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HomeMy WebLinkAboutMiscellaneous - 326 FOSTER STREET 4/30/2018 (2)o --I co co Oo 00 N N N N ooU�U LO N a m f0 U W US N @ a � C O _C2w s O Q L N CL 2 c N 0 C m LL Z IL J W7 LL dj OLU o T'0 J H 0 U M LU 0 N 7 �I 0U 3 01H�cn S U �U. mm U aitoL W O Q F -6-6 C C N 0 Co Ln O oo M U m O E `mW 00 °o m0 0 m�U Z U N N W W o c o U Z ON M ao o Q, voa>- vai a p_ a o m� > 0 -0 00 N O) 0) N O a y ' m(nU)co �p J M M J J r co r OCD O � U @CM ( J O y0)Q -0 0 Q 'a mi Ln O C fl IR 0 n, m X cZ) N N O O i- F- L- Lu LL ? CL w Q LLQ a+ O ON M ' O o Z O Q o 4 H E- �N mvo L 1 L N c p 0 C m LL Z IL J W7 N N W W LU V V Z_ N N Q �O WL d N �I In p » ..OF U �U. mm U aitoL d O Q L 1 0 r 0) cc d rn 00 N N N H 0606 U CO -6-6 C C 0 1- �CO 0000 ' �• t. N N z 0606 3 L ' H W M M J J Q � M yoo O IR 0 LL oo O Quo Z LL ? 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Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 06:1 Commgnweaflth of Massay;hu-$efts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 326 Foster St. Property Address Mike Ribaudo Owner's Name N. Andover City/Town MA 01845 05/26/2011 State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspectit way. Please see completeness checklist at the end of the fo A. General Information Inspector: John Souc Name of Inspector Soucy's Sewer Serivice Company Name 78 N. Broadway Company Address altered in any JUNE X011 TOWN OR NORTH ANDOVER HEALTH DEPARTuouT _Salem _ NH City/Town State 603-898-9339 13397 Telephone Number License Number 3. Certification 03079 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: ® Paste ❑ Conditionally Passes ❑ Fails eed% Further Evaluation by the Local Approving Authority is Signature 05/30/2011 Date yhe system inspector shall submifa 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 • 09/08 Title 5 Official Inspection Form: Subsurfa ge 1 of 17 �1 i, Ay lit S i� �wL itis Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 326 Foster St. Property Address Mike Ribaudo Owner's Name N. Andover MA 01845 05/26/2011 _ City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °^M 326 Foster St, ❑ Y Property Address ❑ Mike Ribaudo Owner Owner's Name information is required for every N. Andover page. City/Town B. Certification (cont.) B) System Conditionally Passes (cont.): MA _ 01845 State Zip Code 05/26/2011 Date of Inspection ❑ 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 • 09/08 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 326 Foster St. Property Address Mike Rihaurin Owner's Name N. Andover MA 01845 _ 05/26/2011 _ City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public.Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 '/z day flow t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 326 Foster St. Property Address Mike Ribaudo Owner Owner's Name information is required for every N Andover MA 01845 05/26/2011 — - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 326 Foster St. Property Address Mike Ribaudo Owner Owner's Name information is MA 01845 required for every N. Andover _ page. City/Town State Zip Code 0. Checklist 05/26/2011 Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ ® ❑ ® ❑ Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components, excluding the SAS, located on site? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, and depth of scum? Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 326 Foster St. _ Property Address Mike Ribaudo Owner Owner's Name information is required for every N. Andover page. City/Town a. System Information Description: MA 01845 State Zip Code 05/26/2011 Date of Inspection Water meter readings, if available (last 2 years usage (gpd)): Detail: Recommend removal of garbage disposal. _ Sump pump? Last date of occupancy: Commerciallindustrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No Current Date ❑ Yes 5 No ❑ Number of current residents: ❑ No ❑ Yes 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 years usage (gpd)): Detail: Recommend removal of garbage disposal. _ Sump pump? Last date of occupancy: Commerciallindustrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No Current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments a96 Foster St. D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: MA 01845 05/26/2011. State Zip Code Date of Inspection General Information Date Source of information: Owner Was system pumped as part of the inspection? If yes, volume pumped: gallons How was quantity pumped determined? Size Reason for pumping: -- 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Property Address Mike Ribaudo Owner Owner's Name information is N. Andover required for every page. City/Town D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: MA 01845 05/26/2011. State Zip Code Date of Inspection General Information Date Source of information: Owner Was system pumped as part of the inspection? If yes, volume pumped: gallons How was quantity pumped determined? Size Reason for pumping: -- 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 • 09/08 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 326 Foster St. Property Address Mike Ribaudo _ Owner Owner's Name information is MA 01845 05/26/2011 required for every N. Andover nage City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information. 1978 - Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): 28" Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: N/Afeet Comments (on condition of joints, venting, evidence of leakage, etc.) Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 6" feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) 5'X9' Dimensions: 3" _ Sludge depth: — ❑ Yes ❑ No t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 326 Foster St. — — --- — Property Address Mike Ribaudo _-- — Owner Owner's Name information is N. Andover MA 01845 05/26/2011 required for every ' — — —- page. City/Town 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 Scum thickness 37" 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" — Tape &Sludge tool _ 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 serviced in 2009 should be cleaned yearly due to age of system and garbage disposal. _ Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal feet ❑ 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 - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 326 Foster St. Property Address Mike Ribaudo Owner Owner's Name information is MA 01845 05/26/2011 required for every N. Andover — — 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.): All baffle teesgood, installed filter, in outlet tee.—. -- 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 Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons ❑ polyethylene ❑ other (explain): gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 15ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 326 Foster St. D. System Information (cont.) MA 01845 05/26/2011 State Zip Code Date of Inspection Distribution Box (if present must be opened) (locate on site plan): il 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.): Clean out solids caryover, flow checked ok. 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Property Address Mike Ribaudo Owner Owner's Name information is N. Andover required for every page. Cityfrown D. System Information (cont.) MA 01845 05/26/2011 State Zip Code Date of Inspection Distribution Box (if present must be opened) (locate on site plan): il 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.): Clean out solids caryover, flow checked ok. 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 • 09/08 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 326 Foster St. ---- Property Address NAika Rihaurin Owner Owner's Name information is N. Andover required for every page. City/Town D. System Information (cont.) _MA 01845 05/26/2011 State Zip Code Date of Inspection Type: ❑ leaching pits number: ❑ leaching chambers number. ❑ leaching galleries number: — - ❑ leaching trenches number, length: ——-- 20'X45' 900 sq' ® leaching fields _ number, dimensions: ❑ overflow cesspool number: --- ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No signs of hydraulic failure. 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 t5ins • 09/08 ❑ Yes ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 326 Foster St. Property Address Mike Ribaudo_ Owner Owner's Name information is required for every N. Andover page. CitylTown MA State Zip Code 05/26/2011 _ 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 • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form im - _lll Subsurface Sewage Disposal System Form Not for Voluntary Assessments 326 Foster St. — — Property Address Mike Ribaudo _ --. --- -- Owner Owner's Name information is_ MA 01845 05/26/2011 N. Andover required for every N. State Zip Code Date of Inspection page. City/Town 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 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 t5ins • 09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 326 Foster St. Property Address Mike Ribaudo Owner Owner's Name information is N. Andover MA 01845 05/26/2011 required for every - — ---- -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells E tim t d d th t hi h ro nd water a s I a e ep o g g u feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record f h kddt fd ; I d' Obtained from test hole 1978 I c ec e, a e o eslgn p an 1 evlewe 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: Dug hole with auger in low drop off area, 6' no water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 326 Foster St. Property Address Mike Ribaudo Owner Owner's Name information is required for every N. Andover _MA 01845 page. City/Town State Zip Code E. Report Completeness Checklist 05/26/2011 Date of Inspection ® 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Summar/ Record Card generated on V1712011 9:07:47 AM by Karen Hanlw, Town of North Andover Tax Map # 210-104.8-0021-0000.0 Parcel Id 16349 326 FOSTER STREET RIBAUDO, MICHAEL 326 FOSTER STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Size Total 1.11 Acres FY 2011 UB Mailina Index Name/Address Type RIBAUDO, MICHAEL Payor 326 FOSTER STREET NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 17805.0 - 326 FOSTER STREET 3170470 03 Cycle 03 UB Services Maint. Loan Number Property Type Active/lnact. From Occupant Name Last Billing Date 4/6/2011 Account No. 3170470 Service Code Rate MISCFEE ADMIN FEE 0,635/6 WTR WATER 01 ALL METER SIZE UB Meter Maintenance Account No. 3170470 Serial No Status Location 36185582 a Active ERT HH Date Reading Code 3/7/2011 141 a Actual 12/8/2010 121 a Actual 9/912010 102 a Actual 6/8/2010 64 a Actual 3/1012010 40 a Actual 12/11/2009 19 a Actual 9/30/2009 0 n New Meter 9/30/2009 3371 r Replacement 6/9/2009 3341 m Manual estimate 3/1612009 3316 m Manual estimate MSG 12/8/2008 3296 a Actual 9/11/2008 3278 a Actual 6/6/2008 3215 m Manual estimate MSG 3110/2008 3193 a Actual 12/12/2007 3172 a Actual 9/6/2007 3149 a Actual 6120/2007 3122 a Actual 3/15/2007 3100 m Manual estimate 12/12/2006 3083 a Actual 9/13/2006 3066 a Actual 6/13/2006 3033 a Actual 3/7/2006 3006 a Actuat 12/22/2005 2988 a Actual 9/20/2005 2965 a Actual Activellnactive Active Charge Multiplier/Users 7.82 1/ 76.00 /1 Brand Type b Badger w Water Consumption Posted Date 20 4/13/2011 19 1/12/2011 38 10/15/2010 24 7/1512010 21 4/14/2010 19 1/12/2010 0 10/15/2009 30 10/15/2009 25 7/20/2009 20 4/29/2009 18 1/20/2009 63 10/10/2008 22 7/16/2008 21 4/1112008 23 1/22/2008 27 10/12/2007 22 7/20/2007 17 4/16/2007 17 1/19/2007 33 10/20/2006 27 7/10/2006 18 4/17/2006 23 1/17/2006 27 10/14/2005 Size 0.63 0.63 Pane 1 Residential Until YTD Cons 141 Variance 6% -48% 53% 13% -11% -100% -100% -10% 44% 0% -69% 160% fi% 0% -32% 53% 24% -3% -47% 30% 15% -3% -23% 7% NEW ENGLAND ENGINEERING SERVICES INC I TOWArRDOVER/ s BOARD Of HEA�� M 3t 3 i November 30, 1998 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: I TITLE V REPORT 326 Foster Street. Enclosed is a copy of the Title V report for 326 Foster Street, North Andover, MA. The system passes our inspection. If there are any questions please call me at my office, 686-1768. Yours truly, Co Benja C. Osgood 3I.T. President 33 WALKER ROAD - SUITE 23 - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 PART A. CERTIFICATION - Property Address,2J o2 E, ��s�� Name of Owner ,�� rKi s Dccc.� Jc7�Je✓l `Xj- i:., — _- Address of Owner- 3a6 .sTcJZ S C__ /�J. �v.0 . Date of Inspecti( 19/1,% /I % L" Name of Inspector: (Please Print) e p•rw•a CO., OJalt.- 1 am a DEP approved system inspector purw to Section 15.340 of Title 5 (310 CMR 15.000) Company Name:,w. C vw�� .0 rcw,nr e: Svi cCy S.—c.. Mang Address: x 3 C 13 — ((,t tR �� Sv tie Z � AJ - 6,v � 6 �1� tZ, AA � Telephone Number: X78 C. - / 7 6 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ZPasses. _ 'Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: g_!2= Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)w'tthin thirty (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 Department aVEnvironmental Protection. The original should be sent lovfe system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS Aj Z) T, -_L. LFGL re_T,-,Q by Q Pk- l " w ->s f -e ? -s et COMMONWEALTH OF MASSACHUSETTS - EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500w , `3 t7 U, F s 1.ai TRUDYCWAaJ ISecretaly` ARGEO PAUL CELLUCCI DAVID B: STBUfib1: 1 Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM CominiscSAner- PART A. CERTIFICATION - Property Address,2J o2 E, ��s�� Name of Owner ,�� rKi s Dccc.� Jc7�Je✓l `Xj- i:., — _- Address of Owner- 3a6 .sTcJZ S C__ /�J. �v.0 . Date of Inspecti( 19/1,% /I % L" Name of Inspector: (Please Print) e p•rw•a CO., OJalt.- 1 am a DEP approved system inspector purw to Section 15.340 of Title 5 (310 CMR 15.000) Company Name:,w. C vw�� .0 rcw,nr e: Svi cCy S.—c.. Mang Address: x 3 C 13 — ((,t tR �� Sv tie Z � AJ - 6,v � 6 �1� tZ, AA � Telephone Number: X78 C. - / 7 6 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ZPasses. _ 'Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: g_!2= Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)w'tthin thirty (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 Department aVEnvironmental Protection. The original should be sent lovfe system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS Aj Z) T, -_L. LFGL re_T,-,Q by Q Pk- l " w ->s f -e ? -s et 3 Ser 1110, revised 9/2/98 Page Iof11 0? Printed on Recycled Pape, SUBSUgFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A $ CERTIRCATION (continued) Property Address: 2 (o Fbs+ck S-, , A-) owner: flabeh Daft of IrWpectiort: _ INSPECTION SUMMARY: Check A, B,. C.,Or A . A. SY TEM PASSES , 1 have not found,any information which indicates that any?of the failure conditions described in 310 CMR 15.303 exist. Any 'failure, nteria not evaluated are indicated belW. COMMS B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound; shows substantial infiltration or exfiltration, or tank failure is imminent.. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in,the distribution box is due to brokep or obstructed pipe(s) or due to.a broken, settled or uneven distribution -box. The system will pass inspection if (with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumphig-more than fourtimes is Wardue to broken or obstructed pipe(s). The System Will Fess-� inspection if (with approval of the Board of Health): - -- broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2of11 W, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) V1 Property Address: 344- ro-c tt!' S {� \� Date of Inspection: 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 protectthe, public health, safety and the environment. 1) SYSTEM WILLPASS UNLESS BOARD 6F HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (111ib) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH-WILLPRO1ECT THE PUBLIC HEALTILAND SAFETY. AND THE OMBONMENL- Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank, and soil absorption system (SAS) and the SAS is within 100 feet of a syrface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply.welL The system has a septic tank and soil absorption system and the SAS is within 60 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 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 free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR -F A CERTIFICATION (continued) Property Address: �3Zb Fos�CJ- s -h Ad, fFK9-D')M O f ' s..) w« dam.., 00l 6-_'1:; )11y� 18 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each'of the following`. 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should tie contacted to determine what will be necessary to correct the lailure. Yes No Backup of sewage into4acili"4Tstem component- due %to an overioeded orcleggedSASorcesspool. 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 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is -within a`Zone 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. 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: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The 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 health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system•is-within 200 ieetof a Eeibutary teaeurfaoadrinkiwg water wpp1Y- ••• - — • --• •• _ _ _ 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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further infortnation. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOS�L SYSTEM INSPECTION FORM PART B CHECKLIST 3g7 C;;. Property address: _37-(, Fjs { m Sfi til. 616 O i CAL Dace of W4*ction: -S "II w•;` s �``" { be. Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: ; Yew No ✓✓/ Pumping information was provided by the owner, oc�upant, or Board of Health. y _ .None of the system sompowants.baus man poatipoddoratJeastiwo.awaahcanddhe'rystem hasJbwoasceiaiagrwsasal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non -sanitary or industrial waste flow. Y _ The site was inspected for signs of breakout. J _ All 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. The size and location of the Soil Absorption System orr the site has been determined'based on: _ Existing information. For example, Plan at B.O.H. Determined in the field.(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)] The facility owner (and.ocrupants,if diffareat frnm.owrner).wera prmrided.with infar natioo nn f SubSurface Disposal Systems. revised 9/2/98 Pagesortt i SUBSURFACE SEWAGE DISPOS�L SYSTEM INSPECTION FORM PART B CHECKLIST 3g7 C;;. Property address: _37-(, Fjs { m Sfi til. 616 O i CAL Dace of W4*ction: -S "II w•;` s �``" { be. Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: ; Yew No ✓✓/ Pumping information was provided by the owner, oc�upant, or Board of Health. y _ .None of the system sompowants.baus man poatipoddoratJeastiwo.awaahcanddhe'rystem hasJbwoasceiaiagrwsasal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non -sanitary or industrial waste flow. Y _ The site was inspected for signs of breakout. J _ All 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. The size and location of the Soil Absorption System orr the site has been determined'based on: _ Existing information. For example, Plan at B.O.H. Determined in the field.(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)] The facility owner (and.ocrupants,if diffareat frnm.owrner).wera prmrided.with infar natioo nn f SubSurface Disposal Systems. revised 9/2/98 Pagesortt PUMPING RECORDS and source of information: .-O System puYnped as part of n pection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed -{if known) -and source of4i0ormation: Saws" odors detected when -arriving at the site: (yes or nov—vd revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT10Pf iFORM )•. PART C ,; SYSTEM INFORMATION Property Address: 3Z16 s. - b -h A)- +,,C6 ­1c,.. Owner: sem, Date of ktspecdon: l�l�ilRB '�� 2� �t8 ,' R. FLOW CONDITIONS , RESIDENTIAL•=`. design flow: g.p.d./bedroom. Number bedrooms (design): Number of bedrooms (actual): of Total DESIGN flow 7 Number of currentresidG� s r p rt Garbage grinder (yes or do):.� Laundry (separate system( (yes or no):W : If yes, separate3nspection•required _ Laundry system inspected (yes or no) Seasonal use (yes or no):_WQ Water meter readings, if available (last two year's usage (gpd): Sump Pump (yes or no):_/,J0 Last date of occupancy: C .; e e,1'i" COMMERCIAL/INDUSTRIA L: Type of establishment: Design flow: gpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non -sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: - GENERAL INFORMATION PUMPING RECORDS and source of information: .-O System puYnped as part of n pection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed -{if known) -and source of4i0ormation: Saws" odors detected when -arriving at the site: (yes or nov—vd revised 9/2/98 Page 6of11 "c#. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t;s PART C SYSTEM INFORMATION (continued) , 2 Property Address: /J A �.b!d CL Owner: -5ivr..i 'Qean D. 15, e.�H Date of hspecbort. i 1�+� s ' ` .1 r I , 20 BUILDING SEWER: (Locate on Site plan) tf Depth below grader a 1 Material of construction: Zcast iron_ 40 PVC - other (explain) Distance from private %, ater supply well or suction line N' IT! • :` . Diameter Co ants: (condition of joints, vejjting, evidence of leakage, -etc.) =� }'4 rJe� Do 5 ! /!W (�_ i lA SEPTIC TANK: (locate on site plan) 'r Depth below grade: � Material of construction: Vconcrete _metal _Fiberglass _Polyethylene _other(explain) If tank is (petal, list age _ ls.age.confirmed by Certificate of Compliance _ (Yes/No) Dimensions: /0100 61a/lD ns Sludge depth: Distance from top of sludge to bottom of outlet tee ortraftle: 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: How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet evidence of leakage, etc.)An/X 16 T-41-0 C TV r'1 U/64 -e Di --,I GREASE TRAP. -_,!k (locate on site plan) or -baffles, depth of liquid level in relation to outlet invert, /) A , Tia//< i_e AK 14/fl- s4 -T Depth below grade:_ 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid.level in relation to outlet invert, structural integrity, evidence of leakage, etc.) revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) a4:. Property Address: Owner: y Date of Inspection: ( 111 TIGHT OR HOLDING TANKc�%(Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) i I Depth below grade _ Material of construction: _concrete _metal _Fiberg4ass _Polyethylene _other(explain) II Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order: Yes _ No_ Data of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: - (locate on she plan) Depth of liquid level above outlet invert: Q Comments: (n if level and distr'but' n is equal, nevidence f solids car yover, 'den a of leak ge into or out of box,, etc.) — - PUMP CHAMBER -,AA (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 Page 9of11 • . K . • t.r gyp.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • ; PART C . SYSTEM INFORMATION (continued) - ,. ,;..� ;•., Property Address 3z 6 �� � N.- Owner: A.-�o ✓�.0 "x Date of Inspection:SvDeaOp(%[n A iSOIL ABSORPTION SYSTEM (SAS) — F'.'•a (locate on she plan, if possible, excavation not required, location mey:be;approximated by non -Intrusive methods); ;=> ,If not located, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length:__ r leaching fields, number, dimensions: X F, 6 y etc overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, *gns of hydraulic failure, le el of ponding, damp soil, condition of vegetation, etc.) CESSPOOLS: &rt. (locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimenslohs of cesspool: Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as part of inspection) 4 Comments: (note,condition of soil, signs of hydraulic failure; -level of pending, condition ef.vegetation, etc.) PRIVY: A fA (locate on site plan) Matedals of construction: Dimensions: _ Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation; etc.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) i revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION" (continued) . Propdrty address: 3a 4 1':&,r it .51he� AX, rj-1. Date of Inspection: ! i Oran �►�g�q8 NRCS Report name i!gC"I e)c /i%� /�7 /t P1,411 Soil Type : C AMT?) A/' Typical depth to groundwater i • t)'` USG . Date website visited ���Z Iles Observation Wells checked j Groundwater depth: Shallow ' Moderatef P Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater %- Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record lbserved. Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers -'—Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 1� �3 5•S.C. S. IJAI'S s Flaw J- LAN o� SL P�y- revised 9/2/98 Page 11 of 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Bop.n�n_JE 41., ,:J:7, J:7,4_11 ' R - 9 2003 , RS TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: z Owner's Name: Owner's Address: Date of Inspection: Z /1 Name of Inspector: (please print) Company Name: o Mailing Address: . i / ) �• � � Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature:v v4, 1. Date: to 3 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. Notes and Comments 4c.o R 0Fort)'S 77# �v sPrcrloh, .57 /A-, /S'uu ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 -14- ' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ,-30'�& /CIJ S r LSf Owner. ` Date of Inspection: L Z Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: 1L I have not found any information which indicates that any of the failure criteria described in 310 CMR 115.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: A- - #B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired: The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: of -. M, Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7kj' "S4 Owner: r/7i Date of Inspection: Z/0-3 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:/ ye�;,4" Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No r�B ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool — t, -,Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool — –f"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 ''/z 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 SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. fir- 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] (Yes/No) 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• You must indicate either "yes" or "no" to.4ach of the following: (The following criteria apply to large systems in addition to the criteria above) 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. 4 Page 5of11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:[�lo Owner:!/ Date of Inspection: Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health ./ Were any of the system components pumped out in the previous two weeks ? _ Has the system received normal flows in the previous two week period? ./Have large volumes of water been introduced to the system recently or as part of this inspection ? f _ 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: Yes no /� 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) [3 10 CMR 15.302(3)(b)] t1A il Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:.3�26 /T -)SE'S/ Owner://7 / Date of Inspection: :!!z_2/z23 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): V DESIGN flow based on 310 CMR 15.203 (for example: I 10 gpd x # of bedrooms): / 0 Number of current residents: 3 Does residence have a garbage grinder (yes or no): Is laundry on a separate sewage system (yes or no): f�v [if yes separate inspection required] Laundry system inspected (yes or no): _ Seasonal use: (yes or no): _�d o Water meter readings, if available (last 2 years usage (gpd)): 0? Sump pump (yes or no): _tk/v d Last date of occupancy: �' e COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): _ Non -sanitary waste discharged to the Title 5 system (yes or no): _ Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: e- S d -H4 Was system pumped as part of the inspection (yes or no): If yes, volume pumped:/<'h o gallons --How was quantity pumped determined? _Z,�14 Reason for pumping: /I /' ga 5 TAIL G z / /D d .r., sem, P TYP 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) _ Tight tank _ Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site (yes or no): 17 O 6 Page 7ofII OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:32S/ Owner:�/'� Date of Inspection: BUILDING SEWER (locate on site plan) Depth below grade: Z J Materials of construction: _cast irony/ 40 PVC _other (explain): Distance from private water supply well or suction line: %av,,'+ oc .4 rrl-' Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK(/9 (locate on site plan) �r Depth below grade: /.L Material of construction: concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions/. {bD Sludge depth: �/ a Distance from top of sludge to bottom of outlet tee or baffle: 3 Scum thickness: i. "' ,, Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: /)// S /T c Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t A GREASE TRAP: _(locate on site plan) Depth below grade: _ 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: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 . . . Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: -Z O 57� Owner• '—�1"/o/ Date of Inspection: +� TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Cj Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX/ -±3 (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: a.2 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.): /`/0 G F' -2K ..z 5' e PUMP CHAMBER: (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3 S Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: , �- leaching trenches, number, length: — 4i leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): X/eJ 1 7 ©-f' WyQ f4vG!C ff>iGr��c e /yw- 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 or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 0 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.): M 1 • M Page 10 of I I N OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION (continued) Property Address: 3Jsr�S Yr ' Alld , Owner: Date of Inspection: i SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. /051 JL 10 g- c S3 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:,3C,24a Z Z57y� Owner:_ 7CrYi Date of Inspection: Jlle_71,) SITE EXAM y Slope Surface water Check cellar -, Shallow wells Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: �'' Obtained from system design plans on record - If checked, date of design plan reviewed: ,Observed site (abutting property/observation hole within 150 feet of SAS) t/ 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: da'-, 11 CDƒ 2 $ » - ° w 4����� w j 0 g @CD@ r � \ } � 2 ® c > ru 7 & / 3 0 7 ° 0 0 7 . / / k ?/ O ƒ / 7 » \ $ r O ƒ G> 0 a / 2j \ m LA J } / � ® ru � � �§ ± \a \� \ � @ p Z ƒ / k Z m 7 \ l 2 \: -k ƒ LIQ R = E � @ 2. G \ » ± r- 2 } .0 z , = m APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: 3,;2 LICENSED INSTALLER: sy O.'d j "L SIGNATURE: ATELEPHONE# 7 6 .9 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As -Built? Yes No Floor Plans? Yes No Approval Date: and of Health rth Andoverz,Maes- SEPTIC SYSTEM INSTALLATICK CHECK LIST Rsaspnst. •1 � I 1 / LOT �;�1✓�, EXCAVATION OK FAIL � 717� 1. Distance To: 11� a. Wetlands b. Drains c. Well 2. Water Line Location 3. No PPC Pipe 4. Septic Tank------ a. ank--:---a. Tees --Length & To Clean Out Covers - b. Cement Pipe to Tank -Chi Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped 'Ends d. Clean Double Washed Stone 7. Leach Pits a. Dimensions b. Stone epth C., 8p1 Pads d. T s e, t Pipe to Pit - Both Sides f. Clean 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 with Regard -to Pere Test d. Elevations e, Water Table Board of Health SEPTIC SYSTEM , North Ano-072EXN" . INSTALLATICK CHECK LIST LOT U �.lReammst 1. Distance Tot a. Wetlands b Drains c. Well 2. Water Line Location 3• No PVC Pipe 4. Septic Tank---- a. Tees --Length & To Clean Out Corers - b. Cement Pipe to Tank - On Both Sides of Tank - = 5• Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flow b. Leach Field or Trench a. Dimensions b. Stone Depth as Capped Inds d. Clean Double Washed Stone 7. Leach Pits a. Diu�nsis b. Stone epth c.X Pads d.t Pipe to Pit - Both Sides f. 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 with Regard -to Perc Test d. Elevations e: Water Table �o ,y to Public Works SUBSURFACE DISPOSAL SYSTEM CHECK LIST �~ . NORTH ANDOVER BOARD OF HEALTH APP VED DATE PROVIDED DISAPPROVED DATE TIME REASON. �fl23l78 Title 5 Reg. 2.5 Reg. 6 FailJOKI The submitted plan must show as a minumum: -(-e)' the lot to be served (area,dimensions,l,ot //,abutters) (Planning Board files) location and log of deep observation holes -distance to ties location and results of percolation tests -distance to ties -(dmf design calculations & calculations showing required leaching area (ti--llocation and dimensions of system (including reserve area) izexisting and proposed contours location of any wet areas within 100' of the sewage disposal system o r disclaimer (check wetlands mapping) � ' � surface and subsurface drains within 100' of sewage disposal system or''disclaimer ' -(-� location of any drainage easements within 100' of sewage disposal system or disclaimer (planning board files) �a) known sources of water supply within 200' of sewage disposal system or disclaimer _Ck) location of any proposed well to serve the lot (100' from leaching facility) (�) location of water lines on property (10' from leaching f facilities) {-m-} location of benchmark f n) driveways garbage disposers no PVC is to be used in construction a profile of the system (elevations of basement, plumbers pipe septic tank, distribution box inlets and outlets, distribution field piping and any other elevations) rt r) maximum ground water elevation in area of sewage disposal, system plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Septic T nks (a) apacities - 150% of flow, water table, tees, depth of tees, access, pumping, Cleanout c 10' from cellar wall or inground swimming pool d 25' from subsurface drains North Andover Subsurface disposal system check list - Page -2 Reg.10.2 Reg.10.4 Reg.11.2 Reg.11 .4 Reg.11 . Reg.11.11 Reg. 15.1 Reg. 15.1 Reg. 15.4 Reg. 15.8 Reg. 3.7 Reg.14.1 Reg.14.3 Reg.14.4 14.5 Reg.14.6 Reg.14.'7 Reg.14.1C Reg. 9.1 Reg. 9.6 it IOKI Distribution Boxes a Slope greater than 0.08 b Sump Leaching Pits Leaching pits are preferred where the installation is possible (a) Calculations of leaching area (minimum 500 S.F.) (b) Spacing (c2 Surface drainage 2% d Cover material rA f2'f�" Qrash p -d(3) Leaching,,Fields (a)No neater than 20 minutes/inch b Area (minimum 900 S.F.) Construction of field d Surface drainage 2% (e 20' from -cellar wall or inground swimming pool Leaching Trenches (a Calculations of leaching area (min. 500 S.F.) Spacing (4 ft. min. 6 ft. with reserve between) Rb Dimensions (d Construction (e� Stone (f) Surface drainage 2% Downhill Slope a Slope y/x to be shown b� y/x X 150 = (to be shown Pump NApproval Stand-by power 0 � v ' SOIL PROFILE & PERCOLATION TEST DATA Board of Health -North Andover, Mass. Street Ttg& Lot No. I Subdivision' �, Owners Investigator j 170 1 Observer Fee 0 .3 2 3 4 J J 7 5 1. Date Elev. Feet Inches 0 W!161 3 2. Date Elev. SOIL PROFILES 3. Dat e Elev. 4. Date Elev. Ties to Test Pits 1. 2. 3. 4. 5. ��- 4 f 10��120 i - Note: Top & subsoil depth; depths of other soil types; depth of water table; depth of refusal. PERCOLATIOI�1 TESTS -- Datee-('75R Date Date PntP T)nfiP Pit Number 1 2 3 4 5 Start Saturation Soak=Mins. Start Test -Time v Drop of 3" -Time v 3� Dropof 6" -Time :dins. 'I st 3" Drop It M fins. 2nd 3" Drop,, rop 1� - ,ate Min. In. 2 °1 \32.00 4Q<!4 ' S 34 14' - i 50Op 10 .00 , �N Lc 1K A= 4, LOT 10 r. d- r a- 1;1 LOT A= 43,570 s.F U) ti w t r77 0 S. f7. LOT 7 ao LOT A= 48, Co14 s.F_ N S ,� � A= 54, 54ec s. F. A= W 52,932 S.P. N •, �s-Iy'Ll � 'n 10.79 2�,, u) �• L' N 30 0 <P U E Co CV 0 ° I O N of 1 0 , In l - �" GN ©F LOT � 1 2 PR LP,&xE.C-) F ov, L4Wp5AlL , imG 2q2 66A=� sm. PV—Ai-4w— C . Gr--%— i r -4,c.,% A.tvoASSoC:IATr. % �:-NC.II'4B-�R� ANO AOLC.Tti.C.'TS Nca.-rH AHt�ov��t.O�Flc� Pc,tZlc Norz-rN /�tvoov�s�,M,o. o�8as C A -r V. AJE6 eii I `l'78 DF.SIGN_DATA GALCVLQ►TIORS - S of L OSS E RVA -r IONS 8`! _ .____� _,.c�,C-�At�l a 1�t►-taF�Rtic L.. PI -31 L� ► PS Soli. Oko-vit i--DEFp PIT No. P�hlCbLA"T vow -'EST NO. j 2„ 3 4 $ OwT C -- To P - E LsviKrio N %ON %ATURAMON-NA%gs. 159 . to CApA( IiY _ _ ._ _ ,. y G� PD /PIT ToP E1.EYA'TiON G D//PxT PIS RE�'6. U$e prrs r -- -TOPSO SIDMAl.t. AE CA..L.jisw.F T Soli. Oko-vit i--DEFp PIT No. SF x G-A.a.r ,' = GPD so-rAREA t s�' X DATE / 5 240) -?g i �,L eA err Le t44 iAC�e CApA( IiY _ _ ._ _ ,. y G� PD /PIT ToP E1.EYA'TiON G D//PxT PIS RE�'6. U$e prrs -TOPSO SIDMAl.t. AE CA..L.jisw.F T Lo" rro EA S L� X Cz-A1.S GAL/ L1N..PT. `To ENCM LEACWINGG CAPAr-I Y GPD PLoV4 � �(.E�. ;= ,...._..:.`# 1�lclaEs R►:q'a. U SE.______ L.F No -r Es WATER-TASLE CJI LT'S' . L-s2/aV EL. . N° Wk -T WA'iER-MULE E LEVACT1gN__ BOTTOM i.E1tATIbri1 I ; Eid 8tJ tt, b11�lC-r�PE. - 6..t►1 i.:iC�' ' `Lbw G° (6pD FLQw x ISv� q oa � v fo �'AL.�•J►''��T1C iAr1iC LE:at,la INL* a �A o GPD FLOW x GAL,-- X44 SF 13 U.SE oca S� P►T3 - 'TYoE Mvw.- (-xyP.l SID�WAI,I. _A._ SF x G-A.a.r ,' = GPD so-rAREA t s�' X GAUZ SF _ G<'PD i �,L eA err Le t44 iAC�e CApA( IiY _ _ ._ _ ,. y G� PD /PIT GP E) F: Low .�;.- G D//PxT PIS RE�'6. U$e prrs SIDMAl.t. AE CA..L.jisw.F T Lo" rro EA S L� X Cz-A1.S GAL/ L1N..PT. `To ENCM LEACWINGG CAPAr-I Y GPD PLoV4 � �(.E�. ;= ,...._..:.`# 1�lclaEs R►:q'a. U SE.______ L.F No -r Es 2 0 PI RM rp G� T Ir 0 tr w to k 5 I� it m� II II II !f +° i1 -bEj"- - TOM ? rn A' If it II I f o.6 10 i t 11 P d . .0 . 1 l �f I $ 1 j 11 f I� p811 i z' _ N` rp G� T Ir 0 tr w I� it m� II II II !f +° i1 ? rn If it II I f o.6 10 i t 11 d . .0 . 1 l �f I $ 1 j 11 f I� p811 i z' _ N` go i-1 II II ��II iI K Hf rtoo- Acz rp �` w I� it m� II II II !f +° i1 ? rn If it II I f o.6 10 i t 11 d . .0 . 1 l �f I $ 1 j 11 f I� p811 i z' _ N` i-1 II II ��II iI rtoo- � �r v b� < f cr F r, I :l 1 rn V* s: aw �lwl T • • mzzz Wit 0.4 ,fit III aw �lwl T 114' mzzz Wit 0.4 aw . SOIL PROFILE & PERCOLAT N TEST DATA � Town/,Cit No.&Street _ 'lt No. V // . ` Loc./Subdiv.,- ter, ff Plan Owner"(..,). Investigator �,- (i7 Cc i� Observer 7 SOIL PROFILES -DATE S 1. Elev. 2. Elev. 3. Elev. 4'Elev. �0 - 0 0 0 Q 1 1 1 1 2 3 4 � 5 d 3 6 0 7 91 9 M 31 41 5 1 M 7 IM M r^. M 4 5 6 7 8 9 10 1 I 10 �_ I 10 1 10 I Benchmark Location Elevation Datum Percolation Tests -Date Pit Number 1 2 3 4 S Start Saturation (.Z Soak -Mins. Start Test -Time ,'Sp Drop of 3" -Time (� Drop of 6" -Time (�• Mins.lst 3"Dr3 2 / Mins.2nd 3"Dro Notes & Sketches on Back Frank C. Gelinas & Associates, North And. 1 j y�rt �_ r..15". � � rye .1;-�w�, �• � � a � ,�. �,; w X r v. z • ?<. � .- '� 4. t� .. � - � t Wil■ ., . AL 1 r t=t2o.NbC GCSE-L-1KIA-AS As�cxta.TES t`NGtNE.E�S� ARL4-ltTEGT� 41 r r t�- � r r i r } !,_.. Q T 9 r {• r .T I 0 � No Gc�213�-�E C�+NGC—fZ St_1,/ut_ � lI Nc 2r=/AGE Vn/A.-*c-2 Su%FL.c L 1 CC Sll QFAC C- DR/3 N t- �2 V Qui KI EA`.,* M CL.fTS r oc oC �• Z CM �I rn�T Id I+J LCL L I Wt-t"4.a U2AVEL . f Y�� r1�cn"�ti - GI• lri`1 tv,1U^J fZ TgZAINti c. GELlNboe-N t c 1r1 ' I T •' 3 - k