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HomeMy WebLinkAboutMiscellaneous - 307 REA STREET 4/30/2018 (2) 307 REA STREET 1 210/038.0-0119-0000.0 \ i `' d ri9��f�1✓ C+-ick 4,& a// s�ieGdr TOWOF NO R3 K ANDOVER/ N Commonweatth of Massachusetts BOARD OF HFAITH Executive Office of Environmental Affairs i 419% Department of Environmental Protectio MWMIAM 0.wom Trudy Cox* Atw Paul Coliuoel Dsvld 8.Struhs U.600ma SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ CERTIFICATION AWI?C /!leer..Gwf a�lok Property Addre*s! 307 R fT'j ^/• �H�ON'Eu� MA 3 Loi/f Address of owner. Date of lttspeoHcn: //L4/ L/i„/ z/L3i0/1.?1t6 R��„� �' y10 a different) Name of Inspector. A*.W ,elryd/dJr � �) /t 4 /+-Vec,esl 1 tv4Z 7k ,t-goLdrls,0;P-aj ,J& CompahyName,Addressand�Telephone Number. A:/L) .* .a�yQe�. 0u1�Me�lVN�uO>Lt rktss'd aKe./ 433nci«>fej, 6 Y/I6bye LaMe� e�iYE►4,//� *-4 G/8) L l ��og 37,x- 9.3G) h�•.�,►�;�.4 /�ok��f CER'T'IFICATION STATEMENT I certify that I have personAlly inspected Ahs sewage disposal system at this address and that the information reported below is true,accurate and complete As of the time of inspection. The inspection was performed based on my training and experience in the proper function and nWhtenmeb of on-rite sewage disposal systems. The system: .� Passes //Jl9 L "L Conditionally passes L/u/j 4 _ Needs further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this hvg4dI6ti: tf the system L A shareA kystem or has a design now of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the irpproprlate regional office of the Department of Environmental protection. TM original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A.11, 0,or D: Al SYSTEM PASSES: 1//.)/„ 'X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 16.303- Arty bilare a riteria not evaluated are indicated below. Bl SYSTIBd1I CONDITIONALLY PASSES: L/L3/1` „ One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,panes Indicate yet,no,of not utetermined(Y,N,or ND). Describe basis of determination In all instances. U"not determined",kpWn why not) The septic tank Is metal,cracked, structurally unsound,shows substantial infiltration or etxfiltration,.or tank failure is Imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) I On*Winter Street * Boston,Massachusetts 02108 a FAX(617)556-1049 * Telephone(617)202-5500 `3 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM w PART A CERTIFICATION (continued) Property Ad&"&. 2.t1 Ate of .ff-., /V nJd vE►' Orener. r? p j j'4)9-. / i Date of Inspootions Vt4j L/.(U,, L JL BI SYSTEM CONDITIONALLY PASSES (continued) y— Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(e) or due to 6 broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(@)are replaced obstruction is removed 1 /�� 9-1 distribution box is levelled or replaced R ena/QC T/ ,�/I o4 V The system requited pumping more than four times a year due to broken or obstructed pipe(s). The system will eau inspection if(with approval of the Board of Health): broken pipe(s)are replaced Obstruction is removed Cl FURTHER 19VALUATION I9 REQUIRED BY THE BOARD OF HEALTH: Conditions hist which require Anther evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 19 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 60 feet of a surface water Cesspool or privy is within 60 feet of a bordering vegetated wetiand or a salt marsh. 31' SYSTEM WILL FAIL UNLESS tHE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,1F APPROPRIATE) DETERMINES THAT THE SYSTEM 19 FUNCTIONING IN A MANNER THAT PRO'T'ECT THE PUBLIC REALTH AND SAFETY AND THE ENVIRONMENT: The systent has b septic tank and soil absorption system and is within 100 feet to a surface water supply or tr&ttaq to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well. Tho system has a septic tank and soil absorption system and is less than 100 feet but 60 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well Is ft" from pollution$om that facility and the presence of ammonia nitrogen and nitrate nitrogen.Is equal to or Iea than 6 ppm. a) ' oTI#ER i (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addre a: L o? tea Owner: 660PA0, , Date of Inspeetlon. '04.0 LAO/ L/L)., D) SYSTEM FAILS: I bare determined that the system violates one or more of the following failure criteria as defined In 810 CMR 16.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. 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 water*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 6 leas than 6"below invert or available volume is leas than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Solt Absorption System, cesapool 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 60 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria Apply to large systems in addition to the criteria above: TM system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public heahh and safety and the environment because one or more of the following conditions exist: the system Is within 400 feet of a surface drinking water supply W 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 Il 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 program requirements of 314 CUR 6.00 and 6.00. Please consult the local regional office of the Department for Anther information.. (revised 11/03/95) 3 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC'T'ION FORM PART B CHECKLIST Property Addrese L 0 7 t a lf�1V '40VIe✓W Owner. G uJf 4.ro ,, Data of Iespootiom: "AGS Check if the following have been done: !fpnmping Wormation was requested of the owner, occupant, and Board of Health. 1 y1'1 A�p ,Mone 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. A&As built piano have been obtained and examined. Note if they are not available with N/A. '*�Tht bcility or dwelling was inspected for signs of sewage back-up. ✓The system does not receive non4mnitary or industrial waste flow /The sit!*as inspected for signs of breakout. fAll system components,excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge,depth of scum. _✓Phe rise and location of the Soil Absorption System on the site has been determined based on existing information or apptotimated by mob-intruslve methods. _fThe facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface bisposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Adareaa: 2 017 Oct S�'., N 4 rlj(1 ver owner: G obt tsoh Dale of itupaotlont �� � F1AW CONDITIONS RMID Design sow: y V* Fdlons Number of bedrooms: If Number of carrent residents: Y Garbage grinder(yes or no):_ft _ Laundry connected to system(yes or no):—Y—er seaWater w nes Lyes dim no): No tel 4a3� I 0Ioh 9j, by ,� Water meter , it available: ! CS 9J� Last data of occupancy:_ eyM4 COMMERCIAL/iNDUSTRtAL: Type of establishment: Design flow:.......gallons/day Grow trap present:(yes or no)_ Industrial Waste Holding Tani: present: (yes or no)_ Non-awdtary waste discharged to the Title 6 system: (yes or no)_ Water meter.reading»,If avertable: Last data of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Ov+ker said L'yNJ en System pumped as part of inspection: (yes or no) 4b If yes,volume pumped: Gallons Reason for pumping: TYPE 6F O ST&M Septic tan Aistr{bution bar/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components,date Installed(it known)and source of information:_I y►'d —1)ww /Mf,W!'(,ho4 017j Sewage odors detected when arriving at the site: (yes or no) /VV (revised 11/03/95) s SUBSUItFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SY9tEM INFORMATION (continued) property Addreer. L U 7 A a Jf, Al *4r+gig v e Dale b!latrpeollon: /f L�� L�l��t,/L3! 3//3/!t eBpTtc31'ANK: JC (beat*ori go plan) Depth below grade:ZC Y Xoonctete_metal—FRP_other(e:plan+) 00c) ,9Q110A. bmahN bans top of a fudge to bottom of outlet tee or baffle!-,-L' Dbukaot 60Mtop of scum to top of outlet tee or bame /C « Dlet"o6 ftota bottom of locum to bottom of outlet tee or baffle: G I tnt#0tr, Co ooftim s: _ ' (tboontt�fllldstion for pumping,condition of Wet and outlet tees or baffles,depth of liquid level in relation to ootid Invert,stru *Abbot of ledkw.etc.) A a P rs fitR>i:A9B TRApsA4 (Wath btt bit*plan) I Depth bola*grade. MatWai of oobett'ueubn:_concrete_instal_FAP _other<e:plain) Dlmetiiiotll: Dom tweltaw., DM,tte+l hem top of kum to top of outlet tee or baffle: p bottetn of tlettm to bottom of outlet tee or baffle: Con►meftb: or, Ing,condition of inlet and outlet tees or baffles,depth of liquid level lu retAlion!o culls!Invert,ettuettiral lnteB�itp, (t�ecotdtnbniatlea f tip "Mew of Ibhhage,ere.) f 8 (reviald 11/03/95), ft SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address L 07 ofCp Sly,N 4 nde v W TIGHT OR HOLDING TANK: &,# (locate on am PIM) Depth below Ori: Material of eontMiction:_cohcrete_metal_FRP_other explain) Dimensions: # Capacity: Gallons' Design flog: sallone/daq Alarm level: Comments: r (condition of inlet tee,condition of ala ni and float switches,etc.) r y T' ' DISTRIBUTION BOX— J h Gro W k 46 pj. . (locate on site plant) Depth of liquid level above outlet invert: NO — WOW O V Y4 III✓t lyls Comments: t (note if level and distribution 1i equal,evidence of solids carryover, vidence of leakage into or out of box,etc.) /Ca 4 P A o.1 rg jo Cee( { PUMP CHAMank" (locate on site plan) Pump in working order:(yes or no) { Comments: (note condition of pump chamber,condition of pump and appurtenances,etc.) f 1 i (rtvlsed 11/03/95) i 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION(continued) Property Address: L p 7 I tGa J f, IV 4MWV V t r Owner. GuS3�f7t�S q h Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): ✓ (looab on @he plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not dsterminad to be present,explain: Type: 1*66ing pits, number:_ Isiching chambers,number:_ leaching galleries,number: leaching trenches,number,length: baching holds,number,dimensions: 0WVKW L V ,x t/ 4y A)sj, �Dlg ti overflow cesspool,number: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) NO C V ode IeLt Q CESSPObLS: Nle (locate oh Alto plan) Number anJ coftflguration: Depth-top of liquid to inlet invert: Depth of solids Dyer: Depth of seam layer: Dimensions of cesspool: Materials of construction: Indication of groundwatty Jnflow(oikapdol must be pumped as part of inspection) Comments:(note condition of soul,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY: (bcate on ate plan) Materials of construction: Dimension*: Depth of solids! Comments:(note condition of soil,signs of hydraulic failure,level of ponding,conditibn of vegetation,tte.) (revised 11/03/95) g r - 1 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: Lo? teff ff.�/Y �st�/d✓br Owner. G v s wu h, Date of Inspsotion: I/L4�V/0/LA.3� SI{SMH OF SEWAGE DISPOSAL SYSTEM! lnc)ude tial to it kart two permanent references landmarks or benchmarks Iocatd au weak within 100' No k/el1 j 4 h t j a rep.- a ro� a Hov�t r 1N.S' Y9� Ser �To#& PAW o Tow w Q.e c,o ydr = Z0 7-o To Rea S f DEPTH TO GROUNDWATER Depth to poundwater.-7Li—Ifeet method of&Wmination of approximation: DEW h 04K " Ltd- 8J/Yl r r �Y /3 a r 4 a 0 (revised 11/03/95) 9 r c i {f� i �• 1 i i° " cu 1 n•' rA 4 rats Fool } 7 i•;� 1 ��+ rr"��"��11 ® }°� V rr/�"1�l ct� ?q�{ 'Y .'�,�� t� ::;. �.i s��t} f�• t i�Y}a � �/ /filo va ..� At Cd ��.1J1 • '' � � ,� .` ;�1 S r�{I{�t ��Y � ��yy,(7'�Fw��r•.I 7 e v ,,� '� ,r•f j.�t98i r 2.. y ON • • .. � Q � ti4 !� MJ,• ��r s i 10, ? .:Cif T. r•Z t Y Y R =} t t. 4t, i •��- G�h7 r TO: NORTH ANDOVER, MASS 19 7 7 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage -_ System I nspection This is to certify that I have inspected the construction of the said disposal system at 4 RE ST - North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 1.9 �P�S H 0 F�Ass9 fPH G <n.I m -°eg. I Ir r e ar� tarian / j t T(�WN of NORTH ANDOVER NORTH ANDOVER BOARD OF HEALTH REPORT OF PERC TEST l Al-DRESS OF SYSTEM-�' (�Lc:._i DATE 7� NAME OF PROFESSIONAL ENGINEER OR SANITARIAN CONDUCTING TESTS !/ v NAME OF LOT OWNER l�+�h-�i�K�► /�!v _ ADDRESS v SHOW APPROXIMATE LOCATION OF PITS ON SKETCH ON REAR OF THIS SHEET Total Soil Loq: Topsoil Subsoil Depths &, Types Water Level Pit Depth [1y // i o� to Time Time to Perc Tests Depth Saturation Time Drop 12" - 9" Drop 9" - 611 00, 01 11) Other Considerations : /E'!�� r� .' CJS,-'` /=rt"�,• IL2 f Recommendations : Signature w�"1s r Y 1 C \ s + V I �� tt n � � � V � k l1 si -CW-W� qt J J04 ;may 5; �{�o GL.,,�►►�1G 5� 1 el. 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SPG. .. ��x� ,-=� r Y ff109LEJ 4 WOMENC � ,- �-I ����o' X ip-4' o�I�.. - , r� 'Iot•.1 PVD ANC S�FZII0g5 'T• �c�� XPrJ NcliOc4K-4�10 --ANV-L q_L� stwl .xchg Ncoiinc;�jf 114 cr Q .r.. a o a '�.:.3 i Q •o` 1a c rZ o r nZ a y, .__ �. q, w -ten ,v �. v . •.-!- .o i- P •. o G - •` •r•• �' �' '. .C` t7 , ., -. _ + _ - r-- _ •i O. ci O 'Q 441�0�1 W1 !-i low AO , �-+no ©�.1R1t1S�ctl - - - 1p VA NVI-•J Nrvl% v AO z a= �•�rry �' ; 3�1 rte= .�sc� �'►R�' a j ( 1 Nl� SIH4-NOalorl "'►���,r1 fv j -_• -- i f�It cr. i1 fq TO: NORTH ANDOVER, MASS f1 C -3 19 7`S BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify thatpI have inspected the construction of the said disposal system at /t L a 7` E/9 S /7— . North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 . F."� eg. Pro . Eri -eer/Reg. Sa Itarian J � �T`f mus _ �OT A 9T. G1�TE • . 7 I ,OG /990 rrr�.-�+ too A- 45� 252117 + � of oto' � 16' 1000 CIAI... Sorrr- N 'mak �► 4m. I -0 100' �,t`1. ZoP of �a�X100,0 /Zs I f _ ao `1 jos ph j. barbagallo, r.s. 1 westward circle• no. reading mess. J 4 V ;?.E,-At_T Y Tzu6T XI-4 OP�� I-{o�-E t C TAT T EST WE �- �' tVMtu.TopSoiL. Co,4 6 7.x•7j 4oIt 8-ly, 7i !''WAS HFO MUSTlW G V&"-,'�►• 4" PagroRATBO MA+"gStC,� �Z To�'� 4J�ali- 16"SAO ctv*so snwa t* - %& 11 20 t - > Tc-) Se?,uc 7-2.sslw— ND t�.1A f� DIST. Boy,. SATt11�AT1�Jt•1 15/nlrJ, 1,111 --le 17 AN.. - Col' 20 AN ,4Poso�T1 c'�N I� . 2 ��vl'�P`�'��1 ►�r� E�r� ���ic�t.1 � ISI PEoPosq7o flogs t` Z c►sT — — -... J 10op daK o o��a i .u�c j �� H Sfs�'f;'tG TA►WK, �� 1- � �j.,. a ✓ i, s �a � Qr... CZ LLA( b�" 7 O� 0 <Y- 0 e 106EPH J� MrWAGoALLO ,h5. aq� -q�BJ Commonwealth of Massachusetts RECEIVED City/Town of o09 System Pumping Record JUN - 8 Z Form 4 == TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Othe ms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: Left front, left rear, left side of hous fight fro , right rear, right sidef house. forms on the computer,use only the tab key Address to move your. cursor- yown State Zi use the return not Citurn lrP Code key. 2. System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record _ 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: 8 Cesspools) Septic Tank Tight Tank Other(describe): 4. Effluent Tee Filter present? 8 Yes � o If yes,was it cleaned? p Yes No 5. Corldition offSys�� 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati re contents were disposed: L.S.D Lowell Waste Water igna ure of H u r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1