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HomeMy WebLinkAboutMiscellaneous - 32 DEER MEADOW ROAD 4/30/2018 32 DEER MEADOW ROAD ,ad I' 210/090.A-0030-0000.0 1 STREET DEERMEADOW NO Commonwealth of Massachusetts = City/Town of System Pumping Record Form 4 DEP has provided this form for use-,by local Boards of Health. Other forms 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 1. System Location: Left/Right front of hous a Righ r of Nous , Left/right side of house, Left/ Right side of building, Left/Right front of buffairig, Left/Right rear of building, Under deck Address hl&v� C4/rown State Trp Code 2. System Owner. C� Name Address if different from location City/Town State ZiD Code Telephone Number t 1,. B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) alSeptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No; 5. Conditi n f System: t se)101, b 6. System Pumped By. Neil.Bateson F5821 Name Vehicle License Number C`c Z �j Bateson Enterprises Inc Company T01 r;C. ;LODOVER 7. L ere contents were disposed: aS: Lowell Waste Water Sign a Hau Date t5form4.doc-06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts . .� Title 5 Official Inspection Form p . Subsurface Sewage Disposal System Form -Not for Voluntary Assessmen s JL,f 32 Deer Meadow Road TOWN OF NORTH ANDOVER Property Address HEALTH DEPARTMENT Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1 Inspector: only the tab key to move your Mark E. Allen cursor-do not Name of Inspector use the return key. Allen Engineering Company Name 2 Willowbrook Lane Company Address Mendon MA 01756 City/Town State Zip Code 508-381-3212 4955 Telephone Number License Number B. Certification 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority / h, &--, 529, 12 Inspector=s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 iii. ��� �- �/� �' l / '� i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. Cityrrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by f4� the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 5 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 32 Deer Meadow Road Property Address Manuel Rei Owner Owners Name information is North Andover MA 01845 5/21/12 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-11/10 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 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. m u must indicate either"yes"or"no"to each of the following,For large systems, you y 9. in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form , a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4M , 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1500 gallon concrete septic tank(w/baffle wall), concrete d-box, and 900 s.f. leaching bed Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d not obtained 9 ( Y 9 (gp ))� Detail: Sump pump? ® Yes ❑ No Full time Last date of occupancy: residence Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is North Andover MA 01845 5/21/12 required for every page. Citylrown State Zip Code Date of Inspection i D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Bateson pumped following inspection on 5/21/12 to check for potential infiltration and to inspect tank Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? by gauge on pump truck Reason for pumping: To look at tank and to check for any potential infiltration Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 t Commonwealth of Massachusetts Tale 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 32 years based on As-Built plan dated 10/3/1980 Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: 1.2feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water enters front of house, building sewer exits rear of house Comments(on condition of joints, venting, evidence of leakage, etc.): Invert of building sewer is 36"down from the Top of foundation, no evidence of leakage upon inspection in the basement. Septic Tank(locate on site plan): 0.8(10" below grade) Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1,500 gallon concrete tank with baffle wall If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'-8"W x 10'-8"L Sludge depth: 4" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 t Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Deer Meadow Road Property Address Manuel Rei Owner owner's Name information is required for North Andover MA 01845 5/21/12 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3'-3" 2.. Scum thickness Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? by tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank was pumped by Bateson following inspection. The tank was inspected and appeared to be structurally sound. There were no signs of infiltration of water into the tank(the tank was watertight). Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): 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: Date t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 32 Deer Meadow Road Property.Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. Cityrrown 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: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 5< 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was structurally intact. Flow appeared to be equal disposal to the leaching bed. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M ,•�''r 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: 900 s.f. field ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching field shown as a 900 s.f. bed on the As-Built plan. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is North Andover MA 01845 5/21/12 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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-11/10 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 M 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A U (2 J SMY 659 qac A,O 30,2 7,21`7 f 6 J2,Mz 74 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. 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: >6.5 feet below gradefeet 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: Oct. 26, 1979 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: From the As-Built plan dated 10/3/1980 the Top of Foundation is at elevation 190.58', which places the ground surface at the septic area at 188.6'. The As-Built has the invert in the leaching bed at 186.42'...the design plan has groundwater at or below elevation 181.0' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts _ Title 5 Official inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 32 Deer Meadow Road Property Address Manuel Rei Owner Owner's Name information is required for North Andover MA 01845 5/21/12 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 DelleChiaie, Pamela From: Jack Sullivan Dacksu1153@comcast.net] Sent: Monday, May 21, 2012 11:37 AM To: DelleChiaie, Pamela Subject: Re: 32 Deer Meadow Pamela, Would you happen to have a septic as-built (or worst case septic design pla for 32 Deer Meadow? Hope you enjoyed the weekend......thanks. Sullivan Engineering Group, LLC Jack Sullivan 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 phone + fax From: "Pamela DelleChiaie" <Pdellech(a)_townofnorthandover.com> To: "Bill Dufresne (wrdufresneacom cast.net)" <wrdufresne(a-comcast.net>, 'Benjamin C. Osgood" <BOs ood _Pennoni.com>, "C&S (pchristiansena-christiansenandsergi.com)" <Pchristiansen(-christiansenandsergi.com>, "Sullivan Jack (jacksuII53acomcast.net)" <jacksull53(a�comcast.net>, "John Morin" <John NeveMorin.com>, "Jim Scanlan" <jim ,scanlanengineering.com>, "Greg Saab" <ess-greg a-comcast.net> Cc: "Susan Sawyer" <ssawyer townofnorthandover.com>, "Michele Grant" <mgrant townofnorthandover.com> Sent: Friday, April 29, 2011 1:11:24 PM Subject: Septic-Town of North Andover- Septic As-Built Plan Checklist To: Septic Plan-Engineers FYI-Attached is the most recently updated Septic As-Built Checklist that should be used as a guide prior to submitting any Septic As-Built plans to the Health Department. Please can the office if you have any questions. Thank you. 96C R1444, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 I Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 Fax-978-688-8476 Email-pdellechiaieatownofnorthandover.com Website httR//www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:htte://www.sec.state.ma.us/Dre/ereidx.htm. Please consider the environment before printing this email. 1 North Andover Board of Assessors Public Access Page 1 of 1 4ORTH 1�l�rfh Andover Burd of Assessors • SS"CHUSEt roperty Record Card Parcel ID :210/090.A-0030-0000.0 FY:2012 Community: North Andover Click on Sketch to Enlarge Click on Photo to Enlarge j f x., 32 DEER MEADOW ROAD Location: 32 DEER MEADOW ROAD j REI,MANUEL T Owner Name: C/O REI FAMILY NOMINEE REALTY TRUST Owner Address: 32 DEER MEADOW ROAD City: NORTH ANDOVER State: MA Zip: 01845 j Neighborhood:7-7 Land Area: 1.12 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3341 sqft Total Value: 559,700 559,700 Building Value: 333,100 333,100 Land Value: 226,600 226,600 Market Land Value: 226,600 Chapter Land Value: LATEST SALE Sale Price: 1 Sale 02/22/1993 Date: Arms Length Sale F-NO-CONVNIENT Grantor: GILES,SCOTT Code: Cert Doc: Book: 03664 Page: 0112 http://csc-ma.us/PROPAPP/display.do?linkld=1893198&town=NandoverPubAcc 5/22/2012 Residential Property Record Card PARCEL ID:210/090.A-0030-0000.0 MAP:090.A BLOCK:0030 LOT:0000.0 PARCEL ADDRESS:32 DEER MEADOW ROAD FY:2012 PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 03664 Road Type: T Inspect Date: 05/30/2008 Owner: Tax Class: T Sale Date: 02/22/93 Page: 0112 Rd Condition: P Meas Date: 05/30/2008 REI, MANUEL T Tot Fin Area: 3341 Sale Type: P Cert/Doc: Traffic: M Entrance: C C/O REI FAMILY NOMINEE REALTY TRUST Tot Land Area: 1.12 Sale Valid: F Water: Collect Id: RRC Address: Grantor: GILES,SCOTT Sewer: Inspect Reas: C 32 DEER MEADOW ROAD Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 7 Main Fn Area: 1908 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R1 Story Height: 2.00 Bedrooms: 4 Up Fn Area: 1433 Bsmt Area: 1232 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1.000 225,640 Ext Wall: AV Half Baths: 1 Unfin Area: Bsmt Grade: A 2 R 101 A 0 0.120 912 Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 3341 DETACHED STRUCTURE INFORMATION Foundation: CN Bath Qual: T RCNLD: 331614 Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond%Good P/F/E/R Cost Class Kitch Qual: T Eff Yr Built: 1987 Mkt Adj: SE S 6 18.00 1988 A A ///88 1,500 1 Heat Type: FA Ext Kitch: Year Built: 1981 Sound Value: Fuel Type: G Grade: G Cost Bldg: 331,600 VALUATION INFORMATION Fireplace: 1 Bsmt Gar Cap: Condition: G Att Str Val 1: Current Total: 559,700 Bldg: 333,100 Land: 226,600 MktLnd: 226,600 Central AC: Y Bsmt Gar SF: Pct Complete: Aft Str Va12: Prior Total: 559,700 Bldg: 333,100 Land: 226,600 MktLnd: 226,600 Aft Gar SF: 576%Good P/F/E/R: M89 Porch Type Porch Area Porch Grade Factor S 168 W 604 SKETCH PHOTO 524 Sq.r'z 8q r r, tee;Y sr 9 880 S e 1 S Q".35/6 B ��EE�� FM 24 576 Sq. 2B 1232'1��'32 54.9p8 28 z 26 s 26 wo 32 DEER MEADOW ROAD Parcel ID:210/090.A-0030-0000.0 as of 5/22/12 Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, May 22, 2012 3:53 PM To: 'jacksull53@comcast.net' Subject: RE: 32 Deer Meadow Okay....I sent it. O From: jacksull53@comcast.net [mailto:jacksu1153(cbcomcast.net ] Sent: Monday, May 21, 2012 5:59 PM To: DelleChiaie, Pamela Subject: RE: 32 Deer Meadow Thanks pam....Tuesday is fine.. no rush Sent from my Verizon Wireless 4G LTE DROID -----Original message----- From: "DelleChiaie, Pamela" <pdellech .townofnorthandover.com> To: Jack Sullivan <iacksu1153(cDcomcast.net> Sent: Mon, May 21, 2012 15:20:45 EDT Subject: RE: 32 Deer Meadow Hi Jack, I am out today, so you can call the office and ask for Susan. If you can wait, III do it tomorrow. Tell her the file should be in the sorter in the general file area if you call. —Pamela From: Jack Sullivan [jacksull53@comcast.net] Sent: Monday, May 21, 2012 11:36 AM To: DelleChiaie, Pamela Subject: Re: 32 Deer Meadow Pamela, Would you happen to have a septic as-built (or worst case septic design plan) for 32 Deer Meadow? Hope you enjoyed the weekend......thanks. Sullivan Engineering Group, LLC Jack Sullivan 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 phone + fax From: "Pamela DelleChiaie" <pdellech aatownofnorthandover.com> To: "Bill Dufresne (wrdufresnea-comcast.net)" <wrdufresneacomcast.net>, "Benjamin C. Osgood" <BOsgood _Pennoni.com>, "C&S (pchristiansena-christiansenandser iq com)" <pchristiansen(a-christiansenandsergi.com>, "Sullivan Jack (jacksull53 aacomcast.net)" <iacksull53(c�comcast.net>, "John Morin" <JohnaNeveMorin.com>, "Jim Scanlan" 1 <jim(a)-scanianengineering.com>, "Greg Saab" <ess-greg(a)-comcast.net> Cc: "Susan Sawyer" <ssawver(d-)townofnorthandover.com>, "Michele Grant" <mgrant aatownofnorthandover.com> Sent: Friday, April 29, 2011 1:11:24 PM Subject: Septic-Town of North Andover- Septic As-Built Plan Checklist To: Septic Plan-Engineers FYI-Attached is the most recently updated Septic As-Built Checklist that should be used as a guide prior to submitting any Septic As-Built plans to the Health Department. Please can the office if you have any questions. Thank you. drat RISUla, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 ^r Office-978-688-9540 Fax-978-688-8476 Email-pdellechiaiegtownofnorthandover.com Website http://www.townofnorthandover.com/Pages/`index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:htto://www.sec.state.ma.us/ore/Preidx.htm. Please consider the environment before printing this email. 2 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, May 22, 2012 3:52 PM To: 'Jack Sullivan' Subject: I.R. -32 Deer Meadow Road -Additional information from septic plan - 1979 Attachments: 20120522152629222.pdf 3 DeIleCtkaie, Pamela From: jacksu1153@comcast.net Sent: Monday, May 21, 2012 5:59 PM To: DelleChiaie, Pamela Subject: RE: 32 Deer Meadow Thanks pam....Tuesday is fine.. no rush Sent from my Verizon Wireless 4G LTE DROID -----Original message----- From: "DelleChiaie, Pamela" <pdellech .townofnorthandover.com> To: Jack Sullivan <jacksull53acomcast.net> Sent: Mon, May 21, 2012 15:20:45 EDT Subject: RE: 32 Deer Meadow Hi Jack, I am out today, so you can call the office and ask for Susan. If you can wait, III do it tomorrow. Tell her the file should be in the sorter in the general file area if you call. -Pamela From: Jack Sullivan Dacksu1153@comcast.net] Sent: Monday, May 21, 2012 11:36 AM To: DelleChiaie, Pamela Subject: Re: 32 Deer Meadow Pamela, Would you happen to have a septic as-built (or worst case septic design plan) for 32 Deer Meadow? Hope you enjoyed the weekend......thanks. Sullivan Engineering Group, LLC Jack Sullivan 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 phone + fax From: "Pamela DelleChiaie" <pdellech townofnorthandover.com> To: "Bill Dufresne (wrdufresnea-comcast.net)" <wrdufresneacomcast.net>, "Benjamin C. Osgood" <BOsaooda-Pennoni.com>, "C&S (pchristiansena-christiansenandserai.com)" <pchristiansena-christiansenandsergi.com>, "Sullivan Jack (oacksu1153a-comcast.net)" <eacksu1153a-comcast.net>, "John Morin" <Johna-NeveMorin.com>, "Jim Scanlan" <iimCa)scanlanengineering.com>, "Greg Saab" <ess-cre- acomcast.net> Cc: "Susan Sawyer" <ssawyer a-townofnorthandover.com>, "Michele Grant" <mgrantatownofnorthandover.com> Sent: Friday, April 29, 2011 1:11:24 PM Subject: Septic-Town of North Andover- Septic As-Built Plan Checklist To: Septic Plan-Engineers i e0 FYI"-Attached is the most recently updated Septic As-Built Checklist that should be used as a guide prior to submitting any Septic As-Built plans to the Health Department. Please call the office if you have any questions. Thank you. scat Re9444, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 a Office-978-688-9540 Fax-978-688-8476 Email-pdellechiaieRtownofnorthandover.com Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:h_p://www.sec.state.ma.us/pre/r)reidx.htm. Please consider the environment before printing this email. 2 Town of North Andover, Massachusetts Form No. 1 No;TN BOARD OF HEALTH 3�0I "E. ,b , - 04 19 ED � APPLICATION FOR SITE TESTING/INSPECTION �9SSACHU5���5 i Applicant ' NAME ADDRESS TELEPHONE Site Location 1 Engineer ' NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. I Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH °� 19 * 1 � 1 n � AT Ew " APPLICATION FOR SITE TESTING/INSPECTION SSACHus���y Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. 5uSSU2FACE .tN 1P0SAL SYSTEM OE'SiGN POOL LOT: 3?M1 'STQECT: CR.EfL"FA90W W. TcKVN ��. 4NP OveTZ , MA ftem o pm AL HIOC34J5 n wooycrz&b-r Qk7- , A Aa �R ENOINP_'E2'b A A2CNITEGTg 3 4si ANDOV[_Q s-raeET Nt7QTH AN0CYVe%Z , MA . ATE -� �ZUi . 191ci DESIGN DgTq � �q�.CUt_A�' 10NS SOS_ �E3` f p4aT �0�.►`, e j ��.►:.- F. �r`" 441;TNEST, 'T. McJi 1-4 1, R rryt R.� cT EST K!C) f -� _ Z 3 4 S DAz E 14 ' 1`i . i 7o - E LE VgT10N iP1'j cj i f } BOTTbM - ELEVA'T 1(aN SA-TURATioN - M1NS i 1 { i2., -- 9.. DRoP M1N5 -- 9" -•- G' D FLoP - M\Ns. - ! SOIL Pk0l:kLE-DEEP PIT No. DATE TOP-ELEVATION TopsoiL jU 85011. � - - - _" - .. _ - - ---------,•.,. DARE NT SOIL I TO - WATER -TABLE N WATT-{ IX fz ►� # r PCQGOLATION TEST Deep TCST Prr a� �_ "" ' f' -- — — — — tXt5T1Nb GC*4-ro lL ,t :, ---- --- PIZOPOBCD COWTOI?tL w WAMell SeQViC TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD OCT 2 4 2005 To �� 111 DATE: "a _ -- — SYS" OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) V1b�--s ,— DATE OF PUMPING: � QUANTITY PUMPED ��,`�") GALLONS CESSPOOL: NO LYES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: Commonwealth of Massachusetts Massa Lh setts 1 1999 System i'urning Record System Owner System Location k-tr Date of i'umping: I p I(� Quantity Pumped: gallons Cesspool: No 1°9' Yes Septic Tank: No U Yes System Pumped by: liar'¢ 6.&VIM a License#_ Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: r C►tnulu►tltr�Nllb of AIN�r►Irburellr MassuchuseRs MAY 38 1996 • 5711111"titcne "'Sj'iteiii`L cal"o , • ' DecO(A)Y t C1Ud►tl�l�' I►uult►�cN /J-0o UAta or uu►l►ind 5 l �� u; es n dcltilsd #1 t s!�Iett1 1'w►►1►eJ l►r ' Cu►Ncnls.Um►sle►►r�l Int , • • • . Ills�►eel�r 1 i� ' i � A3 .P�OVED DATE ATICH OX FA � fteasans� � - I - i FM OK 1. Distance Tot a. Wetlands ` b. Drains c. Well 2. Water Line Location 3. No PPC Pipe . �. Septic Tank - / a. . _Tees -_Length & To Clean-Ont Covers. - i b. Cement Pipe to Tank .- On Both Sides of Tank - 5. Distribution Box € a. Covers & Box - No Cracks i b. All Lines Flowing Equal Amounts_ c. No Back Flow 6. ' Leach Field or Trench a. Dimensions / b. Stone Depth c - Capped.lads . Clean Double'Washed Stone` ?. Leach Pits a. Dizaens no :- b. Ston epth C. SP1 Pads ' d. T s e. C t Pipe to Pit - Both Sides_ f. can Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location,- - -- - = - b. Dimensions of System _ _ _.. . . c. Location -4th Regard_to Perc Test d. Elevations ` e: Water Table r Board of Health , North Andover,Mass SUBSURFACE DISPOSAL DESIGN CHECK LIST LOTv* 3v M APPROPTD DATE DISAPPROVED DATE Provided: Reasons: �1 Title © FAIL Ob . Reg 2. the submitted plan must show as a minimums 4_�q)--Iocation the lot to be served-area,dimensions lot # abutters location and log deep observation hoes-distance to ties location and results percolation tests-distance to ties sign calculations & calculations showing required leaching area and dimensions of system-including reserve area )� existing and proposed contours ) location any wet areas within 100' of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 1001 of sewage disposal system or disclaimer-Planning Board files (j) known sources of water supply within 2001 of sewage disposal /system or disclaimer k) location of any proposed well to serve lot-1001 from leaching facility ) location of water lines on property-1A1 from leaching facility m)-location of benchmark 7(n) driveways (ogarbage disposals (p; no PVC to be used in construction (q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and �/�bther elevations fir) maximum ground water elevation in area sewage disposal system i1(s) plan mast be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks V a) capacities-150% of flow, water table, tees, depth of tees, access, pumping (b), cleanout X,d) 101 from cellar wall or inground m4 ning pool VI(d) 251 from subsurface drains Reg 10.2 ' --Ustribution Boxes (//a) Mpe greater than 0.08 Reg 10.4 L/ b) sump i Subsurface Desizm Check List Pae 2 FAIL OB Leaching Pits Leaching pits are preferred where the installation is possible Reg 11.2 a) calculations of leaching area-minimum 500 eq ft 11.4 b) spacing 11.10 c surface drainage 2% 31.11 cover material e f� R'a2 tx11A lash ad toe at elbow g) no bends in pipe from d-box to pipe Leaching Fields Reg 15.1 gr_ 20 minutes/inch area-minimum 900 sq ft 35.4 ✓ /construction of field 15.8 ) surface drainage 2 % 3.7 e) 20t from cellar wall or inground swimming pool Leachin Trenches - Reg 14.1 a ca-lcs Teaching area-min 500 sq ft 14.3 b spacing-4 ft min 6 ft with reserve between 14.4c dimensions 14.6 d) construction 14.7 a stone 314-10 f surface drainage 2% Downhill Slope a) s9pe 7/x---T& be shown b) y/x X 150 = (to be shown Pumps Reg 9.1 a) aroval 9.6 b) stand-by power 4 Commonwealth of Massachusetts RBCEIVEU City/Town of JUN U 5 1012 System Pumping Record Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms 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 1. System Location: Left/Right front of house a RIg e r of ho , Left/right side of house, Left/ Right side of building, Left/Right front of b ' Ing, Left/ Ig t rear of building, Under deck Address Citylrown �l State Zip Code 2. System Owner. (l c Name Address(if different from location) City/Town Static— in Code CV8 "3 4 a Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quanb Pumped: Gallons 3. Type of system: ElCesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Con it or yst \j 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. LojG.L, contents were disposed: . LowellWaste Water Sig Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN LINE 6oKPoe.t7 NO. ONDOYER. 4t(e.00' - J Q � �Qy V Lo-r 33 s3- ��� 310.0o ' - ( �a i % r -4�0 h Tw4v- 3S ' sol&V .� #7 3�•9, 0 y N0 N Lo-r 3 2 0 . 44,144 S•F. o 0 INV. PIPE OUT OF HSE 1 s3� 5 a3 ACJ` U I L-r I NIV, PIPE INTO TAtAVL 113-7. 3S IKXV._PIPEOUTOFTANVL I67. 13 U�" cjU�� E DISPI�SAL.-. INV_ PIPE INTO D.aoX 186.83 INV. DI PE nuT D.t3aX I Slo, w? CYST EM N),/, 1=N D OP- PI PE 1 8h,4 z- I N '�lO1ZT1.-1 d. NDO �/ EtZ. � �d . >= S� JDYCO CONSTiz..UGTION COQ.P. J' �f K�ALE 1 " = 410/3/ (,-0 .��, ,Z 3kcVt FRANS�. G�Er_I►.IAS � ASSUGI.o.T'ES