HomeMy WebLinkAboutMiscellaneous - 575 WINTER STREET 4/30/2018 (2)North Andover Board of Assessors Public Access poRVN 6 K F ♦� &sntt+us��y Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales e Page 1 of 1 '�_ `ovm ©f lqcwth mover Bow Of A53esscws Parcel ID: 210/104.A-0091-0000.0 SKETCH Click on Sketch to Enlarge Property Record Card Community: North Andover PHOTO No Picture Available Location: 575 WINTER STREET Owner Name: LIND, DAVID J DONNA LIND Owner Address: 575 WINTER STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6 - 6 Land Area: 1.96 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 1830 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 450,600 422,600 Building Value: 212,100 208,100 Land Value: 238,500 214,500 Market Land Value: 238,500 Chapter Land Value: LATESTSALE Sale Price: 295,000 Sale Date: 06/01/1999 Arms Length Sale Code: Y -YES -VALID Grantor: JAY CORMIER Cert Doc: Book: 05451 Page: 0152 http://csc-ma.us/NandoverPubAcc/J*sp/Home.jsp?Page=3&Linkld=989945 10/9/2007 O r A/yOure Jazz. /-3 /"j C -' /tel, fly,►/r.�v. 1rx OF ,z MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS s tAND SURVEYORS •- PLANNERS 66 PARK STREET 0 ANDOVER. MMACH,USETTS 01910 + Tit (6171 475�.355$. 373.572) Zai A 74w,4 oq,..- # lo4A 1' /,vv e A, e 1,ry t ,r Our ,v IfSf 0. 1 y Stir �''"�.�Y' �,,�' /[i C3 • .l `� e CO r I -A "PTDZ 5'!` "'r �. , 4 f� t.,/ &,4,,1' MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 40 LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MISSACHUSETT5 01810 C TEL (617) 475.3555, 373-5721 A1,4 r Donna, Well, this is a hypothetical answer as we do not have an application in front of us from you today. However... Your file indicates that your septic system was constructed for a 4 -bedroom (maximum 9 -room) home. The floor plan as provided indicates that you have 9 or less rooms with the addition. Please note that room numbers do not include bathrooms. There is actually no limit on #'s of bathrooms, just on the # of living spaces. The conclusion is as long as your total # of will be fine with an addition. A copy of this file. Thank you Susan Sawyer Health Director rooms does not exceed 9 you email will be placed in your -----Original Message ----- From: Donna Lind (mailto:Donna-Lind@comcast.net] Sent: Tuesday, August 19, 2008 11:17 AM To: Sawyer, Susan Subject: Septic approval Susan, On the day I met with conservation you approached the round table across from some desks and told me you needed a sketch of our interior of the house. We have a 1.5 bath house and we are looking to add a bedroom to the first floor for Dad. He would like his own private bath if possible, if not my idea could be modified to make the first floor half bath into one full bath with two doors accessing it from the kitchen and from his room. Please check out the attachments. We passed title V in April and I have that report. We have a 1500 gal septic tank. Thanks Donna Lind ` Sawyer, Susan From: Donna Lind [Donna-Lind@comcast.net] ,Sent: Tuesday, August 19, 2008 11:17 AM To: Sawyer, Susan Subject: Septic approval C E* Attachments: Dad's addition0001]pg; Dad's addition0002Jpg Dad's Dad's ition0001.jpg (1 Iition0002.jpg (1 Susan, On the day I met with conservation you approached the round table across from some desks and told me you needed a sketch of our interior of the house. We have a 1.5 bath house and we are looking to add a bedroom to the first floor for Dad. He would like his own private bath if possible, if not my idea could be modified to make the first floor half bath into one full bath with two doors accessing it from the kitchen and from his room. Please check out the attachments. We passed title V in April and I have that report. We have a 1500 gal septic tank. Thanks Donna Lind 1 0 7 p a (16 /I( fit //Iq�,, r 1 Q.� P �1 % 0 4,. PETER F. REILLY l RECEIVED 136 ANDOVER STREET APR Y 1 2008 ' ANDOVER, MA 01810 (978) 375-3750 LHWEALTH WN DF NORTH AND VER DEPARTMEN TITLE V OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION Property Address: 575 Winter Street, North Andover, MA 01845 Name of Owner: David and Donna Lind Address of Owner: same Name of Inspector: Peter F. Reilly Company Name: same Mailing Address: 136 Andover Street, Andover, MA 01810 Telephone Number: (978) 375-3750 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 properfunction and maintenance of on-site sewage disposal systems. I am a DEP approved system inspector pursuantto Section 15.340 of Title 5 (310 CMR 15.000) The system: ✓ Passes N/A Conditionally Passes N/A Needs Further Evalu N/A Fails i Inspector's Signature: Reilly the Local Approving Authority Date: March 29, 2008 The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) 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 regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS ****This report only describes conditions a the time ofinspection and underconditions 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 (See attached Disclaimer). OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 575 Winter Street, North Andover Owner's Name: David & Donna Lind Date of Inspection: 3/29/2008 INSPECTION SUMMARY: A. SYSTEM PASSES: Check A, B, C, D, or E / ALWAYS complete all of Section D ✓ 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. COMMENTS: The system met the Pass Criteria of Title V. B. SYSTEM CONDITIONALLY PASSES: N/A One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no, or not determined (Y, N, ND). Describe basis of determination in all instances. If "not determined", explain why not) N The septic tank is metal, and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: N Observation of a sewage backup or breakout or high static water level 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): N/A broken pipe(s) are replaced N/A obstruction is removed N/A distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): N/A broken pipe(s) are replaced N/A obstruction is removed OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 575 Winter Street, North Andover Owner's Name: David & Donna Lind Date of Inspection: 3/29/2008 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 environment. 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: N/A Cesspool of privy is within 50 feet of a surface water N/A 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, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: N/A The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. N/A The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply well. N/A The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. N/A The system has a septic tank and SAS the SAS is less than 100 feet but 50 feet or more from a private water supply well.**Method used to determine distance N/A This system passes if the water well water analysis, performed at a certified DEP laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. A copy of the analysis must be attached to this form. 3. Other N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 575 Winter Street, North Andover Owner's Name: David & Donna Lind Date of Inspection: 3/29/2008 D. System Failure Criteria applicable to all systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. N/A Liquid depth in cesspool less than 6" below invert or available volume <'Y2 day flow. No required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: once No Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. N/A Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone I of a private water supply well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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 laboratory, for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen is less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form). N/A The system fails. I have determined that one or more of the above failure criteria exist as defined in 310 CMR 15.303, therefore the system fails. The property owner should contact the Board of Health should be contacted to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You Must indicate either "Yes" or "No" to each of the following: (The following criteria apply to a large system in addition to the criteria above) N/A 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: Yes No N/A The system is within 400 feet of a surface drinking water supply N/A The system is within 200 feet of a tributary to a surface drinking water supply N/A The system is located in a nitrogen sensitive area (Interim Wellhead Area - IWPA) or a mapped Zone II of a public water supply well) If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any such 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. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART B - CHECKLIST Property Address: 575 Winter Street, North Andover Owner's Name: David & Donna Lind Date of Inspection: 3/29/2008 Check if the following have been done. You must indicate either "Yes" or "No" as to each of the following: Yes No Yes Pumping information was provided by the owner, occupant, or Board of Health. No Were any of the system components pumped out in the previous two weeks ? Yes Has the system received normal flow in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes Were as built plans of the system obtained and examined ? (If they were available note as N/A) Yes Was the facility or dwelling was inspected for signs of sewage backup ? Yes Was the site was inspected for signs of breakout ? Yes Were all system components, excluding the SAS, located on the site ? Yes Were the septic tank manholes uncovered, opened and the interior of the septic tank inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum? Yes Was the facility owner (and occupants of if different from the owner) provided information on the proper maintenance of subsurface sewerage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes No Yes Existing information. For example, a plan at the Board of Health. N/A Determined in the field if any of the failure criteria related to Part C is at issue (approximation of distance is unacceptable) [15.302(3)(b)]. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: 575 Winter Street, North Andover Owner's Name: David & Donna Lind Date of Inspection: 3/29/2008 FLOW CONDITIONS RESIDENTIAL: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms: Number of Current residents: Does the residence have a garbage grinder (yes or no): Is the laundry on a separate sewerage system (yes or no): Laundry system inspected (yes or no): Seasonal use (yes or no): Water meter readings, if available (last 2 years usage [gpd]) Sump Pump (yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of Establishment: Design Flow gpd (based on 15.203): Basis of Design Flow (seats/persons/sq.ft., etc): Grease trap present (yes or no): Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER: (Describe) PUMPING RECORDS 4 4 600 gpd (per design plan) 2 no no (if yes, separate inspection required) N/A no about 100 gpd no current N/A N/A N/A N/A N/A N/A N/A N/A N/A GENERAL INFORMATION Source of Information: owner (last 2/08 - about once every 2 years) Was system pumped as part of inspection (yes or no): no if yes, volume pumped (gallons): N/A How was quantity pumped determined ? N/A Reason for pumping: N/A TYPE OF SYSTEM ✓ Septic tank/distribution box, soil absorption system Single cesspool Overflow cesspool Privy NO 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 the system owner) Tight Tank Attach a copy of the DEP Approval Other (describe): Approximate age of all components, date installed (if known) and source of information: original system installed in 1983. Were sewerage odors detected when arriving at the site (yes of no): no OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 575 Winter Street, North Andover Owner's Name: David & Donna Lind Date of Inspection: 3/29/2008 BUILDING SEWER: (locate on site plan) Depth below grade: about 8" - 10 " Materials of construction: cast iron ✓ 40 PVC other (explain) Distance from private water supply well or suction line N/A Diameter: 4" Comments: Condition of joints, venting, evidence of leakage, etc.) Building sewer was watertight and appeared sound at foundation. SEPTIC TANK: ✓ (locate on site plan) Depth below grade: about 6" - 8" Material of construction: ✓ concrete metal Fiberglass Polyethylene other (explain) If tank is metal, list age N/A Is age confirmed by Certificate of Compliance N/A (Yes/No) Dimensions: Rectangular - 1,500 gallons Sludge depth: <111 Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: <111 Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined: observation Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level as related to outlet invert, evidence of leakage, etc.) Tank was watertight and appeared to be functioning properly. Original concrete baffles were intact on the inlet and outlet sides. GREASE TRAP: N/A (locate on site plan) Depth below grade: material of construction: concrete metal FRP other (explain) Dimensions: N/A Scum thickness: N/A Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A Date of Last Pumping: N/A Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level as related to outlet invert, evidence of leakage, etc.) N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 575 Winter Street, North Andover Owner's Name: David & Donna Lind Date of Inspection: 3/29/2008 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: material of construction: concrete metal Fiberglass Polyethylene other (explain) Dimensions: Capacity: Design Flow.- Alarm low:Alarm Present (yes or no): Alarm level: Alarm in working order (yes or no) Date of last pumping: N/A N/A gallons N/A gallons per day N/A N/A N/A N/A Comments: (condition of alarm and float switches, etc.) N/A DISTRIBUTION BOX: ✓ (locate on site plan) 0" depth of liquid above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) D -box was level. Two lines leading to SAS were accepting effluent evenly. No solids carryover evident. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order (yes or no) N/A Alarms in working order (yes or no) N/A Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) not applicable OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 575 Winter Street, North Andover Owner's Name: David & Donna Lind Date of Inspection: 3/29/2008 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible; excavation not required) If SAS not located, explain why: Type leaching pits, number leaching chambers and number leaching galleries and number ✓ leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number alternative system (name of technology) N/A N/A N/A 2 trenches (per 1983 design plan) N/A N/A N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Soils in area of SAS appeared normal, no signs of breakout. CESSPOOLS: N/A (locate on site plan) Number and configuration N/A Depth -top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow (cesspool must be pumped as part of inspection) N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable PRIVY: N/A (locate on site plan) Materials of construction N/A Dimensions N/A Depth of solids N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 575 Winter Street, North Andover Owner's Name: David & Donna Lind Date of Inspection: 3/29/2008 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewerage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100'. Locate where public water supply enters the building. WINTER STREET SEPTIC TANK TIES: A to Center 17.0' B to Center 12.5' D -BOX TIES: A to Box 20.2' B to Box 31.1' NOTE: The system is in the right side yard. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 575 Winter Street, North Andover Owner's Name: David & Donna Lind Date of Inspection: 3/29/2008 SITE EXAM Slope mounded in area of SAS Surface water none observed Check cellar dry Shallow wells none observed Estimated Depth to Groundwater >1" (below bottom of SAS) Please indicate (check) all methods used to determine the high ground water elevation: Y Obtained from Design Plans on record - if checked, date of design plan reviewed: 12/1981 Y Observed site (abutting property, observation hole within 150 feet of SAS) Y Check with Local Board of Health - explain: information on file Y Check local excavators, installers - (attach documentation) N Accessed USGS Database - explain: website too complicated You must describe how you established the high ground water elevation. The December 1981 design plan indicated that ground waterwas greater than four feet below the SAS. The SAS was actually elevated to avoid groundwater. The bottom of the SAS is well above the wetland area in the rear yard and the high water mark for yard flooding according to the owner. However, the precise groundwater elevation cannot be determined for certain without a soil evaluation test. *Inspector's Note: Soil Evaluation is the currently recognized method for determining or establishing the high groundwater elevation. Since I am not a licensed or certified soil evaluator, I am not qualified to determine or establish the high groundwater elevation beyond the public information available, such as recent design plans of the site or the nearby area. My estimation of the high groundwater elevation is based on a due diligence effort to obtain all available information both on and off the site and my experience as a certified subsurface disposal system inspector. (see attached Disclaimer) DISCLAIMER This passing septic inspection under Massachusetts Title V is in no way a guaranty or warranty of the inspected septic system. The inspection is a "snapshot in time" and does not constitute a complete assessment of the quality or potential longevity of the septic system. The pass/fail criteria are specific and outlined in detail in this report. Under the limited criteria of a Title V inspection, it is impossible to determine how long any septic system will last. The inspector made a diligent effort to certify the septic system based on the criteria required under Title V. Under Massachusetts Title V, soil evaluation is the accepted method of determining the high groundwater elevation. This inspector is not a certified soil evaluator and is therefore not qualified under Title V to determine or establish the high groundwater elevation. The method used to estimate the high groundwater for this inspection was based on the public records and methods of observation described on the previous page. Groundwater levels can vary greatly from season to season, year to year and soil evaluation is considered the most reliable method of groundwater determination under Title V. P r F. Reilly Inspector March 29,2008 NEW ENGLAND ENGINEERING SERVICES INC July 27, 1998 North Andover Board of Health Town Hall Annex Osgood Street North Andover, MA 01845 RE: TITLE V REPORT 575 Winter Street. Enclosed is a copy of the Title V report for the above referenced location. The system passes our inspection. If there are any questions please call me at my office, 686-1768. Yours truly, 6 C (D 2 Benja?in C. Osgood Jr., E.I.T. President 33 WALKER ROAD - SUITE 23 - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 W'ILLIA*%' F WELD Govemo: ARGEO PAUL CELLUCCI I.I. Governor CO'v MON%VEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. ?,IA 02108 617-292-5560 Property Address: w, A) 7C0� sr' Aj` {'Address of Owner: Dale of Inspection: �/ZZ198 (I( di(icrcnt) Name of Inspector: BENJAMIN C. OSGOOD JR. ` 1 Lm a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.0001 Company Name: NEW ENGLAND ENGINEERING SERVICES, INC. Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA 0 184 5 Telephone Number: 508-686-1768 CERTIFICATION STATEMENT 4 I certify that I have personally inspected the sewage disposal system at this address and that the information reposed 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: ✓ PLLasses , _ `ondtttonalk Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: 1_1L The System inspector shall submit a copy of this inspection report to the Approving Authority twithin 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 repon 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 bgyer, if applicable. and the approving authority I INSPECTION SUMMARY: Check A, B, C, or D: AI SYS M PASSES: 1 have not iound any information which indicates that the system violates any of the failure c: :te::a as d=fined in 310 CNAR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass- section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no. or not determined (Y. N. or ND). Describe basis of determination in all instances. If 'not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (201 years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. TRUDY COXE Sccrc un DAVID B. STRUHS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: w, A) 7C0� sr' Aj` {'Address of Owner: Dale of Inspection: �/ZZ198 (I( di(icrcnt) Name of Inspector: BENJAMIN C. OSGOOD JR. ` 1 Lm a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.0001 Company Name: NEW ENGLAND ENGINEERING SERVICES, INC. Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA 0 184 5 Telephone Number: 508-686-1768 CERTIFICATION STATEMENT 4 I certify that I have personally inspected the sewage disposal system at this address and that the information reposed 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: ✓ PLLasses , _ `ondtttonalk Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: 1_1L The System inspector shall submit a copy of this inspection report to the Approving Authority twithin 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 repon 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 bgyer, if applicable. and the approving authority I INSPECTION SUMMARY: Check A, B, C, or D: AI SYS M PASSES: 1 have not iound any information which indicates that the system violates any of the failure c: :te::a as d=fined in 310 CNAR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass- section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no. or not determined (Y. N. or ND). Describe basis of determination in all instances. If 'not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (201 years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: S75- t,., )'+ T - G tZ 5T.• J(J • fi A) p J J a2 - Owner: Kt.v,, CO2M)ErZ Dale of Inspection: 7/ z z% 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;. Describe observations: 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 pipets) are replaces obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which reouire iunher evaluation by the Board of Health in order to determine i(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 IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONOENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within So 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: t The system has a septic tank and soil absorption system (SCIS) and the SAS is within 100 feet to a surface water supply or tributary to a suriace water supply. I The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free irom pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) revs 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: S?S WeAjT-CrZ _Sr.' N. 440 UL 2 Owner: C✓ a—w i [ /L Date of Inspection: 7%ZZ,-9u D) SYSTEM FAILS: You must indicate either -Yes- or -No- as to each of the following: 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. Yes No 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 tirines pumped AnN: portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Anv portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Am- portion of a cesspool or privy is within a Zone I of a public well. I Am porton of a cesspool or privy is within SO feet,of a private water supply well Anv 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 Nater quality analysis. If the well has been analyzed to be acceptable, anach copy of well water analysis for coliform bactgria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either -Yes- or 'No- as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 go or greater (large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 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 11 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. (r*vipad 04/75/97) Pato 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM tNSPE&ION FORM PART B CHECKLIST Property Address: 5"7.5 i&J t -v —E- >2 57- N. Owner: )41AA COI?M I &/Z Date of Inspection: 712z Jq6 Check if the following have been done: You must indicate either "Yes- or -No" as to each -of the following: Yes No _ Pumping information was provided by the owner, occupant, or 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, A) As built plans have been obtained and examined. Note 4 they ere not available with N/A. The facility or dwelling was inspected for signs of sewage baric -up. _ The system does not receive non -sanitary or industrial waste flow. The site was inspected for signs of breakout. , _ All system components. excluding the Soil Absorption System, have been located on the site. _�•. _ The septic tank manholers were uncovered, opened. and the interior of the septic tank was in{pected (or 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: The facility owner tand occupants, if different from owners were provided with information on the proper maintenance of Sub -Surface Disposal System. Existing information. Ex.iPlan at B.O.H. i _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) I (revised 04%25/271 tege 4 or 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION -FORM PART C SYSTEM INFORMATION Property Address: S75- WI.V TEi2 c7", //. AAldd ✓E2 Owner: �� t N► c o $Z. M I C rz Date of Inspection: Z�zzlkS FLOW CONDITIONS RESIDENTIAL: Design flow:- R.p.d.bedroom (or S.A.S Number of bedrooms: 3 Number of current residents:, Garbage grinder (yes or no): 46L ` Laundry connected to system (yes or no):-�r Seasonal use (yes or no): A Water meter readings. if available (last two (2) year usage (gpd): 2 ( cc-, RS Sump Pump (yes or no): A/ Last date of occupancy: vrr�T COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: aallons/dav Grease trap present: (yes or no)_ , Industrial Waste Holding Tank present: (ves or no) hon -sanitary waste discharged to the Title 5 system (yes or no)_ Water meter readings, if available last date of o-: cupanq% OTHER: (Describe) Last date of occupancy. GENERAL INFORMATION PUMPING RECORDS a d source of information System pumped as part of mspe ,on: (yes or no)�Q If yes, volume pumped:. t allot s Reason for pumping TYPE OF SYSTEM )d_ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes. attach previous inspection records, if any) VA Technology etc. Copy of up to date contractl Other APPROXIMATE AGE of all components, date installed (if known) and source of information: dopv,r eg'ss - Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/97) Tay S of 10 ------- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: .5-7,57- wt,•., T-U✓Z < - /(J. /� NODuc 2 Owner. jai 1 ca 2 N, I c ✓L Date of Inspection: BUILDING SEWER: (Loc2te on site plan) Depth below grade:�rr Material of construction: cast iron _ 40 PVC _ other (explain) Distance from private water supply well or suction Itri it/l9 Diameter lJ�� Comments: �(condition of joints. venting. eviden a of leakage, etc.) Pi pc /c" (,(s q=- ; r %$CY/)e<. SEPTIC TANK:_ (locate on site plain Depth below grader Material of construction: _Zconcrete _metal _Fiberglas; _Polyethylene _other(explain) If tank is metal, list age _ is age confirmed by Cenuicate of Compliance _ (Yes/No) , Dimensions: /..� GU (s --//O.1 A;: Sludge depth: y0 Distance from top of sludge to bottom of outlet tee or baiflte: �� t Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bonom of scum to bonom of outlet tee or baffle: ZO How dimensions were determined. tnM,% S Tit k, Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, stru4iural integrity, evidence of leakage, etc.) _ /Ax lroo p l o .v Q., 770 Al <'D v e v e T�' Tt E's i �✓ C^Od 2 17"7 0 / gee., A46 -,,o I T7 -ftp' Cil j� V 61 774 -e - GREASE TRAP: A10 - (locate on site•plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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.) - (r-viv.d 04/2s/f7) rag. 4 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: SZS LV+,-JTE72 -s7, AJ, 14A.9QOUC 2 Owner: f/it"A GD VCAAtI.'O_ Date of Inspection: 7) a 2(ag . TIGHT OR HOLDING TANK: Nff rTank must be pumped prior to. or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capaan•: gallons Design i!ov` gallonJda% Alarm level Alarm in working order _ Yes. _ No Date of previous pumping: Comments: (condition of inlet tee. condition of alarm and float switches. etc.) DISTRIBUTION BOX:_ (locate on site plani Depth of liquid level above outlet invert: Comments: (noted level and distribution is equal, evidence of solids carryo+er• evidence of leakage into r out of box, C. �L u i • r I i PUMP CHAMBER:IL+ (locate on site plan) Pumps in working order: (Yes or Not Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) tr.vi..d 0{/25/17) ►.p. 7 of 10 0 ____..._....___._...._....... _..... ..... SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5 7S Owner. )(ItM W tN7c ►Z S_7_ l . Date of Insc0 1Z AAL I L fZ Inspection: l I22c�g 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: Type: leaching pits. number:_ leaching chambers. number:_ leaching galleries. number: _ i leaching trenches. number.length: Z ►'e„C�S ` leaching fields, number. dimensions:_ overflow cesspool. number: Alternative system: Name of Technology: Comments: (note condition of soil• signs of ydraulic failure• level of pondin condition of v etation, etc.) r4,-c.L e- s vs ,�-� IU 4'? CESSPOOLS: ,%fi- (locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Dr-pth of solids layer: i Depth of scum laver: Dimensions of cesspoo!: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure. level of ponding, condition of vegetation• etc.) PRIvY: Al (Y (locate on site plan) Materials of construction: Depth of solids: Comments: (dote condition of soil• signs of hydiaulic failure. level of ponding, condition of vegetation. etc.) (r.ri..d 04/2S/27) P.y. a of 10 Dimensions: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S%S t,�9t a T�Z S7 A/. 11N 03 (Je P Owner: 14 i G0 fZAA 1 J; yL Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) I W I&jT[t (revised 04/75/971 Pay 9 of 10 Y / SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S%S t,�9t a T�Z S7 A/. 11N 03 (Je P Owner: 14 i G0 fZAA 1 J; yL Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) I W I&jT[t (revised 04/75/971 Pay 9 of 10 / Z SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57S W t ,,j 7 -CK Owner: Date of Inspection: -'tZ Z( ZZ 1�t3 Depth to Groundwater f' Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting p(operty, obsem•atiori hole• basement sump etc.) Determine it irom local conditions Check %v!th !oca! Board of health Chea FEMA neaps Check pumping records Check local excavators, installers Use USGS Data Describe in vaur own words ho%v you established the High Groundwater Elevation.! (Must be completed) 20�- U+SS•C,S t 3 (rwis.d 04/25/17) P.q. 10 or 10 a i BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 TEL. 682-6400 Building Inspector: Plarch 3 1986 Re=575 Winter St. Lot 1A Proposed addition This office has no objection to Mr. Smiths plans to add 1 bedroom and 2 bathrooms to his existing house. This will result in a total of four bedrooms which is within the design capacity of the Septic System. Very truly yours ------ ------- - - cc=Utley Smith, 575 Winter St. N.A. mg/gc sOa. d of �-ie alth, north AncioT-erZ tea. S� 'T`IC STS' — INST!.LLATICU, CHEF LIST LOT PR rn D DATE DISAPPRUTED t.XCAVATI�1 0� ML � easDnsi E ►., TM—ti - IJ l.Cr tires T� - 4 t•v9>01 OK 1. Distance Tot a. Wetlands / b. Drains c. Well 2. Nater Line Location 3. -No PPC Pipe -- - .. h. Septic Tank a. --Tess -_Length & To Clean Out Covers b. Cement Pipe to Tank On Both Sides of Tank 4� X83 5• Diistribiition Box p� ,n. i� -►3�� a. Covers & Box - No Cracks U/ n*�� 67 b. - All Lines Flo; Amaimts -Ing Equal - c. No Back Flow b. " Leach Field or each a. D imsnsi b. Sto th c: ed Inds Clean Double Washed Stone 7. Leach Pits a* on b. th ceads iltean ipe to Pit -Both Sides c�4sT�� 'IfPF¢� f.uble Washed Stone .� -� 8. No Garbage ,Disposal 6 P�3 9. Anal Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard -to Pere Test d. Elevations If 83 e. Water Table 332Z -d Of He"14, 1 north Angoveri 'a.3B. LPP i ono U. • f x� S i C sn-MI - i — IHST ILATICti CSE LIST r� eaBnnst pec, t,i �Af­c Y 4 1. Distance Tot % a. Wetlands LOT 1� UJIPJT 1p- XCAVATICU OK 1AIL b. Drains c. Well 2. Water Line Location 1-6 3. - No PVC Pipe - i�. Septic Tank = a. .--Tess _Length & To Clean Ont Covers. b. Cement Pipe to Tank -- Oa Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. - All Lines Flooring Equal Amounts C. No Back Flox b. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped lids d. Clean Double Washed Stone 7. Leachs a. _ions bee Depth c.rash Pads d.e.nt Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage. Disposal, 9. -final Grading Inspection 10. Barricading Covered System , 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location -4th Regarcito Per c Test d. Elevations e. Water Table it%vTG .' r:� f a� N Board of YL --J th North Andcvor,!Iass APPROM DATE Provideds ,q $ `i✓ SDBSURFACE DISPUM DESIGN CH&KLISr DISAPPROVED DATE_,,,,,, Reasons: LOT Title FAIL Reg 2.5 a submitted plan must show as a minimum: the lot to be served-area,dimensions lot #,rs abutte location and log deep observation hoes -distance to ties c location and results percolation tests -distance to ties design calculations & calculations showing reTdred leaching area e location and dimensions of system -including reserve area f existing and proposed contours g) location any wet areas within, 1001 of sewage disposal system or Kh) disclaimer-check wetlands mapping surface and subsurface drains within 100' of sewage disposal %J)= stem or disclaimer ation any drainage'eassm�ents within 1001 of stege disposal tem or disclaim3r-Planning Board files sources of tater supply within 2001 of sewage disposal e system or disclaimer ( location of any proposed well to serve lot -1001 from leaching facility location of water lines on property -101 from leaching facility m) location of benchmark driveways 3 garbage disposals no PVC to be used in construction (q) profile of system -elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations maximum ground water elevation in area sewage disposal system (s) plan mast be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 S tem is Tanks (a) capacities -150% of flow, water table, teas, depth of tees, access, puffing cleanout 101 from cellar wal1 or inground swimming pool - (d) 25, from subsurface drains Reg 10.2 Distribution Boxes A) slope greater than 0.08 Reg 10.1 b) sump