HomeMy WebLinkAboutMiscellaneous - 260 CANDLESTICK ROAD 4/30/2018m
M
0
C) X
001
DATE:
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING -Q-1 QUANTITY PUMPED GALLONS
CESSPOOL: NO -- �YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE -,"�E�MERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIEELD RUNBACK
FLOODED
OTHER (EXPLAIN)
COMMENTS:
-�L,IJN OF
BOA
4 7001
CONTENTS TRANSFERRED TO:
Town of North Andover
Office of the Health Department
0
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
Sandra Starr
Health Director
January 9, 2002
Mr. John Vernasco
263 Candlestick Road
North Andover, MA 0 1845
Re: Application to finish basement for playroom
Dear Mr. Vernasco:
Telephone (978) 688-9540
Fax (978) 688-9542
Your application to finish the basement for a playroom at 263 Candlestick Road has been reviewed by the Health
Department. The application was denied on January 9, 2002 for the following reasons:
1. X Missing information
2. Passing Title 5 inspection of septic system may be required
3. Location of structure not acceptable
To address the problem(s):
If #1 is checked, please supply:
a. Floor plan of the existing dwelling
b. Certified plot plan showing house, septic system and proposed project in scale
If #2 is checked:
a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and
whether it is operating properly: OR
b. Tie-in to municipal sewer
If #3 is checked:
a. Relocate the project
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sincerely
Ek'I'an J. LaGrasse, llealth Inspector
Cc: Building Department
File
James Testa, 120B Hill Street, Topsfield, MA 01983
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
WILLIAM F. WELD
Govemo:
ARGEO PAUL CELLUCCI
Lt: Govemor
COMMONATEALTH OF MASSACHUSETTS
ExEcUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMEINT OF ENVIRONMENTAL PROTEC- TIONA-1
ONE WINTER STREET. BOSTON, 161A 62106 611-202-0$00
4
TRUDYICOXE
____j Secretary
DAVID B. S LIHS
Co�
In,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM orn issioner
PART A
CERTIFICATION
Property Address- Q463 - Vc-)4.. AX)q-,ZZ rfoT�nvt�A
Date of Inspection: ( -- _LA --- C? (if different)
Name of Inspector: Kj ksl��
I am a D "cfpr pursuant to Section IS.340 of Title 5 (1310 CMR. 15.000)
Company Name:
Mailing Adiiress: j_k% t-k.010o
Telephone Number: !�j"jLLL41-7S7—W1&0_
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete *as of the time of inspection. The inspection was perform�d based on my training and experience in the proper function and
maintenance of on-site �sewage d' p6s . al systems. The system:
Passes
Conditionally Passes
Needs)f urther luatign Boy the Local Approving Authority
F 'k
Ms,
s
4
copy
Inspector's Signature: Date:
V
The System Inspector s 11 t bmit 4acopy of this inspection report to the Approving Authority within thirty (30) days of tompl6iing this
inspection. If the system it a shared system or has a detign flow of 10,000 gpd or greater, the inspector and the tystem owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection. The original should be tent to the'kystern -owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, 0, C# or D:
A] SYSTEM PA
I have nof found any information which indicates that the systern violates any of the failuri criteria as defink! in 310 CIAR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
8) SYSTEM CONDITIONALLY PASSES:,
One or more system components as described in the 'Conditional Pass" section need to be replaced or repaired. The sys.tem,� upon
completion of the replacerrient or repair, as approved by the Board of Health, will pass.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instance$. W"not determined", explain wh-V hot.
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 (20) years prior to the date of thd ihipection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltrAtion or extiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is "laced with a conforming septic tank
.as approved by the Board of Health.
(revis*d 04/25/97) V of 10
DEP on the VVwW Woe Web: hItp:1hvWw.ft*gWsh0.h0.U81de0
0 Printed on Recycled PaPer
0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address -
Owner: c p31 S-t\cliz f
Date of Inspection: �t r. tl\tg
0-
61 SYSTEM CONDITIONALLY 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). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system I will pass
inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:.
Conditions exist which require further evaluation by, the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WIU PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
4 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 eoARD-OF HEALTH (AND PUBLIC WATER SUPPLIERj IF APPROPRIATE) DFTtRMINESTHA'r
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT$ THE PUBLIC 14EALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and wi I absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has A septic tank and soil abtorption system and the SM is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water ' supply Well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but to feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and Volatile organic cornpoundt Indicates that
the well is free from pollution-from-thatlacility ;jnd,thiie, presenceof ammonia nitrogen and nitrate nitrogenit oeq# to or
less than 5 ppm. Method used to determine distance 4pproxintaflon.not valid).
3) OTHER
(revioited 04/25/07)
jo :
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
C
Property Addreis: X
Owner:
Date of Inspection: Alo V,(Q 11
D) SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 3 10 CMR 15.303, The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to coirrect
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface 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" Wow invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT.due to dogged 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 surfacewater 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 an ' alyzed to be acceptable, attach copy of well water Analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen.and nitrate nitrogen.
Ej LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the fdllowing:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,ODO gpd or greater (Large System) and the system is a significant threat to
Oublic health and safety and the environment because one or more of the following conditions exist:
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 - WPA) or a rnapped Zorw'll of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatrmn t Program
requirements of 314 CMR 5.00 and 6.00. Please consult the local 'regional office of the Department for further information.
,061
(r*vis*d 04/2S/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART 0
CHECKLIST
Property Address:Qc,3
Owner:
Date of Inspection -
Check if the following have been done: You must indicate either 'Yes* or *No* as to each of the following:
Yes No,
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components hove been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volurnes of water have not been Introduced into the system recently or
as 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 signs of sewage back-up.
The system does not receive non -sanitary or industrial waste flow.
The site was inspected for signs of breakout.
All system components, excluding the toll Absorption System, hay, a boo locatw on the shm
The septic tank manholes were uncovered, opened, and the interior ofthe septic tank was Inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum..
The. size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the. proper maintenance of
Sub -Surface Disposal System.
Existing information. Ex. 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) [15-302(3)(b)]
.f-
(reviseA 04/25/97). *ago 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
.Pro'erty Address:
P
Owner:
-il��
Date of InsWpection..
tc)—H—Ti
FLOW CONDITIONS
RESIDENTIAL:
Design flow: t I D p.dJbedroorn for S.A.S.
Number of bedrooms- Ll
Number of current iQdents:
Garbage grinder (yes or no): 60
Laundry connected to SyVqm (yes or no):�&s
Seasonal use (yes or no): NO
.f .. 1q, 1co
Water meter readings, i avp1lable (last two (2) year usage (W)d):
Sump Pump (yes or no): IPTO
LA -6 Z� ct�
Last date of occupancy: VW'2�
COMMERCIALANDUSTRIAL:
Type of establishment:
Design flow:_gallons/day
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:
LastAte of occupancy:_
OTHER: (Describe)
Last date of occupancy:_
GENERAL INFORMATION
PUMPING RECORDS and source of infotmation:
inion:
System pumped as pan of ye or no)
Ins
7—
If yes, Volume pumpe� Ilo
—� S�-7'
Reason for pumping: V S.
TYPE OF SYSTEM
1,.-Wptic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
VA Technology etc. Copy of up to date contract?
Other
APPRO TE A E of 41 components, date installed (if known) and source of information- �4(2A&<,
Sewage odors detected when arriving at the site: (yes or no)
0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Prioperty Addret st 6400�e,� C.A�
Owner: Hs. K C CLO U CA�
Date of Inspedion: L4-9"
BUILDING SEWER:
(Locate on site plan)'
Depth below grade: D
Material of constr40ion:
Distance from private water supply well Of suction lir!�
Diameter
CorprpentS- (con4ition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:.
(locate on site plan) CaJZK-
Depth below grade:
Material of construction: L -'co crete —Metal _Fiberglass —Polyethylene _other(explain)
If tank is metal, list age is age confirmed by Certificate of Compliance (Yes/No)
Y-7 -
Dimensions: L4
Sludge depth.—
Disfance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: U )1 9
Distance from top of scum to top of outlet tee or baffle:
f flet tee or- baffle:
e e
Distance from bottom of scum to bott
How dimensions were d t ined: U �b
C)
Comments:
(recommendation for pumping, con%of �lolan�dude tee, ,�ffles, qepth of ll'qul� level in =t
inte evidence cif leakage, et 4A
/N. t1:1 �Ao
GREASE TRAP: V4>"e—
(locate on site plan)
Depth below grade:
Material of construction: _concrete _r*tal —jiberglass ___Polyethylene .9ftr(expIain)
Dimensions:
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:
Date of last pumping:
Comments: baffles, depth of liquid level in relation to Outlet invert, structural.
(recommendation for pumping, condition of inlet and outlet tees or
integrity, evidence of leakage, etc.)
(rev$xed 04/2S/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection: �c) r7
TIGHT OR HOLDING TANK:fty (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
material of construction: —concrete __rnetal —Fibergl8s —Polyethylene __ptWexplain)
Dimensions:
Capacity!_ gallons
Design flow:_ gallons/day
Alarm level:_ Alarm in working order Yes; — No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm'and float switches, etc.)
DISTRIBUTION BOX:—
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(ncie if le\tel anO distribL4ion is equal, evidence of solidi car%=r, evidtnce of leakage into o t ofoof, etFJ 'D-
how
PUMP CHAMBER: V\
m-R,C�M.U"4*�
(locate on site plan) C-3
Pumps in working order: (Yes or No)_
Alarms in working order (Yes or No)_
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
4,Aok-w�
Property Address: rl)k 11-16-t-, �)A
Owner:
Date of Inspection: 4 -q`7
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavation bot required, but may be approximated by non-intrusiv* methods)
If not determined to be present, explain:
Type:
leaching pits, number:_
leaching chambers, number:_
leaching galleries, number: tov
leaching trenches, number,length:,..
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
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.)
PRI1VY:.IAW
(lowe on site pbn)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of poncling, condition of vegetation, etc)
"A"
(revised 04/25/97) *age I of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection: a
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
e -
tie
Uj 0A
A -A -o
3 14'
ks
0)-�o 5 al �G
(revised 04/2S/97) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address. wo.-�!)
Owner RC MN clvc��A
Date o; Inspection:
Depth to Groundwater Feet
Please d' te all the methods used to determine High Groundwater Elevation:
�Obtai ed from Design Plans on record
Ob tian of Site (Abutting property, observation hole, basement sump etc.)
Deter . e it from local conditions
L- �Check with local Board of heilth
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your o W'n words how you established the High Groundwater Elevation. (�just be completed)
0 4M. Y'\
40 ^1
(revised 04/2S/97) Pago 20 of 10
TEL: (508) 475-1474
FAX: (508) 475-5451
BATESON ENTERPRISES, INC.
Excavating - Water & Sewer Lines - Septic Systems & Pumping Service
I I I Argilla Road a Andover, Mass. 0 1810
Title 5 Inspection Report
CCk-V\Ck\e� Cj� OL,-)CA�J\ ")u'a4
Property Address: ------------------
�A U,�;. At--Ik c_�,
Owner: -----------------------------
Date Of Inspection: -
My report contained herein does not constitute a guarantee
of future usage and the functionality of the existing septic
.1
system. Such report issued herewith is merely based upon my
observations, and I hereby disclaim any further operation
of your current septic system.
k
11 of 11
Neil J, Bateson
Bateson Enterprises Inc.
0�,
is 3 -v�—
ppjf�o \j J�FV
. COAJPlTVJ5::
-Q-T6ujtj DWELL.
W11C G'ISTE/"
P4 -r6' 2-
6 -LL -V AFRWPJ6 AuTtjoi?ry
J,4v 0 cz
CL)P 1-0 IS' R�OAl (T)
AAe &6r 0,)5��Z,
F(oA,) 5 OA:-) 09(6(/k -.)4L PL4Aj AAJC) AC)&,G 7-1-fr=-� VM6--,- 01%JFC-Ul-�
PL,)L :210
4-:-X4V4T(�0
RNAL IV5p6�--Fjoo
4 P 1-21�0 \j Ep
,5,fPr(6 'sy5Tcm OUSUU-4TIOAJ
M -rc
GIUC- 10 -2,1 -ft
AVP(TjoMAL- J.,Aj5Fb:::-,jo,.,j5 (,PWy)
tos
��/15S [] FA I L-
Ap)2j;�001A)6 T�f L,) I? �-Fy
-ru -��Cen-
CCT Ck YT-51,-�a,-nw
Rk4L APPR6VAL 0/6 APPROnkt /3ul-ringjt-\/
>
rt
CD -7
m
(D
0
_0
u
En
(D
CL
Lo
(D
0
'h
m
rf
(D
0
h
-n
h
cu
h
>
(D
Lr)
0
m
a
0
'h
-r
rD
>
rt
CD -7
m
(D
0
_0
u
En
(D
CL
Lo
(D
0
'h
m
rf
(D
0
h
-n
h
a -A 0 C Z:
13 )"-O.D Z
AJ 13. A/ JA ei ti
CO A# 0
A14F!
C6
LOT
ARE'A'.�*-' 4,�56 5 $0,
'00e
IOT 8 Ln
ox
cn
04
�44
50 4,E�
VY 17
-16-D
.................... 7-"
cb,,i
June 9J. 1988
Town o6 Noxth AndoveA
Bocftd o6 Heatth
120 Main St�Leet
Noxth Andova, Muz. 01845
Attn: M. Gxa6
D,eoA Mt. Gta6:
Attached " a copy o6 Lot 9A �ot JERAD PLACE Pha,se I Ishowing the otd
and new tot Una. Moving the house back within the tAeetine wiU ptovide
a much betteA siting, and I appteciate youA hetp in thiz matteA.
SinceAety,
Ro J. Jan
40 Su"et Roc Road
Andovex,, M",s. 01810
RAGGS, INC.
Subsurface Soil Disposal
Inspection Report
In Accordance With
Title 5 (310CMR 15.000)
P. O.,Box 1027, Concord, MA 01742
(508) 369-1100 / (800) 287-5541
FAX (508) 897-3848
4
Li
r7
Li
r -I
LLJ
r-1
L
rl
i
LLI
Lj
r-1
Ljj
r -I
Lzi
rl
L -i
rl
L -j
r -I
L -i
r-1 I
L -d
r -I
LAI
;-zr
4
Li
r7
Li
r -I
LLJ
r-1
L
rl
i
LLI
Lj
r-1
Ljj
r -I
Lzi
rl
L -i
rl
L -j
r -I
L -i
r-1 I
L -d
r -I
LAI
R1&%GGS, INC., P. 0. Box 1027, CONCORD, MA 01742
(508) 369-1100
OFFICIAL CERTIFICATION
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION
IN ACCORDANCE WITH TITLE 5 (310 CMR 15.000)
CERTIFICATION PREPARED FOR: Frank Utano
ADDRESS OF PROPERTY- 260 Candlestick Road
North Andover, MA 0 1845
DATE OF INSPECTION: June 3, 1996
RESULTS:
X This property has PASSED the criteria set
forth in 310 CMR 15.000.
This property has CONDITIONALLY PASSED
the criteri a set forth i n 310 C M R 15. 000.
This property has NEEDS FURTHER
EVALUATION BY THE BOARD OF HEALTH
according to the criteria set forth in
310 CMR1 5.000.
This property has FAILED the criteria set
forth in 310 CMR 15.000.
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742
(508)369-1100
USUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
I
I
ADDRESS OF PROPERTY: 260 Candlestick Road
North Andover, MA 01845
OWNER'S NAME: Frank Utano
DATE OF INSPECTION: June 3, 1996
PART A
CERTIFICATION
Name of Inspector: Wendy Diotalevi, R. S.
Company Name: Raggs, Inc.
Company Address- P. 0. Box 1027, Concord, MA 01742
Certification Statement
I certify that I have personally inspected the sewage disposal system at this address and that
the information reported is true, accurate and complete as of the time of inspection. The
inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
PASSES NEEDS FURTHER EVALUATION BY
THE LOCAL APPROVING AUTHORITY
CONDITIONALLY PASSES FAILS
Inspector's Signature rD- afe
Wendy Diotalevi, Registered Sanitarian #942
Raggs, Inc. certifies that all work performed on the aforementioned property was done in
accordance with the guidelines set forth in Title 5 (310 CMR 15.303).
Fred T. Fish, President
Raggs Septic Service, Inc. d/b/a E. A. Comeau
File No.: 96-10864/UTANOFRANK
Copies to: Payer of inspection
Local Board of Health or its agent
,�; lelleel,
Date
E
I
71
I
I
I
I
I
I
I
I
E,
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-10864/UTANOFRANK
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY
A. System passes:
X I have not found any information which indicates that the system violates any of the
failure criteria as defined in 31 OCMR 15.303 Any failure criteria not evaluated are
indicated below.
B. System Conditionally Passes:
One or more system components need to be replaced or repaired. The system,
upon completion of the replacement or repair, passes inspection.
Septic tank is: Metal: Cracked
Substantial infiltration:
Tank failure imminent:
Structurally unsound:
Substantial exfiltration-.
Tee(s) missing:
The system will pass inspection if the existing septic tank is replaced with a
conforming septic tank as approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box
is due to a broken or obstructed pipe(s) or due to a broken, settled or uneven
distribution box. The system will pass inspection if (with the approval of the Board of
Health):
Broken pipe(s) are replaced:
Obstruction is removed:
Distribution box is levelled or replaced:
The system required pumping more than four times a year due to broken or
obstructed pipe(s). The system will pass inspection if (with approval of the Board of
Health):
Broken pipe(s) are replaced:
EObstruction is removed:
I
E2
I
I
I
I
I
I
I
I
I
I
III
I
I
71
1
RAGGS, INC., P.O. BOX 1027. CONCORD, MA 01742 (508)369-1100
96-10864/UTANOFRANK
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY continued
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, and the
environment.
1. System will pass unless the Board of Health determines 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:
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 will
protect public health, safety, and the environment.
The system has a septic tank and soil absorption system and is within 100 feet to
a surface water supply or tributary to a surface water supply.:
The system has a septic tank and a soil absorption system and is within a Zone 1
of a public water supply well.:
The system has,a septic tank and a 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 volitale organic compounds indicates that the
well is free from pollution from that facility and that the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm.:
3
r
I
I
I
I
III
I
I
I
I
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-10864/UTANOFRANK
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY continued
D. System Fails:
I have determined that the system violates one or more of the following failure criteria
as defined in 31 OCIVIR 15.303. 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.
Backup of sewage into facility or system component due to an overloaded or
clogged SAS or cesspool.:
Discharge or ponding of effluent to the surface of the ground or surface 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 cesspool.:
Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2 day flow.:
Required pumping more than four times in the last year NOT due to clogged or
obstructed pipe(s):
Number of times pumped:
E
III
I
I
I
I
I
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, volitale organic compunds, ammonia nitrogen
and nitrate nitrogen.:
E4
I
I
I
I
I
I
I
I
I
Ell
I
I
I
E
I
I
I
I
El
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-10864/UTANOFRANK
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY continued
E. Large System Fails:
The following criteria apply to large systems in addition to the citeria listed above:
The design flow of the system is 10,000 gpd or greater (Large System) and the
system is a significant threat to public health, safety and the environment because
one or morer 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 11 of a public water supply well):
The owner or operator of any such system shall bring the system and facility into full
compliance with the groundwater treatment requirements of 314 CMR 5.00 and 6.00. Please
consult the local regional office of the Department of Environmental Protection for additional
information.
5
E
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
E96-10864/UTANOFRANK
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
D PART B CHECKLIST
The followinq have been done -
1. Pumping information was requested of the owner, occupant, and Board of Health: Yes
2. None of the system components have been pumped for at least two weeks and the system
has been receiving normal flow rates during that period. Large volumes of water have not
been introduced into the system recently or as part of this inspection: Yes
3. As -built plans have been obtained and examined: Yes
4. The facility or dwelling was inspected for signs of sewage back-up: Yes
5. The site was inspected for signs of breakout: Yes
6. All system components, excluding the SAS, have been located on the site: Yes
7. The septic tank manholes were uncovered, opened, and the interior of the septic tank was
inspected for condition of baffles or tees, material of construction, dimensions, depth of
liquid, depth of sludge, depth of scum: Yes
8. The size and location of the SAS on the site has been determined based on existing
information or approximated by non -intrusive methods: Yes
9. The facility owner (and occupants, if different from owner) were provided with information
It -he proper maintenance of SSDS: Enclosed with report.
E
11
R
R
P6
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
E96-10864/UTANOFRANK
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
FLOW CONDITIONS
Residential: design flow: number of bedrooms: 3
number of current residents: 3 garbage grinder: no
laundry connected to system: yes seasonaluse: no
Water meter readings: see Appendix D private well: no
Last date of occupancy: occupied
Commercial / Industrial: Type of Establishment: n/a
design flow: grease trap. -
industrial waste holding tank:
non -sanitary waste discharged to the Title 5 system:
Water meter readings. -
Other: n/a
Last date of occupancy:
Last date of occupancy:
GENERAL INFORMATION
Pumping records and source of information: see Appendix A; Homeowner
System pumped as part of inspection: yes Volume pumped: 1,500 gallons
Reason for pumping: Examination of the structural integrity of the tank.
Tvr)e of system -
Septic tank/distribution box/soil absorption system: yes
Single cesspool:
Overflow cesspool:
Privy:
Shared system:
Other:
Approximate age of all components.- 8 years
Date installed: 1988
Source of information: Homeowner
Sewage odors detected when arriving at the site: no
7
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-10864/UTAN 0 FRANK
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
SEPTIC TANK (locate on site plan) -- see page 11 and Appendix B
Depth below grade: 5'with a cover built up to 2' below grade
Material of construction - Concrete: X Metal: FRP: Other:
PDimensions: 1 O'X 5'X 4'
I
I
E
I
I
I
I
I
I
E
Sludge depth- .8'
Distance from top of sludge to bottom of outlet tee or baffle: 1.9'
Scum thickness: 2'
Distance from top of scum to top of outlet tee or baffle: .2'
Distance from bottom of scum to bottom of outlet tee or baffle: 1'
Recommendation for pumping: annually
Condition of inlet and outlet tees or baffles: intact
Depth of liquid level in relation to outlet invert: level
Structural integrity: good Evidence of leakage: none
Recommendation for maintenance: pump annually - bring covers to grade or to within 1' of
grade
GREASE TRAP (locate on site plan) -- n/a
Depth below grade
Material of construction - Concrete- Metal: FRP: Other:
Dimensions:
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:
Recommendation for pumping:
Condition of inlet and outlet tees or baffles:
Depth of liquid level in relation to outlet invert:
Structural integrity: Evidence of leakage -
Recommendation for repairs:
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-10864/UTANOFRANK
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
TIGHT OR HOLDING TANK (locate on site plan) -- n/a
Depth below grade:
Material of construction - Concrete: Metal: FRP: Other:
Dimensions:
Capacity:
Design flow:
Condition of inlet tee:
Condition of alarm and float switches:
Recommendations:
Alarm level:
DISTRIBUTION BOX (locate on site plan) -- see page 11 and Appendix B
Depth of liquid level above outlet invert: .01' - due to slight sHme mold build-up in leach lines
Level and distribution are equal, yes Evidence of solids carryover- no
Evidence of leakage into or out or box: no
Recommendation for repairs- recommend waterjetting within 3 years
PUMP CHAMBER (locate on site plan) -- n/a
Pumps in working order:
Condition of pump chamber:
Condition of pumps and appurtenances -
Recommendation for maintenance or repairs:
9
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
n96-10864/UTANO FRANK
11
I
I
I
I
11,
I
I
I
I
III
I
I
11
I
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) -- see page 11 and Appendix B
(locate on site plan, if possible; excavation not required, but may be approximated by non -
intrusive methods).
If not determined to be present, explain.,
Type:
Leaching pits and number:
Leaching chambers and number:
Leaching galleries and number -
Leaching trenches, number, length: three trenches; each approximately 50'
Leach i ngfields, number, dimensions:
Overflow cesspool, number -
Condition of soil: normal Signs of hydraulic failures: none
Level of ponding: none Condition of vegetation: normal
Recommendations for maintenance or repairs: none
CESSPOOLS (locate on site plan) -- n/a
Number and configuration. -
Depth -top of liquid to inlet invert
Depth of solids layer: Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow:
(cesspool must be pumped as part of inspection)
Condition of soil: Signs of hydraulic failure -
Level of ponding: Condition of vegetation:
Recommendations for maintenance or repairs:
PRI (locate on site plan) -- n/a
Materials of construction:
Dimensions:
Depth of solids -
Condition of soil: Signs of hydraulic failure:
Level of ponding: Condition of vegetation:
Recommendations for maintenance or repairs:
10
RAGGS. INC.. P.O. BOX 1027, CONCORD, MA 01742 1508)369-1100
96-10864/UTANOFRANK
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
SKETCH OF SEWAGE DISPOSAL SYSTEM
• Include ties to at least two permanent references, landmarks or benchmarks
• Locate all wells within 100 ft.
7 -/Es
Dr:.scRipri o/J 14 1 9—
SEp-mc TioK 14, 0 '9.6"
Z DISTRIISU-MAJ
L Ll
2(ao 3'+"DCS-nC1< RD.
DEPTH TO GROUNDWATER: more than 4'
METHOD OF DETERMINATION OR APPROXIMATION.- System designed and installed in
accordance with Title 5 (1978).
11 ,
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
E96-10864/UTAN 0 FRANK
0
III
w
APPENDIX A:
HISTORICAL
PUMPING RECORDS, REPAIR RECORDS
12
all
D
III
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-10864/UTANOFRANK
260 Candlestick Road, North Andover, MA 01845
Prior to inspection, system was pumped approximately 3 years ago.
Source of information: Homeowner
13
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-10864/UTANOFRANK
APPENDIX B:
SITE PLAN / AS BUILT PLAN
14
/9
1AIE
-�Mff�
com 0
3 2 413 P
.ro
147
0 is*
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
E96-10864/UTANOFRANK
I
m
Ul
APPENDIX C:
LISTING SHEET
15
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
E96-10864/UTAN 0 FRANK
III
0
III
260 Candlestick Road, North Andover, MA 01845
No listing sheet was provided for this property.
16
p
RAGGS. INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
F96-10864/UTANOFRANK
Ul
w
Appendix D:
Water Usage
Documentation
17
,,bjUUB34/CS/VO4/L010 TOWN OF NORTH ANDOVER
IRMINAL NO: 046 MUNICIPAL AUTOMATION SYSTEM
� -1 SERVICE HISTORY DISPLAY
Acct: 01-4742100-0 CLASEN & ASSOCIATES 260 CANDLESTICK
F,I�om: 01/01/01 To: 12/31/99
Svc
Type
Current
Delinquent Overpay
Total
100
BILL
102.34
239.46
341.80
***
BILL
102.34
239.46
341.80
100
BILL
90.30
341.80
432.10
***
BILL
90.30
341.80
432.10
100
BILL
108.36
432.10
540.46
***
BILL
108.36
432.10
540.46
100
BILL
63.21
540.46
603.67
***
BILL
63.21
540.46
603.67
100
PAYM
63.21-
540.46-
603.67-
***
PAYM
63.21-
540.46-
603.67-
100
BILL
72.24
72.24
***
BILL
72.24
72.24
100
BILL
72.24
72.24
144.48
100
BILL
72.24
72.24
***
BILL
72.24
72.24
100
BILL
72.24
72.24
144.48
***
BILL
72.24
72.24
144.48
100
BILL
108.36
144.48
252.84
***
BILL
108.36
144.48
252.84
100
PAYM
108.36-
144.48-
252.84-
***
PAYM
108.36-
144.48-
252.84-
100
BILL
105.35
105.35
***
BILL
105.35
105.35
100
PAYM
105.35-
105.35-
PAYM
105.35-
105.35 -
BILL
102.34
102.34
100
PAYM
102.34-
102.34-
***
PAYM
102.34-
102.34-
100
BILL
90.30
90.30
***
BILL
90.30
90.30
100
PAYM
90.30-
90.30-
***
PAYM
90.30-
90.30 -
Return, <Fl> Page Forward, <F2> Page Back
Ctrl -Break to exit, SysRq for DOS.
11
Ul
DATE: 05/24/96
TIME: 14:14:04
RD Status: 0
Usage Reference
34 E 94010004793
94010004793
30 A 94010010438
94010010438
36 A 94010016132
94010016132
21 A 94010022060
94010022060
24 A 95010004816
95010004816
24 A 95010010807
24 A 95010004816
95010004816
24 A 9501.0010807
95010010807
36 A 95010016848
95010016848
35 A 95010022966
95010022966
96010004960
30 E 96010011107
96010011107
NUM LOCK CAPS
E
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-10864/UTANOFRANK
0
w
0
911
Ill
ill
11
a
Ill
im
E
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-10864/UTANOFRANK
0
Appendix E:
Recommendations:
Repair, Pumping, & Maintenance
19
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-10864/UTANOFRANK
Recommendations
for
260 Candlestick Road, North Andover, MA 01845
1. Bring covers to grade or to wihtin V of grade.
2. Waterjet leach lines to remove slime mold build-up.
3. Pump annually.
20
Ei
I
I
I
I
I
I
P
I
*z4v you sial
4GGS
General Maintenance Recommendations
Proper maintenance of your septic system can help prevent premature failure of your
soil absorption system. RAGGS, INC. recommends the following:
13
DO PUMP your system ANNUALLY.
DO OPEN your D -Box every THREE TO FOUR YEARS.
DO ensure that your VENT PIPES are installed properly.
DO make sure you know where your TANK is LOCATED.
DO make sure you know where your LEACHING FIELD is LOCATED.
DO look for GREEN STRIPES over leaching field.
EDO check to determine if you can smell any ODORS from field location.
DO bring your COVERS WITHIN 6" OF GRADE.
DO USE LIQUID DETERGENT.
DO USE NON-ABRASIVE HOUSEHOLD CLEANING PRODUCTS.
DO USE ENVIRONMENTALLY SAFE PRODUCTS.
DO INSTALL WATER SAVING DEVICES, where appropriate.
DO USE SMALL AMOUNTS OF BLEACH when cleaning toilets, etc.
DO AVOID having roof gutters and downspouts DRAIN ONTO the LEACHING FIELD.
� 11
RAGGS SEPTIC SERVICE, INC.
P d.b.a. E.A. COMEAU SEPTIC
P.O. Box 1027 Concord, Massachusetts 0 1742 (800) 287-5541 (508) 369-1100 FAX (508) 897-3848
I
I
I
I
I
I
I
E
El
41�4_' Zl-- ty, * ct -"-
fIg -1 ou in 00
GG , i'S
General Maintenance Recommendations (con'd)
DON'T DISPOSE anything NON -BIODEGRADABLE IN TOILETS.
(i.e.: cigarettes, sanitary napkins, diapers)
DON'T wash paint brushes used in latex or oil PAINT.
DON'T allow any PAINT, THINNERS, OR ANY OTHER TOXIC OR CAUSTIC LIQUIDS
to go down sink or toilets.
DON'T allow ANY GREASE or FAT to enter system.
DON'T DISPOSE BONES, EGG SHELLS, COFFEE GROUNDS,OR FIBROUS MATERIAL,
etc. when using a garbage disposal
DON'T use powdered detergents with phosphates. '
F7 DON'T use any DRAIN CLEANERS.
DON'T use any ENZYMES.
DON'T use any GREASE DISSOLVERS.
DO NOT ADD ANY ADDITIVES TO YOUR SYSTEM FOR ANY REASON.
In the event of a clog or other plumbing problem, contact your local
plumber, rooter or pumper.
DON'T PLANT any trees or shrubs WITHIN 10 FT. OF THE LEACHING FIELD.
DON'T ALLOW SPRINKLER SYSTEMS or other WATERING DEVICES OVER THE
LEACHING FIELD.
DON'T DRIVE any VEHICLES or place any HEAVY OBJECTS ON TOP OF THE
LEACHING FIELD.
DON'T INSTALL a swimming pool, a patio, or a driveway over the tank or leaching field.
DON'T CONNECT a basement sump pump to a household drain.
RAGGS SEPTIC SERVICE, INC.
d.b.a. E.A. COMEAU SEPTIC
P.O. Box 1027 Concord, Massachusetts 01742 (800) 287-5541 (508) 369-1100 FAX (508) 997-'IR4R
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
FORM 4 - SYSTEM PUMIPING RECORD
Commonwealth of Massachusetts
North Andover, Massachuse
ystern Owner
Frank Utano
Date Of Pumping: 6/3/96
IN A=$ 7A
N -N— - H ANDOVEH
B O-�O":'
OARDOI-HE.A'"ri
L J L Ic
. -U—L —1Z
System Location
260 Candlestick Road
North Andover, MA
Quantity Pumped: 1500
gallons
Cesspool: No E2 Yes Septic Tank: No El Yes El
Raggs Septic Service, Inc.
S)'stern Pumped by: :0/b/a E. A. Comeau Septic
... ... License #: ....
Contents transferred to:
Date 7/5/96
lnspectors��� 4tf i�
STACEY i U BATO
VICE PRESIDENT OPERATIONS
RAGGS SEPTIC SERVICE, INC.
D/B/A E. A. COMEAU SEPTIC
Date:
Homeowner:
Street :--J(oe
Phone ()Ajc.
Nature of Service:
Observations:
Description of Work:
Comments:
Town of North Andover. MA
Watershed SeRtic System
Servicing Reiport -
Pumper : ZIAG6S a2/-2e.SFJW/ ' I
C?4k� I
Address:PO 66r- (Ooj, e0XjC0LbsI4-
Phone : ;DR -,3(0!2 1/0 D 0 14 q2,
Routine
Emergency
Good Condition
Full to Cover
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
Fly
A-7 "14, ---
Commonwealth of Massachusetts
P. City/Town of NORTH ANDOVER, MASSACHUSETTS
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health Thabys tt-mPin.9 J must
_q [:I I C.,
K26, Secor
be submitted to the local Board of Health or other approving auth:)rity.
A. Facility Information — JUL 10 Z008
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
-.0
1 - System Location:
Address
Nw- \)n And(�vt-�
City/Town
2. System Owner:
MQ�-�A
Name �_j
Aadress (it different from location)
City/Town
B. Pumping Record
I
1. DateofPumping
3. Type of system: 11
El Other (describe):
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Mq or�v"5
State Zip Code
State Zip Code
q,73 - 6? 5 -66;L9
Telephone Number
5 - a) _01;�
Date 2. Quantity Pumped
Cesspool(s) YSeptic Tank
4. Effluent Tee Filter present? E] Yes [2/No
5. Condition qf System:
J'z;00
Gallons
El Tight Tank
If yes, was it cleaned? EJ Yes [] No
6. System Pumped By:
_�2nl yn �QXQU 4r, A LIU)
Vehicle License Number
vind
Company LI f �e_ An a L
7. Location where contents were disposed:
--tDSWI I k A
Signature of Hauler
http://www. mass. 9 ov/dep/water/appi
t5form4.doc- 06/03
htm#inspect
is -k
Date I
System Pumping Record - Pag