HomeMy WebLinkAboutMiscellaneous - 296 BERRY STREET 4/30/2018 (2)K)
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7257
Town of North Andover
HEALTH DEPARTMENT
SA U '
CHECK#: DATE:
0 C,
LOCATIO -PIA
RMOUNNIVIrml 1,1201"M
CONTRACTOR N
Type
of Permit or License: (Check box)
0 Septic - Soil Testing
0
Animal
$
0
Body Art Establishment
$
0
Body Art Practitioner
$
0
Dumpster
$
0
Food Service - Type.
$
0
Funeral Directors
$-
0
Massage Establishment
$
0
Massage Practice
$
•
Offal (Septic) Hauler
$
•
Recreational Camp
$
0
Sun tanning
$
•
Swimming Pool
$
•
Tobacco
$
•
Tras4lSolid Waste Hauler
$-
•
Well Construction
$
SEPTIC Systems
0 Septic - Soil Testing
$
0 Septic - Design Approval
$
0 Septic Disposal Works Construction (DW0 $
0 Septic Disposal Works Installers (DWI)
$-
0 Title 5 Inspector
'*'KTitle
$ A I
VV
50
5 Report
$ Iq
0 Other (Indicate)
$
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
Owner
information is
required for
every page.
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
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VQ
A 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
296 Berry Street
Property Address
Kathrine Walsh -Mu
Owner's Name
North Andover
Cityrrown
MA 01845
State Zip Code
RECEIVED
JUL 2 7 2015/9
TOWN OF NORTH A Do'
H E A LT K D E PA R1 �M E NiVTE17-1,
_
Poef
7/8/15
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.
A. General Information
1 . Inspector:
Jonathan Granz
Name of Inspector
Preventative Septic and Drain L.L.C.
Company Name
327 Asbulry Street
Company Address
South Hamilton
City/Town
978-468-9001
Telephone Number
B. Certification
MA
State
S113405
License Number
01982
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:
0 Passes El Conditionally Passes El Fails
F] Needs Further Evaluation by the Local Approving Authority
7/21/15
InspecV Signatulh,� 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.
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
296 Berry Street
Property Address
Kathrine Walsh -Murphy
Owner Owner's Name
information is North Andover MA 01845 7/8/15
required for
every page. CityTTown 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:
is in Qood condition.
13) System Conditionally Passes:
El 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.
F1 Y 0 N [I 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
296 Berry Street
Property Address
Kathrine Walsh -Mu
Owner's Name
North Andover
City/Town
B. Certification (cont.)
MA 01845
State Zip Code
7/8/15
Date of Inspection
El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
El 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):
E] broken pipe(s) are replaced
F-1 obstruction is removed
F-1 distribution box is leveled or replaced
0 Y 0 N F ND (Explain below):
El Y El N F1 ND (Explain below):
0 Y 0 N F1 ND (Explain below):
F] 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):
0 broken pipe(s) are replaced El Y 0 N F-1 IND (Explain below):
obstruction is removed El Y 0 N 0 ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
F-1 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(l)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
El 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
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
296 Berry Street
Property Address
Kathrine Walsh -Mu
Owner's Name
North Andover
Cityf'rown
B. Certification (cont.)
MA 01845
State Zip Code
7/8/15
Date of Inspection
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:
F-1 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.
F-1 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
F-1 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
El
E
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
El
E
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 1/2day flow
t5ins - 3/13
Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
296 Berry Street
Property Address
Kathrine Walsh -Murphy
Owner Owner's Name
nformation is North Andover MA 01845 7/8/15
required for
wery page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
E-1 0 Required pumping more than 4 times in the last year NOT due to clogged
obstructed pipe(s). Number of times pumped: _.
El M Any portion of the SAS, cesspool or privy is below high ground water elev
El N Any portion of cesspool or privy is within 100 feet of a surface water supp
tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
El N Any portion of a cesspool or privy is within 50 feet of a private water supp
well.
El N Any portion of a cesspool or privy is less than 100 feet but greater than 5
from a private water supply well with no acceptable water quality analysis.
system passes if the well.water analysis, performed at a DEP certifie
laboratory, for fecal coliform bacteria indicates absent and the pres(
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 p
provided that no other failure criteria are triggered. A copy of the an
and chain of custody must he attached to this form.]
E] N 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 failur
criteria exist as described in 310 CMR 15.303, therefore the system fails.
system owner should contact the Board of Health to determine what will b
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
0
D
the system is within 400 feet of a surface drinking water supply
El
El
the system is within 200 feet of a tributary to a surface drinking water supply
El
E]
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
or
ation.
ly or
ly
0 feet
[This
d
nce
pm,
alysis
e
The
e
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
0
D
the system is within 400 feet of a surface drinking water supply
El
El
the system is within 200 feet of a tributary to a surface drinking water supply
El
E]
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
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 - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
296 Berry Street
Property Address
Kathrine Walsh -Murphy
Owner Owner's Name
information is
required for North Andover MA 01845 7/8/15
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
0 El Pumping information was provided by the owner, occupant, or Board of Health
El E Were any of the system components pumped out in the previous two weeks?
El 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?
N El Were as built plans of the system obtained and examined? (if they were not
available note as N/A)
E El Was the facility or dwelling inspected for signs of sewage back up?
E D Was the site inspected for signs of break out?
0 EJ Were all system components, excluding the SAS, located on site?
E El
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?
0 El
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:
N 0
Existing information. For example, a plan at the Board of Health.
Z El
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): 600
per plan
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 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
296 Berry Street
Property Address
Kathrine Walsh -Murphy
Owner's Name
North Andover MA 01845 7/8/15
Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
System is composed of 1500 Gallon septic tank, distribution box and a 20'x45' leaching field.
Number of current residents:
Does residence have a garbage grinder?
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.)
Laundry system inspected?
Seasonaluse?
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Private non -metered well.
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'.
El
Yes
E
No
El
Yes
Z
No
E
Yes
E]
No
El
Yes
H
No
n/a
El Yes Z No
Current
Date
Gallons per day (gpd)
El Yes E] No
El Yes No
El Yes No
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 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
296 Berry Street
Property Address
Kathrine Walsh -Mu
Owner's Name
North Andover
Cityrrown
D. System Information (cont.)
Last date of occupancy/use:
Other (describe below):
Pumping Records:
Source of information:
MA 01845
State Zip Code
Date
General Information
Was system pumped as part of the inspection?
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
7/8/15
Date of Inspection
Last pumped 6/3/14, per BOH records.
1500
gallons
truck sight glasses
inspection & maintenance
Type of System:
Septic tank, distribution box, soil absorption system
El Single cesspool
F1 Overflow cesspool
E-1 Privy
OBEREFE-11110
n Shared system (yes or no) (if yes, attach previous inspection records, if any)
El 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
r-1 Tight tank. Attach a copy of the DEP approval.
E-1 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
296 Berry Street
Property Address
Kathrine Walsh -Murphy
Owner Owner's Name
information is North Andover MA 01845 7/8/15
, ired for
every page. CitylTown
D. System Information (cont.)
State Zip Code Date of Inspection
Approximate age of all components, date installed (if known) and source of information:
The as -built is dated 1/7/80, per 130H records.
Were sewage odors detected when arriving at the site?
Building Sewer (locate on site plan):
Depth below grade: 24"
feet
Material of construction:
E cast iron E] 40 PVC El other (explain):
Distance from private water supply well or suction line. 85'+/ -
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Buildinq sewer is in qood condition with no siqns of leakaqe, backup or
Septic Tank (locate on site plan):
Depth below grade:
Material of construction:
E concrete El metal
101,
feet
El Yes E No
other Droblems.
E:1 fiberglass [] polyethylene El other (explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes El No
Dimensions: 101 x SW x 4'D effective
Sludge depth: 101,
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17
Owner
information is
required for
every page.
t5ins - 3/13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
296 Berry Street
Property Address
Kathrine Walsh -M
Owner's Name
North Andover
Cityf'rown
D. System Information (cont.)
MA 01845
State Zip Code
Septic Tank (cont.)
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
23"
2"
5"
14"
7/8/15
Date of Inspection
'SludgeJudge/Tape measure
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.)-.
Tank is in good conditon, structually sound, no signs of leakage or infiltration, liquid at outlet invert.
Inlet has a concrete baffle in good condition, outlet has a PVC T in good condition, outlet has a Zabel
filter (cleaned at time of inspection). The tank was pumped at time of inspection.
Grease Trap (locate on site plan):
Depth below grade:
Material of construction:
F-1 concrete El metal
Dimensions:
Scum thickness
[:1 fiberglass
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:
feet
polyethylene other (explain):
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
296 Berry Street
Property Address
Kathrine Walsh -Murphy
Owner Owner's Name
information is
r. -i—,' for North Andover MA 01845 7/8/15
every page. City/Town
State 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:
F� concrete El metal El fiberglass El polyethylene other (explain):
Dimensions:
Capacity:
Design Flow:
Alarm present:
Alarm level:
gallons
gallons per day
El Yes El N 0
Alarm in working order:
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
El Yes El No
* Attach copy of current pumping contract (required). Is copy attached? El Yes [-] N o
t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 of 17
ME AWN,
L
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
296 Berry Street
Property Address
Kathrine Walsh -Murphy
Owner's Name
North Andover MA 01845 7/8/15
City/Town
D. System Information (cont.)
State Zip Code Date of Inspection
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
a
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.):
Distribution box is in fair conditon, slight corrosion but still structually sound, no leakage in or out, no
signs of solids carryover, liquid level at outlet inverts, speed levelers are present and adjusted
properly. Top of box is 19" below grade, outlet inverts are 29" below grade.
Pump Chamber (locate on site plan):
Pumps in working order: El Yes E] No*
Alarms in working order: El Yes E] 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 - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
296 Berry Street
Property Address
Kathrine Walsh -Murphy
Owner Owner's Name
information is
rn "i-1 fnr North Andover MA 01845 7/8/15
1i
every page.
t5ins - 3/13
City/Town
D. System Information (cont.)
Type:
F�
leaching pits
E-1
leaching chambers
El
leaching galleries
El
leaching trenches
2
leaching fields
El
overflow cesspool
R
innovative/alternative system
State Zip Code Date of Inspection
number:
number:
number:
number, length:
number, dimensions:
number:
1 @ 20'x45'
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.),.
Soil over system is dry,grassy and consistant with surounding yard with no signs of ponding, breakout
or abnormal veqetation.
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 0 Yes 0 No
Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 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
296 Berry Street
Property Address
Kathrine Walsh -Murphy
Owner's Name
North Andover MA 01845
CityfTown State Zip Code
D. System Information (cont.)
7/8/15
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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
296 Berry Street
Property 4dress
Kathrine Walsh-lMU_rP_hT__
Owner Owner's Name
information is
required for North Andover MA 01845 7/8/15
every page. City/Town State Zip Code Date of Inspe-cii—on—
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
El drawing attached separately
0 WELL,
-7 d 0 e f r
y�,14, r-j�cM
YL
i/07AFM 2 -1,C -f
I# i,- U J - A'
1 13 -
3
A 3 - 2X"i
jj q,31 0 i3--
31 ; W1
W
00, 011"' iiFl?
pC.V -�7L Ile
W
I
Lj
Lj.;-AG411VC—
�Vi
t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 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
296 Berry Street
Property Address
Kathrine Walsh -Murphy
Owner's Name
North Andover MA 01845 7/8/15
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
Check Slope
Surface water
Check cellar
Shallow wells
Estimated depth to high ground water:
4' Below SAS
feet
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: 6/11/79
Date
F-1 Observed site (abutting property/observation hole within 150 feet of SAS)
M Checked with local Board of Health - explain:
Plan on file for the design of this system. All pertinent surounding properties were
checked for newer soil data.
R Checked with local excavators, installers - (attach documentation)
El Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
Soil testing was performed for the design of this system on 11/11/78 by Joseph J. Barbagallo R.S.,
witnessed by Tom Murphy, groundwater was found at elevation 88.00, the bottom of the leaching
field is at 92.00 (per plan). This system was installed in an elevated (above natural grade) area with a
4' seperation from qroundwater (see BOH records), it is not interfacinq with woundwater.
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
Owner
information is
required for
every page.
Commonwealth of Massachuseft
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
296 Berry Street
Property Address
Kathrine Walsh -M
Owner's Name
North Andover
R A A
City/Town State
E. Report Completeness Checklist
01845
Zip Code
7/8/15
Date of Inspection
Z inspection Summary: A, B, C, D, or E checked
Z Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
Z System Information — Estimated depth to high groundwater
Z 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
Board of Health w 11
North Andlover Mass- BEMC SYSTEM LOT
INSTALLATICK CHECK LI ST —0 1565
DATE 91dAVATINNI - FAIL
DATE
Reammst
NUMN
I wc,
1Y,
Ot
1. Distance TO:
a. Wetlands
b. Drains
ce well
2. Water Line Location
3- No PVC Pipe
4. Septic Tank
a. -Tess �,--_Length & To Clean Out Covers.
b. Cement Pipe to Tank — Oa Both Sides of Tank
5. Distribution Box
a. Covers & Box - No Cracks
b. All Lines Flowing Equal AmOunts
c. No Back Flow
Leach Field or Trench
a. Dimensions
b, Stone DePth
a.. Capped Ends
d. Clem Double Washed Stone
7. Leach Pits/
a. Dimensions
b Stone/ Depth
c: ash Pads
d, ees
6. Cment pipe to Pit Both Sides
f. Clean Double Was hod Stone
No Garbage Disposal
9a Final Grading Inspection
10. Barricading Covered System
3.1. JLs Built Subndtted
a. Lot Location
b. Dimensions of System
c. Location T,4th Regard -to, Pere Test
d. Elevations
e.* Water Table
TO: NORTH ANDOVER, MASS -7 -19 F0
BOARD OF HEALTH
F ROM: DESIGN ENGINEER Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
o 7— A 6 7-- North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
19-
.Mngj.-nee
'�,�Reg,��Sanitarian
R Tl�
IV6 7-r::
As- //Y 61� ri 6'(1V6 /-)/- /0/y
Board OZ Health
North AndoverqMass
APPROVED DATE
Providedi
SUBSURFACE DISPOSAL DESIGN CHECK LIST
DISAPPROVED DATE
Reasonst
LOT
Title
Reg 2.
FAIL
09
submitted plan must show as a minimum:
e lot to be served-area.,dimensions lot #.,abutters
cation and log deep observation Mes-distance to ties
location and results percolation tests -distance to ties
sign calculations & calculations showing required leaching area
ocation and dimensions of system -including reserve area
e sting and proposed contours
(g cation any wet areas within 1001 of sewage disposal system or
disclaimer -check wetlands mapping
surface and subsurface drains within 1001 of sewage disposal
system or disclaimw
location any drainage easements vithin 1001 of sesage disposal
stem or discialiner-Planning Board files
knov= sources of water supply within 2001 of sewage disposal
system or disclaimer
location of any proposed well to serve lot -1001 from leaching facility
location of water lines on property -101 from leaching facility
of benchmark
driveways
) garbage disposals
)"no PVC to be used in construction
profile of system -elevations of basement., plumb,9 pipe,, septic tank,
distribution box inlets and outlets., distribution field piping and
Ather elevations
rma mam ground water elevation in area sewage disposal system
s) plan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
L,7
L//
77,Mlocation
,/*"(q)
Reg 6 S tic Tanks
(a capac ties -150% of flow, water table., teesj, depth of tees.,
access., pumping
W""Cleanout,
�70 101 from cellar wall or inground swimming pool
7(d) 251 from subsurface drains
Reg 10.2 Distribution Boxes
I � /Va) slope greater U_= 0.08
Reg 10.4 J_ L_�Xb) map
9
asign Check List
FATL I r M I
Reg 3-1. 2
11-4
n.lo
n.3 -i
Reg 15.1
15.4
15.8
3.7
Reg 14.1
14.3
14.4
14.6
14.7
1�.10
Reg 9.1
9.6
I
Leac Pits
Leaching pits are preferred W—here the installation is possible
a
a) calculations Of area-md ni 500 eq ft
b) spacing
cl surface e 2%
Ld�) covwl terial
o e AIV14" splash pad
tee at elbow
no bends in pipe from d -box to pipe
/�Leaching Fields
no greater than 20 minutes/inch
3
area -minimum 900 aq ft
c
onstruction of field
surface drainage 2 %
*e) 72COt' from cellar van or inground swimming pool
LWh.i!lg Trenches
calculations of leaching area -min 5DO eq ft,
b) spacing -4 ft, min 6 ft, with reserve between
c) dimensions
d) construction
stone
f) surface drainage 2%
Dow3hM SloRe
A) slope y/x = (to be shown)
Fb) 7/k X 150 - (to be shown)
pus
a) approval
stand-by power
1 719)
—,a)
.1e)
—1b)
V1,4 4,41
.60- LA E- E Ij A
,J�,v/<
zs,
lo�
o 7-
cj
FORM 4 — SYSTEM PUMPIN
Commonwealth of Massachusetts
North Andover, Massachusetts
Svstem Pumping Record
System Owner:
Brendan Murphy
296 Berry Street
North Andover, MA 0 1945
Date of Pumping: 6/03/14
Cesspool: No Z Yes EI
System Location:
296 Berry Street
North Andover
RECEWED
j u N 2 014
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Quantity Pumped: 1,500 gallons
Septic Tank: No El Yes Z
System Pumped by: D.F. Clark, Inc. License: BHP -2014-0087
Contents transferred to: Ipswich Wastewater Treatment Plant
Date: —Inspector:
FORM 4 — SYSTEM PUMPING RECORD
Commonwealth of Massachusetts
North Andover, Massachusetts r
System Pumpin2 Record
System Owner:
Brenda Murphy
296 Berry Street
North Andover, MA 0 194 5
Date of Pumping: 5/08/14
Cesspool: No M Yes 0
System Location:
296 Berry Street
North Andover
RECEIVED
MAY Z 2014
T,OWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Quantity Pumped: 1,500 gallons
Septic Tank: No E] Yes N
System Pumped by: D.F. Clark, Inc. License: BHP -2014-0087
Contents transferred to: Ipswich Wastewater Treatment Plant
Date: Inspector:
FORM 4 — SYSTEM PUMPING RECORD
Commonwealth of Massachusetts
North Andover, Massachusetts
System Pumpiniz Record
System owner: S�stem Location:
Brendan Murphy 296 Berry Street
296 Berry Street North Andover
North Andover, MA 0 1945
Date of Pumping: 12/26/13
Quantity Pumped: 1,500 gallons
K9 C-Elkik-D,
JAN 15 7014
TOWN UF NORTH ANDOVER
HEAL7H DEPARTMENT
Cesspool: No 0
Yes F� SepticTank:
No 0
Yes H
System Pumped by:
D.F. Clark, Inc.
License:
BHP -2013-0030
Contents transferred to: IDswich Wastewater Treatment Plant
Date: —Inspector:
4tr
O -A
44
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