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HomeMy WebLinkAboutMiscellaneous - 42 WESLEY STREET 4/30/2018 (3)0 It vlt Commonwealth of Massachusetts Order of Conditions Massachusetts Wetlands Protection Act G.L. c.131, §40 Town -of North Andover Bylaw, Chapter . j)WE'File No. 242-275 (To be provided by EOE) d North Andover • City/Town • Applicant uco and under the 3.5 A & B From North Andove To William S. & Pamela Buco gAMP. (Name of Applicant) (Ns ne of property owner) V10,0 Address .357 Raleigh Tavern Road Address " SAMF North n over, MA,. This Order is issued and delivered as follows: ❑ Iby hand delivery to applicant or representative on ❑ by certified mail, return receipt requested on This project is located at Lots 42-49 Wesley Street The property is recorded at the Registry of Northern Essex Book 57 Page 377 (date) (date) Certificate (if registered) The Notice of Intent for this project was filed on June 4 11)8.9 (date) The public hearing was closed on June 12, 1985 (date) Findings The NACC has reviewed the above -referenced Notice of Intent and plans and has held a public hearing on the project. Based or the information available to the NACC at this time the N has determined that. . the area on which the proposed work is to be done Is significant to tholrollowing Interests In accordance with the Presumptions of Significance set forth in the regulations for•each Area Subject to Protection Under the Act (check as appropriate): M Public water supply . Storm damage prevention %7 Private water supply Prevention of pollution Ground water supply ❑' Land containing shellfish 91 'Flood control ❑ Fisheries - 1 - SENDER: I also wish to receive the follow- ❑ Complete items 1 and/or 2 for additional services. ing services (for an Pxtra fee): Complete items 3, 4a, and 4b. ❑ Print your name and address on reverse of this form so that we can return this card to you. 1. ❑ Addressee';, ' idress ❑ Attach this form to the front of the mailpiece, or on the back if space does not 2. ❑ Restricted De permit. every ❑ Write 'Return Receipt Requested" on the mailpiece below the article number. ❑ The Return Receipt will show to whom the article was delivered and the date delivered. 3. Article Addressed to: LAbjsL,4v .1v0 . ,A clvveAr, � Dlg� 5. Rec—eiivve By: T PS Form toressee or Agent h /W Cates December 1994 4a. Article Number Z3?o6 R �� l 4b. Service Type ❑ Registered entified r ❑ Express Mail ❑ Insured ❑ Return Receipt for Merchandise ❑ COD &C-10 'es (Only if requested and fee is paid) 102595-99-B-0223 Domestic Return Receipt First -Class Mail UNITED STATES POSTAL SERVICE �- Ss� f mss`U & Feees- w r Permit _No GiQ' _._._........... .... _ ..._........_........__,.,.,. _..._...._.........._........�................................L� __.._._....tom .........._..._..._._._.. e , • Print your na a a�1A'ss; and ZIP Code in this box •_ BOARD Of HM 27CWLMSUW NOW ROM MA 0186 BOARD OF HEALTH 27 CHARLES STREET NORTH ANDOVER, MA 01845 TELEPHONE# (978) 688-9540 APPLICATION FOR ABANDONMENT JUN 2 " OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) Pursuant to Section 310 CMR 15.354 of the State Environmental Code, Title V NameV1--11d1-5bkZ L>Qk Phone Address �/ Ltd E S C c-' v s r vL c -'moi Contractor hired for work: Name 4 r- e:i Tvu c /p,,&,f Phone rea> E? c7-3 P, Address ; a x / 4 6, S-4 G -6;- A -t rV9 © ?,.0 -7 Date for scheduled abandonment t3 —p 0 The septic system at the above address has been abandoned according to Title V specifications. Signature of Contractor Method of septic tank abandonment (check one). ( ) removal (=gsandfill ( ) crush ( ) other Name of Offal Hauled c,, , This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVE'S USE ONLY. s'?c 4g Agent Date Completemi.application for-.sel tic:tank �bandonment-:and:subniit it to the Board _of- Heal#h office. 'r �. Hire a contractorto remove the existing tank and connect to the'sewer - -_. appropriately.according to approved engineering plans. An inspection by the Board of Health for the tank abandonment is a necessity as well. Please have your contractor call the office to schedule. aw f Please be advised that failure to perform the specified actions may result in further enforcement actions. If you have any questions regarding this letter, do not hesitate to call the Health Office at the number above. Sincerely, Sandra Starr, R.S., C.H.O. Health Director i? w o �sSwcHuset Fax 978-688-9542 Board of Appeals (978) 688-9541 Building Department (978) 688-9545 Conservation Department (978) 688-9530 Health Department (978) 688-9540 Public Health Nurse (978) 688-9543 Planning Department (978) 688-9535 Town Of North Andover Community Development & Services 27 Charles Street North Andover, Massachusetts 01845 LETTER OF MON-COMPLIANCE June 1, 2000 Vladislav Losik 61 Wesley Street North Andover, MA 01845 Re: Use of septic tank in sewer hook-up Dear Mr. Losik: William J. Scott Director (978) 688-9531 It has come to the attention of the North Andover Board of Health that the disposal of wastewater from the site at 61 Wesley Street, North Andover, owned by you is in violation of Title 5 of the State Environmental Code. In particular, the following items have been found to be in non-compliance with the Code. ♦ The existing septic tank is being used as an integral part of the municipal sewer system without prior approval from the State Department of Environmental Protection. (See 310 CMR 15.354(2)) ♦ A deck has been installed over the septic tank in violation of 310 CMR 15.228(3). I hereby specify that the following actions be taken within fourteen (14) days and that you inform this office when those actions have been completed. 1. Complete an application for septic tank abandonment and submit it to the Board of Health office. 2. Hire a contractor to remove the existing tank and connect to the sewer appropriately according to approved engineering plans. An inspection by the Board of Health for the tank abandonment is a necessity as well. Please have your contractor call the office to schedule. Please be advised that failure to perform the specified actions may result in further enforcement actions. If you have any questions regarding this letter, do not hesitate to call the Health Office at the number above. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: BOH Tim Willett, DPW Jim Rand, DPW Sam Ciraldi, Salem Construction Co. John Zajac, DEP Dave Ferris, DEP File SENT &I I ( o() Z 270 627 490 us f5ostal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail /See reverse) Sen to 51-t}v Ln sr k Street& umber 6i cstE-�- POffice, tate, & ZIP ode Postage Certified Fee .5 Special Delivery Fee Restricted Delivery Fee u� Retum Receipt Showing to Whom & Date Delivered Q Retum RecW Showing to Whom, Q Date, & Addressee's Adrbress 0 TOTAL Postage & Fees $ Postmark or Date 0 LL U) a ( MAekfl«8@dvWJO=ls Cl) § ®0 \E m mak\ ) r£m }-01,00 kE (� EE _ _ CD k{7 Im - k / = �f § \7 E 0 _ CO . k � / k ) �\ Q)` & f Qf §t -k ${/�@ - f & { \ { \ k \ j LL w :C'O ca k} j @ `/ mj 7 6£ 2 q = $ ; f Qm + 0 45 { a)7� -o - k�c ■ \& § }«� §co ) - (§ Lu \\ /\/}CL/ =e u w B C � 2�/&/ - ■ § Z: E � _ - -_r 2 m ) [ ) /\� �k �� 0_ �jj� ® - 0. f2( { '�E \ § » - /�[§ $ / U) co Cc Lr) f. NORTM F lie A s$�CMUSt Fax 978-688-9542 Board of Appeals (978) 688-9541 Building Department (978) 688-9545 Conservation Department (978) 688-9530 Health Department (978) 688-9540 Public Health Nurse (978) 688-9543 Planning Department (978) 688-9535 Town Of North Andover Community Development & Services 27 Charles Street North Andover, Massachusetts 01845 LETTER OF MON-COMPLIANCE June 1, 2000 Vladislav Losik 61 Wesley Street North Andover,— NIA 01845 Re: Use of septic tank in sewer hook-up Dear Mr. Losik: William J. Scott Director (978) 688-9531 It has come to the attention of the North Andover Board of Health that the disposal of wastewater from the site at 61 Wesley Street, North Andover, owned by you is in violation of Title 5 of the State Environmental Code. In particular, the following items have been found to be in non-compliance with the Code. ♦ The existing septic tank is being used as an integral part of the municipal sewer system without prior approval from the State Department of Environmental Protection. (See 310 CMR 15.354(2)) ♦ A deck has been installed over the septic tank in violation of 310 CMR 15.228(3). . I hereby specify that the following actions be taken within fourteen (14) days and that you inform this office when those actions have been completed. ,l. Complete an application for septic tank abandonment and submit it to the Board of Health office. 2. Hire a contractor to remove the existing tank and connect to the sewer appropriately according to approved engineering plans. An inspection by the Board of Health for the tank abandonment is a necessity as well. Please have your contractor call the office to schedule. Please be advised that failure to perform the specified actions may result in further enforcement actions. If you have any questions regarding this letter, do not hesitate to call the Health Office at the number above. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: BOH Tim Willett, DPW Jim Rand, DPW Sam Ciraldi, Salem Construction Co. John Zajac, DEP Dave Ferris, DEP File r; t N r Memorandum To: Sandy Starr, Health directs CC: file From: Susan Ford, Health Inspect Date: 05/31/00 Re: 61 Wesley St. Sandy, This memo is concerning Vladislav Losik, the owner of 61 Wesley Street, and the sewer.tie-in. Please see the attached letter to Mr. Losik before reading on. Since receipt of that letter, Mr. Losik has contacted this office twice. This is a synopsis of the situation to date. Mr Losik contacted John Zajac of DEP, who told him to call Dave Ferris because he did not`get involved with this. (Dave said it was John's jurisdiction). Then Mr. Losk called Dave Ferris. Dave said that the DEP would not grant a variance for the use of his septic tank as a holding tank, however the enforcement of this regulation hes the hands of the local BOH. Therefore, Mr. Losik asked what is next. (I have a\ca11 into Dave Ferris to confirm or deny this) Mr. Vlosik is not volunteering to alter his, now active, sewer tie-in to meet these regulations. In addition, he wants to know who is responsible for this oversight. I told him that the owner is responsible, but he may have cause to place partial blame on his engineer or his contractor, however that is a civil matter for the courts to decide. I told him that DPW does not speak for this office and it is not their job interpret the Health Regulations. At this point, the owner is not planning to do anything, but wait. I said that I would be reporting to you the update on this issue. If this office takes further action, he will be notified in writing. What would you like to do about this now? Thanks Ot NORT/r Town Of North Andover Community Development & Services A 27 Charles Street North Andover, Massachusetts 01845 Fax 978-688-9542 May 20, 2000 Vladislav Losik 61 Wesley Street North Andover, MA 01845 Dear Mr. Losik, William J. Scott Director (978) 688-9531 This correspondence is in regards to the sewer tie-in that is presently under construction at your address, 61 Wesley Street. This is a follow-up to the message I left on your answering machine and in person with your contractor, Sam Ciraldi. The Health Department must inform you that the intended connection will be a violation if used prior to conforming to the Department of Environmental Protection, 310 CMR, commonly known as Title V. This is an unfortunate issue that could have been avoided. I hope you received my card, which I left for you, as well as the section of the State Code regarding this problem. (Please note the additional copy attached) Although the department of public works OK'd the plan, it did not mean that it conformed to all other departments. The Health department did not review the plan that was executed at your property. However, in a conversation with Joe Serwatka, your design engineer, he stated that his design called for replacement tanks to be used. The issue at hand is that your contractor used the old septic tank. 310 CMR 15.354 (2) specifically prohibits the use of the existing septic tank as an integral part of the sewer system unless written approval from the Department of Environmental Protection has been received. The DEP must be contacted immediately for approval to avoid further action by this department. The best person to contact is John Zajac at (978) 661-7748. As an aside issue, this office is confused as to the continued use of this tank as a settling tank. In effect, you will be paying the town for the use of the water and sewer in addition to the need to pay a septic pumper to periodically pump the solids from this tank. Assuming I understand the description of your system as described by Mr. Ciraldi, in concept, it seems to be an extra burden that you may not need., Please contact this office if you have any questions regarding this issue. I hope to hear from you or your contractor by Thursday, June 1, 2000 for an update on the progress of this situation. Sincerel san Ford, R. S. Health Inspector Cc: Tim Willett, Staff Engineer Sam Ciraldi, Salem Construction Co. John Zajac, DEP 1�j C -MR: DEPART, IEN i OF E.VVIRONME\ iAL PROTcCt�ON IS -3J3: continued (b) repair or replacement of one or more structural components of a system which is .otherwise in compliance with 310 CMR 15.000, such as a clogged building sewer or distribution Linc. damaged building sewer, scpac tarty or distribution box, or broken ter which is determined to be the probable aux of the system failure and for which no modification or alteration of the system design is required; and shall be comple;;d within 30 days. (2) All emergency repairs other than pumping shall be followed within 30 days of the emcsgcncy repair by an appdcaIIon for a Disposal System Ccnstracaon Permit loaf upgrade approval, or an appliaaon for a variance, if needed. pursuant to 310 CMR 15.411(2). The applicant may backnll any ucavanon required for the ane:gency 1Cpair unless dirtrted otherwise by the approving authority. Pumping shall be reported to cite local approving authority. (3) Any upgrade or expansion of a system which is not an emergency repair shall be designed, approved, and constructed in accordance wit't 310 CN[R 15.000. s ;51• 1_.__ Aband^r.:rcnt cf Svstcrns (1) Whenever the use of a system is discontinued following connectionto a municipal or Private sanitary se -e: or following condemnation or demolition of a building serve„ by the system, the system shall be considered abandoned and any further use of the systcm for any purpose shall be prohibited unless, after inspection, the approving authority determines the system is in compliance or can be brought into compliance with 310 GtifR 15.000. (2) Continued use of a septic tank where the tank is to become an integral pan of a sanitary sewer: systcm requires cher prior written approval of the Depanment (� (3) The following procedure shall be used to abandon a system: (a) The facility owner shall apply to the approving authority to abandon the cxisang systcm citing the reason(s) abandonment is necessary, and where connection to municipal or private sanitary sewer has been made, a copy of the sewer connection pe:;rtit sha1I be submitted with the applicadon: (b) Upon receipt of the approving authority's wrirten approval to abandon the system, the septic tank shall be pumped of its entire contents by a licensed septage hauler; and (c) The tank shall be excavated and removed from the site, or the bortom of the tank ahall lr �.d _: _•p rL'--rzd its pftr of water and the tank shall be completely filled with clean sand.ztt ztsarnage 15.101: General Provisions (1) Except as set forth in 310 C.'viR 15.40I through 15.47", every application to construct, upgrade or expand a system shall be prepared, and the work therefore authorize pursuant to a Disposal System Construction Permit shall be conducted, in full compliance with the procedural and tchnical requirements of 310 CMR 15.100 through 15.293. (2) In general, full compliance with the provisions of 310 C'KR 15.000 is pres to umed necessary for the protection of publibe health, safey, welfare. and the environment Any requests to vary from the standards of 310 C,MIt 15.000 by means of a local upgrade approval or a variance shall be carefully reviewed by the approving authority and, where required. by the Department. 9(23/91 310CMR-320.39 SENDER: I also wish to receive the follow- ❑ Complete items 1 and/or 2 for additional, -services. "" - ing services (for an extra fee): Complete items 3, 4a, and 4b. G ❑ Print your name and address on the reverse of this form so that we can return this card toou. ti �+ ` - , d 1. ❑ Addressee's Address E3 Attach this form to the front of the mailpiece, dt+d backlpace does not permit. P 5 '1 2. ❑ Restricted Delivery ❑ Write 'Return Receipt Requested" on the mailpiece below the article number. ; ❑ The Return Receipt will show to whom tl e-article-was-'dtli�d'a-na 115he ate i delivered. 3. Article Addressed to: 1/Lga1,5LAV 61 Nol _,6Ve�, 5. Received B : (Print,Name) 6. Signature (Addressee or Agent) PS Form 3811, December 1994 4b. Ell 8. Addre fee is ?Q ertified ❑ Insured k❑ COD requested and 102595-99-s-0223 Domestic Return Receipt UNITED STATES POSTAL SERVICE -PSS ""° ® First-Classsta e & Mail Fid C . 2 , . �w Print our n adp�s , and ZIP Code-iin.thisbox . . .� BOARD WH 27O �Si mm m MA Olga a Q O O Go C') E o` LL rn a. `Z 370 627 491 US Postal Service Receipt for Certified Mai! No Insurance Coverage Provided. . Do not use for International Mail See reverse Vto k L AISLAV LoSt & Number Post Office, State, &.ZIP e fy A— Postage $ + 3 3 Certified Fee 5� Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom, Date, & Addressee's Address TOTAL Postage & Fees Postmark or Date (esJanab) 5661 1!ad`d `0085 wood Sd 'p E N m co N N N N n C O U L w= U r :a . O N O N O S O N O Cl) N N w .L... N Ol U 1 U d O o p N N 'ED E 2 m ii a t O m T •O dp A m N c O' .M c V '00 O UI O E dL..E O is W t U N O 22 O t0 .0 C T O R ciicc C rn a N E cmv CCO m E n o'r Q o o N N m o v E m o `m a E E o m N C E L a> c m v aE m Z m L' E =— t m E U rn u c E o o c N mEEO n c L aNi v N d v x t L c ami m a�n dv EcLi o v> d c = e , cc U 0 N W Y ME O Y C N N C U Y o Z m o E- v ..> '0 J 2 v E U N N 1 0 0 S coO vo O N L:p O W O . p o� is m v E o_� •c��0 dip a�Qi °1 U UJ 0 N 4 U U iC 3� N H co uj C� N O .N L' 4 O on n 2 N '� o€ o•o n� ( d� w� F" d v a a; U CLO ZH N -o N O v �' 'o m E o w m W co E°' E o.oT an d o m cc Y a l0 N :E 3 d U CL41 Q N d rn o o= W v D) O > N C N C U U t0 C y t0 N l0 L (D "o .0 3 E o 0C o ti 0 coo o >> 2 o N G d O N N Q T Y O) T O T c T d E .r N W O. > c = = ca E F — -a U3 U) U cc 3 N E C7 O OlQ 4 R u.d 6 Y! f ~ORT~ 1 0 %j � 'r ' •Y OL • i • 4sS4CHuset Fax 978-688-9542 Board of Appeals (978) 688-9541 Building Department (978) 688-9545 Conservation Department (978) 688-9530 Health Department (978) 688-9540 Public Health Nurse (978) 688-9543 Town Of North Andover Community Development & Services 27 Charles Street North Andover, Massachusetts 01845 May 20, 2000 Vladislav Losik 61 Wesley Street North Andover, MA 01845 Dear Mr. Losik, William I Scott Director (978) 688-9531 This correspondence is in regards to the sewer tie-in that is presently under construction at your address, 61 Wesley Street. This is a follow-up to the message I left on your answering machine and in person with your contractor, Sam Ciraldi. The Health Department must inform you that the intended connection will be a violation if used prior to conforming to the Department of Environmental Protection, 310 CMR, commonly known as Title V. This is an unfortunate issue that could have been avoided. I hope you received my Planning card which I left for you, as well as the section of the State Code regarding this problem. Department � y � g g (978) 688-9535 (Please note the additional copy attached) Although the department of public works OK'd the plan, it did not mean that it conformed to all other departments. The Health department did not review the plan that was executed at your property. However, in a conversation with Joe Serwatka, your design engineer, he stated that his design called for replacement tanks to be used. The issue at hand is that your contractor used the old septic tank. 310 CMR 15.354 (2) specifically prohibits the use of the existing septic . tank as an integral part of the sewer system unless written approval from the Department of Environmental Protection has been received. The DEP must be contacted immediately for approval to avoid further action by this department. The best person to contact is John Zajac at (978) 661-7748. A aside As anas d issue, this office is confused as to the continued use of this tank as a settling tank. In effect, you will be paying the town for the use of the water and sewer in addition to the need to pay a septic pumper to periodically pump the solids from this tank. Assuming I understand the description of your system as described by Mr. Ciraldi, in concept, it seems to be an extra burden that you may not need. ; Please contact this office if you have any questions regarding this issue. I hope to hear from you or your contractor by Thursday, June 1, 2000 for an update on the progress of this situation. Sincerel san Ford, R. S. Health Inspector Cc: Tim Willett, Staff Engineer Sam Ciraldi, Salem Construction Co. John Zajac, DEP JIU COIR: DEPAR%'�IE.',7 OF E,\'V[RbN�E\iAL PROTECTION 15.353: continued (b) repair or replacement of one or more structural components of a system which is dOtherwise in compliance with 310 CMR 15.000, such as a clogged building sewer or istribution line, damaged building sewer, septic tarty or distribution box; or broken to. which is determined to be the probable cause of the system failure and for which no modification or alteration of the system design is Mquired: and shall be completed within 30 days. (2) All emergency repairs other than pumping shall be followed within 30 days of the emergency repair by an application for a Disposal System Construction pest, local upgrade approval, or an application for a variance, if needed, pursuant to 310 CMR 15.411(2). The applicant may bacL-U any excavation required for the emergency repair unless directed Otherwise by the approving authority. Pumping shall be reported to the local approving authority. (3) Any upgrade or expansion of a system which is not an emergency repair shall be designed, approved, and constructed in accordance with 310 CNIR 15,000. 15.354' Aband_nn•— of Svstems (1) Whenever the use of a system is discontinued following connection to a municipal or private sanitary sewer or following condemnation or demolition of a building served by the system, the system shall be considered abandoned and any further use of the system for any Purpose shall be prohibited unless, after inspection, the approving authority determines the system is in compliance or can be brought into compliance with 310 CMR 15.000. J� (2) Continued use of a sepric tank where the tank is to become an integral part of a sanitary sewer system requires the prior written approval of the Department (b i✓ (3) The following procedure shall be used to abandon a system: (a) The facility owner shall apply to the approving authority to abandon the existing system citing the reason(s) abandonment is necessary, and where connection to municipal or private sanitary sewer has been made, a copy of the sewer connection permit shall be submitted with the applicadon; (b) Upon receipt of the approving authority's written approval to abandon the system, the septic tank shall be pumped of its entire contents by a licensed septa¢e hauler; and (c) The 'tank shall be excavated and removed from the site, or the bottom of the tank shall Lr rap=ed :r be=g PUMPed � its tnnMx M MloFteverrt zerairta e of water and the tank shall be completely filled with clean sand. g 15.401: General Provisions 93/94 (1) Except as set forth in 310 CMR 15.40] through 15.422, every application to construct, upgrade or expand a system shall be prepared, and the work therefore authorized pursuant to a Disposal System Construction Permit shall be conducted, iri full compliance with the Procedural and technical requirements of 310 CMR 15.I00 through 15.293. (2) In general, full compliance with the provisions of 310 CMR 15.000 is presumed to be necessary for the protection of public health; safety, welfare and the environment Any requests to vary from the standards of 310 CMR 15.000 by means of a local upgrade approval or a variance shall be carefully reviewed by the approving authority and, where required, by the Department 3 10 CM R - 320.39 To: Sandy Starr, Health director CC: file From: Susan Ford, Health Inspector Date: 05/31/00 Re: 61 Wesley St. Sandy, This memo is concerning Vladislav Losik, the owner of 61 Wesley Street, and the sewer tie-in. Please see the attached letter to Mr. Losik before reading on. Since receipt of that letter, Mr. Losik has contacted this office twice. This is a synopsis of the situation to date. Mr Losikcontacted John Zajac of DEP, who told him to call Dave Ferris because he did not` get involved with this. (Dave said it was John's jurisdiction). Then Mr. Losk called Dave Ferris. Dave said that the DEP would not grant a variance for the Us" of lus septic tank as a holding tank, however the enforcement of this regulation hes a the hands of the local BOH. Therefore, Mr. Losik asked what is next. (I have a call into Dave Ferris to confirm or deny this) Mr. Vlosik is not volunteering to alter his, now active, sewer tie-in to meet these regulations. In addition, he wants to know who is responsible for this oversight. I told him that the owner is responsible, but he may have cause to place partial blame on his engineer or his contractor, however that is a civil matter for the courts to decide. I also told him that DPW does not speak for this office and it is not their job interpret the Health Regulations. At this point, the owner is not planning to do anything, but wait. I said that I would be reporting to you the update on this issue. If this office takes further action, he will be notified in writing. What would you like to do about this now? Thanks SOWN�PR� OF iNEP'v",:' 80 Commonwealth of Massachusetts 9 Executive Office of Environmental Affairs 1 Qq_MNN0NWMMN� Department of Environmental Protection William F. Weld Goyarnor Argeo Paul Cellutxi LL Gmmnnor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Trudy Coxe Secretary David B. Struhs Commissioner Property Address: 6 1 V,/EStjE y ST N. ANDOVER Address of Owner. Date of Inspection: ]Z -3-9S (If different) Name of Inspector. 0T-apHEj.4 Company Name, Address and Telephone Number. G. `Y 6A&.A4o14 f/JSI�!>"T1gN CEmVICE t' O. 8o x 1409 N I -I o a0 _2q (tSeo -4984 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's signature: -4/— -446`6~ Date: I The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: V'*'_ 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 11/03/95) 1 One Winter Street • Boston, Massachusetts 02108 • FAX (617) 556-1049 • Telephone (617) 292-5500 es V. Pnnied on Recycled Paper 6 ! !SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) r Property Adareas (o - wc_ StE y S r. N • i4iv �Duecz Owner. Gl�vN Date of Inspection: IZ,'--3-95 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level 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 Cl 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 IS NOT FUNCTIONING INA 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 a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _, The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: I W&-SLEy. ST. IY. A.#14bovBR Owner. �l.4NM1 Date of Inspection: 12 - 3 - c '&- D] SYSTEM FAILS: 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. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply: Any portion of a cesspool or privy is within a Zone 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 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well.water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: I The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 H of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address 601 WE'SL.-Y ST. Owner. G IANN I Date of Inspection: 1 Z - 3 - q6 Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 141A As built plans have been obtained and examined. Note if they are not available with N/A. ZThe facility or dwelling was inspected for signs of sewage back-up. 1Z The system does not receive non -sanitary or industrial waste flow The site was inspected for signs of breakout. . Z. Allsystem components, excluding the Soil Absorption System, have been located on the site. ... -- The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non -intrusive methods. t/ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub - Surface Disposal System. (revised 11/03/95) 4 IFI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address (o I WESLEY ST Owner. 61ANN 1 Date of Inspection: IZ-3-�iS FLOW CONDITIONS RESIDENTI .I.: Design flow:?O gallons Number of bedrooms: Number of current residents: Z Garbage grinder (yea or no):_p Laundry connected to system (yes or no):•Yar, Seasonal use (yes or no):_ O Water meter readings, if available: W F_t I Inst date of occupancy: Uzara T COMMERCIAL /INDUSTRIAL: 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 Title 5 system: (yea or no)_ Water meter readings, if available:_ LAm aace ox occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information NoWL:e System pumped as part of inspection: (yes or no)jloS If yes, volume pumped: 1.42n gallons Reason for pumping: JAY IN 5.Pan- rION 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 10(-23 Sewage odors detected when arriving at the site: (yes or no) LD (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address Col Owner. &/ANN Date of Inspection: i2_ -3--g SEPTIC TANK_ (locate on site plan) Depth below grade:_" Material of construction: X_concrete _metal _FRP _other(explain) Dimensions: Sludge depth: Z" Distance from top of sludge to bottom of outlet tee or baffle:T%.. Scum thickness: I " Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: I l" Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) . GREASE TRAP -_W,4 (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address C.1 WESLZ y ST. 1Q. AA4 D0 VF- Z Owner. GIANN I Date of Inspection: 12.- 3 - 95 TIGHT OR HOLDING TANK -_N/,& (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: D Comments: (note if level and distnbution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working orden(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addr.s 6,1 KlESLLY Cr. /V • ANC)Ove lZ Owner. C,4A)QN Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods) If not .determined to be present, explain: 6/M leaching pits, number:_..?— leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc. CESSPOOLS: LL/A (locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer- Depth ayerDepth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Mow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: kl A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)_ (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addreea: I WSLEy S'T N . HN DOVE2 Owner. GIstNN 1 Date of Inspection: IZ- 3 -cps SKETCH OF SEWAGE DISPOSAL SYS'T'EM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' W�s(,.Ey Sr son GAL - L15AGH prr 1 I Ii' ,I 28'-7 r i I I I I i I \ ' I K. /� "' 6EPr Icr f 1 1-70 `I I i I I 16pp GaL I SHED L.EAGH PIT DEPTH TO GROUNDWATER Depth to groundwater. i L feet method of determination or approximation: Lx- (revised 11/03/95) 9