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HomeMy WebLinkAboutMiscellaneous - 92 BRIDGES LANE 4/30/2018 (2)Owner information is required for every page. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner's Name North Andover City/Town Ma 01845 State Zip Code 11-29-16 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: John DiVincenzo Name of Inspector J and S Development Corp. dba Stewart's Septic Service, Andover Septic Company Name 58 South Kimball st Company Address Bradford Cityrrown 978-372-7471 Telephone Number B. Certification Ma State s113386 License Number 01835 Zip Code 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 ❑ N�eOs Fu Signature ❑ Conditionally Passes ❑ Fails Evaluat' by the Local Approving Authority Date The system inspector Miall subO(a copy of this inspection report to the Approving Authority (Board of Health or DEP) wit ' ys 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. "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. L15,ns113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner's Name North Andover Ma 01845 11-29-16 City/Town State Zip Code Date of Inspection B. Certification (cont.) 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: ❑ 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. Check the box for "yes", "no" or "not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner's Name North Andover CityrFown B. Certification (cont.) Ma ni Rdri 11-29-16 State Zip Code Date of Inspection ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner's Name North Andover Ma 01845 11-29-16 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 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 fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® 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 ''Y2 day flow t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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 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. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover Ma 01845 11-29-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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 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. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. City/Town C. Checklist Ma 01845 State Zip Code 11-29-16 Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ 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? ® ❑ 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 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? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): AGA DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. City/Town State 01845 Zip Code 11-29-16 Date of Inspection D. System Information Yes ❑ No Description: Yes ❑ No ❑ Yes ❑ No Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No occupied Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GqM 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. Cityfrown D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Ma 01845 11-29-16 State Zip Code Date of Inspection General Information D ate Source of information: Stewart's Septic Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? site guage on truck Reason for pumping: inspect tank 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. City/Town D. System Information (cont.) State 01845 Zip Code 11-29-16 Date of Inspection Approximate age of all components, date installed (if known) and source of information: 33 vears Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 38"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 10'-5 x 5'x 4' 30" feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: Sludge depth: ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover Ma 01845 page. CitylTown State Zip Code D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 29" 0 7° 14" 11-29-16 Date of Inspection How were dimensions determined? Tape measure sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Bith baffles are good, no leakage and the liquid leavels are good. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness ❑ fiberglass 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: t5ins - 3/13 feet ❑ polyethylene ❑ other (explain): D ate Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts F W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover Ma 01845 11-29-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane M Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. , City/Town D. System Information (cont.) Ma 01845 11-29-16 State Zip Code Date of Inspection Distribution Box (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.): Equal distribution, no solids are carrying over and there is no leakage Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins - 3/13 Title 5 official Inspection Forth: Subsurface Sewage Disposal System - Page 12 of 17 Commonwealth of Massachusetts N w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 92 Bridges Lane GSM Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. City/Town D. System Information (cont.) State Zip Code 11-29-16 Date of Inspection Type: ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system 2-1000 gallons Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No hydraulic failure, no ponding and no damp soils. 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 ❑ No l5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is North Andover required for every page. City/Town t5ins • 3/13 D. System Information (cont.) Ma 01845 State Zip Code 11-29-16 Date of Inspection 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.): Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. Cityrrown Ma 01845 11-15-16 State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate 7whe public water supply enters the building. Check one of the boxes below: hand -sketch in the area below ❑ drawing attached separately t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is North Andover required for every page. Cityrrown D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Ma 01845 State Zip Code 4 11-29-16 Date of Inspection feet Please indicate all methods used to determine the high ground water elevation: L7 Obtained from system design plans on record If checked date of design Ian reviewed 9/8/83 ' g p Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: Had old Title 5 from 2004 had plans Checked with local excavators, installers - (attach documentation) Accessed USGS database - explain: You must describe how you established the high ground water elevation: Taken from desiqn plan on record. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. CitylTown State E. Report Completeness Checklist 01845 11-29-16 Zip Code Date of Inspection ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information — Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ream Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis ORwner's Name North Andover City/Town Ma 01845 State Zip Code 11-29-16 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not by altered in any way. Please see completeness checklist at the end of the form. v/ Gmq A. General Information 1. Inspector: DEC 15 2016 John DiVincenzo TOWN OF NORTH ANDOVER Name of Inspector J and S Development Corp. dba Stewart's Septic Service, Andover%eptic Company Name 58 South Kimball st company Address Bradford City/Town 978-372-7471 Telephone Number B. Certification Ma State s113386 License Number 01835 Zip Code 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 ❑ IlWs Fu Signature ❑ Conditionally Passes ❑ Fails by the Local Approving Authority 0 Date The system inspector ball sub ifa copy of this inspection report to the Approving Authority (Board of Health or DEP) wit 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. ****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. t5ins • 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner's Name North Andover Ma 01845 11-29-16 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® 1 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. Check the box for "yes", "no" or "not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 _rk Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner's Name North Andover City/Town B. Certification (cont.) Ma n1 Adri 11-29-16 State Zip Code Date of Inspection ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins • 3/13 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner's Name North Andover Ma 01845 Cityrrown State Zip Code B. Certification (cont.) 11-29-16 Date of Inspection 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 fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® 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 Y2 day flow t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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 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. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover Ma 01845 11-29-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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 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. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is North Andover required for every page. Cityrrown C. Checklist Ma 01845 State Zip Code 11-29-16 Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ 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? ® ❑ 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 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? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: 13 Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 450 t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. City/Town Ma 01845 11-29-16 State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: ❑ Yes ® No occupied Date Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. City/Town D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: Ma 01845 State Zip Code Date General Information Stewart's Septic Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: 1500 gallons site guage on truck inspect tank ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy 11-29-16 Date of Inspection ® Yes ❑ No ❑ 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 8 of 17 Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. CitylTown t5ins • 3/13 D. System Information (cont.) Ma 01845 11-29-16 State Zip Code Date of Inspection Approximate age of all components, date installed (if known) and source of information: 33 vears Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: ❑ Yes ® No 38" feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 10'-5x5'x4' 30" feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: Sludge depth: ❑ Yes ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. CitylTown D. System Information (cont.) Septic Tank (cont.) Ma 01845 11-29-16 State Zip Code Date of Inspection Distance from top of sludge to bottom of outlet tee or baffle 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 29" 0 7" 14" How were dimensions determined? Tape measure sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Bith baffles are good, no leakage and the liquid leavels are good. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness ❑ fiberglass 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: t5ins • 3/13 feet ❑ polyethylene ❑ other (explain): Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. City/Town State 01845 11-29-16 Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3/13 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner's Name North Andover Ma 01845 11-29-16 City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (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.): Equal distribution, no solids are carrying over and there is no leakage Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C 4�M 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. CitylTown t5ins • 3/13 D. System Information (cont.) Type: Ma 01845 State Zip Code 11-29-16 Date of Inspection ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system 2-1000 gallons Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No hydraulic failure, no ponding and no damp soils. 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 ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. Cityrrown D. System Information (cont.) Ma 01845 11-29-16 State Zip Code Date of Inspection 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.): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�M A 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover Ma 01845 11-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate whe public water supply enters the building. Check one of the boxes below: hand -sketch in the area below ❑ drawing attached separately I A .0 a ao G -G=13. �yGr3�. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 92 Bridges Lane t5ins • 3113 D. System Information (cont.) Site Exam: ® Check Slope ❑ Property Address ® Ted Lewis Owner Owner's Name information is required for every North Andover page. City/Town t5ins • 3113 D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Ma 01845 State Zip Code 11-29-16 Date of Inspection Estimated depth to high ground water: 4 feet Please indicate all methods used to determine the high ground water elevation: 0 i Obtained from system design plans on record If checked date of design plan reviewed: 9/8/83 ' Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: Had old Title 5 from 2004 had plans Checked with local excavators, installers - (attach documentation) Accessed USGS database - explain: You must describe how you established the high ground water elevation: Taken from design plan on record. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Bridges Lane Property Address Ted Lewis Owner Owner's Name information is required for every North Andover page. City/Town Ma 01845 State Zip Code E. Report Completeness Checklist 11-29-16 Date of Inspection ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information — Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 North Andover Health Department Community and Economic Development Division 12/15/16 Address: 92 Bridges Lane All North Andover Residents with Septic Systems and GarbalZe Disposals Please note that due to a recent review of a Title 5 Report, your property has been identified as maintaining a working garbage disposal that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage disposals are never recommended where septic systems are used, but if they are installed, the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this disposal could quickly cause a pre -mature failure of your septic system, resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdeptgnorthandoverma. gov. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. Sincerely, k frian aGrasse, CERT Director of Public Health 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov 11/23/2004 11:35 9786851099 NEW ENG ENG PAGE 01 L-. fav 71 Tee Sue Sawyer Frons Benjamin Osgood, Jr. Dmft November23, 2004 Raoei PaPae�e 1 no TRe b queam CO L7 UIvw* x For Review D Fleas Cees &WO E3 Fka" Reply © Pkmo Rec"b The folloWno is a fetter asking for dadficdon on the use of mukVe reductions avowed with the use of aitemOM systems that I sent to qdf Gorden at DEP Sincerely, Benjamin C. , Jr., P, E. b.r-1 r 0 11/23/2004 11:35 9786851099 NEW ENG ENG PAGE 01 4 Tot Sue Sawyer plrions Benjamin Osgood, Jr. COMP W- Novetnber23, 2004 Rare Papaw no Tile 5 quemon oa is Un wd x for RwM w D Phrase ON w a t D Plowe Reply © Plow Raonls Sue, The fowWng is a IdW asking for dariicabon on the use of mugtple roducdons a0owed witty the use of alternative systems that I sent to Clair Golden at DEP Sirx,erely, Benjamin C. , Jr., P, E. 11/23/2004 11:35 9786851099 NEW ENG ENG PAGE 02 NEW ENGLAND ENGINEERING SERVICES INC November 23, 2004 By Fax and Mail Attention Clair Golden Department of Environmental Protection Division of Water Pollution Control I Winter Street Boston, MA 02108 RE: 94 Bridges Lane, North Andover Dear Clair: Thank you for your call today regarding the above referenced property. The specific issue which needs clarification is the "doubling" of different reductions allowed by different alternative leaching and treatment systems in one subsurface sewage system repair design. The specific question regarding the above referenced property is the use of a Fast pretreatment system to lower the required offset between the bottom of the leaching system and the water table from 4 feet to 2 feet combined with the use of the Infiltrator chamber system to reduce the required area for the leach system, It is the opinion of the review engineer for the Town of North Andover that the systems can not be combined to take multiple reductions without first applying to DEP for a variance. I am specifically asking for your interpretation of the matter and it is my belief that a variance should not be required, My reasoning is as follows. The Fast pretreatment system is being used to pre -treat the effluent prior to distribution in the leach field. The fact that the effluent is cleaner and therefore needs less treatment Prior to corning in contact with the water table is the basis for AEP having granted the approval of the Fast system for this type of reduction. The science behind the granting of the approval of this system is separate from the science behind the granting of the Infiltrator system approval. The infiltrator system approval for a reduced leach field size is based upon the fact that there is more surface area to treat the effluent at the bottom of the trench than that of a stone trench. By combining these two approvals there is no loss of the ability of each system to work as designed. The infiltrator field will work as designed to treat the effluent .in the same manner as a system without the Fast pretreatment unit. 6o BEECHWOOD DRIVE -NORTH ANDOVER, MA 0j645 -(978)68&-1I768- (888)359-7645- FAX (978) 685-1099 11/23/2004 11:35 9786851099 NEW ENG ENG PAGE 03 This same question has been raised before by the same review engineer but the combination of reductions was different. In those instances I asked for reductions in leach area size for the use of pretreatment, pressure dosing, and the equivalent size of the leach chambers. In that instance I agreed that the proposal coupled reductions in a manner that was not allowed. This present request however does not couple the same type of reduction and in my opinion should be viewed separately and therefore allowed. Thank you for your expedient review of my question. If you need any additional information please do not hesitate to contact me at the office number or at my cell phone number which is 508-328-4633.. Sincerely, . 25--�7 C C) Benjamin C. Osgood, r., PE President CC Susan Sawyer, RS North Andover board of Health Agent w M � 15 i • i r ' I CERWY TWAT THe SEPTIC 3YSTEM WAS INYXLEO AS SEiOVJ N . THIS PIAN ISNOT INTEl DEG AS A WARRAN'I" Y OP Tic �4, S o t ELEVATIONS TOP FND 162-0 HOUSE OUTLET 160.0 JT I NST 154.40 STOUTIET 154.27 D -BOX HET 153.76 D•BOX OUTi -r 153.62 PI T'°I 153.42 PIT`2 152.77 . t vrED SUBSURFACE SEWMAGE DISPOSAL, SYSTEM AS -BUILT LOCAM 1 LOT .7 -BPJDGES LANE OWNER FRED BISCHOF*P DATE 1045~$4 SCALE 1. PREPARED F LYNN ASSOC. P Co P. 0. 5 PLAISTOVt N.H. 03Bh5 J 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: t Z Z Owner's Name:,—A,�`� Owner's Address: Date of Inspection:Toil 1 lirii OF NORTH AN- =s�, SOARD OF HEALTH Name of Inspector: (please print) ON) �C�1 Company Name,�o f—Y AN 2 2004 i 6 Mailing Address:c Telephone Number: 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 Fails Inspector's Signature:,C1 �,/,1��1� Date:/— /�-- 0 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 bf inspection and under the conditions of use at that time. This inspection does not address how the sv_ stem will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 ,+ Page 2 of l 1 F � OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A *` CERTIFICATION (continued) Property Address: 4 ,9 4 Owner: Date of Inspection: ti Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: 7� S 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: N. 4 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) 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): ND explain: broken pipe(s) are replaced obstruction is removed - 2 r b°a t "Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS r, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of I sp : 1— 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: t eGsspool or privy is -within- 50 feet of a surface Seater µ" _ 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 anal sis must be.attached to.dos...form.: _. ._ ,r. , _ 4 , y,, . _ y -r _.F . + .. Y6 3. Other: „Wage 4 of I 1 , OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propert Owner: Date of D. System Failure Criteria applicable to all systems: You must indicate "yes” or "no" to each of the following for all inspections: Yes No ,__L.. -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 w4'Static.iaq tid�level,in-the!-distribution-box-above o�itiet"invEit due' 1i"er7oaded of cl6ggeif 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 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/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 designflowof 10,000 gpd to,15,000k w .. You must indicate either "yes" or "no" to.426 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. 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. 4 T, r ,Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner. s Date of Inspection: Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Le**" Pumping information was provided by the owner, occupant, or Board of Health `''Were any of the system component%pumped out in the previous tjxo-weeks ? Has the system received normal flows in the previous two week period ? LHave large volumes of water been introduced to the system recently or as part of this inspection ? 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 —J Were all system components, excluding the SAS, located on site ? __ 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 ? `�— 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: Ye no - ', �" ` - ~_ = Existmuiformion�For exai4iple, a flan afthe Board of Healtli. 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)] 5 �,3:._. ti ,"SY.:�j,nuc.,r+J..-;t�:.v�<A....'+14t�'.7zK..-tt.b��:ti.;l �� ���c✓��..,".+!*•`J..+e:.:'i'-SYGY�.. .�.«—.w,^.. Page 6 of 11 A OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C A SYSTEM INFORMATION Property Address: Date of FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): off o Number of current residents: �Q_ Does residence have a garbage grinder (yes or no): Is laundry on a separate sewage system (yes or no): k [if yes separate inspection required] Laundry system inspected (yes or no) Seasonal use: (yes.or.no).%ut%_ s;. S " . P's:,.. ._..... �r .. E Water meter re'a pings#if avapable (fast 2 years usage (gpd)). Sump pump (yes or no): _t 0 Last date of occupancy: 6 Up( C COMMERCIALANDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sqft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): _ Non-sanitarywaste 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: �9�JL S Was system pumped as part of the inspection (yes or no): _yj- S If yes, volume pumped: jj&gallons -- How was quantity pumped determined? _ Reason for pumping: fz -7 A A„t 5 r'a_'r C-ruQ TYPE, FSYSTEM _ = f w u'Se -tic '�smbntion'boz� soil abs m-. - p _ Single cesspool _ Overflow cesspool r _ 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: Were sewage odors detected when arriving at the site (yes or no): W0 wa:. t ...- .,.�`; c... ��:t/'w^►+F 1FL•.�. �Yi'�^,.+.a.,.+,�.: viw' .r+�� :4� .;F,*y.,.-My..J.-r.+--d �+....J.a---.:��-,te.�y.y�,^�� • 1 y $ Page 7 of I 1 A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert Owner: Date of BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction: _ ast iron _40 PVC _other (explain): — Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): 0 crwiTRR »Mtr �s:: ti'r: r. f�: SEPTIC TANK: _ (locate on site plan) I Depth below grade: 6 Material of construction: _ oncrete _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: Sludge depth: G/' i1 Distance fromtop of sludge to bottom of outlet tee or baffle: .7 S 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: How were dimensions determined: A / S 7-F Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): G'aoo -- L4Gin Zi-UelL=yre %+v GREASE TRAP: '(locate on site plan):; Depthbelow grade: v_ �...: Mateiial'of construction: concrete metalfiberglass Aolyethylene _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: k 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.): 7 :%"" . 1Lrs,�iy.�i.`r �l l'-.•rss..i .f,,,�+��}+1 �..%"•"!F.-a l'"Zs�+.-l�.i^�.c vYr+....•,../a,- [yam,,,.,,-•.^ .. 'kyv... •>''u^r"'.�F" x -S :'s"ti. "'t .7 *.'age 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: TIGHT or HOLDING TANK: ,dAtank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: ,,,..---Cap'acity i �� 6, p Design Flow: " 'allons7day' y, .J f '� 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: P (if present must be opened)(locate on site plan) Depth: of liquid level above outlet invert: .2 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.): 130 A 4 ncl d (`QM 0 / 'x'70 A—' PUMP CHAMBER: H r (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.): 8 Page 9 of 11 • OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ( / Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Tip e eachiil$ pits -' x, F � ,� leaching c ambers, number: l `� leaching galleries, number: leaching trenches, number, length: 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.): 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 laver: 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.): 9 ,.Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) /1 n y 1-4/y Property Address.:. A'�P-T Le-zle Owner:&'--5&-)�� Date of Inspection: 1— 107--) U 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. ji, 71 � x-13 LAje jZ%4 10 p1m we 4 • V Page I I of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:. Date of 13sped'idn:' I_1!T=0!1 SITE EXAM Slope )6 r p rc; 4 0 Surface water Check cellar PA—( Shallow wells PON Estimated depth to ground water feet I m6t'ho'd ica�� c6, k)ii th Please md�- ec s4W to dete ine e h0ground ater efivatiok Obtained from system design plans on record - If checked, date of design plan reviewed: --6bserved site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked.with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: /J 6 G -V 44 S Al- 1-40 W41!!r17_ (03-14 :J1 11 CERTIFIED PLOT PLAN LOCATED /N NORTH ANDOVER, MASS. SCALE: I"= 40' Scott L. Giles R.f Frank. S. Giles R. 50 Deer Meadoi North Andover, iN OF I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE ,� THE OFFSETS OF THE BUILDING INSPECTOR ONLY � SC '� s SHOWN COMPLY AND SUCH USE IS FOR THES .13972 � WITH THE ZONINGDETERMINATION OF ZONING �9f"ISTE4�� BYLAWS OF CONFORMITY OR NON -CONFORMITY NORTH ANDOVER WHEN CONSTRUCTED. q, ��g WHEN BUILT Board of Health BEPTIC SZSTEH North Andnver2,i"a. INSTALLATICK GMK LIST � ovID DATg DI �A.PPflC1PED LOT' AVATI CN OK FAIL OK 1. Distance To: a. Wetlands b. Drains.. c.. Well 2. Water Line Location 3. No PVC Pipe !t. Septic Tank ' a. Tees .:Length & To Clem Out Cowers b. Cement Pipe to Tank - on Both Sides ,of Tank 5• 'D'istribution Box a.'• Covers &,Box - No Cracks ,. b. All Lines , Flblving-`Fqu4jl 'Amounts c. ,No Back . Flou 6. Leach Field or Trench a. Dimensions, b. Stone Depth c. Capped Ends d. Clean Double Washed Stone 7. Leach Pits _ a.. Dimensions b. Stone Depth c. Splash Pads ` d. Tees e. Cement Pipe to Pit - Bo th Si es '-_._---_._. f. Clean Double Washed Stone 8. No Garbage Disposal (© -Z7 / 9. Final Grading Inspection 10. Barricading Covered System 11. _.._AL. Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard -to Perc Test d. Elevation - e: Water Table . 0 . j�v �,f Health :,ndover,Yasa K DATE LOT # 7 `i�e aga, , ~--- W Iq 17 - i Reg 2:`5''x' The submitted plan must show as a mini mum; the lot to be served-area,dimensions loti�,abutters b location and log deep observation hoes -di -stance to ties Location and results percolation tests -distance to ties design calculations & ealevlati ons sl�rnring rea_uireci leaching area j location and dimensions of system-3neluding reserve area � f . existing and proposed contours g) location any vat areas within 100' of sepage disposal system or disclaimer -check wetlands napping `h) surface and subsurface drz,ns vithin 100' of sewage disposal system or disclaimer location any drainage easeL.ents within 100' of serge disposal system or diselair'.er-Planning Board files j) kn = sources of nater supply within 2001 of s e-,--- ge di spo sal e system or disclaim• --r--,, - �C) Aocation-ef -rte ve proposed -veli to serlot-100' from leaching fac_i_li' ,� �) Location of mater lines on property -1U' from leachi..ng facili N (m)/7.ocation of benchmark drivev-ays o garbage disposals _ },,no PVC to be used in construction plumb., s tic tan (#q*) profile of - system- ellevations of basement, p ., distribution box inlets and outlets, distribution field piping and Other elevations () may- ground -,ester elevation in area se,age disposal system ,O(s) plan must be prepared by a Professional Eagineer or other I professional authorized by lax to prepare such plans Reg 6 Septic Tanks capacities -150 ' of flog, �=�,ter table, tees, depth of tees, accees, pumping 1000' (b) cleanout ool ,/ (c) 10' fro m cellar i,a11 or in nground sw�- --ng P I (d) 251 from subsurface drains Reg 10.2 I ` Distribution Faxes I (a) s pe gr eatsr tcan 0.08 Reg 10.4 (e kb) WAS SOIL PROFILE & PERCOLATION TEST DATA North Andover,, Mass. Street NoLot No Loc/Subdiv. / P1 and Owner Investigator �,�,r �C.Y.t� %/(/ Observer, ,/ a PT SOIL PROFILE DATES ,.rev 2.Elev 3.Elev 4.Elev V o 0 2 2 3 3 4 u 4 B �hmarrc Elevation f 0 1 2 3 4 5. 6 7 8 1 2 5 6 7 8 �+ 5 6 7 8 Start Saturation Soak -Minutes 17 9 9 i10 10 10 I< Location N© WA•O- Datum PERCO TION TESTS DATES 1 k I I Z -:� Ties Pt�q sTest Pit Number 1 2 3 �+ Start Saturation Soak -Minutes Start. e Drop of 3" -Time Drop of 6" -Time "• ,i Mims.lst 311 drop Mins.2nd 311 Drop if Percolation ,(p 'VQ BOARD OF HEALTH DESIGN APPROVAL Lot # STREET %-% L( C -S Septic Tank Permit'# Proposed Constructioni��-�'1 Approx Building Size Garage Under Attached None Min elevation of top of slab Min elevation of top of foundation N�A Height of foundation wall Footing in fill yes no Further Comments A