HomeMy WebLinkAboutMiscellaneous - 18 JOHNNY CAKE STREET 4/30/2018 (4)9
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Town of North Andover
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CHECK #: _DATE: /D�"/
LOCATION: XZ7
H/O NAME:
CONTRACTOR NAME:f:u�-1(�
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
$
❑ Swimming Pool
$
❑ Tobacco
$
❑ Trash/Solid Waste Hauler
$
❑ Well Construction
$
SEPTIC Sustems:
❑ Septic - Soil Testing $
❑ Septic - Design Approval $
❑ Septic Disposal Works Construction (DWC) $
❑ Septic Disposal Works Installers (DWI) $
❑ Ti!!p5-Inspector $
Title 5 Report $ _6
❑ Other: (Indicate) $
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
PETER F. REILLY
136 ANDOVER STREET
ANDOVER, MA 01810
(978) 375-3750
TITLE V
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART A - CERTIFICATION
Property Address:
Name of Owner:
Address of Owner:
Name of Inspector:
Peter F. Reilly
Company Name:
same
Mailing Address:
136 Andover Street, Andover,
Telephone Number:
(978) 375-3750
18 Johnny Cake Street, North Andover, MA 01845—
Brian &Kristen Lessard
same
'`***This report only describes conditions a the time ofinspection and under conditions of use at that time.
This inspection does not address how the system will perform
CERTIFICATION STATEMENT
MA 01810
OCT 2 3 2008
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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR
15.000) The system:
✓ Passes
N/A Conditionally Passes
N/A Needs Further Evaluation By the Local Approving Authority
N/A Fails
Inspector's Signature: Date: October 2, 2008
AFReillyy
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of
Health or DEP) 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 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
in the future under the same or different
conditions of use (See attached Disclaimer).
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART A - CERTIFICATION (continued)
Property Address: 18 Johnny Cake Street, North Andover
Owner's Name: Brian & Kristen Lessard
Date of Inspection: 10/2/2008
INSPECTION SUMMARY:
A. SYSTEM PASSES: Check A, B, C, D, or E / ALWAYS complete all of Section D
✓ 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.
COMMENTS:
The system met the Pass Criteria of Title V.
B. SYSTEM CONDITIONALLY PASSES:
N/A 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). Describe basis of determination in all instances. If "not determined",
explain why not)
N The septic tank is metal, and over 20 years old* or the septic tank (whether metal or not) is 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. *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 a sewage backup or breakout or high static water level 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):
N/A broken pipe(s) are replaced
N/A obstruction is removed
N/A 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):
N/A broken pipe(s) are replaced
N/A obstruction is removed
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART A - CERTIFICATION (continued)
Property Address: 18 Johnny Cake Street, North Andover
Owner's Name: Brian & Kristen Lessard
Date of Inspection: 10/2/2008
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 environment.
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:
N/A Cesspool of privy is within 50 feet of a surface water
N/A Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh.
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:
N/A The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to
a surface water supply or tributary to a surface water supply.
N/A The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply well.
N/A The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
N/A The system has a septic tank and SAS the SAS is less than 100 feet but 50 feet or more from a
private water supply well.**Method used to determine distance N/A
This system passes if the water well water analysis, performed at a certified DEP 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. A
copy of the analysis must be attached to this form.
3. Other
N/A
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART A - CERTIFICATION (continued)
Property Address: 18 Johnny Cake Street, North Andover
Owner's Name: Brian & Kristen Lessard
Date of Inspection: 10/2/2008
D. System Failure Criteria applicable to all systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes No
No Backup of sewage into facility or system component due to an 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.
N/A Liquid depth in cesspool less than 6" below invert or available volume <'/ 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: once
No Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
N/A Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water
supply.
N/A Any portion of a cesspool or privy is within a Zone I of a private water supply well.
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well.
N/A 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 laboratory, for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate
nitrogen is less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis
must be attached to this form).
N/A The system fails. I have determined that one or more of the above failure criteria exist as defined in 310
CMR 15.303, therefore the system fails. The property owner should contact the Board of Health should be
contacted 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 a large system in addition to the criteria above)
N/A 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 exist:
Yes No
N/A The system is within 400 feet of a surface drinking water supply
N/A The system is within 200 feet of a tributary to a surface drinking water supply
N/A The system is located in a nitrogen sensitive area (Interim Wellhead 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 such 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.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART B - CHECKLIST
Property Address: 18 Johnny Cake Street, North Andover
Owner's Name: Brian & Kristen Lessard
Date of Inspection: 10/2/2008
Check if the following have been done. You must indicate either "Yes" or"No" as to each ofthe 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 flow 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 ? (If they were available note as N/A)
Yes Was the facility or dwelling was inspected for signs of sewage backup ?
Yes Was the site was inspected for signs of breakout ?
Yes Were all system components, excluding the SAS, located on the site ?
Yes Were the septic tank manholes uncovered, opened and the interior of the septic tank inspected for
condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,
depth of scum?
Yes Was the facility owner (and occupants of if different from the owner) provided information on the proper
maintenance of subsurface sewerage 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. For example, a plan at the Board of Health.
N/A Determined in the field if any of the failure criteria related to Part C is at issue (approximation of
distance is unacceptable) [15.302(3)(b)].
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C - SYSTEM INFORMATION
Property Address: 18 Johnny Cake Street, North Andover
Owner's Name: Brian & Kristen Lessard
Date of Inspection: 10/2/2008
FLOW CONDITIONS
RESIDENTIAL:
Number of bedrooms (design):
Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203
(for example: 110 gpd x # of bedrooms:
Number of Current residents:
Does the residence have a garbage grinder (yes or no):
Is the laundry on a separate sewerage system (yes or no):
Laundry system inspected (yes or no):
Seasonal use (yes or no):
Water meter readings, if available (last 2 years usage [gpd]):
Sump Pump (yes or no):
Last date of occupancy:
COMMERCIAL/INDUSTRIAL:
Type of Establishment:
Design Flow gpd (based on 15.203):
Basis of Design Flow (seats/persons/sq.ft., 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)
PUMPING RECORDS
4
4
440 gpd (per design plan)
4
no
no (if yes, separate inspection required)
N/A
no
about 300 gpd
no
current
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
GENERAL INFORMATION
Source of Information: owner (last 5/07 - previously 2003 & 2001)
Was system pumped as part of inspection (yes or no): no
if yes, volume pumped (gallons): N/A
How was quantity pumped determined ? N/A
Reason for pumping: N/A
TYPE OF SYSTEM
✓ Septic tank/distribution box, soil absorption system
Single cesspool
Overflow cesspool
Privy
NO 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 the 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: original system installed in
1985.
Were sewerage odors detected when arriving at the site (yes of no): no
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C - SYSTEM INFORMATION (continued)
Property Address: 18 Johnny Cake Street, North Andover
Owner's Name: Brian & Kristen Lessard
Date of Inspection: 10/2/2008
BUILDING SEWER: (locate on site plan)
Depth below grade: about 22" - 24 "
Materials of construction: cast iron ✓ 40 PVC other (explain)
Distance from private water supply well or suction line N/A
Diameter: 4"
Comments: Condition of joints, venting, evidence of leakage, etc.)
Building sewer was watertight and appeared sound at foundation.
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: about 14" - 16"
Material of construction: ✓ concrete metal Fiberglass Polyethylene other (explain)
If tank is metal, list age N/A Is age confirmed by Certificate of Compliance N/A (Yes/No)
Dimensions: Rectangular - 1,500 gallons
Sludge depth: <111
Distance from top of sludge to bottom of outlet tee or baffle: 28"
Scum thickness: <111
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: 16"
How dimensions were determined: observation
Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level
as related to outlet invert, evidence of leakage, etc.)
Tank was watertight and appeared to be functioning properly.
GREASE TRAP: N/A (locate on site plan)
Depth below grade:
material of construction: concrete metal FRP other (explain)
Dimensions: N/A
Scum thickness: N/A
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
Date of Last Pumping: N/A
Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level
as related to outlet invert, evidence of leakage, etc.)
N/A
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C - SYSTEM INFORMATION (continued)
Property Address: 18 Johnny Cake Street, North Andover
Owner's Name: Brian & Kristen Lessard
Date of Inspection: 10/2/2008
TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection) (locate on site plan)
Depth below grade:
N/A
material of construction: concrete metal Fiberglass Polyethylene other (explain)
Dimensions: N/A
Capacity: N/A gallons
Design Flow: N/A gallons per day
Alarm Present (yes or no): N/A
Alarm level: N/A
Alarm in working order (yes or no): N/A
Date of last pumping: N/A
Comments: (condition of alarm and float switches, etc.)
N/A
DISTRIBUTION BOX: ✓ (locate on site plan)
0" depth of liquid above outlet invert
Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into
or out of box, recommendation for repairs, etc.)
D -box was level. Two lines leading to SAS were accepting effluent evenly. Minimal solids carryover
evident. The d -box was severely deteriorated and was replaced following the inspection.
PUMP CHAMBER: N/A (locate on site plan)
Pumps in working order (yes or no) N/A
Alarms in working order (yes or no) N/A
Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.)
not applicable
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C - SYSTEM INFORMATION (continued)
Property Address: 18 Johnny Cake Street, North Andover
Owner's Name: Brian & Kristen Lessard
Date of Inspection: 10/2/2008
SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible; excavation not required)
If SAS not located, explain why:
Type
leaching pits, number
leaching chambers and number
leaching galleries and number
✓ leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool, number
alternative system (name of technology)
N/A
N/A
N/A
2 trenches 85' long each (per design plan)
N/A
N/A
N/A
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.)
Soils in area of SAS appeared normal, no signs of breakout.
CESSPOOLS: N/A (locate on site plan)
Number and configuration
N/A
Depth -top of liquid to inlet invert
N/A
Depth of solids layer
N/A
Depth of scum layer
N/A
Dimensions of cesspool
N/A
Materials of construction
N/A
Indication of groundwater inflow (cesspool
must be pumped as part of inspection)
N/A
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations
for maintenance or repairs, etc.)
not applicable
PRIVY: N/A (locate on site plan)
Materials of construction N/A
Dimensions N/A
Depth of solids N/A
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations
for maintenance or repairs, etc.)
not applicable
a
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C - SYSTEM INFORMATION (continued)
Property Address: 18 Johnny Cake Street, North Andover
Owner's Name: Brian & Kristen Lessard
Date of Inspection: 10/2/2008
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Provide a sketch of the sewerage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100'. Locate where public water supply enters the building.
APP.
WTR.
HOUSE
A B
AN
REAR
YARD
D -
BOX
DSAS
SEPTIC TANK TIES: A to Center 33.0' B to Center 31.0'
D -BOX TIES: A to Box 52.5' B to Box 48.0'
NOTE: The system is in the rear yard
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C - SYSTEM INFORMATION (continued)
Property Address: 18 Johnny Cake Street, North Andover
Owner's Name: Brian & Kristen Lessard
Date of Inspection: 10/2/2008
SITE EXAM
Slope Flat and level in area of SAS
Surface water none observed
Check cellar dry
Shallow wells none observed
Estimated Depth to Groundwater >1" (below bottom of SAS)
Please indicate (check) all methods used to determine the high ground water elevation:
Y Obtained from Design Plans on record - if checked, date of design plan reviewed: 1985
Y Observed site (abutting property, observation hole within 150 feet of SAS)
Y Check with Local Board of Health - explain: information on file
Y Check local excavators, installers - (attach documentation)
N Accessed USGS Database - explain: website too complicated
You must describe how you established the high ground water elevation.*
The 1985 design plan indicated that ground waterwas greaterthan fourfeet belowthe SAS. However, the
precise groundwater elevation cannot be determined for certain without a soil evaluation test.
*Inspector's Note: Soil Evaluation is the currently recognized method fordetermining orestablishing the
high groundwater elevation. Since I am not a licensed or certified soil evaluator, I am not qualified to
determine or establish the high groundwater elevation beyond the public information available, such as
recent design plans of the site or the nearby area. My estimation of the high groundwater elevation is
based on a due diligence effort to obtain all available information both on and off the site and my
experience as a certified subsurface disposal system inspector. (see attached Disclaimer)
DISCLAIMER
This passing septic inspection under Massachusetts Title V is in no way a guaranty or
warranty of the inspected septic system. The inspection is a "snapshot in time" and does not
constitute a complete assessment of the quality or potential longevity of the septic system. The
pass/fail criteria are specific and outlined in detail in this report. Under the limited criteria of
a Title V inspection, it is impossible to determine how long any septic system will last. The
inspector made a diligent effort to certify the septic system based on the criteria required
under Title V.
Under Massachusetts Title V, soil evaluation is the accepted method of determining the high
groundwater elevation. This inspector is not a certified soil evaluator and is therefore not
qualified under Title V to determine or establish the high groundwater elevation. The method
used to estimate the high groundwater for this inspection was based on the public records
and methods of observation described on the previous page. Groundwater levels can vary
greatly from season to season, year to year and soil evaluation is considered the most reliable
method of groundwater determination under Title V.
P er F. Reilly
Inspector
October 2, 2008
CONSERVATION DEPARTMENT
Community & Economic Development Division
May 24, 2017
Sean & Roisin Cahill
18 Johnny Cake Street
North Andover, MA 01845
RE: Selective cutting of six (6) trees within the buffer zone to Bordering Vegetated Wetland
(BVW).
This is a follow up letter pertaining to your request to remove four (4) pine trees and two (2) red
maples which are damaged and/or dying and are in close proximity to and are leaning towards
your home or yard at 18 Johnny Cake Street. The trees were identified by Mr. Cahill during a
site visit by the Conservation Department on May 17, 2017. It was determined that the trees are
located outside of the 25' No -Disturbance Zone pursuant to the North Andover Wetlands
Protection Bylaw (C. 178 of the Code of North Andover) but within the 100' Buffer Zone.
Removal of vegetation, including pruning and cutting, is prohibited within the Buffer Zone
without a permit except for rare circumstances, such as safety. The identified trees are visibly
damaged and/or dying or are in close proximity to the house and existing yard posing a safety
hazard. An additional tree is located on the edge of the Wetland and has a trunk/stem that is
dead. If the dead portion of the tree can be removed without harming the remainder of the tree
this work may also be done.
Due to the potential danger imposed by the trees, the Conservation Department will permit the
removal to prevent possible injury or property damage. These cutting activities shall be limited
to the trees identified.
The approved cutting will be subject to the following conditions:
❖ It is anticipated that the work approved in this letter will be completed by September 1,
2017.
❖ No machinery shall enter the 25' No Disturbance Zone.
❖ No work shall occur in resource areas.
❖ All tree limbs, brush, and other debris materials shall be taken off site and disposed of
properly.
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542 Web www.northandoverma.gov
❖ Stumps of the trees shall not be removed and shall be left in place. Stumps may be ground
down or cut flush with the landscape.
❖ Care shall be taken to prevent damage to surrounding trees during removal of the approved
trees.
❖ Upon completion of the tree removal, all disturbed areas shall be properly stabilized.
❖ The applicant shall notify this department immediately following completion of work for a
final site inspection.
❖ Areas within 100 -feet of wetland resource areas shall remain in a natural state and no further
vegetation shall be removed without the prior approval of the Conservation
Department/ Commission.
Please do not hesitate to contact me should you have any further questions or concerns in this
regard.
Sincerely,
NORTH ANDOVER CONSERVATION COMMISSION
j er Hu hes
onservation Administrator
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542 Web www.northandoverma.gov