HomeMy WebLinkAboutMiscellaneous - 153 MILL ROAD 4/30/2018 (2) -- —153-MILL-ROAD Pond Condos
210/107.0-0080-0000.0
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET,BOSTON MA 02108 (617)292-5500
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B. STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
_CERTIFICATION
Property Address:153 Mill'Road,N.Andover Name of OwnerHenry Bodenrader
Address of Owner 153 Mill Road_N.Andover
Dace of Inspection:3/26/2000
Name of Inspector:(per priro Jonathan Markey
1 em a DEP approved system Inspector pursuant to Section 15.340 of ride 5(310 CMR 15.000). .
Company Name: jonathan Markey
Maing Address: 17 Highland Terr.N Andover,MA 01845
Telephone Number: (508)3 95-7710
CER iRCATkm STATEMENT
1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in,the proper function and
maintenance of on-site sewage disposal systems. The system:
x Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fai
baspectors Signature: Date: 3/26/2000
The System inspector shall submit a copy of is inspection report to the Approving Authority(Board of Health or DEP)whhin thirty(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 Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
No as-built plans available at BOH.Inspection of the system reveals no D-box present,therefore excavation of the leaching_
facicity for inspection has been executed.Inspectionof the leaching facility meets no failure criteria,See page 9 for details on
leaching facility inspection.
APf �nr9�
revised
98 9/2/98 Page t of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Noperty Address: 153 Mill Road,N.Andover
)wrier: He Bodenrader
''-'Daft of Iropection: 3/26/2000
INSPECTION SUMMARY: Cho* A, 8, C, a Q
A. SYSTEM PASSES:
Yes I have not found any information which indicates that any of the failure conditions described.in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
IL 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.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined',explain why not.
The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of .
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection:or
the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.. .
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).
broken pipe(s)are replaced
V obstruction is removed
distribution box is levelled or replaced
_ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pips(s)are replaced
obstruction is removed
revised 9/2/98 Page 2of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(contenued)
Property Address: 153 Mill Road,,N.Andover.
Owner: .Henry Bodenrader
Date of Inspection: 3/26/2000
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 fairing to protect the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES N ACCORDANCE WITH 310 CMR 15.303(1 Nb)THAT THE SYSTEM
IS NOT RNCTIONNG IN A MANNER WHM WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of surface water -
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
I'
21 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 AND SAFETY AND THE 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 3011 absorption system and the SAS is within a Zone 1 of a public water supply well.
_ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well..
The system has a septic tank and soil absorption system and the SAS Is less than 100 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. Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 Page 3oftt
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Ply Ate: 153 Mill Road,N.Andover
Owner: Henry Bodenrader..
Dam of Inspection: 3/26/2000
D. SYSTEM FAILS:
You must indicate either"Yes"or"No" to each of the following:
I have determined that one or more of the following failure'conditions exist as described 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 or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool'.
_ Liquid depth in cesspool Is less than 6"below invert or available volume is less than 112 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 Sol!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 supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any onion of a cesspool or privy is within 50 feet of a private water supply well.
_
Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
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:
The system serves a facility with a design flow of 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 exist:
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 was(Interim Wellhead Protection Area-1WPAl or_a mapped Zone 11 of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 ragc4oru
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
praimly Address=153 Mill Road,N.Andover.
owner: Henry Bodenradei
Date of Inspection,3/26/2000
Check if the following have been done:You must indicate either"Yes"or"No" as to each of the following:
Xs. No
X _ Pumping information was provided by the owner,occupant,or Board of Health.
X _ None of the system components have been pumped for at leasttwo weeks and the system has been^rece)ving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
N/A_ As bulk plans have been obtained and examined. Note if they are not available with N/A.
X _ The facility or dwelling was inspected for signs of sewage back-up.
x _ The system does not receive non-sanitary or industrial waste flow..
X _ The site was inspected for signs of breakout.
X All system components,excluding the Sod Absorption System,have been located on the site.
X _ The septic tank manholes were uncovered,.opened,and the interior of the septic tank was inspected for condition of baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
X Existing information.For example,Plan at B.O.H.
•1 X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
I15.302(3)(b)1
x The facility owner(and occupants,N different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
I
J
revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Ply Address:153 Mill Road,NAndover
Owner: Henry Bodenrader
--
Data of Inspecdan: 3/26/2000
FLOW CONDITIONS
RESIDENML:
Design floZ710 g.p.d.l6edroom.
Number of bedrooms(design):_. Number of bedrooms(actual):5
Total DESIGN flow
Number of current residents:3
Garbage grinder(yes or no):��
Laundry(separate system) (yes or no):No; if yes,separate inspection required
Laundry system inspected (yes or no)
Seasonal use(yes or no):No
Water meter readings,if available(last two year's usage(gpd): N/A -
Sump Pump lyes or no):No
Last date of occupancy: ent
COMMERCIALANDUSTRWL
Type of establishment:
Design flow: gud (Based on 15.203)
Basis of design flow
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:
OTHER:(Describe!
Last date of occupancy:
GENERAL INFORMATION
AJMPING RECORDS and source of information:
According to owner system pumped 26 mos.prior to inspection.No records at BOH.
System pumped as part of Inspection:(yes or no)
If yes,volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM .
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
1/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other Single Septic Tank with single leaching line.No distribution box found.
System is 21 ears old.. Owner's records.
APPROXIMATE AGE of all components,date installed(if known)and source of information. .Y� Y
Sewage odors detected when arriving at the site:(yes or no)NO
-
revised 9/2/98 Page6of 11
• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address•153 Mill Road,N.Andover
Owner:.Henry.Bodenrader
,.� Date of Inspection:3/26/2000 .
BUILDING SEWER:
(Locate on site plan)
Depth below grade:21
Material of construction:.X cast iron 40 PVC_other(explain)
Distance from private water supply well or suction line NIA
Diameter 4
Comments:(condition of joints,venting, evidence of leakage,etc.)
Interior plumbing not visible at foundation outlet(behmd wall).Exits through foundation wall.Vented through roof stack.Visible
portions ot plumbing s ow no water staining or evidence ot leakage.
SEPTIC TANK.
(locate on site plan)
Depth below grade:14"
Material of construction:X concrete_metal_Fiberglass _Polyethylene—other(explain)
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions:101 x TW x 4'effective depth(I500ga1)
Sludge depth:3R 1�,�
Distance from top of sludge to bottom of outlet tee or baffler
Scum thickness: g��
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:26"
How dimensions were determined: Tape Measure
Comments:•
(recommendation for pumping condition f inlet and outlet tees or baffles,depth of ligpid level in relation to outlet invert,stzuctu►al'nt ty,
evidence of leakage,etc.) Inlet and out�e cast in place concrete tees in good working order.No leakage into or out o tank.YanK
appears to be structurally soun .Liquid levelin tan k is at outlet invert elevation.Pumping is not re uired at this time.
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:.
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level In relation to outlet invert,structural integrity,
evidence of leakage,etc.)
revised 9/2/98 Pap 7oftt
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continu eA.
Property Address:153 Mill Road,N.Andover.
Owner: Henry Boderuader
L Date of fnapeetion: 3/26/2000
TIGHT OR HOLDING TANK:N/A (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 present
Alarm level: Alarm in working order:Yes_ No_
Date of previous pumping:
Comments:
(condition of inlet tea,condition of alarm and float switches,etc.)
DISTRIBUTION Box:N/A
(locate on site plan)
Depth of liquid level above outlet Invert:
I
Comments:
1(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
PUMP CHAMBER.N/A
(locate on site plan)
Pumps in working order:(Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
revised 9/2/98 PageYiOf11
I
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM
PART C
SYSTEM 11NFORMATION(continued)
property Addrea j53 Mill Road,N.Andover
Owner. Henry Bodenrader
Date of :3/26/2000
SOIL ABSORPTION SYSTEM(SAS):X
(locate on site plan,if possible;excavation not required,location may he approximated by non-intrusive methods)
If not located,explain:
Type: .
leaching pits,number:_
leaching chambers,number._
leaching galleries,number:
leaching trenches,number,length:single>25'
leaching fields,number,.dimensions:
overflow cesspool,number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil,siggns of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
Area over leaching facilmy consistent with remainder of yard.No s1 s of pondig or sewage odors.Inspection of leaching facilit_ iy
`showed no c oggmg,Hydrogen sultide crus Mg or hydraulic tailure-Anobservation it3__ eep placed next to leaching faciclity
showed no group(lewa er. I neiengtn oot the rreenclii is not Known.It was tollowed tor 2Y ataep-Tit of 3.4deep,
CESSPOOLS-_WA
(locate on she 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.) .
IyY.N/A
pR
(locate on she plan)
Materials of construction: Dimensions:
Depth of solids
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc.)
revised 9/2/98 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM
PART C
SYSTEM INFORMATION(eordnued)
Property Addresr153 Mill Road,N.Andover
Owner: Henry Bodenrader
" Date of hmpecoon:3/26/2000
NRCS Report name
Soil Type
Typical depth to groundwater
USGS Date website visited 3/26/20.00
Observation Wells checked Andover
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope No slope over field,3:1 150'from SAS
Surface water >350'from SAS.SAS about 35'higher than water level.
Check Cellar No evidence of water staining,no sum um
g PP .P
Shallow wells
Estimated Depth to Groundwater 12 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
Yes Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
Yes Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
The groundwater level was taken from the website'http://ma.water.usgs.gov/current—cond.Abutting towns report observation well
data as folows..Andover- 16.02'(water below surface datum).Haverhill-12.39'(water below surface.datum).The latter value was
used to estimate the high groundwater elevation.A 5'deep observation hole was excavated with no groundwater encountered.
revised 9/2/98 Page uof11
� YEQNO
Fo
TOWN OF NORTH ANDOVER /*
SYSTEM PUMPING RECORD ®v
'. 9 X00/
DATE:t
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
153 ;1J
DATE OF PUMPING: QUANTITY PUMPED GALLONS
i
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY: S
COMMENTS:
CONTENTS TRANSFERRED TO: • L -�
Commonwealth of Massachusetts RECIW ®
City/Town of APR 2 3 2008
System Pumping Record
,rForm 4 TOWN OF NORTH ANDOVER
5HEALTH 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. SySt2111 Location:
' forms on the
computer,use
only the tab key Address --� Nil
to move your �
cursor-do not
use the return CRylTown State Zip Code
key. 2. System Owner:
v l�
Name
ISI Address(if different from location)
City/Town Stat �� 47
Code
Code
Telephone Number `� vim%
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes E3-iq-o— If yes,was it cleaned? ❑ Yes ❑ No
5. Conditi n of System w1A� �
6. SystePu �
Name Vehicle License Number
Company
7. Location ere content re d' sed:
Sign re olTulir Date
t5form4.doc•06/03 System Pumping Record.Page 1 of 1
Commonwealth of Massachusetts
W City/Town of R� ®
System Pumping Record APR ?b W1
Form 4
4�M s TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. Other form T
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 front of house, right front of house, left side of ho a ri ht side �house, ft
rear of house, right rear of house, left side of building, right rear of building, under ec .
City/Town State Zip Code
2. System Owner: (�
Name
Address(if different from location)
City/Town S" r de
Telephone Number
B. Pumping Record
1. Date of Pumping Date ntity Pumped: Gallons
3. Type of system: ElCesspool(s) ;�SSZptiucTank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
i
6. System Pumped By:
Neil J. Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc.
Company
7. Local here contents were disposed:
G.L.S.D. 10well Waste WaW
40U
Signat e H uler Date
06/03 System Pumping Record•Page 1 of 1
TOWN OF
SYSTEM PUMPING RECORD
DATE: -12- 6� NaV 2 6 2G�3
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example:left front of house)
J
DATE OF PUMPING: QUANTITY PUMPED : GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTBER(EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
i
CONTENTS TRANSFERRED TO: G.L.S.Dj Lowell Waste