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HomeMy WebLinkAboutMiscellaneous - 17 FULLER ROAD 4/30/2018 (2) / 17 FULLER ROAD - f 210/065.0.0075-0000.0 AJ2's_ 1- �!g- � MI: Title of File Page g of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes, action Document/ document/ filum• Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department F rt A l T • '� � i � 4 .. _ I �� = h Re : oi ;_ Ansnrntton Se,uage Disposal . .;tem s t � Op -It oucti n materials of said + � t r,catlon a�mp air �,, c triad {n .!T plans and j . PC t ,at '_{. Il.. - ^�---' s CK/, ani Ae, '" r,. _ _...�Y�' ---1-1987 t Board 4f Realth BEPTIC SISTYX North An(j:q�Vg.1Kaas. INSTALLATICCI CHECK LI 3T LOT 114 FuLl,w- C)VFD DATE , DI PRUM AVATIC�i OK FAIL A easnnsl G'��,� , 1.9�t39�E z7isy�s-mac_ FAILOK 1. Dis ce To j a. Wetlands b. Drains - c. Well D1-Y LjELL •s a 2. ,Tater Line Location �s i fit. Septic Tank a. _Tess !.--Length & To Clean Ont Covers. . t' b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amaunt8 c. No Back Flow 6. Leach Field or Trench + a. Dimensions b. Stone Depth c. Capped lids d. Clean Double Washed Stone' i 7. Leach Pits a. Dimensremp6th s b. Ston c. Sp sh Pads d. s e. Cement Pipe to Pit - Both Sides. - ' Clean Double Washed Stone 8. No Garbage Disposal ' 9. -Final Grading Inspection e let, 10. Barricading Covered System .11. As Built Submitted. a. Lot Loca.tion b. Dimensions of System c. Location with Regard_to Perc Test d. Elevations u,.jq t e: Water Table s Boar°d of 4ealth North Avidover,Hass SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT, ' / .kPPRonm DATE y3 N DISAPPROVED DATE Provided: Reasons: -746 V itle V FAIL. Me ,eg 2.5 The submitted plan must show as a minimums ) the lot to be served-area,dimensions lot #,abutters location and log deep observation hoes-distance to ties location and results percolation tests-distance to ties design calculations & calculations showing required leaching area location and dimensions of system-including reserve area . existing and proposed contours g) location any wet areas within 1001 of sewage disposal system or • disclaimer-check Wetlands mapping h) surface and subsurface drains within loot of sewage disposal system or disclaimer i location any drainage easements within 1001 of sesage disposal system or disclaimer-Planning Board files (3) kno-n sources of nater, supply within 200+ of swage disposal >' system or disclaimer location of any proposed well to serve lot-loot from leaching' facility P� location of water lines on property-l0� from leaching facility mW" location of benchmark fdriveways garbage disposals no PVC to be used in construction q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations r maadmum ground water elevation in area sewage disposal system plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic. Tanks (a) capacity-1 % of flow, Water tables tees, depth of tees, ' access, pumping cleanout lot from cellar wall or inground swimming pool d) 25+ from subsurface drains .eg 10.2. Distribution Boxes ( slope greater 0.08 eg 10.4 b) sump SubsurAce Design Check List Pae 2' ` FAIL OK Leaching Pits Leaching pits are preferred where the installation is possible Reg 11.2 a) calculations of leac area-minimum 500 eq ft 11.1 b) spacing 11.10 c surface a 2% 11.11 n cover mate al e 2,x2Ix4n lash pad f tee a elbow g) no ds in pipe from d-box to pipe LeachingFields Reg 15.1 no greater an 20 minutes/inch area-mint= goo sq ft 15•� construction of field X5.8 surface drainage 2 % 3.7 e) 201 from cellar wall or inground swimdng pool Leachin �rmches -- Reg 111.1 a c c ons o eaching area-min 500 eq ft 111.3 b spacing-4 ft 6 ft with reserve beteg 14.4 c dimensio 14.6 d) cans on 111.7 e) sto 1.1 .10 f) surface drainage 2% Downhill Slo e slope�=(tto be shote -5z b y/x X 150 = (to be shownn s Reg 9.1 a) app Val, 9.6 b) d-by power FLYNN Assoc. P. C. CIVIL, SANITARY and CONSTRUCTION ENGINEERS P.O. Box 569 Plaistow, New Hampshire 03865 Tel. (617)686-3559 September 7 , 1982 Board of Health 120 Main Street North Andover, Mass . 01815 Re : Lot X11 Fuller Road Gentlemen : Enclosed for your records are three (3) copies of a plan entitled "Plan Showing Subsurface Sewerage Disposal System and Roof Brain Seepage Pit As—Builts" dated September 7 , 1982 for the referenced site . Please schedule the site inspection as soon as possible . Thank you for your continued cooperation in this matter. Sincerely , FLYNN ASSOCi6haboo , PC A1fre . E . President A A S : n f TOWN OF t•t't e 'AI€%iO ERS BOArm H Commonweafth of Massachusetts Im 101997 Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Trudy Coxe covemor Secretary Argeo Paul Cellued David B.Struhs U.G"mor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A mm ` ,C`,ERT'I`FI_CATION Property Address: f t'V'1Q�' til'�O�L� W(n(-A-►\ A\V\&UQA_Address of Owner. Date of Inspection: 0 W (If different) Name of Inspector. Q_ 5 0.� ov-\ Company Name,Address and Telephone Number. BATESON ENTERPRISES, INC. TEL(508)475-1474 Excavating-Water&Sewer Lines-Septic Systems&PumpingService FAX:(508)475-5451 CERTIFICATION STATEMENT 111 Argilla Road Andover,Mass.01810 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewpge disposal systems. The system: wsasses Conditionallv Passes Neads Fttfthbr Evaluation By the I+osal Approvin$r Authority _ F ' Inspector's Signature: � Date: The System Inspector shall submit a copy 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 10,000 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. f INSPECTION SUMMARY: Check A, B, or D: A) SYS PASSES: 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 system,upon completion of the replacement or repair, passes inspection. 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,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 ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108. a FAX(617)SSS-1049 6 Telephone(611)292-&wo tis Printed on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: t11 7V, 12,E �C NQ�4 4AA-&uai�- Owner. Date of Inspection: (� 15—a--� H - V 9 'B]SYSTEM CONDITIONALLY PASS(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): broken pipe(#)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 pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replased obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which further evaluation b the Board of Health in order to determine if the m is failing to protect the �9� y system g 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 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 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. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. 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 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 leas than 5 ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: VI V V '�� VI� k�o Owner. ^ (� ! ©� Bate at inspeetfont �y QV1 D] SYSTEM FAILS: a4'_ -I 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. 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 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 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 supply. 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 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. r E] LARGE SYSTEM FAILS: The following criteria apply to large sy>tems 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: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 ; i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addeeex Owner. Date of Iaapeotion: Check if th�7u�m ve been done: formation was requested of the owner, occupant, and Board of Health. Atone of the systam eampononta have been pumped for at least two weeks and the system has been receiving normal flow rat" dt period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _As built have been obtained and examined. Note if they are not available with N/A. L1119.:�m or dwelling was inspected for signs of sewage back-up. he does not receive non-sanitary or industrial waste flow _The ' was inspected for signs of breakout. _ All 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, rial of construction,dimensions, depth of liquid,depth of sludge,depth of scum. _Thand location of the Soil Absorption System on the site has been determined based on existing information or LIZapp ted by non-intrusive methods. facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. e (revised 11/03/95) 4 I ' t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �� ��� 0(04� fir'k�ujw Owner. Date of Inspection: 15c:�4 J FLOW CONDITIONS RESIDENTIAL_• Design flow:_ ons Number of bedrooms:1 UU Number of current residents: T Garbage grinder(yes or no): NO Laundry connected to system(yes or no)A46 Seasonal use(yea or no): 3 qcll /a Water meter readings, if available: 5 Do yC0 X S = tiJ 3 �bZS r _ cZ�S + `'al Abp K 1.8 = g = g W t 9 s, 2a U = g13 Ja L46ti Ma. cLv Last date of occupancy:6QVMk.N _COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow.,-----gallons/day Grease trap present: (yes or no)_ Industrial Waste Bolding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, iT available: Leat date of occupancy;_ OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: o f _0wyv-. - System pumped as part of inspection: (yes or no*C:S If yes,volume pumped: t a ns Reason for pumping: h_�`�tU — TYPE O�TEM !/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) AP rr PROXIMATE AGE of all components, date installed(if known)and source of information: ©(j Sewage odors detected when arriving at the site: (yes or no) Uv (revised 11/03/95) 6 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 11.0x- Owner. D f Hate of Inspeetiont SEPTIC TANK- (locate ANK(locate on site plan) Depth below grade: a Material of constriction:_concrete_metal_FRP—other(explain) Dimensions: 1 ' X Sludge depth: �' V fir Distance from top of sludge to bottom of outlet tee or baffle:C> Scum thic)mess: 9 r' f r Distance from top of scum to top of outlet tee or baffle- 6 Distance from bottom of scum to bottom of outlet tee or baffle: L Comments: (recommendation for pumpcondition ndition o inlet and ou let tee or baffles,, depth If li 'd level in Q tion to out in ructural integrity, evidence of 1 etc.) c G GREASE TRAP440"z (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP—other(explain) Dimensions: Scum thicimess: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: P 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 11/03/95) s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: � L real- � V�CJ� �Y`��-����J�it� Owner. ,—\�.,Xb'_v Date of Inspection: TIGHT OR HOLDING TANK�1C7V1Q (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP—other(explain) Dimensions: capacity cellons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if le 1 an dist; utio is equal,evidence of solids carryover,eviden of leakage into oryut 0AM I � CU F C Gt v U PUMP CBAMBER.�AD�AQ (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 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: I� PQ Atk&ua'c Owner. n, Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,if possfi)le;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: leaching fields, number,dimensions: overflow cesspool, number: Comments: (note r�onditjpn_o�oii�jgns of hydraulic failp , 1 0(p�nU��nditiq�n of vegeta 'on,et UcZc tJ � l OBJ 1,� CESSPOOLS:WX\Q_ (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: Mow(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:3LXCh9-- (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.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFOOR�MfA�TION(cont ed) Property Address: �� �� L hex- N Owner. . Sp(- O V\P- Date of Inspection: '���11_T (`\� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' co I v ��( z, T A wicl( Z-Q�= aW q ��G� o m Q) �z ao-\,UCaV-,- 3 = a3 , y5 DEPTH TO GROUNDWATER Depth to groundwater:_ feet �^ - method of determination or approximation: 0—s, �j V-, (revised 11/03/95) 9