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Home My WebLink AboutMiscellaneous - 225 HAY MEADOW ROAD 4/30/2018 (2) 225 HAY MEADOW ROAD t� 210/1.04.B-0087-0000.0 iJ u - --- I TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: I SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) gtl-v 00 1 Li , DATE OF PUMPING: (_-1C�QUANTITY PUMPED ACoQ GALLONS CESSPOOL: NO /YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: i NEW ENGLAND ENGINEERING SERVICES INC Otj VER/ OF NORF�EPLTH T0�g0AR0 0 � A 195 1� June 12, 1996 North Andover Board of Health Town Hall Annex Main Street North Andover,MA 01845 RE: TITLE V REPORT Enclosed is the Title V report for 225 Haymeadow Rd. ,North Andover,MA. The system did pass the inspection. If there are any questions please call me at my office,686-1768. Yours truly, jamin C. sgood Y resident 33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768 Commonwealth of Massachusetts Executive Office of Environmental Affairs. RSH Ar11D SOW Oepi►artment of gOFF OF HEALTH Environmental Protection .AIS Wlliiam F.Weld T xe Governor Argeo Paul Cellucel secrobry LL Go"mor David 6. nmbeloner i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Prvpert,?Address: a�o�,� 9 y/jf to�0'o�c �� {/o e �/�jC !/Prf', ''Address of Owner. Date of Inspection G�3/ � (If different) Name of Inspector. Benjamin C. Osgood Jr. Company Name,.Address and Telephone Number. N.ew England EngineeringServices, Inc. 33 Walker Road, North Andover, Ma 01845 CERTIFICATION STATEMENT Tel. 508-686-1768 Fax. 50876.85-1099 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 inspectionwas 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 Further Evaluation By the Local.Approving Authority _ Fails. inspector's Signature: Date: The System Inspector shall a copy of this ' ion report to the Approving Authority within thirty (30)days of completing this inspection. If the system is a s system or has a design flow of 10,000914 or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Departmettt of Environmental Protection: The original should be sent to the system owner and copies sent to'the.buyer, if applicable and the approving authority. INSPECTION SUMMARY: . Check A, &, C, or D: A] SYSTEM PASSES: � I have not found any information whichindicates 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: l` One or more system components need to be replaced or repaired. The system,upon completion of the replacement or re Po P P Pau, passes. inspection. Indicate yes, no, or not determined(Yi 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 Fonforming septic tank as approved by the Board of Health, (revised 11/03/95) 1 One Winter Street • Boston, Massachusetts 02108 • FAX(617)556-1049 a .Telephone(617)292.5500 i, Printed on Recycled Paper SUBSURFACE SEWAGE_ DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addrem ..�// /*er.VI w A� 41d04G4 ✓Z!� Owner. S• ��,e �G Date of Inspection: Bj SYSTEM CONDITIONALL/Y PASSES (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 pipes)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to hroken 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 CI.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 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 aseptic tank'and soil absorptionsystem 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 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'PART A CERTIFICATION (oontinued) PropertyAdd Ass 4X w e 4do q:Pal, P, 4-.,4o Pee, .oO Owner. Date of Inspection D!a"SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. 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. i Backup of sewage into facility or system component due to an overloaded or.ciogged SAS or cesspool. .� Discharge or ponding of effluent tothe.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. T Liquid depth.in:cesspool is leas than.6"below invert or.available volume is leas 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. El LARGE SYSTEM FAILS: The following criteria apply,to large systema in addition to the criteria above: 'I`he 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_grwr.'--ter treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for flirGher information. (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B: CHECKLIST �J_ /lb. / Jude Property Address: 3 - ' Owner. Data of Inspection:' Check if the following have been done:. Pumping information was requested of the owner,occupant, and Board of Health, _None of the system components have been pumped for at least two,weeks and the system has been receiving normal flow rates � enduring that period:.Large volumes of water have not been introduced into the system recently or as part of this inspection. V(#As built plans have been obtained and examined. Note if they are not available with N/A The facility or dwelling was inspected for signs of sewage.back-up. v The system does not receive non-sanitary or industrial waste flow 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, dimenhions,_depth of liquid,depth of sludge, depth of scum. vThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBS URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ��//��r / y, SYSTEM INFORMATION Property Addstres ,��/Y,i� Owner. S� JCU e1., Date of Inspection RESIDENTIAL FLOW.CONDITIONS Design flow: Pllons Number of bedrooms, 5�' Number of current residents:__:. � Garbage grinder(yes-or no):_& Laundry connected to system(Yee.or no): Seasonal use(yes or no):__& Water meter readings, if available: Ali f Last date of occupancy: d uese q COMMERCIAL/I ND USTRIA I, Type of establishment: Design flow: Sallons/day Grease trap: present: (yes or no) Industrial Waste Holding Task present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system:-(yes or no) Water meter`madinp, if available: Last date of.occupancy: OTHER (Describe) Last date of.occupancy: GENERAL INFORMATION PUMPING RECORDS andurce of information:' �Ivt. W'1"ks 41110 C P,&,e Att.Ltp System pumped as part of inspection: (yes or no) If yes,volume pumped: eaLons Reason for pumping TYPE QF SYSTE?ri y' 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) APPAO)aMATE AGE of.all components, date installed(if known)and source of information: L 7 Sewage odors detected when arriving at the site: (yea or no) �6 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ^ nn SYSTEM INFORMATION (continued) Property Addres�d `� H7�#�C7.li K�� Nv -+c�pvac� 31i . Owner. kU C. U C, Date of Inspection:. SEPTIC TANK: (locate on site plan)' Depth below.,grade: Material of construction: croacrete_metal_FRP_other(ezplain) i Dimensions: /s Gb G-+6 L Sludge depth Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments.' (recommendation for pumping, condition of inlet and outlet/tees o baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) 2F. ti GJ ��rJ f i` 0 �oc�L TJ CX-,'A4 o/Z n'z GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction:—concrete_metal FRP—other(explain) Dimensions Scum thickness: --- Distance from top of scum to top of outlet tee,or'baffie: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlettees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) i (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C j. SYSTEMd�//INFORMATION (continued) Pioperty Address �.�� u/ y/Y/'e�ad w Gd, il?m A 4od elg, W4— Owner— Date tIl- Owner.Date of Inspection: �1314c, TIGHT OR,HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction:„concrete_metal_FRP—other(explain) Dimenaionsi Capacity: eallons Design flow: gallons/day Alarm level; Comments:, (condition of inlet tee', condition of alarm and float switches, 'etc.) DISTRIBUTION BOX (locate on site pian) Depth of liquid level.above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage.into.or out of box, etc.) -4 oK- lZ d e AV 29fV / A I-,ae ..t<A o x 7-5 0.AZ PUMP CHAMBER (locate on site.plan) Pumps in working order:(yes qr no) Comments (note condition of pump chamber,condition of pumps and,appurtenances, etc.) (revised 11/03/95) ? - i e�v� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM /I II,NFORMATION (continued) Property Adder �,:�2_57 Y 01 61 je jV 0t A-t eve, Aq,n Owner. . S, t;Uf� Date of Inspection SOIL ABSORPTION SYSTEM (w):� (locate on site plan, if possible;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: � o 7evpe-40r.5 00.ele /;2S ,?u i,l /01,441 leaching fields, number,dimensions. overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of pon , condition of vegetatioa,etc.) AA Q 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) 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.) (revised 11/03/95) g aw8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Addreaec v o 4 t�p'-t. fid, ki U c�ove e tkU i Date of Iimpec tion: 04 SKETCH OF SEWAGE DISPOSAL SYSTEM. inctude ties to at least two permanent references iandmarks or benchmarks locate all weli.s within 100' - I �IZ S DEPTH To.:GROUNDwATER Depth to groundwater:- -' feet method of determination or approximation: Q"P 0 G-el- (revised•11/03/95) 9. Commonwealth of Massachusetts "p�Massachusetts stem Pumping Record System Owner System Location Date of Pumping: Quairiity Pumped: gallons Cesspool: No ("i" Yes L_) Septic Tank: No U Yes System Pumped by: tatedere Srfan med License# Q)ntentS transierrred to : greater Lawrence 8anitanr District Date: Inspector: a Commonwealth of Massachusetts City/Town of rNOV E a System Pumping Record Form 4 '10 2010 DEP has provided this form for use by local Boards of Health. OthwN NORTHWN OF * he information must be substantially the same as that provided here. a re ck with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. S sterryLeEat' n: Left front of house, right front of house, left side of house, right side of house rear of right rear of house, left side of building, right rear of building, under deck. �J tec Citylrown. State Zip Code 2. System Owner: '4—C L Name 14f �-A) Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping - 2. uantity Pumped: D Date Gallons 3. Type of system: ElCesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes n/No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Locatio ere contents were disposed: G.L. Lowell Waste Water Signature of uler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1