HomeMy WebLinkAboutMiscellaneous - 179 HAY MEADOW ROAD 4/30/2018 (2)N
Board of 5ealth By�MC SISTER
Nort - An ver Maas. INSTALLATICK CHECK LIST
APPROVED DATh DI PZUPF.D
eascnst
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OK
V/
LOT
1. Distance Tot
a. Wetlands
b. Drains
c. Well
2. Water Line Location
3. No PVC Pipe
h. Septic Tank
a.. -Tees -_Length & To Clean Out Cowers_
b. Cement Pipe to Tank Cn Both Sides of Tank
stribution Box
5. Ili
a. Covers & Box - No Cracks
b. All Lines Flowing Equal Amounts
c. No Back Floss
6,.. Leach Field or Trench
a. Dimensions
b. Stone Depth
c. Capped ids
d. Clean Double washed Stone
7. Leach . ' s
a. sions
b. no Depth
c. lash Pads
d. e8s
e. Cement Pipe to Pit - Both Sides.
f. Clean Double Washed Stone
8. No Garbage Disposal
9. .71nal Grading Inspection
10. Barricading Covered System
11. As Built submitted.
a. Lot Location _
b. Dimensions of System
c. Location with Regard_to Pere Test
d. Elevations
e. Water Table
Town of North Andover, M24
Watershed Septic SVstem
Servicing Report
Date: 5/8/01
Homeowner: TAGARELIS
Street 179 HAYMEADOW ROAD
Phone 978-685-9155
Nature of Service: Routine X
Emergency _
Pumper : RAGGS SEPTIC SERVICE INC.
Address: P.O. BOX 1027, CONCORD MA
Phone 978-369-1100
Observations: Good Condition X
Full to Cover
Baffles in Place
Leachf field Runback -,
�QA��3
Excessive Solids ; 13ON
Heavy Grease
Roots F
Other (Explain)
r.
Description of Work: .
PUMPED TANK
Comments:
Septic Compliance, Inc.
affilliate of Thomas E. Neve Assoc., Inc.
October 30, 1996
North Andover Board of Health
146 Main Street
North Andover, MA 01845
Attn: Sandra Starr
Re: Sanitary Disposal System Inspection
179 Haymeadow Road - Carolina Relocators
Dear Ms. Starr:
il AY"
4
1009
I
In accordance with the Commonwealth of Massachusetts, Department of Environmental
Protection, State Environmental Code (Title V), 310 CMR 15.301, paragraph 7, please find
attached a "Subsurface Sewage Disposal System Inspection Form" for your records.
If you have any questions regarding this report or any of its contents, please do not hesitate to
contact this office. We thank you, in advance, for your continued cooperation in these matters.
Very truly yours,
SEP O IANCE, INC.
Paul Cardone
Certified Septic Inspector
Attachment
N.Andlet.sam
• SYSTEM INSPECTORS -
• SOIL EVALUATORS • • ENVIRONMENTAL ENGINEERS •
447 Old Boston Rd., US Route 1, Topsfield, MA 01983
Tel (508) 887-8586 Fax (508) 887-3480
Septic Compliance, Inc.
aflliate of Thomas E. Neve Assoc., Inc.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: Carolina Relocators Address of Owner:
179 Haymeadow Road, North Andover (if different)
Date of Inspection:
October 29, 1996
Name of Inspector:
Paul Cardone
Company Name, Septic Compliance, Inc.
Address and 447 Old Boston Road, Topsfield, MA 01983
Telephone Number: (508) 887-8586
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 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:
Inspector's .Signature:
XX Passes
Conditionally Passes
Needs further Evaluation By the Local Approving Authority
Date: October 29. 1996
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.
1
• SYSTEM INSPECTORS • • SOIL EVALUATORS • • ENVIRONMENTAL ENGINEERS -
447 Old Boston Rd., US Route 1, Topsfield, MA 01983
Tel (508) 887-8586 Fax (508) 887-3480
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 179 Haymeadow Road No. Andover, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
INSPECTION SUMMARY:
Check A, B, C, or D:
A) SYSTEM PASSES:
X 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.
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
conforming 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
obstruction is removed
distribution box is leveled 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 replaced
obstruction is removed
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 179 Haymeadow Road No. Andover Ma., 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
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 the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS THE BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT
FUNCTIONING IN A MANNER THAT PROTECTS 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 PROTECTS
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
supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 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 less than 5 ppm.
N
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 179 Haymeadow Road No. Andover, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
D) 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 contact 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 water 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.
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 179 Haymeadow Road No. Andover, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
D) SYSTEM FAILS (continued)
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private
water supply well with no acceptable water quality analysis. 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:
The following criteria apply to large systems in addition to the criteria above:
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 exists:
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.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 179 Haymeadow Road No. Andovber, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
Check if the following have been done:
X Pumping information was requested of the owner, occupant, and Board of Health.
X 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.
X Asbuilt 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 Soil 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.
X The size and location of the Soil Absorption System on the site has been determined based on existing
information or approximated by non -intrusive methods.
X The facility owner land occupants (if different from owner) were provided with information on the proper
maintenance of Subsurface Disposal System.
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 179 Haymeadow Road No. Andover, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
FLOW CONDITIONS
RESIDENTIAL
Design flow:
600 gallons
Number of bedrooms:
4
Number of current residents:
4
Garbage grinder (yes or no):
yes
Laundry connected to system (yes or no):
yes
Seasonal use (yes or no):
no
Water meter readings, if available:
Last date of occupancy: occupied
�lu�_Iu�3�IIII_I�►iili�yl ll��57
Type of establishment:
Design flow:
Grease trap present (yes or no):
Industrial Waste Holding Tank present (yes or no):
Non -sanitary waste discharged to the Title V
system (yes or no).
Water meter readings, if available:
Last date of occupancy:
OTHER (Describe):
Last date of occupancy:
7
gallons/day
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 179 Haymeadow Road No. Andover, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
GENERAL INFORMATION
PUMPING RECORDS and source of information:
According to owner tank was pumped three years ago.
System pumped as part of inspection (yes or no): yes
If yes, volume pumped: 1500 gallons
Reason for pumping: To inspect Baffles, to check for leaks, to check structual integrity of the tank.
TYPE OF SYSTEM'
X Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or not) [If yes, attach. previous inspection records, if any]
Other (explain)
APPROXIMATE AGE of all components, date installed (if known) and source of
information
17 years of age 6-6-79 As -built
Sewage odors detected when arriving at the site (yes or no): no
SEPTIC TANK: yes
(locate on site plan)
Depth below grade: 2 feet deep
Material of construction: X concrete metal FRP
8
Other (explain)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 179 Haymeadow Road No.Andover, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
Dimensions: 10'6" x 6'4" x 5'4"
Sludge Depth: 6"
Distance from top of sludge to bottom of outlet tee or baffle: 33"
Scum thickness: 1"
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: 20"
Comments:
(recommendations 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.)
We recommend tank be pumped once per year, baffles in good condition,structurally sound, no evidence of leakage.
GREASE TRAP: none
(locate on site plan)
Depth below grade:
Material of construction:
Dimensions:
Scum thickness:
Concrete Metal FRP
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
9
Other (Explain)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 179 Haymeadow Road No. Andover, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
Comments:
(Recommendations 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.)
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade:
Material of construction: Concrete Metal FRP
Dimensions:
Capacity:
Design flow:
Alarm level:
gallons
gallons/day
Comments:
(Condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: yes
(Locate on site plan)
10
Other (explain):
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 179 Haymeadow Road No. Andover, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
Depth of liquid level above outlet invert:
none
Comments:
(Note if level and distribution is equal evidence of solids carryover, evidence of leakage into or out of box, etc.)
Box was level no signs of carryover no signs of leaks.
PUMP CHAMBER: none/gravity
(Locate on site plan)
Pumps in working order (yes or no):
Comments:.
(Note condition of pump chamber, condition of pumps and appurtenances, etc.)
SOIL ABSORPTION SYSTEM (SAS): yes
(Locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods)
If not determined to be present, explain:
11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 179 Haymeadow Road No.Andover, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
Type:
Leaching pits, number:
Leaching chambers, number:
Leaching galleries, number:
Leaching trenches, number, length:
Leaching fields, number, dimensions: 1 field 20'x 45'
Overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
normal none none normal
CESSPOOLS:
(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):
12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 179 Haymeadow Road No Andover, Ma. 01845
Owner: Carolina Relocators
Date of Inspection: October 29, 1996
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.):
13
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references, landmarks or benchmarks.
Locate all wells within 100'.
Depth to groundwater: no water at 8' feet
Method of determination or approximation: Deep hole was done - perc rate 4 minutes per inch- sandy till
14
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77
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i
L'` 1 Sc GG
DEPTH TO GROUNDWATER
Depth to groundwater: no water at 8' feet
Method of determination or approximation: Deep hole was done - perc rate 4 minutes per inch- sandy till
14
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D
CERTIFICATION
Name of Inspector Paul Cardone
Company Septic Compliance, Inc.
Address 447 Boston Road, Topsfield, MA 01983 (508) 887-8586
Certification Statement
I certify that I have personally inspected the sewage disposal system at this address and that the information
reported is true, accurate and complete as of the time of inspection. The inspection was performed and any
recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in
the proper function and maintenance of on-site sewage disposal systems.
Check one:
I have not found any information which indicates that the system fails to adequately protect public health or
the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the
XX FAILURE CRITERIA section of this form.
I have determined that the system fails to protect public health and the environment as defined in 310 CMR
15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form.
Inspector's Signature:
Date:
Copies to:
Buyer (if applicable) Approving authority:
October 29, 1996
Board Of Health
FORM - SISIk:-N1 Yl.UFVP G RECORD
Commonwealth of Massachusetts
NORTH ANDOVER
Massachusetts.
t7— Lro
System Pumping Record
-stem N%mer bvstem Location
TAGARELIS 179 HAYMEADOW ROAD
est.
Date of Pumping: 11./20/03 Quantity Pumped:. 15 0 0 gallons
Cesspool: No ❑ Yes . El Septic Tank: No ❑ Yes 49
RAGGS SEPTIC SERVICE, INC. _
System Pumped by- d.b.a. E. A. COMEAU SEPTIC License r:
Contents transferred to: GREATER LAWRENCE. SANITARY DISTRICT
Date 1/6/04 Inspector RAGGS SEPTIC SERVICE, INC.
TOWN OF NORTH ANDOVER
SYSTEM PIOMPING RECORD
DATE: 10/27/04
SYSTEM OWNER & ADDRESS
TAGARELLIS
179 HAY MEADOW ROAD
DATE OF PUMPING: 9 /10 / 0 4
NOV - 3 2004
TOWN OF PiORTH ANDOVER
HEALTHC c:F
SYSTEM LOCATION
(example: left front of house)
BACK OF.HOUSE
QUANTITY PUMPED 10 0 0 GALLONS
CESSPOOL: NO X YES SEPTIC TANK: NO
NATURE OF SERVICE: ROUTINE X EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
YES x
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: RAGGS SEPTIC SERVICE INC.
COMMENTS:
CARVER
CONTENTS TRANSFERRED TO:
RAGGS, INC.
Subsurface Soil Disposal
Inspection Report
In Accordance With
Title 5 (310CMR 15.000)
', ng you Since
1"
P. 0. Box 1027, Concord, MA 01742
(508) 369-1100 / (800) 287-5541
FAX (508) 897-3848
RAGGS, INC., P. O. Box 1027, CONCORD, MA 01742
(508) 369-1100
OFFICIAL CERTIFICATION
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION
IN ACCORDANCE WITH TITLE 5 (310 CMR 15.000)
CERTIFICATION PREPARED FOR:
ADDRESS OF PROPERTY:
DATE OF INSPECTION:
RESULTS:
William and Frances Rogers
179 Haymeadow Road
N. Andover, MA 01845
March 14, 1995
X This property has PASSED the criteria set
forth in 310 CMR 15.000.
This property has FAILED the criteria set
forth in 310 CMR 15.000.
J1
h
11
RAG GS, INC., P.O. BOX 1027, CONCORD, MA 01742
(508)369-1100
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
ADDRESS OF PROPERTY
OWNER'S NAME.-
DATE
AME:
DATE OF INSPECTION
The following have been done -
179 Haymeadow Road
N. Andover, MA 01845
William and Frances Rogers
March 14, 1995
PART A
CHECKLIST
1. Pumping information was requested of the owner, occupant, and Board of Health: Yes
2. 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: Yes
C
n
3.
As -built plans have been obtained and examined: Yes
4.
The facility or dwelling was inspected for signs of sewage back-up: Yes
5.
The site was inspected for signs of breakout: Yes
6.
All system components, excluding the SAS, have been located on the site: Yes
7.
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: Yes
8.
The size and location of the SAS on the site has been determined based on existing
information or approximated by non -intrusive methods: Yes
9.
The facility owner (and occupants, if different from owner) were provided with information
the proper maintenance of SSDS: Enclosed with report.
C
n
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
Residential: number of bedrooms:
number of current residents:
garbage grinder:
laundry connected to system
seasonal use:
Non -Residential, calculated flow:
Water meter readings: see Appendix D
Last date of occupancy: occupied
4
3
yes
yes
no
private well:
GENERAL INFORMATION
Pumping records and source of information: See Appendix A; Owner
System pumped as part of inspection: yes Volume pumped: 1,500 gallons
Reason for pumping: Examination of the structural integirty of the tank.
Tvae of system -
Septic tank/distribution box/soil absorption system: yes
Single cesspool:
Overflow cesspool:
Privy:
Shared system:
Other:
Approximate age of all components: 15 years
Date installed: January 30, 1980
Source of information: Board of Health records
Sewage odors detected when arriving at the site: no
2
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742(508)369-1100
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SEPTIC TANK (locate on site plan) -- see Appendix B
Depth below grade: 3'
Material of construction - Concrete: X Metal: FRP: Other:
Dimensions: 10'8" X 5'8" X 5'8"
Sludge depth: 12"
Distance from top of sludge to bottom of outlet tee or baffle: 2'6"
Scum thickness: 0
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Recommendation for pumping: Annually
Condition of inlet and outlet tees or baffles: good
Depth of liquid level in relation to outlet invert: level
Structural integrity: good Evidence of leakage: none
Recommendation for repairs: none
DISTRIBUTION BOX (locate on site plan) -- see Appendix B
Depth of liquid level above outlet invert: zero
Level and distribution are equal: yes Evidence of solids carryover: none
Evidence of leakage into or out or box: none
Recommendation for repairs: none
PUMP CHAMBER (locate on site plan) -- n/a
Pumps in working order:
Condition of pump chamber:
Condition of pumps and appurtenances:
Recommendation for maintenance or repairs -
3
ERAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
n PART B
4 SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) -- see Appendix B
(locate on site plan, if possible; excavation not required, but may be approximated by non -
intrusive methods).
If not determined to be present, explain:
a Type:
Leaching pits and number:
Leaching chambers and number:
Leaching galleries and number:
Leaching trenches, number, length:
Leaching fields, number, dimensions: one field; 3 lines; each 45' long
OOverflow cesspool, number:
Condition of soil: good Signs of hydraulic failures: none
Level of ponding: none Condition of vegetation: good
CRecommendations for maintenance or repairs: none
CESSPOOLS (locate on site plan) -- n/a
Number and configuration:
Depth -top of liquid to inlet invert:
Depth of solids layer: Depth of scum layer:
C Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow:
El (cesspool must be pumped as part of inspection)
Condition of soil: Signs of hydraulic failure:
Level of ponding: Condition of vegetation:
Recommendations for maintenance or repairs:
PRIVY(locate on site plan) -- n/a
Materials of construction:
Dimensions:
Depth of solids:
Condition of soil: Signs of hydraulic failure:
ELevel of ponding: Condition of vegetation:
Recommendations for maintenance or repairs:
E 4
F-1
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE DISPOSAL SYSTEM
* Include ties to at least two permanent references, landmarks or benchmarks
*Locate all wells within 100 ft.
SEE APPENDIX B
DEPTH TO GROUNDWATER: more than 6'
METHOD OF DETERMINATION OR APPROXIMATION: Hand augered a 4" hole to a depth of
approximately 6'. No groundwater was determined to be present.
M
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes, no, not applicable or not determined (Y, N, N/A or ND). Describe basis of
determined in all instances. If "not determined", explain why not.
1. There is backup of sewage into facility: N
2. There is evidence of discharge or ponding of effluent to the surface of the ground or
surface waters: N
3. The static liquid level in the distribution box is above outlet invert: N
4. Liquid depth in cesspool is <6 in. below invert or available is < 1/2 day flow: N/A
E5. Required pumping 4 times or more in the last year: N
number of times pumped: N/A
[� 6. Septic tank is: Metal: N
L� Substantial infiltration: N
Tank failure imminent: N
Cracked: N Structurally unsound: N
Substantial exfiltration: N
7. Any portion of the SAS, cesspool or privy is below the high groundwater elevation: N
8. Within 50 feet of a surface water: N
9. Within 100 feet of a surface water supply or tributary to a surface water supply: N
10. Within a Zone I of a public well: N
11. Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies
only, not the SAS): N
12. Within 50 feet of a private water supply well: N
13. Less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis: N
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.
.1
I
71
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D
CERTIFICATION
Name of Inspector:
Company Name:
Martin Weiss, P. E.
Raggs, Inc.
Company Address: P. 0. Box 1027, Concord, MA 01742
Certification Statement
I certify that I have personally inspected the sewage disposal system at this address and that
the information reported is true, accurate and complete as of the time of inspection. The
inspection was performed and any recommendation regarding upgrade, maintenance and
repair are consistent with my training and experience in the proper function and maintenance of
on-site sewage disposal systems.
Check one:
X I have not found any information which indicates that the system fails to adequately
protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not
evaluated are as stated in the FAILURE CRITERIA section of this form.
I have determined that the system fails to protect public health and the environment as
defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE
CRITERIA section of this form.
Inspector's Signature
Martin Weiss, Professional Engineer #19501
?S
Date
Raggs, Inc. certifies that all work performed on the aforementioned property was done in
accordance with the guidelines set forth in Title 5 (310 CMR 15.303).
Fred T. Fish, President
Raggs Septic Service, Inc. d/b/a E. A. Comeau
File No.: 95-4531/ROGERSWILL
Copies to:
Payer of inspection
Local Board of Health or its agent
tl
Date
N
11
0
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
APPENDIX A:
HISTORICAL
PUMPING RECORDS, REPAIR RECORDS
0
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
0 -
11
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179 Haymeadow Road, N. Andover, MA 01845
OPrior to inspection, this system was pumped in October, 1994.
Source of information: Owner.
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1 RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
1
APPENDIX B:
SITE PLAN / AS BUILT PLAN
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APPENDIX C:
1 LISTING SHEET
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DRAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
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179 Haymeadow Road, N. Andover, MA 01845
D
No Listing Sheet was available for this property.
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1 RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
1 Appendix D:
Water Usage
Documentation
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Appendix E:
Recommendations:
Repair, Pumping, & Maintenance
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RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
Recommendations
for
179 Haymeadow Road, N. Andover, MA 01845
1. Pump system annually.
17
V elt,7,ng you Since 18"
General Maintenance Recommendations
Proper maintenance of your septic system can help prevent premature failure of
your soil absorption system. Raggs, Inc. recommends the following:
DO PUMP your system ANNUALLY.
DO OPEN your D -Box every THREE TO FOUR YEARS.
DO ensure that your VENT PIPES are installed properly.
DO make sure you know where your TANK is LOCATED.
DO make sure you know where your LEACHING FIELD is LOCATED.
DO look for GREEN STRIPES over leaching field.
DO check to determine if you can smell any ODORS from field location.
DO bring your COVERS WITHIN 6" OF GRADE.
DO USE LIQUID DETERGENT.
DO USE NON-ABRASIVE HOUSEHOLD CLEANING PRODUCTS.
DO USE ENVIRONMENTALLY SAFE PRODUCTS.
DO INSTALL WATER SAVING DEVICES, where appropriate.
DO USE SMALL AMOUNTS OF BLEACH when cleaning toilets, etc.
RAGGS SEPTIC SERVICE, INC.
d.b.a. E.A. COMEAU SEPTIC
P.O. Box 1027 Concord, Massachusetts 01742 (800) 287-5541 (508) 369-1100 FAX(508)897-3848
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General Maintenance Recommendations (con'd)
DON'T DISPOSE anything NON -BIODEGRADABLE IN TOILETS.
(i.e.: cigarettes, sanitary napkins)
DON'T use caustic CHEMICALS.
DON'T wash paint brushes used in latex or oil PAINT.
DON'T allow any PAINT, THINNERS to go down sink or toilets.
DON'T allow ANY GREASE or FAT to enter system.
DON'T DISPOSE BONES, EGG SHELLS, COFFEE GROUNDS„ etc. when
using a garbage disposal
DON'T use powdered detergents with phosphates.
DON'T use any DRAIN CLEANERS.
DON'T use any ENZYMES.
aDON'T use any GREASE DISSOLVERS.
DO NOT ADD ANY ADDITIVES TO YOUR SYSTEM FOR ANY REASON.
In the event of a clog or other plumbing problem, contact your local
plumber, rooter or pumper.
C DON'T PLANT any trees or shrubs OVER THE LEACHING FIELD.
a DON'T ALLOW SPRINKLER SYSTEMS or other WATERING DEVICES
OVER THE LEACHING FIELD.
DON'T DRIVE any VEHICLES or place any HEAVY OBJECTS ON TOP OF THE
LEACHING FIELD.
RAGGS SEPTIC SERVICE, INC.
d.b.a. E.A. COMEAU SEPTIC
j� P.O. Box 1027 Concord, Massachusetts 01742 (800) 287-5541 (508) 369-1100 FAX(508)897-3848
Town of North Andover, MA
Watershed septic system
Servicing Report
Date: 9/5/98
Homeowner: TAGARELIS
Street 179 HAYMEADOW ROAD
Phone
Nature of Service:
Observations:
Description of Work:
ROUTINE PUMPING
Comments:
Routine X
Emergency
Pumper : RAGGS SEPTIC SERVICE INC
Address: P.O. BOX 1027, CONCORD
Phone : 978-369-1100
Good Condition
Full to Cover
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
commonwealth of Massachusetts
. Pj,)d a,&-4 , Massachusetts
&Steffi Pum"in Record
Date of Pumping: Q) z i ! 1
" 'I � 2 t�
TOWN OF WORTH ANDOVeR
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Quantity Pumped: D 0 gallons
Cesspool: No yes'. ❑ Septic Tank: No ❑ Yes B
RAGGS SEPTIC SERVICE• INC.
System Pumped b.: d.b.a.. E. A. COMEAU SEPTIC License AN
Contents transferred to: _WATER SOLUTIONS GROUP TAUNTON
Date
Q.1 2.( ISD Inspector RAGGS SEPTIC SERVICE. INC.
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