HomeMy WebLinkAboutMiscellaneous - 740 SHARPNERS POND ROAD 4/30/2018�_
G
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Commonwealth of Massachusetts
City/Town of NORTH ANDOVER,
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of
be submitted to the local Board of Health or other apa
A. Facility Information
Ith. The System' Pu
Ig authority.
APR � 4 ' 090
1. System Location: fi(Wiv �, �E�THEALfiHdiE Aw R.
740 SHARPNERS POND ROAD
Address
City/Town
2. System Owner:
Address (if different from location)
City/Town
State
State
Telephone Number
Zip Code
Zip Code
B. Pumping Record
1. Date of Pumping 3 191.106 2. Quantity Pumped: 2000
Date Gallons
3. Type of system: ❑ Cesspool(s) FL] Septic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? 0 Yes ❑ No
5. Condition of System:
6. System Pumped By:
RAGGS INC.
Name
Company
7. Location where contents were disposed:
Signature of Hauler
http://www. mass.gov/dep/water/approvals/t5forms. htm#inspect
t5form4.doc• 06/03
Record must
If yes, was it cleaned? R1 Yes ❑ No
Vehicle License Number
4/15/06
Date
System Pumping Record • Page 1 of 1
r. r.
�rn
N N
m O
O0x U) O
N U) J
m a) N m
fa 6 '0 QC
a
U C LJ U
CL m a CD
�nmcpw a
52WU5 O
D
Z
0
Hai
O
G
C
6.2
Z
T-
d~
-
O U
m0i:? 3
OZ_
of
CC
W
(6
(DLO
z
a
G Q W
N
Q
GQ UJ aZ
O
=
U)
Oo
N M
J�
O O Z
O
Qr =x
Udo
O
OW
O (Ma N J
maU
�U
Q3M0r-Z
a
Q
U Q
J
c }
O
cC O
N 0
C
��
Q
CL
C a-
vod}C7
a.
f0
c c
CU
a0�> p
N
�-
Ncncncn0
� O
J
O O
OCD
F- N CR
C
O
Y ca
O ai��Q
m 0 m ¢ C
V L) fu
O y o 0
Ui HTu
O
d
Q
of
0
0
J_
CO
E
E
O
U
—1
.I 0
O
Z
O
O
O
O
Q
O
cn
O
Ln
w CO
CA Cl)
OZ_
O i
CD
(6
(DLO
J
G Q W
N
Q
GQ UJ aZ
O
a
Om
J�
Qr =x
Udo
L: W w (A Ix
wCH
-4O
Q3M0r-Z
a
Q
00
CA Cl)
Ncli
N
(6
(DLO
cc
r r
U
LO
C C
J J
, '•
N
�
O ♦I•
z
M (O
(p LO
Z
t
Q Z
J J
N
O` 00
�-
.•.
0
ONQo
z00
_
Q
LL
Z
Z C (6
u% w('M
LL
O M M
ZCl)fl
cn M
N
�
a
dW
i
N
mm
o
m �U)
1�
W
00
a
Z
N N
t
d
M
It
j
Q
Op
L)
Nr
N
w
O
0 C
U HCL.
H fp-
O
In
�a
O
=
Z CO
CO) —
U
a
w o
M O
N
co cz CDM
r
z ~ M M
r
m
Qa a-N�
y m m 01 (a fa
w
� (] .. >:2 > >
Om C
N
N
.
E , E ZQ O (n��o
LL
m c w Use p O: wo
m
cc MA
Z
aoo 0 00o a~o aoo
(LjN
6w
mLA
m
e~-eN- N ��C9Q
p
�
Q
�
a
Cu w w
LL CO m
O 0
Z
z
C LLQ L
a) •O
C LL }
C U 0
a .. m@
ffi20 r -f-
V
w}U' Udo
Z
W
r-leNv- HH N
rr
N m�
(/�
X m LLt
m
E 7 N (OLL
O(D�
p .'C. 7 w
E
o O m mC7d._ C�C� ia
a c) c)
`omm°ow �Y E EO
!-p COLi2wm w mmQ
0 0
+
m
UNC9m U S0c4Z
_rn Ho aiy U
CL
m
>
=
�
2 m c 0 f- co m
ai00
t
U
E=
cn:3 ioummc
L
W
Y
cn(nIxw2U. MLLLLU
aa->
North Andover Board of Assessors Public Access
Parcel ID: 210/105.D-0003-0000.0 Community: North Andover
SKETCH PHOTO
Click on Sketch to Enlarge Click on Photo to Enlarge
740 SHARPNERS POND ROAD
Location: 740 SHARPNERS POND ROAD
Owner Name: BARBATO, DAVID
CHERYL BARBATO
Owner Address: 740 SHARPNERS POND ROAD
City: NORTH ANDOVER State: MA ZIP: 01845
Neighborhood: 5 - 5 Land Area: 0.88 acres
Use Code: 101- SNCL -FAM -RES Total Finished Area: 2980 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 494,200 473,200
Building Value: 330,300 316,900
Land Value: 163,900 156,300
Market Land Value: 163,900
Chapter Land Value:
LATEST SALE
Sale Price: 479,900 Sale Date: 07/31/2001
Arms Length Sale Code: Y -YES -VALID Grantor: GREGORY WILLIAMSON
Cert Doc: Book: 06288 Page: 0039
Page 1 of 1
http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=467215 5/13/2005
COMMONWEALTH OF MASSACHUSETTS P'n
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Ob
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: _740 Sharpners Pond Road_
_North Andover_
Owner's Name: _Greg Williamson_
i
Owner's Address: _740 Sharpners Pond Road_
A,.Date
North Andover, Ma. 01845_
of Inspection: 6/1/2001
a
Name of Inspector: Neil J. Bateson_
Company Name: Bateson Enterprises Inc._
Mailing Address: _111 Argilla Road_
Andover, Ma. 01810_
Telephone Number: _( 978 ) 475-4786_
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 the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
�X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
F,/[_ ail
Inspector's Signature: Date: _6/1/2001_
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Page 2 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _740 Sharpners Pond Road_
_North Andover
Owner: Williamson
Date of Inspection: _6/1/2001
Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D
A. System Passes:
�X I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the "Conditional Pass" section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please
explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is 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:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _740 Sharpners Pond Road—
North Andover
—
Owner: Williamson
Date of Inspection: 6/1/2001
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health, safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
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:
_ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Page 4 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _740 Sharpners Pond Road_
_North Andover—
Owner: Williamson
Date of inspection: 6/1/2001_
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 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
_No Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h 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
_No_ Any portion of the SAS, cesspool or privy is below high ground water elevation.
_No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_No_ Any portion of a cesspool or privy is within a Zone 1 of a public well.
—No Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system 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 large systems in addition to the criteria above)
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 lI 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 large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: _740 Sharpners Pond Road-
- North
oad__North Andover—
Owner: Williamson
Date of Inspection: 6/1/2001
Check if the following have been done. You must indicate "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 flows in the previous two week period ?
No Have large volumes of water been introduced to the system recently or as part of this inspection ?
_N/A _ Were as built plans of the system obtained and examined? (if they were not available note as N/A)
Yes_ _ Was the facility or dwelling inspected for signs of sewage back up ?
Yes_ _ Was the site inspected for signs of break out ?
Yes Were all system components, excluding the SAS, located on site ?
_Yes_ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the
condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of
scum ?
_Yes_ _ Was the facility owner (and occupants if different from owner) provided with information on the
proper maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes no
N/A_ _ Existing information. For example, a plan at the Board of Health.
No Determined in the field (if any of the failure criteria related to Part C is at issue approximation of
anc
diste is unacceptable) [3 10 CMR 15.302(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 740 Sharpners Pond Road_
^_North Andover_
Owner: Williamson
Date of Inspection: 6/1/2001_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): N/A_ Number of bedrooms (actual): _4—
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): N/A
Number of current residents: _5
Does residence have a garbage grinder (yes or no): Yes_
Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required]
Laundry system inspected (yes or no): —
Seasonal use: (yes or no): No_
Water meter readings: _On well water
Sump pump (yes or no): No
Last date of occupancy: _Current_
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow (based on 310 CMR 15.203): gpd
Basis of design flow (seats/persons/sgft,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):
GENERAL INFORMATION
Pumping Records
Source of information: Pumped in 1998, owner
Was system pumped as part of the inspection (yes or no): Yes _
If yes, volume pumped: _1500_gallons -- How was quantity pumped determined? _Measured tank _
Reason for pumping: _Inspect tank & tees
TYPE OF SYSTEM
X Septic tank, distribution box, soil absorption system
_ Single cesspool
_ Overflow cesspool
_ Privy
_ Shared system (yes or no) (if yes, attach previous inspection records, if any)
_ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
— Tight tank ` Attach a copy of the DEP approval
— Other (describe):
Approximate age of all components, date installed (if known) and source of information: _18 years old, owner _
Were sewage odors detected when arriving at the site (yes or no): –No
Page 7 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _740 Sharpners Pond Road _
_North Andover—
Owner: Williamson
Date of Inspection: 6/1/2001
BUILDING SEWER (locate on site plan) X
Depth below grade: 3'
Materials of construction: —X—cast iron _X_40 PVC other (explain):
Distance from private water supply well or suction line: > 100'_
Comments (on condition of joints, venting, evidence of leakage, etc.): _4" Cast iron thru wall. 3" PVC in house.
No leaks._
SEPTIC TANK: X locate on site plan)
Depth below grade: _2'_
Material of construction: —X—concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: ____ Is age confirmed by a Certificate of Compliance (yes or no): (attach a copy of
certificate)
Dimensions: 10' x 5' x 4'
Sludge depth: 6"
Distance from top of sludge to bottom of outlet tee or baffle: 21",
Scum thickness: 6"_
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: _15"_
How were dimensions determined: _Subtract scum & sludge depth to tee length. _
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.): _Pumped septic tank inlet & outlet tees ok. Depth of liquid
at outlet invert. No evidence of leakage. _
GREASE TRAP: _(locate on site plan)
Depth below grade: _
Material of construction: concrete metal fiberglass_
polyethylene ,other
(explain): T
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 (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _740 Sharpners Pond Road
North Andover
Owner: Williamson
Date of Inspection: 6/1/2001
TIGHT or HOLDING TANK: (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: gallons
Design Flow: gallons/day
Alarm present (yes or no):
Alarm level: Alarm in working order (yes or no):
Date of last pumping:
Comments (condition of alarm and float switches, etc.):
DISTRIBUTION BOX: X (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: `0—
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.): _D -box level & distribution equal. No evidence of leakage. Evidence of
carryover, pumped d -box to clean. _
PUMP CHAMBER: (locate on site plan)
Pumps in working order (yes or no):
Alarms in working order (yes or no):
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 740 Sharpners Pond Road
—North Andover—
Owner: Williamson
Date of Inspection: 6/1/2001
SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required)
If SAS not located explain why:
Tyle
leaching pits, number: _
leaching chambers, number:
leaching galleries, number:
leaching trenches, number, length:
_X_ leaching fields, number, dimensions: —15' x 45' Leach Field _
overflow cesspool, number:
innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.): —Soil oL Vegetation oL No sign of ponding to surface. _
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth — top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow (yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Page 10 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _740 Sharpner Pond Road _
North Andover -
Owner: _Williamson
Date of Inspection: 6/1/2001
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
2'5"
4'5"
30'
42'2"
15'
Y
Page 11 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
. PART C
SYSTEM INFORMATION (continued)
Property Address: 740 Sharpners Pond Road _
North Andover
—
Owner: Williamson
Date of Inspection: 6/1/200
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water > 6_ feet
Please indicate (check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record - If checked, date of design plan reviewed:
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health -explain:
Checked with local excavators, installers- (attach documentation)
X Accessed USGS database -explain: Essex County Soil Map
You must describe how you established the high ground water elevation: _Essex County Soil Map, Sheet # 37,
_Canton Soil , Water > 6' Deep.
Tel: (978) 475-4786
Fax: (978) 475-5451
BATESON ENTERPRISES, INC.
Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service
111 Argilla Road Andover, Mass. 01810
Title 5 Inspection Report
Property Address: 740 Sharpners Pond Road, North Andover
Owner: Williamson
Date of Inspection: 6/1/2001
My report contained herein does not constitute a guarantee of future usage and the functionality of the existing
septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further
operation of your current septic system.
4�1-
Neil
J. Bateson
Bateson Enterprises, Inc.
ACTION-KING ENTERPRISES, INC.
26 LIVINGSTON STREET RYN A�pOV
LOWELL,MA 01852 TOS of Of,�EALTH
TEL: (508) 452-7750
FAX: (508) 459-0770
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
PROPERTY ADDRESS: 740 SHARPNER'S POND ROAD N ANDOVER, MA 01845
DATE OF INSPECTION: 6-3-96 ADDRESS OF OWNED:
NAME OF INSPECTOR: FRANCIS KING III (IF DIFFERENT)
CERTIFICATION STATEMENT
I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS
ADDRESS AND THA T 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.
X PASSES
CONDITIONALLY PASSES
NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY
FAILS
INSPECTOR'S SIGNATURE-. DATE: 6-3-96
THE SYSTEM INSPECTOR SHALL SUBMIT A COPY OF THIS INSPECTION REPORT TO THE APPROVIN G
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:
X I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM VIOLATFS
ANY OF THE FAILURE CRITERIA AS DEFINED IN 310 CMR 15303.
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, OR 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 SYSTE t
WILL PASS INSPECTION IF THE EXISTING SEPTIC TANK IS REPLACED WITH A CONFORMING
SEPTIC TANK AS APPROVED BY THE BOARD OF HEALTH.
PAGE 1
ACTION -KING ENTERPRISES, INC.
26 LIVINGSTON STREET
LOWELL, MA 01552
TEL: (505) 452-7750
FAX: (505) 459-0770
PROPERTY ADDRESS: 740 SHARPNER'S POND ROAD N ANDOVER, MA 01545
OWNER: VICTOR SIMON
DATE OF INSPECTION: 6-3-96
ACTION KING ENTERPRISES, INC. HAS BEEN RETAINED BY THE OWNER TO PROVIDE AN INSPECTION
OF THE ON-SITE SEWERAGE DISPOSAL SYSTEM AS DEFINED BY 310 CMR 15.303.D.E.P. GUIDANCE
INSTRUCTS THE INSPECTOR TO MAKE AN EVALUATION OF THE SYSTEMS PERFORMANCE ON THE
DAY OF THE INSPECTION. THE TITLE 5 INSPECTION IS NOT DESIGNED TO PROVIDE INFORMATION
TO DEMONSTRATE THAT THE SYSTEM WILL ADEQUATELY SERVE THE USE TO BE PLACED UPON IT
BY THE NEW OWNER AS STATED IN 15.302. THIS ISPECTION IS NOT A WARRANTEE OR GUARANTEE
OF THE SYSTEM FUTURE PERFORMANCE, AND DOES NOT EITHER EXPRESS OR IMPLY IT.
PAGE 1-A
ACTION -KING ENTERPRISES, INC.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (CONTINUED)
PROPERTY ADDRESS: 740 SHARPNER'S POND ROAD N ANDOVER, MA 01845
OWNER: VICTOR SIMON
DATE OF INSPECTION: 6-3-96
B) SYSTEM CONDITIONALLY PASSES (CONTINUED)
N/A 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 PIPES) ARE REPLACED
OBSTRUCTION IS REMOVED
DISTRIBUTION BOX IS LEVELED OR REPLACED
THE SYSTEM REQUIRED PUMPING MORE THAN FOUR TIMES A YEAR DUE TO BROKEN OR
OBSTRUCTED PIPE(S). THE SYSTEM WILL PASS INSPECTION IF (WITH APPROVAL OF THE
BOARD OF HEALTH).
BROKEN PIPE(S) ARE REPLACED
OBSTRUCTION IS REMOVED
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
N/A _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 IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY
AND THE ENVIRONMENT:
CESSPOOL OR PRIVY IS WITHIN 50 FEET OF A SURFACE WATER
CESSPOOL OR PRIVY IS WITHIN 50 FEET OF A BORDERING VEGETATED WETLAND
OR A SALT MARSH.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF
APPROPRIATE) DETERMINES THAT THE SYSTEM IF 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 THE 5PPM.
PAGE 2
ACTION -ICING ENTERPRISES, INC.
D) SYSTEM FAILS:
NIA 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 FAILUR.
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 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 U2 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.
NIA THE DESIGN FLOW OF SYSTEM IS 10,000 GPD OR GREATER (LARGE SYSTEM) AND THE
SYSTEM IS A SIGNIFICANT THREAT TO PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT BECAUSE ONE OR MORE OF THE FOLLOWING CONDITIONS EXIST:
THE SYSTEM IS WITHIN 400 FEET OF A SURFACE DRINKING WATER SUPPLY
THE SYSTEM IS WITHIN 200 FEET OF A TRIBUTARY TO A SURFACE DRINKING
WATER SUPPLY.
THE SYSTEM IS LOCATED IN A NITROGEN SENSITIVE AREA (INTERIM WELLHEAD
PROTECTION AREA (WPA) OR A MAPPED ZONE H OF A PUBLIC WATER SUPPLY
WELL.
THE OWNER OR OPERATOR OF ANY SUCHSYSTEM 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.
PAGE 3
' • 1
ACTION -KING ENTERPRISES, INC.
PART B
CHECKLIST
PROPERTY ADDRESS: _740 SHARPNER'S POND ROAD N ANDOVER, MA 01845
OWNER: VICTOR SIMON
DATE OF INSPECTION: 6-3-96
CHECK IF THE FOLLOWING HAVE BEEN DONE.
X PUMPING INFORMATION WAS REQUESTED OF THE OWNER, OCCUPANT, AND BOARD OF
HEALTH.
X NONE OF THE SYSTEM COMPONENTS HHAVE 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.
NIA AS BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT
AVAILABLE WITH NIA.
_X THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP.
X THE SYSTEM DOES NOT RECEIVE NON -SANITARY OR INDUSTRIAL WASTE FLOW.
_ X THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT.
X ALL SYSTEM COMPONENTS, EXCLUDING THE SOIL ABSORPTION SYSTEM, HAVE BEEN
LOCATED ON THE SITE.
X THE SEPTIC TANK MANHOLES WERE UNCOVERED, OPENED, AND THE INTERIOR OF THE
SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEE, MATERIAL OF
CONSTRUCTION, DIMENSIONS, DEPTH OF LIQUID, DEPTH OF SLUDGE, DEPRTH OF SCUM.
X THE SIZE AND LOCATION OF THE SOIL ABSORPTION SYSTEM ON THE SITE HAS BEEN
DETERMINED BASED ON EXISTING INFORMATION OR APPROZIMATED BY NON -INTRUSIVE
METHODS.
X THE FACILITY OWNER AND OCCUPANTS, IF DIFFERENT FROM OWNERS WERE PROVIDED
WITH INFORMATION ON THE PROPER MAINTENANCE OF SUB -SURFACE DISPOSAL SYSTEM.
PAGE 4
ACTION -KING ENTERPRISES, INC.
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C
SYSTEM INFORMATION
PROPERTY ADDRESS: 740 SHARPNER'S POND ROAD N ANDOVER, MA 01845
OWNER: VICTOR SIMON
DATE OF INSPECTION: 6-3-96
RESIDENTIAL:
DESIGN FLOW:— 440 GALLONS.
NUMBER OF BEDROOMS:_4
NUMBER OF CURRENT RESIDENTS: 3
GARBAGE GRINDER (YES OR NO) YES
SEASONAL USE (YES OR NO) NO
WATER METER READINGS, IF AVAILABLE:_ WELL WATER
LAST DATE OF OCCUPANCY: OCCUPIED
COMMERCIAL/INDUSTRIAL:
TYPE OF ESTABLISHMENT: NIA
DESIGN FLOW: GALLONSIDAY
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 DAY OF OCCUPANCY:
OTHER: (DESCRIBE)
LAST DAY OF OCCUPANCY:
GENERAL INFORMATION
PUMPING RECORDS AND SOURCE OF INFORMATION.
JUNE 1993 HOMEOWNER
SYSTEM PUMPED AS PART OF INSPECTION (YES OR NO) YES
IF YES, VOLUME PUMPED 2000 GALLONS.
REASON FOR PUMPING INSPECTION OF TANK
TYPE OF SYSTEM
X SEPTIC TANK/DISTRIBUTION BOX/SOIL ABSORPTION SYSTEM
SINGLE CESSPOOL
OVERFLOW CESSPOOL
PRIVY
SHARED SYSTEM (YES OR NO) (IF YES, ATTACH PRVIOUS INSPECTION RECORDS, IF ANY)
OTHER (EXPLAIN
1986 HOMEOWNER
APPROXIMATE AGE OF ALL COMPONENTS, DAINSTALLED (IF KNOWN) AND SOURCE OF
INFORMATION. , q 81. c Ike m e c w ale �^
SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE. (YES OR NO) NO
PAGE 5
ACTION -KING ENTERPRISES, INC.
PART C
SYSTEM INFORMATION (CONTINUED)
PROPERTY ADDRESS: 740 SHARPPNER'S POND ROAD N ANDOVER, MA 01845
OWNER: VICTOR SIMON
DATE OF INSPECTION: 6-3-96
SEPTIC TANK: YES
(LOCATE ON SITE PLAN) .
DEPTH BELOW GRADE: 3 1/2'
MATERIAL OF CONSTRUCTION: X CONCRETE METAL FRP OTHER (EXPLAIN)
DIMENSIONS: 14'X 7'X 6'
SLUDGE DEPTH: 3"
DISTANCE FROM TOP OF SLUDGE TO BOTTOM OF OUTLET TEE OR BAFFLE: 2 U2'
SCUM THICKNESS: 3"
DISTANCE FROM TOP OF SCUM TO TOP OF OUTLET TEE OR BAFFLE: NO SCUM BY OUTLET
DISTANCE FROM BOTTOM OF SCUM TO BOTTOM OF OUTLET TEE OR BAFFLE: O"
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.) TANK CONDITION LOOKED GOOD - LIGHT SCUM AND SLUDGE
GREASE TRAP: N/A
(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.)
PAGE 6
ACTION -KING ENTERPRISES, INC.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (CONTINUED)
PROPERTY ADDRESS: 740 SHARPNER'S POND ROAD N ANDOVER, MA 01845
OWNER: VICTOR SIMON
DATE OF INSPECTION: 6-3-96
TIGHT OR HOLDING TANK: N/A
(LOCATE ON SITE PLAN)
DEPTH BELOW GRADE:
MATERIAL OF CONSTRUCTION:
(EXPLAIN)
CONCRETE METAL FRP OTHER
DIMENSIONS:
CAPACITY: GALLONS
DESIGN FLOW: GALLONS/DAY
ALARM LEVEL
COMMENT:
(CONDITION OF INLET TEE, CONDITION OF ALARM AND FLOAT SWITCHES, ETC.)
DISTRIBUTION BOX: NIA
(LOCATE ON SITE PLAN)
DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT:
COMMENTS:
(NOTE IF LEVEL AND DISTRIBUTION IS EQUAL, EVIDENCE OF SOLIDS CARRY OVER, EVIDENCE OF
LEAKAGE INTO OR OUT OF BOX, ETC.)
COULD NOT LOCATE - HEAVY LEDGE IN AREA
PUMP CHAMBER:
(LOCATE ON SITE PLAN)
PUMPS IN WORKING ORDER (YES OR NO) N/A
COMMENTS:
(NOTE CONDITION OF PUMP CHAMBER, CONDITION OF PUMPS AND APPURTENANCES,
ETC.)
PAGE 7
ACTION -KING ENTERPRISES, INC.
PROPERTY ADDRESS: 740 SHARPNER'S POND ROAD N ANDOVER., MA 01845
OWNER: VICTOR SIMON
DATE OF INSPECTION: 6-3-96
SOIL ABSORPTION SYSTEM (SAS):- X
(LOCATE ON SITE PLAN, IF POSSIBLE, EXCAVATION NOT REQUIRED, BUT MAY BE APPROXIMATED BY
NON-INTURSIVE METHODS).
IF NOT DETERMINED TO BE PRESENT, EXPLAIN:
TYPE:
LEACHING PITS, NUMBER: 4
LEACHING CHAMBER, NUMBER:
LEACHING GALLERIES, NUMBER:
LEACHING TRENCHES, NUMBER LENGTH: 3 OR 4 X 40' HOMEOWNER
LEACHING FIELDS, NUMBER, DIMENSIONS:
OVERFLOW CESSPOOL. NUMBER:
COMMENTS: (NOTE CONDITION OF SOIL, SIGNS OF HYDRAULIC FAILURE, LEVEL OF PONDING,
CONDITION OF VEGETATION,
ETC.)
CESSPOOLS: N/A
(LOCATE ON SITE PLAN)
NUMBER AND CONFIGURATION:
DEPTH -TOP OF LIQUID TO INLET INVERT:
DEPTH OF SOLIDS LAYER:
DEPTH OF SCUM LAYER:
DIMENSIONS OF CESSPOOL:
MATERIALS OF CONSTRUCTION:
INDICATION OF GROUNDWATER:
INFLOW (CESSPOOL MUST BE PUMPED AS PART OF INSPECTION:
COMMENTS: (NOTE CONDITION OF SOIL, SIGNS OF HYDRAULICA FAILURE, LEVEL OF PONDING,
CONDITION OF VEGETATION, ETC.)
PRIVY: N/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.),
PAGE 8
ACTION -KING ENTERPRISES, INC.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (CONTINUED)
PROPERTY ADDRESS: 740 SHARPNER'S POND ROAD N ANDOVER, MA 01845
OWNER: VICTOR SIMON
DATE OF INSPECTION: 6-3-96
SKETCH OF SEWAGE DISPOSAL SYSTEM:
INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES LANDMARKS OR BENCHMARKS
COAT ALL WELLS WITHIN 100-1
LEACHING AREA
DEPTH TO GROUNDWATER
DEPTH TO GROUNDWATER: >9'
METHOD OF DETERMINATION OR
APPROXIMATION:
1006 0.445
NEARBY POND AND CATCH BASIN - NO SUMP LOCATED IN CELLAR
PAGE 9
WELL
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: 6., ( —aza—)
t , n Vj
-7 G W-�
�e�
SYSTEM LOCATION
(example: left front of house)
C 0
DATE OF PUMPING: ��� --r QUANTITY PUMPED GALLONS
CESSPOOL: NO � SEPTIC TANK: NO YES !�
NATURE OF SERVICE: ROUTINE
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
EMERGENCY
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
CONTENTS TRANSFERRED TO: `�
TOWN OF NORTH ANDOVER MORTM
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT 40
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 �'ss�C,i�t�
978.688.9540 — Phone
Susan Y. Sawyer, REHS/RS 9-78.688.9542 — FAX
Public Health Director E-MAIL: healthdeptntownofnorthandover.com
WEBSITE: hqp://www.townofiiorthandover.com
April 11, 2005
To all Sharpeners Pond Road Residents:
Please note that it has come to the attention of the Health Department that many residents are
leaving their trash barrels and trash bags out at the curbside for days, or weeks at a time.
Empty trash barrels blowing about in the road are a safety hazard, and trash and debris along the
roadway is a health hazard. Please be mindful of this, as the Health Department will conduct
periodic inspections of the area to determine who is in violation, and fines will be issued if
protocol is not followed.
The Board of Health follows the State Sanitary Code regarding Human Habitation,
105.CMR.410, Section 1:
410.600
(A): Garbage or mixed garbage and rubbish shall be stored in watertight receptacles with tight-
fitting covers. Said receptacles and covers shall be of metal or other durable, rodent -proof
material. Rubbish shall be stored in receptacles of metal or other durable, rodent -proof material
Garbage and rubbish shall be put out for collection no earlier than the day of collection.
(B): Plastic bags shall be used to store garbage or mixed rubbish and garbage only if used as a
liner in watertight receptacles with tight -fitting covers as required in 105 CMR 410.600(A),
provided that the plastic bags may be put out for collection except in those places where such
practice is prohibited by local rule or ordinance or except in those cases where the Department of
Public Health determines that such practice constitutes a health problem. For purposes of the
preceding sentence in making its determination the Department shall consider, among other
things, evidence of strewn garbage, torn garbage bags, or evidence of rodents.
410.602
(A) Land. The owner of any parcel of land, vacant or otherwise, shall be responsible for
maintaining such parcel of land in a clean and sanitary condition and free from garbage, rubbish
or other refuse. The owner of such parcel of land shall correct any condition caused by or on
such parcel or its appurtenance which affects the health or safety, and well-being of the
occupants of any dwelling or of the general public.
(D) Common Areas. The owner of any dwelling abutting a private passageway or right-of-way
owned or used in common with other dwellings or which the owner or occupants under his
control have the right to use or are in fact using shall be responsible for maintaining in a clean
and sanitary condition free of garbage, rubbish, other filth or causes of sickness that part of the
passageway or right-of-way which abuts his property and which he or the occupants under his
control have the right to use, or are in fact using, or which he owns.
Residents should know the following:
The Town has a mandatory paper and cardboard recycling ordinance that requires
residents to separate these items from their household trash. Paper and cardboard are
collected every other week on the same day as the household's normal trash. Residents
can call the DPW at 978.685.0950 to get their recycling schedule.
• Residents are responsible for picking up loose trash left at the curb after collection.
Banned Items and Recycling Requirements:
Please refer to the DPW website for a complete list of all the recycling requirements:
http://www.northandoverrecycles.com.
Please contact the Health Department if you have any additional questions. Thank you.
YanlY.
Sawyer,REHS/RS
Public Health Director
File
WELL DATABASE
7� 0
AGE OF WELL: WELL DRILLER:
WELL PERMIT 'rr: WELL-LOCA7701
WELL PERMIT DATE: DEPTH 01
TYPE OF WELL: a.. DRILLED b. DUG c. UiN- K Ni 0 WN
TYPE O� WATER BEARING ROCK:
WATER ANALYSIS DATE: HIGH MANGANESE
HIGH IRON: Y N OTHER CONTAINM4ANTS: Y
0
Y
IN