HomeMy WebLinkAboutTitle V Inspection Report - 165 BOSTON STREET 8/5/1996 ._. ......._ Commonwealth it onY_ ealth of I tl Iassach6setts _ ..
Executive Office of Environmental Affairs
lepartment of
Environmental Protection
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Metro Boston/Northeast Regional Office
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William F.Weld ,
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David S.Struhs
Commissionar
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
`165 Boston St.
Property Addre": N.Andover, MA of Owner.
Date of LuPscH= 8/5/9 6 (If different)
Name of James W. Wright, JR.
Company Name, and Telephone Nnfi bm`: (508)681 -8759
R'.J. Inspections
1 Osgood'.-,St. Methuen, MA 01844
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 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
® Conditionally Passes
Further Evaluation By the Local Approving Authority
InsPectPrIs Sjr ,- -----_ •Date:
The System 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 gpd 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 buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C,or D:
A] SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303,
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,pasm
inspection.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not deternined",explain why not)
® The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 8/15/95) 1
10 Commerce Way • Woburn,Massachusetts 01801 a FAX • Telephone
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):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
i
v
(revised 8/15/95) 2
- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
• PART A
-
CERTIFICATION(continued)
Property Address: 65 Boston: St. , N.Andover, Ma
Omer: - Arthur Chase
Date of Ia�/5/9 6
BI SYSTEM CONDITIONALLY PASSES(continued) -
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 replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
i
Conditions exist which require 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 ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated.wetland or a salt marsh..
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNC'T'IONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE .
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100'feet to a surface water supply or tributary to a
surface water supply. -
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis 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.
Dl SYSTEM FAILS:
have determined that the system violates one or more of the following 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.
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.
L, 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 U2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
(revised 8/15/95) 3
Number of times pqmlped
Any portion of the Soil Absorption System, cesspool or privy is below the.high groundwater elevation.
Any portion of 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 privy is within a Zone I of a public well.
1
(revised 8/15/95) 4
MSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAST A
CESTIF'ICATION(continued)
Property Address: 16.5 Boston-St. , N.Andover, MA - -
owner. Arthur Chase
Date of Lumection: 8/5/96
D)SYSTEM FAILS(continued):
Any portion of a cesspool or privy is within 50 feet of a private water pply 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. If the well has been analyzed to be acceptable,:attach copy of well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAUX:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd 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:
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)
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 5.00 and 6.00. Please consult the local regional office of the Department for further information.
PART B
CE[ECHLIST
Check if the following have been done:
` Pumping information was requested of the owner,occupant, and Board of Health.
1;, one of the system components have been pumped for 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 part of this.
inspection.
built plans have been obtained and examined. Note if they are not available with N/A
_—Thh,facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow
site was inspected for signs of breakout.
m components,excluding the Soil Absorption System,have been located on the site.
(revised 8/15/95) 5
_✓The,septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for
condition of baffles or tees, material of"cgnstruction,dimensions, depth of liquid, depth of sludge, depth of scum.
he size and location of the Soil Absorption System on the site has been determined based on existing
information or app ted by non-intrusive methods.
_The facility owner(and occupants,if different from owner)were provided with information on the proper
maintenance of Sub-Surface Disposal System.
(revised 8/15/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
- PART C
SYSTEM INFORMATION
Property Address: 165 Boston St. , N.Andover, MA
owner Arthur Chase
Date of Inspection: 8/5/9 6
- FLOW CONDITIONS
RESMENTIAIr
Design flow: gallons
Number of bedrooms:
Number of current residents:
Garbage grinder(yes or no):_4161
Laundry connected to system(yes or no).-Yof
Seasonal use(yes or no): A/rJ
" Water meter readings,if available:
Last date of occupancy:
COMMERCIALIINDU�/TRL
Type of establishment:
Design flow_�llons/day
Grease trap present:(yes no)
Industrial Waste I3oldi�g ee (yes or no)_
Non-sanitary waste'dis to :/"tle 5 system: (yes or no)_
Water meter readings,if a le:
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and
wurce of info tion
,Z ,;�i�, 7> 3 � 2s . mac
System pumped as part of inspection:(yes or no)_
If yes,volume Pumped: 0 2 gallons -
Reason for pumping:
TYPE OF Septic t M
✓Septic ank/distributioa box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records, if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if]mown) and source of information:
Sewage odors detected when arriving at the site:(yes or no)_
(revised 8/15/95) 7
m
r
SUBSURFACE SEWAGE DLSPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
property Address: 165 Boston St. N.Andover :MA
o..� _ Arthur Chase - -
abate ad Iaspecon:$
5/96
"SEPTIC TANK:
(locate on site plan)
Depth below.8rade: ,
Material of construction:_concrete metal FW other(ezplain)
Dimensions: '' t �/ L
Sludge depth
Distance from top of sl jdge to bottom of outlet tee or baffler
Scum thickness: '3 '
Distance from top of scum to top of outlet tee or baffle:_
Distance from bottom of scum to bottom of outlet tee or baffie: C�
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 lealiage,'etc.)
/S7�r� ri/ /°tea/ -6
rti19 -7-
I
GREASE TRAP:
(locate on site plan) .
Depth below grade:
Material of construction: concrete_metal _other(explain)
;Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee o'
Distance from bottom of scum to bottom of ou t or affle:
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 8/15/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
_ PART C -
SYSTEM INFORMATION(confirmed)
Pity • 165 Boston St. , N.Andover, MA
O Arthur Chase
Date of Imped60n:8/5/9 6
TIGHT OR HOLDING TANS:_
(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_FRP—other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Qomments:
(condition of inlet tee,condition of alarm anF.�he tc)
DI STRIBUTION BOX--
(locate on site plan)
Depth of liquid level above outlet' rt:
Co nts:
note if level and distrilution is equal,evidence of solids carryover, evidence of lealrge into or out of box,etc.)
s' L
PUMP CHAl IBEBc
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber, condition of ps and p ces, etc.)
(revised 8/15/95) 9
SUBSURFACE SEWAGE DLSPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continned)
Property Ad&-e B-- 165 Boston St. , N.Andover, MA
o..ner Arthur Chase
Date of Inspection- .8/5
/96
SOIL ABSORPTION SYSTEM(SAS):_ -
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined p n plain:
0�2 17X
leaching pits,number
leaching chambers,number._
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number.
Comments: (note condition of soil,signs of hydraulic failure,level of n '
po duig,condition of vegetation,etc.)
CESSPOOLS:
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert: '
Depth of solids layers
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped
71aryA, pection)
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 so' signs o c failure,level of ponding,condition of vegetation,etc.)
(revised 8/15/95) 10
SUBSURFACE SEWAGE DISPOSAL - _ -
SYSTEM INSPECTION FORM _
. _ _ PART C
- SYSTEM INFORMATION(wed) -
PropertiA1fi5 Boston St. , N.Andover, MA
O"nar thur Chase _
Date
of Iatped�an 51,96
SSF'I'CS OF_SEVPAGE DL4POSAL SYSTEM
include ties to at least two permanent references landmarks or benchmarks d
•'locate all wells'within 100'
S -
�r
DEPTH TO GROUNDWATER -
Depth to poundwater.—X:—rfeet
method of determination approumatioas
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I
i
(revised 8/15/95) 12
a P ; 1 ?�,i; f.:I l.i._...'0 i L I!'.J 'r'1�- .._L 31 11 T,
HEALTH _ -. \. pr. p�
- .'i a-.�Lt.l�.i�l i� lV�w i`;{iJ.1H ATIT 0VE S'�l��?D
I. hereby r".ake p pl:i.4.:ct'viot"s f o.. - j3t,s':il.�,� u YD a :a,.y3g� C 2L C:i?L
install,ation at l;o7 . T -nill install ta_s
317St.etil in 7iCC01'dc1aCc :wi ah 33.�fi 't:�. rcbw;� G1 _Lai2OTil l�':1�V�a�.T,h o'f
1 ,,_,..
I��SSachuSet�c5_ arl _ rep„?atz�n3 of the Board of .Health of the Town
of North 'Andover,
Further, s LTx.lj coric;truCt. the t1CLiS° 5d'J°;' of bel? 3P.w 3;�3t,At
pipe, the minJILIM"11 di;ws,-Lott�r b nze 4 inches, an j v-i.11 maint-ai:a a
minimum grade of 1 m ti3. 10 f ee-c preceding -t',a septic iar.%, ?Nher t;
the grade steal' not exceed 2`Zo 1 install 2 concrete s:.t t-I c
tank of -5-,O-V4Ot in siz:,, A manhole (s) permitting easy cle.�in<-
ing will be p. �*�sied with removable cover (s) of iron or concrete
Within 12 incheo of 3,he grcu id s "fc`icue l .vi?1 provide
disposal field with open Jointed bell and spigot Ack on pipe at
least Lr inchas in diameter and lade, in a se.iz3s of trenches, the
bottom of which will provide a. min.irrua of
(gam) feet of effect-'v- azu sorption area. The pipes will be i s
on a 6 inch layer of wash ed r.�avel or crushed stone ranging in
size from 3/� to 1 1/2 inches_ (dia. ) and the a_ ices will bs
surrounded by similar material to a h4:i ght of 2 Lech s above the
crown of the pipe. The ,points of these pipas will be protected
from clogging and before filling the trench, 2 inczes of gravel.
or stone 1/817 to 1/411 (&_. ) wi.11 be placed over the course grad-et
or stone. The disposal field will be installed at a grade of 4
to 6 incises/100 feet. No single tile line Trill exceed 100 feet
in length and in any case, tgo lines of tile will be installed.
A minimum of 6 feet iTill- be maintained between the center lines o”
the disposal field trenches and the average depth of :,ranch shall
not exceed 36 inches. No part of the installation will be Less
than 100 feet from any private �water supply, 25 feet from any
stream, 20 feet from any dwelling or 10 fee-. _roil any property
line. I further a&ree not to cover and port-ion of this insf,allat'JXn
until a Rrove ]2j the inspection oxf'16er, as provide be oTn anT
to incorporate any additional requlre.m nts `,ha mar be attached to
the permit. Plot Plans must be submitted with application.
DATE 1. 19, L9-ss
Sigr_atur -of-App licant
I hereby issue the above permit for the Board of Health of the
Town of North Andover, 11Ybssachusattsa
Date
b:gna V uS \i of eaTIEF iLg�l
I have inspacted the u< co>rer. d system i:]dicateti above and f .12W
everything done as described.
Date
Signature of respecting CTfioa..
Percolation Test
Garbage Grinders � ��