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HomeMy WebLinkAboutMiscellaneous - 198 DALE STREET 4/30/2018 T98 DALE STREET f 210/037.B-0004-0000.0 I i I i I 1 i WDATEINVOICEAMOUNT 5-20/110 N KENNETT, INC. s6728 AU -.OBODY:AND INDUSTRIAL SUPPLIES395 BROADWAY .ENCE,MA 01841: .I 'U{PI illi{ ✓� 1„i Al '` f r: DOLLARS i *� +4s DATE CHECK AMOUNT DON KENNETT, INC. SHAWMUT BANK Auth BOSTON.MA 02211, Sig } Y y Y �i!0067 28!i' 1:0 11000 2064 :_ 3 2 036806 611' t.{ —77 DATE DESCRIPTION AMOUNT u. 7/31/93 Pumped Septic Tank $145.00 ..r af�93 s L. +" {;M;>„. Bateson Enterprises, Inc. —Andover, MA 01810 '�v`"7j v d1�wl' SEPTIC SYSTEM INSPECTION FORM ADDRESS DATE INSPECTED ° PROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS : a 14A'3'E:R QUALITY TES r t-b `' DYE TEST PERFORMED? Y N DATE? SKETCH: WATERSHED RESIDENTS QUESTIONNAIRE 1. Name L Y) 1_e T2, ke. 2. Street Address J r IN,, I V j 3. How many members are in your household? y 4. What type of sewage disposal system do you have? ❑ cesspool 2'septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for rur sewage disposal system on file with the Board of Health? ❑ yes ❑ no 5? do not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? El yes Imo' no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? Ldp annually ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes ❑ no If yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each applia a are connected to your swage disposal system? washing machine dishwasher t/ garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher S i°n ) AFtt clotheswasher —/ 12. Does your property have a lawn? L+�' yes ❑ no If yes, approximately what size? �-�// ❑ less than 1/4 acre El 1/4 acre I 1/z acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres _ 13. How often do you fertilize your lawn? No. of applications per year = Season(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: ❑ Check here if your lawn is maintained by a professional landscape contractor. Address- Title of File Page of Date f=ile Open: a�t� ale dosed Doc Document/Action Title Date of action Refer to other purpose of 17ocuMent/Action and notes Nun-1. Document/ document/ -- Action De artment Board of Appeals - Board of Heal -..-I lanmm��g Board ; Cons ervatiion Commission - Buil-ding Departnlen.t --'— Commonwealth of Massachusetts Massachusetts System Pumping Record System Owner System Location T/f 1--( c- 9 ®fJ- (. G S? Date of Pumping: D / Quantity Pumped: gallons Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes. Y System Pumped by: br`4r¢d" 4i9&"Qdw License# Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: t NEW ENGLAND ENGINEERING SERVICES INC June 17, 2000 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 190 Dale Street,North Andover Dear Sirs: Enclosed is a copy of the Title V report for the above referenced property. The systemaP ssed our inspection. If there are any questions please call me at my office, 686-1768. Sincerely 1314 rlin C. Osgoo2r., E.I.T. President ,7:1 2'G .- 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 1. p.yy^f C&MONWEALTH OF MASSACHUSE'T'TS , EXECUTIVE'OFFICE OF ENVIRONMENTAL AFFAIRS 'l°= jt r DEPARTMENT OF ENVIRONMENTAL PROTEMON ONE WINTER STREET,BOSTON MA 02108 (617).29A500 , 2?d .ay ARGEO PAUL CELLtUCCI- DAVID 0:S7`&Ugg Governor Cotttmiss�Qigei:' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - :,..:;._..•. PART A CERTIFICATION Property Address:, /4vN. AAJ D Name of owner Gt-e&V o*Jjr u s W . Address of Owner: 1410 0-ALiE sT1 ,t,9, fin!Q. Date of Inspection: Name of In.spector (Please Print) Beniatnin C. Osgood,Jr. i am a DLP approved system Inspector pursuant to Section 15.340 of Title 5(310-CMR 15.000) Company Name: New England -Engineering Services Inc. Ma.'ingAddress: 60 Beechwood Drive. North Andover, MA Telephone Number: 978-686-1768 CERTIRCAIION STATEMENT 1 certify that 1 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: Passes • _ Conditionally Passes Needs FurtherEvaluation By the Local Approving Authority Fags• Inspector's Signature: Date: / 00 The System Inspector shall submit a copy zs inspection report to the Approving Authority(Board of Health or DEP)wMin thirty(301-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 aKinv)ronmental Protection. The original should')*sent tovw system owpar•and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS j), s��fi'e 7�.�/e o..T1,�'i Te�tF /S (,.n,��; .(l E'w TES a� /.a✓.v D R .Vee p r �U b e '�'t�c c.Y i., 76 revised 9/2/98 ' per Ior11 1 el IRFACE SEWAGE DISPOSAL SYSTEM INSPECTION-fORM . PART'A Property Address: 190 Dale Street CERTiRCAY7011(con itzmd) '. ^'- -North Andover. ^ Owner:Gregory Kanevski Date of Inspection:6/17/00 ,;+< v INSPECTION SUMMARY: Check A, •B, �, or D: Ap SYSTEM PASSES: ' V 1 have not found any Information which indicates that any of the failure conditions described In 310 CMR 15:303 exist. Any:faQure'•' criteria not evalyated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass:"section need to be'replaced or repaired. The system,upon completion pf the replacement or repair,as approved by the Board of Health,will pals. 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(201 Years prior to the date of the inspectioh;or the septic tank,whether or not metal,is cracked,stntcturaily,unsound,shows substantial infiltration or exfiluation,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 pips(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 levelled or replaced - _ - The system required pumpMMore thanfourlmes n year•due to broken or vtrstmcted plpe(si. The sys inspection If(with approval of the Board of-Health): broken pipes)are replaced obstruction is removed C r j f revised 9/2/98 Pace 2or11 w"VRFACE SEWAGE DISPO$AL SYSTEM INSPECTION FORM _ •, ;�s"/h+ . ri PART A *:.x•:.,:�� Property Address: 190 Dale Street CERMFiCATION(continued) North Andover Owner:Gregory Kanevski _ Date of Inspection:6/17/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Co6ditiohs exist which require further evaluation by the Board of Health in order(o determine If the system Is taping to protedithe•:"- public health,safety and the environment. 1) SYSTEM WiLL PASS UNLESS BOARD OF HEALTH DETFRMWES IN ACCORDANCE WiTH 310 CMR 16.303(1)(b)•THATTHESYSTE IS NOT FUNCTIONING IN A MANNER WH.ICH_WILLPRQgCT,THE PUBLIC HEALTH_AND SAFETY AND THE E3f.KIHONME2,Lt 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 soil absorption system and the SAS is within a Zone I of a public water supply wap: _ The system has a septic tank and soil absorption system and the SAS is within 60 feet of a private water supply wall. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 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 niuogen is etluaito or less than 5 ppm., Method used to determine distance (approximation not valid).• 31 OTHER � f f revised 9/2/98 Pate 3ofti �' � ' :,ty�fir• c SUBSURF�CESEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART A + '; CERTIRCATiON(continued) _ Property Address: 190 Dale Street 4 North Andover ' Owner:Gregory Kanevski - - - Date of Inspection:6/17/00 ^ 1 . r i D.• SYSTEM FAILS: l You must indicate either"Yes"or"No' to each.of the following; 1 r 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. The basis for this determination is identified below. The B and of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of- a lage lato facility-or- -tom component•due%to an ovedoeded or•ciaggedSASor•cesspooi.' • jr►——:�-_, 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 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 Soll'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 portion of a:cesspool or privy is within 60 feet of a private water supply well. Any portion of a'eesspooi or privy is less-than 100 feet but greater than 60 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 fiow'of 1:0.000 gpd or greater(Large System)and the system Is a significant throat to public health and safety and the environment because one or more of the following conditions exist: Yes No the`system is within 400 feelt of a surface drinking water supply l the syctem4a-wIWn200 feet ofa t�ibuEarY lsa�urt�oe�dnkiwy waNr w�}iY• -- the system Is located in a nitrogen sensitive area(Interim Wellhead Protection Area=iWPA)or a napped Zone 0 of a public water supply wen) { The owner or operator of any such system shall upgrade the System in accordance with 310 CMR 16.304(2). Please consult the local regional office of the Department for further(nfortnation. revised 9/2/98 Page 4oftt *;wr :fti x•;� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC710 FORM L PART B "x,£ ~' CHECKLIST Property Address: 190 Dale Street - I North Andover - Owner:Gregory Kanevski Date of Inspection: 6/17/00 ', y ' Check if the following have been dorie:You must Indicate either"Yes"or"No"as to each of the following: Yes No Pu.L ping information was provided by the owner,occupant,or Board of Health. -None of the syctemcompoaanu.hstw bean pnatiPadxfor atlaast two•aueakc sru the•syctam hasbaaa=calssipg-saiiKal-low rates during that period. Large volumes of water have not been introduced into the system recently oras part of-this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for sighs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. Ae _ The site was inspected for signs of breakout. _ All system components.excluding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimenslons,depth of liquid,depth of sludgb,depth of scum. / The size and location of the Soil Absorption System on-the site has been deormined based on:- ✓ Existing information.For example.Plan at B.O.H. ✓ Determined In the field(if any of the failure criteria related to Part C is at issue,approximation of distance Is unacceptable) (16.302(3)(6)1 - The facility owner(and.occupaats,H different rormati monsla pto ••^gar uasna"f SubSurface Disposal Systems. is l S revised 9/2/98 Page sertt SUBSURFACE SEWAGE OISPOSAI;SYSTEM INSPECTION FORM ....ti PART SYSTEM INFORMATION Property Address: 190 Dale Street F' North Andover i. ' '•I Owner:Gregory Kanevski �,.:. Date of Inspection: 6/17/00 FLOW CONDITIONS RESIDENTIAL: t �•ih. Design flow: i g.p.d./bedroom. Number of bedrooms{design): Number of dedrooms(actual) t Total DESIGN flow NY'mber of current residents.-?— Ghrba9e grinder(yes or no)-,LO Laundry(separate system) (yes or no):jej If yes,separate.i{upection•required Laundry system Inspected (yes or no) rS 1�fTw Seasonal use(yes or no):,A/—U Water meter readings,if available(last two ear's usage( d):: 9 Y 9 9P Sump Pump(yes or no)-." Last date of occupancy: Gc9r/e Alr'r i C6MMERf3AL/iNDUSTRIAL• Type of establishment: Design flow: 9pd (Based on 15.203) Basis of design flow Grease trap present:(yes or nol_ Industrial Waste Holding Tank present:(yes or no)_ Non-sanitary waste discharged to the Title b system:(yes or no)_ Water meter readings,if available: t . Last date of occupancy: Oj HER:(Describe) Last date of occupancy: GENERAL WFORMATION. PUMPING RECORDS and source of information: w K t lefty O4e t>w*wf- System pumped as part of inspection:(yes or no).44V If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Y Septic tank/distribution box/soll absorption system T Single cesspool Overflow cesspool :. Privy f Shaved system(yes or no) Of yes,attach previous Inspection recprds,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval s s Other R APPROXIMATE AGE of ail components,date lnstalle"f icnown)•end source oMnformation: -•--• lJl'l'? rg43 r Sewage odors detected whewarriving at the she:(yes or no).&V f ` revised 9/2/98 Put 6Oftt I cr mcI NFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Property Address: 190 Dale Street SYSTrrm INFORMATION(condnuedl North Andover .'~ Owner:Gregory Kanevski Date of Inspection:6/17/00 ty- ! BUILDING SEWER: (Locate on site pian) Depth below grade-& t Material of construction: /cast iron 40 PVC other(explain) Distance from private.water supply well or su tion line Diameter r• _ ,.�:... . Comments: condition t foints.ve tin ,evidence of toe a-etc.1 7 SEPTIC TANK•_ (locate on site•ptan) Depth below grade: Material of construction:oncrete—metal_Fiberglass _Polyethylene_other(explain) If tank is(netal,fist age_ 1s.age.confirmed by Certificate of Compliance_(Yes/No) Dimensions: /,ta 6W^-.0✓'> Sludge N •S u g _ Distance from top of sludge to bottom of outlet tee ortiaffle:166L4' N Scum thickness: t9 Distance from top of scum to top of outlet tee or baffle:;eV* Distance from bottom of scum to bottom of outlet tee or baffle:A,* How dimensions were determined: srYltrsryw tt1GIG Comments: (recommendation for pumping.condition of inlet and outlet tees or-baffles,depth of fiquid level In relation to outlet Invert.-structuraHMerlr(ty, evidence of leakage,etc.) 1,AJ r r 4L ✓VY. Ns w Is if"an&FWo> rV s N e" ZU l N IN 4r3 O�'N ly✓Cr�3 GREASE TRAP:,i./�. (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 df outlet tee or baffle: s Date of last pumping: Comments: (recommendation for pumping,condition of Inlet and outlet tees or baffles,depth of fiquid.level in relation to outlet Invert,structural integrity, evidence of leakage,etc.) r revised 9/2/98 Pate 7ofit �e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOAM• � S PART C r,t SYSTEM INFORMATION(condelued) :c.. Property Address: 190 Dale Street r 4 North Andover 1: • ' �'• ; Owner:Gregory Kanevski t • Date of Inspection: 6/17/00 TIGHT OR HOLDING TANK"tTank must bo pumped prior to,or at time of,Inspection) (locate on site plan) ^i S t r Y`rAi Depth below grade:_ Material of construction: c'ncrete_metal Fber foss_Polyethylene—other(explain) Dimensions: - Capacity: gallons . Design flow: gallons/day Alarm present Alarm level: Alarm In working order:Yes_ No Datd of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION 130X:_ (locate on site plan) Depth of liquid level above outlet invert: 0_ Comments: (note If level and distribution Is equal,evidence of solids carryover,evidence of leakd$$a Into or out of box,etc.) — — Bez iN 6-VOP [oNOr716Ar, No FurQG�tlGC' O/` �a�ivc c,m,rttJavr,L y.tJ E4dk3 Al_ �r s T Mt tl,w A PUMP CHAMBER.&A (locate on site plan) Pumps In working order:(Yes or No) Alarms In working order(Yes of No) Comments: 1. 1 (note condition of pump chamber,condition of pumps and appurtenances,etc.) - i _ • f f revised 9/2/98 Pate I of 11 ' '•r :.�'s+•Y Ili -FACE SEWAGE DISPOSAL YSTEMiNSPECTiO.k FORM -� PART C Property Address: 190 Dale Street SYSTEM INFORMATION(cor>tinued) North Andover :t'M Owner:Gregory Kanevski Date of Inspection:6/17/00 SOIL ABSORPTION SYSTEM(SAS):_ (locate on site,plan,if possible;excavation not required,location may be approximated by non4ntruslve methods) If not located,explain; Ty e: leaching pits;number:_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: Z r cµtrf. leaching fields,number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) f np /S'fLE'Pa- SYsTVA4 f-06 IL,S NO 1 A4&. NO iiNO/t 4 h a� s3r ►7dNt34�1q QwwP 5614 blZ 1-5A) Cols&f 77P77d M CESSPOOLS: (locate on site plan) Number and configuration: ; Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensiot*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 faituraAevel of ponding,condition of.vegetation,etc.l i PRIYY:1y_.a - ` l: (locate on she plan) s t s Materiels of construction: Dimensions! = Depth of solids• Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation.etc.) f i revised 9/ / 2 9/ /98 Pile 9 of It • i SUBSURFACE 9ErGE DISPOSAL SYSTEM INSPECTION FORM i PART C SYSTEM INFORMATION(continued) Property Address: 190 Dale Street North Andover r r n - Owner:Gregory Kanevski Date of Inspection:6/17/00 ` :SKETCH OF SEWAGE DISPOSAL SYSTEM: , Include ties to at least t*o permanent reference landmarks or benchmarks I locate all wells within 100'(Locate where public water supply comes into house) ' L H5'S�r r . V 31 � 'tot;,. r revised 9/2/98 Page 10 of 11 owe- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION TIM PART C SYST_EPA INFORMATION(con6nueA Property Address: 190 Dale Street North Andover Owner:Gregory Kanevski Date of Inspection: 6/17/00 NRCS Report nems god-Y ELS EK Cc%✓T•y MrFxs No fzTHtXw M d7 Soil Type_ .5 V S ` IS TTaaJ Typical depth to groundwater j► S' 7t� 3..5� -` USGS Date website visited Observation Weill checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check cellar Shallow wells Estimated Depth to Groundwater_Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record _Y Observed.Site(Abutting property,observation hole,basement sump etc.) - Determined from local conditions Checked with local Board of health Checked FEMA.Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) t1,oPorw Tb- gAClc bc,RO, %V C7- AREA• lJ e" TO 8� OA of IYL' c C •- VS(s s ,P&—IA drf- be fie.... (�-��,�o. p�„Ira a G s�s,Tf"il•►4� b«., /Yic�� q 5 revised 9/2/98 : Pact tt or it