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HomeMy WebLinkAboutMiscellaneous - 35 WOODBERRY LANE 4/30/2018I/ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF +ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 15 Woodberry Lane North Andover, MA 01845 Owner's Name: John R T : nda S -hrader Owner's Address: 3.5 Wnndberry Tane )1inrth Andover, MA 01845 Date o1' Inspection:.12,1161/05 Name of Inspector: (please print) Ja._mes Wright Company Name: R.J. Inspections, Inc. Mailing Address: One Osgood Street Methuen, M.A 01844 Telephone Number: 978-681-8759 CERTIFICATION STATEMENT RECEIVED JAN 1 1 200 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 1 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: r/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: i The system inspecto s I submit a copy of this inspection report to the Approving Authority (Board of Health or DEPT within 30 da 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 ****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 - of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:.35 Woodberry Lane Owner: John &NLiAndover, ndaSar hraerMA 01845 Date of inspection: X211 h 10 r, Inspection Summary: Check A,B,C,D or E / ALWA,yS complete all of Section D A• Systei asses: 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 pa:;s. Answer ves, no or. not determined (Y,N,ND) in the for the follow ng statements. If ".not determined" please. _-____,___ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structtn-ally 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 20-7nttt—i-;i-kie ND explain: Oliserva n of sewage backup or break out or high static water level in the distribution box due to broken or obsnvcted pi e(s) or due to a broken, settled or uneven distribution box. System will pass i appy°vat Board of Health): nspection if (with 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): ND explain: broken pipe(s) are replaced obstruction is removed 2 Pa"C of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 Woodberry Lane nd ver MA 01845 Owner: John & Linda Schra er Date of inspection: 1 2/ UL 5 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 failinb 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 ublic Water Supplier, if any) determines that the system is functioning in a manner that pr cts the public health, safety and environment: — The system has a septi ' and soii absorption system (SAS) and the SAS is within 100 feet of a surface water supply or utary to a surface water supply. _ T/The'stem as a septic tank, and SAS and the SAS is within a Zone 1 of a public water supply. has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 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 Iess than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form, 3. Other: 3 1'a` -e 4 of l l OFFICIAL, INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 Woodberry Lane NorthAn over, A 01845 Owner: John & Lin a c ra .Date of Inspection' 1 / 1 6_/ 0S .D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No _ _.1-*' ckup 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 ged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool M4! uid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow _. _;Required pumping more than 4 times in the last year NOT due to clogged or obstructed i e Mmes pumped p p (s). Number —._ ��ny y portion of the SAS, cesspool or privy is below high ground water elevation. portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface _�N ter supply. �ny portion of a cesspool or privy is within a Zone 1 of a public well. y portion of a cesspool or prigreater vy is within 50 feet of a private water supply well. _! Any portion of a cesspool or privy is less than 100 feet but �r er 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.] /UW (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 mus gpd. t serve a facility with a design }low of 10,000 gpd to 15,000 You must indicate either "yes" or "no" to each of the following: (The folloNving criteria apply to large systems in addition to the criteria above) yes no �-- ______ the system is within 400 feet offace drinking water supply ___ the system is within feet of a tributary to a surface drinking water supply the systemi ocated in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone ILof 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 "vcs' 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, Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Z9h_N35 Woodberry Lane orth Andover MA 01845 Owner: -n L nda Schrader Date of Inspection:_, 21/1 fil 9 5 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Pumping information was provided by the owner, occupant, or Board of Health V Were any of the system components pumped out in the previous two weeks ? _ .Has the system received normal flows int e h previous two week period Havee large volumes of water been introduced to the s stem recently y 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 u b p 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 sctun ? Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? p 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 i ' s a tissue approximation of distance is unacceptable) [310 CMR 15302(3)(b)J Page 6 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: —3 5 WQQdbexry Lane -North Andover MA 01845 Owner: John & Linda Schrader Date of Inspection: 1 Ing RESIDENTIAL FLOW CONDITIONS Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of 1Sedrooms): Number of current residents: Does residence have a garbage grinder (yes or no): ,Ve Is laundry on a separate sewage system (yes or no): X;t7 [if yes separate inspection required] Laundry system inspected (yes or no): -1 Seasonal use: (yes or no):/►rd Water meter readings, if available (last 2 years usage (gpd)): Sump pump (yes or no): // 0 Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR _ , : gpd Basis of design flow (seats rsons/sgft,etc.): Grease nap present or no): _ Industrial was olding 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): Pumping Records " GENERAL INFORMATION Source of information: Ll r nofiev_ Was system pumped as part of the inspection (yes or no): ni0 If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: TYPP -M 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) _ TiQht 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): 41-67 Page 7 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Woodberry Lane worth Andover., MA 01845 Owner: John & Linda Schrader Date of Inspection: A 211 ti 61; BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: _ (locate on site plan) Depth below grade.- Material rade: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 :certiicate) (attach a copy of Dimensions: Sludge depth: /1 Distance from top of sludge to bottom of outlet tee or baffle: acf r� Scum thickness: Distance from top of scum to top of outlet tee or baffle: z,r Distance from bottom of scum to bottom of outlet tee or baffle: /,P How were dimensions determined: �f9 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as .related to outlet invert, evidence of leakage, etc.): GREASE TRAP: _(locate on site plan) Depth below grade: _ Material of construction. _ (explain): Dimensions: Scum thickness: Distance from top of to top of outlet tee or baffle: Distance from b om 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.): concrete _metal rglass __polyethylene _other Pale 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Woodberry Lane North Andover MA 01845 Owner:John & Linda Schrader Date of] nspection: 1 2/ 1 6/ 0 5 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concreteme�rberlass y y g —___polyethylene leve other(explain) Dimensions Capacity: Crallons Design Flow: gallons/day Alarm present or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIB UTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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 )- PUMP CHAMBER: (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or Continents (no [e conditio pump chamber, condition of pumps and appurtenances, etc.): 8 ]'age 9 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Woodberry Lane North Andover, MA 01845 Owner: John & Linda Schrader Date of Inspection: 12 116/ 0 5 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why.- Type hy: Type leaching pits, number: _ leaching chambers, number.- leaching umber:leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: _ umovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): CESSPOOLS: yr�Z: (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 scam layer: Dimensions of cesspoo Materials of cons ction: Indication of groundwater inflow (yes or no): 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 con 'io1 of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Woodberry Lane orth Andover, MA 01845 Owner: J-ohn & 1�ILinda Schrader Date of Inspection: �� 116 / 0 5 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. J w a Page 1 l of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Woodberry Lane North Andover, MA 01845 Owner:john & Linda Schra er Date of'Inspection: 1 2116/05_ SITE EXAM 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 fi-om system design plans on record - If checked, date of design plan reviewed: _ Observed site (abutting property/observation hole within 150 feet of SAS) Cd 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: _ II tt CCO ti O y wLi, r`o`vt1i �- I � ' Ip AGI i ' pN Q CD C) 88p C) © p iD Q - 0 g v ca Q- A is fiT .,J .A . is tli CiT U1 M fp m : Wqyy ' rs : mLp(nn�� Cph�y to m �2,1 yWy p) A to t4 'v a i..i W O p.;Cn (D tD w O a =3 Q:1'A m"OD N N 'a cz FLCLO is W r3 GD A " C71 Cn . •P p. . 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TT y ANN t " ii tt�.17,rrl iD �� i 1 czt c h i � � rA fi •�. 12, i �df � in cSt � ���. ay ,1 �,�.�ti�^ $, p"'" �i :•� x -- t IAS tts 4*-Hxt�.,': � ;A'. '� r., ;.., tAt+ �, . i -t �e t�h.t�jt� � �' � •-`L:.. r «�.,r-r"� z���i i� �{�C�� � _` z. ' tc, f: Y ;14 1 �* tYJ •^a.4 tx' r � X}jq�' 11 0 ' w SUMMARY OF GROUND -WATER LEVELS NOVEMBER 2005 PROVISIONAL (NOTE: Wells with + also available in real-time at top of Ground -Water Data Oge; OWC, monthly measured value used in high ground -water level estimation report, USGS Open -File Report 80-1205.) WELL L START NET CHANGE DEPARTURE WATER LEVEL 14.50 28 T I YEAR IN MONTH IN ONE FROM BELOW LAND - 1.02 0 T OF VT 1992 - 0.26 YEAR MONTHLY SURFACE 0.98 4.45 > 28 P H RECORD - 1.08 + 12.02 MEDIAN 14.07 DATUM BURRILLVILLE 398 HT 1992 0 0 + 3.96 + 4.38 5.51 > 28 CHARLESTOWN 18 (OWC) + 0.68 + 1.83 + (FEET) 15.24 29 (FEET) (FEET) - 0.23 (FEET) DAY + 0.22 3.36 29 MASSACHUSETTS ST 1992 - 1.11 + 2.48 ACTON 158 * TS 1965 + 0.71 + 2.32 + 3.02 16.86 > 30 ANDOVER 462 VS 1968 - 1.12 - 0.36 - 0.46 15.41 22 ATTLEBORO 63 VS 1964 - 0.70 + 0.44 + 0.49 3.27 30 BARNSTABLE 230 FS 1957 + 0.54 + 2.27 + 2.11 22.76 28 BARNSTABLE 247 FS 1962 + 0.38 + 2.29 + 2.06 23.20 28 BECKET 12 TS 1986 ----- + 0.66 + 0.70 2.50 > 29 BLANDFORD 9 VS 1986 - 0.45 + 0.45 + 0.49 1.63 > 29 BOURNE 198 FS 1962 + 0.56 + 1.97 + 1.62 32.74 28 BREWSTER 21 FS 1962 + 0.10 + 2.43 + 1.80 8.75 21 BREWSTER 22 * FS 1962 + 0.17 + 2.06 + 1.89 29.87 30 CHATHAM 138 FS 1962 + 0.45 + 0.38 + 0.99 23.60 21 CHESHIRE 2 HT 1951 - 1.81 + 3.06 + 1.22 3.99 30 CHICOPEE 95 TS 1984 + 0.65 + 1.78 + 1.31 20.79 > 29 COLRAIN 8 VS 1965 + 7.09 + 8.51 + 10.49 10.94 >> 30 CONCORD 165 IS 1965 - 0.07 + 1.82 + 1.38 40.90 21 CONCORD 167 TS 1965 - 0.63 + 1.38 + 0.75 6.78 21 CUMMINGTON 13 VS 1986 - 0.85 + 1.77 + 1.22 3.41 > 30 DEDHAM 231 ST 1965 - 1.53 + 2.24 + 1.76 6.18 21 DEERFIELD 44 VS 1965 + 0.16 + 0.75 + 0.81 1.83 30 DOVER 10 TS 1965 + 1.08 + 2.13 + 2.64 32.04 > 21 DUXBURY 79 * VS 1965 - 0.26 + 0.95 + 1.23 7.08 > 30 DUXBURY 80 VR 1965 - 0.40 + 1.32 + 1.61 20.40 > 29 EAST BRIDGEWATER 30 HT 1958 + 0.01 + 8.77 + 6.98 5.49 29 EDGARTOWN 52 VS 1976 - 0.46 + 1.86 + 1.01 17.51 30 FOXBOROUGH 3 TS 1965 - 0.19 + 1.28 + 1.47 18.38 30 FREETOWN 23 TS 1964 + 0.19 + 2.24 + 2.26 11.89 29 GEORGETOWN 168 VS 1965 - 0.78 + 0.02 + 0.03 4.53 22 GRANBY 68 VS 1954 + 1.38 + 2.43 + 2.56 6.08 29 GRANVILLE 5 TS 1965 + 1.23 + 1.19 + 1.85 32.22 29 GRANVILLE 6 SS 1965 - 0.70 + 2.27 + 1.64 3.22 29 GREAT BARRINGTON 2 VT 1951 - 1.07 + 2.65 + 3.28 8.07 29 HANSON 76 VS 1964 - 0.24 + 0.56 + 0.37 4.15 29 HARDWICK 1 TS 1965 - 0.88 ----- + 2.56 13.20 30 HAVERHILL 23 IS 1960 + 0.00 + 2.21 + 2.22 11.09 22 HAWLEY 8 ST 1986 - 0.82 + 1.07 + 1.19 2.83 > 30 LAKEVILLE 14 * TS 1964 + 1.07 + 6.69 + 7.62 10.19 > 30 LEXINGTON 104 VS 1965 - 0.88 + 0.24 + 0.79 1.75 21 MASHPEE 29 FS 1976 + 0.12 + 1.12 + 1.08 8.09 28 MIDDLEBOROUGH 82 VT 1965 + 1.69 + 7.11 + 9.07 3.61 > 28 MONTGOMERY 19 SS 1986 - 0.28 + 0.48 + 0.62 0.76 29 NANTUCKET 228 FS 1976 ----- + 0.33 + 0.75 24.63 23 NEW BEDFORD 116 VS 1964 - 0.10 + 0.37 + 0.26 3.63 29 NEWBURY 27 VT 1965 - 0.92 + 1.12 + 2.09 5.86 22 NORFOLK 2.7 * VS 1965 - 0.03 + 0.67 + 0.79 5.34 30 NORTHBRIDGE 54 VS 1984 - 0.65 + 1.08 + 1.15 3.23 > 30 NORTON 37 FS 1964 - 2.54 + 2.14 + 1.85 5.06 30 ORANGE 63 TS 1985 - 0.52 + 2.39 + 2.59 4.91 > 21 OTIS 7 VS 1965 - 1.82 + 1.27 + 0.73 7.45 29 PELHAM 23 * SR 1961 + 0.82 + 0.91 - 1.78 14.06 30 PELHAM 24 SS 1984 - 1.73 + 1.03 + 1.32 2.98 > 21 PETERSHAM 16 ST 1984 - 2.65 + 3.68 + 4.05 10.23 > 30 PITTSFIELD 51 * VS 1963 + 1.55 + 1.36 + 2.82 14.48 30 PLYMOUTH 22 IS 1956 + 1.06 + 4.11 + 3.69 21.74 > 28 PLYMOUTH 494 SS 1985 + 0.46 + 4.10 + 3.01 27.55 28 SANDWICH 252 FS 1962 + 0.16 + 0.48 + 0.61 46.96 28 SANDWICH 253 FS 1962 + 0.20 + 2.50 + 1.56 49.18 28 SEEKONK 275 VS 1964 - 0.01 + 0.21 + 1.16 5.34 > 29 SHEFFIELD 58 FS 1987 + 0.31 + 1.05 + 2.13 11.97 29 SOUTHBOROUGH 12 HT 1990 - 1.91 + 3.67 + 3.68 2.75 21 SOUTHWICK 95 TS 1986 WELL DESTROYED STERLING 1 ST 1947 - 0.11 + 2.16 + 1.89 2.57 > 21 STERLING 177 SS 1995 - 0.93 + 0.68 + 0.79 13.86 21 SUNDERLAND 7 SS 1957 ----- + 10.24 + 7.71 8.62 > 21 SUNDERLAND 68 VS 1983 - 0.21 + 1.35 + 1..67 1.54 > 21 TAUNTON 337 TS 1964 - 0.57 + 1.79 + 1.81 7.42 > 30 TEMPLETON 3 VS 1957 - 0.99 - 0.08 + 0.26 3.15 21 TOPSFIELD 1 HT 1936 + 1.96 + 1.98 + 3.69 11.00 22 TOWNSEND 13 TS 1965 + 0.53 + 2.51 + 2.41 11.75 > 21 TRURO 1 TS 1950 - 0.23 + 0.12 + 0.26 10.49 21 TRURO 89 TS 1962 + 0.16 + 0.53 + 0.50 11.76 21 WAKEFIELD 38 FS 1965 - 0.14 + 0.54 + 1.49 5.58 > 30 WARE, 43 VS 1965 + 0.41 + 1.87 + 2.08 7.12 > 30 WAREHAM 51 TS 1959 + 0.31 + 3.50 + 3.43 5.93 28 WAYI.AND 2 TS 1965 + 0.22 + 1.07 + 0.85 15.58 21 WEBSTER 1 HS 1958 - 0.06 + 4.45 + 2.33 12.40 30 WELLFLEET 17 VS 1962 + 0.07 + 1.43 + 0.37 1.0.68 21 WENHAM 76 VS 1965 - 0.29 + 0.56 + 0.98 1.66 22 WEST BOYLSTON 26 SS 1995 - 2.02 + 2.36 + 3.68 3.80 21 WEST BROOKFIELD 2 TS 1959 + 0.18 + 2.43 + 2.71 17.04 > 30 WESTHAMPTON 20 SS 1986 + 4.85 + 3.92 + 5.81 8.97 30 WESTFIELD 62 SS 1957 - 1.12 + 2.97 + 2.54 5.62 29 WESTFIELD 152 IS 1986 - 0.75 + 0.58 + 1.06 2.28 > 29 WESTFORD 160 VS 2001 - 0.58 + 0.55 ----- 10.47 > 30 WEYMOUTH 2 FT 1965 + 0.21 + 8.59 + 8.85 6.23 > 29 WEYMOUTH 3 VS 1965 - 0.31 + 0.65 + 1.15 3.93 29 WEYMOUTH 4 IS 1965 ----- ----- ----- ----- WILBRAHAM 55 IS 1965 + 0.22 + 9.00 + 8.81 34.45 > 29 WILMINGTON 78 * FS 1951 + 0.15 + 1.17 + 0.92 7.45 30 WINCHENDON 13 ST 1939 - 0.04 + 1.26 + 4.38 3.37 21 WINCHESTER 14 ST 1940 - 3.96 + 2.03 + 0.48 9.21 22 RHODE ISLAND BURRILLVILLE 187 TS 1968 + 0.67 + 1.45 + 1.59 14.50 28 BURRILLVILLE 395 UT 1992 - 0.85 - 0.83 - 1.02 9.90 28 BURRILLVILLE 396 VT 1992 - 0.26 + 0.85 + 0.98 4.45 > 28 BURRILLVILLE 397 HT 1992 - 1.08 + 12.02 + 14.07 10.98 > 28 BURRILLVILLE 398 HT 1992 - 1.30 + 3.96 + 4.38 5.51 > 28 CHARLESTOWN 18 FS 1946 + 0.68 + 1.83 + 4.66 15.24 29 CHARI.ESTOWN 586 VT 1992 - 0.23 - 0.04 + 0.22 3.36 29 CHARLESTOWN 587 ST 1992 - 1.11 + 2.48 + 3.68 4.83 29 COVENTRY 342 VS 1991 - 1.05 + 2.05 + 1.01 7.98 28 COVENTRY 473. SS 1961 - 0.36 + 1.92 + 2.07 20.09 28 1 of 2 12/20/2005 2:16 PM N. Andover Health Dept. • 400 Osgood Street N. Andover, MA 01845 • 978 688-9540 fax 978 688-8476 To: Jim Wright Fax: 978 687-7096 From: Susan Sawyer, Health Director Date: 2/10/2006 Re: 35 Woodberry Pages: 2 CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑ Plem Reply ❑ Please Recyde i Attached you will find a letter regarding a recent Title V report you submitted to the N. Andover Heal -Department. I attempted to contact you by phone, however our schedules have just not been compatible. It is important that we get this resolved as soon as possible. Your application to become a permitted inspector has not been approved to date. This approval is necessary to continue to conduct local Title V inspections. Thank you. 'TOWN OF NORTH ANDOVER of NORTH , Office of COMMUNITY DEVELOPMENT AND SERVICES ,o HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 1SSACHU6�� Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX healthdept.Atownofnorthandover. com a ww.townofnorthandover. coin R. J. Inspections, Inc. James Wright One Osgood Street Methuen, MA 01844 February 10, 2006 Re: 35 Woodbury Lane Dear Mr. Wright, The North Andover Health Department has reviewed the Title V Inspection report, submitted by you, in regard to 35 Woodberry Lane. Unfortunately, this correspondence is to inform you that the inspection report has been rejected. Upon review, the following deficiencies were found. 1) All components must be uncovered. a. A note on the cover page indicated that the distribution box was viewed using a camera. b. Another problem found on page 5 was the question "Were all system components, excluding the SAS, located on site?" As the Dthox was not excavated this is in fact "No", but it was incorrectly noted as "Yes". c. Page 8 is clear in this matter as well. It states, "if present must be opened". The Health Department has the duty to ensure that the Title V inspections are conducted properly. In this case the distribution box must be uncovered. It is expected that you will return to the site, complete the task of opening the distribution box, redo the title V forms to reflect the additional information and resubmit these forms to the Health Department. Thank you for your anticipated cooperation in this matter. Failure to comply as listed above shall result in fii they action by the Health Department. If you have any questions regarding this correspondence please contact the Health Department. Sincerely, S wyer, REHS/R S. Public Health Director Cc: Homeowner Town of North Andover Office of the Health Department Community Development and Services Di 400 OSGOOD STREET North Andover, Massachusetts 01845 hft://www:townoftiorthandover.com Susan Y. Sawyer, REHS/RS e-mail: healthdept@townofnorthandover:com Public Health Director INFORMATION REQUEST Health Department P (978)688-9540 F (978)688-8476 Please use this form if the Health Director is unavailable to provide immediate assistance. Please fill out this form in its entirety to ensure an accurate and prompt response. All requests for information will be handled as soon as possible. CONTACT INFORMATION Date: pSf Name: 4SMlll ldlel_ Phone number: G� - �dfp j z �� Fax number: 2 ' - zl zzw - // 3 Address: e6— INQUIRY - Property in question: (Please include as much information as possible) Subject: �Zj17�5�0' Or�CL Inquiry: i'�7 � , Lx41� 0/. "aw a74- ?Ili it�'Kv ww& 0,4- T LOI/ee A ,7_12K -11V ITaIlleS_ Thank you for your interest and inquiry. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 - == -7 LA B0 -A -R -D Off: HEALTH 120 MAIN STREET s,C►,U5�ti� NORTH ANDOVER, MASS. 41845. 0 61 �J C February 10, 1995 Dear Lake Cochichewick Watershed Resident, District #3: TEL. 582-6483 Ext,3 - As a homeowner in District three (3) of the Watershed of Lake Cochichewick, you have been previously notified of- the septic pumping regulations adopted in June of 1993. This required all homeowners in your district to have had your sears tic tanks pumped by September 3, 1994, and every three (3) y there after. our records indicate that as of this date, you are in violation of this regulation. If our records are incorrect, please submit proof of pumping to the Board of Health office. Failure to have your septic tank pumped within thirty (30) days of this notification can result with penalties as stated in Section 8.4 of the North Andover Board of Health Regulations. A copy of the pumping regulation is enclosed. The Town of North Andover relies on a cooperative effort to ensure a safe drinking water supply. As a watershed resident it is vital that you comply with all standards set in regards to this effort. if you have any questions, please do not hesitate to call the Board of Health office at the rurtber above. 11 Sincere, Susan Ford Environment/Health Agent SF/cjp Encicsure SEPTIC SYSTEM INSPECTION FORM ADDRESS DATE INSPECTED ? PROPERLY FUNCTIONING? Yl� N WEATHER CONDITIONS COMMENTS: tR Ql,t;ALE i y ES Ti C- 2 ?LTS? DYE TEST PERFORMED? Y N DATE? SKETCH: WATERSHED RESIDENTS QUESTIONNAIRE 1. Name Jorip, ` Ll wo A cS" aAaa 2. Street Address 35' (Jcx)n 6Z 4,1 x Z~ 3. How many members are in your household? 1Y 4. What type of sewage disposal system do you have? ❑ cesspool septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? yes ❑ no ❑ do not kndw"- 6. How old is your sewage disposal system? ❑ "0-5 years > 6-10 years ❑ 11-20 year ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes 9 no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually every 2-4 years Elevery 5-10 years .. ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes no If yes, what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connects t to your sewage disposal system? washing machine dishwas: !r J garbage disposal dehumidifier drain sump p:. ap toilet_ roof/pavement drains shower/ ihtub 11. Please state the brand and type (liquid c. .,owder) of detergent you use for: dishwasher + d—CAll -- clotheswasher AM W_Q'Y 12. Does your property have a lawn? yes ❑ no If yes, approximately what size? less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per year Ll Season(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: C,if�M-L..�wyv Check here if your lawn is maintained by a professional landscape contractor. cc TO: NORTH ANDOVER, MASS J u E !74 19 7 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at Z - o ?` 7 WGa .fid u P—y Ldj6YE North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 . Avvi 4. SOIL PROFILE & PERCOLATION TEST DATA Town/ C tUUP No.&Street (�� 4 a Lot No._,_,,�, Loc. /SubdivC�,-.b� h GI e �✓�- Plan Owner IS Investigator�C�-✓�b �y' Observer SOIL PROFILES -DATE 4. 1' lev. 2. Elev. =° Elev.__Elev.�_ 75 0 % 71 0 0 2 1 1 2 3 3 O� 4 4 5 5 6 6 Benchmark Elevation 7 I_ I 7 101 f 10 Location Datum Percolat}on TestsrDate 2' 3 41 6 7 RE 9 10 Pit Number 1 2 3 4 5 Start Saturation ' Soak -Mins. Start Test -Time Drop of 3" -Time U' Drop of 6"7Time 20 Mins.lst 3"Drop rn- Mi n� OnA Q4lrlrnn t !_+4/Y1•#f /J^' i A Notes & Sketches on Back Frank C. Gelinas & Associates, North And. AJ P-7-14 �p -fla 9 � fir 0 l Juj y� h"o�oti AJ P-7-14 �p -fla 9 � fir 0 l 11 N sA. m 1 W 3 0 v 0 v � o Q � Q q4q�� � � 0 � L 11 N ,,,,.� ��'� ..,� a �° Ft `�:,°�