated on 12/11/2007 1:00:25 PM by Lisa Evans Page 1 • . Town of North Andover Tax Map # 210-107.A-0017-0000.0 ' 146 RALEIGH TAVERN LANE RETHMAN, NICHOLAS L Since Jan 2003 146 RALEIGH TAVERN LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.04 Acres FY 2008 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until RICHARD&KIMBERLEY SERVINO Owner 146 RALEIGH TAVERN LANE NORTH ANDOVER,MA 01845 RETHMAN,NICHOLAS Previous Customer Inactive 5/25/2007 146 RALEIGH TAVERN LANE NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14204.0-146 RALEIGH TAVERN LANE Last Billing Date 9/5/2007 2100198 02 Cycle 02 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 104.98 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 16335644 a Active ERT METE METE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 11/1/2007 795 a Actual 22 -34% 8/3/2007 773 a Actual 26 9/14/2007 3354% 5/25/2007 747 f Final Bill 1 5/25/2007 -96% 2/21/2007 746 a Actual 34 3/23/2007 -10% 11/1/2006 712 a Actual 31 12/22/2006 -12% 8/1/2006 681 a Actual 34 9/13/2006 7% 5/4/2006 647 a Actual 33 6/20/2006 10% 2/1/2006 614 a Actual 30 3/13/2006 -13% 11/1/2005 584 a Actual 34 12/14/2005 -10% 8/2/2005 550 a Actual 38 9/12/2005 23% 5/2/2005 512 a Actual 30 6/8/2005 -3% 2/2/2005 482 a Actual 31 3/15/2005 12% 11/5/2004 451 a Actual 27 12/17/2004 -11% 8/10/2004 424 a Actual 31 9/20/2004 5/13/2004 393 a Actual 30 6/14/2004 38% 2/17/2004 363 a Actual 26 4/16/2004 0% 11/6/2003 337 n New Meter 0 11/6/2003 0% Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water&Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 146 Raleigh Tavern Lane , North Andover Owner: Servino Date of Inspection: 11/30/2007 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. B eson Bateson Enterprises, Inc. Page 1 of 4 Sawyer, Susan From: Nick Rethman [nrethman@comcast.net] Sent: Tuesday,April 24,2007 8:32 PM To: Sawyer, Susan Cc: nick@clkda.com Subject: RE: 6 month Title 5 reinspection of 146 Raleigh Tavern Lane. Dear Ms. Sawyer; I have read you letter and have some questions and comments. In your second paragraph you mention that there are no previous plans showing the drywell. I have a Title V done by Neil Bateson on 2/19/98 when we purchased the house showing the drywell. If you need a copy I would be happy to provide it to you. When we met in December you gave me a copy of a page from the North Andover Septic Regulations with 17.06 on it. I was told this was the reason for the 6 months reevaluation. i find it troubling that this has now been changed to a different regulation, 310 CMR 15.301(9),when the conditions surrounding our septic have not changed. In the third paragraph you state that based on our prior water meter reading we used 292 gallons per day. This is incorrect. According to water bill I received and paid we used 3400 cubic feet of water for 114 days. This works out to 3400`7.48(gallons per cubic foot)/114 (days)=223 gallons per day. I look at our water bills for 11/1/05 to 2/1/06 and 11/5/04 to 2/2/05 and we averaged 253 gallons per day. I can provide you with copies of these water bills if you want. This shows an average reduction of 30 gallons per day. As I stated in my previous email the work started in November and ended in January so the full savings would not be reflected in this water bill. The last toilet to be replaced was the flrst floor toilet which is by far the most used toilet in the house. In addition to this the upstairs bath tub valve broke 3 to 4 weeks before we remolded that bathroom. The break caused us to not completely be able to shut off the hot water. I asked the people doing the remodel work if they could fix it. They told me the only way to fix it was to replace the valve. Being the engineer that I am I calculated that it was cheaper to let the valve leak for 3 to 4 weeks then fix it. (Had I known that it could affect my Title 51 would have changed my mind.) I am sure this added several bath tubs of water per day for the 3 to 4 weeks while it was leaking. In my original email, l calculated changing the toilet would save 68.68 gallons per day. I feel the 30 gallon saving seen using the water meter reading method matches up with my calculations given the last water meter reading does not fully reflect the saving because of changing the toilet and because of the leaking tub. I met with you in December to talk about our Title V situation for 146 Raleigh Tavern Lane and to talk about the Title V situation at the house we were purchasing, 102 Spring Hill Road. At this time we had an accepted offer to buy 102 Spring Hill Road but had not signed the P&S yet. We talked a lot about when things would happen because I was concerned about getting an approved septic plan on 102 Spring Hill Road before our planned closing of January 2"d. I was also concerned about having to have another Title V inspection done in 6 months at 146 Raleigh Tavern Lane and how that would affect the sale of our house. During this conversation you asked me questions about when we would put 146 Raleigh Tavern Lane on the market and when we would move. I told you we planned to move sometime in February after we had some work done to 102 Spring Hill Road. A few weeks after this we would put 146 Raleigh Tavern Lane on the market after some painting and floors were redone. You tried to assure me that the 6 month reinspection was not a major hardship because the likelihood of closing on a sale of 146 Raleigh Tavern Lane by May 17th(6 months after the first Title V)was small. I even went so far as to question the need for the 6 month reinspection because the house would be vacant at the time of the inspection. Your response was that this was even better for use because the likelihood of any issues showing up with the new Title V was smaller. My family made a big financial decision based on this conversation. There are a number of things we could have done to meet your new requirement of occupancy,such as delayed the closing on 102 Spring Hill Road and 4/27/2007 Page 2 of 4 delayed our move from 146 Raleigh Tavern Lane. The change in your position on our Title V while affect my family financially. In your 4th paragraph you quote Clair Golden as saying °MassDEP has consistently advised BOHs to consider requiring another inspection of the septic systems for unoccupied houses six months after occupancy." There are currently a lot of unoccupied houses in.North Andover. I have asked realtors if these houses are also being required to have a six month inspection after occupancy and nobody has heard of this. So I am feeling singled out by this regulation. The only water that was going into the dry well before it was closed up was the cloth washing machine and a utility sink in the basement,which we almost never used. In my previous email I showed how an average house of 4 people would use 59.2 gallons of water per day to do laundry. So even if you do not consider any water saving by changing the toilets from 5 gallon models to 1.6 gallon models,we are still only talking about adding 59.2 gallons of water per day to the septic system. In paragraph 4 you say that if even 1 person lived in the house that it would constitute regular flow. I would argue that the difference in the amount of water used by 1 person compared to 4 people is a lot more than 59.2 gallons per day. Therefore, I do not see your argument that the septic system was not receiving regular flow when the Title V was done on November 17th- Using any of the three flow methods that have been discussed(my previous email flow calculation method, or the water meter method, or the number of people required for regular flow method)shows the house was receiving regular flow when the Title V testing was done. Given all of this, I would like you to reconsider the requirement for a Title V to be done 6 months after occupancy. At this time we have an accepted offer letter. We are trying to get a signed P&S but the Title V issue is a major sticking point. The real-estate attorneys we are working with have never heard of your request for a reinspection 6 months after occupancy and they have asked me to send you a letter in hopes to remove this 6 month re- inspection requirement. i Sincerely, Nicholas L. Rethman -----Original Message----- From: Sawyer, Susan [mailto:ssawyer@townofnorthandover.com] Sent: Wednesday,April 18, 2007 8:11 AM To: nrethman@comcast.net Subject: FW: 6 month Title 5 reinspection of 146 Raleigh Tavern Lane. Mr. Rethman, I received your message this morning.As I stated last week, I am responding to your change of inquiry.Your questions prompted much conversation with the Department of Environmental Protection and its position on this subject. The attached document will be sent regular mail as well, but I wanted to get it to you as soon as possible. As you know this was a holiday week, hence why this is just coming out today. I tried to make the letter self explanatory, however you are welcome to contact me with any questions you may have. Susan Sawyer -----Original Message----- From: Sawyer, Susan Sent:Tuesday, April 10, 2007 1:41 PM To: 'Nick Rethman' Subject: RE: 6 month Title 5 reinspection of 146 Raleigh Tavern Lane. Mr. Rethman, I just wanted to let you know I have received your inquiry and will be responding in writing as soon as possible. Susan Sawyer 4/27/2007 1 Page 3 of 4 -----Original Message----- From: Nick Rethman [maift:nrethman@comcast.net] Sent: Monday,April 09, 2007 9:39 PM To: Sawyer, Susan Cc: nick@clkda.com Subject: RE: 6 month Tide 5 reinspection of 146 Raleigh Tavern Lane. Dear Susan Sawyer: 1 have read over the North Andover Septic Regulations and 1 am not clear why we need a second Title 5 inspection 6 months after the one we had on November 17th,2006 at 146 Raleigh Tavern Lane. The regulation that I think is requiring this inspection is in Part F item 17.06. The copy of the regulations that I have is as follows 17.06 Any septic system that conditionally passes a Title 5 inspection due to a component failure,which has resulted in the leaching area having not received usual effluent flow,is required to have a second inspection conducted 6 months later. A MA licensed septic inspector must conduct this inspection and a proper report must be submitted to the Health Department. In our case,the flow going into the septic system has remained virtually unchanged with just a small decrease in flow. Only the source of the flow has changed. Starting in November and ending the first part of January we refinished all three bathrooms in our house to get rid of the 1970 avocado green and harvest gold. We did this to get the house in better shape to sell. During this process all 3 of the 1970's 5 gallon toilets were replaced with new 1.6 gallon toilets. I did some research and found a study done by American Water Works Association Research Foundation located at http://www.aguacraft.com/Publications/resident.htm. Out of the 2275 houses in the study,the average number of flushes per person was 5.05 times per day. There were 4 people living in our house so by changing the toilets we saved (5 gallons-1.6 gallons)*5.05*4 people=68.68 gallons of water per day going into the septic system. However,the clothes washing machine was added to our septic system when the dry well was closed up. This same study says the average number of loads of laundry per person per day is .37. According to http://www.energystar.gov_the standard washing machine(the type of washing machine we used) uses 40 gallons of water per load. This means we added 40 gallons* .37*4 people= 59.2 gallons per day. So we reduced the overall water going into the systems by 68.68-59.2= 9.48 gallons per day. In addition,we also replaced the faucets and shower heads in all the bathrooms even further reducing the water going into the septic system. We have accepted on offer on our house. I would like to avoid the cost and paper work of having another Title 5 inspection done. Since the Title 5 for our septic system passed on November I r 2006 and since we did not add more flow into the system,why are we required to have the 6 month inspection? Sincerely, Nicholas L.Rethman -----Original Message----- From: Nick Rethman [mailto:nrethman@comcast.net] Sent: Friday, April 06, 2007 12:46 PM To: 'Sawyer, Susan' Subject: RE: 6 month Tile 5 reinspection of 146 Raleigh Tavern Lane. We moved out on February 16th Nick Rethman -----Original Message----- From: Sawyer, Susan [mailto:ssawyer@townofnorthandover.com] Sent: Friday,April 06, 2007 10:57 AM To: Nick Rethman 4/27/2007 Page 4 of 4 Subject: RE: 6 month Title 5 reinspection of 146 Raleigh Tavern Lane. Can you tell me how long the property has been vacant? Susan Sawyer -----Original Message----- ' From: Nick Rethman [mailto:nrethman@comcast.net] Sent: Wednesday,April 04, 2007 9:03 PM To: Sawyer, Susan Cc: nick@clkda.com Subject: 6 month Tide 5 reinspection of 146 Raleigh Tavem Lane. Dear Susan Sawyer: We spoke on Wednesday April 4th about having our 6 month Title 5 re-inspection done on or after May V to fulfill the town's 6 month reinspection requirement. I am writing this email to get your approval for this. The original inspection was done on November 17,2006. We have an offer on the house and the buyers would like to close on May 18th. Moving the inspection up two weeks from May 17th would greatly aid us in processing the paper need for closing and give us time to resolve any small issues if they occur. If you need to contact me I can be reached during the day at 978-836-0884 or at nick@clkda.com. Thank you, Nicholas L. Rethman 4/27/2007 Page 1 of 4 Sawyer, Susan From: Nick Rethman [nrethman@comcast.net] Sent: Tuesday,April 24,2007 8:32 PM To: Sawyer, Susan Cc: nick@clkda.com Subject: RE: 6 month Title 5 reinspection of 146 Raleigh Tavern Lane. Dear Ms. Sawyer; I have read you letter and have some questions and comments. -TWO- In i O-In your second paragraph you mention that there are no previous plans showing the drywell. I have a Title V done by Neil Bateson on 2/19/98 when we purchased the house showing the drywell. If you need a copy would be happy to provide it to you. When we met in December you gave me a copy of a page from the North Andover Septic Regulations with 17.06 on it. I was told this was the reason for the 6 months reevaluation. 1 find it troubling that this has now been changed to a different regulation, 310 CMR 15.301(9),when the conditions surrounding our septic have notes// changed. In the third paragraph you state that based on our prior water meter reading we-bled 20 gal dris pear day. This is as -t.,-;r incorrect. According to water bill I received and paid we used 3400 cubic feet of water for 114 days. This works out to 3400"7.48 (gallons per cubic foot)/114 (days) = 223 gallons per day. 1 look at our water bills for 11/1/05 to 2/1/06 and 11/5/04 to 2/2/05 and we averaged 253 gallons per day. I can provide you with copies of these water bills if you want. This shows an average reduction of 30 gallons per day. As I stated in my previous email the work started in November and ended in January so the full savings would not be reflected in this water bill. A-r The last toilet to be replaced was the first floor toilet which is by far the most used toilet in the house. In addition .z to this the upstairs bath tub valve broke 3 to 4 weeks before we remolded that bathroom. The break caused us to not completely be able to shut off the hot water. I asked the people doing the remodel work if they could fix it. /S They told me the only way to fix it was to replace the valve. Being the engineer that I am 1 calculated that it was . © cheaper to let the valve leak for 3 to 4 weeks then fix it. (Had I known that it could affect my Title 51 would have changed my mind.)I am sure this added several bath tubs of water per day for the 3 to 4 weeks while it was leaking. In my original email, I calculated changing the toilet would save 68.68 gallons per day. I feel the 30 gallon saving seen using the water meter reading method matches up with my calculations given the last water meter reading does not fully reflect the saving because of changing the toilet and because of the leaking tub. I met with you in December to talk about our Title V situation for 146 Raleigh Tavern Lane and to talk about the Title V situation at the house we were purchasing, 102 Spring Hill Road. At this time we had an accepted offer to buy 102 Spring Hill Road but had not signed the P&S yet. We talked a lot about when things would happen because 1 was concerned about getting an approved septic plan on 102 Spring Hill Road before our planned closing of January 2"d. 1 was also concerned about having to have another Title V inspection done in 6 months at 146 Raleigh Tavern Lane and how that would affect the sale of our house. During this conversation you asked me questions about when we would put 146 Raleigh Tavern Lane on the market and when we would move. I told you we planned to move sometime in February after we had some work done to 102 Spring Hill Road. A few weeks after this we would put 146 Raleigh Tavern Lane on the market after some painting and floors were redone. You tried to'assure me that the 6 month reinspection was not a major hardship because the likelihood of closing on a sale of 146 Raleigh Tavern Lane by May 17m(6 months after the first Title V)was small. I even went so far as to question the need for the 6 month reinspection because the house would be vacant at the time of the inspection. Your response was that this was even better for use because the likelihood of any issues showing up with the new Title V was smaller. y v L44- , %% My family made a big financial decision based on this conversation. There are a number of things we could have done to meet your new requirement of occupancy,such as delayed the closing on 102 Spring Hill Road and 4/25/2007 Page 2 of 4 delayed our move from 146 Raleigh Tavern Lane. The change in your position on our Title V while affect my family financially. In your 4th paragraph you quote Clair Golden as saying "MassDEP has consistently advised BOHs to consider requiring another inspection of the septic systems for unoccupied houses six months after occupancy." There are currently a lot of unoccupied houses in North Andover. 1 have asked realtors if these houses are also being required to have a six month inspection after occupancy and nobody has heard of this. So I am feeling singled out by this regulation. The only water that was going into the dry well before it was closed up was the cloth washing machine and a utility sink in the basement,which we almost never used. In my previous email I showed how an average house of 4 people would use 59.2 gallons of water per day to do laundry. So even if you do not consider any water saving by changing the toilets from 5 gallon models to 1.6 gallon models,we are still only talking about adding 59.2 gallons of water per day to the septic system. In paragraph 4 you say that if even 1 person lived in the house that it would constitute regular flow. I would argue that the difference in the amount of water used by 1 person compared to 4 people is a lot more than 59.2 gallons per day. Therefore, I do not see your argument that the septic system was not receiving regular flow when the Title V was done on November 17th- Using any of the three flow methods that have been discussed(my previous email flow calculation method, or the water meter method,or the number of people required for regular flow method)shows the house was receiving regular flow when the Title V testing was done. Given all of this, I would like you to reconsider the requirement for a Title V to be done 6 months after occupancy. At this time we have an accepted offer letter. We are trying to get a signed PSS but the Title V issue is a major sticking point. The real-estate attorneys we are working with have never heard ofour request for a reins ection Y � P 6 months after occupancy and they have asked me to send you a letter in hopes to remove this 6 month re- inspection requirement. Sincerely, Nicholas L. Rethman -----Original Message----- From: Sawyer, Susan [mailto:ssawyer@townofnorthandover.com] Sent: Wednesday,April 18, 2007 8:11 AM To: nrethman@comcast.net Subject: FW: 6 month Title 5 reinspection of 146 Raleigh Tavern Lane. Mr. Rethman, I received your message this morning. As I stated last week, I am responding to your change of inquiry.Your questions prompted much conversation with the Department of Environmental Protection and its position on this subject. The attached document will be sent regular mail as well, but I wanted to get it to you as soon as possible. As you know this was a holiday week, hence why this is just coming out today. I tried to make the letter self explanatory, however you are welcome to contact me with any questions you may have. Susan Sawyer -----Original Message----- From: Sawyer, Susan Sent:Tuesday, April 10, 2007 1:41 PM To: 'Nick Rethman' Subject: RE: 6 month Tide 5 reinspection of 146 Raleigh Tavern Lane. Mr. Rethman, I just wanted to let you know I have received your inquiry and will be responding in writing as soon as possible. Susan Sawyer 4/25/2007 Page 3 of 4 -----Original Message----- From: Nick Rethman [mailto:nrethman@comcast.net] Sent: Monday, April 09, 2007 9:39 PM To: Sawyer, Susan Cc: nick@clkda.com Subject: RE: 6 month Tide 5 reinspection of 146 Raleigh Tavern Lane. Dear Susan Sawyer: I have read over the North Andover Septic Regulations and I am not clear why we need a second Title 5 inspection 6 months after the one we had on November 17th,2006 at 146 Raleigh Tavern Lane. The regulation that I think is requiring this inspection is in Part F item 17.06. The copy of the regulations that 1 have is as follows 17.06 Any septic system that conditionally passes a Title 5 inspection due to a component failure,which has resulted in the leaching area having not received usual effluent flow,is required to have a second inspection conducted 6 months later. A MA licensed septic inspector must conduct this inspection and a proper report must be submitted to the Health Department. In our case,the flow going into the septic system has remained virtually unchanged with dust a small decrease in flow. Only the source of the flow has changed. Starting in November and ending the first part of January we refinished all three bathrooms in our house to get rid of the 1970 avocado green and harvest gold. We did this to get the house in better shape to sell. During this process all 3 of the 1970's 5 gallon toilets were replaced with new 1.6 gallon toilets. 1 did some research and found a study done by American Water Works Association Research Foundation located at http://www.aquacraft.com/Publications/resident.htm. Out of the 2275 houses in the study,the average number of flushes per person was 5.05 times per day. There were 4 people living in our house so by changing the toilets we saved (5 gallons-1.6 gallons)*5.05*4 people=68.68 gallons of water per day going into the septic system. However,the clothes washing machine was added to our septic system when the dry well was closed up. This same study says the average number of loads of laundry per person per day is .37. According to http://www.energystar.gov the standard washing machine(the type of washing machine we used) uses 40 gallons of water per load. This means we added 40 gallons* .37*4 people= 59.2 gallons per day. So we reduced the overall water going into the system by 68.68-59.2= 9.48 gallons per day. In addition,we also replaced the faucets and shower heads in all the bathroom even further reducing the water going into the septic system. We have accepted on offer on our house. I would like to avoid the cost and paper work of having another Title 5 inspection done. Since the Title 5 for our septic system passed on November 17th 2006 and since we did not add more flow into the system,why are we required to have the 6 month inspection? Sincerely, Nicholas L. Rethman -----Original Message----- From: Nick Rethman [mailto:nrethman@comcast.net] Sent: Friday, April 06, 2007 12:46 PM To: 'Sawyer, Susan' Subject: RE: 6 month Tide 5 reinspection of 146 Raleigh Tavern Lane. We moved out on February 16tH Nick Rethman -----Original Message----- From: Sawyer, Susan [mailto:ssawyer@townofnorthandover.com] Sent: Friday,April 06, 2007 10:57 AM To: Nick Rethman 4/25/2007 Page 4 of 4 Subject: RE: 6 month Tide 5 reinspection of 146 Raleigh Tavern Lane. Can you tell me how long the property has been vacant? Susan Sawyer -----Original Mage----- From: Nick Rethman [mailto:nrethman@comcast.net] Sent: Wednesday,April 04, 2007 9:03 PM To: Sawyer, Susan Cc: nick@clkda.com Subject: 6 month Tide 5 reinspection of 146 Raleigh Tavern Lane. Dear Susan Sawyer: We spoke on Wednesday April 4th about having our 6 month Title 5 reinspection done on or after May 3rd to fulfill the town's 6 month reinspection requirement. 1 am writing this email to get your approval for this. The original inspection was done on November 17,2006. We have an offer on the house and the buyers would like to close on May 18th. Moving the inspection up two weeks from May 17th would greatly aid us in processing the paper need for closing and give us time to resolve any small issues if they occur. If you need to contact me I can be reached during the day at 978-836-0884 or at nick@clkda.com. Thank you, Nicholas L. Rethman 4/25/2007 V%ORTiy Q� t�ec ,6q�0 Q 1A icy 0 va yy� T O COCwAKE 1- A 0 -A0 .IsACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division April 17, 2007 Nick Rethman 146 Raleigh Tavern Lane North Andover, MA 01845 Re: 146 Raleigh Tavern Lane, Title V Inspection ORDER LETTER Dear 1&. Rethman, The Health Department has received your recent letter requesting clarification on the situation regarding the Title V Inspection for the property listed above. In response, Health Department staff has; reviewed the information provided in your email, obtained your current water usage reports and has had professional consultation advice from the Department of Environmental Protection(DEP)Waste Water Division. The end result of the research has unfortunately caused this office to revipe the conditions surrounding this property, causing the required inspection to occur 6 months after the property is reoccupied. The septic system at 146 Raleigh Tavern Lane was initially required to have a second inspection conducted six months after the first inspection. This was due to the fact that the main system had not been receiving regular flow because of a drywell that was taking the washer and sink waste water, not because of the failure criteria in 17.06, as indicated by you. Your letter attempted to substantiate that this request was invalid. In actuality, according to DEP, "310 CMR 15.301(9) gives a Board of Health the authority to require an inspection at.any time! . The fact that this drywell was not shown on any previous plan is a concern and makes it valid;to ask for the inspection. The new problem is that initially the inspection was due to happen in May and this office was under the assumption that the system would have been receiving regular flow. Review of the home's water usage, and information obtained from you, has found that the home has not been occupied and has only been accepting on average 17 gallons a day since your last water reading on February 21, 2007. Your prior water reading found your usage to be at 292 gallons per day on average, which is normal. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com I r i If a Title V Inspection were conducted when there is such a low flow it would not accurately reflect the systems capabilities. I asked Claire Golden, of the DEP, the following question, " Does DEP have a position of this issue of regular flow?"DEP's response was as follows. "MassDEP has consistently advised BOHs to consider requiring another inspection of the septic systems for unoccupied houses six months after occupancy. The unwritten requirement is that the house has six months of (or at least mostly)continual occupancy so that the system can be adequately evaluated. What constitutes regular flow is another matter entirely. I would view that as long as the system is receiving any consistent flow(whether it be one or two people or more), the results of an inspection would at least show how the system is responding." In closing, please be advised that it is important that you advise any potential future owners that the necessity of this inspection is now because of the lack of occupancy of the home in addition to noted issues. This letter is an official Board of Health Order Letter. There must be a Title V Inspection conducted(6)months after the property's system is receiving regular flow. This will be substantiated by water meter readings. The requirement to have an inspection six months after the December 2006 inspection has been replaced with the above requirement. You are no longer responsible to have this done if you sell the property in the mean time. A new homeowner should understand that they are going to be contacted and required to comply with this Order. Thank you for your cooperation in this very important matter of public health. Sincerely, Susan Sawyer,REHS S Public Health Director CC: file 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Bateson Enterprises Inc. Neil Bateson 111 Argilla Road Andover, MA 01810 n g� (978) 475-4786 Invoice Mr. Nick Rethman 146 Raleigh Tavern Lane North Andover MA 01845 Invoice INVOICE# DESCRIPTION WORK DATE AMOUNT PAID 11755 Pump Drywell & Fill With Sand. 12/11/06 400.00 0.00 Invoice Totals: 400.00 Total Paid: 0.00 Total Due: 400.00 r �- FRECEIVED COMMONWEALTH OF MASSACHUSETTS DEC 15 2006 Z EXECUTIVE OFFICE OF ENVIRONMENTAL AIFFAIRS d DEPARTMENT OF ENVIRONMENTAL PRO p PARTME°TSR e� � 1 SV0 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 146 Raleigh Tavern Lane North Andover_ Owner's Name:_Nick Rethman Owner's Address:_146 Raleigh Tavern Lane _North Andover,MA 01845 Date of Inspection:_11/17/2006_ Name of Inspector: Neil J.Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ —Andover,MA 01810 Telephone Number:_(978)4754786_ 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(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ils 1[aInspector's Signature: Date: _11/17/2006_ 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:Title 5 Inspection For Main Septic System. ****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. jj � /Z� Pare 2 of.l l° i- OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_146 Raleigh Tavern Lane- -North Andover— Owner:_Rethman_ Date of Inspection:_11/17/2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: 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.Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain . The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Page 3 of.l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Rethman_ Date of Inspection:11/17/2006_ 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Pad 4 of.11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner: Rethman_ Date of Inspection:_11/17/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: _ No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _No Liquid depth in cesspool is less than 6"below invert or available volume is 1/2 day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No_Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No_ 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 form.] _No_(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 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 _ Interim Wellhead Protection Area— the system is located in a nitrogen sensitive area IWPA ma( )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. Page 5 of 11 ' OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Rethman_ Date of Inspection 11/17/2006_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes _ Pumping information was provided by the owner,occupant,or Board of Health _No_ Were any of the system components pumped out in the previous two weeks? I Yes _ Has the system received normal flows in the previous two week period? No_ Have large volumes of water been introduced to the system recently or as part of this inspection? Yes — Were as built plans of the system obtained and examined? Yes _ Was the facility or dwelling inspected for signs of sewage back up? Yes — Was the site inspected for signs of break out? Yes_ — Were all system components,excluding the SAS,located on site? _Yes_ _ 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 ? _Yes_ _ 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 _Yes_ — Existing information. _Yes_ _ 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)] t 1`4ge 6 of 11. OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_146 Raleigh Tavern Lane_ _North Andover– Owner:_Rethman_ Date of Inspection 11/17/2006_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203_440 Number of currant residents:_5 Does residence have a garbage grinder(yes or no):_Yes_ Is laundry on a separate sewage system(yes or no):_Yes_ Laundry system inspected(yes or no): _Yes_ Seasonal use:(yes or no):_No_ Water meter reading:–Yes– Sump es_Sump pump(yes or no): Yes_ Last date of occupancy:— Current-COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):_gpd 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 meter readings,if available:— Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Pumped last year year,owner Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1000_gallons--How was quantity pumped determined?_Measured tank Reason for pumping: _Inspect tank&tee&baffles_ TYPE OF SYSTEM X 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:_18 years old,4/12/1988 As built plan _ Were sewage odors detected when arriving at the site(yes or no):_No Page 7 of l l i OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Rethman_ Date of Inspection:_11/17/2006_ BUILDING SEWERS_X_ (locate on site plan) Depth below grade:—20"_ Materials of construction: _X_cast iron _X_40 PVC_other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) _4"Cast iron thru wall,3"PVC in house. No leaks visible. SEPTIC TANKS: X Depth below grade:_8"_ Material of construction: X 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: 7'x 5'x 4' Sludge depth —311_ Distance from top of sludge to bottom of outlet tee or baffle:_24"_ Scum thickness:_411 _ Distance from top of scum to top of outlet tee or baffle:- 8"-Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined:_Tape Measure_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc _Pumped septic tank.Inlet baffle ok. Outlet baffle ok.Outlet tee ok. Depth of liquid at outlet invert.No evidence of septic tank leaking._ GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane- - North Andover- Owner:_Rethman_ Date of Inspection: 11/17/2006_ 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/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:_X_ Depth below grade _1811 _ 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.)_D-box level&distribution equal.No evidence of leakage.Evidence of carryover,pumped d-box to clean.D-Boz cover broken,replaced it._ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):— Alarm in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pate 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman_ Date of Inspection: 11/17/2006 SOIL ABSORPTION SYSTEM_(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _ leaching chambers,number:— leaching galleries,number: leaching trenches,number,length: X leaching field,number,dimensions:_1 field 20'x 43'_ 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.):—Soil ok.Vegetation ok.No sign of ponding to surface._ CESSPOOLS: Number and configuration:_ Depth—top of liquid to inlet invert:_ Depth of sludge 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.): Pa�'e 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_146 Raleigh Tavern Lane_ —North Andover— Owner:_Rethman_ Date of Inspection:_11/17/2006_ 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 Driveway House D Garage Laundry Drywell 1 Porch Septic Tank � Ato1 =16'10" A to 2=1918" Bto1=10'9" Bto2=9'3" B to D-Box=36' C to D-Box=35' D-Box D to Drywell=17'8" E to Drywell=2015" I I r Page 11 of 11- OFFICIAL lOFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman_ Date of Inspection:11/17/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_>4'_ Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed:_10/28/1980_ 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: You must describe how you established the high ground water elevation: No water 7'deep.Info from design plan_ Summary Record Card generated on 11/16/2006 2:51:15 PM by Elaine Barclay Page 1 _ Town of North Andover Tax Map # 210-107.A-0017-0000.0 146 RALEIGH TAVERN LANE RETHMAN, NICHOLAS 146 RALEIGH TAVERN LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.04 Acres FY 2007 UB Mailing Index Name/Address Type----, Loan Number Active/Inact. From Until RETHMAN, NICHOLAS Payor 146 RALEIGH TAVERN LANE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14204.0- 146 RALEIGH TAVERN LANE Last Billing Date 9!7/2006 2100198 02 Cycle 02 Active UB Services Maint, Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 130.36 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 16335644 a Active ERT METE METE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 11/1/2006 712 a Actual 31 -12% 8/1/2006 681 a Actual 34 9/13/2006 7% 5/4/2006 647 a Actual 33 6/20/2006 10% 2/1/2006 614 a Actual 30 3/13/2006 -13% 11/11/2005 584 a Actual 34 12/14/2005 -10% 8/2/2005 550 a Actual 38 9/12/2005 23% 5/2/2005 512 a Actual 30 6/8/2005 -3% 2/2/2005 482 a Actual 31 3/15/2005 12% 11/5/2004 451 a Actual 27 12/17/2004 -11% 8/10/2004 424 a Actual 31 9/20/2004 5/13/2004 393 a Actual 30 6/14/2004 38% ��� �� �? � �� fi _r./� !, y e, EI F 1� f f� i rd� � i' �\ 3�, 3c� ', �3 i �� ?� � ,I Gi i �, i i Tel: (978)475-4786 Fax: (978) 475-5451 V BATESON ENTERPRISES, INC. Excavating-Water.&Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 146 Raleigh Tavern Lane, North Andover Owner: Rethman Date of Inspection: 11/17/2006 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. OJ &hz� Neil J. Bateson Bateson Enterprises, Inc. ComMonwealth.of Massachusetts - Cityrfown of System Pumping Record Form 4 DEP has provided this form for use by local Boards-of Health. The System Pumping Record must be submitted to the.focal Board of Health or other approving authority. A. Facility Information Important: When fitting out 1. Syste Locatio t� forms on t he computer.use only the tab key Address to move your Lam. curs —�= Ue-� or- et not Gityfrown State Zi Code use theretum P key. 2. System Owner. �42 t� Name Address(f different from-Location) -CityfTown Statede Telephone Number B. Pum'pin�.:Recaord = l ( -- c=-7� -1. -Date.of Pum_ping Date ._ -cam 22 Quan*Pumped: - GafWs . 3. Type of systeirt: ❑ Cesspool(s) �c Tank- ❑ Tight:Tank Other(describe): 4. Effluent Tee Fite present? ❑ Yes Q-Nc If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of,System- 6. System uraaped By" P: :'Name' �--- Vehide License Number Company . 7ocatio eke t:orfi` posed:; SPgnalu of... ul r Date http:/Iwww.mass gov/dep/wateriappravais/t5fbrms htrn inspect 45fomi4.d6c•0W3 System PyFiap!n9 Record•Page 1 of i i DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, April 18, 2007 3:25 PM To: DelleChiaie, Pamela Subject: RE: 146 R.T. Lane I will email him -----Original Message---- From: DelleChiaie,Pamela Sent: Wednesday,April 18,2007 2:29 PM To: Sawyer,Susan Subject: 146 R.T. Lane Importance: High Hi, Do we have Mr. Rethman's new mailing address? $¢8!R¢guvd8, Patiy¢Ba Del'l�¢G�lfiai¢Q Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover,MA o1845 2978.688.9540-Phone A 978.688.8476-Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com 1 7 VF�F A � o , . w r! _ Y cs e ,I DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, April 10, 2007 11:41 AM To: Sawyer, Susan; Grant, Michele Subject: 146 Raleigh Tavern Lane Importance: High Buyer: Lauren Klib nsk - 61 8.15680 Aost Regwldg, L PAiw e'a D¢G'�aG�ltiwi¢Q Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover,MA o1845 ' 978.688.9540-Phone A 978.688.8476-Fax http://www.townofnortha-ndover.com healthdept@townofnorthandover.com i 1 Ota y�NO Town of North Andover '�•-o;-;p;. HEALTH DEPARTMENT 1ysACNUSf,< r CHECK#: LOCATION: H/O NAME: +� NAME: + CONTRACTOR Type of Permit or License:(Check box) 0 Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ I ❑ Food Service-Type. $ ❑ Funeral Directors $ I ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ i ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ I ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title Inspector $ F�Title 5 Report $ i ❑ Other. (Indicate) $ I , 2035 Health Agent Initials I White-Applicant Yellow-Health Pink-Treasurer o: Page 1 of 2 Sawyer, Susan From: Sawyer, Susan Sent: Tuesday,April 10,20071:41 PM To: 'Nick Rethman' Subject: RE: 6 month Title 5 reinspection of 146 Raleigh Tavern Lane. Mr. Rethman, I just wanted to let you know I have received your inquiry and will be responding in uniting as soon as possible. Susan Sawyer -----Original Message----- From: Nick Rethman [mailto:nrethman@comcast.net] Sent: Monday,April 09, 2007 9:39 PM To: Sawyer, Susan Cc: nick@clkda.com Subject: RE: 6 month Title 5 reinspection of 146 Raleigh Tavern Lane. Dear Susan Sawyer: I have read over the North Andover Septic Regulations and 1 am not clear why we need a second Title 5 inspection 6 months after the one we had on November 17th,2006 at 146 Raleigh Tavern Lane. The regulation that I think is requiring this inspection is in Part F item 17.06. The copy of the regulations that I have is as follows 17.06 Any septic system that conditionally passes a Title 5 inspection due to a component failure,which has resulted in the leaching area having not received usual effluent flow, is required to have a second inspection conducted 6 months later. A MA licensed septic inspector must conduct this inspection and a proper report must be submitted to the Health Department. In our case,the flow going into the septic system has remained virtually unchanged with just a small decrease in flow. Only the source of the flow has changed. Starting in November and ending the first part of January we refinished all three bathrooms in our house to get rid of the 1970 avocado green and harvest gold. We did this to get the house in better shape to sell. During this process all 3 of the 1970's 5 gallon toilets were replaced with new 1.6 gallon toilets. I did some research and found a study done by American Water Works Association Research Foundation located at ,hftp://www.a2275 Out of the 2275 houses in the study, the average number of flushes per person was 5.05 times per day. There were 4 people living in our house so by changing the toilets we saved (5 gallons-1.6 gallons)*5.05*4 people=68.68 gallons of water per day going into the septic system. However,the clothes washing machine was added to our septic system when the dry well was closed up. This same study says the average number of loads of laundry per person per day is .37. According to hftp://www.energystar.gov the standard washing machine(the type of washing machine we used) uses 40 gallons of water per load. This means we added 40 gallons* .37*4 people=59.2 gallons per day. So we reduced the overall water going into the systems by 68.68-59.2= 9.48 gallons per day. In addition,we also replaced the faucets and shower heads in all the bathrooms even further reducing the water going into the septic system. We have accepted on offer on our house. I would like to avoid the cost and paper work of having another Title 5 inspection done. Since the Title 5 for our septic system passed on November 17th 2006 and since we did not add more flow into the system,why are we required to have the 6 month inspection? Sincerely, Nicholas L. Rethman -----Original Message----- 4/10/2007 Page 2 of 2 From: Nick Rethman [mailto:nrethman@comcast.net] Sent: Friday,April 06, 2007 12:46 PM To: 'Sawyer, Susan' Subject: RE: 6 month Tile 5 reinspection of 146 Raleigh Tavern Lane. We moved out on February 16th. Nick Rethman -----Original Message----- From: Sawyer, Susan [mailto:ssawyer@townofnorthandover.com] Sent: Friday, April 06, 2007 10:57 AM To: Nick Rethman Subject: RE: 6 month Title 5 reinspection of 146 Raleigh Tavern Lane. Can you tell me how long the property has been vacant? Susan Sawyer -----Original Message----- From: Nick Rethman [mailto:nrethman@comcast.net] Sent: Wednesday,April 04, 2007 9:03 PM To: Sawyer, Susan Cc: nick@clkda.com Subject: 6 month Title 5 reinspection of 146 Raleigh Tavern Lane. Dear Susan Sawyer: We spoke on Wednesday April 4th about having our 6 month Title 5 re-inspection done on or after May 3`d to fulfill the town's 6 month re-inspection requirement. I am writing this email to get your approval for this. The original inspection was done on November 17, 2006. We have an offer on the house and the buyers would like to close on May 18th. Moving the inspection up two weeks from May 17th would greatly aid us in processing the paper need for closing and give us time to resolve any small issues if they occur. If you need to contact me I can be reached during the day at 978-836-0884 or at nick@clkda.com. Thank you, Nicholas L. Rethman i I 4/10/2007 r10RTp 0 (,-ZD 06'9 ® 6 O in O'j, cocm-g2K y1. �.INS ACHU`���'t� PUBLIC HEALTH DEPARTMENT Community Development Division April 17, 2007 Nick Rethman 146 Raleigh Tavern Lane North Andover,MA 01845 Re: 146 Raleigh Tavern Lane, Title V Inspection ORDER LETTER Dear Mr. Rethman, The Health Department has received your recent letter requesting clarification on the situation regarding the Title V Inspection for the property listed above. In response, Health Department staff has; reviewed the information provided in your email„ obtained your current water usage reports and has had professional consultation advice from the Department of Environmental Protection(DEP)Waste Water Division. The end result of the research has unfortunately caused this office to revise the conditions surrounding this property, causing the required inspection to occur 6 months after the property is reoccupied. The septic system at 146 Raleigh Tavern Lane was initially required to have a second inspection conducted six months after the first inspection. This was due to the fact that the main system had not been receiving regular flow because of a drywell that was taking the washer and sink waste water, not because of the failure criteria in 17.06, as indicated by you. Your letter attempted to substantiate that this request was invalid. In actuality, according to DEP,."310 CMR 15.301(9) gives a Board of Health the authority to require an inspection at any time,. The fact that this drywell was not shown on any previous plan is a concern and makes it valid to ask for the inspection. The new problem is that initially the inspection was due to happen in May and this office was under the assumption that the system would have been receiving regular flow. Review of the home's water usage, and information obtained from you, has found that the home has not been occupied and has only been accepting on average 17 gallons a day since your last water reading on February 21, 2007. Your prior water reading found your usage to be at 292 gallons per day on average,which is normal. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com q:r If a Title V Inspection were conducted when there is such a low flow it would not accurately reflect the systems capabilities. I asked Claire Golden, of the DEP, the following question, " Does DEP have a position of this issue of regular flow?"DEP's response was as follows. "MassDEP has consistently advised BOHs to consider requiring another inspection of the septic systems for unoccupied houses six months after occupancy. The unwritten requirement is that the house has six months of (or at least mostly)continual occupancy so that the system can be adequately evaluated. What constitutes regular flow is another matter entirely. I would view that as long as the system is receiving any consistent flow(whether it be one or two people or more), the results of an inspection would at least show how the system is responding." In closing, please be advised that it is important that you advise any potential future owners that the necessity of this inspection is now because of the lack of occupancy of the home in addition to noted issues. This letter is an official Board of Health Order Letter. There must be a Title V Inspection conducted(6)months after the property's system is receiving regular flow. This will be substantiated by water meter readings. The requirement to have an inspection six months after the December 2006 inspection has been replaced with the above requirement. You are no longer responsible to have this done if you sell the property in the mean time. A new homeowner should understand that they are going to be contacted and required to comply with this Order. Thank you for your cooperation in this very important matter of public health. Sincerely, Susan Sawyer,RENS S Public Health Director CC: file 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com RECEIVED COMMONWEALTH OF MASSACHUSETTS 'e. EXECUTIVE OFFICE OF ENVIRONMENTAL AF AIRPEC 15 2006 Z d DEPARTMENT OF ENVIRONMENTAL PROT NORTH ANDOVER r W F C Oji_ JeV TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_146 Raleigh Tavern Lane North Andover_ Owner's Name:_Nick Rethman Owner's Address:_146 Raleigh Tavern Lane _North Andover,MA 01845_ Date of Inspection:11/172006_ Name of Inspector: Neil J.Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,MA 01810 Telephone Number:j 978)4754786_ 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 X Fa' Inspector's Signature: �---Date: _11/17/2006_ 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:Title 5 Inspection For Washer &Cellar Sink Drywell. ****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 gyp) OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman_ Date of Inspection:_11/17/2006_ 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: 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.Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Page 3 of 11 Y OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman_ Date of Inspection 11/17/2006_ 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 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 I 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_146 Raleigh Tavern]Lane_ _North Andover— Owner:_Rethman_ Date of Inspection:_11/17/2006_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: _Yes_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _Yes_ _ Liquid depth in cesspool is less than 6"below invert or available volume is'/z day flow. —No— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ No_Any portion of the SAS,cesspool or privy is below high ground water elevation. No Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No_ 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 form.] _Yes_(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 now of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. i Page 5 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Rethman_ Date of Inspection: 11/17/2006_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes _ Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes_ ` Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? N/A _ Were as built plans of the system obtained and examined? Yes _ Was the facility or dwelling inspected for signs of sewage back up? Yes Was the site inspected for signs of break out? Yes_ _ Were all system components,excluding the SAS,located on site? _Yes_ _ 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? _Yes_ _ 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 _N/A_ _ Existing information. _Yes_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_146 Raleigh Tavern Lane_ _North Andover– Owner:_Rethman_ Date of Inspection'11/17/2006_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_ Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203_ Number of current residents:_5_ Does residence have a garbage grinder(yes or no):— Is laundry on a separate sewage system(yes or no):_Yes_ Laundry system inspected(yes or no): _Yes_ Seasonal use:(yes or no):_ Water meter reading: Yes Sump pump(yes or no):_ Last date of occupancy:_ COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):_gpd 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 meter readings,if available:— Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Pumped last title 5 inspection_ Was system pumped as part of the inspection(yes or no): No_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _X 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:_Unknown _ Were sewage odors detected when arriving at the site(yes or no):_No_ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Rethman_ Date of Inspection 11/17/2006_ BUILDING SEWERS_X_ (locate on site plan) Depth below grade:_24"_ Materials of construction: _cast iron _X_40 PVC other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) _1.5"PVC thru wall to drywell._ SEPTIC TANKS: Depth below grade:_ Material of construction:_concrete—metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions:_ Sludge depth Distance from top of sludge to bottom of outlet tee or baffle: 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:— How were dimensions determined:_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc _ GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 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:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Rethman_ Date of Inspection: 11/17/2006_ 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 Tpolyethylene 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:_ Depth below grade _ 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.):._ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):_ Alarm in working order(yes or no):— Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman_ Date of Inspection:11/17/2006_ 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: leaching trenches,number,length: leaching field,number,dimensions:— 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.): CESSPOOLS: X Washer Machine&Cellar Sink Number and configuration:_1_ Depth—top of liquid to inlet invert:_Liquid above inlet pipe 8"_ Depth of sludge layer:—0 — Depth of scum layer:—0 Dimensions of cesspool:_3'x 3'x 2' Materials of construction: _Cinder blocks with cement cap_ Indication of groundwater inflow(yes or no):—NO— Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):_Soil around drywell ok.Liquid level above inlet pipe.Sign of hydraulic failure._ 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.): Page 10 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Rethman_ Date of Inspection:11/17/2006_ 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 Driveway D Garage House Laundry Drywell Porch D to Drywell=17'8" E to Drywell=20'5" • Page 11 of 11 J OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman_ Date of Inspection:_11/17/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_>4'_ Please indicate(check)all methods used to determine the high ground water elevation: _X_ Obtained from system design plans on record-If checked,date of design plan reviewed:_10/28/1980_ 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: _ You must describe how you established the high ground water elevation: No water 7'deep.Info from design plan for main septic system_ Summary Record Card generated on 11116/2006 2:51:15 PM by Elaine Barclay Page 1 Town of North Andover Tax Map # 2'10-107.A-0017-0000.0 146 RALEIGH TAVERN LANE RETHMAN, NICHOLAS 146 RALEIGH TAVERN LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.04 Acres FY 2007 US Mailing Index Name/Address Type-- Loan Number Active/Inact. From Until RETHMAN, NICHOLAS Payor 146 RALEIGH TAVERN LANE NORTH ANDOVER, MA 01845 US Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14204.0- 146 RALEIGH TAVERN LANE Last Billing Date 9/7/2006 2100198 02 Cycle 02 Active US Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 130.36 /1 US Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 16335644 a Active ERT METE METE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 11/1/2006 712 a Actual 31 -12% 8/1/2006 681 a Actual 34 9/13/2006 7% 5/4/2006 647 a Actual 33 6/20/2006 10% 2/1/2006 614 a Actual 30 3/13/2006 -13% 11/1/2005 584 a Actual 34 12/14/2005 -10% 8/2/2005 550 a Actual 38 9/12/2005 23% 5/2/2005 512 a Actual 30 6/8/2005 -3% 2/2/2005 482 a Actual 31 3/15/2005 12% 11/512004 451 a Actual 27 12/17/2004 -11% 8/10/2004 424 a Actual 31 9/20/2004 5/13/2004 393 a Actual 30 6/14/2004 38% DelleChiaie, Pamela Subject: Title 5 Follow-up Location: 146 Raleigh Tavern Lane Start: Thu 5/17/2007 12:00 AM End: Fri 5/18/2007 12:00 AM i Show Time As: Free I Recurrence: (none) i Importance: High F-up with Neil Bateson. Owner notified that system would need an inspection from 6 months of 11/17/06. Was a conditional pass, then passed. i 1 RE: Title V inspections Page 2 of 2 There is no simple way of explaining the situation but I will try. A Title V Insp.was conducted on a single family home on 11/17/06-A dry well found servicing the washer,was determined to be in failure but the main system was not. The drywell was abandoned and tied into the main system. Because of this, it was determined that there was not regular flow in that system at the time of inspection, so N.Andover required a 2nd inspection in six months. The problem is that now we have been informed that the home has been vacated since February 17th, and there has not been regular flow to the system since Feb.and it will be vacant the remaining 3 months. The age old question of what to do if there has been no flow. If there is not regular flow,the town of North Andover's policy is to ask for another inspection in six months.In this case however,this would actually end up being a requirement of having a reinspection done six months after it is reoccupied or in this case, if sold,6 months after the sale. We think this is good protection for our new homeowners. However... 1)Are towns allowed to require this of homeowners even though not specifically stated under Title V? 2)Does DEP have a position on this issue of regular flow? 3) Do you have a professional opinion regarding how long a house could be vacant, but still get a Title V that shows regular flow? Any other thoughts on this?I would be happy to fill in any questions. Feel free to call me. Thanks Susan Sawyer 978 688-9540 4/10/2007 RE: Title V inspections Page 1 of 2 i Sawyer, Susan From: Golden, Claire(DEP) [Claire.Golden@state.ma.us] Sent: Tuesday,April 10,20071:32 PM To: Sawyer, Susan Subject: RE:Title V inspections Hi Susan, The first question I would ask relative to the connection of the washer to the septic system is whether there was a COC in the file with design flow, etc. or if this was a pre-1978 system with inadequate files? If the CoC exists, fine,if not,there may be a problem. Let's drop that one for now. I MassDEP has consistently advised BOHs to consider requiring another inspection of the septic systems for r unoccu is that the house has six months of . The unwritten requirement 'ed houses six months after occupancy. P continual(or at least mostly)continual occupancy so that the system can be adequately evaluated. What constitutes regular flow is another matter entirely. 1 would view that as long as the system is receiving any consistent flow(whether it be one or two people or more),the results of an inspection would at least show how the system is responding. In answers to your questions: 1)310 CMR 15.301(9)gives a BOH the authority to require an inspection at any time. MassDEP advises that the BOH, under the circumstances discussed in your e-mail, may want to document that its the unoccupancy of the home that's necessitating the future inspection. By letting the buyer and seller know the BOH is not springing this requirement on the new owner. 2) As previously discussed any flow to a system may1 be considered regular. We all know of 5 bedroom homes where only two people live there year-round. The term can be very subjective. 3) Some inspectors have attempted to simulate regular flow to a system serving a vacant house by having the tap running continually at a rate of about 330 gpd for a three-bedroom house. This is a difficult thing to regulate and truly quantify. In addition,few,if any,three-bedroom homes actually discharge 330 gpd. This is NOT required or recommended by Title 5 or MassDEP. MassDEP has received complaints about such inspectors but based on the facts associated with that particular case, MassDEP found that the inspector had not violated Title 5. I hope this helps. Claire t From: Sawyer,Susan [mailto:ssawyer(cbtownofnorthandover.com] Sent: Tuesday,April 10,2007 12:21 PM To: Claire Golden (E-mail) Subject:Title V inspections Claire, I have a Title V question. 4/10/2007 DelleChiaie, Pamela Subject: Title 5 Follow-up Location: 146 Raleigh Tavern Lane Start: Thu 5/17/2007 12:00 AM End: Fri 5/18/2007 12:00 AM Show Time As: Tentative Recurrence: (none) Meeting Status: Not yet responded Required Attendees: Sawyer, Susan Importance: High F-up with Neil Bateson. Owner notified that system would need an inspection from 6 months of 11/17/06. Was a conditional pass, then pas 4/4/07- Nick Rothman of 146 R.T. Lane called. They want to put their house on the market. Has questions about wh exactly is involved in the inspection required. He met with you in December of 2006, and spoke with you via phone. The inspection had to do with the water flow. Please call him to clarify: 978.836.0884. Neil Bateson will be doing the inspection. I will leave file in your inbox.--p.d. G r��� �'�1 s� !tel- h✓L- � 0 ../' 1 �,G Y 1 �C..G.../ XV t_- 'r_"Z5� e- lis �I V� M > , fio-/ �. f ` COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS x d DEPARTMENT OF ENVIRONMENTAL PROTECTIO � See TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_146 Raleigh Tavern Lane North Andover_ Owner's Name:_Nick Rethman Owner's Address:_146 Raleigh Tavern Lane _North Andover,MA 01845_ zQ0s Date of Inspection:11/17/2006_ � �5 Name of Inspector: Neil J.Bateson— TOWN OF NORTH AN ANT Company Name: Bateson Enterprises Inc._ HEALTH DEPART^ __ - Mailing Address:_111 Argilla Road_ _Andover,MA 01810_ Telephone Number:_(978)475-4786_ 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: X Passes _X_ Conditionally Passes Needs Further Evaluation by the Local Approving Authority F ' Inspector's Signature: Date: _11/17/2006_ 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. ' t ' Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Rethman_ Date of Inspection:_11/17/2006_ Inspection Summary: Check A B,C,D or E/ALWAYS complete an 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: B. System Conditionally Passes: X 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.Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain.Laundry&Sink needs tied into septic system N 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. ND explain: N 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 obstruction is removed distribution box is leveled or replaced ND explain: N 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 obstruction is removed ND explain: • Page 3 of l l , OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman Date of Inspection_11/17/2006_ 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman_ Date of Inspection:_11/17/2006_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: _ No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6"below invert or available volume is'/2 day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ No Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No_ 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 form.] No (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 1Td- You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Rethman_ Date of Inspection:_11/17/2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes_ _ Pumping information was provided by the owner,occupant,or Board of Health _No Were any of the system components pumped out in the previous two weeks? Yes_ _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes_ _ Were as built plans of the system obtained and examined? _Yes , Was the facility or dwelling inspected for signs of sewage back up? Yes_ _ Was the site inspected for signs of break out? _Yes _ Were all system components,excluding the SAS,located on site? _Yes_ _ 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? _Yes_ _ 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 _Yes_ _ Existing information. _Yes_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_146 Raleigh Tavern Lane_ _North Andover– Owner:_Rethman_ Date of Inspection:11/17/2006_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203_440_ Number of current residents:_5 Does residence have a garbage grinder(yes or no): Yes_ Is laundry on a separate sewage system(yes or no): Yes_ Laundry system inspected(yes or no): _Yes,goes to drywell that is in failure_ Seasonal use:(yes or no):_No Water meter reading: Yes_ Sump pump(yes or no): Yes_ Last date of occupancy:_Current_ COMMERCIAIA NDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):,gpd Basis of design flow(seats/persons/sqft,ete.): 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): GENERAL INFORMATION Pumping Records Source of information:_Pumped last year year,owner Was system pumped as part of the inspection(yes or no) Yes_ If yes,volume pumped:_1000_gallons--How was quantity pumped determined?_Measured tank_ Reason for pumping: _Inspect tank&tee&baffles_ TYPE OF SYSTEM X 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:_18 years old,4/12/1988 As built plan _ Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover_ Owner:_Rethman_ Date of Inspection:11/17/2006 BUH,DING SEWERS_X_ (locate on site plan) Depth below grade:_20"_ Materials of construction: _X_cast iron _X 40 PVC other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) _4"Cast iron thru wall,3"PVC in house. No leaks visible. SEPTIC TANKS: X Depth below grade:_8"_ Material of construction: X 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: 7'x 5'x 4' Sludge depth3"_ Distance from top of sludge to bottom of outlet tee or baffle: 24"_ Scum thickness:_4" Distance from top of scum to top of outlet tee or baffle:_8" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined:_Tape Measure_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc Pumped septic tank.Inlet bate ok.Outlet bate ok.Outlet tee ok. Depth of liquid at outlet invert.No evidence of septic tank leaking._ GREASE TRAP:_(locate on site plan) Depth below grade:— Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane- - North Andover— Owner:_Rethman_ Date of Inspection: 11/17/2006_ 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/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: Depth below grade _18"— 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.):_D-box level&distribution equal.No evidence of leakage.Evidence of carryover,pumped d-box to clean.D-Box cover broken,replaced it._ PUMP CHAMBER: (locate on site plan) Pump in working order(yes or no):_ Alarm in working order(yes or no):— Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman_ Date of Inspection:_11/17/2006_ SOIL ABSORPTION SYSTEM(SAS): R (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: X leaching field,number,dimensions:—1 field 20'x 431 _ overflow cesspool,number: innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil oL Vegetation oL No sign of ponding to surface._ CESSPOOLS: Number and configuration:_ Depth—top of liquid to inlet invert:— Depth of sludge 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.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman_ Date of Inspection:11/17/2006 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 Driveway House D Garage Laundry Drywell 1 Porch Septic Tan ® Ato1=16'10" A to 2=19'8" Bto1=10'9" Bto2=9'3" B to D-Boz=36' C to D-Boz=35' D-Boz D to Drywell=17'8" E to Drywell=2015" Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_146 Raleigh Tavern Lane_ _North Andover— Owner:_Rethman_ Date of Inspection: 11/17/2006_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_>4'_ Please indicate(check)all methods used to determine the high ground water elevation: _X Obtained from system design plans on record-If checked,date of design plan reviewed:_10/28/1980 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: _ You must describe how you established the high ground water elevation: No water 7'deep.Info from design plan_ Commonwealth.of Massachusetts City/Town of System Pumping Record w� Form 4 DEP has provided this form for use by local Boards!of Health..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. Syste LOcatio (� comps the computer,use only the tab key Address /� to move your C-5 cursor-do not City/Town State use the�retum Zip Code key- .21. System Owner Name Address(if different from-focationj . Cityfrown State e Telephone Number B. Pumping Record D 1_ ate of Pum mein - 2. u g Date Q anttty Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ".0-S-eept'ic Tank ❑ Tight Tank ❑ Other(d'escribe).: 4: Effluent Toe Filter present? ❑ Yes Q-fdtr'- If yes, was it cleaned? El Yes ❑ No 5. Condition of System* 6: System unaped By Name �--�' Vehicle icense Number Company !. 7 Locatio here cole',- Signatu of. ul r D_ a_to http://Www.mass:gov/dephmaterlapprovals/t5forms h"nspect t5fomp4.doc-06/03 System Purrpp►rlg Record•Page 9 of 1 Summary Record Card generated on 11/16/2006 2:51:15 PM by Elaine Barclay Page 1 Town of North Andover Tax Map # 210-107.A-0017-0000.0 146 RALEIGH TAVERN LANE RETHMAN, NICHOLAS 146 RALEIGH TAVERN LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.04 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number Active/inact. From Until RETHMAN, NICHOLAS Payor 146 RALEIGH TAVERN LANE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14204.0- 146 RALEIGH TAVERN LANE Last Billing Date 9/7/2006 2100198 02 Cycle 02 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 130.36 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 16335644 a Active ERT METE METE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 11/1/2006 712 a Actual 31 -12% 8/1/2006 681 a Actual 34 9/13/2006 7% 5/4/2006 647 a Actual 33 6/20/2006 10% 2/1/2006 614 a Actual 30 3/13/2006 -13% 11/1/2005 584 a Actual 34 12/14/2005 -10°/u- 8/2/2005 550 a Actual 38 9/12/2005 230/7." 5/2/2005 512 a Actual 30 6/8/2005 -3 2/2/2005 482 a Actual 31 3/15/2005 12% 11/5/2004 451 aActual 27 12/17/2004 -11% 8/10/2004 424 a Actual 31 9/20/2004 5/13/2004 393 a Actual 30 6/14/2004 38% � f Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems &Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 146 Raleigh Tavern Lane, North Andover Owner: Rethman Date of Inspection: 11/17/2006 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. Septic System Information ' 146 RALEIGH TAVERN LANE Printed On: Thursday,December 07, 2 System ID: BHS-2002-1257 General System Information Latest Permit Information Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity: Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder: Yes No Soil Type: Depth: Laundry: No No Inspections: Inspected: Expires: Inspector: Status: 11/17/2006 Neil J. Bateson Conditionally Passes Comments: Title 5 r 0 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 Commonwealth.of Massachusetts City/Town of.l System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. 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 the computteo r,use � only the tab key Address to move your �T IAL cursor-do not v use the return City/Town State Zip Code key. 2. System.Owner Name D Address(if different from location) DE , Cityfrown Stat .:pRT NO de . PA Tel ep ne Number .B. Pumping Record l ( -� f 1. Date.of Pumping Date 2. Ouantity Pumped: Gallons .3. Type of system:- ❑ Cesspools) .[ ep c Tank- ❑ Tight.Tank ❑ other(describe) 4: Effluent dee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes: ❑ No 6. Condition of.system- System Furqped By. ^1 i Name 7 Vehicle License Number Company 7. Locatio here conteQts�ivec posed:eN : r� Signatii of ui r Date http://www.mass.gov/dep%water/approvalstt5forms.htnn#inspect t5fonn4.doc•06103 System Pumping Record•Page 1 of 1 Commonwealth.of Massachusetts City/Town of \\\Jl System Pumping Record RECEIVED Form 4 DEP has provided this form for use by local Boards of Health. he Sn1Phj Record must be submitted to the local Board of Health or other approving au hority. - TOWN OF NORTH ANDOVER A. Facility Information - Important: When ruing out 1. System LocaUoa- forms on the \�/�` `a <G computer,use only the tab key Address to move your �• � ��� cursor-do not use thCity/Town rZip Code e�retum State key. 2. System Owner: Name Address(if different from location). CitylrownState Zip Code Telephone Number B. Pu'rnping Record 1.. Date.of Pumping 2: Quantity Pumped: Date Gallons . I Type of system ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank �Otfier-_(describiay 4. Effluent Tee Filter present? ❑ Yes ❑. No-. If yes, was it cleaned? ❑ Yes`❑ No 5. Conditio f Ss y fem:' -cam c;�.� 6: System P mped By` Name Vehicle Incense Number C:ompa Y 7. L.ocatio5,wh6r nte VtsWere "s sed:: Sign ur € uler Date hftp://www.mass.gov/dep/"water/approvalt/t5forms.htm#inspect t5fortn4.doc•06103 _ System Pumping Record•Page 1 of 1 I@ � ,��9 �, ;�� ��� 1�4 P, COMMONINTEALTH OF MASSACH'U'SETTS.;. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS jVz A DEPARTMENT OF ENV.IRONMENTA OTECTiON, t ONE WINTER STREET. BOSTON. NIA 02108 617-29-1-5500 FEB 2 5 1993 WILLIAM!F.WELD TRUDY COXE Governor Secretary ARGEO PAUL CELLUCCIDAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM "'""" . Commissioner PART A CERTIFIC�IA'TICI Property Address. Date of Inspection: � -;«"- (If different) Name of Inspector: 1 am a D pr ed system ins or ursuant to Se ion - 340 of Title 5 (310 CMR 15.000) Company Name: c ` P Y . Mailing Address: t U 1 91 0 116 10 Telephone Number: CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported beloity it true accurate and complete'as of the time of inspection. The inspection was performed based on my training and expenerice in the proper fuhi ibh and maintenance of on-site sewwaagee disposal systems. The system: r t,-Passes -Conditionally Passes N s urther valuation By the Local Approving Authority F 0- Inspector's Signature: Date• The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of tompleting this inspection. If the system is a shared system or has a design flow of iO,000 god:or greater, the inspector and the system bwner shall submit the report to the appropriate regional office of the Department of Envieonrri6tai Protection. The original should be Sent to the"systerri owner and copies sent to the buyer, if applicable, and the approving authofity. INSPECTION SUMMARY: Check A, B, C; or D' A) SYSTEM P S: I have not found any information which indicates that the system violates any of the failure criteria as defined th 310 CMR 5.303:. Any failure criteria not evaluated are indicated below. COMMENTS: t� F B) SYSTEM CONDITIONALLY PASSES: A.- One or more system components as described in the "Conditional Pass"section need to be eplaeedo .►epaiW'. The$yst4i*,upon completion of the replacement or repair, as approved by the Board of Health,will pass.'. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of McRninaiion in all instances If 4hot deterrrtmed (sScplain why hot. _ The septic tank is metal, unless the owner or iypeiator has provided the system_inspedor With a copy 6f a Certificate of Compliance (attached) indicating that the tank was installed Withi i twenty i20)years pride to the date'of the inspection; or, the septic tank, whether or not metal, is cracked, struddri ally unsoiihJ,,#how's Wbttantial infiltrattott 6r exfiltiattion,or tank . . failure is imminent. The system will pass inspection if the clotting septic Sank is replaced Vvith a i orifortrttng Septic tank as approved by the Board of Health. (rwisod 04%25/97) $a$ii 1 ! 10 DEP on the World Wide Web: http:/hvww inagriet:rti t-hff s.uttidep Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: L —4 o�� Q''`-`'i A Date of Inspection: Q.- `9 —"`e5 6) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a,broken, settled or uneven distribution box. The system will pass inspection if(with Approval of the Board of Health): Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipets): The system irvill pass inspection if(with approval of the Board of Health): broken pipes) are replaced obstruction is removed ; 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 0 the system is failing to bf6tiict the public health, safety and the environment. a., 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT TME SYSTEM IS NOT FUNCTIONING IN A MAiVNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 oir a salt marsh: # s 2 SYSTEM WILL FAIL UNLESS THE BOARD-OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES tk,AT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND-THE , ENVIRONMENT: e z t The system has a septic tank and soil absorption system (SAS7 and the.SAS is Within 100 feet to a siirface`watef stjpply of tributary to a surface water supply. The system has a septic tank and 'soil akfsorptiori systerh and tiie SAS Is.vi�dFtin a tone 1 of pput3fic water supppp�`wellf _ The system has a septic tank and "soil abisorption system and the SA5 within 50 feet of a Fivate water su i vieil The system has a septic tank and 'soil absotptioh system and the SA5 it iess than i0d feet biA Sb feet or more from a ria and irotatile o `"fiic comm" ifrtds"indicates That " well w' er Arial tis for ooltform baste rBa po unless a e at � private water supply well YS the well is free from pollution from that facility and the presence of arnmortia nittoget and nithdte fiitrogen iS+aqua)to or. less than 5 ppm. Method used to determine distance (aPpfrofrirnafion rwt"valid) fir# `}, 3) OTHER :., (rrvi*id.04/45/97) Digi '2 of ,10 ' ,. F. 'Tp ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) , t •Property Address: Owner: 1 �1� Date of Inspection:a \q—qE3 D) SYSTEM FAILS: You must indicate either "Yes" or"No" as to each of the following: 1 have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what Will be necessary:to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS of cesspool;. " + Discharge or ponding of effluent to the surface of the ground or surface waters due to an b`v6rloaded or clogged SAS or cesspool. — — Static liquid level in the distribution box above outlet invert due to ars overloaded or clogged SAS or cesspool a Liquid depth in cesspool is less than 6"below invert or available volurrne is less than, 1/2 day flow'. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water suptsly Any portion of a cesspool or privy is within a Zone,I of a public well.. Any portion of a cesspool or privy is within 50 feel of a private wate�tsupply well. :•-7 Any portion of a cesspool or privy it less than 100 feet butgreater than 50 feet from a I"Ovate, iwater rsupply401 with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well.water as for. coliform bactefia, volatile organic compounds, ammonia nitrogen and nitfate hiocigen: Q LARGE SYSTEM FAILS: K t S You must indicate either "Yes" or "No" as to each of the f6ilowing: The following criteria apply to large systems in addition to the,criteria above: The system serves a facility with a design flow of 10,000 gpd of greater(Large System) and the system (3 a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No _ the system is within 400 feet of a surface drinking water supply 4 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)r r a Fnapped Zone 1(of a public water supply well) The owner or operator of any such system shall bring the system and facility into full corrtplWice with the groundwater treatment program . requirements of 314 CMR 5.00 and 6.00. Please consult the local.regibnal office of the.DepattmLnt f'f,f(irthd�infomtattoh (revis*d 04/2S/97) Pigra 3 di 30 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'PART 6 CHECKLIST ` a f ' Property Address: Owner: 1 Date of Inspection: Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following: Yes _ Pumping information was provided by the owner, occupant, or 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. t/ _ 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 bath-tip. t _ The system does not receive non-sanitary or industrial wasie flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System; 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;depih of liquid,depth of sludge;depth of scum The size and location of the Soil Absorption System on the site has been determined based on: " �_✓//�✓✓/ _ The facility owner (and occupants, if different from,owrier) were provided With information on the proper maintenance of _. H Sub-Surface Disposal System. Existing information.Ex. Plan at B.O.H. Determined in the field (if any of the failure critena.ielated to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)J •« �,r a 4j i c i } �� (:evirid 0{/23/§!) 1'h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: ��� ��C `r \��IJ�� �• 1`�©'�"�v` `1`-��.�J Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: e. /bedroom for S.A.S. Number of bedrooms: Number of current residents: s Garbage grinder (yes or no): S nn r n : t"v S'�J C=J1 m o Laundryected to s e s o rn ) Seasonal use (yes or no):-l(7 n t D(,S� �6 Water meter readings, if available (last two (2)year usage (gpd): / c Sump Pump (yes or no): S ` 1 jys a�/�65LC Last date of occupancy: Q�^ 3 + 5S3 - 2RV J COMMER C I.ALA N D USTRI AL: Type of establishment: Design flow: Rallons/day Grease trap present: lyes 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 orcupanc•: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: ` a ��, System pumped as part of inspection: (yes or no) �S If yes, volume pum t Ilons x Reason for pumping: �V\s TYPE OF TEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy }: , Shared system (yes or no) (if yes,attach previous inspection tecords; if any) VA Technology etc. Copy of up to date contract( 4 ., Other . .. .. ' APPRO (MATE AGE of all components, elate installed (if known)and source of information: --•� �_ • ;,`..¢« i Vi Sewage odors detected when arriving at the site: (yes or no) (r*vired 04/2S/97) ?846 § of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address: lQ V4C(�-QA Owner: Date of Inspection: BUILDING SEINER: (Locate on site plan) Depth below grader Material of constru ion: has iron _40 PVC _other a pljin) k 1 O L4 Cos vi Distance from%ivate water supply well or suction linE Diameter y Comments: (condition of joints, venting, evidence of leakage, etc.) r., SEPTIC TANK:..t/ (locate on site plan) tt Depth below grade: ` ti n. _. metal Fiberglasslass _Polyethylene material f oustrus _.co �crete _other(explain) ,,. Is age confirmed b Certificate of Compliances(Yes/No) . :n list age y If tank is meta s g ,. to g ! r- ! r 4� u Dimensions: V Sludge depth: 'r tee or baffle- to bottom of outlet f Di E nce from to asludge s0 P Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bo om of Qutti tt a or baffle: ,a , 1 How dimensions were determined: vb�` "`�— SCV��'� ��U Ho d me Comments: (recommendation for pumping, conditi of inletAnd tle' ees or ffles, o�ttho���-f liquid I"vot i relay n t outlet i Eructural ( integrity, vides e I akag e v ' /c� i. �'. RFQP: rA AA 1L�5E � I r (locate on site plan) Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene ._other(explain) Dimensions: : Scum thickness: Distance from top of scum to top of outlet"tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles;depth of liquid level in'Wation to outlet iitveit,strudural integrity, evidence of leakage, etc.) r (revised 04/25/97) Pigi i b 10 . t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION (continued) 1n Property Address: (0 �� a�v� v� l I`1• � v " p Owner: Date of Inspection: TIGHT OR HOLDING TANK: Vl"��(Tank must be pumped prior to, or 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 level: Alarm in working order_ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) i. DISTRIBUTION BOX: y; (locate on site plan) Depth of liquid level above outlet invert: G) Comments: (note if le I an4 Oistriution is equal, evidence of solids carry ve" "dece f leakage into or out cs n at4 ca� Q t " h.�- vr PUMP CHAMBER: �Q \aAX (locate on site plan) C v Pumps in working order: (Yes or No) " a Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) �r s (rwii*d 04/2S/97) Paq `) b! 10 " + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: '�^ l 121t— Cr SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation-not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number. leaching trenches, number,length:_ ` t ' r I leaching fields, number, dimensions: 1� "c'� �C e-, T3 overflow cesspool, number:. Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: .i Depth of scum layer: ` Dimensions of cesspool: ' k 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, etc) � . y., 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) (roviaed 04/25/97) Pagi d bf id SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C s SYSTEM INFORMATION (continued) Property Address: ( 4C, Owner: �� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Glace -0 vi c- ® l (revised o4/25/97) Pati 9 of 10 ,>< l x t; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C S SYSTEM INFORMATION (continued) Property Address:® `L4 � Owner: Date of Inspection: Depth to Groundwater Feet 71ea7seindite all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Obervation of Site (Abuttingin8 ProPertY observation hole, basement nt sum etc.) ) G� Det'ermine it from local conditions `-- Check with local Board of health Check FEMA Maps Check pumping records Checklocal excavators, installers Use USGS Data Describe in your own words how You established th¢ High Groundwater Elevation, (int be completed) a_ k h: 1 (revised 04/25/97) Peg* 30 of 10 x • S- 7�L: (50$) 01.1474 FAX: (508) 475.5451 BATESON ENTERPRISES; I N y Excavating=Water&Sewer lines Septic§Oteni8&F UMPIA9 Setvice . 111 Argtlla Road v Andover, Massa 0 a1 0 Title 5 Irispectibn Rep6 t l Property Ad--drresee - ---�-- - owners --------------=-- -----------_ Date Of inspection: ---1---��---- i k R tp My report coritairied herein does not bonatituta =a guaeafite+a " k. of future usage and the fiinCtii�nality bf -therxietih� t dept.# `'�iErk, x fir`# "' y 7: syr, b {� .•QQ,,���y r •. a o-�k�.�t`'�r�'�rr;t�4 surd t `�s_w.. syetemt Such report 1,§auoA herewithis observations> and f hereby disbiaim ahy turth6rj�speratioi� _ of your Current heptle aystettts ex tit{,�,k 1 vo k Y, Naif._.►i ;a'ateabri' °' d iJat6d6A 9tlter0 • r $ *�-��. 'St,�� �., f�$s '`, s r €:: *. � �- wk� ;.fur r ': x � N j ..r� S'. ti,k+^a •, aa� r�4tr s 'i "_} v4 '�7'-,�t�l�l�k4d���jti+"� 'yFy, . 2 �.�`, v i,,, ,�,r iw i.. rt � y»�'& �€..Y r����+ '''gip.• 3 yrs commonwealth of Massachusetts Executive office of Environmental Affail-'s ®�NO�'go e� Department of 2� \995. Environmental Protection Nab William F.Weld Gowmor Trudy Coxe See,e Y EDEA David S.Struhs commissioner - _ CTION FORM SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE PART A j CERTIFICATI �` Property Address: `� � � N ' Address of o%t neri Date of Inspection: �t\ «--� (If different) . Name of Inspector: �)J( A . Company Name, Address and Telephone Number: CERTIFICATION STATEMENT V 1 certify that 1 have personally inspected the sewage d sposal system at this address a 'ti-sit the information reported below i3 true, accurate and complete as of the time of inspection. The inspection was performed based on my t-aining and experience in the proper function and maintenance of on-site sewaa posal systems. The system: _ Passes S _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority F iI Inspector's Signature: _ Date: � The System Inspector shall submit a py of this inspection report to the Approving Authority within thirty(30) days of completing this inspection. If the system is a shared system or has a design flow of 10,OOo gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,.if app:icabi-e and the approving authority. INSPECTION SUMMARY: Check A, B,C; or D: AJ SYSTEM P I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below: B) SYSTEM CONDITIONALLY PASSES: One�or more system components need to be replaced or repaired. The s)-tem., upon completion of the replacement or repair, passes.inspection. Describe basis of determination in aft instances. If"not determined', explain why not) Indicate yes, no, or not determined (Y, N, or Nb). _ The septic tank is metal, cracked, structurally unsound, show's substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank ss replaced with a conforming septic tank as approved by the Board of Health. (revised 0/15/95) One Winter Street a Boston,Massachusetts 02108 a FAX(617)5564049 4 Telephone(617)292-SM Printed m R CVCW Paas SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Date of Inspection: BI SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstruct ed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box id levvllod or replaced _ The system required pumping more than four times a yeai due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pi e s are replacedlaced obstruction is removed Cj FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:' Conditions erctst which require further evaluation by the Board of Health in order to determine if the system is failing to protect the . public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within So feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD Of HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT . THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to A surface water supply or tributary to a surface water supply. _ soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than t00 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. O) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. I Backup of sewage into facility or system component due to an overloaded•or clogged SAS or cesspool I — I Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS.or cesspool. 2 ` Izeviaed 8/15/95) r • SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART A CERTIFICAT ONN (continued) Property Address: (0 Owner: Date of Inspection: DI SYSTEM FAILS(continued):• `� _ Static liquid level in the distribution box above outlet invert due to an merloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year Vj M due to cloyed or obstructed pipels). Number of limes pumped Any portion of the So.l Absorption System, cesspool or privy is be high groundwater elevation. _ Any portion of a cesspool or privy is within 100 feet of a surface A3ter Upply 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 weer a.rpply 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. If it's well Jim bray; h ali#od to Int ocrvPtable, Attach coon of well water Tinalywit (at coliform bacteria, volatile organic compounds, ammonia nitrogen and r.crate nidogen. Ej LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria abo.e: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exi-cL- the system is within 400 feet of a surface drinking water supph 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 Wellheac Prcr_xtion Area (IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such sysrem shall bring the system and facility into ful' cor--o':ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of:^e D--oartment for further information. I (revised 8/15/95) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: � �" Check if the following have been done; Pumping information was requested of the owner, occupant, and Board of Health. _LNone of the system components have been pumped for at least two weeks and the system has been receiving normal (low rates during that period. Large .a'umes of water have not been introduced into the system recently or as part of this inspection. n ' plans have been obtained and examined. Note it they are not available with N/A. Te facility or dwelling was inspected for signs of sewage back-up. —_Zhe stem does not reee" non•sanitary or industrial waste flow _ was inspected for signs of breakout. C/AII sys components, exduding the Soil Absorption System, have been located on the site. 1 — he septic tank manholes Mere uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or 1 sludge,depth of scum. �hesize terial of construction, dimensions, depth of liquid, depth o s g., p and location of the Soil Absorption System on the site has been determined based on-existing information or �aximated by non-intrusne methods. if different from owner) were provided with information on the proper maintenance of Sub- _The facility owner (and occupynts, Surface Disposal System. .4 (revised 6/15/9s) f • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM�INFORMATION Y Pro ert Address: 'Q(p P _ Owner: W. �Q�n,v� ���Ce Date of Inspection: I FLOW CONDITIONS RESIDENTIAL B Desi n flow: Q II ns Number of bedrooms: `"1 11 '' Number of current residents:L4 natbagn stinde r(yes or no):V—U � / Laundry connected to sy em (yes or no)ko- Seasonal use (yes or no): o WA`�n Water meter readings, if available: f�/ A Last date of occupancy: COMMERCIAUINDUST RIAL: Type of establishment: Design now:._____gallons/day Grease trap present, (yes or no)— Indut♦trial Waste Holding Tank present: lyes or no)_ Non-sanitary waste discharged to the Tltld 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: H4_A_6�QSystem pumped as part of inspection: (yes or no) If yes, volume pumped: � al ons 1 , Reason for pumping: V\-O h t TYPE OF YSTEM 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) m onents date installed (if known)and source of information! - QHS A?IN PPROXIMATE GE of all co p � �Q�Ok Sewage odors detected when arriving at the site: (yes or no)Lo (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address. l Owner: `�.I . C2 Date of Inspection: t Q SEPTIC TANK:_(, pocate on site plan) G` f► 1 C_ Depth below grade. Material of construction: T oncrete _metal _FRP—other(explain) Dimenalo Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 3 rt 6 r 1 Distance from top of scurn to top of outlet tee y baffle: �a It Distance from bottom of scum to bottom of o,-ret tee or baffle: Comments: (recommendation for pumping, cond of in and outt�t t s r baffle , dept of liquid le el in rel 'on t inve truuetur al legrity evi ence of leakage, etc. _ �� f G EASE P• (locate on site plan VS�C- Depth below grade: Material of construction: _concrete _metal _FRP—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 octet tee or baffle: Comments: (recommendation for pumping, condition of it et and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/15/95) 6 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: I Y 0 Owner: Date of Inspection: TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: _concrete —metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: Rallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) � r / DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note it level d d' trib tion i equal, evidence of oli carryo r, evidence o1 le , ge into or ut of box, etc.) x �l chi u o A g�A kAv .PUMP CHAMBER-W&P—IC016 ( 'S {S`0`A (locate on site plan) \ v Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 9/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,C SYSTEM INFORMATION (contin ed) Property Address: Owner: Date of Inspection: r _ SOIL ABSORPTION SYSTEM (SAS)._ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) if not determined to be present, explain: Type: leaching pits, number:! leaching chambers, number._ leaching galleries, number: leaching trenches, nurnber,length: leaching fields, number, dimensions: c —t overflow cesspool, number: Wments: (note onditign,of soil igns of by raulic (ai e, I ( of p ding, conditi f veget ion etc.) r• CESSPOOLS: VXDV� (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, etc.) PRIVY: `L (locate on site plan) Dimensions: Materials of construction: . Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 9/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Dale of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within IW ArAo 1-7 S DEPTH TO GROUNDWATER Depth to groundwater:_Teets method of determination or approximation: ©� Irevised 8/15/951 9 TOWN OF SYSTEM PUMPING RECON ;;of t4 oGi- , DATE: SYSTEM OWNER& ADDRESS SYSTEM—LOCAyTION-_--- 41vvuxv'� (example:left front of hoose) -� 0-A ku<'-c- DATE OF PUMPING: `O`{ QUANTITY PUMPED : GALLONS CESSPOOL: NO YES -----7/SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACIFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED To: G.L.S.D Lowell Waste Conunonw alth of Massachusetts �"uz(Massachusetts System Pumping Record System Owner System Location Date of Pumping: 7—" --��� Quantity Pumped: CC- gallons Cesspool: No (.T Yes Septic Tank: No Yes System Pumped by: &Wea Sid&mA4i e4 License# Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector' f' FORM 4 - SYSTEM PL1Q'L\G RECORD oJ� Commomvealth of Massachusetts Massachusetts ®Q�o0- system Pumping Record }stem Owner N-stem Location Date of Pumping if ` ( Quantity Pumped: Cesspool: No ,1�1' Yes ❑ Sentir Tnnl•• t��r, � Yes S%stem Pumped by.- License #: Contents transferred to: �• ' Date Inspector CORM 4- SYSTEM I'LNII'L\G RECOIW Cotttntonivealth of Alassachusetls J��I Massachusetts �2 6 Skin P ff 7 ill Ileco i E. ys eni miel "stem ocat on Date of Pumping l �� Quantity Pumped: Cesspool: No ,1�!" ties ❑ Seniir Tanl X1- Yes CC�� System Pumped by- ---T - License #: Contents transferred to: Date Inspector N Commonwealth of Massachusetts RECEN ® NM f City/Town of AUG 13 200 System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTMENT 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 Location: forms on the computer,use only the tab key Address ) ` to move your t cursor-do not CityfTow n State Zip Code use the return key. 2 System Owner: YQ vto Name AA Address(if different from location) Cityrrown State ip Code Telephone Number B. Pumping Record 1. Date of Pumping Date r`C 2. Quantity Pumped: Gallons� 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No ' S. Conditi n of System: � 6. System Pumped By: ------ Vehicle —Vehicle License Number Compa 7. Locatio re pontent re I osed: Signat a of 7er Date t5form4.doc^06/03 System Pumping Record^Page 1 of 1 �LN Commonwealth of Massachusetts City/Town of System Pumping Record EiEALTH Form 4DEP has provided this form for use by local Boards of Health. Other forsQc 911 theinformation must be substantially the same as that provided here. Befoorm, check w h your local Board of Health to determine the form they use. The System PumfiMtt fitted to the local Board of Health or other approving authority. PARTMENT A. Facility Information . _ 1. System Location: Left front of house, right front of house, left side of house, right side of house Left —::) ear o house ht rear of house, left side of building, right rear of building, under deck. City/Town State Zip Code 2. System Owner: 'eco t-VI d Name Address(if different from location) i City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping , 1'( 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) [S/Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Lo i here contents were disposed: G.L.& Lowell Waste Water Signature of Hauler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 I i I Commonwealth of Massachusetts City/Town of System Pumping Record 1 QIti�N OP'NORTH ANDOVeR ME:AL1'H Deje ARTMENT ` Form 4 M V 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 1. System Location: Left/Right front of housera Rig er of house ft Left/right side of house, Le / Right side of building, Left/Right front of bui Ing, Left'/Might rear of building, Under deck AddressI Lf �� AIv r Cityrrown t (O State (/`/ Zip Code 2. System Owner. Name Address(if different from location) City/Town State �� `C� Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 2--No If yes,was it cleaned? ❑ Yes ❑ No 5. Conditiop of SysteJ 6. System Pumped By: Neil Bateson F5821 Name .Vehicle License Number Bateson Enterprises Inc Company 7. Loere contents were disposed:. Lowell Waste Water ule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1