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Home My WebLink AboutMiscellaneous - 40 GRANVILLE LANE 4/30/2018 40 GRANVILLE LANE / .210/106-C-006770000-0 I r T s I} SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? YES NO TYPE OF CONSTRUCTION: NEW EPAI NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT PAID? - NO DWC PERMIT NO. 84,7 INSTALLER:-�8�a 5c-4 � BEGIN INSPECTION - YES 0: EXCAVATION INSPECTION: NEEDED: PASSED BY— CONSTRUCTION Y CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: YES• -- °- :. .. ..... .. - .F APPROVAL TO BACKFILL: DATE: al9� –BY— FINAL BYdFINAL GRADING APPROVAL: DATE 8BY N �� FINAL CONSTRUCTION APPROVAL: DATE: BY Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use,by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of housighr of hous , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address (i r uj� City/Town state Trp Code 2. System Owner. Name Address(if different from location) Ckyrrown stat Telephone Number B. Pulmping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. ;Type of s ❑ sspool(s) ❑ Sep' Tank Tight Tank Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No; " 5. Condition of.System: 6. System Pumped By. Neil Bateson F5821 , Name Vehicle License Number lr Bateson Enterprises Inc Company 7. Location where contents were disposed: Q j US. Lowell Waste Water TOWN of NORTH ANDOVER n-r_a Si H ' 9n aule Date t5form4.doc-06/03 System Pumping Record•Page 1 of 1 PITS MIN 660 LEACHING MIN 1 (131x16 ' ) PIT MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W) xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE . 005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16 ' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W) xD x #) (G/ft2) FIELDS MIN 660 GPD_Z 900 ft2 BED GW MIN 4 ' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 4" PEA STONE? DIST LINE SLOPE . 005? >31COVER-VENT SCH 40 MIN 12" COVER RATE LDG X 660 = X = TOTAL G/ft2 REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY gpm L W D Vol. DISCHARGE SIZEDISCHARGEa-r- DISCHARGE RATE /DD DISCHARGE TIME / In gpm MANHOLES TO GRADEy ALARM SEP. CIRC. ..W (Min. 1 ' below inlet) HWL��LWL�S,f CHECK VALVE � BLEEDER HOLE MANUAL OP. SWITCH t/ Copyright 0 1995 by S.L.Start Sawyer, Susan From: Richard Carfagna <rpc2242@yahoo.com> Sent: Wednesday, May 15, 2013 9:53 AM To: Sawyer, Susan Subject: Re:subsurface disposal system at 40 Granville Susan, I will have to agree with your viewpoint. I will consult with the engineers about my options. Thanks, Richard Carfagna cell 978-590-0872 From: "Sawyer, Susan" <ssawyer(cDtownofnorthandover.com> To: Richard Carfagna <rgc2242 ),yahoo.com> Sent:Wednesday, May 15, 2013 9:38 AM Subject: RE: subsurface disposal system at 40 Granville No doubt it is a tight site with all the wetlands, but I am not an engineer so I won't say what is or isn't possible. Susan From: Richard Carfagna [mai Ito:rpc2242(&yahoo.com] Sent: Tuesday, May 14, 2013 9:13 PM To: Sawyer, Susan Subject: Re: subsurface disposal system at 40 Granville Thanks Susan for your guidance in this matter. I will start my new journey to understand the rules, regulation and cost for a lower mount. Best regards, Richard Carfagna cell 978-590-0872 From: "Sawyer, Susan" <ssawyer(cD-townofnorthandover.com> To: "rpc2242(a-yahoo.com" <rpc2242 .yahoo.com> Sent: Tuesday, May 14, 2013 6:00 PM Subject: subsurface disposal system at 40 Granville Hello Rich, Please find attached two documents; one shows the "proposed" location and one shows the "as built" location of the septic. There are many good engineers and sanitarians on the list, but it is alphabetical as you know we cannot recommend anyone in particular. The one person who recently went to DEP for the extra reduction is David Jordan. Jack Sullivan has submitted a few recently as did Christiansen that you mentioned. I do not know what they may come up with,but clearly there are a lot of wetlands so be sure that the person you i ire should have experience in wetlands applications with the Conservation department as well. I am sure we will talk more in the future if you find any alternatives that suit your needs. Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssgMerntownofnorthandover.com Web http://www.townofiiorthandover.com/ Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 2 . ' 6369 of Mo oT�7a ~?�.r� L9 = Town of North Andover s HEALTH DEPARTMENT SACHUS! CHECK#: I DATE: b A) LOCATION: U ArnmJ1,111 I bm H/O NAME: 0-0riny%- CONTRACTOR NAME.ffo,(Lba,56D�� Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Title 5 Report $ ❑ Other:(Indicate) $ t 0- Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts Title 5 Official Inspection Form I47 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rLIN 40 Granville Lane Property Address r -„ Richard Carfagna Owner Owner's Name information is required for North Andover MA 01845 1/15/2013 every page. City/Town State 7 Zip Code Date of Inspection Inspection results must be submitted on this.form.Inspection forms may not be altered in any. way.Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Neil James Bateson cursor-do not use the return Name of Inspector key. Bateson Enterprises Inc. . .Company Name , 111 Argilla Road '4 ::iCompanyAddress, Andover MA 01810 City/rown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the,sewage disposal system at this address and that the information reported below.is true,laccurate and complete as of the time of the inspection. The inspection was performed based on my&wining 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 E I FaRECIEiVED El N e Furt r Evaluation by the Local Approving Authority SAN 2 22013 TOWN OF NORTH ANDOVER " HEALTH DEPARTMENT 1/15/2013 lnspectoesNSignatvr Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the.system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority.. *"'**Thls'report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17. Y r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for W untary Assessments 40 Granville Lane Property Address Richard CarfagnIa Owner Owners Name information is required for North Andover MA 01845 1/15/2013 every page.. 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B)••System.Conditionally Passes: ri1 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 replaceddwith 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 El N ❑ ND(Explain below): t5ins•11110 _ Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 x Commonwealth of Massachusetts a v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 40 Granville Lane Property Address Richard Carfagna Owner Owner's Name information is required for North Andover' MA 01845 1/15/2013 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation.of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND.(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or rliplaged ❑ Y ❑. N ❑ ND (Explain below): ❑ 'The system required pumping more than 4-times a year due to broken or obstructed pipe(s). The "system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR .15.303(1)(b)that the system is not functioning In a manner which will protect public health, safety and the environment: ❑ Cesspool or.privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title S.Olflaal Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts~ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Granville Lane Property Address Richard Carfagna Owner Owner's Name information is required for North Andover MA- 01845 .1/15/2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2: System will fall unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS.is within 50 feet of a.private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more-from a private water supply well". Method used to determine distance: '**'This system passes if the well water analysis; performed at a DEP certified laboratory, for fecal cpliform.bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal Jo 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: ln D) System Failure Criteria Applicable to All Systemsd2`_. ::: 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 ❑ 0 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 .,,:'.•thanJ/2 day flow t5ins•11/10 a Title S Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth.of kqo chusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments In 40 Granville Lane Property Address Richard Carfagna Owner Owners Name information is required for North Andover MA 01845 1/15/2013 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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 weii. El ® 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 ❑ G Tee 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 SectiomE the system is considered a significant threat, or answered"yes" in Section D above the'large"system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with-310•CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments 40 Granville Lane Property Address Richard Carfagna Owner Owner's Name information is required for North Andover MA 01845 1/15/2013 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ®. Were any of the system.components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Z . ElWere as built plans.pf.theSystem 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? ..N ❑ 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•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Granville Lane Property Address Richard Carfagna Owner Owner's Name information is required for North Andover MA 01845 1/15/2013 . every page. CityrFown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder?. ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No :Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Induttrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11110 Tifle 5 official Inspection Fond:Subsurface Sewage Disposal System•Page 7 of 17 Y 4 Commonwealth of Massachusetts' Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 40 Granville Lane Me Property Address Richard Carfagna Owner Owner's Name information is required for North Andover MA 01845 1/15/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information .Pumping Records: Source of information:, Pumped 2006,pumping records at B.O.H. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees 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. El' Other describe): „< t5ins-11/10 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 •40 Granville Lane i Property Address Richard Carfagna Owner Owner's Name information is required for North Andover MA 01845 1/15/2013 ` every page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source.of information: Tank original; pump tank, d-box&trenches installed 8/26/1996, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction:, ® cast iron ®40 PVC , ❑ other(explain): Distance from private water supply well or suction line: feet `Comments(on condition of joints, venting, evidence of leakage, etc.): 4"Cast iron thru wall. 3" PVC in house, no leaks visible Septic Tank(locate on site plan): AY , t:h belowgrade- feet Material of construction:.. .,,. ® concrete ❑ metal El fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 4' Sludge depth: 6" t5ins 11/10 „z,,: .",Title 5 tKfleial Inspection Form:Subsurface Sewage Disposal System Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 40 Granville Lane Property Address Richard Carfagna Owner Owner's Name information is North Andover MA 01845 1/15/2013 required for every page. City/Town State Zip Code Date of Inspection Q. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 21" 4.. Scum thickness 811 Distance from top of scum to top of outlet tee or baffle O Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Tape Measure Comments(on pumping recommendations, unlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet baffle ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap(locate on site plan): Depth.below grade:. feet Material of construction*- ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet.tee or baffle Date of last pumping: Date t5ins•11110 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth.of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 40 Granville Lane Property Address Richard Carfagna Owner Owner's Name information is required for North Andover MA 01845 1/15/2013 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank-(tank must be pumped at time of inspection) (locate on site.plan): Depth below grade: . Material of construction: ET concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.):. *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes 0 No <, t5ins•11/10 Title 5 Official Inspedion Forth:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �I 40 Granville Lane Property Address Richard Carfagna Owner owner's Name information is required for North Andover MA 01845 1/15/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): . D-box level&distribution equal. No evidence of carryover. No evidence of leakage 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.): Pump tank ok. Pump cycled on then off.Alarm has both audible&visual Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts • Title .5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 40 Granville Lane Property Address Richard Carfagna Owner Owner's Name information is required for North Andover MA 01845 1/15/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: 0 leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 75' long �;. leaching fields {,' 9 : 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.): :- Vegetation ok. Soil ok. No sign of'ponding to surface 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 s Dimensions of cesspool.- Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11110 Title 5,Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 1r Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Granville Lane Property Address :;; _,,r.•Yz wzo r Richard Carfagna Owner Owner's Name information is required for North Andover MA 01845 1/15/2013 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction:` .r. Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, Y t5ins•11/10 Title 5,0fficlal Inspectiorr,Form:Subsurface Sewage Disposal System-Page 14 of 17 s Commonwealth of Massachusetts ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� 40 Granville Lane Property Address . Richard Carfagna Owner Owner's Name information is North Andover MA 01845 1/15/2013 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont:) Sketch Of Sewage Disposal System: Provide a view of'the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ .drawing attached separately �1ive 13 b _WA - 3t4 t I t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of IMassachusetts. .�=...� ;. .. . • Title+ 5 Official Inspection Form Subsurface Sewage Disposal System Form-'Not for Voluntary Assessments 40 Granville Lane Property Address Richard Carfagna Owner Owner's Name information is required for North Andover MA 01845 .1/15/2013 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope 0 Surface water ® Check cellar ® Shallow wells Estimated depth to high;groundwater 5 31 feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: Date 996 - , . . ... . ...,. . ... Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Design plan Checked with local excavators, installers-(attach documentation) Accessed.USES database=explain: You must describe how you established the high ground water elevation: As per design plan test pit data. ..L. i Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 16 of 17 Commonwealth of.Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 40 Granville Lane Property Address Richard Carfagna Owner Owner's Name information is required for North Andover MA 01845 1/15/2013 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file / t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System.•Page 17 of 17 a Summary Record Card generated on•1/17/201311:39:31 AM by Maureen McAuley Page 1 Town of North Andover y . Tax Map # 210-106.C-0067-0000.0 Parcel Id 17702 40 GRANVILLE LANE CARFAGNE, RICHARD 40 GRANVILLE LANE ......:�,d;�.:�:.}..: N. ANDOVER, MA. 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.08 Acres FY 2013 UB Mailing Index Name/Address Type Loan Number Active/inact. From Until CARFAGNE,RICHARD Payor 40 GRANVILLE LANE N.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id.17398.0-40 GRANVILLE LANE Last Billing Date 1/3/2013 3170068 03 Cycle 03 Active - UB Services Maint. Account No.3170068 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER.SIZE. 60.80 /1 UB Meter Maintenance Account No.3170068 Serial No Status Location Brand Type Size YTD Cons 36433710 a Active ERT HH b Badger w Water 0.63 0.63 21 E Date Reading Code Consumption Posted Date Variance 12/7/2012 220' aActual -16 1/9/2013 -26% 9/12/2012 204 a Actual 24 10/15/2012 -1'4% 6/8/2012 180 a Actual 25 .7/16/2012 0% 3/14/2012 y,:.; 155 a Actual 28 4/14/2012 51% 12/9/2011 127 a Actual. 17 1/17/2012 0% ., 9/12/2011 110 a Actual'. c:.: ' 19 10/13/2011 -8% 6/6/2011 91 a Actual 19 7/20/2011 16% 3/8/2011 72 a Actual 16 4/13/2011 13% 12/10/2010 56 a Actual 15 1/12/2011 -19% 9/8/2010 41 a Actual 19 10/15/2010 45% 6/4/2010 22 a Actual 12 7/15/2010 -21°/c 3/8/2010 1.0 a Actual 10 4/14/2010 -100% 1/9/2010 0 n New Meter 0 4/14/2010 -100% 1/9/201.0 4340 r Replacement ;6.. :4/14/2010 15% 12/10/2009 4334 a Actual 16 1/12/2010 -16% 9/9/2009 4318 a Actual 20: • 10/15/2009 33% 6/4/2009 s. 4298 aActual 13 •7%20/2009 -6% 3/12/2009 4285 a Actual 16 4/29/2009 21% 12/5/2008 4269 a Actual 12 1/20/2009 -60/c 9/8/2008 4257 a Actual 14 10/10/2008 0% 6/4/2008 4243 a Actual 13 7/16/2008 7% 3/7/2008 4230 a Actual 12 4/11/2008 -22% 12/10/2007 4218 a Actual 17 1/22/2008 -280/c 9/4/2007 4201 '..a Actual 20 10/12/2007 31% 6/14/2007 4181 a Actual 17 7/20/2007 8% 3/15/2007 4164 a Actual 20 4/16/2007 1% 12/6/2006 4144 a Actual 17 1/19/2007 0°k .9/12/2006 ti 4127 a Actual 18 10/20/2006 4% 6/14/2006 „ . :i=', —4109 a Actual ,..,,:.;:;r"a:•;:'.'.. =19.. ;'7/10/2006 9% Commonwealth of Massachusetts City/Town of . System Pumping Record Foran 4 DEP has provided this form for use by local Boards of Health. Other forms may be"used, but the information must be substantially the same as that provided here. Before.using.this form, check with you local Board of Health to determine the form they use.The System Pumping Record must be submitted tc the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left rear of hous Left/right side of house, Left Right side of building,Left/Right front of building, Left/Right rear of building, Under deck Address Cityrrown State Zip Code 2. System.Owner. ( Q V\lq Name Address(if different from location) City/Town . statezi p Code gQ� Telephone Number B. Pumping Record Pate of Pumping pate 2. Quantity Pumped: Gallons 3: Type of system::. . ;. ], . Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 91q If yes,was it cleaned? ❑ Yes ❑ No. ' 5. Condition ofSystem: 6.• System Pumped"By: " Neil.Batson F5821 Name - Vehicle License Number Bateson Enterprises Inc Company T.- Location-where contents were disposed: . GL. S. . Lowell Waste Water' C--r r--C3 Sig t e Haule Date t5fonn4.doc•06103 System Pumping Record•Page 1 of 1 FORM. 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Determination for Seasonal Hieh j ater Table Method Used: El 'Depth;observed standing in observation hole inches Q Depth weeping from side of.observation hole inches Depth to soil mottles inches ❑ Ground vv iter 'adjustment .................. feet Index Well Number`-... ........ Reading Dale Index well level ......... ...... Adjustment factor Adjustedound water level ........................................... ........_ Depth of Naturally Occurring Pervious Mate gyi@l Does at least.four feet of;naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? >5 If not, what is `C he depth:of naturally occurring pervious material? Certification I certify that on i t' (date) I have passed the soil evaluator examination approved by the epartmrent of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310.CMR 105,:317 Signature./4-1 f Date DEP APPROVED FORM 12/07/95 V I. Form No.4 i Town of North Andover, Massachusetts BOARD OF HEALTH August 29 , 1996 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (X ) by INSTALLER at 40 Granville Lane, North Andover, MA SI TF LOCA I ION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 843 dated May 21 , 19 96 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. OARD OF HEALTH PLAN REVIEW CHECKLIST ADDRESS (SJe1AJ'U/LL. GT Z19 ENGINEER 0�5(00,6 /Tg�G�32✓� GENERAL 3 COPIES STAMPcl� LOCUSy' NORTH ARROW SCAL CONTOURS PROFILES SECTIONe--� BENCHMARK — SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED? DRIVEWAY C----(Elev) WATER LINE// FDN DRAIN SCH40:/' TESTS CURRENT? SOIL EVAL SEPTIC TANK MIN 1500G . 17 INVERT DROP--� GARB. GRINDERL(2 comps +200) 25 ' TO FDN �� MANHOLE ELEV GW ## COMPS. GB D-BOX SIZE ## LINES Z FIRST 2 ' LEVEL STATEMENT /C7 INLET 13 - OUTLET 17 (2" OR .17 FT) TEE REQ'D? it 15 5 J��TO� 80-' LEACHING MIN 660 GPD?Z RESERVE AREA 4' FROM PRIMARY? s 2% SLOPE Ja100 ' TO WETLANDS 100 ' TO WELLS 4 ' TO S.H.GW 35 ' TO FND & INTRCPTR DRAINS 4'0�0� TO SURFACE H2O SUPP �- 4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER (151 ) BREAKOUT BREAKOUT MET? TRENCHES 0 SP' s MIN 660 gpd X SLOPE (min .005 or 6"/1001 ) V SIDEWALL DIST. 3X EFF. W OR D (MIN 61 )\ RESERVE BETWEEN TRENCHES? IN FILL? � MUST BE 10 ' MIN. --- 4" PEA STONE? VENT? �(>3 ' COVER; LINES >501 ) BOT a 6z) + SIDE X LDNG Z<,I-' = TOT 444 —/&/&10 (L x W x ##) (DxLx2x##) (G/ft2) Copyright 0 1995 by S.L. Starr i M TOWN OF NORTH ANDOVER/ I BOARD OF HEALTH Anthony&Joyce E. Volpe JUN — 7 1996 50 Granville Lane ` North Andover, Mass 01845 Home Phone: 508-794-8275 Business Phone: 617-937-1270 June 6, 1996 North Andover Health Department Ms. Sandra Starr 120 Main St. North Andover, Mass 01845 Dear Ms. Starr, I am an abutter to the property on 40 Granville Lane,North Andover, Mass. and would like to express my concern and objection to proposed new subsurface disposal system(septic system) design on file in the Conservation Commission's office, June 3, 1996, and the plan presented by Mr. Benjamin C. Osgood Jr. at the Conservation Commission public hearing on June 5, 1996. The proposed design calls for a 5' raised leach bed,whose slope begins to rise along the property line. At present the landscape slopes down towards my property along the property line, and water collects at the bottom of the slope during the winter and spring seasons. Adding an additional 5' slope will certainly increase the amount of standing water on my property due to surface runoff from the raised leach bed, and will likely increase the risk of my basement flooding. There is no provision in the plan to divert surface runoff away from my property, thus the plan assumes that half the runoff WILL flow onto my property. I request that the plan include, and provisions be made,to divert the runoff away from my property. I have discussed ways to mitigate the situation with Mr. Benjamin C. Osgood Jr. and a couple of options were discussed. I cannot accept the risk of my property flooding due to this septic design. I wish that a barrier be installed along the leach bed to divert surface runoff away from my property. I intend to discuss this further with Mr. Osgood, and hope to come to an amicable agreement with him. I wish that you take my objection into consideration prior to approval of this or any other subsurface disposal system located on 40 Granville Lane,North Andover, Mass. Sincerely, 6? ?thronyy Volpe Joyce E. Volpe cc: Mr. Benjamin Osgood Jr. Town of Nortel Andover NORTH • of t.,..D ,,�b OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES p 146 Main Street � O � North Andover,Massachusetts 01845 pDAfID PP``.�y SSACHUS� June 11, 1996 New England Engineering Services Mr. Ben Osgood, Jr. 33 Walker Road, Suite 22 North Andover, NIA01845 Re: 40 Granville Road Dear Ben: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. distance between trenches not 3 times effective width (3 10 CMR 15.25 1 (1) (d)). 2. Please show length of trenches on section or site plan, which needs to be in a stated scale. 3. What is elevation of pump chamber outlet? 4. Please provide an efficiency graph for the pump. What is the emergency storage capacity of the pump chamber? How many doses per day? (see 310 CMR 15.25 4). Please give elevations of pump on, purip off, alarm on and width of pump chamber walls. If you L,--.re any questions, please do not hesitate to call the Health Office. Sincerely, �d Sandra Starr, R.S., Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NEW ENGLAND ENGINEERING SERVICES INC % of 11*- ®- 'CO �pP May 15, 1996 North Andover Board of Health 120 Main Street North Andover,MA 01845 Dear Sirs: Enclosed you will find copies of the soil evaluator reports for 40 Granville Lane in North Andover,MA. If you have any questions please do not hesitate to contact this office. Yours truly, Benjaxffin C. Osgood r. 33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768 , •• - . - -. ^-^' '-' ..�-.�., .._ - ,- ._.-K- —'7— A .,-•-•h<— _.•„r:.K,.i + ,� i r.. r- .-.�p"y. : b`^ ^••. `' .""� K;: ie''✓k` '�.I 4, �r ._ r, r ,.w:;� s:'•s. ,o' `t: `J'� i i e - ` t w x' t a t .a Jf• + ,kF' a .4 r r b �d9 i A. a 101�, •. 5 _ • J ♦ +• _�{�, 1,. - _ �.�7• {. a u. , 1740 III--- III ;' MMM^^^✓✓✓ b9 {J�/��•,/�,��, M� • y ' - a 4 Y je � y r� ' ". suf5_ A,1'i•IT+t .�' Y . •<•' . ,per4r,��1 �44jO " , it!"Sf+ �" ♦ 1 f .r •S ,: � -�w7��g"!' -. _ «. . .-#.t .�' ,�'�Y'*�+!�.dLlYP 4L ..[`1�� '-IIy� - -_ ♦ C,.a�r JiF r�"• r�r p^f-y-- ; j�yj, - ' ��.,(y�� 4+" '//� ... .• 10 won 46 V,�'�. � w. .+.a,..5 a_K .• ._.s" �Ivy .✓ �x;!y7"r• r .S�•• "i"^'_•# �'_�I� r ,i,. � � �� A-�'� n ... - - n' � r a S^ .•.« , .-,' ,t �, f l.. `e. �r::.p' '� •• '�'. ... K ..y ,5 r t .'�' 1? i , ' . C. ,o'a.�.eM,.+w.'.� .. - �, - _ .` y;' '#• 4 •�' 'x L :� � °Y.�... 'r +,�. art. �.�t .. !-.! ... .. .. Y CA �, .. _ ,4. 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(((�//�.//"' r `fir r` •i 1 ,moi'1 fie' � •� - •JA - " <'� +9 4 . f �4 ., p J Mt. • , r .' � �r .. r . .. t i 3 t SFr "t� �•i 14 • _ ,r `�•,,;," -' { .. .•A •l/�+�� r,. r5p•' - L %M. 1. ♦ .�•�'„ .T ••t lk� a,� " ~ r t"'F f F 'f 1J'I ^q • t 1/??" .- Sr t y +! _ •j - ,. a 4J 'F yy,Vt r. ali.r ip„ _ - �: r- rte', '�� _ _ i .. _ - •I d r . . �j' Ido '1. ` • w �,. � ��,� •-. . ..,'�1:��'�' � " tV�.`, a},,� • q�'�' .. - f.S Ada ��., , s Form No. 3 ; Town of North Andover, Massachusetts NORTH BOARD OF HEALTH n rl-Lx2 • ..a o� o m a . �•'`��,,:o.:•'`�� DISPOSAL WORKS CONSTRUCTION PERMIT �SS�cHUSE� F e Applicant 2:2 Q"i:l� NAME _ ADDRESS TELEPHONE Site Location S1 Permission is hereby granted to Construct ( ) or Repair (Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. �� CHAI RMAN,BOARD OF HEALTH Fee D.W.C. No. s : Town of North Andover, Massachusetts Form No.2 MORTp BOARD OF HEALTHo ,o, w P • i 1ii i DESIGN APPROVAL FOR : sS"`HU SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant �-1 � � Test No. Site Location �Lo Reference Plans and Specs. ENGINEER USIGN ATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. • IR OAR FHEALTH LFee � Site System Permit No. �� _ I FORM 11 - SOIL EVALUATOR FORM a Page I of 3 3 Na Date: .. Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment for On-.g to Sewage D sat Performed By: :� ...._T� ��, y} ;? Date: Witnessed By; �!'.. ..........:................... , tAcaiion Add= A/ C) n! J4 � 0mvMr 1 Nurse, Lot /Y ' f(�/C? ✓, fLr '%/��i.'9. 4Sesi,oad <frA T ��G'.�.: j411 'Ta�c,shone_f ew+Constructlon C] Repair ; z �) 9,�-: 7 Office Review Published Soil Survey Available: No ' Yes Year Published ublicationScale Soil Map Unit . '~_.._... Drainage Class So-it, Limitations ........,...... Surficial Geologic Report Available: o. Yes Year Published Publication Scale Geologic Material (Map Unit) .. .. ........ f. .,.� an orm ��r�r� s. � �� .,.:. . '1 iood Insurance Rate Map:' Above 500 year flood boundary No, Yes Within 500 year flood boundary No Yes Q Within 100 year flood boundary No LYes �'''' ''� Wetland Area: National Wetland Inventory Map (map unit) ..... . ......:...........:........... Wetlands Conservancy Program Map (snap unit) .................. .. . .... ... ................. Current Water Resource Conditions(USGS): Month Range:Above Normal EINormal LBelcw Normal 0 Other References Reviewed: DEP APPROVED FORM-MOMS DORM I1 - SOIL EVALUATOR FORM Page 2of3 Location Address.or Lot IJ71o, iaiLE �� , � ��u ,✓' On-site Review Deep Hole (NumberDate 2 �' �'n� Weather -r✓� ��% � c..r / /�'.7(�" Tune;. Location (identify on site plan) Land Use ', r ! /.� Slope (%) Surface Stones /U Vegetation .G0e' ''� . U Landform Positron on landscape (sketch.on the back) � �'� e � .,, Distances from: Open Water Body - feet Drainage way feet Possible Wet Area i r ` feet Property Line' . . feet Drinking.Water Well feet. Other _ DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil (Munsell) Mottling Structure Stones, Boulder$, ConsiatencY Y Surface.lnchesl (USDA) Gravel L14 1 / - w `e l z57/,V /. yo c� ,.9 I, /O_ 3 Jo r 6:P. Parent Material(geologic) inDepthtoBodrock; -- pepth to Groundwater; Standing Water in the Hole: Weeping from Pit Face: �S,l Estimated Seasonal High Ground 'Water: ' - TaP aF TEsT 10177 F41 r�� 98 :6 9 �2vv.d p U✓ra rc' Ee F VArrv.tl s 95a 7 7 llEP APPROVER FORM• 17/07195 FORM 11 - SOIL N;VAI,UATOR FORM Page 2 of 3 Location Address or Lot No. -7 ' OnnWe Review r Deep Nole Number .:. Date: Time:. a ' 0 Weatlieri.A/my Location (identify On plan) Land Use? Slope (%)��T . , Nva`/ • ,. . Surface.Stones . Vegetation Landform ri�Ish Position on,landscape (sketch on the back) � �- Distances from: Open Water Body feet Drainage way feel Possible Wet Area feet Property Line feet Drinking.Water Well feet Other DEEP OBSERVATION HOLE BOG" 'Depth from Soil Horizon Soil Texture Soil'Color, Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, Gravel 7-�%�-3�3 /Y�-sSi�'G� ria'-✓.9 d,��" 4. Sr C- /i%�a✓ esu=:�je�P':�: Parent material.(geologic) DepthtoBedrock; Depth to Groundwater:- Standing Water in the Ho1e: c2 Weeping from Pit dace: Esprnated $easonaf High Ground Water: )-4:5 7- F,/T t t:Y GlGdNO WMER E. Al � - 6 9 DEP APPROVED FORM• 12/07/95 1' L a . 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S�q£�Y"�F�C��fiL )a)i�? ��Y�itl i � � C v k7'•4 � ,his'.. �' � d .1� �!.t' -. `. 4 77 7 NEW ENGLAND ENGINEERING SERVICES INC �PNOON R OFNOO�`�� 926 OCG. December 2, 1995 North Andover Board of Health Town Hall Annex Main Street North Andover,MA 01845 RE: TITLE V REPORT Enclosed is the Title V report for 40 Granville Lane,North Andover,MA. If there are any questions please call me at my office,686-1768. Yours truly, `C B aurin C. O&f0od Jr. President 33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768 Commonwealth of Massachusetts, Executive Office of Environmental Affairs Department of 111 Environmental Protection William F.Weld Governor Trudy Coxe S..., vy,EOEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: yD 1;Mk(j,LGA! /A,P0 14006e, ma' Address of Owner: Date of Inspection: /:1,4,' h31 (If different) Name of Inspector: �7J 'j" 6' trk60° D 4' �,fit+4 ��6�9�°''C•irG...�!!Gi/�.-Gl�S, 2.r4 Company Name, Address and Telephone Number: /Ue��"G 3 3 c;¢, 0 is k�c e&, CERTIFICATION STATEMENT 1 certihr that 1 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: _ Passes _ Conditionally Passes _ Needs Further Evaluation By the local Approving Authority Fails Date: !/f Inspector's Signature: The Svstem Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this nspeciion. 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 :ne report to the appropriate regional office of the Department of Environmental Protection, ne onginal should be sent w trrc sysiern owner and cope: sen: to the bujei, if applicable and the aj pro%ing authont;. INSPECTION SUMMARY: Check A, B, C, or D. Aj SYSTEM PASSES: I have not found any information which,indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated,are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. 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, 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 conforming septic tank as approved by the Board of Health. (revised 6/15/95) 1 One Winter Street a 803ton,Massachusetts 02106 • FAX(617)556-1049 Y Telephone (617)292-5500 on r ,-;ova 4:� 7,3746 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Z,1062'e&vV.-Ct8 m Owner: C'onne, eCeg@�'S Doh S�A�� Na Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued). .Sewage backup or breakout or high static:waterlevel observed in the,distribution box is due to broken 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 pumping more than four 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: 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 the, public health, safety and the environment, 1) : SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM I$ NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 salt marsh. 2) SYSTEM,WILL FAIL UNLESS THE BOARD.OF HEALTH (AND PUBLIC WATER SUPPLIER,.IFAPPR0PRIATE) DETERMINES THAT THE SYSTEM 15 FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE . ENVIRONMENT: The system has a secinc tank ano scii1 aosorption system and is within 100 feel lu a >uiio4c'vy i -,uNyi� o 'rib iu o surface water-supply,' The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic'tank and soil absorption system,and'is within SA feet of a private water supply well, The.sy,:rn,, tic,a septic tank and soil absorption system and is less than.100 feet but 50 feet or more from a private water supply well,i 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 ofr ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm D) SYSTEM FAILS: Y I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground.or 'surface waters due to an overloaded or clogged SAS or cesspool, revised 8/15295) 2 9�s�86 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 4o (re4t'U 14r 4 Owner: Date'of Inspection: P ; ItS/ss . D) SYSTEM,FAILS (continued): Static liquid level in the distribution box above`outlet invert due to an overloaded or clogged SAS or.cesspool Liquid depth in cesspool.is les's 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 hit$LtL Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool orprivy is.within 100 feet of a surface water supply or tributary to a surface water supply, . Any portion,of:a cesspool or privy is within a Zone I of a public well Any.portion.of a cesspool or privy is within 50 feet,of a private,water supply- ;well. Any portion of a cesspool or privy is less:than 100 feet but greater than'S0 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. EJ LARGE..SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: 'The design flow of system is 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:' 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 Il.of a public.water supply wells The.owner,or,operator of any such system shall bring the system and facility into full compliance with the groundwater,treatment program requirements of 314 CMR 5.00 and 6.00.. Please consult the local regional office of the Department for further information. I zev;sed 8/15/95) 3 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B - CHECKLIST Property Address: p ruV;L�Q �.GA IUo �OU�°r Owner: (20,1 neY t: ED BeiCc�",5 Date of Inspection: Check it,,the.follow i.ng have been done: /Pumping information was requested of the owner, occupant, and Board of Health. 1�Nohe of the system,components have been pumped 'for at least two weeks and the system has been receiving norma) 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 backup. -- , The system does not receive non=sanitary or industrial waste flow V'The site was inspected for,signs of breakout. kl_�AII system components, excluding.the Soil Absorption System, have been located on the site. !/—,The septic tank manholes were uncovered, opened, and the interior of theseptictank 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 on the site has been determined based on existing information or approximated by non-intrusive methods. The faei(iri o -nc;.fa:-,d occuP ,.< if d:f wer from owner. were provided With information on the proper maintenance of Sub-. .Surface Disposal System, (rev.-sed 8/15/95) 4' �5 a' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Pro ertYAddr ss: 6:604j,," � 49 Owner: /1,0 q! �'... vert .y.t Jo6'.-e 4 Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: gallons Number of bedrooms;: Sr 0o :s Number of current residents: -5 Garbage grinder(yes or:.no): Laundry connected to system (yes or no): . Seasonal use (yes or no): ./to Water meter readings if available: iso q4 ri w e: Last date of occupancy; eka4,2 COMMERCIAUINDUSTRIAL:: Type of establishment; Design flow:__gallons/day Grease trap present- (yes or no)_ Industrial Waste Holding Tank present:.(yes or no)_ Non<sanitary waste discharged to.the.Titie,5 system: (yes or no) V''ater meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: _,.�' /��' q•Go (�So u eco O u.n e e� System pumped as part of inspection`: (yes or not If yes, volume pomped //70 >allon; - Reason for pumping! T+7:j&c p4,'-4 TYPE OF SYSTEM Septic tank/distribution box/soii absorption system Single.cesspool _ 'Overflow cesspool, Privy: Shaped system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information; 1�f Vgees Sewage odors detected when arriving at the site; (yes or no)Kd (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C.. SYSTEM INFORMATION (continued) ez, 14 4 Property Address: yb. �re, d.'Gc r� 9, v Owner: C ay.� 'e"*:44 0o�t Q Date of Inspection: j SEPTIC TANK:.._ (locate on site plan) Depth belowgrade: Go mate rial,of.construction: /Concrete _metal FRP—other(explain) Dimensions:'. Sludge depth Distance from.top of sludge to bottom of outlet tee or,baffle: /f Scum thickness:,; 7 Distance from top of Scum to top of outlet tee or baffle: OW Distance from bottom of scum to bottom of outlet fee or baffle— Comments, (recommendation for pumping; condition of inlet and outlet tees or baffles; depttho�quid level.in relation to outlet invert, structural integrity, evidence of leakage;etc.) N IS / a D 1p vnA L 4eme aa a,? M'1700 ma ee oxeoa GREASE TRAP._ (locate on site plan), Depth below grade:;____ material of construetion:._concrete ,_,metal —FRP Tother(explain.) Dimensions:. . Stun tied ness' D stance from top of scum to top of outlet tee or baffle: Cl,Ctance from bottom ni crtim t- honor- of outlet tee or baffle- _ Commen,c (recommendati.on 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:t (revised a/l*$%95) : 6. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:40 6"64A 1/,'6 L Z dee. 0,V Owner: el) eC0,4SA'Nr-o,0 Date.of Inspection: TIGHT OR HOLDING TANK:, (locate on site plan) Depth below.grade; Material of construction: ,concrete metal ,_FRP —Other(explain)_ Dimensions.. Capacity: gallons Design flow: gallons/day Alarm level: . Comments. (condition of inlet tee—condition of alarm and float switches, etc.). DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above:outlet invert: Comments; ,,,,e leve! and ^ st•,b equa! evidence cf solids car--over evidence of leakage into or out of box,etc.) 5�,►, 1fAVO0�GlF ow ehwe y d Uvle. 3 0 a,P;.sg Oo.:.;->1 7*110 F u.�.v�;• /�esf res� osis t PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments:' (note condition of pump chamber, condition of pumps and'appurtenances, etc,) trevised 8/15/95) c- SUBSURFACE SFEYVAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYS EM INFORMATION (continued) Property Address:�j o 67,2$n 4:1,47 4�746!/ioe. 06 Owner: c obrl�'ye eoS�iI ( +nS� Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not require,:i, but may be approximated by non-intrusive methods) f not determined to be present, explain; Tvoe: leaching pits,.number: leaching chambers,.number: leaching galleries, number;. Teaching_trenches, number,length: _ leaching fields,number, dimensions: overflow cesspool, number: ortments: (note condition of.soiif, signs of hxxdrauhc f iiure, level of ponding; condition of vegetation,etc,j 'g; '01AY -01P t' So;is . ;0,e@r eo SF GOP eL, Sys a �Pe�c r 19ce aea'nsmv CESSPOOLS ilocal e on site,plan) tiumber and Configuration: Depth-top;of liquid;to inlet invert: , epth of solids layer. Death of scum laver D:Mensions of:cesspool: n,verials of construction: :rmcanon of grounciwate inflow,(cesspool must. be pumped as pan of n. pection) . ommerts. (note_condition of soil; signs of hydraulic ,, :lure, level of ponding; condition of vegetation, etc.) , PRIVY: locate on site plan) ',t,aterials of construction; Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic fasljre, level of ponding, condition of vegetation, etc.) ,evaed`8/15L95P $ ca t+sy $•y,a,-c,}�u v:ri tom °t £ A trta 1 R p '.F 1'k x r.. -f r �j/ r ,,9•s' fi F�yY:. -..�r•�`"E .;y'j s ^f^e'`s r,y'�' �}a�,+r�i E�,aF'k r3 ;y ,�- ,. . y:- x t A ° 9 a V { P 71 SUBSURFACE SEWAGE DISPOSAL SYSTEM'INSPECTIONr FORM PART C SYSTEM INFORMATION (continued) Property'Addressc4 d 6,t q-41% Owner: nvley/ G ea/�/3/� C p•tS9''�7''�O Date of Inspection: ' SKETCH OF SEWAGE DISPOSAL SYSTEM; include,iies to at least.two permanent Te3erences aandmarks or benchmarks locate all wells within,100' � map•X L: e` 14.62 �. DEPTH TO GROUNDWATER ti U i L L. Depth to groundwater S feet method of determination.or approximation: 1v�'o N D dS%G�t' �+ irevised 8/15/95) 9 Commonwealth.of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health.. The System Pumping Record must be submitted to the local Board of-Health or other approving authority. . A. Facility Information Important: When filling out 1. Syst m Location: 9 forms the � computer,use only the tab key Address to move your Q g� � cursor-do not `! / �' � ► Cityown State t use the return /TZip Code key. 2. System Owner: Name Address(if different from location) Cityrrown Stat .,ode Telephon Numbe B. Pumping. Record 1. Date of Pumping pate 2. Quantity`Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No 5. Conditi n of lc�stem: 6. Syste Pu ped Bya. - Name Vehicle License Number Company 7. Loca ' where contents wer sposed: y If Sign a't a of aul r Date http://www.mass.govidep/waterlapproval8/t5forms.htm#inspect t5form4.doc•06103 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECO 3 0 �pp5 / A�G QRSN�MEN�R DATE: �� Cj F pR SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING. —> -' UANTITY PUMPED ��GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES 'L NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: