HomeMy WebLinkAboutMiscellaneous - 747 GREAT POND ROAD 4/30/2018BVBSVJtF M SSU Di#iR"AL BYSTUM ragYiF#m]
Address of property
Owner's name t 7 ir 7 0-eklr A�
Date of insgecti0n
41271f 557— gART II
Cr'LYST
Check If the following have been clone:
7
Pumping information was requested of the cener, ocogmnt, and Board of
Health.
None of the system components have been pumped for at least two weeks
and the system has been renewing normal flow rates during that
period. Large volumes of water have not been introduced into the
system recently or as part of this inspection.
XA— As built plans have been obtained and examined. Note if they arenot
available with N/A-
w.:k- The facility or dwelling was inspected for signs of sewage back-up,
,.The Site was inspected for signs of breakout.
x
_
All systen components, excluding the. SAS, have been located on the
site.
The septic tank manholes were uncovered, opened,, and the interior of
the septic tank was inspected for condition of baffles or tees.,
material of construction, dimensions& depth of liquid, depth`of
sludge, depth of scum.
The size and location of the S,AS on the site has been determined based
on existing information or approximated by non -intrusive methods,
..,e/ The facility owrmr (and occupants. if different from owner) were
Provided with information on the proper maintenance of SSDS.'
If residential
._.-1, number of bedrooms
number of current residents
garbage grinder, yes or no
_ laundry connected to system, yes or no
AP- seasonal uga, yes or no
If •nonresidential, calculated flow:
water meter readings, if available:
09'y ,rv. Last date of occupancy
, Z f�Y !aa zy fir
GERML INFOIWATIoN
PumPing records and source of information:
Purr r3 6 q
system pUMpe as part of inspection, yes or no
if yes, volume pu 1ped
Reason for pumpinq:
Ty of system
Septic tenkfdistribution box/soil absoription system
single cesspool
Overflow cesspool
Privy
reco4 syir a (Yes or no) {if yes, attach pravious inspection
recor�.s, if any •
Other '(0Xplaln)
Approximate, aqe of all components
information; . Date installed, if knoTm. Source of
Np Sewage Odors detected when arriv3a9 at the site
you or no
9
' 1. 1 � Vie_ M i '.`.i: { '�•' @ `�.�� °re _ 'r ! ti e # „<gnj
SEPTIC Tom:_._
(locate arxsite plan)
depth below. grades � r�
material off. construction: -A'—Concrete _metal ,,,,,,,,,,,_.FRF—otber(expl.ain)
d�.mensians•` �` riC T x! �i � /4'ai3 !t.4 -C - --
sludge depth
JT dista4co from top of sludge to bottom of outlet too or baffle
•' scum thickness
distanco from top of scum to top of outlet tee or baffle
distance from bottom of scuta to bottom of outlet tee or baffle
comments:
(recommendation for pumping, condition of inlet and outlet tees or bagfles,
depth of liklud level in relation to outlet invert, structural integrity,,
evidence of°leakage, recomendations for repairs, etc.)
DZSTRIBUTI00 BOX: AWWC w'7'( Cfr»rvfi ?.'aw Ex -V'
(locate on site plan}
G� depth of liquid level above outlet invert
comments:
(note if leVel and distribution is equal, evidence of solids carryover,
evidence or leakage into or out of box, recommendation for•repafrs, et+0.)
PMP cum
8 a�•
(locate on q1ite plan)
pugs in working order, yes or no
Comments;
(note condi ion of pump chamber, condition of pub and appartenancas,.
recommendat one for maintenance or repairs,etc.)
BmH# u"ACR SNUAM DISPOSAL BUS= I PBCT= vom
$AW 8
SOIL AHSO1 rION SYSTEM ( SAS) ;
locate oh site plan, if -possible.; excavation not required, but may be
approximated by non -intrusive methods)
If not de"rmined to be present, explains
Type
leaching 16 -its and number
xeacriing 4ftubers and namber
leaching cjalleries and number
leaching #enches, number, length
leaching fields, number, dimensions
overflow Qesspool, nulaber
IQ
Comments:
(note con4ition of soil, signs of hYdraulic failure, level of ponding,
condition iof vegetation, recommendations for maintenance or repeirs,etc.)
CESSPOOLS ;(locate on site plan) : A,1e�4c-_
number ate, configuration
depth-topif liquid to :inlet invert
depth of s+6lids layer
depth of sclum layer
dimensions( of cesspool
materials paf construction
indicationlof groundwater
inflow (c0sspool must be pumped as
pant of i0specti:on)
Comments:
(note con4tion, of soil, signs of hydraulic failure, level of ponding,
Condition �f vegetation, recommendations for maintenance or repairs s etc_ j
PRIVY: ANovW
(locate onsite plan).
materials cif construction
dimensions.,
depth of s o' l itis
Comments:. :°
(note •conditf on of soil,
condition Of Vegetation,
signs .sof hydraulfe Failure, level of pcmding,.
redations .for maintenance or rpepairs etre I ..�'
StMOURVAM RUMM DISP►SM. SYST= MapnenoW VopM
ASTM 11MOMMT10M ocm►tin
SKETCH OF iMACM DZSFOSAL SYSTMI:
include ti is to at least two pervanent references landmarks or benchm wks
locate all ;Wells within loo'
N6
t
o $mac
5d ,
L `I',1,e
DEPM To GUOuNnwjkTXR
depth t4 groundwater
method of deterptination or approximation.
!-
lhpfs (Pj gfav—
11
12
FA 1 F s - -•s •:.t+ :. a as :J 4,-,4JrA14 t4 F • re
a
Indicate yes, no, or not determined (Y, M, or 33D) Describe ]oasis of
determination in all instances. if Onot determined", explain why not)
_4JO Backu#o of sewage into facility?
. bisch*rge or ponding of effluent to the surface of the ground or
surf4e graters?
Static liquid level in the distribution box above outlet invert?
ko Liqui4i depth in cesspool: <4" below invert or available volume< 1/2 day
flow?'
A Required pumping 4 times or more in the last year?
numbed" of times pumped
AZ Septi
tank is
metal? cracked? structurally unsound?
substantial
infiltration?
substanti.al exfiltration? tank failure
imminent?
Is any portion of the SAS, cesspool or privy:
.
belowthe high groundwater elevation?
1 Vithih 50 feet of a surface water?
ko within no feet of a surface water supply or tributary to a surface
hater supply?
Lko
trithira a Zone Y of a public well?
within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, n2t the SAS)?
withiii 50 feet of a private grater supply well?
Pw less than 100 feet but greater than 50 feet free a private Ester
supply well with no acceptable water quality analysis? if the well
has been analyzed to be acceptable, attach copy Of" well water lanatlyal.-
for cOliforn bacteria, volatile organic coapmnds, ammonia nitrogen
and nitrate nitrogen.
13
BUBSUM M= BUMM DI&P SAL STSTM =BPSMOM 170
PART D
CBRTXFXCDTZca
Name of Ini*pectox
Company Name
Company Address
old +
Mtlfic-+,go BtatwMat
I certify t#at I have personally inspected the savage, disposal syr at
this addre4le and that the information reported is true., accurate and
complete ai! of the tixae of inspection. The inspection was performed arm&
any recoxmapdations regarding upgrade, maintenance and repair are
conn intent _with my training and experience in the proper function and
manitenance. of on-site sewage disposal systems.
Ch one:
I have; not found any information which indicates that the system r&ils
to adgcluate3y protect public health or the environment as defined in.
31.0 CP 15.303. Any failure criteria not evaluated are an stated in
the MikLURE CMtXTB=a section of this form.
I havd determined that the system fails to protect public health and
the er*ironment as defined in. 31Q CLgR 15.303. The basis for this
deterj#nation is provided in the PAILM CRT ZM section of this
form.
3nspector l s ! Signature Q�
Date 3 7 93--
1
Original to . system owner
copies to: �,ertQ a� �,k(� AJ . l�n+►�atrr�r
Buyei (ifapplicable)
Approving:�nthority
110%c;c
AOi
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rt�cer.�cs .w.etvr� »wr'ir�c�s cau�►c+ti! !N
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,4rrPIV
Dr. Elias
Great Pond Road
�-a I` ff-
APPLICATION FOR SEWE DISPOSAL INSTALLATION
HEALTH DEPARTDZWT--NORTH ANDOVER, MASS.
I hereby make application for a permit for a sewage disposal installation at
Great Pond Road _ . I wi11 install this system in
accordance with all the lays of the Commonwealth of Massachusetts and regulations
of the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet
preceding the septic tanks, where the grade shall not exceed 2%. 1 will install a
concrete septic tarn of 2' 50&52Q. in size. A manhole (s) permitting easy
cleaning will be provided with removable cover (s) of iron or concrete within 12
inches of the ground surface. I will provide subsurface disposal field with open
jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a
series of trenches, the bottom of which will provide a minimum of ,_ .33a lineal
(s7q'e) feet of effective absorption area. The pipes will be laid on a 6 inch
layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches
(dia.) and the pipes will be surrounded by similar material to a height of 2 inches
above the crown of the pipe. The joints of these pipes will be.protected from
clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4"
(dia.) will be placed over the course gravel or stone, The disposal field will be
installed at a grade of 4 to 6 inches 100 feet. No single tile line will exceed
100 feet in length and in any case, two lines of tile will be installed. A minimum
of 6 feet will be maintained between the center Lines of the disposal field trenches
and the average depth of trench shall not exceed 36 inches. No part of the in-
stallation will be less than 100 feet from any private water supply, 25 feet from
any stream, 20 feet from any dwelling or 10 feet from any property Line. I further
ofr ficer, as provided below, and to incorporate any additional requirements that
may be attached to the permit. Plot Plans must be submitted with application..
DATE
Signature of Alfplicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE
S gnature of Health Agent
I have inspected the uncovered.system indicated above and find everything done_
as described.
DATE
Signature of Inspecting officer
Percolation Test 10 -Min. Soil- clay -gavel 7/3 016-�,
4,= - Garbage Grinder G /,..
lk - ,'
BOARD OF HEALTH
TOWN OF NORTH AINDOVER, hMSS.
po
Cr; Et. N . . . . . . . . . . . DATE . � �•/ ,/ j7?. .
2. ADDRESS .3 p�-®21^ . . . .L. !�R� No. TEL. b .
3. N0. OF BEDROOM . �; . . DEN YES NO.. . . . .
l,. GARBAGE GRINDER YES . NO.. . . . .
5. SHOW DILEPSIONS OF MOUSE 'L
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LIM ��
7. SHOW DIPRE BIONS OF LOT '
1 w�
8. SHOW LOCATION AND SIZE OF SEPT IC TANK OR CESSPOOL 0 /s -1 SSU 0 k 4�
9. NOTE LOCATION AND DISTANCE OF WELL FRO1.1 SEWERAGE SYSTEM
10. SHOW LOCATION OF BROOKS, STREA16, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FRO14 HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
I
i
N
V7
mss'
August 15,1956
Miss Mary Sheridan R.N.
Health Agent
Board of. Health
North Andover, Massachusetts
Dear Miss Sheridan:
An examination has been made relative to
the suitability of the soil for the sub -surface
disposal of sewage, on the proposed. Great Pond Road
site of Mr. Fred Elias.
The soil in the area was mixed with clay
and gravel. A ten minute percolation test was con-
ducted.
It is recommended that two tanks be in-
stalled. One tank 750 gallon in size and. the other
a 500 gallon tank.
The drainage area to be consistant with
the results of thepercolation test. The sizes of
these are noted on aturda.,ys reports.
Very truly yours,
b Ernest F. Romano f'
t. BOARD OF HEALTH p .
TCVFN OF' NORTH ANDOVERp
A �
IVA
VA
a
rA
i
.. DATE . . 'e: i .` . . .
2. ADDRESS . . LOT N0. . . . . . . TEL. . '... . . . .
3. NO, OF BEDROOM .� . � DEN YES NO..x. .
4. GARBAGE GRINDER YES NO..
5. SHOW DII11ENSIONS OF HOUSE
6. SHOR DISTANCES OF HOUSE TO ALL PROPERTY LAMS _
7. SHOD DIPIIENSIONS OF LOT-
8,
OP 8. SHOW LOCATION AMID SIZE OF SEPTIC TANK OR CESSPOOL
9, NOTE LOCATION AND DISTANCE OF WELL FR011 SEWERAGE SYSTEM
10. SHOW LOCATION OF BROOKS 0 STREM s DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
ROTE: LOCAL REGULATIONS SHOULD IE READ CAREFULLY.
Walter J. Sinsheimer
747 Great Pond Road
North Andover, MA 01845
Please forwArd us as much of the following information that is possible;
1. Type of system
2. aced
3. Location",
4- Maintenance records and date of last pumping out
15 i%oci,m nts-t; on of repairs and reconstruction
6. Site conditions
7. 13ui lder of system
8. Engineer who approved,
— Site
-- System
f/
//
10
9 R Installation Procedure
a
10, Problems
Nature of Service:
Observations:
Description of Work:
Comments:
Routine
Emergency _
Good Condition
Full to Cover
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
Town of North
Andover,
MA
Watershed Septic
System
Servicing
Report
-4
Date: —(?— -qC4
V �-
e�
Pumper
Homeowner:
`�
��
.
Address:
�4��
Street
C��
Phone
_
Phone
Nature of Service:
Observations:
Description of Work:
Comments:
Routine
Emergency _
Good Condition
Full to Cover
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name -S kn t 1 -k- • lJ , S � � C`
2. Street Address )
O3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
91 septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
[9 yes ❑ no ❑ do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
RC1 over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes ❑ no 9 do not know
If yes, approximately how long ago? years. What was done?
S. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years every 5-10 years ❑ over 10 years ❑ never.
O9. Have you had any problems with your sewage disposal system? ❑ yes R no
If yes, what problems?
❑ repeated pump -outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine x dishwasher garbage disposal
dehumidifier drain sump pump toilet 4_
roof/pavement drains shower/bathtub _�4
11. Please state the rand an pee((_liquid or powder) of detergent you use for:
dishwasher
clotheswasher I A! p
12. Does your property have a lawn? EX yes ❑ no
If yes, approximately what size?
E4 less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres _
13. How often do you fertilize your lawn?
No. of applications per year L _ K_
OSeason(s) of the year Vw.
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.
SEPTIC ;SYSTEM INSPECTION FORM
ADDRESS --74 ri �� QB✓L �°
DATE INSPECTED
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS: