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Home My WebLink AboutTitle V Inspection Report - 2177 TURNPIKE STREET 8/6/2015 (2) / / Commonwealth of Massachuseft ^Title 5 Official Inspection Form L)/ � Subsurface Sewage Disposal System Form Not for Voluntary Assessments T��N�F�Q��AW0J`'�-� ^'' ' Turnpike T Property Address itAtTHE)EPART Joseph P and Alice Casey Owner Owner's Name information is MA O1845 8-8-2U15 eqvipm«^�er North Andover page. c|km�wn S:ge Zip Code -- Date of Inspection Inspection results must be submitted mn this form. Inspection forms may not be a|bmnmd in any way. Please see completeness checklist mt the end mf the form. /m;mm^m:When A. ��U 0��^��n on the computer, filling out forms ^ ~~ General Information ~^~^ use only"the tab 1. Inspector: key to move your cursor'unnot Michael JWood use the return wemam|mpe�n, �y, �SerVice Pumping_& Drain Co,, Inc. Company Name � 5 Hallberg Park Company Address � � North Reading MA ------- City/Town mae Zip Cvu* | | 878-276-0217 5021 | Telephone Number License Number � B 4��¢�� B. Certification � | certify that| havo personally inspected the sewage disposal eyetametMhis 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 (310 CyNR 15.0O0).The system: Z P000ea El Conditionally Passes El Fails L� Needs Further Evaluation by the Local Approving Authority 8-13-2015 � mavec�;�mo ' ��~^ Date � The system inspector shall submit a copy of this inspection report to the Approving Authority(Board � cf Health orOEP)within 3Oda�.of completing thia|napeotion. |f the system iaashared ~�~"~. or � has a design flow of1O.UUOgpdor greater, the inspector and the system owner shall submit the � report to the appropriate regional office of the DER 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 ofuse ot that time.This inspection does not address how the system will perform in the future under � the same mr different conditions ofuse. mns'3x3 Title s Official Inspection Form;Subsurface Sewage Disposal System'Page,m,, � �� Commonwealth of Massachusetts ' Title 5 Official Inspection F o ~m Subsurface Sewage Disposal System Form' Not for Voluntary Assessments 2177 Turnpike Street Property Address Jose and Alice J Casey Owner owner's Nam'* information is required for every North Andover MA 01845 8-6-2015 � page. citynrown State�� Zip Code-- B. Certification (cont.) Inspection Summary: Check /\B.C.DorE/always complete all of Section D A) System Passes: Z I have not found any information which indicates that any of the failure criteria described in3iUCN1R15.3O3orin31OCK8R15.3O4 exist.Any failure criteria not evaluated are indicated below. Comments: � � | 13) System Conditionally Passes: Fj One as described in the"Conditional Pass"section need to be replaced orrepaired. The system, upon completion of the replacement or repair, uo 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 Kit is structurally sound, not leaking and ife Certificate of Compliance indicating that the tank is less than 2O years old isavailable. � El Y [] N D ND(Explain be|ow)� � � � � t5ins'3113 Title,nfficu Inspection Form:Subsurface Sewage Disposal System'Page zm17 Commonwealth of Massachusetts ��=°�� "��Q ��^�~�� UD�Nm= �� 0M��Q�w0 Inspection �-�*u �vm Subsurface Sewage Disposal System Form'Not for Voluntary Assessments 2177 Turnpike Street Property Address J h Owner Owner's Name information is required for every NorthAudover MA 01845 8-6-2015 pane. Q�n w on SE��-- Zip Coue-- Date of Inspectio-n �l Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/o|armsara repaired. B) System Conditionally Passes (cont.): [l Observation of sewage backup or break out or high static water level in the distribution box due � to broken or obstructed pipe(m)or due boa broken` aaU|ed or uneven distribution box, System will pass inspection if(with approval of Board ofHea|th): F7 broken pipe(m)are replaced Fl Y l N [l NO(Explain bu|mw)' � � El obstruction is removed � Y � N � ND � __ -- � El distribution box ia leveled orreplaced [] Y [] N F-1 ND(Explain be|om): � � � | LJ 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 ofHeahh): � [] broken pipe(e)are replaced [] Y El N El ND(Explain be|ow): ! F1 obstruction ieremoved MY n N F-1 NO(Explain be|ow): � � | � � Cl Further Evaluation is Required by the Board of Health: � [J Conditions exist which require further evaluation by the Board of Health in order to determine if the system ie failing to protect public health, safety or the environment. � 1 System Board ofHealth determines in accordance with 310CK8R 15.303(1)(b)that the system|a not functioning imm manner which will protect public health, safety and the environment: � � LJ Cesspool or privy ie within 6O feet ofa surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh � � t5lns'3n3 Title u Official Inspection Form:Subsurface Sewage Disposal System'Page`mn Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2177 Turnpike St t Property Address Owner Owner's Name information is required for every North A MA 01845 8��01S page, City/Town Tuwn �� State -- Date of Inspectio-n B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, ifany) determines that the system imfunctioning In a manner that protects the public health, safety and environment: M The system has a septic tank and soil absorption system(SAS)and the SAS is within 1OO feet ofa surface water supply or tributary toesurface water supply. � M The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply, � LJ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. � L] The has a septic tank and SAS and the SAS ia less than 10O feet but 5D feet or � more from a private water supply wo|l ° � Method used bn 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 bo All - : � You must indicate "Yes"mr"No"bo each of the following for all inspections: i � Yes No E-1 Z Backup of sewage into facility or system component due tn overloaded or clogged SAS orcesspool Discharge orpondin of effluent io the surface of the ground or surface waters � due toan overloaded or clogged SAS orcesspool [] �� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS nrcesspool [] E available Liquid depth in cesspool is less than 8^ ba/m*inme�nrvo|ume is less than ��day flow mw"'oo» Title o Official Inspection Form:Subsurface Sewage Disposal System'Page^w1r � � � u�^ Commonwealth of Massachusetts Title��"��H�� J��"��"��H 0��"�� N�8�� NUQ��H�=M �mm=°��W�=ww Form Subsurface m ��ag��o��| �y�i� Fovm -NotforVo|untmryAeoeoamenhe 2177T ik Gtnaat Property Address Joseph_P and Alice Casey Owner Owner's Name information is North [NA 01845 -8 ewui�u�,mm� '`" '' page. City/Town y State —' -- ---—'-- -- B. Certification ��t\ � . . � Yes No � �l �� Required pumping more than 4dmesin the�s year NOT due tnc�ggedor �� obstructed pipe(s). Number of times pumped: ____. � El z Any portion of the SAS, cesspool or privy is below high ground water elevation. E-1 2 Any portion of cesspool orph v� vyiothin10Dhaetofoeurfaoewaheraupp|yor tributary Uoo surface water supply. � � El Z Any portion ofo cesspool or privy io within m Zone 1 ofo public well. � n z Any portion of a cesspool or privy is within 50 feet of a private water supply well. Fl z Any portion of a cesspool or privy ia less than 1OO feet but greater than 5Ufeet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis performed ateDEPcertified laboratory,for fecal co|iform bacteria indicates absent and the presence mf ammonia nitrogen and nitrate nitrogen ie equal toorless than 5ppnn. provided that no other failure criteria are triggered.A copy of the analysis and chain qf custody must be attached to this fmrmn.] The system ioa cesspool serving a facility with a design flow of2OUOQpd- ^~ 10.000gpd. F� �� The mysbwrn��s. / have determined that one or more of the above failure �~ criteria exist madescribed in 310 C[NR 15 3O3. 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: Tmba considered a large system the system must serve m facility with o design flow uf 10,000 gpdtm16,000 gpd' For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the | | questions in Section D. | Yee No � [] Fl the system is within 4OO feet ufo surface drinking water supply [l n 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—|VVPA)ora mapped Zone|| ofa 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 16.304. The system owner should contact the appropriate � regional office of the Department. � t5m"`3n3 Title o Official Inspection Form:Subsurface Sewage Disposal System'Page vm,r � � � � � � � Commonwealth *fMassachusetts � ��4.�� "��D 0��°��^�� k�� 08��= �� w�0UN��N�m0 Nvo��B��mu 0—��uomx Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Turnpike Oroperty Address Joseph P and Alice J Casey Owner Owner's wumo information is i8 8 �nvimo�rove� North page. QtyfF»w» a,ove Zip Code Date mInspection � C. Checklist Check if the following have been done. You must indicate"yes nr^no"asto each of the following: � Yes No � D Pumping information was provided by the owner, occupant, or Board ofHealth � �l N Were any of the system components pumped out in the previous two weeks? D Has the system received normal flows in the previous two week period? � [l �� Have large volumes nf water been introduced bo the system recently mroopadof � �� this inspection? � �� VVareas built plans of the eyo�mobtained and examined? (If they were not � ~� ^~ available note ooNAH � • Fl Was the facility or dwelling inspected for signs of sewage back up? • F-1 Was the site inspected for signs of break out? � [9 F1 Were all system components, excluding the SAS, located onsite? N El 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 ofscum? 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: Z M Existing information. For example, o plan ot the Board ofHealth. Fl �� Determined in the field(if any of the failure criteria related to Part C is at issue | approximation Vf distance isunacceptable) [310 CK4R 15.302/5>] | | | D. S��e0M U�� | �--- | | Residential Flow Conditions: � Number nf bedrooms(deeig 4 n)� -------' Number of bedrooms(actuo0 4� ----�----- | DESIGN flow based Vn31OC[NR15.2O3 (for exompl 44OGPD�� 11Ogodx#ofbedrO�mg)� --------- 15i°'3113 Title o Official Inspection Form:Subsurface Sewage Disposal System-Page 6m`, � � Commonwealth of Massachusetts � ��=�� w��^��"��0 0��^��=�� 0°��A Title ��BU��@�*0 Inspection 0—��" mww "� H�� Subsurface Sewage Disposal System Form~Not for Voluntary Assessments 2177 T rn ikeGtreed Property Address Joseph P and Alice JCasey Owner Owner's Name � information is mqu|mu for every North Andover MA 01845 — page. ^'p = �E�� ' ' ^',~"= ~"="'"~'~=~' D. System Information Description: � � � � � � Number of current e � 4 eiden � ---------- � Does residence have a garbage grinder? E] Yee 0 No |a laundry ono separate sewage system?(Include laundry system inspection �� yea �� No � info/modnnin #hionepo�.) ^~ �� Laundry system inspected? 7 Yes Z No Seamona/ ueeY F7 Yes Z No � Water meter readings, if available(last 2 years usage(gpd)): Detail: | Sump pump? -- --[l ymo K� No | | Last date ofoccupancy: currently cu | d / Commmnen:|mUNnduskrim) Flow Conditions- Type of Establishment: Design flow(based on31OCKAR1b203)� | � � Gallons per day(gpd) | Basis of design flow(anats/peroons/sq.ft, etcj: Grease trap present? [] Yea Fl No Industrial waste holding tank present? [l Yen R No i Non-sanitary waste discharged to the Title 5eyatemY El Yes El No Water meter readings, if available: mm°'m`` Title o Official Inspection Form:Subsurface Sewage Disposal System'Page rm', � � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form^Not for Voluntary Assessments 2177 T n |k Street Property Address Joseph P and AU J Casey Owner Owner's Name information is required for every North Andover MA 01845 1 vanu. ""''.~_, State Zip Code_ ___of Inspection D. System Information (cont.) Last date ofocoupanny/use: Date Other(describe below): � � � � General Information Pumping Records: Source information: owner Was system pumped ae part of the inspection? El Yes E No If yes, volume' ' gallons How was quantity pumped determined? Reason for pumping: Type of System: E-1 Septic tank, distribution box, soil absorption system El Single cesspool � Fl Overflow cesspool � � E] Privy [l 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/A\system by system operator under contract � Fl Tight tank.Attach a copy nf the DEPapproval. Other(describe): se;ttic tank, chamber, d-box, SAG t5ins'3m3 Title^Official Inspection Form:Subsurface Sewage Disposal System'Page om,r � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2177 Turnpike Street Property Address Joseph P and Alice J Casey Owner Owners Name information is required for every North Andover MA 01845 8-6-2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: The system is approximately 10 years old according to plans dated 4-10-2005. Were sewage odors detected when arriving at the site? ❑ Yes M No Building Sewer(locate on site plan): 20" Depth below grade: feet Material of construction: ❑cast iron M 40 PVC ❑ other(explain): -- >100' Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): There are no visible signs of failure or leakage. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: ye ars Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 6'x 5' <1 Sludge depth: t5ins 3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System-PaQO 9 Of 17 Commonwealth of Massachusetts it 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2,177 Turnpike Street Property Address Joseph P and Alice J Casey Owner Owner's Name information is required for every North Andover MA 01845 8-6-2015 page. &j�y—fTown---'----- state Zip Code --5-a—te of inspect—ion D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle >2 Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum 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.): There are no visible signs of failure. Both the inlet and outlet tees are intact and appear to be working as designed._ Grease Trap (locate on site plan): Depth below grade: poet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date - 15ins-3113 Tide 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 2177 Turnpike Street Property Address Joseph P and Alice J Casey Owner Owner's Name information is North Andover MA 01845 8-6-2015 required for every page. dit-y/Town 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 F-1 metal ❑fiberglass F-1 polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: E-1 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 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 <L Commonwealth of Massachusetts it 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2177 Turnpike Street _ _ Property Address Owner Owner's Name information is North Andover MA 01845 8-6-2015 required for every page. b7tiyifiown ___'_ ---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 at invert 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.)-. There are no visible signs of failure. ------------- 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 (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2177 Turnpike S-treet--- ----- ----Property Address Joseph P and Alice J Casey Owner Owner's Name information is required for every North Andover MA 01845 8-6-2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: F-1 leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: 0 leaching fields number, dimensions: 1, 20'x50' ❑ 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.): There are no visible signs of failure. 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 t5ins•3/13 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 m Not for Voluntary Assessments 2177 Turnpike Street Property Address Joseph P and Alice J Case Owner Owner's Name information is required for every North Andover MA 01845 8-6-2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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 <L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2177 Turnpike Street Property Address Joseph P and Alice J Casey_. Owner Owner's Name information is required for every North Andover MA 01845 8-6-2015 page. CityTrown 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 where public water supply enters the building. Check one of the boxes below: F-I hand-sketch in the area below Z drawing attached separately t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 17 <C� Commonwealth of Massachusetts it 5 0"Wr al Inspection Form Subsurface Sewage Disposal System Form«Not for Voluntary Assessments 2177 Turnpike Street Property Address Joseph P and Alice J Casey Owner Owner's Name information is required for every North Andover----..-.--..- MA 01845 8-6-2015 ---- page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: E Check Slope Z Surface water Z Check cellar Shallow wells 6' Estimated depth to high ground water: feet _ Please indicate all methods used to determine the high ground water elevation: z Obtained from system design plans on record 4-10-2005 If checked, date of design plan reviewed: Date ---- F-1 Observed 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: Plans that were supplied bK the homeowner. mn n, 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2177 Turnpike Street Property Address Joseph P and Alice J Casey Owner Owner's Name information is required for every North Andover MA 01845 8-6-2015 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist 0 inspection Summary: A, 8, 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 N tkF;a L 1-5 Jt ............ r s