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Home My WebLink AboutMiscellaneous - 240 CANDLESTICK ROAD 4/30/201811 WATER SUPPLY: WELL PERMIT____ WELL TESTS: -~~ COMMENTS: _ WELL DRILLER CHEMICAL ' -� ~' BACTERIA I BACTERIA II ____________ DAJE APPRUVEQ________ DAYE APPRUVEl� DATE APPHUVED_______ FORM U APPROVAL: APPROVAL. TO ISSUE NO DATE I��SU��{� �� ______-___' --'-----'— ��UNQ��uN�: -_-__-__'_____- / / FINAL APPROVAL: ALL PERMITS PAID NO / / WELL CONSTRUCTION APPROVAL NU SEPTIC SYSTEM CONSTRUCTION APPROVAL NO OTHER YES NU ANY VARIANCE NEEDED NO FINAL BOARD OF HEALTH APPROVAL: DA7E:7��/�� 8Y: . LOT # {�E�- # �o��BPARCEL '__________� STREET __��._�_�==== HAS PLAN REVIEW FEE BEEN PAID? NO PLAN APPROVAL: DATE APP. BY__e�� ... ....... DESIGNER: PLAN DA[E .__'-�-��z-��_ CONDITIONS WATER SUPPLY: WELL PERMIT____ WELL TESTS: -~~ COMMENTS: _ WELL DRILLER CHEMICAL ' -� ~' BACTERIA I BACTERIA II ____________ DAJE APPRUVEQ________ DAYE APPRUVEl� DATE APPHUVED_______ FORM U APPROVAL: APPROVAL. TO ISSUE NO DATE I��SU��{� �� ______-___' --'-----'— ��UNQ��uN�: -_-__-__'_____- / / FINAL APPROVAL: ALL PERMITS PAID NO / / WELL CONSTRUCTION APPROVAL NU SEPTIC SYSTEM CONSTRUCTION APPROVAL NO OTHER YES NU ANY VARIANCE NEEDED NO FINAL BOARD OF HEALTH APPROVAL: DA7E:7��/�� 8Y: . Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner's Name North Andover City/Town MA 01886 August 25,2015 State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. RECEIVE® -� Important: When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor - do not John DiVincenzo use the return key. Name of Inspector Stewarts Septic Serive Q Company Name 58 South Kimball street Company Address Bradford City/Town 978-372-7471 Telephone Number B. Certification l MA State S113386 License Number r SEP 17 7015 Oj TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 01835 Zip Code 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 the 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 ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �r Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 JU Commonwealth of Massachusetts u Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is North Andover MA 01886 August 25,2015 required for every g page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated 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 of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner's Name North Andover MA 01886 August 25,2015 City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 public health, safety or the environment. 1. 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: ❑ 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 t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Commonwealth of Massachusetts s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is North Andover MA 01886 August 25 2015 required for every g page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. 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: ❑ 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 SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins • 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 4 of 17 ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes Commonwealth of Massachusetts Title 5 Official Inspection Form the system is within 400 feet of a surface drinking water supply Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ❑ 240 Candlestick road ❑ Property Address the system is located in a nitrogen sensitive area (Interim Wellhead Protection James Grifone Area — IWPA) or a mapped Zone II of a public water supply well Owner Owner's Name information is required for every North Andover MA 01886 August 25 2015 g , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of 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 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. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 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 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 large 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. t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 5 of 17 S _m Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is required for every North Andover page. Cityrrown C. Checklist MA 01886 August 25,2015 State Zip Code Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is required for every North Andover page. Cityrrown D. System Information Description: RAA 01886 August 25,2015 Zip Code Date of Inspection Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No off and on 5 years ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes Number of current residents: No 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No off and on 5 years ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No l5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is North Andover required for every page. Cityrrown D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: MA 01886 August 25,2015 State Zip Code Date of Inspection General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date 1500 gallons Site guage on truck inspect tank Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Yes ❑ 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 system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 240 Candlestick road Property Address James Grifone Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) MA 01886 August 25,2015 State Zip Code Date of Inspection Approximate age of all components, date installed (if known) and source of information: 25 years Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line 36" feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): ❑ Yes ® No Septic Tank (locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: Sludge depth: ❑ Yes ❑ No l5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is required for every North Andover page. Cityfrown D. System Information (cont.) Septic Tank (cont.) nnn 01886 Zip Code 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 33" 0 611 16" August 25,2015 Date of Inspection How were dimensions determined? tape measure & sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both baffles good no leakage no liquid levels good. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins • 3/13 Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is North Andover required for every page. City/Town State 01886 August 25,2015 Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is North Andover MA 01886 August 25 2015 required for every g , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Equal dist. no leakage no solids carryover. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts u u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 240 Candlestick road Property Address James Grifone Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) State 01886 August 25,2015 Zip Code Date of Inspection Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (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 ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) l -.k. 01886 August 25,2015 Zip Code Date 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.): t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 v�= Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is North Andover required for every page. City/Town MA 01886 August 25,2015 State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand -sketch in the area below ® drawing attached separately t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: MA State niAAA uN -.- 124" feet August 25,2015 Date of Inspection Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: March 11,1986 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Pulled files ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Taken from design plans water at elevation 124.0 bottom of pits 129.0 5' seperation Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 =til= Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Candlestick road Property Address James Grifone Owner Owner's Name information is required for every North Andover page. City/Town MA 01886 August 25,2015 State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 1 A 11 l : IJ >- ` 1 Form No 3 Town of North Andover, Massachusetts BOARD OF HEALTH NORTH 3?O.",i° ,..4oOt / ' /f�'�/ � 167 �19 O 9 F DISPOSAL WORKS CONSTRUCTION PERMIT ,SSAC14 Applicant NAME ADDRESS TELEPHONE Site Location T� CNo4��TiG/< Permission is hereby granted. to Construct (e or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH (A Fee � � D.W.C. No. AS -BUILT CHECK LIST and .FINAL INSPECTION Proposed Elevations As -Built Elevation House 3,, Jam- Tank IN 13 • G 13R , b6 Tank OUT /3 1(3 71 D -box IN D -box OUT )31.09 Trench Inverts Line 1. j a /• d Line 2 Line 3 Line 4. Bottom of Exc. oo �� d Stone OK? Cr- D -box checked? Pipes cemented? �- II Town of North Andover, Massachusetts Fo►m N& 2 ,►oRr„ BOARD OF HEALT a? ��... • soot t 19� a • •-- • • ' DESIGN APPROVAL FOR Argo as"C"°5`` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No, /� Site Location ! A S J,' ,, Reference Plans and Specs. �'Vl' ENGINEER " DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee Z 0 CHAIRMAN, BOARD OF HEALTH Site System Permit No. -S 9 7-- NorE : Vag 01- - o'V% Sl Zt l C1 Z . BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 7A CANDLESTICK ROAD - TOM NEVE - 8:00 P.M.: TEL. 682-6483 Ext. 32 Mr. Steve Durso from Neve Associates was present representing Bob Janusz, Lot#7 Candlestick. Mr. Durso proceeded to read a letter dated April 15, 1992 from Neve Associates. The letter requested that a variance be granted to local regulations allowing the leaching area to be installed within 70 feet of the edge of a bordering vegetating wetland. Mr. Durso stated that when IEP originally flagged this wetland that the wetlands line was set at the edge of the current BVW and due to the fact this retention area was created to take street run off and was not grated to contain run off in a specific area that the vegetation has crept up slope. He stated that this is not a wetland that existed, this a wetland that crept up slope do to an increase in run off. Mrs. Nelson mentioned that the Conservation Commission Administrator disagrees with that interpretation/opinion. Ms. Conboy stated that Mr. Rosati is familiar with the property but he has not reviewed the plan and he recommends that the Board Members hold off on any actions regarding the property until he reviews the plan. On a motion by Mr. Osgood, seconded by Dr. Rizza, the Board voted unanimously to wait and ask Mr. Rosati to review the plan and vote on a variance at the next meeting. Minutes: April 23, 1992 BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 LOT #7 CANDLESTICK ROAD: Mr. Robert Janusz, Owner, was present. Mr. Rosati reviewed the plans and he met with the Building lplastic o bard e he mutually agreed to install a 20 polyplastic under thn foundation footing. Septic tank 25 feet from building, 80 feet from detention area. Bottom of bed 5 feet above water table. Plan revised May 20, 1992. On a motion by Mr. Osgood, seconded by Dr. MacMillan, the Board voted to grant the varianclethe distance ofsections the tanks fromothe cal regulations, one dealing with house 25 feet verses 35 feet and distance m the between the field and the wetlands 80 feet verses 10 BOARD OF HEALTH MINUTES MAY 21, 1992 SUBDIVISION ASSESSORS MAP FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM ��_ SUBDIVISION LOT(S) -;'� PERMANENT ADDRESS (ASSIGNED BY D.P.W.fj� STREET C�441 A-eC j-77 APPLICANT �%�k1�. 1 /Y/GQ-/� 0 h ► PHONE DATE OF APPLICATION /, — / C TOWN USE BELOW THIS LINE PLANNING,BOARD TOWN( PLAN CONSERVATION COMMISSION CONSERVATION ADMIN. BOARD OF HEALTH HEALTH SANITARIAN DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT .-4ZWMt� WATER CONN FIRE DEPT. 06-3-Fb3 (") DATE APPROVED' DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. a DATE Sheet of l BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE PERMIT # 3: DATE RECEIVED_ APPLICANT - � ASSESSOR'S MAP ADDRESS ENGINEER ADDRESS PLAN DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED PARCEL # LOT # STREET REVISION DATE (l gra '�, '� io �, a c:, r62 ►.� i �r� � , THS April 15, 1992 ING Board of Health Town Hall 124 Main Street North Andover, MA 01845 RE: Lot #7A, Candlestick Road, North Andover, MA Land of Robert Janusz Dear Board Members: Please find attached a Sanitary Disposal System Design plan for Lot #7, prepared for Robert Janusz, originally on August 22, 1986. This lot is in the Jered Place development Phase I. Recently, this lot went under a Purchase and Sales Agreement to sell to James Grifoni. We have revised the plan to show the house which Mr. Grifoni wishes to build, and in doing so have submitted the plan with a Notice of Intent to the North Andover Conservation Commission. The North Andover Conservation Commission reviewed the edge of the wetlands when the subdivision was originally proposed in 1988, and those wetlands as established were shown on the drawing which measure 101 feet away from the edge of the leaching chambers. Recently Mr. Doucette, Conservation Administrator, has redelineated the wetland as a result of n wn vegen. tatioThis new wetland edge resulted because this area is now ei.ng used as a detention pond, which was constructed as a result of the Candlestick Road subdivision. Drainage—from Candlestick Road now discharges into this detention pond. It is our professional opinion, that this has caused a wetter condition to exist which in turn has caused vegetation tom creep up the hillside closer to the area where the system was designed. The _j- new line creates a 70 foot separation to exist from these newly f agged we ate. our ocal regulations require that the be separ� from wetlands by a distance of 100 feet. You are aware that the state code only requires a separation distance of 50 feet. • ENGINEERS • 447 Old Boston Road (508) 887-8586 • LAND SURVEYORS • U.S. Route #1 • LAND USE PLANNERS • Topsfield, MA 01983 FAX (508) 887-3480 This lot currently has a construction works disposal permit. We have reviewed this matter with Mr. Doucette. He thinks that it is more appropriate that we request a variance from the local regulations rather than proposing to fill this new found wetland area in order to provide the 100 foot separation. We agree with Mr. Doucette. Please consider the following: 1. The soil logs indicate that the land being built on is comprised of well=drained gravel. 2. In the springtime of the year, the water tables were found at a depth of 9 feet and 10 feet below the surface of the ground respectively and the percolation rate was well below 2 minutes per inch. 3. These conditions guarantee a vertical percolation of sewage. 4. The area where the system will be built is flat. As designers we realize that the horizontal separation distances are more a function of soil conditions. If this lot contained glacial till or clay soils which promote more lateral movement than vertical movement, I would have a different opinion, but since gravel will ensure vertical movement, I feel a variance in this matter is appropriate. Since this area if flat the separation distance is not as critical since there are no slopes at which sewage in the latter stages of the system's life could break out over the ground. This flat land coupled with very pervious soils, establishes in my opinion what the intent of the separation distances are. Mr. Doucette indicated to me today that he was forwarding a letter to your Board recommending that this variance be granted. I hope that you will look favorably upon this request and grant a waiver to your local regulations allowing the leaching area to be installed within 70 feet of the edge of a bordering vegetating wetland. Steven D'Urso, our soil scientist, will be accompanying Robert Janusz to your meeting this evening in order to present these plans with our request. I appreciate your expeditious response to this matter. Sincerely, EVE ASSOCIATES, INC. THOMAS E. Thomas E. Neve, P.E., R.L.S President TEN/alg cc: Robert Janusz TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) OCT - 3 200 - DATE OF PUMPING: QUANTITY PUMPEDZ? GALLONS CESSPOOL: NO 1/ 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: _ _%ino6ver COMMENTS: CONTENTS TRANSFERRED TO: M� 0 'rOWN OF NO TH ANDOVF-�, L) A F h SYSTEMU PU PINQ CORL, SYSTEM i� UWNFR ADDRESS DATE OF PUMMNQ; —/ r -M LWATION op Lq -QUANTITY PUMPED: ... -t/, Of YESX L-:OSPOOL: NO __.._.......YES,. .... .. ISnpcic NO "A rURE OF SERVICE: RourINE... CMSERVATIONS: QOOD CONDInoN HEAVY 0"WE M U LL JYJ COVER ROOTS �-�BAES IN PLACE. iner, LEACIVIELD RLJNRAtle DEC 0 7 2004 0001 v r, SOLIDS_FLOODED SOLID CAkRYC)VEp,"-- O'MER EXPLAIN aim; �Q. '-'UMMENTS. ......... . m 0, I/ .:.:i;:;,jrrjiEtli';4:i�4�:4%d:j��:�,f�(:1<i�.1i�X'`\'��'N.''`U�' ;•'�'`''. .: 'Y'�Y�''!n+iW:•1i:YV.:',}III`:•Id�CY`hP.''a:'iVi�.k,:: •a. Gj rf` ��, :(;�(,��',r•l,}}��4 � (� i •�/FI�(�I�•4+1�, •II(i'•f"f.:.•ti,. .,.,,':,.;.'.. ',�i��:'! b�h:: ��i•'iJ }�•":•�''Y ,:. t�i''\.'�ilt J�., y,.{', G.:; :.i'. i,i ,,.'•, ,i ��'>•!'�M' N 1 CSS 171 •,:.,f,:,.' ,, tip, . , Ue rMq .. .�,. u.��':'�"\i'i('(�d:�i}y.t5<'i.`�f/j�l�(: I,fa�. �i '' n,.'�. :',. , •^-+._._......... ... T m Y, .1 _ uuV, no's.:. ys ser• f� .. � ';t..; •:�'; �. w,•i%i ,' .. � � �-_.�... yes. 'iTUKEO.F.;SER`IY.LCEi.'`ROVTInE.' EM ERCE�C'r u�L.Tu cur" . � "'GX'CES.SI,YEr$.Q,�'I•�S •:: '' : FLO.O.OE� � _... .:'..:.�"1,54�1�4`!�1�.hv'ft•f�'YO.YYft>�''�, p,xF�t!�x°�.�.• '• -.... i,��,.'.�•' �)1�j"d' A'i'�I 1•�'�'��'jj��JY�L ,11' i�//.;',��f)'''�1 ��ll i`�,.',�i�', 1�::'-�1 ' �.,.:,i:'�I;II�.i'�`�'�l'.�i.?..yS't'I'',1:.��'il��l,�`;s•1�Y�`�;.).�jtS �r,;r}j`.��;:;r,::•a";;': ( Ai'S'I VMIPVMPCO:OY. • ... /'f� �•Y!:`; X�' ,,. ' I f -!4.:_ 4 i o,iTfio I, r�5`rcli'Ict,p l'u. rf+ � �x L k-"yc• � a v' y st •m'.i%�2ssr, '..0 r 'z..rs '�< .�.rr �� t � `�w ' a> , } a; �- � k � nF�'�,r�",s'��'�1� j...'�'a t .� 1 �•r f n r ,Vr a c , 57 ji 09 xs?r* S r}',�'; '' -a. i i r' ',r�afx t 4"'- ix � 11'l'•*.;rtri:,k TOWN, VA rk , � SYSTBX" PL)MPINU R COKI' 1 � 1 :' •MMe.Yi�yr.wltie+s+nw.xr..y.r� L ®WA��Rr� h�DR�ss ' '._"_"'" sY\Sr�M i..�x•:��ii � ... ....__.... �. __...... ... G � , I DATI 0F QUANTITY PUMPEp Y•�s, 3�Rl+i rit�c t tr 404UR VA'nt,}J r q cpct�Nt�i rION r yyY IN PLAT, t YQFLOODED ' �OLtD�,�1V�Y��.,.... AC31'WBR EXPLAIN 4'UMMtNT f q„ as"t.gi33..7 Tr a}x 1 t f c vH � �N I � ril�1N�T�KKI�iJ 1 t { n f .. ., :r, r w. n , S� t•'s+ ytgrs. i r mr<w r t -f r`�`"✓JVG.Kt•C1'w .Fie kRt rL�S"'i'1'_� !mss#�k+k•Y'��q�^�'Y°'314`'*}> '.'#. - '1 � r ��Ff�lyr��s North Andover Board of Health 120 Main St. North Andover Ma. 01845 Haul Lic. #151 -OOH Install Lic. # 128-0 Date Name & Address 12/1/2000 Murphy - 16 Crossbow Lane 12/2/2000 Manzi - 72 Foster St 12/4/2000 Grifin - 240 Candlestick Rd 12/5/2000 Mcilvien - 57 So .Cross Rd 12/6/2000 Small - 440 Fosrer St 12/6/2000 Orlando - 274 Foster St 12/7/2000 Weger - 29 Barco lane 12/8/2000 Walton - 161 Bridges Lane 12/11/2000 Coflan - 73 Christian Way 12/12/2000 Orlando - 7 Laconia Cir 12/12/2000 Fitzgerald - Sharpner Pond Rd 12/18/2000 Mangano - 324 Bradford St 12/19/2000 Galea -= 1589 Salem St 12/19/2000 Johnson - 91 Boston St 12/22/2000 Senton - 1620 Turnpike St Andover Septic 47 Railroad St. Bradford Ma. 01835 Gallons Comments 1500 1000 1500 1500 Flooded 1000 1000 1000 1500 1500 1000 1500 1500 1000 1000 1250 Flooded PA -� December 2000 JANUARY 28, 1992 TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, NA. 01845 ATTN: MR. MICHAEL ROSATI DEAR MR. ROSATI: WHEN I MET YOU LAST WEEK ON LOT #43, I WAS SADDENED TO LEARN OF YOUR PLANNED DEPARTURE FROM THE BOARD OF HEALTH. IF YOUR DEPARTURE IS PLANNED WITHIN THE NEXT 30 DAYS, I WOULD LIKE YOU TO CONSIDER THE FOLLOWING: 1) A SEPTIC DESIGN FOR LOT #7 JERAD PLACE PHASE 1 WAS APPROVED ON JUNE 12, 1987 ( SITE SYSTEM PERMIT NO 547). 2) THE PERMIT HAS EXPIRED AND THE REDESIGN OF THE SYSTEM IS SUBJECT TO NEW REGULATIONS. 3) ABOUT A MONTH AGO, WE REVIEWED THE TOPOGRAPHY OF THE LOT AS EXPRESSED IN THE ORIGINAL SEPTIC DESIGN - AND THE AREA IS ESSENTIALLY LEVEL - BOTH DEEPHOLES WERE 100% GRAVEL BELOW A 30" LEVEL OF TOPSOIL & SUBSOIL TO WATER DEPTHS OF 108" AND 124" RESPECTIVELY. I ASKED IF EITHER DEEPHOLES OR PERCS WOULD HAVE TO BE RE- DONE, AND AFTER REVIEW - YOU INDICATED "NO" AS LONG AS THE RE-VISED SYSTEM WAS IN THE SAME PLACE. MIKE, THIS LOT WILL BE GOING UNDER PURCHASE AND SALE IN THE VERY NEAR FUTURE AND I EXPECT TO BE COMING TO THE BOARD OF HEALTH WITH A PLAN IN THE NEXT 30 DAYS. I WOULD LIKE YOU TO REVIEW, VERIFY, AND SIGN - WITH WHATEVER QUALIFICATIONS MAY BE NECESSARY - THAT NO NEW DEEPHOLES OR PERCS ARE NECESSARY IF THE SYSTEM IS RE -DESIGNED IN THE SAME LOCATION. THANK -YOU FOR YOUR ATTENTION, AND SINCERE BEST WISHES IN THE FUTURE. SINCERELY, �1 ?NUSZ ROBERT 40 SUNSET ROCK RD. ANDOVER, MA. 01810 .> ^j ) J tr- rj&OL_ 1 F, I iVOI�-rH AAJIPOVEI�I M,4, -r)-,' sPE,y �r _7 C,Q►�� c.� s nc..�.1 �4PPLi CAti) I_ -% COA)PI Tro,vs = D I 5A PPRp VED RF4Soms : /JPi-AovlN6 /6ur(loj�i-ry Dt-�.� SrP1-r c SyST�tit 1.� sii0 I-LQTi o�1 E7CAU4 T(c►/v FINAL I �SPFcrlon� A PPj�n�)Ep Mrc Q4TC ,aVDIrjom,aL, I/k,; jOA,� (J�- any DIS/3PPKovED R��5 j N5 FRAC APPFNAL orE D ►,ass ❑ F411 APPNDvwG AUTor�jTr APPRovc&16 4 u -1 Hogg cy