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HomeMy WebLinkAboutMiscellaneous - 826 DALE STREET 4/30/2018a � a N N O O N N 00 c U � O ca 0 N fn J f0 N N m 00t a a U � y N t]) tp C O S2LuOS O ram hi .2 T C F- � L) 3 W ip H W J Go o N O O ao uj o co 0 M c w O N O F U � mdU 'a 0 J_ Q LU L � U) Q 2 Q. TOaLLW o a CL W V N O c o dp�j 0 O N N Q) a) @ 5f0 fD f6 F-- UUCOUU of O J to r M O O w r I-- 0 U a) m o0Qc UULL-i U W w O O Q O Z CD O O O O O 0 J m In lc m E E O U O O T 0 O r 0 m rn �I0 XIW Q W. d a 0 0 c V LL Z OJ 0) a0 IZ LLI W y Wj � r r �Z LU U U) a� U >. c=a SNC Q 0 0 2 0 Q O O co N N N 0) a0 � r r U 0 0 C C 7 22 i�'ct 00 M N ? r 0) � Z O 3 O� Q cc ~ Q Z H f0 m J J V D N Q o z o o`' r W I�T It Z ?. ..o U. m o rn+i!" (D LO Z y Cl) Q N .tn � JU C J v v L j mm mG 2 �coQ oo Z r to V d ov 0 o v Opp fhM (0 L) r te W I c `O F - x O Z (%rN U CL LOo O LMC) M N t00 r r r r t0 7 N c m QN f0 f0 f6 w m U m Z a 7 O L d y In c m U Y 0 0: w 0 QmLLm m2C0 << y Ln ZLn In r CD 0) N _ O Cl) � � a Q N d W O O aLL m7 E� CQc< cQ LL pLL ai:E 0 O Z C: LLW cii Lm topvco a�icc (� �DQDH W }( Udo Lr . Z 0 40 Cl) N to cc ti X V W Ix CO LL - - LL E EsSr , =s m mm C � a� Baa c�c� m omm HmLL=W mYW mmQ m N m w 0 2ONZ rn Hp ai6 U d = a)-Zm a,�, H U T O Cl O N j W c LU in600ui2LLL. M:U_E a°m U) TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845-2909 J. WILLIAM HMURCIAK, DIRECTOR, P.E. Timothy J. Willett. Water Superintendent February 4, 2005 Ms. Susan Sawyer Health Agent 400 Osgood Street North Andover, MA 01845 RE: 826 Dale Street — Future Sewer Connection Dear Susan: REC EV p FEB 0 7 2005 Telephone (978) 685-0950 Fax (978) 688-9573 TOWN O; ., ., : H ANDOVER HE_._. A___! 6L*-ARTMENT I have been asked to provide you with a status on the potential for sewer connection at the above referenced address. At this time, the sewer main and service stub have been installed in front of 826 Dale Street as part of the town's Phase 3D Sewer Project. Although our project has been essentially completed, the sewer lines are not active yet because they are designed to connect to the sewer system for Meetinghouse Commons. Therefore, I have asked the developer of Meetinghouse Commons, Tom Zahouriko, to provide a status report (attached) for his sewer pump station. Once the sewer system for Meetinghouse Commons is activated, we will inform Dale Street residents they can connect to town sewer. Very truly yours, //I Timothy J. Willett Water & Sewer Superintendent THOMAS D. ZAHORUIKO MEETINGHOUSE COMMONS LLC 121 Carter Field Road, North Andover, MA 01845 Tel: 978-687-2635 Fax: 978-689-2310 Mr. Tim Willett, Water and Sewer Superintendent Department of Public Works Town of North Andover 384 Osgood Street North Andover, MA 01845 Dear Tim, January 24, 2005 RECEIVED FEB 0 7 2005 TOWN U : - ,ANDOVER HEALTH DEPARTMENT In response -to your inquiry regarding the -status -of the •sewer,pump station at Meetinghouse Commons (off Dale Street), which is intended to provide service for the Phase IIID Sewer Extension of the Town of North Andover, I offer the following update. As you may be aware, the Pump Station basic components have been installed, and all related components, devices and mechanicals have been purchased and are currently being stored locally, awaiting availability of electric power from Massachusetts Electric as well as final resolution of some administrative documents, relating to the affordable housing project which subsidizes this pump station, which are under the control of our Zoning Board of Appeals. Some administrative documents relating to the affordable housing project have been completed and resolved, and we hope that the remaining documents can be finalized in the next few months also. Also, Massachusetts Electric has indicated that electric service may be available by sometime in March or April. In summary, our investment is nearly complete, and we will work diligently to complete the Pump Station as soon as we are sure that all related documents and process with the Zoning Board of Appeals have been resolved, and the first units at Meetinghouse Commons are eligible for occupancy permits; I expect that 30-45 days is all we need to complete the facility once we are given the final consent. The pump station will then be made available for service, subject to all DPW inspections and approvals. As always, please call if you want additional information or clarification. D. Zahoruiko J�� J ..% NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF APPROVAL FOR CONTINUED USE OF A TITLE V FAILED INSPECTION SYSTEM Name (s) of seller ?--hrr q 9- A& -f -A 26 s Address of property �lQ�� ��. tsz. At( byec (iA , o�$��J Town Map®Y C Parcel In 7 We, the undersigned buyers of the above referenced property owned by the above sellers, acknowledge the "FAILED" status of the septic system at said property. In accordance with the provisions of Title 5, the State Environmental Code, 310 CMR 15.305 (see copy on reverse side) we hereby agree to continued use of the system approved and permitted by the North Andover Board of Health on condition of a proposal to connect to the municipal sanitary sewer within 60 days of the sewer activation or replacement of the failing system within five years of the date of transfer of title or sooner if ORDERED by the Board of Health. By our signature we hereby acknowledge disclosure of this binding agreement upon us as subsequent owners. Printed Name (s) of Buyer Signature of Buyer Date As sworn and subscribed to this Signature of Buyer Date 12 , day ofA& UQ( Notary Public Commission Expiration I hereby certify that the continued use of the septic system for the above cited property is approved and permitted by the North Andover Board of health in accordance with the provisions df 310 CMR 15.305. The basis for continued use include a proposal to connect to the municipal sanitary sewer within 60 days of the sewer activation or upgrade or replacement of the system within 5 years of the date of transfer of title. This approval for continued use of the system is in no way to be construed as a guarantee of efficacy of the system nor will it limit the power of the North Andover Board of Health to take any and all alternate enforcement action as it may deem necessary to achieve compliance with such code and to protect the public health including, but not limited to, ordering the performance of any interim measures (i.e. pumping) to achieve compliance with this approval. * This certificate is not valid until signed by an agent of the Board of Health Da� or he North An over B of Health * This certificate is not valid until signed by an agent of the Board of Health j 305 headlines for Com 1 tion of 11pgradec (1) If a system is_f i ; g to protect public health and safety. or the environment as set forth in 310 CMR 15.303(1) or 15.304(1), the owner or operator shall upgrade the system within two years of discovery. unless: (a) a shorter period of time is set by the local approving authority or the Department based upon the existence of an imminent health hazard; or (b) the continued use of the system is permitted by the local approving authority in accordance with the provisions of an tnforceable schedule -for upgrade. Bases for continued use include, but are not limited to, proposals to connect to a sanitary sewer.or.shared system. A fiscal commitment to the sewering plan or shared system plan,- together with an approved. facility plan where appropriate, proposing, connection or replacement of the failing system within five years, and an enforceable commitment by the owner to perform interim measures (for example,, regular pumping) shall accompany any such local approval. Such approval shall expire in. five. years or upon the failure.. of the applicant for such approval to meet interim deadlines set forth in the enforceable schedule for upgrade and the plan. The Department may by specific written approval authorize the local approving authority. to allow a longer period of time, where the municipality has provided the Department a proposed implementation schedule for design and construction and has made a demonstrated financial commitment to the construction schedule. The Department may revoke any such approval if the approved schedule is not met. .a. y 310 CMR - 548.3 .a. y Owner Rhys Barry 826 Dale St north Andover, MA, 01845 (978)-683--9189 x Customer Service Report 1 Location Primary Home 826 Dale St North Andover, MA, 41845 (978)-683-9189 x 022200 26 Cust ID: 1291095 Customer Home Yep Household Size Technician 1 2 3 4 5 6 7 8 System Type Standard Tank Size 1000 22 20 18 16 14 12 12 12 Previous Service 04—Jan-2005 1250 22 20 18 18 16 14 12 12 Next Service 1500 24 22 20 20 18 16 14 14 bate of Service 12 -Jan -2005 PM 1750 26 24 22 24 20 18 16 16 Service Code Description Charge Score From Table Pumping 1000 0.00 179.7800 17Y Inspection Title 5 1.00 299.9000 $L99_90 Subtroct6forgarbagedisposal Inspection ( Labor/ Exposur 0.00 145.3900 �M'74? Subtract 5 if system is older than 10 years Inspection Title 5 Credit 1.00-250.0000 $(250.00) Add 8 for seasonal use i Add 5 if system additive is used: Net Swrc: / ( / Score Frequency Less than 5 Every 6 months Subtotal a."`9 6 to 15 Every Year Payment Type: t Expires Tic?,IJ•, 00 16 to 23 Every 18 months Credit Card #: ( p �/ Total . greater than 24 Every 2 years Technician Comments: j"� / --^'� 7 / Tank Observations Good Condition / ; 7 Leachfield Runbadc Ve, Riding High (liquid kveQp Excessive Solids (top bottom) Al,,re e, r' �' �!� f t � � r � 7 &,-1 r p % / / d) f r Use No Powdered Soap 1 1 J SPL e, i. Heavy Grease 1 Roots Outlets Baffle Missing Inlet Baffle Missing Wind River EnviroruDent,al LLC 163 Western A ie, , Glouce:;ter, MA 0 : r- 3r) Terms Jlle C`''1 Receipt Customer Signature Casymmr Copy F A J t/ r V V40 q 4, M 7 - A�Oer U Daniel A. G'ar Estimate 130A Appleton St.;74,, __. No. A ndover, MA 01845 DATE (978) 686-7653 1/14/05 1 i NAME/ADDRESS MRS BARRY RHYS 826 DALE STREET NO. -ANDOVER -1 MASS. 01845* i - DESCRIPTION SEWER ESTIMATE: Installation of Sewer From Stub to House. i Price Includes: Pumping, Crushing and Filling Septic Tank. Backfilling and Grading to Rough Grade. 6" SDR 35 Sewer Pipe To Be Used. Trenches compacted to the best of our ability. Landscaping Not Included: Town Permit Fee (if applicable). Conservation Requirements (if applicable). Any Unforeseen Obstructions (such as Ledge and underground utilities ect..) is extra and priced accordingly. TERMS: 2/3 TO START $ 3500.00 AT COMPLETION $balance TOTAL $5250:00 Estimate Valid For 30 Days TOTAL$5250.00 CUSTOMER SIGNATURE 577 MAIN STREET HUDSON, MA 01749 800-499-1682 WIXDRIVER ENVIRONMENTAL RECEIVED FEB 0 3 2005 TOW 0 HEALTH©PARTMC THANDOE ��� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNER'S NAME: RHYS, BARRY PROPERTY ADDRESS: 826 DALE ST.,NO.ANDOVER, MA 01845 ADDRESS OF OWNER: SAME (IF DIFFERENT) DATE OF INSPECTION: JANUARY 13, 2005 NAME OF INSPECTOR THOMAS CHIGAS COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 826 DALE ST. NO. ANDOVER MA 01845 Owner's Name. RHYS, BARRY FRECEIVED Owner's Address: 826 DALE ST. NO. ANDOVER, MA 01845 0 20Date of Inspection: JANUARY 13, 2005 FEB Name of Inspector: (please print) THOMAS CHIGAS TOtjNOF NORTH ANDOVER Company Name: Windriver Environmental ALTH DEPARTM�_ Mailing Address: 577 Main Street Hudson, MA 01749 Telephone Number: 800-499-1682 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: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority E Fails V Inspector's Signature: C Date: JANUARY 13, 2005 The system inspector shall submit a copy ofis inspetion 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 I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 826 DALE ST NO. ANDOVER, MA Owner: RHYS Date of Inspection: JANUARY 13, 2005 Inspection Summary: Check A, B, C,@or E / ALWAYS complete all of Section D A. System Passes: NO 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: NO 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. NO 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: NO 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): NO broken pipe(s) are replaced NO obstruction is removed NO distribution box is leveled or replaced ND explain: NO 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): NO broken pipe(s) are replaced NO 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: 826 DALE ST NO. ANDOVER, MA Owner: RHYS Date of Inspection: JANUARY 13,200 C. Further Evaluation is Required by the Board of Health: NO 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: N/A Cesspool or privy is within 50 feet of surface water N/A 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: NO 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. NO The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. NO The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. NO 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: N/A Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 826 DALE ST NO. ANDOVER, MA Owner: RHYS Date of Inspection: JANUARY 13, 2005 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No YES 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 YES 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 is less than 6" below invert or available volume is less than V2 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 YES Any portion of the SAS, cesspool or privy is below high ground water elevation. N/A Any portion of 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 1 of a public 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 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.] YES (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 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 Protection 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 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 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 826 DALE ST NO. ANDOVER, MA Owner: RHYS Date of Inspection: JANUARY 13, 2005 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? YES 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 YES Existing information. For example, a plan at the Board of Health. YES Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance 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: 826 DALE ST NO. ANDOVER, MA Owner: RHYS Date of Inspection: JANUARY 1.3, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder (yes or no)? NO Is laundry on a separate sewage system (yes or no): NO [if yes separate inspection required] Laundry system inspected (yes or no): N/A Seasonal use: (yes or no): NO Water meter readings, if available (last 2 years usage (gpd)): UNAVAILABLE AT TIME OF INSPECTION Sump pump (yes or no): YES Last date of occupancy: CURRENT COMMERCIAL/INDUSTRIAL 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: OWNER Was system pumped as part of the inspection (yes or no)? YES If yes, volume pumped: L 00gallons -- How was quantity pumped determined? SIZE OF TANK Reason for pumping: CHECK TANK'S INTEGRITY TYPE OF SYSTEM. YES Septic tank, distribution box, soil absorption system NO Single cesspool NO Overflow cesspool NO Privy NO Shared system (yes or no) (if yes, attach previous inspection records, if any) NO Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) NO Tight tank Attach a copy of the DEP approval N/A Other (describe): Approximate age of all components, date installed (if known) and source of information: INSTALLED 1961, OWNER AND PLANS 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: 826 DALE ST NO. ANDOVER, MA Owner: RHYS Date of Inspection: JANUARY 13, 2005 BUILDING SEWER (locate on site plan) Depth below grade: 20" Materials of construction: 4_� cast iron 40 PVC other (explain): Distance from private water supply well or suction line: N/A Comments (on condition of joints, venting, evidence of leakage, etc.): THERE WERE NO SIGNS OF LEAKAGE IN OR AROUND PIPE SOILS WERE CLEAN AND DRY. SEPTIC TANK: YES (locate on site plan) Depth below grade: I1" Material of construction: YESconcrete 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: 6'D X 5'H OUTLET INVERT 608" =1000 GALS Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle: N/A Scum thickness: 2" 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 How were dimensions determined? ROD AND RULER Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): THE INLET AND OUTLET BAFFLES ARE CEMENT AND IN GOOD CONDITION. THERE WERE NO SIGNS OF LEAKAGE IN OR AROUND AREA. THERE WAS A HIGHER LIQUID LEVEL IN TANK, SHOWING SIGNS OF BACKUP. GREASE TRAP: NO(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 (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: 826 DALE ST NO. ANDOVER. MA Owner: RHYS Date of Inspection: JANUARY 13, 2005 TIGHT or HOLDING TANK: NO (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: YES (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0" DEPTH BELOW GRADE: 24" 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.): THE BOX WAS FULL OF LIQUID AT TIME OF INSPECTION. THERE IS EVIDENCE OF FAILURE LEAKAGE AND WEAR. SOILS WERE WET AND DIRTY WITH ODOR. THERE WERE ONE INLET AND FOUR OUTLETS ALL WERE ORENGE-BERG CONSTRUCTION AND IN POOR CONDITION. PUMP CHAMBER: NO (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 I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 826 DALE ST NO. ANDOVER, MA Owner: RHYS Date of Inspection: JANUARY 13, 2005 SOIL ABSORPTION SYSTEM (SAS): YES (locate on site plan, excavation not required) If SAS not located explain why: Type Leaching pits, number: Leaching chambers, number: Leaching galleries, number: YES Leaching trenches, number, length: FOUR, 2'W X 55'L Leaching fields, number, dimensions: 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.): THE LEACH TRANCHES WERE FULL AT TIME OF INSPECTION. SOILS ARE WET AND -HAVE ODOR, THERE CONSTRUCTION WAS ORENGE-BERG AND THERE IN POOR CONDITION. CESSPOOLS: NO (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: NO (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 If of It OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 826 DALE ST NO. ANDOVER, MA Owner: RHYS Date of Inspection: JANUARY 13, 2005 I c "BOARD OF HEALTH n,., T3711 OF NORTH A:.'DOVER, MASS. Leaeh W. /,I >/q4 SJ Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 826 DALE ST NO. ANDOVER, MA Owner: RHYS Date of Inspection: JANUARY 13, 2005 SITE EXAM Slope: NO Surface water: YES Check cellar: YES Shallow wells: NO Estimated depth to ground water 5' feet Please indicate (check) all methods used to determine the high ground water elevation: YES Obtained from system design plans on record - If checked, date of design plan reviewed: JUNE 14, 1961 YES Observed site (abutting property/observation hole within 150 feet of SAS) YES Checked with local Board of Health -explain: INFORMATION NO Checked with local excavators, installers- (attach documentation) YES Accessed USGS database -explain: MAPS You must describe how you established the high ground water elevation: THE HOME HAS A 4' FOUNDATION WITH A SUMP PUMP AND BASEMENT WAS DRY. THERE WERE SIGNS IN BACK YARD THAT fEHSGWI WAS AT 5'. WHILE DIGGING IN YARD, THERE WERE SIGNS OF SOILS BEING WET AND INDECATION AROUND SYSTEM THAT WATER TABLE WAS IN AND AROUND SYSTEM. THE SYSTEM WAS AT FAILURE AND WILL NEED TO BE REPLACED.