The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 87 FOSTER STREET 4/30/2018 (2)b L T lJ 0 f � m 9D cn m M m m 0 NEW ENGLAND ENGINEERING SERVICES lk INC 6p North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 87 Foster Street, North Andover, MA Dear Sir or Madam: TF BOA J e- E ARR 6 7,7t April 5, 2004 Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely /� Benjamin C. Os od, Jr. Certified Title 5 inspector 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 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: 9 7 i=vs. e2 i /Lc e 02.x4 Aljpe), t2 Owner's Name: sa-M V E GlG I i i Owner's Address:-. F37 s7/>- c- c 7- Wt>R-f7-1 A -,I P 00c/L Date of Inspection: 3 % z#►oy Name of Inspector: (please print) Benjamin C. Osgood, Jr. CompanyName:New England Engineering. Services Inc. Mailing Address:60 Beechwood Drive, North Andover,MA01845 Telephone Number: 978-686-1768 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: f Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: -3 2 �' The system inspector shall submit a copy of this m pection 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: 67 t --o5 7r 2 sT: Owner: J-FPAV,yG [r►it,LjpTTI Date of Inspection: '?�.12 y y Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A.. System Passes: 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: ND 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: .97 r s Ea s--ktE V v 2 i7t �,1 Dov 2. .►-� Owner: RnrN 1(rLi OTT -1 Date. of Inspection: 3� zy J C,K 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. L System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(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 aseptic 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 andthe 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; a ? mos gait S, KCe ii N o 2 T1 -t A"i 0 i)"e (– Owner: -'CA n),v i �-7 C3 -t U L t of l Date of Inspection: I Lil LD Li D. System Failure Criteria applicable to all systems: You mast indicate "yes" or `Sno" to each of the following for all inspections: Yes No — J 9�—M Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of 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. 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 £ems 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/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 W or "ho" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ — the system is with400 feet of a surface drinking water ply- - the ly_the system is within 200 f vftribu46– "PIo a surface drinking water supply the system is located i""itr'ogen sensiiift area (Interim Wellhead Protection Area – IWPA) or a mapped Zone II of a pubJie-W&er supply well \ r` If youhave answered "yes" to any question in Section E the 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: 97 /ys l—,v� SM AV 0 /L77f /4,n17 0 ,/E/L Owner:_-Cr9Nnle' C-tUL.107'; 1 Date of Inspection: 311 z V.1 a y Check if the following have been done. You must indicate ` es" or `ono" as to each of the following: Yes llo Pumping information was provided by the owner, occupant, or Board of Health V111 -Were any of the system components pumped out in the previous two weeks ? V_ Has the system received normal flows in the previous two week period ? ✓Have large volumes of water been introduced to the system recently or as part of this inspection ? _ A Were as built plans of the system obtained and examined? (if they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up ? Was the site inspected for signs of break out ? Were all system components, excluding the SAS, located on site ? Were the septic tank manholes uncovered, opened, and the inteior 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 ? 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 Existing information. For example, a plan at the Board of Health. _ _�etemined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unz c;: ptable) 1310 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: 67 FJs rE2 i 2 c` __No2—JH 6vr'VL Owner: _ J-Giq N N t; &I 6-i-\ G ri Date of Inspection: ?, L -V/-& y ��FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): -- Number of bedrooms (actual): DESIGN flow based on 310 CMR 15203 (for example: 110 gpd x # of bedrooms): Number of current residents: — I Does residence have a garbage gander (yes or no): Ue5 Is laundry on a separate sewage system (yes or no).� [if yes separate inspection required] Laundry system inspected (yes or no): — Seasonal use: (yes or no): " Water meter readings, if available (last 2 years usage (gpd)): Sump pump (yes or no): AL Last date of occu—�cY r ✓�r2 vi L_ .-- --- - - --- ------------- --_ _..------- ----------- ----- — COMMERCIALINDUSTRIAL 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: �-j nn P 9gq Was system pumped as part of the inspection (yes or no): AZL) If yes, volume pumped: gallons — How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _ 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: I AJ t✓ Were sewage odors detected when arriving at the site (yes or no): ALD Page 7 of 11 OFFICIAL INSPECTION FO SUBSURFACE SEWAG'DISPOSAL D POOT FOR VOL AL SYSTEM�ARY ASSESSMENTS PART C INSPECTION FORM Pr°PertY Address; SYSTEM INFORMATION (�tinued Owner: yv27 —— , Date of inspeChOn: zC 11UXDING SEWER (locate on site plan) Depth below ' Materials o f grade: � construction: Distance from — iron —40 PVC _ Comments Private water supply well or suctionother (explain): _ (on condition of joints, vera Of fig, evidence of 1 I etc.). SEPTIC TAW. — (locate on site plan) Depth below grade: Material of construction: —other(explain) ije ✓ Crete —metal _fiberglass _polyethylene certificate) — age confirmed b Dimensions: Y a C� , tate of Compliance (yes or no): Sludge depth: �R` N y (attach a copy of Distance from top of sludge Scum thickness: to bottom of outlet tee or Distance from top o� t ✓a s v ,�� ;�,� i—s Distance from bottom to top of outlet tee �, C m How were d' � to bottom of out e. (on Pumping determined: ��s or baffie: Comments Pumping r 2" sic as rel14 ated to outlet invert evidence � >n, t )d met tees baffle Condit( J a 04 real integrity, liquid levels . 7 L r C: L c7SS 0f- =- `SSS v G- REME TRAP: r�l ovate on site.plan) Depth below grade: Material of co n (explain): uchon_: _concrete _metal etal _fiberglass _polyethylene Scum thi_other ckness• Dice from top of n to t Distance from bottom of �' °f outlet tee or baffle: Date of last �� to bottom of outlet tee Pumping or baffi�e Comments (on Pumping recommendations, �_ as related to outlet invert inlet evidence of leakage, and outlet tee or baffle condition, g , an outlet aural integrity, liquid levels Page 8 of 11 OFFICIAL INSpEC SUBSURFACE SEON FORM _ NOT FOR VOL WAGE DISPOSAL SYSTEM IUNNST'PARY ASSESSME�S SYSTE PART C ECTION FOR11Z M INFORMATION (continued) ]property Address: 7 Fes Owner: ;-s%rc ti]�G Date of Ltspection: tiN ^ G-t�� i i r (tank mu 11"T or HOLDING TANX m be Pumped at time Depth below grade: the of mspection Material of conA — )(locate on site plan) on —concretemetal Came* : 'fiberglass_polyethylene��other(explaQ): isign Flow: lions Alarm Present (Yes or no): all0nVday Alarm level: ! Al �, Date of last pumping: g order Comments orkrn (yes or no): (condition of 'alarm and float switch mac.): DLvTRMVn0NBOX: — (if Present must be Depth of liquid level above °P�lceate on site plan) Comments (note if box • outlet invert image into or out of is level and diyb i on too Outlets ox tA, box, etc.): equal, an evidence K Y vidence of solids carryover s c , any evidence of P UW ER: 2.,4 (locate ! cis= f .ill Puwps in worlctn on site plan) Alarms norworking g order (Yes or tro). commeants (notConditi (yam m no): Condition of pump c"nber cendition of pumps and appurtenances, etc.): Page 9 of l l OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 23? s t ,, e e, Owner.• -0 jgAJ AJ C 6-1 &-tJ O Tf -i Date of Inspection: -31 z,3y . SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: leaching trenches, number, length: i/ leaching fields, number, dimensions: /.5 overflow cesspool, number: innovativelaltemative system Type(name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): --)9-(2.c79 c F�c�2c� Siyci,.. E v l L 2c'Q CESSPOOLS: IVA (cesspool must be pumped as part of inspeotionxlocate 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: //i -(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 FOR POSA SUBSURFACE SEWAGE D SpNOT FOR SYSTEM ASSESSMENTS TEM INSPECTION FORM SYSTEMPART C INFORMATION (continued) PropertY Address; -1 iUJ ,2 i7t /� ✓ i� Owner: ,7 -Tt f -, 4Na _ C'U 2 Date of Inspection• U� T- to T� . `y ETCH OF SEWAGE DISPOSAL, SYSTEM Provide a ski of the ben'Locate all w g' di �pp f including ties to at least two Vstemeet Locate where Permanent reference landmarks or se*aPublic water supply enters the building. 5T J ' Page 11 of 11 OFFICIAL, INSPECTION FO SUBSURFACE SEWAGE DISPOSAL SYSTEM ASSESSMENTS TEM INSPECTION FORM PART C SYSTEM FORMATION (continued) Property Address; 87 f"US�j2 ST/Lec i NJr2 Owner. � `9aN Date of inspection: i U c a SITE EXAM Slope Surface water Checkcellar Il V/IL Shallow wells NUn E Estimated depth to ground water to feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design Plans on record Observed site (abutting es /o - If checked, date of deli gn Checked with local Board oo f � bs�tion hole within 150 feet of SAS) l� reviewed: Checked with local excavators,ealth-explain: �—' — Accessed USGS "base -explain: (attach docum�tation) You meast describe how You established the r61 L� high ground water elevation: r`'' e --