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Home My WebLink AboutMiscellaneous - 1 POND STREET 4/30/2018North Andover Board of Assessors Public Access poRYy 2� a. •. • "�'^ of h � &macWmi Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales Page 1 of 1 'FOwn of North. Aactovew Ekoard, of Assessors Property Record Card Parcel ID: 210/090.C-0027-0000.0 Community: North Andover SKETCH. Location: POND STREET Owner Name: STONE HOUSE FARM REALTY TRUST #2 HENRY W & RUTH C NASON, TR Owner Address: 276 WASHINGTON STREET City: WEST BOXFORD State: MA ZIP: 01885 Neighborhood: 6 - 6 Land Area: 4.5 acres Use Code: 131 - RES-PDV-LAND Total Finished Area: 0 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 143,400 121,400 Building Value: 0 0 Land Value: 143,400 121,400 Market Land Value: 143,400 Chapter Land Value: LATEST SALE Sale Price: 1 Sale Date: 06/02/1993 Arms Length Sale Code: F-NO-CONVNIENT Grantor: NASON, HENRY Cert Doc: Book: 03747 Page: 0043 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=988861 6/27/2007 0 • O F- IL o c ni •° T= 03 3 w 0�H�cn W p n� O OO M L) m C, E mdU U Z U Q ai = '2 J rn Z o O U o t0/� 0 Q Q �OJILO CL Z T- N J d c a0H>$ .o 0 O J ti G M N O U o N J m O _@ a C m UUE3 E V F°--� w 0 0 �F@- 0 Q 4 Z o O_ CDt- ti Q _jZ 0 �Q Wo00 O LL Z of o Uo Z yQ cn o W LL p G V N N 6 ZLL O O Q O° 1 a x3 Us JI W>- Qm U ••OZ U) N F- W N W IX c Q 3:fA2-0N� a O Q O o ,It 't H N cl � N U -c c ,It CO O 31 0 J y Y y 22 M r 00 > N co qt Nt Z C61-: N 7 O ZN~ 2w Q =o=o QW 0 JJ 2z 0 0 LQ ONQui Z LL Z Z U)U)� �.. _3 J B Q> pL d m co m Q O O Z ? d M � -I- C14 W O d 2 F- O m d =a = Z N U a 2 U F- W Y U) PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 10/26/2015 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Construction of an On -Site Sewage Disposal System By: Jason White At: 1 Pond Street Map 090.0 Lot 0027 IATorth Andover, MA 01845 of this ce "DI ate shall kot be construed as a guarantee that the system will function satisfactorily. Michele Grant Public Health, 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com s North Andover Health Departmen' (ommunity and Economic Development Divis" ONSITE WASTEWATER SYSTEM CONSTI LOCATION INFORMATION ADDRESS: 0 Pond St. MAP: LOT: INSTALLER: Jason White f DESIGNER: ASB Design Group PLAN DATE: 9/30/13 BOH APPROVAL DATE ON PLAN: 10/31/13 INSPECTIONS I TANK INSPECTION: 6/22/15 _ DATE OF BED BOTTOM INSPECTION: 6/23/15 DATE OF FINAL CONSTRUCTION INSPECTION: 6/29/15 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan N/A Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: new construction SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ® Cleanouts per plan X Bottom of tank hole has 6" stone base ® Weep hole plugged X 2000 gallon tank has been installed H-10 loading; 2 compartment X Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 0 Pond St. MAP: LOT: INSTALLER: Jason White DESIGNER: ASB Design Group PLAN DATE: 9/30/13 BOH APPROVAL DATE ON PLAN: 10/31/13 INSPECTIONS TANK INSPECTION: 6/22/15 DATE OF BED BOTTOM INSPECTION: 6/23/15 DATE OF FINAL CONSTRUCTION INSPECTION: 6/29/15 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan N/A Existing septic tank properly abandoned, ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: new construction SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ® Cleanouts per plan X Bottom of tank hole has 6" stone base ® Weep hole plugged X 2000 gallon tank has been installed H-10 loading; 2 compartment X Monolithic tank construction ® Watertightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port Z Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of finish grade installed over one access port ® Neoprene boots around inlet & outlet Comments: need an email from Thad regarding the change in the pipe, adding 2 45 degree. I told them I need a clean out on that. Also need on as -built DISTRIBUTION -BOX ® Installed on stable stone base ® H-20 D -Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution N/A Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) X Bottom of SAS excavated down to C soil layer, as provided on plan X Size of SAS excavated as per plan X Title 5 sand installed, if specified on plan N/A 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: 62x22 with overdig; c -layer 24" SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Presby Advanced Enviro-Septic ® Number of pipes per row: 5 ® Number of rows (trenches): 20 Comments: Total Pipes = 20 FINAL GRADE /Loamed Seeded Cover per plan Comments: DOCYMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by ngineer and installer As -Built Plan SYSTEM ELEVATIONS *All rod readings are invert BM = 192.68 HR = 1.96 H I = 194.64 ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT 4.49 190.15 190.15 Septic Tank IN 4.75 189.89 189.89 Septic Tank OUT 5.00 189.64 189.64 Distribution Box IN 5.30 189.34 189.34 Distribution Box OUT 5.47 189.17 189.17 Lateral 1 TOP 5.22 To / Bottom pipe Bottom pipe Lateral 1 INVERT 189.42 / 188.42 188.50 Lateral 2 TOP 5.45 Lateral 2 INVERT 189.19 / 188.19 188.25 Lateral 3 TOP 5.66 Lateral 3 INVERT 188.98 / 187.98 188.00 Lateral 4 TOP 5.90 Lateral 4 INVERT 188.74 / 187.74 187.75 b• q w 0 < . & CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ® Wetlands bordering surface water supply or trib. (in Watershed) Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ® Wetlands bordering surface 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10 (5) 20 (10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Nashoba Analytical, LLC Tel: 978-391-4428 Fax: 978-391-4643 LabNumber: 160341 31A Willow Road, Ayer MA 01432 Website: http://www.NashobaAnalytical.com Use this number with all correspondence Client: Skillings and Sons, Inc. 9 Columbia Drive Amherst, NH 03031 Certificate of Analysis 03851 Parameter Method - Eric Peterson, 1 Pond Street, North Andover MA Sampled: 10172015 6:00:00 PM by Brian C. Total Coliform Bacteria, /100ML MF-SM9222B Arsenic, Total, MG/L SM 3113B Calcium, MG/L EPA 200.7 Copper, MG/L EPA 200.7 Iron, MG/L EPA 200.7 Lead, MG/L SM 3113B Magnesium, MG/L EPA 200.7 Manganese, MG/L EPA 200.7 Potassium, MG/L EPA 200.7 Sodium, MG/L EPA 200.7 Alkalinity, MG/L SM 2320B Ammonia as N, MG/L SM 4500-NH3-D Chloride, MG/L EPA 300.0 Chlorine, Free Residual, MG/L SM 4500 -CL -G Color Apparent, CU SM 2120B Conductivity, UMHOS/CM SM 2510B Fluoride, MG/L EPA 300.0 Hardness, Total, MG/L SM 2340B Nitrate as N, MG/L EPA 300.0 Nitrite as N, MG/L EPA 300.0 Odor, TON SM 2150B pH, PH AT 25C SM 4500 -H -B Sediment, pos/neg -------------- Sulfate, MG/L EPA 300.0 Total Dissolved Solids, MG/L SM 2540C Turbidity, NTU EPA 180.1 Result MCL ReportDate: 10/14/2015 MRL Date of Analysis Analyst 0 0/Absent 0 10/8/2015 3:00:00 PM M-MA1118 ND 0.01 0.001 10/9/2015 M-MA1118 23 Not Spec 0.2 10/9/2015 M-MA1118 0.007 1.3 0.003 10/9/2015 M-MA1118 0.046 0.3 0.003 10/9/2015 M-MA1118 ND 0.015 0.001 10/9/2015 M-MA1118 4.5 Not Spec 0.1 10/9/2015 M-MA1118 0.003 0.05 0.002 10/9/2015 M-MA1118 2.1 Not Spec 0.1 10/9/2015 M-MA1118 8.3 See Note 0.2 10/9/2015 M-MA1118 68 Not Spec 1 10/8/2015 M-MA1118 ND Not Spec 0.1 10/8/2015 M-MA1118 5.4 250 1 10/8/2015 M-MA1118 ND Not Spec 0.02 10/8/2015 M-MA1118 0 15 0 10/8/2015 M-MA1118 223 Not Spec 1 10/8/2015 M-MA1118 ND 4 0.1 10/8/2015 M-MAI118 76 Not Spec 1 10/9/2015 M-MAI118 0.07 10 0.05 10/8/2015 M-MAI118 ND 1 0.02 10/8/2015 M-MA1118 0 3 0 10/8/2015 MFL 6.9 6.5-8.5 NA 10/8/2015 M-MA1118 NEG ------ NEG 10/8/2015 MFL 25.7 250 1 10/8/2015 M-MA1118 134 500 1 10/13/2015 M-MA1118 0.8 Not Spec 0.1 10/8/2015 M-MA1118 MCL=Maximum Contaminant Level (EPA Limit), MRL = Minimum Reporting Level Sodium Guidelines- Mass 20, EPA 250, # = Result Exceeds Limit or Guideline ND = None Detected (<MRL), ' = Background Bacteria Noted Massachusetts Certified Laboratory #M -MAI 118 David L. Knowlton Laboratory Director Page 1 of 1 Nashoba Analytical, LLC Tel: 978-391-4428 Fax: 978-391-4643 LabNumber: 160341 31A Willow Road, Ayer MA 01432 Website: http://www.NashobaAnalytical.com Use this number with all correspondence Client: Skillings and Sons, Inc. ReportDate: 10/14/2015 9 Columbia Drive Amherst, NH 03031 Certificate of Analysis 03851 Parameter Method - Eric Peterson, 1 Pond Street, North Andover MA Sampled: 101712015 6:00:00 PM by Brian C. Total Coliform Bacteria, /100ML MF-SM9222B Arsenic, Total, MG/L SM 3113B Calcium, MG/L EPA 200.7 Copper, MG/L EPA 200.7 Iron, MG/L EPA 200.7 Lead, MG/L SM 3113B Magnesium, MG/L EPA 200.7 Manganese, MG/L EPA 200.7 Potassium, MG/L EPA 200.7 Sodium, MG/L EPA 200.7 Alkalinity, MG/L SM 2320B Ammonia as N, MG/L SM 4500-NH3-D Chloride, MG/L EPA 300.0 Chlorine, Free Residual, MG/L SM 4500 -CL -G Color Apparent, CU SM 2120B Conductivity, UMHOS/CM SM 2510B Fluoride, MG/L EPA 300.0 Hardness, Total, MG/L SM 23408 Nitrate as N, MG/L EPA 300.0 Nitrite as N, MG/L EPA 300.0 Odor, TON SM 2150B pH, PH AT 25C SM 4500 -H -B Sediment, pos/neg --------------- Sulfate, MG/L EPA 300.0 Total Dissolved Solids, MG/L SM 2540C Turbidity, NTU EPA 180.1 Result MCL MRL Date of Analysis Analyst 0 0/Absent 0 10/8/2015 3:00:00 PM M-MA1118 ND 0.01 0.001 10/9/2015 M-MA1118 23 Not Spec 0.2 10/9/2015 M-MA1118 0.007 1.3 0.003 10/9/2015 M-MA1118 0.046 0.3 0.003 10/9/2015 M-MA1118 ND 0.015 0.001 10/9/2015 M-MA1118 4.5 Not Spec 0.1 10/9/2015 M-MA1118 0.003 0.05 0.002 10/9/2015 M-MA1118 2.1 Not Spec 0.1 10/9/2015 M-MA1118 8.3 See Note 0.2 10/9/2015 M-MA1118 68 Not Spec 1 10/8/2015 M-MA1118 ND Not Spec 0.1 10/8/2015 M-MA1118 5.4 250 1 10/8/2015 M-MA1118 ND Not Spec 0.02 10/8/2015 M-MA1118 0 15 0 10/8/2015 M-MA1118 223 Not Spec 1 10/8/2015 M-MA1118 ND 4 0.1 10/8/2015 M-MA1118 76 Not Spec 1 10/9/2015 M-MA1118 0.07 10 0.05 10/8/2015 M-MA1118 ND 1 0.02 10/8/2015 M-MA1118 0 3 0 10/8/2015 MFL 6.9 6.5-8.5 NA 10/8/2015 M-MA1118 NEG ------ NEG 10/8/2015 MFL 25.7 250 1 10/8/2015 M-MA1118 134 500 1 10/13/2015 M-MA1118 0.8 Not Spec 0.1 10/8/2015 M-MA1118 MCL=Maximum Contaminant Level (EPA Limit), MRL = Minimum Reporting Level Sodium Guidelines- Mass 20, EPA 250, # = Result Exceeds Limit or Guideline ND = None Detected (<MRL), ' = Background Bacteria Noted Massachusetts Certified Laboratory #M-MA1118 David L. Knowlton Laboratory Director Page 1 of 1 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 .��b""�';� �'sAtf+uss� NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX healthdentOtownofi-,oMiandover com wNvw. towno fn orthand o ver, cola Well and 'or Pump Application (Please print) DATE: May 27 2014 LOCATION to Drill Well or install a pump:1 Pond Street North Andover Licensed Well Contractor Name and Company Name: Skillings and Sons Inc. Well drilling license #1543 Phone 1-800-459-2600 Contact Phone Numbers: Homeowner: Eric Peterson Address: 202 High Street - P.O. box 924 North Andover Contact Phone Numbers: 617-512-6155 WELLS (to be completed at time of pump test) M L Type of weU —.i�c &i V D G i �— Ilse:—� �I t t� s 1' �. (0 li f I t Diameter of well: �V ++ Size of Casing: (0 Depth of bedrock: Slp j Cry Depth of casing into bedrock: 5 3 ' Seal been tested? YesFil ® Na❑ Date of test: Depth of well. _ J Water -bearing ruck: 10 IJP Depth ofwatem.1 Delivers: ' GPM for: 14 Drawdown 14, Ion } - feet after pumping: ,• 15 Date of Completion:_ (0 PUMPS (To be rdled in before installation) Name & size of Pump: 'A L l `' I � Y►� Site of Tank: 2,:;, J Pipe used in well.POV4 Cast Iron❑ Sleeve used to protect pi'pe�? Ycs t Date: O�t3`a0ly Cu zd�►� Date water analysis report submitted to Health Plumbing Q Type:160)e'si-61 (- Pump delivers: 1 GPM Galvanized❑ Plastic No ly ofw11seal I./V1ip Wiring Inspector C:\D000ME-1\bcurran\LOCALS--]\Temp\Well Application.doc 0fftz Health Department Representative Grant, Michele To: bcastora@skillingsandsons.com Cc: Blackburn, Lisa Subject: 1 Pond Street North Andover MA Attachments: 201508031131.pdf Hi Brian, Please see the attachment. Please fill out the remainder of the application as well as the 2015 water analysis and forward them along to me. Thank you, Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email errant@townofnorthandover.com Web www.TownofNorthAndover.com -----Original Message ----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Monday, August 03, 2015 11:32 AM To: Grant, Michele Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 08.03.2015 11:31:35 (-0400) Queries to: noreply@townofnorthandover.com 1 Grant, Michele To: Eric Peterson Cc: Blackburn, Lisa; Brandi Coulter; Brian Castora Subject: RE: FW: FW: 1 Pond Street North Andover Hi Eric, In New Construction of a home: It's the construction of the new home too. Our practice is to have a pre -construction analysis and a post construction analysis. However, I just spoke to the Building department about your last inspection with them and they indicated, that you haven't had a final inspection to date and that you don't have a Certificate of Occupancy yet. I was under the impression that the home was completed. However, you can still move forward and complete our process, so when time comes for Occupancy I can sign off on the building card. It's in every homeowners best interest to make absolute certain that the Well Casing has not been compromised and the well water has not been infiltrated with contaminants, and it is potable. From: Eric Peterson [mailto:eriscopet@gmail.com] Sent: Friday, October 02, 2015 10:29 AM To: Grant, Michele Cc: Blackburn, Lisa; Brandi Coulter; Brian Castora Subject: Re: FW: FW: 1 Pond Street North Andover Hi Michele So what exactly is the problem with the information you got from Skillings? The date of the test, what was tested for or both? I have seen two different documents, one was a full analysis from 6/14/2014 and then the one you forwarded dated 6/24/2015 that only details the arsenic levels. I think I could make the argument that the 6/24 water sample was drawn when construction was essentially finished, all site work near the well was done, and the only thing that took place after the sample was the back fill of the septic system. (The septic system was inspected by the engineer on 6/24 and 6/25 of 2015) However, it clearly doesn't show the full analysis like the sample from 2014. If there is a full analysis available from the 6/24 sample will that work? Sorry that this is turning out to be a hassle Eric PUBLIC HEALTH DEPARTMENT a f0V% (ommunity Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION ijVER p1bR�� Nb The undersigned hereby certify that the Sewage Disposal System ( constructed; ( } repaired; 100 DIwPF+�TM � By: 1 White Cnntractinq (Print Name) Located at: 1 Pond Street, North Andover (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated 9/30/2013 and last revised on 4/21/2015 , with a design flow of __.__330 _ gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Lam; / N Bottom of Bed Inspection Date: June 24, 2015 Engineer Representative (Signature) Thad David Berry And — Print Name June 25, 2015 Final Construction Inspection Date: vU Engineer Representative (Signature) Thad David Berry And — Print Name Installer: (Signature) Engineer: (Signature) Date: 6/1 And — Print Name Date: 101131ZD6 D, � n Add — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 97:8.688.8476 Web http://www.townofnorthandover.com P n �-S -'/ NU (�oat+rc)Ck� Town of North Andover — Septic System - AS -BUILT CHECKLIST 1) All changes to the design plan have been reflected and noted on the as -built plan 2) ✓ As -built plan has a suitable scale•, 0 inch = 40 feet or fewer for plot plans) 3) V° Street Address, Assessor's Map and Lot Number 4) '� Lot Lines and Location of Dwellings served by the system ✓ ,✓ 5) Locations, Elevations and Dimensions of As -built system component , including reserve if applicable) 6) ✓ Ties to all tank openings, d -box, and leach area from dwelling or Permanent Structure Setback distances are shown on the as -built plan from system components to: Subsurface, interceptor & foundation drains Catch basins Property lines Dwellings or other structures Private water supply or irrigation wells Watercourses or wetlands 8)J Locations of Wells, Drains, Wetland Resource Areas within 150 feet of system 9) `U Location of water, gas, electric lines, cable, control panel (if applicable) 10) ✓ Location of Structures within 6 Inches of Finished Grade 11) 10riginal Stamp & Signature 12) N Location and holder of any easements which could impact the system 13) Impervious Areas; Driveways, etc 14) `/ North Arrow 15) Location & Elevation of Benchmark used 16) STATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, tees, cover material; exposed component covers etc., shown on this as -built substantially agree with the approved plan and have determined that the break out elevations, if applicable, have been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT (NA 4.9) a Letter or statement on the as -built indicating the wall -was, or was not, constructed in accordance with the intended design and any manufacturer's S ifcations." Signature of Designer Date As of: Tuesday, September 29, 2015 Grant, Michele To: Eric Peterson Cc: Blackburn, Lisa Subject: FW: FW: 1 Pond Street North Andover Attachments: Peterson -1 Pond-03648.pdf, Well Regulations.doc Good Morning Eric, Please see my attachments. Skilling's again sent an Arsenic test result that was taken before building on the site was done. Please see the Well Regulations, page 4 of 5 for the criteria on well water testing. A test, after construction of the site, will include primary contaminants. If you have any questions, please let me know. Sincerely, Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email merant@townofnorthandover.com Web www.TownofNorthAndover.com From: Brandi Coulter [mailto:BCoulter@skillingsandsons.com] Sent: Wednesday, September 30, 2015 4:28 PM To: Grant, Michele Subject: RE: FW: 1 Pond Street North Andover Here you go Michele! grovkAL CouLter Skillings & Sons, Inc. 9 Columbia Drive Amherst, NH 03031 603-459-2600 www.skiIlingsandsons.com 1 From: Grant, Michele [mailto:MGrant@townofnorthandover.com] Sent: Wednesday, September 30, 2015 4:21 PM To: Brandi Coulter Subject: RE: FW: 1 Pond Street North Andover Hi Brandi, We need another one "After Construction" This one was done prior to construction Thank you Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email merant@townofnorthandover.com Web www.TownofNorthAndover.com From: Brandi Coulter [ mai Ito: BCoulterC�skiIli ngsandsons.com] Sent: Wednesday, September 30, 2015 4:06 PM To: Grant, Michele Subject: RE: FW: 1 Pond Street North Andover Hi Michele, I am submitting the test results for the homeowner. I have attached them here. Sorry for any confusion. Regards, gravid% coulter Skillings & Sons, Inc. 9 Columbia Drive Amherst, NH 03031 603-459-2600 www.skillingsandsons.com Hi Eric, 2 I received the completed form from Skillings. On the bottom it states that you will be submitting the final well water testing. Please submit it, when it is completed, along with the completed Installation Certification form signed off by the engineer as well as the installer. Many Thanks Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email rarg ant(a_,townofnorthandover.com Web www.TownofNorthAndover.com From: Brandi Coulter[mai Ito: BCoulter@skillinasandsons.com] Sent: Wednesday, September 30, 2015 9:57 AM To: Grant, Michele Subject: RE: 1 Pond Street North Andover Here you go Michele. gravod COulter Skillings & Sons, Inc. 9 Columbia Drive Amherst, NH 03031 603-459-2600 www.skillingsandsons.com From: Grant, Michele[mailto:MGrant@townofnorthandover.com] Sent: Tuesday, September 29, 2015 3:27 PM To: Brandi Coulter Cc: Blackburn, Lisa Subject: 1 Pond Street North Andover Hi Brandi, Please see the attached paperwork. Please complete the paperwork. North Andover also requires a water test at the completion of construction. Thank you Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email m agr nt cgtownofnorthandover.com Web www.TownofNorthAndover.com From: Brandi Coulter[mailto:BCoulter(abskillingsandsons.com] Sent: Tuesday, September 29, 2015 3:21 PM To: Grant, Michele Subject: From Brandi at Skillings grRvL. {L Cou.Lter Skillings & Sons, Inc. 9 Columbia Drive Amherst, NH 03031 603-459-2600 www.skillingsandsons.com All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma » » > m w; n n o ■ / ; \ \ ' m m , § 0 > - 2 ( ; \ , . e _ > z 8 2 § §m , ; y CL § w i ro 0-0 V_ »«( q ( G § e n- 7 A; \ k ° 7 2 / . . k } 0 \ � fb N a 0 - . 0. I§ 0 ) _ 7 \ [ \ ) \ \ D 2 e z m to ( 0 0 n 7 ® # > OL \ -n a, / _ \ / V) _ . V) CD CL 0 m > -n M ; M o o ® m } > > z z ° k/ 2 2 ; m m § k :m \* § 0 / 2 § > , ([ } q » ( ± 0 0 } 2 ) � k \ \ _ _ _ i mmm, > > > ; \ E m \ \ $ 7 \ § ® S S Ln ` } (� \ _ , _ a ° ƒ ® () . / > _ § ° § k } - N 22 k<0� Grant, Michele To: Eric Peterson Cc: Blackburn, Lisa Subject: FW: 1 Pond Street North Andover Attachments: North Andover, 22875 Peterson 1 Pond St Well -Pump App 6-19-14.pdf Hi Eric, I received the completed form from Skillings. On the bottom it states that you will be submitting the final well water testing. Please submit it, when it is completed, along with the completed Installation Certification form signed off by the engineer as well as the installer. Many Thanks Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email msrant@townofnorthandover.com Web www.TownofNorthAndover.com From: Brandi Coulter[mailto:BCoulter@skillincisandsons.com] Sent: Wednesday, September 30, 2015 9:57 AM To: Grant, Michele Subject: RE: 1 Pond Street North Andover Here you go Michele. BrpvOd CouLter Skillings & Sons, Inc. 9 Columbia Drive Amherst, NH 03031 603-459-2600 www.skillingsandsons.com 1 From: Grant, Michele [mailto:MGrantCd)townofnorthandover.com] Sent: Tuesday, September 29, 2015 3:27 PM To: Brandi Coulter Cc: Blackburn, Lisa Subject: 1 Pond Street North Andover Hi Brandi, Please see the attached paperwork. Please complete the paperwork. North Andover also requires a water test at the completion of construction. Thank you Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email msrant@townofnorthandover.com Web www.TownofNorthAndover.com From: Brandi Coulter [mailto:BCoulter@skillingsandsons.com] Sent: Tuesday, September 29, 2015 3:21 PM To: Grant, Michele Subject: From Brandi at Skillings gra vud% Cou Iter Skillings & Sons, Inc. 9 Columbia Drive Amherst, NH 03031 603-459-2600 www.skillingsandsons.com All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. . Grant, Michele From: Eric Peterson <eriscopet@gmail.com> Sent: Tuesday, September 29, 2015 2:40 PM To: Grant, Michele Cc: Thad Berry; jwhitecontracting@comcast.net; Brian Castora Subject: Re: Pond St well paperwork My apologies Michele, I'll make sure you get that information ASAP. On Tuesday, September 29, 2015, Grant, Michele<MGrant(cr�,townofnorthandover.com> wrote: httP://www.townofnorthandover.com/Pages/NAndoverMA Health/InstallationCertification.pdf Good Afternoon Eric, Just wanted to give you a heads up..... Lisa is still waiting for a couple things to close out the file and issue a Certificate of Compliance. 1. The installation Certification —To be signed by the Engineer and the Installer. This certification can be found on our website. Please see the above link. 2. Skilling's and Son's has not completed their paperwork —We've never heard back from them. Please see the attached If you have any other question, please don't hesitate to call me at the phone number listed below. Sincerely, Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 1 They've been good about the quality of their work and showing up when they say they will, but a little less attentive with the paper in general, so hopefully this is all the reminder they will need. On Tue, Aug 4, 2015 at 10:14 AM, Grant, Michele<MGrantna,townofnorthandover.com> wrote: Thank you, I spoke to them. I will await their paperwork. Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com From: Eric Peterson [mai Ito: eriscopet@gmail.com] Sent: Monday, August 03, 2015 11:45 AM To: Grant, Michele Subject: Pond St well paperwork Hi Michelle, I just got your message, I had long meeting this morning so I didn't pick up when you called. I just got in touch with my contact at Skillings, He told me he'd get the paperwork to you in the next couple of days. They have an 800 number on their website, 1(800) 441-6281 My contact there is Brian Castora, if you ever need to get a hold of him directly, his number is 603-459-2600, ext 28, or his cell is 603-235-7646 Thanks Eric RII email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma Grant, Michele From: Eric Peterson <eriscopet@gmail.com> Sent: Monday, August 03, 2015 11:45 AM To: Grant, Michele Subject: Pond St well paperwork Hi Michelle, I just got your message, I had long meeting this morning so I didn't pick up when you called. I just got in touch with my contact at Skillings, He told me he'd get the paperwork to you in the next couple of days. They have an 800 number on their website, 1(800) 441-6281 My contact there is Brian Castora, if you ever need to get a hold of him directly, his number is 603-459-2600, ext 28, or his cell is 603-235-7646 Thanks Eric Grant, Michele From: Thad Berry <thadberry2@verizon.net> Q ��-- Sent: Tuesday, June 23, 2015 9:13 PM To: Grant, Michele Cc: 'Eric Peterson'; Paul Donohoe Subject: Septic System Pond Street - Job Number 2013-28 Hi Michele This is to confirm our conversation yesterday concerning the 2 45° bends being place form the house outlet to the septic tank inlet. As long as one of the bends has a cleanout I do not have a problem with this. I have copied Paul Donohoe of Donohoe Survey Inc. just to let him know that the field crew will need to pick this up when they do the as -built survey on the septic system. If you have any questions or concerns please feel free to give me a call at 978-500-8419. Thanks Thad Thad Berry, P.E. principal .- director of civil engineering ASB design group architecture civil engineering traffic engineering landscape design & construction 363 boston street, topsfield ma 01983 (978) 500-8419 www.asbdesigngroup.com • Application for Septic Disposal System Construction Permit -TOWN OF NORTH ANDOVER, MA 01845 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Application Is hereby made fora permit to: Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facility Information TODAY'S DATE $ 250.00 - Full Repair $125.00 - Component y ga,, l S? Address or Lot # )Qa"No /'dip r A -i.- A&,,,au C! City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump VGravity (choose one) ***If pump system, attach copy of electrical permit to application*** ➢ ❑ Conventional System (pipe and stone system) JUN 17 2015 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ➢ E91nfiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S. (No D -Box) ➢ ❑ Pressure Dosed (D -Box Present) S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) Wb2t is the Make? 2. Owner Information -O' re 1 Chloe Oe Name Address (if different from above) City/Town Email address 3. Installer Information What is the Moder State Telephone Number Zip Code Name Name of Company 14 3 rtn �.., t•.� 1,�7 Address " City/Town State Zip Code 1,78-40C110944 Telephone Number (Cell Phone # if possible please) 4. Designer Information 1 ka,a Astn LLC Name Name of Company 37f 3 tecko... Address Top!&:e LA City/Town PKK In 19 State Zip Code ?81 - Fy,-i - 5'66A Telephone Number (Best # to Reach) Application for Disposal System Construction Permit - Page 1 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) Relative to the application of 7 AS. #,J Wl _, (Installer's name) Dated �' 17 bs— (Ioo ay's ate For plans by TX 1. J 6er,-_1 (Engineer) And dated/3 rigina ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed — Generally, this is the first (V5 inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdept@townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install setitic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the at)nroved Mans. No instructions by the homeowner. Eeneral contractor. or anv other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (,,/1'7 /t S (Today's Date) (Name int(Namee ti s Application for Septic Disposal System TODAY'S DATE Construction Permit -TOWN OF $ 250.00 - Full Repair NORTH ANDOVER, MA 01845 $125.00 - Component PAGE 2 OF 2 A. Facility Information continued.... 5. Type Of Building: esidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover. I understand that until a final Certificate of Compliance has been issued by this Board of Health, the installed system is not approved. Name Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Project Manager Obligation Form Attached. Yes No 3. Pump Ssy tem? Ifso, Attach coPv ofElectrical Permit Yes No Applicant received copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewed approvalletter, aBpaperworkreceivedP Yes No Missing: 5. Foundation As -Built? (new construction only): (Same scale as approved plan) Yes No 6. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 Commonwealth of Massachusetts Map -Block -Lot 090.CO027 --------------------- BOARD OF HEALTH Permit No Z, North Andover - BHP -2015-02 - 69 - --------------- -- FEE $250.00 --------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Jason-)A/bite ------------------------------------------------ to (Construct) an Individual Sewage Disposal System. at NoO- PONDSTREET as shown on the application for Disposal Works Construction Permit No. BHP -2015-026 Dated June 17, 2015 ------------------------ ----------------------------- ----------------- ---- 0 HE - Vi Y Issued On: Jun- 17-2015 Lr -C- rAT ----------------------------------- - - ------------------------------------------ October 31, 2013 Eric and Chloe Peterson 202 High Street North Andover, MA 01945 North Andover Health Department (ommunity Development Division Go� RE: Subsurface Sewage Disposal System Plan for 0 Pond St, North Andover, MA, map 90C, Parcel 27, and Washington St, Boxford Tax Map 9 Block 1 Lot 5. Dear Property Owners, The North Andover Board of Health has completed the review of the septic system design plans for the above referenced properly, submitted on your behalf by ASB Design Group, LLC, dated September 30, 2013, and received October 7, 2013. A plan was previously approved for this site; however the technology on this submission for the subsurface disposal system has been changed as well as the size of the home. The owner is also requesting that the Board of Health accept a deed restriction regarding the number of bedrooms allowed. The request will restrict the homeowner to only 3 bedrooms. This includes the space above the garage which is not to be converted to sleeping space without an upgrade. The design has been approved for use in the construction of a new onsite septic system for a 3 - bedroom home. This plan is good for 3 years from the date of approval. During this time, a licensed septic system installer must obtain a permit and complete this work, all paperwork including the "Deed Notice" etc. must be submitted and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. This plan approval is subject to the approval of a deed restriction that is to be granted to the Board of Health pursuant to M.G.L. c. 21A, §13 and 310 CMR 15.000 (collectively, "Title 5") and shall run with the deed of the land in perpetuity. As stated in "section 3. Enforcement. Grantor expressly acknowledges that a violation of the terms of this Restriction could result in the following: (i) upon determination by a court of competent jurisdiction, in the issuance of criminal and civil penalties, and/or equitable remedies, including, but not limited to, injunctive relief, such Page 1 of 3 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 �. 0 Pond Street October 31, 2013 injunctive relief could include the issuance of an order to modify or remove any improvements constructed upon the Property in violation of the terms of this Restriction; and (ii) in the initiation of an enforcement action and/or assessment of penalties by the Local Approving Authority and/or the Massachusetts Department of Environmental Protection, a duly constituted agency with a principal office located at One Winter Street, Boston, MA 02108 (DEP),. to enforce the terms of this Restriction pursuant to Title 5; M.G.L. c. 111. (see Title V for complete details) The owner understands and agrees to submit to the Health Department all required information and executed documents prior to receiving the approval and the issuance of a disposal works construction permit to a licensed installer. This includes a second deed notice as required in #4 below, regarding the alternative septic system. This approval is also subject to the following conditions: Y1. Proof of executed deed notices must be submitted prior to the signing of a building permit for the home. 2. Prior to the issuance of a Disposal Works Construction permit the following must be submitted. a. A Foundation plot plan in a 1" = 20' scale; the same as the approved plan fib. Floor plans of the proposed home C. 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and. municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 5. Comply with DEP requirements as found at http://www.mass.gov/eea/docs/dep/water/wastewater/o-thru-v/stdconda.pdf (see excerpt below regarding Deed Notice) A System approved under these Standard Conditions consists of a septic tank conforming to the requirements of Title 5, either conventional or I/A approved, followed by the Alt. SAS which may provide for a reduced effective leaching area. The use of an approved Alt. SAS, subject to these Standard Conditions, requires, among other things: ❑ A Disclosure Notice in the Deed to the property for systems installed under Remedial Use Approval (3 10 CMR 15.287(10)) (A Deed Notice template is available from the Department); Page 2 of 3 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 0 Pond Street October 31, 2013 • Certifications by the Designer and the Installer (310 CMR 15.021(3)); • Notification within 24 hours by the System Owner to the Local Approving Authority • (LAA) of any System failure; • When pumping is required to discharge to the SAS, 24-hour emergency wastewater storage capacity above the elevation of the high level alarm; • System Owner Acknowledgement of Responsibilities, in accordance with these standard conditions and the Technology Approval's Special Conditions. If you wish to increase the size of the system rather than place the deed notice regarding septic system size or if you choose to reduce the home size, please contact the health office. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. ySincer Public He .S cc: ASB Design Group, LLC file Encl. copy of the approved Installers List for N.A. Page 3 of 3 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 V I R E L. IP 1 P T PIrinted: Apri i 16. 2015 a' 8:541:34 Essex North Regi stry M. Paul TannUCC1110 it t i&r Trans#: 7222 0,j.-)er: LRRErKM PETERSON = � � � m � � __ � a = _.. � im 7 _.. L r, -1 -1 __ � z �� 71 � = 1-1 �._ � _m � _. _.. Bo.,)K- 1�193� Page: InST#: 645 @ �: 54:34"a ctlif: 9 Rec:4-162 I NANG I POND �3`1' DOC DESCRIPTION TRANS AMT RES RICTION �ur(,harge CIPA $20.00 20.00 50.00 recordina fee 50.00 5.00 TECH fric-r, 5.00 rutal fee",: 75.00 7 75. 00 xww �otal CASH PMI PAYMENT -CASH -7�:_oo 'j q. North Andover Health Department Community Development Division 4/7/2015 Eric and Chloe Peterson 202 High Street North Andover, MA 01845 Mr. & Mrs. Peterson, Please bring the enclosed Deed Restriction to the Registry and provide a copy of the proof of recording to the Health Department. Thank you. L Michele Grant Health Inspector Page 1 of 1 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 L� Bk 14193 Ps 332 834.4 04-16-2015 a 08 2 54a Return to: Department of Environmental Protection Bureau of Resource Protection, Wastewater Management {Applicable Regional Office or Boston Office address} GRANT OF TITLE V BEDROOM COUNT DEED RESTRICTION This Grant of Title V Bedroom Count Deed Restriction is made as of this day of August, 2014, by Eric S. Peterson and Chloe Peterson ("Grantor"), of North Andover, Essex County, Massachusetts, pursuant to M.G.L. c. 21A, §13 and 310 CMR 15.000 (collectively, "Title 5"). WITNESSETH WHEREAS, Grantor, being the owner(s) in fee simple of that certain parcel of vacant land located in North Andover, Essex County, Massachusetts, with the buildings and improvements thereon, pursuant to a deed from James H. Nason, Successor Trustee of the Stone House Fane Realty Trust #2 to Grantor, dated November 20, 2012, and recorded with Essex North Registry of Deeds in Boob 31944, Page 298 ("Property"); and Said Restriction operates to restrict the Property as follows: 1. Restriction. Grantor hereby restricts the total number of Bedrooms in, on, upon, through, over and under the Property to three (3) Bedrooms, such that at no time shall there exist more than three (3) Bedrooms in, on, upon, through, over and under said Property. 2. Severability. Grantor hereby agrees that, in the event that a court or other tribunal determines that any provision of this instrument is invalid or unenforceable: WHEREAS, Grantor desires to restrict the number of bedrooms, as the term bedroom is defined at 310 CMR 15.002 ("Bedroom"), through the granting of this Title V Bedroom Count Deed Restriction; NOW, THEREFORE, Grantor does hereby GRANT to North Andover of Essex County, Massachusetts, a municipal corporation located in Essex County, having a r mailing address of 120 Main Street, North Andover, Massachusetts 01845, and acting by and through its Board of Health ("Local Approving Authority"), for nominal and non - monetary consideration, the sufficiency and receipt of which are hereby acknowledged, with QUITCLAIM COVENANTS, a TITLE V BEDROOM COUNT DEED RESTRICTION ("Restriction") in, on, upon, through, over and under the Property. Said Restriction operates to restrict the Property as follows: 1. Restriction. Grantor hereby restricts the total number of Bedrooms in, on, upon, through, over and under the Property to three (3) Bedrooms, such that at no time shall there exist more than three (3) Bedrooms in, on, upon, through, over and under said Property. 2. Severability. Grantor hereby agrees that, in the event that a court or other tribunal determines that any provision of this instrument is invalid or unenforceable: (i) That such provision shall be deemed automatically modified to conform to the requirements for validity and enforceability as determined by such court or tribunal; or (ii) That any such provision, by its nature, cannot be so modified, shall be deemed deleted from this instrument as though it had never been included herein. In either case, the remaining provisions of this instrument shall remain in full force and effect. 3. Enforcement. Grantor expressly acknowledges that a violation of the terms of this Restriction could result in the following: (i) upon determination by a court of competent jurisdiction, in the issuance of criminal and civil penalties, and/or equitable remedies, including, but not limited to, injunctive relief, such injunctive relief could include the issuance of an order td modify or remove any improvements constructed upon the Property in violation of the terms of this Restriction; and (ii) in the initiation of an enforcement action and/or assessment of penalties by the Local Approving Authority and/or the Massachusetts Department of Environmental Protection, a duly constituted agency with a principal office located at One Winter Street, Boston, MA 02108 (DEP), to enforce the terms of this Restriction pursuant to Title 5; M.G.L. c.l 11, §§ 2C, 17, 31, 122, 123, 125, 127A-0, inclusive, and 129; and M. GI c. 83, §11. 4. Provisions to Run with the Land. The rights, liabilities, agreements and obligations created under this Restriction shall run with the Property and any portion thereof for the term of this Restriction. Grantor hereby covenants for [himself/herselfritselfj and is/herfits executors, administrators, heirs, successors and assigns, to stand seized and to hold title to the Property and any portion thereof subject to this Restriction. The rights granted to the Local Approving Authority, its successors and assigns, do not provide, however, that a violation of this Restriction shall result in a forfeiture or reversion of Grantor's title to the Property. 5. Concurrence Presumed. It is agreed that: (i) Grantor and all parties claiming by, through, or under Grantor agree to and shall be subject to the provisions of this Restriction; and (ii) Grantor and all parties claiming by, through, or under Grantor, and their respective agents, contractors, sub -contractors and employees, agree that the Restriction herein established shall be adhered to and shall not be violated, 2 and that their respective interests in the Property shall be subject to the provisions herein set forth. 6. Incorporation into Deeds, Mortgages, Leases, and Instruments of Transfer. Grantor hereby agrees to incorporate this Restriction, in full or by reference, into all deeds, easements, mortgages, leases, licenses, occupancy agreements or any other instrument of transfer by which an interest and/or a right to use the Property, or any portion thereof, is conveyed. 7. Recordation. Grantor shall record and/or register this Restriction with the appropriate Registry of Deeds and/or Land Registration Office within 30 days of receiving the approved Restriction from the Local Approving Authority. Grantor shall file with the Local Approving Authority and the DEP a certified Registry copy of this Restriction as recorded and/or registered within 30 days of its date of recordation and/or registration. 8. Amendment and Release. This Restriction may be amended only upon the approval and acceptance of such amendment by the Local Approving Authority. Release of this Restriction shall be granted by the Local Approving Authority upon (i) Grantor's request of such release; and (ii) the Property being connected to a municipal sewer system and the septic system serving the Property being abandoned in accordance with 310 CMR 15.354. Any such amendment or release shall be recorded and/or registered with the appropriate Registry of Deeds and/or Land Registration Office and a certified Registry copy of said amendment or release shall be filed with the Local Approving Authority and the DEP within 30 days of its date of recordation and/or registration. 9. Term. This Restriction shall run in perpetuity and is intended to conform to M.G.L. c.184, §26, as amended. 10. Rights Reserved. This Restriction is granted to the Local Approving Authority. It is expressly agreed that acceptance of this Restriction by the Local Approving Authority shall not operate to bar, diminish, or in any way affect any legal or equitable right of the Local Approving Authority or of DEP to issue any future order with respect to the Property or in any way affect any other claim, action, suit, cause of action, or demand which the Local Approving Authority or DEP may have with respect thereto. Nor shall acceptance of the Restriction serve to impose any obligations, liabilities, or any other duties upon the Local Approving Authority. 11. Effective Date. This Restriction shall become effective upon its recordation and/or registration with the appropriate Registry of Deeds and/or Land Registration Office. WITNESS the execution hereof under seal this 110 day of August, 20 Eric S. Peterson, Grantor ESSEX,ss Coe Peterson, Grantor COMMONWEALTH OF MASSACHUSETTS August ) 4 #,, 2014 Then personally appeared the above-named Eric S. Peterson and Chloe Peterson and acknowledged free act and deed before me. ]pate&_1111q j3U8A h- Olt Not�ry� PuDtrC fifi�ssathusett3' bA '14.2oi;.�s.: fu-� o— (.- 3 � Notary Public: U YEA F-3 1) i L My commission expires: 10 01 20 2 Approved and Accepted By: 1 Approving Autho 7)/S)6261�P Grant, Michele To: Subject: Eric Peterson RE: Pond St Floor plans Good Morning Eric, Thank you for the information. There's no need to submit hardcopy of the floorplans, I can print out the Electronic copy. I don't see the basement copy, could you email me that. Also, please submit a hard copy of the foundation As -Built in a 1=20 Scale. It looks like the attachments are 30 Scale. I will have to overlay that on the Septic Plan and red line the foundation in. Many Thanks Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St ( Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web -----Original Message ----- From: Eric Peterson [mailto:eriscopet@gmail.com] Sent: Tuesday, April 07, 2015 7:11 PM To: Grant, Michele Subject: Pond St Floor plans www.TownofNorthAndover.com Re sending, with the 1 st floor plan from the builders set.. Hi Michelle, I wanted to send along electronic copies of the floor plans. I have included the architects set as well as the individual pages for the foundation, first and second floor from the builders set. Please let me know which of these you would like hard copies of and I will print them and mail them along with the paper copy of the foundation as -built. I will hand deliver the deed restriction after getting it to the registry. Thanks Eric Peterson zo W O _ �I J �• u o LU Z g LU0 f Z LU c Sym Wp ppm (n cmw ow ZLu Ear v 8 .E d 0 M rn z¢ �� W Z O L '$s � s �inaz � awz U) a °c Y 3 9 4 3 gJnigj po:;a u z w o> L R s i 8 e e k s o LL rc 4 w k 2' w Y qq$ Ir if if LU �i�p F V I Ili � :\ \ \ •� \ �.\�\ /� U1 W t .I I -\� ��•'. � < .�-,i..1 � t��ht :�\•\.. \` ISL' lli Ory V LL lu In 0 11 9 4 1 X w w w I i I iV If LU is I , i'I I a Y ga Ii7y 19 pry Wf / FO ° ry .°: r C X a I iPjilYl 8 4 u I I f ry I Z Y Y h°I1111 §' Ig <I 11l kkkk Pg 1 g g TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540 — Phone Susan Y. Sawyer, RENS/RS 978.688.8476— FAX Public Health Director E-MAIL: healthdept(z townofilorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: October 7, 2013 Site Location: 1 Pond Street Engineer: Thad D. Berry RECEIVED OCT O K',3 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT New Plans? Yes $225/Plan Check # (includes 1" submission and one re- review only) Revised Plans?Yes X $75/Plan Check # 1228 Site Evaluation Forms Included? Yes No X Local Upgrade Form Included? Telephone #: 978-500-8419 Yes No X E-mail: thadberry2@verizon.net Homeowner Name: Eric and Chloe Peterson, 617-512-6155 OFFICE USE ONLY Fax #: When the submission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database N ashoba Analytical, LLC 31A Willow Road, Ayer MA 01432 Client: Skillings and Sons, Inc. 9 Columbia Drive Amherst, NH 03031 22875 Tel: 978-391-4428 Fax: 978-391-4643 Website: http://www.NashobaAnalytical.com Parameter Method - Pond Rd, North Andover MA - Well Head Sampled: 6/162014 1:15:00 PM by Client Total Coliform Bacteria, /100ml ENZ. SUB. SM9223 Arsenic, Total, MG/L SM 3113B Calcium, MG/L EPA 200.7 Copper, MG/L EPA 200.7 Iron, MG/L EPA 200.7 Lead, MG/L SM 3113B Magnesium, MG/L EPA 200.7 Manganese, MG/L EPA 200.7 Potassium, MG/L EPA 200.7 Sodium, MG/L EPA 200.7 Alkalinity, MG/L SM 2320B Ammonia as N, MG/L SM 4500-NH3-D Chloride, MG/L EPA 300.0 Chlorine, Free Residual, MG/L SM 4500 -CL -G Color Apparent, CU SM 2120B Conductivity, UMHOS/CM SM 2510B Fluoride, MG/L EPA 300.0 Hardness, Total, MG/L SM 23406 Nitrate as N, MG/L EPA 300.0 Nitrite as N, MG/L EPA 300.0 Odor, TON SM 2150B pH, PH AT 25C SM 4500 -H -B Sediment, pos/neg -------------- Sulfate, MG/L EPA 300.0 Turbidity, NTU EPA 180.1 Certificate of Analysis LabNumber: 146641 Use this number with all correspondence Report Date: 6/18/2014 Result MCL MRL Date of Analysis Analyst Absent Absent Absent 6/16/2014 3:45:00 PM M-MA1118 # 0.019 0.01 0.001 6/17/2014 M-MA1118 23.7 Not Spec 0.2 6/18/2014 M-MA1118 ND 1.3 0.003 6/18/2014 M-MA1118 # 1.3 0.3 0.003 6/18/2014 M-MA1118 ND 0.015 0.001 6/17/2014 M-MA1118 4.2 Not Spec 0.1 6/18/2014 M-MA1118 # 0.42 0.05 0.002 6/18/2014 M-MA1118 2.3 Not Spec 0.1 6/18/2014 M-MA1118 12.4 See Note 0.2 6/18/2014 M-MA1118 58 Not Spec 1 6/16/2014 M-MA1118 ND Not Spec 0.1 6/16/2014 M-MA1118 10.3 250 1 6/17/2014 M-MA1118 ND Not Spec 0.02 6/16/2014 M-MA1118 # 20 15 1 6/16/2014 M-MAI118 244 Not Spec 1 6/16/2014 M-MA1118 ND 4 0.1 6/17/2014 M-MA1118 76 Not Spec 1 6/18/2014 M-MA1118 ND 10 0.05 6/17/2014 M-MA1118 ND 1 0.01 6/17/2014 M-MA1118 0 3 0 6/16/2014 RPM 7.3 6.5-8.5 NA 6/16/2014 M-MA1118 NEG ------ NEG 6/16/2014 RPM 30.6 250 1 6/17/2014 M-MA1118 6.9 Not Spec 0.1 6/16/2014 M-MA1118 MCL=Maximum Contaminant Level (EPA Limit), MRL = Minimum Reporting Level Sodium Guidelines- Mass 20, EPA 250, # = Result Exceeds Limit or Guideline ND = None Detected (<MRL), ' = Background Bacteria Noted Massachusetts Certified Laboratory #M-MA1118 David L. Knowlton Laboratory Director Page 1 of 1 LC3 Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: SKILLINGSWELL Transaction ID: 663822 Document: Well Driller Size of File: 248.70K Status of Transaction: In Process Date and Time Created: 7/1/2014:12:50:07 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection Bureau of Resource Protection • Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 1 POND STREET Please specify well type: Building Lot#: Assessor's Map #: Domestic Assessor's Lot#: ZIP Code: Number Of Wells: City/Town: Well Location NORTH ANDOVER In public right-of-way: GPS C'. Yes C No North: West: 42.71293 71.08515 Subdivision/Property/Description: Mailing Address: click here if same as well location addres Property Owner: Street Number: Street Name: ERIC AND CHLOE PETERSON 202 HIGH STREET City/Town: State: Engineering Firm: ABINGTON MASSACHUSETTS .--- - -_ ZIP Code: _- 01845 Board of health permit obtained: l:, Yes C Not Required Permit Number: Date Issued: 6809 5/27/2014 Massachusetts Department of Environmental Protection \e Bureau of Resource Protection - Well Driller Program Well Completion Reports(General) �4 Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Air Hammer Air Hammer WELL LOG OVERBURDEN LITHOLOGY Loss or addition of Visible Rust Extra Large From To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition of (ft) r Ye r- Ye stem drill rate fluid 0 20 Iclay jBrown YES r'e ND is Fast Slowl t Loss Addition 20 40 Clay -� Brown G' YES ND ` Fast Slo_wJ C, Loss r Addition 40 56 IClay Brown %, YES C) q ! , Fast r Slowl I r Loss r Addition WELL LOG BEDROCK LITHOLOGY From Drop in drill Extra fast or slow To(ft) Code Comment Loss or addition of Visible Rust Extra Large (ft) stem drill rate fluid Staining Chips 56 100 Granite (' YES' NO �' Fast (- Slow Chi Loss (7 Addition I r Ye r- Ye -i 100 200 GraniteYES i, q (. Fast (—)Sl ow - r- Loss �' Addition Ee Ye 200 300 Granite % YES r` NO] I C Fast G Slow f^ Loss C` Addition Ye f Ye ADDITIONAL WELL INFORMATION Developed I (,% Yes No Disinfected t:, Yes C, No Total Well Depth 300 Depth to Bedrock 56 Fracture Surface Seal Type None Enhancement t71 Yes (;, No CASING FIs Casing above ground. From: 1.50 To: 0 From To Type Thickness Diameter Driveshoe 0 83.50 Steel 17# 6 Ke SCREEN r' No Scree From To Type Slot Size Diameter -- Choose Screen Type �I WATER -BEARING ZONES DRY WEL From To Yield (gpm) 121 123 4 283 285 8 PERMANENT PUMP (IF AVAILABLE) Pump Description Massachusetts Department of Environmental Protection Bureau of Resource Protection — Well Driller Program Well Completion Reports(General) 2 Wire Constant Speed Submersible Horsepower 3/ Pump Intake Depth (ft) 260 Nominal Pump Capacity (gpm) 7 ANNULAR SEAL / FILTER PACK Water From To Material 1 Weight Material 2 Weight (gal) Batches Method Of Placement 0 83.50 Native Material Choose Material lGravity WELL TEST DATA WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate (gpm) 6/13/2014 17.4 6/16/2014 16.8 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision, according to the applicable rules and regulations, and this report is complete and accurate to the best of my knowledge. CHRIS Monitoring [M] Supervising Driller SKILLING Driller BERNIER Registration # 943 Signature DEREK, SKILLINGS AND SONS WELL Date Job Complete Firm DRILLING, INC. Rig Permit # 20 6/16/2014 NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. Time Pumping Time To Recovery (ft Date Method Yield (gpm) Pumped Level (ft Recover .BGS) (HH:MM) BGS) (HH:MM) 6/10/2014 Air Blow With Drill Stem 12 00:30 300 6/16/2014 Constant Rate Pump 11 04:15 46.2 00:10 17.3 WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate (gpm) 6/13/2014 17.4 6/16/2014 16.8 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision, according to the applicable rules and regulations, and this report is complete and accurate to the best of my knowledge. CHRIS Monitoring [M] Supervising Driller SKILLING Driller BERNIER Registration # 943 Signature DEREK, SKILLINGS AND SONS WELL Date Job Complete Firm DRILLING, INC. Rig Permit # 20 6/16/2014 NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. Massachusetts Department of Environmental Protection Bureau of Resource Protection — Well Driller Program Well Completion Reports(General) North Andover Health Department (ommunity Development Division 4/7/2015 Eric and Chloe Peterson 202 High Street North Andover, MA 01845 Mr. & Mrs. Peterson, Please bring the enclosed Deed Restriction to the Registry and provide a copy of the proof of recording to the Health Department. Thank you. Michele Grant Health Inspector Page 1 of 1 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Return to: Department of Environmental Protection Bureau of Resource Protection, Wastewater Management {Applicable Regional Office or Boston Office address} GRANT OF TITLE V BEDROOM COUNT DEED RESTRICTION This Grant of Title V Bedroom Count Deed Restriction is made as of this day of August, 2014, by Eric S. Peterson and Chloe Peterson ("Grantor"), of North Andover, Essex County, Massachusetts,_ pursuant to M.G.L. c. 21A, §13 and 310 CMR 15.000 (collectively, "Title 5"). WITNESSETH WHEREAS, Grantor, being the owner(s) in fee simple of that certain parcel of vacant land located in North Andover, Essex County, Massachusetts, with the buildings and improvements thereon, pursuant to a deed from James H. Nason, Successor Trustee of the Stone House Farm Realty Trust #2 to Grantor, dated November 20, 2012, and recorded with Essex North Registry of Deeds in Book 31944, Page 298 ("Property"); and WHEREAS, Grantor desires to restrict the number of bedrooms, as the term bedroom is defined at 310 CMR 15.002 ("Bedroom"), through the granting of this Title V Bedroom Count Deed Restriction; NOW, THEREFORE, Grantor does hereby GRANT to North Andover of Essex County, Massachusetts, a municipal corporation located in Essex County, having a mailing address of 120 Main Street, North Andover, Massachusetts 01845, and acting by and through its Board of Health ("Local Approving Authority"), for nominal and non - monetary consideration, the sufficiency and receipt of which are hereby acknowledged, with QUITCLAIM COVENANTS, a TITLE V BEDROOM COUNT DEED RESTRICTION ("Restriction") in, on, upon, through, over and under the Property. Said Restriction operates to restrict the Property as follows: 1. Restriction. Grantor hereby restricts the total number of Bedrooms in, on, upon, through, over and under the Property to three (3) Bedrooms, such that at no time shall there exist more than three (3) Bedrooms in, on, upon, through, over and under said Property. 2. Severability. Grantor hereby agrees that, in the event that a court or other tribunal determines that any provision of this instrument is invalid or unenforceable: (i) That such provision shall be deemed automatically modified to conform to the requirements for validity and enforceability as determined by such court or tribunal; or (ii) That any such provision, by its nature, cannot be so modified, shall be deemed deleted from this instrument as though it had never been included herein. In either case, the remaining provisions of this instrument shall remain in full force and effect. 3. Enforcement. Grantor expressly acknowledges that a violation of the terms of this Restriction could result in the following: (i) upon determination by a court of competent jurisdiction, in the issuance of criminal and civil penalties, and/or equitable remedies, including, but not limited to, injunctive relief, such injunctive relief could include the issuance of an order td modify or remove any improvements constructed upon the Property in violation of the terms of this Restriction; and (ii) in the initiation of an enforcement action and/or assessment of penalties by the Local Approving Authority and/or the Massachusetts Department of Environmental Protection, a duly constituted agency with a principal office located at One Winter Street, Boston, MA 02108 (DEP), to enforce the terms of this Restriction pursuant to Title 5; M.G.L. c.111, §§ 2C, 17, 31, 122, 123, 125,4 27A-0, inclusive, and 129; and M. GI c. 83, §11. 4. Provisions to Run with the Land. The rights, liabilities, agreements and obligations created under this Restriction shall run with the Property and any portion thereof for the term of this Restriction. Grantor hereby covenants for [himself/herself/itselfi and[his/her/its] executors, administrators, heirs, successors and assigns, to stand seized and to hold title to the Property and any portion thereof subject to this Restriction. The rights granted to the Local Approving Authority, its successors and assigns, do not provide, however, that a violation of this Restriction shall result in a forfeiture or reversion of Grantor's title to the Property. 5. Concurrence Presumed. It is agreed that: (i) Grantor and all parties claiming by, through, or under Grantor agree to and shall be subject to the provisions of this Restriction; and (ii) Grantor and all parties claiming by, through, or under Grantor, and their respective agents, contractors, sub -contractors and employees, agree that the Restriction herein established shall be adhered to and shall not be violated, 0A and that their respective interests in the Property shall be subject to the provisions herein set forth. 6. Incorporation into Deeds Mortgages Leases and Instruments of Transfer. Grantor hereby agrees to incorporate this Restriction, in full or by reference, into all deeds, easements, mortgages, leases, licenses, occupancy agreements or any other instrument of transfer by which an interest and/or a right to use the Property, or any portion thereof, is conveyed. 7. Recordation. Grantor shall record and/or register this Restriction with the appropriate Registry of Deeds and/or Land Registration Office within 30 days of receiving the approved Restriction from the Local Approving Authority. Grantor shall file with the Local Approving Authority and the DEP a certified Registry copy of this Restriction as recorded and/or registered within 30 days of its date of recordation and/or registration. 8. Amendment and Release. This Restriction may be amended only upon the approval and acceptance of such amendment by the Local Approving Authority. Release of this Restriction shall be granted by the Local Approving Authority upon (i) Grantor's request of such release; and (ii) the Property being connected to a municipal sewer system and the septic system serving the Property being abandoned in accordance with 310 CMR 15.354. Any such amendment or release shall be recorded and/or registered with the appropriate Registry of Deeds and/or Land Registration Office and a certified Registry copy of said amendment or release shall be filed with the Local Approving Authority and the DEP within 30 days of its date of recordation and/or registration. 9. Term. This Restriction shall run in perpetuity and is intended to conform to M.G.L. c.184, §26, as amended. 10. Rights Reserved. This Restriction is granted to the Local Approving Authority. It is expressly agreed that acceptance of this Restriction by the Local Approving Authority shall not operate to bar, diminish, or in any way affect any legal or equitable right of the Local Approving Authority or of DEP to issue any future order with respect to the Property or in any way affect any other claim, action, suit, cause of action, or demand which the Local Approving Authority or DEP may have with respect thereto. Nor shall acceptance of the Restriction serve to impose any obligations, liabilities, or any other duties upon the Local Approving Authority. 11. Effective Date. This Restriction shall become effective upon its recordation and/or registration with the appropriate Registry of Deeds and/or Land Registration Office. WITNESS the execution hereof under seal this 16 day of August, 20 Eric S. Peterson, Grantor ESSEX,ss C—o Peterson, Grantor COOMMONWEALTH OF MASSACHUSETTS Auguste, 2014 Then personally appeared the above-named Eric S. Peterson and Chloe Peterson and acknowledged t free act and deed before me. 1pate: 1I 1 q El bA Notary Public: \Z'l1 YEA My commission expires: 10' i d 20 Approved and Accepted By: y0c,roving Autho � �� i Ss1o�U i✓x �i��s,r 7�/.��d 1 Return to: Department of Environmental Protection Bureau of Resource Protection, Wastewater Management {Applicable Regional Office or Boston Office address GRANT AT -L-1 5 BEDROOM COUNT DEED RESTRICTION r � Z This Grp t of Title 5 Bedroom Count,Deed estriction is\,alde as of this day of August, 20 4 Eby ric S. Peterso n and Chloe Peterson (" Jr ,or"), of orth� Andover, Essex County;, assachusettss pursuant to M.G.L. c. N A, § 13 and -310 CMR 15.000 (collectively, "Titl'e,� "). WITNESSETH WHEREAS, Grantor, being the owner(s) in fee simple of that certain parcel of vacant land located in North Andover, Essex County, Massachusetts, with the buildings and improvements thereon, pursuant to a deed from James H. Nason, Successor Trustee of the Stone House Farm Realty Trust #2 to Grantor, dated November 20, 2012, and recorded with Essex North Registry of Deeds in Book 31944, Page 298 ("Property"); and WHEREAS, Grantor desires to restrict the number of bedrooms, as the term bedroom is defined at 310 CMR 15.002 ('Bedroom"), through the granting of this Title 5 Bedroom Count Deed Restriction; NOW, THEREFORE, Grantor does hereby GRANT to North Andover of Essex County, Massachusetts, a municipal corporation located in Essex County, having a mailing address of 120 Main Street, North Andover, Massachusetts 01845, and acting by and through its Board of Health ("Local Approving Authority"), for nominal and non - monetary consideration, the sufficiency and receipt of which are hereby acknowledged, with QUITCLAIM COVENANTS, a TITLE 5 BEDROOM COUNT DEED RESTRICTION ("Restriction") in, on, upon, through, over and under the Property. Said Restriction operates to restrict the Property as follows: 1. Restriction. Grantor hereby restricts the total number of Bedrooms in, on, upon, through, over and under the Property to three (3) Bedrooms, such that at no time shall there exist more than three (3) Bedrooms in, on, upon, through, over and under said Property. 2. Severability. Grantor hereby agrees that, in the event that a court or other tribunal determines that any provision of this instrument is invalid or unenforceable: d IA 6o m , I , I I � O is i m NK N n M O z C N O m 1 o z z N 24'-0 3/4' 104 — 11'-53/4' 2'-6I/4' F7 -d Y -d �7-163/1 C36%54'-2 C36':54' g O O - ^ T Ti O p n O n d az N \ O h CC ilm".1. _ \14 O I m 2/6 -INT _ O CD K: 01,E 2/6 -INT C30'x36' C30':36' Y-53/4' 2'-61/4' 6 -D4 -d 11'-5 3/4' 14'-0' 24'-0 3/4' i -------------------------------------------------------- jIf i {GV LAST PRINTED: 5/6/2014 AT 6:34 AM R:\-DRAWINGS\JOBS\SPEC\2014\14-029 (MA) PETERSON SPEC x n _ n mzm,_�,_ v Z� r+'I H n fmTl N Z IT' Z a C O NZo o �W N Z mm� o 41 C LJLJLJ o -moo mteu O m z=a, v ^�mIJU _ II D �orsoz OO n 00 cNO DC'30�m o�_� -A O� VJ 2 m K DZ �0 n00 X 00 mC0 Cl)� G) 0 z0 Z zzM.n SNn2 �~MO m "m � z x co CD C Q 0 m V Q N m C O in. D G F n 9 D 7 n °mmmF��0>'0 CD ? ! 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SULLIVAN JR. Governor Secretary TIMOTHY P. MURRAY KENNETH L. KIMMELL Lieutenant Governor Commissioner REMEDIAL USE APPROVAL Pursuant to Title 5, 310 CMR 15.00 Name and Address of Applicant: Presby Environmental, Inc. 143 Airport Road Whitefield, NH 03598 Trade name of technology and models: Presby Enviro-Septic® Wastewater Treatment System (hereinafter called the "System"). The "Massachusetts Enviro-Septic® Wastewater Treatment System Quick Reference Guide" including schematic drawings of typical Systems, an inspection checklist, and a System Installation Form are part of this Approval. Transmittal Number: X233395 Date of Issuance: Revised March 19, 2013 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000; the Department of Environmental, Protection hereby issues this Approval for Remedial Use to: Presby Environmental, Inc., 143 Airport Road, Whitefield, NH 03598 (hereinafter "the Company"), certifying the System described herein for Remedial Use in the Commonwealth of Massachusetts. The sale, design, installation, and use of the System are conditioned on compliance by the Company, the Designer, the Installer and the System Owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. OJ4 �� March 19, 2013 David Ferris, Director Date Wastewater Management Program Bureau of Resource Protection This information is available in alternate format. Call Michelle Waters-Ekanem, Diversity Director, at 617-292-6751. TDD# 1-866-639-7622 or 1-617-674-6868 MassDEP Website: www.mass.gov/dep Printed on Recycled Paper Revised Remedial Use Approval — Special Conditions Page 2 of 4 Presby Enviro-Septic Wastewater Treatment System Issuance Date: March 19, 2013 Technology Description The System is an alternative subsurface Soil Absorption System (SAS) that replaces a conventional SAS designed in accordance with 310 CMR 15.000. The System consists of an 11 5/8 -inch diameter corrugated, high-density plastic pipe with a 9.5 -inch interior diameter and a standard length per unit of 10 feet. The pipe is perforated with eight holes equally distributed around its inner circumference at each corrugation. Each hole has a plastic skimmer extending inwards. The exterior of the pipe has ridges on the peak of each corrugation and is wrapped with two layers of fabric material. The inner layer is a thick layer of coarse, randomly oriented polypropylene fibers. The outer fabric layer is a non -woven geo-textile polypropylene. The System includes required connectors designed to connect pipe units together. The System also includes six inches of sand, specified as concrete sand meeting ASTM C-33 (also called `System sand'), surrounding the pipe on all sides. Conditions of Approval The term "System" refers to the Alternative Soil Absorption System in combination with the other components of an on-site treatment and disposal system that may be required to serve a facility in accordance with 310 CMR 15.000. The term "Approval" refers to the technology -specific Special Conditions, the Standard Conditions for General and Remedial Use Approval of Alternative Soil Absorption Systems (the `Standard Conditions'), the General Conditions of 310 CMR 15.287, and any Attachments. For Alternative Soil Absorption Systems that have been issued Remedial Use Approval for the installation of Systems to serve facilities where the site meets the requirements for new construction, the Department authorizes reductions in the effective leaching area (3 10 CMR 15.242), subject to the applicable portions of the Standard Conditions, and subject to the below Special Conditions applicable to this Technology. Special Conditions 1. The System is an approved Patented Sand Filter System for use as an Alternative Soil Absorption System. In addition to the Special Conditions contained in this Approval, the System shall comply with all Standard Conditions for Alternative Soil Absorption Systems, except where stated otherwise in these Special Conditions. 2. This Approval applies to the installation of a System for the upgrade or replacement of an existing failed or nonconforming system, provided that the facility meets the siting requirements for upgrades, as provided in II(7) and II(9) of the Standard Conditions. For the upgrade or replacement of an existing failed or nonconforming system, all installed Systems shall also comply with the Deed Notice requirement of paragraph IV(1) and the transferee notification requirements of paragraph IV(2) of the Standard Conditions. The proposed use of the System shall also comply with any other Standard Conditions which pertain wholly or in part to upgrades of existing systems. 3. SAS Design - For the upgrade or replacement of an existing failed or nonconforming system, Systems sited in soils with a percolation rate of 60 minutes or less per inch, the size of the Revised Remedial Use Approval — Special Conditions Presby Enviro-Septic Wastewater Treatment System Issuance Date: March 19, 2013 Page 3 of 4 SAS shall be sized with 40 percent less effective leaching area than required when using the loading rates for gravity systems of 310 CMR 15.242(1)(a). For soils with a recorded percolation rate of between 60 and 90 minutes per inch, the size of the SAS shall be sized with 40 percent less effective leaching area than required when using the loading rate of 0.15 gpd/square foot as specified by 310 CMR 15.245(4). No reduction greater than 40% in the required effective leaching area is allowed, including any reductions under a LUA or a variance. The required effective leaching area of the SAS shall be reduced in accordance with the above requirements, except a minimum of 400 square feet of effective leaching area shall be provided if any proposed reduction in the leaching area would result in less than 400 square feet of effective leaching area. Where 400 square feet of effective leaching is not feasible, the greatest effective leaching area shall be installed provided that no more than a 40 percent reduction is taken. 4. Alternative Design Standards - Provided that the Designer demonstrates that the impact of the proposed Alternative System has been considered and the design requirements of 310 CMR 15.000 have been varied to the least degree necessary so as to allow for both the best feasible upgrade within the borders of the lot and the least effect on public health, safety, welfare and the environment, the local approving authority may allow any combination of the following alternative design standards without the need for granting a variance under 310 CMR 15.400 or obtaining Department approval: a) If a reduction in the depth to groundwater required by 310 CMR 15.212 is necessary, the depth to groundwater may be reduced by up to 2 feet, resulting in a minimum separation distance of two feet in soils with a recorded percolation rate of more than two minutes per inch and three feet in soils with a recorded percolation rate of two minutes or less per inch, measured from the bottom of the soil absorption system to the high groundwater elevation, only if, i. An approved Soil Evaluator who is a member or agent of the local Approving Authority determines the high groundwater elevation; ii. No reduction is granted under LUA for setbacks from public or private wells, bordering vegetated wetlands, surface waters, salt marshes, coastal banks, certified vernal pools, water supply lines, surface water supplies or tributaries to surface water supplies, or drains which discharge to surface water supplies or their tributaries, is allowed; and iii. In accordance with 310 CMR 15.212(2), for systems with a design flow of 2,000 gpd or greater, the separation to high groundwater as required by 310 CMR 15.212(1) shall be calculated after adding the effect of groundwater mounding to the high groundwater elevation as determined pursuant to 310 CMR 15.103(3). b) If a reduction in the depth of the naturally occurring pervious material layer is necessary, a proposed reduction of up to 2 feet may be allowed in the four feet of naturally occurring pervious material layer required by 310 CMR 15.240(1) provided that it has been demonstrated that no greater depth in naturally occurring pervious material can be met anywhere on the site. Revised Remedial Use Approval — Special Conditions Presby Enviro-Septic Wastewater Treatment System Issuance Date: March 19, 2013 Page 4 of 4 5. In no case, shall the reductions in the effective leaching area, depth to groundwater, and depth of naturally occurring pervious material allowed under this Approval be made less stringent. Any reductions in the effective leaching area, depth to groundwater, and depth of naturally occurring pervious material allowed under this Approval shall not be combined with any reduction that may allowed under the procedures of Local Upgrade Approval or the variance procedures of 310 CMR 15.401-413. The local Approving Authority may vary other design requirements under the LUA provisions of 310 CMR 15.405 or under the variance procedures of 310 CMR 15.411. 6. The System shall only be installed in bed or field configuration, as described in 310 CMR 15.252. The System shall not be installed in trench configuration and no sidewall area shall be considered in the total effective leaching area provided. The effective leaching area shall be the bottom area only (length times width) of the sand bed. 7. Systems shall be installed with differential venting for aeration and inspection access at end of each run of pipe, section or serial bed and whenever the System is installed under impervious surfaces. 8. Serial distribution laterals shall be limited to no more than 500 gpd with each lateral a maximum of 100 feet, and must be laid level. Multi-level systems shall not be allowed. 9. System component material specifications for the pipe, plastic components, fabric and sand shall comply with the specifications identified in the initial I/A technology approval. Prior approval from the Department for any change from these specifications shall be requested in writing. 10. Any changes to the approved plans must receive Local Approving Authority (LAA) approval prior to any changes. Before a Certificate of Compliance can be issued by the LAA the System Designer must include any changes to the approved plan into the as -built plans. pORTy O�,�s�eo 2 'a O �n Oq_ COCMIC �wKM _ 1' PUBLIC HEALTH DEPARTMENT Community Development Division May 28, 2010 Ruth Nason P.O. Box 44 West Boxford, MA RE: Subsurface Sewage Disposal System Plan for 0 Pond St, North Andover, MA, Map 90C, Parcel 27, and Washington St, Boxford Dear Ms. Nason, This correspondence is in regards to the subsurface disposal system plan, dated March 24, 2008 that was approved for the above mentioned property on June 2, 2008. At a regularly scheduled meeting of the North Andover Board of Health, held on May 27, 2010, you requested an extension of this approval for a period of one year. This request was granted by a unanimous vote. This was a single extension of one year as allowed by local and state code. During this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. In accordance with local subsurface disposal regulations "Acceptable plans and any variances shall expire two years from the date approved unless construction on the lot has begun". 1. Prior to receiving a building permit or installation permit, the applicant must provide complete floor plans of the new home. Including basements and attics. 2. Prior to receiving an installation permit, the applicant must provide a foundation plan in 1" = 20' scale to overlay on the septic plan. 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com s Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. X Susan Y. Sa er, RE /RS Public Health Director Encl: list of licensed septic system installers 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ' /K — a �lAi 1 i 01.0 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT w�ST QUxr� � MA 0)ke�- )D N bdV�� vv 0 'a�SoN C vm X13) , uS� i PUBLIC HEALTH DEPARTMENT Community Development Division June 2, 2008 Ruth Nason P.O. Box 44 West Boxford, MA RE: Subsurface Sewage Disposal System Plan for 0 Pond St, North Andover, MA, map 90C✓, Parcel 27, and Washington St, Boxford Dear Ms. Nason, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property. These plans dated February 19, 2007, final revision dated March 24, 2008 have been approved for a five (5) bedroom, maximum eleven -room home. In accordance with local subsurface disposal regulations "Acceptable plans and any variances shall expire two years from the date approved unless construction on the lot has begun". During this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. 2. 3 4. Prior to receiving a building permit or installation permit, the applicant must provide complete floor plans of the new home. Including basements and attics. Prior to receiving an installation permit, the applicant must provide a foundation plan in I" = 20' scale to overlay on the septic plan. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3I0 CMP. 15.020(1)). It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 918.688.8476 Web www.townofnorthandover.com 'r shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Zus:an. SawyeZRE7H.S, Public Health Director Encl: list of licensed septic system installers Cc: Thad Berry, PE Xeriscape Design LLC 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Page 1 of 1 DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Tuesday, July 24, 2007 6:41 PM To: Daniel Ottenheimer; dobrzut@millriverconsulting.com; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Soil Results for Pond Street, Parcel #27 from July 23, 2007 Attached please find the soil results from Pond Street, Parcel 27, done yesterday with Thad Berry. Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx www.millrivercorLsL�lfing.com 7/25/2007 "Ice /V. +'l Cot, /. 'l4 stxtr=s��, lip r o Y y�z ISS. j3_G-.---- G(/�� z ors� 5 Ac se4e--,-( -3 0 7r �� 3.3 1 0A /z 23 /0-137 2`, -- wn 12.33 0\ LD ri a SOILS REPORT LOCATED AT POND STREET, NORTH ANDOVER NORTH ANDOVER MAP 90C LOT 27 AND PART OF BOXFORD MAP 9 BLOCK I LOT 5 PREPARED FOR: RUTH C. NASON 236 WASHINGTON STREET P.O. BOX 44 WEST BOXFORD, MA 19.7:17:10till :�•i� RECEIVED AUG 2 8 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT IIIIXERISCAPE DESIGN LLC. 18 OAK STREET READING MA 01867 phone 781.481.9211 fax 781.279.9136 e-mail: tberry@xeriscapedesign.com AUGUST 02, 2007 r IIII XERISCAPE DESIGN LLC JOB #: 07-18 PAGE: 1-1 FORM 11- SOIL EVALUATOR FORM Commonwealth of Massachusetts SOIL SUITABILITY ASSESSMENT FOR ON-SITE SEWAGE DISPOSAL PERFORMED BY: Thad D Berry WITNESSED BY: Mill River Consulting - Mr. Randy Burley DATE OF TESTING: 7/23/07 Location Address or Lot# Owner's Name & Address Map 90C Parcel 27 Ruth C. Nason Pond Street 236 Washington Street North Andover P.O. Box 44 West Boxford MA. OFFICE REVIEW Published Soil Survey Year Published Drainage Class NO 1981 Publication Scale 1"=1320' WD Surficial Geological Report Available Year Published Geological Material (Map Unit) Landform Flood Insurance Rate Map Above 500 -Year Flood Boundary? Within 500 -Year Flood Boundary Within 100 -Year Flood Boundary? NO 0 Publication Scale YES FX Soil Map Unit CaC Soil Limitations YES 0 NO YES NO YES ❑ NO YES Wetland National Wetland Inventory Map (Map Unit) Wetlands Conservancy Program Unit (Map Unit) Current Water Resource Conditions (USGS) Month Range: Above Normal ❑ Other References Reviewed Normal ❑ Below Normal n pR New Construction F-1 Repair M Best Management Practice III) XERISCAPE DESIGN LLC JOB #: 7-18 PAGE: 2-1 FORM 11 - SOIL EVALUATOR FORM Commonwealth of Massachusetts Deep Hole Number: 1 Date: Location (identify on plan): See Plan Land Use: See Plan Slope (%): Vegetation: Landform: Position on Landscape Distances From: 7/23/07 Weather: 78 OF Cloudy See Plan _ Surface Stones: See Plan See Plan See Plan See Plan Open Water Body: See Plan feet Drainage Way: See Plan feet Possible Wet Area: See Plan feet Property Line: See Plan feet Drink'g Water Well: See Plan feet Other: See Plan feet DEEP HOLE OBSERVATION LOG Depth from Surface inches Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling ter: (Structure, Stones, Boulders, Consistent % Gravel 0 - 12" Ap S. L. 10 YR 4/2 Roots 12'1-36" Bw S. L. 10 YR 6/8 @ 36" 10 YR 6/8 36" - 138" Cl F.S.L. 2.5 Y 6/2 Receiving Layers: C1 Parent Material (geological) Glacail Till Depth to Groundwater: - Weeping from Pit Face: 96" Estimated Seasonal High Ground Water: MNew Construction Design Class: Depth to Bedrock: Standing Water in the Hole: @ 36" l OYR 6/8 E] Repair M Best Management Practice IIII XERISCAPE DESIGN LLC JOB #: 7-18 PAGE: 2-2 FORM 11 - SOIL EVALUATOR FORM Commonwealth of Massachusetts Deep Hole Number: 2 Date: 7/23/07 Weather: 78 °F Cloudy Location (identify on plan): See Plan 0 - 12" Ap S.L. Land Use: See Plan Slope (%): See Plan Surface Stones: See Plan Vegetation: 10 YR 6/8 See Plan 24" - 138" Landform: F.S.L. 2.5 Y 6/2 See Plan Position on Landscape See Plan Distances From: Open Water Body: See Plan feet Drainage Way: See Plan feet Possible Wet Area: See Plan feet Property Line: See Plan feet Drink'g Water Well: See Plan feet Other: See Plan feet DEEP HOLE OBSERVATION LOG Depth from Surface inches Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling ter: (Structure, Stones, Boulders, Consistency, % Gravel 0 - 12" Ap S.L. 10 YR 4/2 Roots 1211-2411 Bw S.L. 10 YR 6/8 24" - 138" C1 F.S.L. 2.5 Y 6/2 @ 36"10 YR 6/8 Receiving Layers: C1 Parent Material (geological) Glacai) Till Depth to Groundwater: - Weeping from Pit Face: 96" Estimated Seasonal High Ground Water: New Construction Design Class: Depth to Bedrock: Standing Water in the Hole: 36" 10 YR 6/8 E] Repair Best Management Practice IIII XERISCAPE DESIGN LLC JOB #: PAGE: FORM 11 - SOIL EVALUATOR FORM Commonwealth of Massachusetts 7-18 2-3 Deep Hole Number: 3 Date: 7/23/07 Weather: 78 OF Cloudy Location (identify on plan): See Plan 0 - 12" Ap S.L. Land Use: See Plan Slope (%): See Plan Surface Stones: See Plan Vegetation: 10 YR 6/8 See Plan 24" - 132" Landform: F.S.L. 2.5 Y 6/2 See Plan Position on Landscape See Plan 'Distances From: Open Water Body: See Plan feet Drainage Way: See Plan feet. Possible Wet Area: See Plan feet Property Line: See Plan feet Drink'g Water Well: See Plan feet Other: See Plan feet DEEP HOLE OBSERVATION LOG Depth from Surface inches Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling ter: (Structure, Stones, Boulders, Consistency, % Gravel 0 - 12" Ap S.L. 10 YR 4/2 1211-2411 Bw S.L. 10 YR 6/8 24" - 132" C1 F.S.L. 2.5 Y 6/2 @ 36" 10 YR 6/8 Receiving Layers: C1 Parent Material (geological) Glacail Till Depth to Groundwater: - Weeping from Pit Face: 106" Estimated Seasonal High Ground Water: FX New Construction Design Class: Depth to Bedrock: Standing Water in the Hole: @ 36" 10 YR 6/8 Repair Best Management Practice IIII XERISCAPE DESIGN LLC JOB #: 7-18 PAGE: 2-14 FORM 11 - SOIL EVALUATOR FORM Commonwealth of Massachusetts Deep Hole Number: 4 Date: 7/23/07 y Weather: 78 OF Cloudy Location (identify on plan): See Plan Land Use: See Plan Slope (%): Vegetation: Landform: Position on Landscape Distances From: See Plan _ Surface Stones: See Plan See Plan See Plan See Plan Open Water Body: See Plan feet Drainage Way: Possible Wet Area: See Plan feet Property Line: Drink'g Water Well: See Plan feet Other: DEEP HOLE OBSERVATION LOG See Plan See Plan .See Plan feet feet feet Depth from Surface inches Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling ter: (Structure, Stones, Boulders, Consistency, % Gravel 0 - 12" Ap S. L. 10 YR 4/2 1211-2411 Bw S. L. 10 YR 5/8 24" - 126" C1 F.S.L. 2.5 Y 6/2 @ 36 " 10 YR ' Receiving Layers: C1 Parent Material (geological) Glacail Till Depth to Groundwater: - Weeping from Pit Face: 126" Design Class: Depth to Bedrock: Standing Water in the Hole: Estimated Seasonal High Ground Water: @ 36" 10 YR 6/8 MX New Construction Repair Best Management Practice IIII XERISCAPE DESIGN LLC JOB #: PAGE: FORM 11 - SOIL EVALUATOR FORM Commonwealth of Massachusetts DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth observed standing in observation hole Depth weeping standing in observation hole Depth to soil mottles Groundwater adjustment Index Well Number: Date: Adjustment Factor: 7-18 3-1 Test Hole Number: 1 - 4 At 36" 10 YR 6/8 Index Well Level: Adjusted Ground Water: inches inches inches feet Depth of Naturally Occurring Pervious Material Does at least four (4) feet of naturally occuring pervious material exist in ALL observed throughout the proposed for the soil absorption system? Yes If not, what is the depth of naturally occuring pervious material? Certification I certify that on May 1996 I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise, and experience as described in 310CMR 15.017. Signature Date Comments: Fx New Construction F-1 Repair F-1 Best Management Practice IIII XERISCAPE DESIGN LLC JOB #: PAGE: 7-18 4-1 FORM 12 - PERCOLATION TEST Commonwealth of Massachusetts PERCOLATION TEST Location, Address, or Lot No. Parcel 27 Map 90C Pond Street North Andover DATE: July 23, 2007 TIME: See Below Observation Hole # Perc 1 @ D.H. # 3 Perc 2 @ D.H. # 1 Depth of PERC 64" 65" Start Pre -Soak 10:17 10:39 End Pre -Soak 10:33 10:54 Time @ 12" 10:33 10:54 Time @ 9" 11:03 11:13 Time @ 6" 12:23 11:53 Time Elapsed (9" to 6") 80 min. 40 min. PERC Rtae (minutes/inch) 27 min./in. 14 min./in # MINIMUM OF 1 PERCOLATION TEST MUST BE PERFORMED IN BOTH THE PRIMARY AREA AND RESERVE AREA. Site Passed Site Failed Performed By: Thad D. Berry Witnessed By: Mill River Consulting Randy Burley Comments: PERC # 1 ❑R New Construction PERC # 2 Repair ❑ Best Management Practice I c, Ill ON I C."Ll I/ NIM I RUTH C. NASON FIGURE 1 NORTH ANDOVER MAP 90C LOT 27 AND USGS QUAD: MAGIS DRG PART OF BOXFORD MAP 9 BLOCK I LOT 5 POND STREET NORTH ANDOVER MA QUAD DATE: IIIIXERISCAPE DESIGN LLC CITY/TOWN: NORTHANDOVER SITE LOCATION MAP SCALE: V = 2500'± 18 OAK STREET READING MA 01867 DATE: 08/02/07 phone 781.481.9211 fax 781.279.9136 ..i . -'•4f •v�f. III 1� 't s Y i ♦ tt Y ' `F�.II`i�' � � a'..�i p f •' , � � � . tt � 3 J J fiA'S;" Now lik �✓ Cts.+�� • , '�.��;� .s• I� *n �./��+ ti��, ;w � . • yr,. "tl's' !' � .i '� `' ti ,Ir -;t` �=�� ry � �`%�� /ZV - i �y�l }�,• its i��.� ti �.�JeY �' Y +P` : �' -s' r 1� � � r} �d�t, � t I��f... �. �.`,�+� ONb ^ ` "sat t � � �. ~�� r � � {�� i'"�tY. ` t ► �'* t �. � . M Yi .+1.�.. `� \ J`4f-. � N�j '� •�.t'F� ��"s �;It,,iw�,.�,�±. �\ t� z� � s � •�r .f, ,'`,♦ . tti. .. t'lp 'Y- %- '."`.� t ^fig •�t •, 7� N l - .. ouf Nt+ �t.•� tR� SITS y�• ..`' ,j.'$�,w . y7y 4 Ail: c f R i,, � t• 1 r i ' � r �. � ,�• yr i r S♦ � r a i i A• V V m n 310B 253C . s (WrB) ��`�� (HfC) 717B dO (RoD) 305C 420C (PaC) (CaC) 51A • 305D 411B (PaD) (SuB) 420C Vol 411C 420C C) \ . • 6A . , (SuC) (Ca (CaC). (Se)'' 420C 70B' Vl (CaC) 311D (WsD) (RdB) . SITE 411C411B � (SuC). 305D 67B (PaD) (SuB) O (LeB) 72A (�'�'g) 411'B 305C 405it (SuB) (PaC) (CmB)'. O 6A (Se) �d 405B �O 305D (CmB) PaD 72A 410C (StC) 602 (Ur) 52A 305C (MC) (PaC) 406C I (CoC) RUTH C.NASON NORTH ANDOVER MAP 90C LOT 27 AND COUNTY: ESSEX FIGURE 3 PART MAP 9 BLOCK 1 LOT 5 POND STREETREST N NORTH ANDOVER MA S CITY/TOWN: NORTH ANDOVER SCS SOILS MAP MAGIS SCALE: I"=400'f IIIIXERISCAPE DESIGN LLcSHEET#: — ---- - 18 OAK STREET READING MA 01867 phone 781.481.9211 . fax 781.279.9136 DATE: 08/02/07 SEPTIC Sustems: 0 Septic - Soil Testing /96 0.-- 'Septic - Design Approval $ 0 Septic Disposal Works Construction (DWC) 0 Septic Disposal Works Installers (DWI) $ 0 Title 5 Inspector $ 0 Title 5 Report $ 0 Other. (Indicate) Health Agent Initials, White - Applicant Yellow - Health Pink - Treasurer ': 317 7 Town of North Andover HEALTH "s4ow DEPARTMENT CHECK #: DATE: LOCATION: H/0 NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) • Animal $ • Body Art Establishment $ • Body Art Practitioner $ 0 Dumpster 0 Food Service - Type. $ 0 Funeral Directors $ 0 Massage Establishment $ 0 Massage Practice $ 0 Offal (Septic) Hauler $ 0 Recreational Camp $ 0 Sun tanning $ • Swimming Pool $ • Tobacco $ • TrashlSolid Waste Hauler $ • Well Construction $ SEPTIC Sustems: 0 Septic - Soil Testing /96 0.-- 'Septic - Design Approval $ 0 Septic Disposal Works Construction (DWC) 0 Septic Disposal Works Installers (DWI) $ 0 Title 5 Inspector $ 0 Title 5 Report $ 0 Other. (Indicate) Health Agent Initials, White - Applicant Yellow - Health Pink - Treasurer ': �J 1 law y...J TOWN OF NORTH ANDOVER N0* Tk Office of COMMUNITY DEVELOPMENT AND SERVICES o •'. '•' ''�°°� HEALTH DEPARTMENT ' 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845spa u� 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.8476— FAX Public Health Director E-MAIL: healthdept@townofnorthandover.com WEBSITE: http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: f J�, g J o e Site Location: Pon S -T C 9 C+ �7 JAN 2 1008 1 a �` y TOHEALTH DEPARTMENT k� Engineer: j7/f 1 1 New Plans? Yes J $225/Plan Check # �� (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes t No Local Upgrade Form Included? Yes V, No Telephone #: � ° 0 4 � 3 d Fax #: E-mail: �RS0% J@CO MCW,Nl;T, Homeowner Name: OFFICE USE ONLY When the submission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database s No:, FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, I nr4h Ardrye r- , MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(, Repair( ) Upgrade( ) Abandon() - 41Complete System ❑ Individual Components Location p Owner's Name Map/Parcel# - f Gi Address P D , Lot# �'� Telephone# Q -78 % �' b Installer's Name Designer's Name- f Address I_ Address iv 08k. lsiv Telephone# Telephone# 78 - L181 - q 211 Type of Building n/1.51 Dwelling - No. of Bedrooms Other - Type of Building _ Other Fixtures �1 No. of persons Lot Size 1701324— sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design Flow (min. required) -tui gpd Calculated design flow •4413 Design flow provided -440 gpd Plan: Date Q 1/0,q / o b Number of sheets 5 Revision Date Title GGPk1 Ci C✓VS �'i(11 UZlo o T Description of Soil(s) �J • �''• Soil Evaluator Form No. Name of Soil Evaluator ./lr1'1 Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Inspections Date No. COMMONWEALTH EALTH ®F MASSACHUSETTS FEE Board of Health, , MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. , dated . Approved Design Flow (gpd) Installer Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. Board of Health, MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT FEE Permission is hereby granted to; Construct( ) Repair( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at Disposal System Construction Permit No. , dated as described in the application for Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date Board of Health �,�c Na- COMMONWEALTH � Board of Health, Mork) AMcy/G' Ir MA. FEE APPLICATION FOP DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct(h Repair( ) Upgrade( ) Abandon( ) - U Complete System ❑ Individual Components Location p Owner's Name RA Ma5nn Map/Parcel# - f ,10 qo Address P Lot# 711 Telephone# 978 1 14 �f b,—o Installer's Name Designer's Name A&d Address Address iv Oak S Telephone# _ Telephone# 78 _ AP31 r Type of Building Dwelling - No. of Bedrooms Other - Type of Building Other Fixtures k No. of persons Lot Size i %(� { �%4 sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design Flow (min. required) A40 gpd Calculated design flow —1,40 Design flow provided '440 gpd Plan: Date d 11 oZi 10 b Number of sheets S Revision Date Title Gt_t�h'c, �//�-'G() Description of Soil(s) K-1,5 . L • Y Soil Evaluator Form No. I) Name of Soil Evaluator Date of Evaluation 7/,-73/0-3 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Inspections Date No. COMMONWEALTH Of MASSACHUSETTS FEE Board of Health, , MA. CERTIFICATE OF COMP]LIANCC Description of Work: ❑ Individual Component(s) 0 Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by. 7. at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. , dated . Approved Design Flow (gpd) Installer Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. COMMONWEALTH Of MASSACHUSETTS Board of Health, , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT FEE Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at as described in the application, for Disposal System Construction Permit No. , dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date __ __ Board of Health ,4Orth Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01045 97&688.9540 - Phone 9M688.8476 — Fox henithdept@townofnorthandover.com - E-mail www.towndnorthandover.com - Website <0010't 0RT#j ' 61,0 Letter of Transmittal 0 AK 0 Page f of S CHU$ d" TO- DANIEL OTTENHEIMER DATE. - COMPANY. MILL RIVER CONSULTING FROM.- Pamela DelleChiaie, Heoith Department Assistant Phone: 1.800.377.3044 or 978.282.00 T 4 Re: Fox: 970. 82.001 We are sending you, 0-S&I best Application I_7ftns for Review 13 Other These are transmitted as checked below: ®As Required ®As Requested, • .. • 1\ ( c I f... e I\III 3 ` " orory , �i41 I}IT ,",{_) S....RV1 C.;I-, S 14 JI 20-.- 1 `i '"j :y 1. ,.;I!`" ` h, ' [�_.i�l:: I•�Z ,:�Ityt... ,�.:�I �_i,), 5._ �} �(!0 i(. i-ll>.dllf!'-:,Il:x;�.[.ii .:-rl>.,,,,s.;i';d/G i:.:AN it/)II!o.l l?Il_lb''/r I i r'ilrl �✓rl[)Ifloritl.1110°nv .f.G ("Cr.E. �_. D ��___._F... APPLICATION FOR SOIL TESTS I! "N, 1 3 IJt�7 DATE: o ! _ MAP& PARCEL: �,,�, ��,�_� TOWN O N r? � } ANDOVI t; LOCATION OF SOIL_ TESTS r_?_4��R1 -( _ HEAL! Hi 17 17,1.' OWNER: V I! ---Contac #: APPLICANT: A.0Contact ADDRESS: ENGINEER: Contact CERTIFIED SOIL EVALUATOR:> Intended Use of Land: Residential Subdivision Single Family Home Commercial IsThis: Repair Testing: 1 --""Undeveloped Lot Testing:.__ Upgradefor Addition: In the Lake Cochichewick Watershed? Yes No A✓` THE FOLLOWING MUST DE INCLUDED WITH THIS FORM A Proof of land ownership (Tax bill, or letter from owner permitting test) A 8.5_x 11 -Plot plan & Location of Tectinq (please i ndicate test pit sites on the Dian A Feeof$425.00per lot for new construction, This ooversthe minimurn two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION A Only Certified Soil Evaluators may perform deep hole inspections. A Only Mass. Registered Sanitarians andProfessional Engineers can design septic plans. A At least two deep holes and two pexcoi ation tests are requi red for each septic system disposal area A Repai rs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. v Full payment will be required for all additional testswithin two weeks of testing. A Within 45daysoftesting, ascaledplan (nosmallerthan 1-100�shall besubmittedtothe Board ofHealth showing the I ocati on of all tests (i nd udi ng aborted tests). A Within 60 days of testing soil evaluation for ms shall be submitted. Pla@seDo Not Write Below This Line N.A. Conservation Commission Approval Date.. Signature of Conservation Agent: Date back to Health Department: (stab in): 40mc, %K W � � If 5CPV&- s IaCe/j . ,AORTN 0 Town of North Andover HEALTH DEPARTMENT C CHECK#: DATE: ... LOCATION: 141 H/ONAME, CONT&Cth N/ -A7-&&- .4, Type of Permit or License: (Check box) 0 Animal $ 0 Body Art Establishment $ 0 Body Art Practitioner $ 0 Dumpster $ 0 Food Service - Type. $ 0 Funeral Directors $- 0 Massage Establishment $ 0 Massage Practice $ 0 Offal (Septic) Hauler $ 0 Recreational Camp $ 0 Sun tanning $ 0 Swimming Pool $ 0 Tobacco $ 0 TrashlSolid Waste Hauler $ 0 Well Construction $ SEPTIC Systems: 0 Septic Soil Testing $ - 0 Septic - Design Approval $ 13 Septic Disposal Works Construction (DW0 $ 13 Septic Disposal Works Installers (DWI) $ 0 Title 5 Inspector $ 13 Title 5 Report $ 0 Other. (Indicate) $ 2473 ealt�V rge�t�nitials White - Applicant Yellow - Health Pink - Treasurer TRANSMIS= ZION VERIFICATION REPORT TIME 061L2,'L00i 09:49 NAME HEALTH FAX 9786898476 TEL 9786888476 SER.# 000E4J120960 DATE, TIME 06 22 09:47 FAXNO.INAME 819782820012 DURATION 00:00:52 PAGE "'. 0'L RESULT OK MODE STANDARD ECM palsanbas sbt] paainbaa snp -molaq papap so pellpsuaal an asagj -101P0 J M-7140 j -101919 old a maOxf ovddr �Saj llok)� :,OO f 091PUOS 0-10 Ohl Z i00'Z9b'$L6 :xnl Polluw �p xnj :01 Ado) PRITY1 io # xnj 01 AdO) p�lroW ja # xnd )RUMoamoH :01 Ad0] d 5z h.., k,rat s? � s� --T.y ',4Fc��t palsanbas sbt] paainbaa snp -molaq papap so pellpsuaal an asagj -101P0 J M-7140 j -101919 old a maOxf ovddr �Saj llok)� :,OO f 091PUOS 0-10 Ohl Z i00'Z9b'$L6 :xnl North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax healthdept(aD-townofnorthandover.com - E-mail www.townofnorthandover.com - Website Letter of Transmittal Page 1 of -3 NORTH �6gti0 6 OL TO: DANIEL OTTENHEIMER DATE: Zz-/Z Z/o 7 COMPANY: MILL RIVER CONSULTING FROM: Pamela DelleChiaie, Health Department Assistant Phone: 1.800.377.3044 or 978.282.0014 Re: Fax: 978.282.0012 -�� We are sending you. �40# Test Application O Pons for Review O Other These are transmitted as checked below: []As Required 0 A Requested REMARKS: —t= l %.`aS of 4S r>v� c�/� nP� . S/ (5 H t -�-o •iC_ b i� �O �n 1 i h + !S P a 6 't_ COPY TO: Homeowner Fax # Or Mailed COPY TO: Fax # Or Mailed Fax # COPY TO: Or Mailed TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS, RS Public Health Director APPLICATION FOR SOIL TESTS DATE: 6 h A 978.688.9540 — Phone 978.688.8476 — FAX Al JUN 2 2 2007 www.townofnorthandover.comf TOWN OF NORTH ANDOVER i HEALTH DEFARTiiENT MAP & PARCEL: M012 q06 LOCATION OF SOIL TESTS: �,_ au I to rond 5Vy'46 ' K1, Andnyey' OWNER: ,56611m6c, /yg1� i�- Contact #: 9 � g g S x 6-5 APPLICANT: c N �S U ' ° Contact #: W e—sr(30XrQPZD 1h ADDRESS: � 1 b wA3k))03 ro0 sY t '0 Bay, 44 ENGINEER: Am J� t�err,� Contact #: Z61 / 4b-1 ' q Z 11 CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision ✓ Single Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing: ./ Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No ✓ THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x 11" Plot plan & Location of Testing (please indicate test pit sites on the plan) ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date. Signature of Conservation Agent: Date back to Health Department: (stamp in): E pORT,tj Or M s 1 "us Health Health Department March 18, 2008 Mr. Thad Berry P.E. 18 Oak Street Reading, MA 01867 Re: Septic System Design Plan for Lot 27 — Pond Street - Man 90C, Lot 27 Dear Mr. Berry: The proposed wastewater system design plan for the above site dated October 19, 2007 and revised on January 4, 2008 was received on January 30, 2008 and has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover (NA) regulation that has not met by this design follows each item for your convenience. 1,/ Please provide the locations of all percolation tests on the site plan (220(4)(i)) Please indicate magnetic marking tape of system components (221) Please clarify the length of the building sewer. Currently it is listed as 12 feet on the site plan and 13.5 feet on the scaled profile Please specify and depict an inspection port in the soil absorption system (240(13)) Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. .r 'Suxan. Y. Public Health _13 cc: Owner File 1600 Osgood Street HEALTH DEPARTMENT Building 20; Suite 2-36 E -Mail: healthdept@townofnorthandover.com North Andover, MA 01845 Phone: 978.688.9540 Page 1 of 1 Fax: 978.688.8476 Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Thursday, March 20, 2008 9:03 AM To: Grant, Michele; Marianne Peters; DelleChiaie, Pamela; Randy Burley; Sawyer, Susan Subject: Pond Street Lot 27 Plan Review attached Plan review attached. Dan >Alfll'Rivier consultin Daniel Ottenheimer, President Mill River Consulting, Inc. On -Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com dano@.millriverconsulting.com 3/20/2008 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, February 01, 2008 1:33 PM To: Daniel Ottenheimer (E-mail); Marianne Peters (E-mail); Obrzut Dan (E-mail); Randy Burley (E- mail) Cc: Sawyer, Susan Subject: Plan Reviews Mailed - Pond Street; Lots 1 & 2 Ogunquit Importance: High Hi, The following plans are being mailed out today: Pond Street - Xeriscape Design - Thad Berry (h/o: Ruth Nason) Lot 1 Ogunquit Road - Neve Morin Group (h/o: Peter Breen) Lot 2 Ogunquit Road - Neve Morin Group (h/o: Peter Breen) Please let me know when you receive them. Thanks. Bag! A004Ads, Pauy10104 AWI& ' ai¢ Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 2978.688.9540 - Phone A 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.cwm North Andover On -Site Wastewater System Design Plan Review Checklist The following checklist incorporates Title 5 and local regulations for septic plans Property Address: j!!�2 4-� Map: Lot: Name of Applicant:f 4 s k !V G4lcc.- � �-�S� Name of Designer: Plan Date: �i '' ?v � % � Revision Date: r, Date received: at BOH O 7 1 at MRC �n vFi-v �� ' [,P, r 5 MRC Staff Reviewer: Date of Review: C /7 1' Type of Plan: new ❑ upgrade Number of Bedrooms in Assessor's Records: Number of Bedrooms in Design: -,3 — (,�D gpd) Garbage Disposal Allowed: ❑YE�NA 0 General Information: = North Andover Design Standards Other numbers refer to Title 5 ❑ YES ❑ NO Is the lot in the Lake Cochichewick Watershed? NA 3.2 (Requires Alternative Treatment) OK Problem N/A Street number and map/lot - 220(4) Names of abutters from recent tax map - NA 3.2 Name & address of record owner & applicant - NA 3.2 Name & address of designer - NA 3.2 Maximum scale of 1 "=20' for profile and component details - 220( Locus plan - 220(4) (Not to scale) Date(s) of soil testing - 220(4) Name of approving authority representative - 220(4)(h)(i) Name & GeFtifiGatien numbe of soil evaluator - 220(4)0) Complete profile of the system - 220(4) Complete scaled profile of the system no less than 1 "=2' verticalnd 1 "=20' horizontal - NA 3.2 Cross section of leaching facility - NA 3.2 (Not to scale) Note listing all variance requests with proper citations - 220(4) Local upgrade approval request form submitted & noted on plan - 403(1) Original R.S./P.E. stamp, signature & date on one copy - 220(2) Use approvals / standards checked for I/A system - DEP docs. System is in Nitrogen Sensitive Area? - 214 & 215 Loading rate <= 440gpd/acre (new construction) - 214 Perc rate - check loading rate (differs w & w/o pressure dist) 242 Perc rate > 60 MPI - use modified tight tank or 1/A techn. at 0.15 LTAR - 245(4) Proposed system qualifies as "shared" system - 002 (definitions) Flow is over 2,000 gpd - No R.S, P.E. required - 220(1) Number of bedrooms with design calcs -220(4) Design flow was set in accordance with code - 203 Notation that all piping shall be minimum Schedule 40 PVC - NA 3.2 Design notation regarding garbage grinder Site Plan: OK Problem N/A Maximum scale of 1 "=40' for plot plan - 220(4) Holder and location of all easements - 220(4)(b) l� All dwellings and buildings, existing and proposed - 220(4)(c) Page 1 of 10 (Revised May 2013) North Andover On -Site Wastewater System Design Plan Review Checklist Location of all existing or proposed impervious areas - 220(4)(d) Legal boundaries of the facility being served - 220(4)(a) Lot area and dimensions — NA 3.2 Location and dims of the system (incl. reserve area for new const.) - 220(4)(e) All distances on site plan from all tanks, primary/reserve SAS to: NA 3.2 Subsurface, interceptor & foundation drains Catch basins G� Property lines dwellings or other structures Private water supply or irrigation wellsz4l�1/ Watercourses or wetlands, North arrow - 220(4)(g) Existing and proposed contours - 220(4)(g) 2 ft contour intervals existing and proposed — NA 3.2 Locations and logs of deep holes - 220(4)(h) Locations and logs of percolation tests - 220(4)(i) Statement identifying property is within or not within Watershed of Lake Cochichewick — NA 3.2 Locations of waterlines, drains, and subsurface utilities - 220(4)(m) Location of benchmark(s) within 50-75 feet of facility - 220(4)(q) Show all watercourses, wetlands, drains, wells within 150' of system — NA 3.2 Within 400' of system if in Watershed of Lake Cochichewick A note or chart listing all T5 variances, LUA, BOH variances — NA 3.2 Design shall specify all components of system and model/brands — NA 3.2 Notation all concrete tanks <2500 gallons shall be monolithic — NA 3.2 Notation all concrete d -boxes be H-20 loading — NA 3.2 Notation operation & maintenance contract is required if I/A tech. used — NA 3.2 Following statement required: NA 3.2 I certify the locations, elevations and ties shown on this plan result from an actual survey made on the ground. Signature of Designer Date Existing system location and note on proper abandonment —354 & NA 3.2 Sensitive receptors within 100' shown beyond setback —220(4)(1) Magnetic marking tape indicated —221 Setback Distances (given in feet) 15.211 (NA 3.9) OK Problem N/A Septic, Pump or Treatment Tank Leach Facility Sewer Property line 10 10 -- ✓ Cellar wall 10 20 -- In -ground pool 10 20 -- Slab foundation 10 10 -- Deck, on footings, etc 5 10 -- _J,� ✓ Waterline 10 10 10' Private drinking we112 50 1003 50 ' Suction line 222(2) Page 2 of 10 (Revised May 2013) North Andover On -Site Wastewater System Design Plan Review Checklist Local Upgrade Approval Hierarchy: Note that the goal for a septic system design is FULL compliance wherever feasible as set forth in 310 CMR 15.404(1). Where full compliance is not possible, allowed to reduce setback to following (405) w/o abutter notification unless property line or neighboring private water supply setback (with "a" the first preference, and "i" being LAST preference :) a) property line but not w/in 10' of another SAS - need survey if w/in 5' b) cellar wall, pool, or slab; up to 72" cover with venting and H-20; tank liquid depth to 3' c) Up to 25% reduction in size of SAS d) Relocate private well if septic system failed because of this criteria e) Setbacks to BVW's fl Setbacks to surface waters, salt marsh, inland and coastal banks, vernal pools, leaching CB's, dry wells, or surface or subsurface drains not leading to water supplies g) Setback to water lines, private wells (not <50'), water supplies and tribs. and drains leading to the same (not <100') h) Reduce required separation to g.w. (BOH must set GW, 3 or 4' only (depending on perc rate), <2000 gpd flow, no increase in flow or square footage, no reduction to SAS size, setbacks to wells, BVW's, wetlands, surface. waters, salt marsh, coastal bank, vernal pool, water line, water supplies or tribs./drains). i) Sieve analysis in lieu of percolation test j) Tank inlet or outlet <12" to ESHGW with watertight connections and watertight tank k) Perform only one deep observation hole per disposal area Building Sewer OK Problem N/A Grease trap required for certain uses (check 230 for detail Pipe diameter listed (4" minimum) - 222(1) Pipe schedule listed - 222(3) Sch 40 PVC — NA 3.2 Watertight joints specified - 222(3) & (4), Pipe laid on compact, firm base - 222(5) Pipe laid on continuous grade in straight line - 222(7) Cleanouts precede all changes in alignment and grade - 222(8) Cleanout provided every 100 feet — 222(8) 2 New construction allowed up to 440 gallons/day/acre when on a private well pursuant to 15.214(2). 4 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Page 3 of 10 (Revised May 2013) Irrigation well 5040 1002-5 50 Surface Water 25 50 ✓ Bordering Vegetated Wetland Salt Marsh, Inland / Coastal Bank 7525 10050 cl Wetlands bordering surface water Supply or trib. (in Watershed) 1502-5 15050 Trib to Surface Water supply 325 2A8 325 200 Public well 400 400 Interim Wellhead Prot. Area not > 440 g/acre/d (new const. only —15.214) .� Reservoirs 400 400 .� Drains (wat. supply/trib.) 50 100 Drains (intercept g.w.) 25 50 Drains (Other) 5 10 Drywells 10 25 Downhill slope or barrier wall 15' to 3:1 slope w/o barrier For new construction location and elevation of foundation drain (or note) — NA 3.2 I`----� Surface supplies(w/in 400'), pub wells(w/in 400'), private wells(w/in 100')-220(4)(k) ✓ RLS plan reference & certification (if property line setback variance) - 220(3) Components on lot or easement for grading (upgrades only) - 211 Local Upgrade Approval Hierarchy: Note that the goal for a septic system design is FULL compliance wherever feasible as set forth in 310 CMR 15.404(1). Where full compliance is not possible, allowed to reduce setback to following (405) w/o abutter notification unless property line or neighboring private water supply setback (with "a" the first preference, and "i" being LAST preference :) a) property line but not w/in 10' of another SAS - need survey if w/in 5' b) cellar wall, pool, or slab; up to 72" cover with venting and H-20; tank liquid depth to 3' c) Up to 25% reduction in size of SAS d) Relocate private well if septic system failed because of this criteria e) Setbacks to BVW's fl Setbacks to surface waters, salt marsh, inland and coastal banks, vernal pools, leaching CB's, dry wells, or surface or subsurface drains not leading to water supplies g) Setback to water lines, private wells (not <50'), water supplies and tribs. and drains leading to the same (not <100') h) Reduce required separation to g.w. (BOH must set GW, 3 or 4' only (depending on perc rate), <2000 gpd flow, no increase in flow or square footage, no reduction to SAS size, setbacks to wells, BVW's, wetlands, surface. waters, salt marsh, coastal bank, vernal pool, water line, water supplies or tribs./drains). i) Sieve analysis in lieu of percolation test j) Tank inlet or outlet <12" to ESHGW with watertight connections and watertight tank k) Perform only one deep observation hole per disposal area Building Sewer OK Problem N/A Grease trap required for certain uses (check 230 for detail Pipe diameter listed (4" minimum) - 222(1) Pipe schedule listed - 222(3) Sch 40 PVC — NA 3.2 Watertight joints specified - 222(3) & (4), Pipe laid on compact, firm base - 222(5) Pipe laid on continuous grade in straight line - 222(7) Cleanouts precede all changes in alignment and grade - 222(8) Cleanout provided every 100 feet — 222(8) 2 New construction allowed up to 440 gallons/day/acre when on a private well pursuant to 15.214(2). 4 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Page 3 of 10 (Revised May 2013) North Andover On -Site Wastewater System Design Plan Review Checklist Manhole at any 90 degree alignment change — 222(8) Invert elevation at building: Invert elevation at septic tank: Length of run: Slope: (minimum of 0.01 - 0.02 desired) - 222(6) Septic Tank: septic tank below g.w. table ❑ yes ❑ no ❑ assumed No tank allowed in a velocity zone or on a coastal beach, barrier beach, dune, or in a regulated floodway (213) OK Problem N/A tank is larger than 2500 gallons and not monolithic it must be vacuum tested (NA 4.5) Tank is accessible - 228(3) 200% of flow (required & provided given, 1500 min.) - 220(4)(f) & 223(1)(a) 2"(min)-3"(max) drop from inlet to outlet - 227(5) Minimum of 4' liquid depth - 223(2) or LUA 3" air space above tees/baffles (minimum) - 227(4) 9" air space above flow line (minimum) - 227(4) Tees are located under manhole - 227(1) Inlet and outlet tees on center line - 227(1) (/ Tees extend 6" above flow line - 227(1) Inlet tee extends 10" below flow line (minimum) - 227(6) VX Outlet tee extends 14" below flow line (more for deeper tanks) - 227(6) Gas baffle installed on outlet - 227(4) Effluent filter Brand and model approved by DEP Filter type/name noted on manhole covers. Riser with manhole cover at grade placed over filter— 227(7) Annual filter maintenance specified — 227(7) Access manhole cover above center of tank & each tee (except 2 compart) -228(2) 3-20" manholes specified - 228(2) 1 childproof 20" riser/manhole w/in 6" of final grade if <1000gpd- 221 & 228(2) 2 childproof 20" risers over inlet & outlet tees to 6" of final grade if Greater than 1000 gpd -221,228(2) Soil compaction below tank specified (if soil is non-native) - 221(2) 6" of <=1 1/2" stone beneath tank specified - 221(2) & 228(1) If > 1,000 gpd AND not a single fam. dwell. must be 2 tks or 2 comp. — 223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart. tank - 223(1)(c) Buoyancy calculations required if tank at or below water table - 221(8) Notation as to tank water tightness — 221 (1) Inlet & Outlet >12" above ESHGW — 227(5) or LUA 9" of cover over tank (minimum) - 228(1) Top of tank <=36" below grade - 221(7) or LUA H-10 loading (min.) - H-20 if traffic - 226(3) All pumping to tank (if applies) in accordance with — 229 Tight Tank (Check here if not present: ❑ ) tank below g.w. table ❑ yes ❑ no ❑ assume Note: No tight tank allowed in a velocity zone or on a coastal beach, barrier beach, dune, or in a regulated floodway (213) OK Problem N/A 500% o esign flow or 2000 gallons provided — 260(2)(a) 3-20" man es - 228(2) Soil compactio elow tank specified (if soil is non-native) - 221(2) Page 4 of 10 (Revised May 2013) North Andover On -Site Wastewater System Design Plan Review Checklist 6" of <=1'/z"stone beneath tank specified - 221(2) & 228(1) Buoyancy calculations required if tank is at or below water table - 221(8) Notation as to tan watertightness —221(l) 9" of cover over tan (minimum) - 228(1) Top of tank <=36" b ow grade - 221(7) H-10 loading (min.) - -20 if traffic - 226(3) All pumping to tank (if a plies) in accordance with — 229 Equipped with an audio a d visual alarm set at 3/5 tank cap — 260(2)(c) AN alarm set at 3/5 tank c acity — 260(2)(b) Alarm signal to locus manne 24 hours per day if deemed necessary— 260 (2)(c) Tank is set to keep old syste 'n service during install if possible Min. 1-24" frame w/cover at finis ed grade — 260 (2)(f) Year round access for pumping — 0 (2)(g) Odor control provided if required — 2 (2)(k) Inlet >12" above ESHGW — 227(5) or LUA Distribution Box ( Check here if not present: ❑ ) OK Problem N/A p Inlet elevation: 0 � 1 3 Outlet elevation: , 0.17' drop from inlet to outlet (minimum) - 232(3)(b) 6" sump (minimum) - 232(3)(e) All outlets at same elevation (notation) - 232(3)(b) Outlet pipes laid level for first 2 ft. (notation) - 232(3)(c) Inlet baffle/tee min. 1" over outlet invert for all d -boxes whepiped or slope greater than .08 - 232(3)(a) Soil compaction below distribution box specified (if soil is non-native) - 221(2) 6" of <= 1 '/2" stone beneath distribution box specified - 221(2) Box is watertight (notation) - 221 (1) D -Box is H-20 — NA 3.2 Top of chamber <=36" below grade - 221(7) Riser to within 6" of final grade if greater than 9" of cover - 232(3), 221(13), 228(1) Pump Chamber (Check here if not present: ❑ ) Pump chamber below ground water table ❑ yes ❑ no ❑ assume OK Problem N/A Volume specified: - 220(4)(r) Pu off elevation: - 220(4)(r) Pump elevation: - 220(4)(r) Alarm one ation: - 220(4)(r) Number of cycle er day specified by designer - 220(4)(r), 254(1)5 Minimum 2" delivery ' from d -box to SAS if gravity - 254(1)(c) Cycles per day is consiste ith chamber volume - 231(3) Volume calculations include flo ck volume - 231(2) 24 hour storage capacity above pump elevation - 231(2) Dual alternating pumps with valves if system es >2 dwelling units - 231(6) High water alarm is in building and powered on separate circuit from pump - 231(9) Pump sequence correct (off -lead on -lag on -alarm on) - 231(8) Pump performance curves included - 220(4)(r) Pump can provide flow needed against calculated head - 220(4)(r) 5 Encourage more than 1 cycle per day. Page 5 of 10 (Revised May 2013) North Andover On -Site Wastewater System Design Plan Review Checklist 1 childproof, 24" riser/manhole at final grade - 231(5) Soil compaction beneath pump chamber specified (if soil is non-native) - 221(2) 6" of <_1'/" stone beneath chamber specified - 221(2) & 228(1) Buoyancy calculations if chamber is at or below water table - 221(8) Chamber is watertight (notation) - 221 (1) Top of chamber <_36" below grade - 221(7) H-10 loading (min.) - H-20 if traffic (notation) - 226(3) Inlet & Outlet >12" above ESHGW — 227(5) or LUA Effluent filter provided before or inside pump chamber — 231 (10) On-site Soil and Groundwater Review OK Problem N/A Proper deep observation hole logs on plan - 220(4)(h) Soil evaluation forms 11 &12 submitted within 60 days of field work - 018(2) Existing grade elevation of each deep hole - 220(4)(h) Soil evaluation/perc test results on current DEP forms 11 & 12 — NA 2.3 If soil evaluation conducted on new lot, all test pits & perc tests located on scaled site plan. Tie distances from permanent structures — NA 2.4 Proper percolation test log - 220(4)(i) Ample deep observation holes in primary disposal area (minimum 2) - 102(2) Ample deep observation holes in secondary disposal area (minimum 2) - 102(2) Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4) Perc test(s) done in most restrictive layer - 104(2) Observed and adjusted g.w. elevation in the vicinity of the system - 220(4)(n) soil class 7A�r' perc rate loading rate (LTAR) (check pressure distribution rates in 242) Critical Design Parameter Calculations Test Pit Numbers: Elevation at grade a. top acceptable soil el. b. bottom acceptable soil el. c. naturally occurring soil depth (a -b) ❑ yes ❑ no > 4' natural soil? 240(1) ❑ if NO, variance (repair & I/A) 415(1) Page 6 of 10 (Revised May 2013) North Andover On -Site Wastewater System Design Plan Review Checklist Critical Design Parameter Calculations (continued) a. bottom of leach facility elev b. ground water elevation c. separation to groundwater (a -b) ❑ yes ❑ no > 4' (5' in sands) ground water sep? - 212(a) & (b) a. top acceptable soil el. b. breakout el. _ ❑ yes ❑ no 5' over dig required? — 255(1) ❑ yes ❑ no if "yes" specs for fill provided? Leaching Facility (Complete for all designs except tight tanks) OK Problem N/A SAS size calculations provided 220(4)(0 50% larger if garbage disposal - 240(4) SAS size >= required size Trenches to be used whenever possible 24t0(6)) No v'ehiGle-a66 � r imnoRi apeaabovve-l.f. unle66 Rayeidable _ 240(7) Vepted ofundSG^„ 1) Vented through same pipes as distribution system - 241(1)(a) Vent protected from precipitation/animal entry - 241(1)(b) Vent is placed beyond traffic or impervious area - 241(1)(c) All lines connected to vent - 241(1)(d) 9" cover over pea stone or filter fabric - 240(9) Reserve area provided (new construction) - 248(1) GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005 - 251(9) Fill material specs provided — 255(3) Top of leach facility <= 36" below grade - 221(7) Final grade over leach field at a minimum 0.02 ft/ft -240(10) Surface & subsurface drainage away from leach field - 240(l 1) & 245(3) Grading slopes away from dwelling Inspection port specified in SAS — 240(13) Pressure distribution provided if multiple SAS — 254(2) Class I I I or IV cannot use bed or field — 249(4) 3/8"-5/8" orifices specified (gravity system) - 251(8) Toe of fill slope stops 5' from property line or swale installed - 255(2) 3:1 slope where grading required - 255(2) Impermeable barrier if < 3:1 slope or < 15 feet to 3:1 slope - 255(2) Retaining wall stamped by P.E. - 255(2)(b) Top of retaining wall/barrier >= top of pea stone elevation (breakout) - 255(2)(f) 10' offset from edge of leach facility to edge of ret. wall - 255(2)(e) Page 7 of 10 (Revised May 2013) North Andover On -Site Wastewater System Design Plan Review Checklist Leaching Facility (continued) Leach pipes PVC S40 NA 3.2 Pressure dosing guidance followed if pressure distribution - 254(2)(c ) Orifice spacing < 5' Dose volume 5x —10x void volume of leach lines Pump volume includes Dose Volume + Drain Back Volume Squirt height on plan (min 2.5'). Pressure required over 2,000 gpd or with I/A remedial use — 231 (1) Infiltrator Chambers (Check here if not present: ❑ ) OK Problem N/A Model of Infiltrator Chambers = Design flow= gpd Loading rate = gpd/sf Required leaching area = gpd / gpd/sf = sf Chamber area = sf/If x ft = sf/chamber Chambers required = sf / sf/chamber = chambers Provided leaching area = chambers x sf/chamber = Rows x Chambers/row = total # chambers Capacity provided = sf x gpd/sf = gpd Capacity provided is >= design flow of facility being served Leach Fields (Check here if not present: ❑ ) OK Problem N/A Leaching Trenches OK Problem N/A Number of fields: (need dosing chamber if >1) - 231 (1)) Length (100' max.): - 252 (2)(b) Width: Total area: L x W = s.f. Effective leach area given total of s.f. Loading factor: Effective area = total area s.f. x LTAR = g/day Effective area is >= design flow of facility being served Minimum of two distribution lines - 252(2)(a) 6' line separation (max.) - 252(2)(d) 4' maximum separation from edge of field to line - 252(2)(e) 10' minimum separation between adjacent leach fields - 252(2)(f) Between 6" and 12" of 3/4 - 1 1/2" stone beneath field - 252(2)(g) & 247(2) Ends of distribution lines tied together with solid pipe - 251(9) 2"of 1/8"-1/2" 2x washed pea stone or filter fabric - 247(2) ( Check here if not present: ❑ ) Number of trenches: Depth of trenches (max eff. 2'): Width of trenches (2' min., 3' max.) Length of trenches (100' max.): _ feet - 247(1) feet - 251(1)(b) feet - 251(1)(a) Page 8 of 10 (Revised May 2013) sf North Andover On -Site Wastewater System Design Plan Review Checklist Trenches are vented (when > 50') - 251 (11) Trenches follow contour lines - 251(2) Trench spacing 3 times effective width or depth, 2 times width if reserve area not specified between trenches- 251(1)(d) Available leach area given Bottom = L x W X# = s.f. Sidewall = L x D x# x 2= s.f. Effective leach area given Loading factor: Effective area = total area s.f. x LTAR = g/day Effective area is >= design flow of facility being served 2" of 1/8"-1/2" 2x washed pea stone - 247(2) %" to V/z" double washed stone from bottom of SAS to distribution lines or filter fabric - 247(1) Non -Traditional Dispersal Systems (Check here if not present: ❑ ) OK/;Problem N/A Dispersal system approved for use in Massachusetts Loading rate correctly applied Page 9 of 10 (Revised May 2013) North Andover On -Site Wastewater System Design Plan Review Checklist Notify Health Department that the Following is/are Necessary: Approvals: ❑ Health Department, no LUA ❑ Health Department, w/ LUA ❑ Board of Health, local regulation variance ❑ Board of Health, w/ LUA ❑ Board of Health, Title 5 variance ❑ DEP, Title 5 variance ❑ DEP, holding tank ❑ Notice of Intent (NOI) forms from Conservation Commission Other: ❑ Draft maintenance agreement with hauler for tight tank Method and frequency of removal specified — 260 (2)(d) Location and method of content removal — 260 (2)(e) [ Deed Restriction regarding # bedrooms or presence of a particular technology that requires a notice be placed on the deed ❑ Draft maintenance Agreement (Pressure Distribution delivery to SAS requires this) ❑ Proper License ❑ with class 2 WWTP operator for Advanced treatment ❑ Licensed installer or hauler (or above) for simple Pressure Distribution ❑ Minimum 2 -year term ❑ Quarterly scheduled maintenance for PD only, semi-annual for VA with Remedial Use ❑ Check pressure distribution if part of design See NA regulations chapter 6 for maintenance contract requirements Page 10 of 10 (Revised May 2013) ylewa slyl buguud ajolaq }uawualnua ayl Japlsuoo aseald why xpla� baa Asn ew ale;s oas nnnnnn��: uy :off ja}ai aseald uogeuiio;ul ajow jo j -spjooaa ollgnd ale spogo pue seogo ledlolunw woj; pue of sllewe 1sow }eyj pawwjalap sey ao!p s,ajejg }o tiejajoag suasnyoesseW ayj ajou aseald 9S9L-Z£8-LL8 suo!ln!os;!pny luaw!!oau3 aas euuoa •suaa:)uo:) ao suollsanb Aue aney noAp moul aw lad aseald •a!! j anoA ala!dwoo of aaayl wayl l!wgns pue noA yl!m wayl 8uuq Aew noA `asnoy p!a!3 !OOPS 481H aanopuy ylaoN ayl le 0£:tb-0£:TT woaj 4,gT aagolz)O'AepsaupaM lxau aol pa!npaps alej ylleaH s,umol ay} pua}le of ue!d noA }! 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Aaessa:)au ayl mot's l,usaop y:)lym'asuao!l aseuaew e aol uoileo!!dde inoA to Ado a panla:)aa aney am 'awll slyl 1t' •paa!nbai si aleolj!:pao agepiew anoA jo Ado e'lsal3 •suolldaoxa oml yl!m ala!dwo:) s! @Iq anoA pue 'asuodsaa anoA paAla:)aa aney aM •I!pne luapuadap s janopuy y1aoN Io umol ayl of Sulpuodsai aol noA lueyl •a!ay:)!w 'o!!aH }!pny lu9w!!wu3 eouejnsul yl!eaH aanopuy PON 10 umol :loefgns a!ayo!W `;ueJE) :ol Wd 69:Z £lOZ'06 Jago}op `Aepsjnyl :lugs [woo-suo!;n!osl!pneluaw!!ojua@n gasp] aaS euuoa :wa3 0101431W `}ueaE) to 6 Appendix B Enviro-Septic® Wastewater Treatment System Technology. Checklist Purpose This technology checklist is to be completed by an operator trained by Presby Environmental, Inc., to inspect Enviro-Septic wastewater treatment systems. Note: The Department's technology approval requires all Enviro-Septic® systems to be inspected annually. Submit copies to A completed copy of this checklist and the DEP Approved Inspection and . the local 0&M Form for Title 5 I/A Treatment and Disposal Systems must be authority and submitted to the local approving authority and the Department. Copies of the the DEP inspection forms shall be submitted by January 30th for remedial systems inspected during the prior year and by September 31St for General use systems. Any required sampling and test results should accompany this completed checklist. DEP address Mail a copy of this checklist to Department of Environmental Protection Title 5 I/A Program One Winter Street, 6`'' Floor Boston, Massachusetts 02108 I. Facility Owner: 2. Facility Address: 3. Installation Date: Previous Inspection Date: 4. Date of Inspection: 5. Residential Number of Bedrooms 6. Inspection Port Location(s): 7. Other (Explain): /Commercial Design Flow GPD Inspection data (Complete all fields) 8. Is daily flow within the system design flow? ❑ Yes ❑ No If no, explain: 9. Does the owner verify the system use as described above? If no, explain: Over ❑ Yes ❑ No Section D Title 5 and Aggregate Systems Exceptions Introduction Due to the unique capabilities of Enviro-Septic systems, some Title 5 and other requirements commonly associated with aggregate systems do not apply. This page presents some of the more common exceptions. No septic tank Effluent tee filters will not be required for septic tanks used in Enviro-Septic tee filters systems. Serial Lines of Enviro-Septic pipe may be installed in serial configuration for flows distribution of up to 500 GPD per basic serial bed or combination section. allowed No pressure Pressure distribution may not be used with any Enviro-Septic® system, distribution including systems that are designed for over 2000 GPD. Restaurants/ Enviro-Septic systems may be used for restaurants and other facilities that use grease traps grease traps. New These are provisions for new construction. construction provisions Reduced area size Enviro-Septic® systems may be installed in an area up to 40% smaller than a conventional Title 5 bed designed in accordance with 310 CMR 15.252. Note: The system sizing tables used in this manual identify minimum Enviro- n Septic arequirements reflecting this reduction. Reduction Limitation: Currently Massachusetts limits all systems to a minimum bed size of 400 square feet. j Continued 16 Title 5 and Aggregate Systems Exceptions continued New Minimum vertical separation distances to EHGW construction In soils with percolation rates of 2 min/in or less the minimum vertical provisions separation distance to the EHGW is 5' measured from the required 6" of (continued) system sand at the bottom of the Enviro-Septic® pipe. In soils with percolation rates greater than 2-60 min/in the minimum vertical separation distance to the EHGW is 4' measured from the required 6" of system sand at the bottom of the Enviro-Septic pipe. Minimum naturally occurring pervious soil depth In soils with percolation rates to 60 min/in, the minimum depth of naturally occurring pervious material under a bed is 4', measured from the required 6" of system sand at the bottom of the Enviro-Septic pipe. Remedial use Minimum vertical separation distances to EHGW provisions For remedial systems in soils with percolation rates of 2 min/in or less, the minimum vertical separation distance to the EHGW, measured from the bottom of the 6" of system sand below the Enviro-Septic® pipe, may be reduced to 3' if allowed by the local approving authority. In soils with percolation rates greater than 2 to 90 min/in, the minimum vertical separation distance to the EHGW, measured from the bottom of the 6" of system sand below the Enviro-Septic® pipe, may be reduced to 2' if allowed by the local approving authority. 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