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HomeMy WebLinkAboutMiscellaneous - 7 CANDLESTICK ROAD 4/30/2018 I i I. 1 I I I s i 0 0000-ti000-y-9oLlotz pi CIV06 NOUSTONVO L ,r, UOerf- ANDD 16�e Date pay 26,, 1981 Scale �O ' CYR 4ENGINEE !NG V/ S CANAL srwEr LAWRENCE; MASS Q pCM01afton Tests / 3 Date 7'op elevation 2.0 Botta w elevation D .Saturation time fr�.0 /2�- 9 faro (min) 9t 6" fir- raaJ 1 Parc. rata�rnc�len Soil Profile, Pests arm a/a +aft" D ruse s0/f .n.M.rMe�q. SoAsoaf �. Parefif soft h: FILE# 11009 X 107 Forest St. Middleton,MA 01949 (508)77 -27724 s e 1141 ', SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 Ir» 1 { PROPERTY OWNER'S NAME: PROPERTY ADDRESS: '7 ca',AP 4ik Rol All.. And wer �. l ADDRESS OF OWNER: . (if different) +" DATE OF INSPECTION: J - ll a " 4k NAME OF INSPECTOR: -DPaH G. 1--oSGOm d "F t. j i 'THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY• ` I FILE# -� e fi i - At SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM z' PART A ,5 'i4W ! > t<4i ;t i t.f+.•t ,, : c F CERTIFICATION roperty Address: moire//. Address of Owner: c '``Q �n a t Date of Inspection: / � �Q�� I ; p IC�ovem Jai' �. (If different) . . �• r�� Name of Inspector: --qq��rr�n G. �� ✓!- as 4 4 " Company Name,Adi r and Telephone Number: Currier Septic&Drain Service,Inc. ; I 107 Forest Street, Middleton, MA01949_.--_ - -- ' (508) 774-2772 _ ; t CERTIFICATION STATEMENT „:" ,{ certify that I have personally inspected the sewage disposal system at this address and that the information reported 3 fi F eiow is true,accurate and complete as of the time of inspection. The inspection was performed based on my training an� { #, experience in the proper function and maintenance of on-site sewage disposal systems. The system: I' _t/Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority f; Fails t Inspector's Signature: C9. 5 Date: a b¢/ 9i b i - v6 .j 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 authorityI, INSPECTION SUMMARY: Che c A B, C, or D: a , k 1` A) SYSTEM PASSES: LL6 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 dtermination in all instances. If"not,determmed explain whx not t N The septic tank is metal, cracked structurally unsound, shows substantial infiltration or exfiltration,or;tank" , f ( 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. t� ; (revised 8/15/95) 1. i FILE# SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 6 4_ PART Ats CERTIFICATION (coNANuEd) B) SYSTEM CONDITIONALLY PASSES(continued) a- Sewage backup or breakout or high static water level observed in the distribution box is due to broken ori 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): 1 broken pipe(s)are replaced obstruction is removed ? ' a f distribution box is levelled or replaced r ) x` The system required pumping more than four times a year due to broken or obstructed pipe(s). The j system will pass inspection if(with approval of the Board of Health): # r broken pipe(s)are replaced rF ' obstruction is removed t ` IC) FURTHER EVALUATION IS REOUIRED BY THE BOARD OF HEALTH: Ig 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) it 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. s, The system has a septic tank and soil absorption system and is within a Zone I of a public water supply; f j well. ; i The system has a septic tank and soil absorption system and is within 50 feet of a private water supply g f 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 F' 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. D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 C.MR , .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. i Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool N Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or t 1 l clogged SAS or cesspool. (revised 8/15/95) 2 i ��. FILE# �r�/�J ,,• I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A, ! . CERTIFICATION(continued) Y x D) SYSTEM FAILS(continued) a f Static liquid level in the distribution box above oulet invert due to an overloaded or clogged SAS or lcesspool. } , `' IJ Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. JJ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. , Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy.is within a Zone 1 of a public well. I N 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 r 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 ing criteria apply to large systems in addition to the criteria above: The design flow of sys 000 gpd or greater(Large System)and the system is a si nt threat t public' I . health and safety and the environm ause one or more of the following condi' exist: the system is within 400 feet of a surface drinkin r y the system is within 200 feet of a tribut a surface drinking wa ply ; t" _ the system is located in a en sensitive area(Interim Wellhead Protection A IWPA)or a mapped ' Zone.11 of a public supply well) The owner or oper any such system shall bring the system and facility into full compliance with the groundwa � s f treatment pro requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for r further i mation. ; ((revised 8/15/95) } G t•.. s[t w ro-, FILE# i �. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 4 r i PART B i CHECKLIST .:;: Check if the following have been done: 4 pumping information was requested of the owner, occupant, and Board of Health VZNone of the system components have been pumped for at least two weeks and the system has been receiv1ng r, normal flow rates during that period. Large volumes of water have not been introduced into the system 7 i recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. f I V-The facility or dwelling was inspected for signs of sewage back-up. The i system does not receive non-sanitary or industrial waste flow. 1.— , V The site was inspected for signs of breakout. , &/AIl system components, excluding the Soil Absorption System, have been located on the site: 1 The septic tank manholes were uncovered, opened, and the interior of the septic tank was in for 1: 1. condition of baffles or tees material of construction, dimensions,depth of liquid,depth of sludge,depth of- .. .41 SCUM. - .t, !ZThe size and location of the Soil Absorption System on the site has been determined based on existing ! j formation or approximated by non-intrusive methods. 1 ' _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal System. r r i (revised 8/15/95) 'P 4 i � i ! FILE# T SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a PART C SYSTEM INFORMATION FLOW CONDITIONSESIDENTIAL- >, Design flow: fffDall ns �tumber of bedrooms: umber of current residents: 3 arbage grinder(yes OED JU-0 t_aundry connected to 1ste r no)j�5 easonal use(yes oi :S w� Water meter,`readings, if available: .= 7a�.i+. c.J fie/ 3 c. C 5(7�{ ' Last date of occupancy: r 'Ell Typ stablishment Design flow: allons/day Grease trap present: (yes ,Industrial Waste Holding Tank present: ,Non-sanitary waste discharged to the Title 5 syste t ;Water meter readings, if avialble: {Last date of occupanc .' . . OTHER: ribe) ILas a of occupancy: I GENERAL INFORMATION PUMPING RECORD and source of information: ih _'Q �S � p t . Syste pumped part of inspection: (yes or `'`` ! If yes,volume pumped- 'R ' Reason for pumping: U �TYP F SYSTEM :. • 7 �a Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy: a Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) 1 APP OXIMATE AGE of all components, date instal d if known and source of information: Sewage odors detected when arriving at the site: (yes no }}. 3t it (revised 8/15/95) 5 �' { f �FILE# '�s. . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' ? I;. PART C a i SYSTEM INFORMATION(continued) � EPTIC TANK: �2, ` ��•_�� �- (locate on site p anI t Depth below grade: w. yy 'q�r'A1a_tenal of construction:'�oncrete °MetaiFRP -=other(explain), F {if. Freed C* rye { 2 #y. ;Dimensions: X 5r-'w 1016 15106 I Baffle Depth Below.Outlet Invert: 3f # Te Sludge depth:' iDistance from top of sludge to bottom of outlet tee or baffle: 0 1 Scum thickness: bistance from top of scum to top of outlet tee or baffle: i Distance from bottom of scum to bottom of outlet tee or baffler~ ` Comments: , trecommendation for pumping;condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structufral integrity, evidence of lea1ka/ge,etc..)_/ 7� Ger ;g 7a�k i� ilv� �tc)A _ %r,lrtf Gl.4o� G?4f�ivRYt" �)egwl c in rXliiG T„/(C i 1tct� .�. ,., c &v E. f �i;� 'ce.rser �S G ns. .,_� l7tV w/ A)cti S(—ray, OFGi-1rr�r� A►� r� Yy, ' '�' }}�� i 1Sf l` GREASE TRAP: D i (locate on site an J a 1 . Depth grader s s { f Material of con ion:_concrete metal FRP_other(explain) $ 4 �Lensions: Baffle Depth Below nvert: �l` Scum thickness: ; t: Distance from top of scum to top of outlet tee or Distance from bottom of scum to bottom of outlet tee or Comments: `t (recommendation for pumping, cond' ` inlet and outlet tees or baffles, dep liquid level in relation to outlet invert, 'structural integrity, evidence age, etc.) I t- i r j F E � Tf (revised 8/15/95) 6 s:. i - t a �` IFILE# SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t6,n i PART C € SYSTEM INFORMATION(continued) *' R` r F $ TIGHT OR HOLDING TANK:PD (loc to on site plan) — Ma Depth below g (h Material of construe concrete_metal_FRP_other(explain) I r` Dimensions: # .e Capacity: gallons Design flow: gallons/day x' Alarm level: Comments " `3 (condition of inlet tee, conditio alarm and float'switches, etc) ji DISTRIBUTION BOX:�S (locate on site plan) s 9" l Depth below grader Depth of liquid level above outlet invert: ZierO Dimensions of D-Box'20, bepth of Sump: `t Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box,etc.) i' I i� te- do -5 Gtn a ' 1 Ca C r' Q a i rib' n 4 ' e- �. 1� k +� .S�rg �JCc;4t1Ae0l rlOw t;4_, 1 !J ! W A.kJ r PUMP CHAMBER: Uj 14 (lo n site plan Depth below grade: Pumps in working order:(yes o F i'4 j Comments: (note conditions of pump chamber, condition of app noes, etc.) EEE (revised 8/15/95) 7 s 1 e • 4 ' FILE# SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 8 r- PART C i t . SYSTEM INFORMATION(continued) t : OIL ABSORPTION SYSTEM (SAS): v°5 ' Klocate on site plan, if possible excava on not required, but may be approximately by non-intrusive methods) l . ; epth to bottom of SAS; ton or Pit) i9p<qe ; ' f not determined to be present, explain: 1 I Ype �'` Lea G�a K �i n�Gs Set S'FA,�& g pits, number: 5 f j 10 f leaching chambers, number: 32' L.on Flh Owl i leaching galleries, number: ; k< �li: ' '� { leaching trenches number, length �,. t' i > i , leaching fields, number, dimensions j Feld � i. - ':•.e '. '� d. �k. fi:.�. t ,v;• '� ...:,:d" .�.- ._;y„re°,. ..'-. '� t 'FrY".' P, _71 Comments (note condition of soil,signs of hydraulic failure,// level of ponding, condition,of vegetation, etc.) ' no i �l 1 r "IFT �i SSPOOLS U:' i Fy r:i r� #gyp r 4�nf (lo a on sit an y Depth grader. : . Number and uration: Depth-top of liquid to invert: T Depth of solids layer v Depth of scum layer: Dimensions of cesspool: Materials of construction: u lindication of groundw inflow(c pool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition ofvegetatio , c) �: + 1 „ r � •'fir'.. PRIVY: (lo on site plan) Materials of construction: ;. Dimensions: °. Depth of solids: E r ;Comments: (note condition of soil, signs of hydraulic failu of pon on of vegetation, etc) ' ' t ; (revised'8 15/95) $ FILE# SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: : „ i, include ties to'at least two permanent references landmarks or benchmarks tl locate all wells within 100' ' I A to.T �',f � . - prep _' + ., . 0 Sew C, �. e• DEPTH OF GROUNDWATER Depth to groundwater: 7' f feet i} method of determination or approximation: 4u 5 � :S ?' low -f-�o c � . cr 1 a -�/ fs h d/ e�<G,-r- 7.e r�� 1�a- qtr~ �a r u a u►w dJ i I� i �'K 'Ca1�leSA C k � awl (revised 8/15/95) 9 „x CYR � ft. ArT o AlJG�FP yeti `✓ Y A �uAr: 1;"74 I ��Fo 4 (✓f+v/7 / Afe/sl°” f' 4.+ - J� . .yw •fir � - � /�:.., '•:S �©3"�{��°mss �� icy` -� r 1 .�:4°,'' �1{61t �r•• t{i.'�,'.��, ���d*t/R,�° �rr���' ,. t� , . F I jl�}y `r•y •X +A d j trR �iR.l� •r'r• '�•'F•�ty r�.,aw,, '+1Jr .f}7i�+��s�+l y v1,r;/ �. 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'•iL'._;.>/+ `i 1'•f" a.`�< '�i." , :f ,ty. t•'.'.�` �'YP P.� ��lditl:. ,. {, 1 ,1•' 4 t„1.+:'�.�. •iRjr h' ;i "il Y, " "�r ' w v ,1+' �P ''!�t u+ >1. ! ,'(t `o.�• ' t,`• ' , ,�•." �t'' 'T fir; •' K. "° � '� ' cj cn do w . n ' co i E 0 0 t/:,r ? 1 ) t''d, t 1 t 7♦ I';, ,Ikr r� t j�{J 1' '[�{ -ri -1`1 /�''4 /14 p 1 ,''•.�•, r. t ,i T •'v 1} t A¢ i•l. t t , ,, . • , r V 1 C� &1 E-i Q d•.'( d • cY. «, '" S , 4 i t, ° f '� J rod f ' M fn t11'T i t Q) -W Vi V9 (n 0 or-iN CTI ri ,j IV Nfto 4� 0 ��• • ! i • �� �� �.._ i I HT I - i l a � I I ` 1 i `�5 1 n AP 11 , BOARD OF HEALTH No.Andover, Mass . SUBSURFACE DISPOSAL DESIGN CHECK ',IST LOT # z S CQtiDLG_STIL'T_ APPROPED - DATE— DISAPPROVED DATE, -?S Provid6ds Reasons: / (,- A11s,1 NSC SfEa��j7 Z EX tSTI�G C C,0�l°1�'`'-L-AS rads i4 SCJ" Ti-W1 Title V FAIL CK Reg 2.5 The submitted plan must show as a minimum: a) the lot to be served-area dimensions lot #,abutters b location and log deep observation hoes-distance to ties c location and results percolation tests-distance to ties d design calculations & calculations showing required 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 disclaimer-check wetlands mapping (h) surface and subsurface drains within 1001 of sewage disposal system or disclaimer (i) location any drainage easements wi.thiL 1001 of sage disposal system or disclaimer-Planning Hoard files 0) known sources of water supply within 2)0l of sewage disposal d system or disclaimer (k) location of any proposed well to serve lot-1001 from leaching facility (1) location of water lines on property-10 � from leaching facility (m) location of benchmark (n) driveways (o) garbage disposals (p) 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 ether elevations (r) maximum ground water elevation in area sewage disposal system plan mast be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (a) capacities-150,% of flow, water table, tees, depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground s-Am rdng pool (d) 251 from subsurface drains Reg 10.2 7 Distribution Boxes (a) slope greater than 0.08 Reg 10.4 b) sump I I 1 i / I j � I I I t i i i I t , I I I I i r" -' 1 Board of Health North An¢over,x se. SEPTIC* SISTER INSTALLATICK CHECK LIST LOT"-0 -aWD1,9F-51 OVED DATE DISAPPROVED AVATIC81 Ob FY�IL • � - 4 _ I D�ID �S i 0K i 1. Distance To: a. Wetlands b. Drains c.. Well 2. Wat ar Line Location 3. No .'VC Pipe Sep Ac Tank a. .. "ees -_Length & To Clean Out Covers b. "ement Pipe .to Tank - On Both Sides of Tank 5. Distribution Box a. Covers & Boic - No Cracks b. All Lines 'Floging Equal Amounts C. No Back Flow Leach Meld or Trench a. Dimensions b. Stone Depth c. Capped Bads d. Clean Double'Washed Stone 7. LF zch Pits a. Dimensions • b. Stone Depth c. . Sp' .sh Pads d. fees d e. Cement Pipe to Pit - Both Sides f. Olean Double Washed Stone 8. No Garbage Disposal 9. "Fir al Grading Inspection 10. Barricading Covered System ",• 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location -4th Regard-to.Perc Test d. Elevations e: Water Table ORDER OF CONDITIONS: Lot 10 SALDI STREET 19. Issuance of these conditions does notvin any way imply or certify that the site or down stream areas will not be subject to flooding, storm damage. or any other form of damage due to wetness. 20. Upon completion of construction and grading, all areas shall be stabilized permanently against erosion. This shall be done either by sodding, mulching according to Soil Conservation Service standards, or by loaming and seeding. If the latter course is chosen, stabilization will be considered once the surface shows complete 'vegetative cover has been achieved. 21. All erosion prevention and sedimentation protection measures found necessary during construction by the North Andover Conservation Commission will be implemented at the direction of the NACC or Highway Surveyor. 22. Any changes in the submitted plans, Notice of, Intent or resulting from the aforementioned conditions, must be submitted to the NACC for approval prior to implementation. If the NACC finds, by majority vote, said changes to be significant and/or deviate from the original plans, Notice of Intent or this Order of Conditions to such an extent that the interests of the Wetlands Protection Act cannot be protected by this Order of Conditions and would best be served by the issuance of additional conditions, then the NACC will call for another public hearing within` 21 days, at the expense of the applicant, in order to take testimony from all interested parties. Within 21 days of the close of said public hearing, the NACC will issue an amended or new Order of Conditions. 23. Any errors found in the plans or information submitted by the applicant shall be considered as changes and procedures outlined for changes shall be followed. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 01�T LE° ib�tiQ OL 19 O 4{ q{ A APP CATION FOR SITE TESTING/INSPECTION �9SSACHUS���y Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. ��0 8• S.S. Permit No. y D.W.C. NoDate Plbg. Permit No. 1 Town of North Andover, Massachusetts Form No. 1 J NORTH • BOARD OF HEALTH 3�0��5`ED ,6�•YOL ' 19 <o< E x APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUS���� _r Applicant NAME , ADDRESS TELEPHONE Site Location ' Engineer NAME /j ADDRESS TELEPHONE Test/Inspection Date and Time C/ J CHAIRMAN,BOARD OF HEALTH Fee U ' Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. C�D /addressC of 0�� Sit c.(;�Ti°tle of File Page of Date f=ile Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action _ Document/ document/ Num. Action -Department -------_------------ Board Board of Appeals – Board of Healt�nniing Board - Conservafl—on Commission – B uildin� aepartm, ent �— ,� G