HomeMy WebLinkAboutMiscellaneous - 995 FOREST STREET 4/30/2018IS
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January 15, 2014
995 Forest Street —
Request for information by an architect regarding an addition. SS responded
Research found a very thin file; no information other than a Title V insp from 1998
T — V Insp. noted a three bedroom home — built in 1978 —
- System is comprised of 1000 gal concrete septic tank, d -box and 3 pits
Caller verbally described a home currently @ 8 rooms. Wish to add two rooms and subtract one wall
with a net increase of 1 room possibly.
An increase in flow from the assumed 3- bedroom (seven room) home to 8 or more would require an
upgrade of the septic system. Advised the caller to tell the owner to contact an engineer to begin
process if they plan to move forward with the addition. Often if an approved plan is obtained the Health
Department will accept a letter requesting to start the addition prior to septic system installation. This
could be a possibility, but they have to have made a commitment; ie by getting the approval, signed
agreement, estimate or signed contract etc.
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TOWN OF NORTH ANDOVER
S STEM PUMPING RECORD
DATE: O5 �a
SYSTEM OWNER & ADDRESS
D-57-/
SYSTEM LOCATION
(example: left front of house)
Ems - s i clp_ 10-�- hou s'e.
DATE OF PUMPING:. -ZS��� QUANTITY PUMPED GALLONS
CESSPOOL: NO �_ YES SEPTIC TANK: NO YES G'(
NATURE OF SERVICE: ROUTINE �_ EMERGENCY
OBSERVATIONS: n'
GOOD CONDITION l�
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
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WILLIAk! F VELD
Govcrno:
COMMONN EALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON. ?,IA 02108 61:-_292.$500
ARGEO PAUL CELLUCCI
Lt. Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 99,6�_ rc pest 4t-eeef, .V- 1-Jz>,,e-L Address of Owner:
Date of Inspection: 'it 21 lees (If different)
Name of Inspector: BERJAMIN C. OSGOOD JR. '
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: NEW ENGLAND ENGINEERING SERVICES, INC.
Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA_ 0 184 5
Telephone Number: 508-686-1768
TRUDY CORE
Sccrcun
DAVID B. STRUHS
Commissioner
CERTIFICATION STATEMENT f
1 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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems The system:
Passes
•% Condr4ronalh Passes I
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature:Date:
The System inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system or has a design flow of 10.000 go or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the byyer, if applicable. and the approving authority
INSPECTION SUMMARY: Check A, 8, C, or D:
AI SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure crite:-a ss dtfined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
BI 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.
Indicate yes, no, or not determined (Y. N. or ND). Describe basis of determination in all instances. If 'not determined-, explain why not.
The ieptic tank is metal, unless the owner or operator has provided the system inspector with a ropy of a Certificate of
Compliance (attachedl indicating that the tank was installed within twenty (201 Years prior to the date of the inspection: or
the septic tank, whether or not metal, is cracked. structurally unsound, shows substantial infiltration or ex(ittration, or tank
failure is imminent. The system will pass inspection i(the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
rr.vid 04/7s/971 raq. 1 or 10
.......... .......
In
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: cjq S Fa rCs f' S Ft e 4-r /l� , fry-Qci i t/1 -
Owner: \ So rt
Date of Inspection:
81 SYSTEM CONDITIONALLY PASSES (continued!
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken. settled or uneven distribution box. The system will pass inspection if'(with approval of the
Board of Health;. Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if (with approval of the Board of Health)
broken pipe(s) are replacer
obstruction ,s removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which reouire further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health. safety and the environment:
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRON 0ENT:
Cesspool or privy ,s within SO feet of a surface water
Cesspool or p(nv is within SO feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT: t
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply. I
The system has a septic tank and soil absorption system and the SAS is within a Zone 1 o(a public water supp'v well.
The system has a septic tank and soil absorption system and the SAS is within SO feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well. unless a well water analysis for coli(orm 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 S ppm. Method used to determine distance (approximation not valid).
3) OTHER
(c.vi..d 04/75/21) ►.y. 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
t
Property Address: A''(J
Owner: p is o ✓I
Date of Inspection:
�i(27
DJ SYSTEM FAILS:
You must indicate either -Yes-or "No- as to each of the following:
I have determined that the system violates one or more of the f6llowing failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool
r
Static liquid level in the distribution boa 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 floe,..
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of Mines pumped _.
Any porton of the Soil Absorption System, cesspool or privy is below the high groundwater elevation
Am• porton o: a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privyis within a Zone I of a public well. I
Any ponion of a cesspool or privy is within 50 feet of a private water supply well
Anv portion of a cesspool or privy is less than 100 feet but greater than SO feet from a private water supply well with no
acceptable Nater quality analysis. If the well has been analyzed to be acceptable. attach copv of well water analysis for
coliform baagria. volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
EJ LARGE SYSTEM FAILS: I
You must indicate either -Yes- or -No- as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 go or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
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 11 of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR S.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/91) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: qct S aFo rc s} 5�—n ��', N. &Jole. eL
Owner: ply 0.N
Dale of Inspection:
Check if the following have been done: You must indicate either 'Yes- or -No- as to each -of the following:
Yes No
_ Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped (or at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
/ as pan of this inspection
V _ As built plans have been obtained and examined. Note d they are not available with N/A.
✓ _ The iacility or dwelling was inspected for signs of sewage back-up.
✓ _ The system does not recFtve non -sanitary or industrial waste flow.
✓ _ The site was inspected for signs of breakout.
_ All system components. excluding the Soil Absorption System, have been located on the site.
✓ _ The septic tank manholets were uncovered, opened. and the interior of the septic tank was tnfipected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
✓ _ The facility owner Land occupants, if different from owners were provided with information on the proper maintenance of
Sub -Surface Disposal System.
Existing information. Ex.tPlan at B.O.H. t
Determined in the field (ti any of the failure criteria related to Pan C is at issue, approximation of distance is
unacceptable) (15.302(3)(b)) I
trevs..d 04/75/7'1) :.y. 4 of 10
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION -FORM
PART C
SYSTEM INFORMATION
Property Address: 1q5- Fo.cs1' �Shrtie{� /V. f '-kotit.
Owner: 01-%.D n
Date of Inspection: H I z,11 Qct 9
FLOW CONDITIONS
RESIDENTIAL:
Design flow: Q.p.dJbedroom (or S.A.S
Number of bedrooms: 3
Number of current residents: .5
Garbage grir.der (yes or no?:
Laundry connected to system yes or no): t�
Seasonal use (yes or no): (L/_
Water meter readings, if available (last two (2) year usage (gpd): Wel
Sump Pump (yes or no):_AL__
Last date of occupancy: 'Ca ni.r-wt
COMMERCIAL/I NDUSTRIAL:
Type of establishment:
Design flow: gallons/day
Grease trap present: (yes or not_
Industrial Waste Holding Tank present: (yes or no)_
Non -sanitary waste discharged to the Title i system: (yes or no)_
Water meter readings, if available
Last date of o•-cupanc•:
OTHER: (Describe!
Last date of occupancy.
GENERAL INFORMATION
PUMPING RECORDS and source of information '
rs
System pumped as part of inspection: (yes or no)-Sf-S
If yes, volume pumped: / v o o gallons
Reason for pumping _ j0&- rJ wn e�- ►^eu , �, f'
TYPE OF SYSTEM
_X Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
VA Technology etc. Copy of up to date contractl
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: ffS- f3.i- i1- JQ—kS1 t! 29 7 3
Sewage odors detected when arriving at the site: (yes or no) .&
(ravio.d 04/2s/97) >.yo s of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: C19 S- (corc,t Si -(ref; A),
Owner: pjs o n
Dale of Inspection: ti ZZ 1.1 G
BUILDING SEWER:
(Locate on site plan)
Depth below grader_
Material of construction: ✓cast iron _ 40 PVC _ other (explain)
Distance from private water supply well or suction lire 1�5 r
Diameter —
Comments: (condition of joints, venting, evidence of leaks C. etc.)
(2, pc— IS h 64�,e
SEPTIC TANK:_
(locate on site plana
Depth below grade:
Material of construction: concrete _metal _Fiberglas) _Polvethylene —other(explain)
If tank is metal, list age _ Is age confirmed by Cenificate of Compliance _ (Yes/Nol
Dimensions: /000 Cy- 4" 13 .v
Sludge depth: S"
Distance from top of sludge to bottom of outlet tee or bafftte: Z
I
Scum thickness: G "
Distance from top of scum to top of outlet tee or baffle.__
Distance from bottom of scum to bottom of outlet tee or baffle: Z6`�
How dimensions were determined: M e tv.,> ^e- S T. c K
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, struoural
integrity, evidence of leakage, etc.) TAn/K / s / i / Csvo o C o N D4 1-7ID" e- cc., 't�t
GREASE TRAP: :a4'
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _o(her(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle.
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles. depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
(revised 04/7S/)lt Page 9 or 10
PUMP CHAMBER-"
(locate on site plan)
Pumps in working order: (Yes or Nol
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/171 page 7 of 10
" fi `;
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: qqS Fv.rCs $ N. /ti'Zo.itt. M4
Owner: a ✓\
Date of Inspection: N t Z liq s
TIGHT OR HOLDING TANK: /Vi -rank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacm: gallons
Design flow gallon/da\
Alarm level Alarm in working order _ Yes; _ No
Date of previous pumping:
Comments:
(condition of inlet tee. condition of alarm and float switches. etc.)
DISTRIBUTION BOX:_
(locate on site plani
rr
Depth of liquid level above outlet invert:_
Comments:
(note ii level and distribution is equal. evidence of solids carryover, evidence of leakage into or out of box, etc.)
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PUMP CHAMBER-"
(locate on site plan)
Pumps in working order: (Yes or Nol
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/171 page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: q$S FJres�' Sf; N•
Owner: p l s o'l
Date of Inspection: 412-11119
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible: excavation not required, but may be approximated by non -intrusive methods)
if not determined to be present, explain:
Type:
leaching pits, number: 3
leaching chambers, number:_
leaching galleries, number:
j leaching trenches, number.length:
leaching fields. number, dimensions:_
overflow cesspool, number:
Alternative system:
Name of. Technology:
Comments:
(note condition of soil, signs of hydraulic failure. level of onding, condition of vegetation, etc.)
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CESSPOOLS: IV(*'?'
(locate on site plan)
Number and configuration.
Depth -top of liquid to inlet invert:
DRpth of solids layer:
Depth of scum laver:
Dimensions of cesspoo!:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as pan of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY: /llq-
(locate on site plan)
Materials of construction:
Depth of solids:
Comments:
(riote condition of soil, signs of hydraulic failure, level of ponding, contlition of vegetation, etc.)
(r-rim.d 04/25/17) ►aye 4 of 10
Dimensions:
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: O`
Date of Inspection:
(.� 2-1' q
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
ISO
(revised 04/25/!71 Paq• I of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: q47 Stv,ee� /1„L_
Owner: O)
Dale of Inspection:
W(z7Iq-,
Depth to Groundwater i(- Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abuning property. observation hole. basement sump etc.)
Determine ,t irom local conditions
Check with !oca! Buard of health
Checi FEMA Maps
Check pumping records
Check local excavators. installers
Use USGS Data
Describe in \•our own words how you established the High Groundwater Etevation.t (Must be comple(ed)
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(r.vl..d 04/25/91) P.q. 10 or 10
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NORT/i
BUILDING PERMIT
TOWN OF NORTH ANDOVER so
APPLICATION FOR PLAN EXAMINA I04
ON
Permit NO: Date Received
Date Issued:
c►+uset�5
IMPORTANT: Applicant must complete all items on this page
LOCATION 5 Fo r2 s- S fres.+
(,
PROPERTY OWNER M iCk(qrL 1 t J'ch,Pri�e.ntr V
Print P Ck URiyrr�MAP NO: fe�PARCEL:,ZONING DISTRIC'
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
❑ New Building
® One family
& Addition
❑ Two or more farr
❑ Alteration
No. of units:
❑ Repair, replacement
❑ Assessory Bldg,
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain E
❑ Water/Sewer
a'J"1J New MnsW SeJl?xarn "'otree- �r'i4r�9t%t
ofisn�Q
V {GV fY�.
AA ,�Identification Please Type or Print Clearly)
m
OWNER: Name: ao'a1 �C�,���r (�q0�-�-�, Phone:g� -6�9�4515
Address: q q 5 r re S- S�re d.+
CONTRACTOR Name: 41-389--333,_ Phone:
sft"0'4 blckd'411r4
Address:
PO 909 3s 6 tieu,ioa A/1 038s9
Supervisor's Construction License:/ Exp. Date:
Home Improvement License: / J Exp. Date: 2 J 114/
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: SULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ Sr/, 0" FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the gu, aarranty�fund
Signature of Agent/Owner -- Signature of contractor 1�