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HomeMy WebLinkAboutMiscellaneous - 100 CANDLESTICK ROAD 4/30/2018 (2)(0 n" L1Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands 1 WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 4:1 A. General Information From: North Andover wpaform2.doc • rev. 3/1/05 Conservation Commission To: Applicant Robert Montuori Name 100 Candlestick Road Mailing Address North Andover MA. 01845 CityTrown State Zip Code Property Owner (if different from applicant): Name Mailing Address City/Town State Zip Code 1. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: Proposed Subsurface Sewage Disposal Systeme Title Title Title 2. Date Request Filed: 3/3/05 B. Determination 2/16/05 Date Date Date Pursuant to the authority of M.G.L. c. 131, § 40, the Conservation Commission considered your Request for Determination of Applicability, with its supporting documentation, and made the following Determination. Project Description (if applicable): The placement of erosion controls and grading associated with the installation of a subsurface sewage disposal system in the Buffer Zone to a Bordering Vegetated Wetland. Project Location: 100 Candlestick Road Street Address Map 106A Assessors Map/Plat Number North Andover City/Town Parcel 97 Parcel/Lot Number Page 1 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) or Order of Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received from the issuing authority (i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act. Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent. ❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent or ANRAD Simplified Review (if work is limited to, the Buffer Zone). ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Citation wpaform2.doc • rev. 3/1/05 Page 2 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 1 WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post -marked for certified mail or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone. ❑ 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). See attached condition ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpaformldoc • rev. 311105 Page 3 of 5 Negative Determination of Applicability 100 Candlestick Road Conservation Conditions Record Documents: Request for Determination of Applicability, received dated March 3, 2005; Plans entitled "Proposed Subsurface Sewage Disposal System." Consisting of sheets 1 & 2. Prepared for Robert Montouri, prepared by New England Engineering Services, dated February 16, 2005. Plans stamped & signed by Ben Osgood, Jr., P.E. Pre -Construction ➢ Prior to the commencement of any work activities on site, the applicant shall install erosion controls as in accordance with the approved plan referenced herein. ➢ Prior to the commencement of any work activities on site, the applicant shall permanently mark the 25 -foot No -Disturbance Zone with eight (8) signs or markers spaced evenly every 25 feet incorporating the following text: "Protected Wetland Resource Area". This will designate their sensitivity and assure no inadvertent encroachment into the wetland or the vernal pool. These permanent markers are available at the Conservation Office for $2 apiece and are subject to review and approval by the NACC. The applicant shall instruct all agents to explain these markers to buyers/ lessees/ landscapers and all persons taking over the property from the applicant. ➢ Prior to commencement of any work activities on site, the applicant shall submit a revised plan to accurately reflect site conditions (changing the word "ditch" to the word "stream"). The plan shall also note whether this stream is intermittent or perennial. In addition, the revised plan shall show the existing back deck attached to the dwelling. This plan shall be subject to review and approval by the Conservation Administrator. Immediately following completion of the above, the applicant shall contact the Conservation Department, at least 72 hours in advance, to schedule an on-site pre - construction meeting. Post Construction ➢ Upon completion of construction activities, the Conservation Department shall be notified to conduct a final compliance inspection. Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 5. The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: Exempt Activity (site. applicable statuatory/regulatory provisions) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. North Andover Wetland Protection Bylaw Name C. Authorization Chapter 178 Ordinance or Bylaw Citation This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on [J/by certified mail, return receipt requested on Y 7 S. Date Date This Determination is valid for three years from the date of issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office (see Attachment) and the property owner (if different from the applicant). l -- M,, ck a3. duos Date wpaform2.doc • rev. 3/1/05 Page 4 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Appeals The applicant; owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see Attachment) to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Request for Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wpaform2.doc • rev. 3/1/05 Page 5 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP Regional Addresses 1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments, payable to: Commonwealth of Massachusetts Department of Environmental Protection Box 4062 Boston, MA 02211 DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham 436 Dwight Street Agawam Conway Hancock Montague Plainfield Wales Suite 402 Alford Cummington Hatfield Monterey Richmond Ware Phone: 617-654-6500 Amherst Dalton Hawley Montgomery Rowe Warwick Springfield, MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone: 413-784-1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell Fax: 413-784-1149 Belchertown East Longmeadow Holland New Ashford Savoy Westfield Bemardston Egremont Holyoke New Marlborough Sheffield Westhampton Blandford Erving Huntington New Salem Shelburne West Springfield Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge Buckland Gill Lee Northampton Southampton Whately Charlemont Goshen Lenox Northfield South Hadley Wilbraham Cheshire Granby Leverett Orange Southwick Williamsburg DEP Southeast Region Chester Granville Leyden Otis Springfield Williamstown 20 Riverside Drive Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor Lakeville, MA 02347 Chicopee Greenfield Ludlow Pelham Sunderland Worthington Clarksburg Hadley Middlefield Peru Tolland Wellfleet DEP Central Region Acton Charlton Hopkinton Millbury Rutland Uxbridge 627 Main Street Ashburnham Clinton Hubbardston Millville Shirley Warren Worcester, MA 01608 Ashby Athol Douglas Hudson New Braintree Shrewsbury Webster Phone: 617-654-6500 Bedford Dudley Holliston Northborough Southborough Westborough Phone: 508-792-7650 Auburn Dunstable Lancaster Northbridge Southbridge West Boylston Fax: 508-792-7621 Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield TDD: 508-767-2788. Barre Bellingham Fitchburg Gardner Leominster Littleton Oakham Oxford Sterling Westford Berlin Grafton Lunenburg Paxton Stow Sturbridge Westminster Winchendon Blackstone Groton Marlborough Pepperell Sutton Worcester Bolton Harvard Maynard Petersham Templeton Wilmington Boxborough Hardwick Medway Phillipston Townsend Winchester Boylston Holden Mendon Princeton Tyngsborough Winthrop Brookfield Hopedale Milford Royalston Upton Woburn DEP Southeast Region Abington Dartmouth Freetown Mattapoisett Provincetown Tisbury 20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro Lakeville, MA 02347 Attleboro Dighton Gosnold Nantucket Rehoboth Wareham Avon Duxbury Halifax New Bedford Rochester Wellfleet Phone: 508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater Fax: 508-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport TDD: 508-946-2795 Bourne Brewster Easton Edgartown Harwich Kingston Norwell Oak Bluffs Scituate Seekonk West Tisbury Bridgewater Fairhaven Lakeville Orleans Sharon Whitman Wrentham Brockton Fall River Mansfield Pembroke Somerset Yarmouth Carver Falmouth Marion Plainville Stoughton Chatham Foxborough Marshfield Plymouth Swansea Chilmark Franklin Mashpee Plympton Taunton DEP Northeast Region 9 Amesbury Chelmsford Hingham g Merrimac Quincy Wakefield 1 Winter Street Andover Chelsea Holbrook Methuen Randolph Walpole Boston, MA 02108 Arlington Ashland Cohasset Concord Hull Ipswich Middleton Millis Reading Waltham Phone: 617-654-6500 Bedford Danvers Lawrence Milton Revere Rockport Watertown Wayland Fax: 617-556-1049 Belmont Dedham Lexington Nahant Rowley Wellesley TDD: 617-574-6868 Beverly Billerica Dover Dracut Lincoln Lowell Natick Salem Wenham Boston Essex Lynn Needham Newbury Salisbury Saugus West Newbury Weston Boxford Everett Lynnfield Newburyport Sherbom Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester -By -The -Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Winthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield Wpaform2.doc • DEP Addresses • rev. 1016/04 Page 1of 1 a L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 1 Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. Request Information Important: When filling out 1 forms on the computer, use only the tab key to move your cursor - do not use the return key. teb IG�I Person or party making request (if appropriate, name the citizen group's representative): Name Mailing Address City/Town Phone Number Project Location Mailing Address State Fax Number (if applicable) �iN %.vuc Cityrrown State Zip Code 2. Applicant (as shown on Notice of Intent (Form 3), Abbreviated Notice of Resource Area Delineation (Form 4A); or Request for Determination of Applicability (Form 1)): Name Mailing Address City/Town Phone Number 3. DEP File Number: B. Instructions State Fax Number (if applicable) Zip Code 1. When the Departmental action request is for (check one): ❑ Superseding Order of Conditions ($100 for individual single family homes with associated structures; $200 for all other projects) ❑ Superseding Determination of Applicability ($100) ❑ Superseding Order of Resource Area Delineation ($100) Send this form and check or money order for the appropriate amount, payable to the Commonwealth of Massachusetts to: Department of Environmental Protection Box 4062 Boston, MA 02211 wpaform2.doc • Request for Departmental Action Fee Transmittal Form - rev. 10/6/04 Page 1 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Instructions (cont.) 2. On a separate sheet attached to this form, state clearly and concisely the objections to the Determination or Order which is being appealed. To the extent that the Determination orOrder is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. 3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office (see Attachment A). 4. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she is not the appellant. wpaform2.doc • Request for Departmental Action Fee Transmittal Form • rev. 10/6/04 Page 2 of 2 10 August 27, 2010 44 Commerd Raynham,M) 02767 Tel: (508) 880-0233 Fax: (508)880-7232 SEP - 7 2010 North Andover Board of Health Ll T!O!W ARii�i 1600 Osgood Street ��..er, North Andover, MA 01845 Attention: Health Agent Reference: FAST° Wastewater Treatment System - Serial Number: 27259 Attached please find the Field Inspection & Service Report with field test results for services performed on 8-10-10 at the property of Robert Montouri located at 100 Candlestick Road, North Andover, MA. Please-cail-ifyoiiliave any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Robert Montouri Massachusetts DEP 1-N e Massachusetts Department of Environmental. Protection LlBureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 UA Treatment and Disposal Systems 1309 A. Installation Robert Montouri Owner 100 Candlestick Road Facility Street Address MA 02767 North Andover 01845 City Zip Mailing address of owner, if different: 100 Candlestick Road 12920 Street Address/PO Box: Certification Number North Andover MA 01845 City State Zip 978-682-9543 Telephone Number B. Authorized Service Provider Wastewater Treatment Services, Inc O&M Firm 44 Commercial Street Street Address Raynham MA 02767 City State Zip 508-880-0233 Telephone Number David Zavelle 12920 Certified Operator Name Certification Number . Facility/System Information 27259 Bio-Microbics, Inc. DEP ID Manufacturer ID 8/28/2006 8/28/2006 MicroFAST .5 Model Number Installation Date Start of Operation Approval Type: [ ] General [ ] Provisional [ ] Piloting [x] Remedial Seasonal Residence — used less than 6 mo./year: [ ] Yes [x] No Operating Information 8-10-10 Inspection Date Previous Inspection Date Sludge Depth (to be checked yearly) Pumping Recommended [ ] Yes [x].No Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 1309' E. Field Testing Field Inspection: Color: [] gray 0 brown [x] clear [l turbid [] Other (specify): Odor: [] musty [x] earthy [] moldy [] offensive turbid Effluent Solids: [x] no [] some pH 7 SU DO 13.79 mg/L Turbidity 9.11 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: [ ] Influent [ ] Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 440 gpd Parameters sampled: Influent: [ ] pH [ ] BOD [ ] CBOD [ ] TSS [ ] TKN Nitrate [ ] Nitrite [ ] Phosphorus [ ] Spec. Cond. [ ] Ammonia [ ] Alkalinity [ ] Oil Grease [ ] VOC [ ] Fecal Coliform Effluent. [ ] pH [ ] BOD [ ] CBOD [ ] TSS [ ] TKN [ ] Nitrate [ ] Nitrite [ ] Phosphorus [ ] Spec. Cond. [ ] Ammonia [ ] Alkalinity [ ] Oil Grease [ ] VOC [ ] Fecal Coliform G. Inspection and Maintenance Description of any maintenance performd i ce previous inspection & during this inspection: Cleaned Filter Checked Splash Rec cle Notes and Comments: 2 v Massachusetts Department of Environmental Protection LlBureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 13091 H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. Operator Signature 8-10-10 Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use — by January 31st of each year for the previous calendar year Piloting Use - within 45 days of -inspection date Provisional Use — by March 31 th of each year for the previous 12 months General Use — by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 0 FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST* System 13091 INSTALI ATION AUTHORIZED SERVICE PROVIDER Installation Address: 100 Candlestick Road Name: Wastewater Treatment Services, lnc. North Andover, MAO 1845 Owner Name: Robert MontOnri Mail Address: 100 Candlestick Road Mail Address: 44 Commercial Street North Andover, MAO 1845 Raynham, MA 02767 Phone: 978-682-9543 Fax: e-mail: Phone: (508) 880-0233 Fax: (508) 880-7232 e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pump out M icroFA ST .5 27259 8/28/2006 8/1/2007 EQUIPMENT YES, ; NO MAINTENANCE. PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating x Audio Alarm Operating (if present) x Blower(s) Air Inlet Filter Clean x Blower Flood Vents Clear x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Pumpout Required x Primary Settling Zone Aerobic Treatment Zone EFFLUENT (optional) Ll IM IT RESULT . Estimated Daily Flow 440 gpd pH (Standard Units) 7 Color Clear Temperature 78 Odor Earthy Comments: TECHNICIAN � SERVICE DATE David Zavelle 18-10-10 -C-\ Commonwealth of Massachusetts City/Town of a w� System Pumping Record w Form 4 APR 'I 4 2.090 M DEP has provided this form for use by local Boards of Health.h f! : �'� t the information must be substantially the same as that provided her eck with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left. side of -house, Right side of house, Left front of house, Right front of house, Right rear ou Left rear of hous eft rear of building. Right rear of building. Address C+L"'d City/Towh State Zip Code 2. System Owner: Name Address (if different from location) Citylfown Stat6&S—'—���Zip � de Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: - Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): ` 4. Effluent Tee Filter present? ❑ Yes [9-iqo If yes, was it cleaned? ❑ Yes ❑ No 5. Conditi n of System: 6. Syste QeRy: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: Lowell Waste Water WHaul g Date t5form4.doc- 06/03 System Pumping Record • Page 1 of 1 N �J A c. June 18, 2015 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 RECEIVED JUN 3 0 2015 TOWN OF NORTH ANDOVER North Andover Board of Health HEALTH DEPARTMENT 1600 Osgood Street North Andover, MA 01845 Attention: Health Agent Reference: FAST' Wastewater Treatment System - Serial Number: 27259 Attached please find the Field Inspection & Service Report with field test results for services performed on 4/25/15 at the property of Robert Montuori located at 100 Candlestick Road, North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Robert Montuori Massachusetts DEP r_! 14-C 0 R P 0 R A 7 £ 0 8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808 e-mail:onsite biomicrobics.com, www.biomicrobics.com, 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST` System 23011 �� INSTALLATION AUTHORIZED 'SERVICE PROVIDER: Installation Address: 100 Candlestick Road North Andover, MA 01845 Name: Wastewater Treatment Services, Inc. Owner Name: Robert Montuori Mail Address: 100 Candlestick Road North Andover, MA 01845 Mail Address: 44 Commercial Street Raynham, MA 02767 Phone: 978-682-9543 Fax: e-mail: Phone: (508) 880-0233 Fax: (508) 880-7232 e-mail: INSTALLATION INFORMATION h Model No. Serial No. Date of Installation Date of last pump out MicroFAST .5 27259 8/28/2006 10/9/2013 EQUIPNIENT,r. " Y l �� YES, NO' F MAINTENANC E P' FORMED'AND COMMENTS Electrical Panel(s) — Visual Alarm Operating x Audio Alarm Operating (if present) x Blower(s) Air Inlet Filter Clean x Blower Hood Vents Clear x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Pumpout Required x Primary Settling Zone 12.5" Aerobic Treatment Zone 12" ,EFFLUENT (optional) LIMIT RESULT Estimated Daily Flow 440 gpd pH (Standard Units) 6.2 Color Clear Temperature Odor Earthy Comments: Pumps and floats have been inspected and are operational. TECHNICIAN��,, , ,SERVICE DATE" �, ria Michael Foisy 4/25/15 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 23011 A. Installation Robert Montuori Owner 100 Candlestick Road Facility Street Address North Andover 01845 City Zip Mailing address of owner, if different: 100 Candlestick Road Street Address/PO Box: 2762 North Andover MA 01845 City State Zip 978-682-9543 Telephone Number B. Authorized Service Provider Wastewater Treatment Services. Inc O&M Firm 44 Commercial Street Street Address Raynham MA 02767 City State Zip 508-880-0233 Telephone Number Michael Foisy 2762 Certified Operator Name Certification Number C. Facility/System Information 27259 Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer ID Model Number 8/28/2006 8/28/2006 Installation Date Start of Operation Approval Type: [ ] General [ ] Provisional [ ] Piloting [x] Remedial [ ] General Denite Seasonal Residence — used less than 6 mo./year: [ ] Yes [x] No D. Operating Information 4/25/15 Inspection Date 12.5" Sludge Depth (to be checked yearly) Previous Inspection Date Pumping Recommended [ ] Yes [x] No Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 I,-,— DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 23011 E. Field Testing Field Inspection: Color: [] gray [] brown [] Other (specify): _ [x] clear [] turbid Odor: [] musty [x] earthy [] moldy [] offensive [] turbid Effluent Solids: [x] no [] some pH 6.2 SU DO 4.00 mq/L Turbidity 8.99 NTU 6 to 9 1 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: [ ] Influent [ ] Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 440 gpd Parameters sampled: Influent: [ ] pH [ ] BOD [ ] CBOD [ ] TSS [ ] TKN [ ] Nitrate [ ] Nitrite [ ] Phosphorus [ J Spec. Cond. []Ammonia []Alkalinity [ ] Oil Grease [ ] VOC [ ] Fecal Coliform Effluent. []pH []BOD [ ] CBOD []TSS [ ] TKN [ ] Nitrate [ ] Nitrite []Phosphorus []Spec. Cond. []Ammonia []Alkalinity [ ] Oil Grease [ ] VOC [ ] Fecal Coliform G. Inspection and Maintenance Description of any maintenance performed since previous inspection & during this inspection: Cleaned Filter, Checked Splash Recycle, Pump(s) Inspected, Float(s) Inspected Notes and Comments: Pumps and floats have been inspected and are operational. 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 23011 H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. Operator Signature 4/25/15 Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use — by January 31 st of each year for the previous calendar year Piloting Use - within 45 days of inspection date Provisional Use — by March 31 th of each year for the previous 12 months General Use — by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 3 r i June 18, 2015 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 RECEIVED North Andover Board of Health JUN 3 0 2015 1600 Osgood Street TOWN OF NORTH ANDOVER North Andover, MA 01845 HEALTH DEPARTMENT Attention: Health Agent Reference:. FAST° Wastewater Treatment System - Serial Number: 24277 Attached please find the Field Inspection & Service Report with field test results for services performed on 4/25/15 at the property of David Wondolowski located at 100 Raleigh Tavern Lane, North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: David Wondolowski Massachusetts DEP P �.eL.:3$ a4erxa�'�i MC 0 RPD RAT E 0 8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808 e-mail:onsite biomicrobics.com, www.biomicrobics.com, 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST' System 23617 INSTALLATION AUTHORIZED SERVICPR E OVIDER i; Installation Address: 100 Raleigh Tavern Lane North Andover, MA 01845 Name: Wastewater Treatment Services, Inc. Owner Name: David Wondolowski Mail Address: 100 Raleigh Tavern Lane North Andover, MA 01845 Mail Address: 44 Commercial Street Raynham, MA 02767 Phone: 617-821-1617 Fax: e-mail: Phone: (508) 880-0233 Fax: (508) 880-7232 e-mail: Imo- - INSTALLATION INFORMATION t Model No. Serial No. Date of Installation Date of last pump out MicroFAST .5 24277 11/11/2004 9/23/2013 EQUIRMENT` YES'. NO MAINTENANCE PERFORMED AND CONIIvIENTS' Electrical Panel(s) Visual Alarm Operating x Audio Alarm Operating (if present) x Blower(s) Air Inlet Filter Clean x Blower Hood Vents Clear x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Pumpout Required x Primary Settling Zone 12" Aerobic Treatment Zone 0" EFFLUENTk(optional) LIMIT RESULT"-' Estimated Daily Flow 440 gpd pH (Standard Units) 6.89 Color Clear Temperature Odor Earthy Comments: . a ", TECHNICIAN rSERVICE y DATE; Michael Foisy 4/25/15 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 Ll DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 2361'. A. Installation David Wondolowski Owner 100 Raleigh Tavern Lane Facility Street Address North Andover 01845 City Zip Mailing address of owner, if different: 100 Raleigh Tavern Lane Street Address/PO Box: 2762 North Andover MA 01845 City State Zip 617-821-1617 Telephone Number B. Authorized Service Provider Wastewater Treatment Services. Inc. 0&M Firm 44 Commercial Street Street Address Raynham MA 02767 City State Zip 508-880-0233 Telephone Number Michael Foisy 2762 Certified Operator Name Certification Number C. Facility/System Information 24277 Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer ID Model Number 11/11/2004 11/11/2004 Installation Date Start of Operation Approval Type: [ ] General [ ] Provisional [ ] Piloting [x] Remedial [ ] General Denite Seasonal Residence — used less than 6 mo./year: [ ] Yes [x] No D. Operating Information 4/25/15 Inspection Date 12" Sludge Depth (to be checked yearly) Previous Inspection Date Pumping Recommended [ ] Yes [x] No v Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 2361' E. Field Testing Field Inspection: Color: [] gray [] brown [] Other (specify): _ [x] clear [] turbid Odor: [] musty [x] earthy [] moldy [] offensive [] turbid Effluent Solids: [] no [] some pH 6.89 SU DO 2.99 my/L Turbidity 98.4 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: [ ] Influent [ ] Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 440 gpd Parameters sampled: Influent. [ ] pH [ ] BOD [ ] CBOD [ ] TSS [ ] TKN [ ] Nitrate [ ] Nitrite [ ] Phosphorus [ ] Spec. Cond. [ ] Ammonia [ ] Alkalinity [ ] Oil Grease [ ] VOC [ ] Fecal Coliform Effluent. [ ] pH [ ] BOD [ ] CBOD [ ] TSS [ ] TKN [ ] Nitrate [ ] Nitrite [ ] Phosphorus [ ] Spec. Cond. []Ammonia []Alkalinity [ ] Oil Grease [ ] VOC [ ] Fecal Coliform G. Inspection and Maintenance Description of any maintenance performed since previous inspection & during this inspection: Cleaned Filter, Checked Splash Recycle Notes and Comments: 2 Massachusetts Department of Environmental Protection LlBureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 23617 H. Certification certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. xx�t� 4A� Operator Signature 4/25/15 Date System owner must submit this report, technology 0&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use — by January 31 st of each year for the previous calendar year Piloting Use - within 45 days of inspection date Provisional Use — by March 31 th of each year for the previous 12 months General Use — by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 3 September 11, 2012 North Andover Board of Health 1600 Osgood Street North Andover, MA 018+5 Attention: Health Agent SEP I a 2012 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 Reference: FAST' Wastewater Treatment System - Serial Number: 27259 Attached please find the Field Inspection & Service Report with field test results for services performed on 8/27/12 at the property of Robert Montouri located at 100 Candlestick Road, North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Robert Montouri Massachusetts DEP s Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and 0&M Form for Title 51/A Treatment and Disposal Systems 16865 A. Installation Robert Montouri Owner 100 Candlestick Road Facility Street Address North Andover 01845 City Zip Mailing address of owner, if different: 100 Candlestick Road Street Address/PO Box: 15651 North Andover MA 01845 City State Zip 978-682-9543 Telephone Number Authorized Service Provide-., lfias ew ter reatment Services, inc. O&M Firm 44 Commercial Street Street Address Raynham MA 02767 City State Zip 508-880-0233 Telephone Number David Nix 15651 Certified Operator Name Certification Number C. Facility/System Information 27259. Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer ID Model Number 8/28/2006 8/28/2006 Installation Date Start of Operation Approval Type: [ ] General [ ] Provisional [ ] Piloting [x] Remedial Seasonal Residence — used less than 6 mo./year: [ ] Yes [x] No D. Operating Information 8/27/12 Inspection Date 12" Sludge Depth (to be checked yearly) Previous Inspection Date Pumping Recommended [ ] Yes [x] No Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 16865 E. Field Testing Field Inspection: Color: [] gray [] brown [x] clear [j turbid [] Other (specify): Odor: [] musty [x] earthy [] moldy [] offensive [] turbid Effluent Solids: [x] no [] some pH 7 SU DO 5.76 m4/L Turbidity 8.92 NTU 6 to 9 2 or greater 40 or less Should a Remedial or Generai Use system-: fail the Fisica Testing, effluent samples shiall be collected per Standard Methods and analyzed for BOD and TSS. R Sampling Intorn-va ion Samples Taken: [ ] Influent [ j Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: Influent. [ ] pH [ ] BOD [ ] CBOD [ ] TSS [ ] TKN [ ] Nitrate [ ] Nitrite [ ] Phosphorus [ ] Spec. Cond. []Ammonia []Alkalinity [ ] Oil Grease [ ] VOC [ ] Fecal Coliform Effluent. [ ] pH []BOD [ ] CBOD []TSS [ ] TKN [ ] Nitrate [ ] Nitrite []Phosphorus []Spec. Cond. []Ammonia []Alkalinity [ ] Oil Grease [ ] VOC [ ] Fecal Coliform G. Inspection and Maintenance Description of any maintenance performed since previous inspection & during this inspection: Cleaned Filter, Checked Splash Recycle Notes and Comments: 0 2 a, Massachusetts Department of Environmental Protection LlBureau of Resource Protection - Title 5 DEP Approved Inspection and 0&M Form for Title 5 I/A Treatment and Disposal Systems 16865 Ho Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. y � 8/27/12 Operator Signature Date &sterni &wni,.r miust sui:,ii,lit1h15 reooi_, ti5chiiVi'o'gW`CMM, checklist, and any required samplin:.ir <:; 't + e l r h itch and r1EP s f for e c. tion per{ r f• 8u. S 10 the t.Cc7i board C� C_� .ra t: 8i _ ` ii ,VVS c: •h ii Si C;iL , a , ,OC; fiev. Remedial Use — by January 31 st of each year for the previous calendar year Piloting Use - within 45 days of inspection date Provisional Use — by March 31th of each year for the previous 12 months General Use — by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808 e-mail:onsite(o)biomicrobics.com, www.biomicrobics.com, 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST° System 16865 INSTALLATION AUTHORIZED SERVICE PROVIDER, Installation Address: 100 Candlestick Road North Andover, MA 01845 Name: Wastewater Treatment Services, Inc. Owner Name: Robert Montouri Mail Address: 100 Candlestick Road North Andover, MA 01845 Mail Address: 44 Commercial Street Raynham, MA 02767 Phone: 978-682-9543 Fax: e-mail: Phone: (508) 880-0233 Fax: (508) 880-7232 e-mail: ilvs iNLt AT (,i4'N ORMAT10N Mode! No. �— Serial No. Date of Installation Date of last pump out 1t1tcroF.AS:.5 �;L�y j Sr"i/20t? ----- r<LAINITENANCE.PE UORIMEDAl47 COME i N I'S EQUIPMENT Electrical Panel(s) Visual Alarm Operating x Audio Alarm Operating (if present) x Blower(s) Air Inlet Filter Clean x Blower Hood Vents Clear x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Pumpout Required x Primary Settling Zone 12" Aerobic Treatment Zone 101, EFFLUENT (optional) LIMTT . RESULT Estimated Daily Flow 440 gpd pH (Standard Units) 7 Color Clear Temperature Odor Earthy Comments: TECHNICIAN SERV ICE.DATE David Nix 8/27/12 October 19, 2009 North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Attention: IHealth Agent RECEoV/Ep OCT 2 7 2009 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508)880-7232 Reference: FAST° Wastewater Treatment System - Serial Number: 27259 Attached please find the Field Inspection & Service Report with field test results for services performed on 09/11/2009 at the property of Robert Montouri located at 1.00 Candlestick Road - North Andover, MA. Please call if you have -any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: : Robert Montouri Massachusetts DEP Massachusetts Department of Environmental Protection r Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 51/A Treatment and Disposal Systems Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 11147 A. Installation Robert Montouri Owner 100 Candlestick Road Facility Street Address North Andover City Mailing address of owner, if different: 100 Candlestick Road Street Address/PO Box: North Andover MA City State 978-682i-9543 ext. Telephone. Number t. B. Authorized Service Provider 01845 Zip 01845 Zip Wastewater Treatment Services, Inc. O&M Firm i 44 Commercial Street Street Address Raynham City 508-880=0223 ext. Telephone Number David Koshiol Certified Operator Name MA State C. Facility/System Information 27259 DEP ID 02767 Zip 2976 Certification Number Bio-Microbics, Inc. MicroFAST .5 Manufacturer ID Model Number Installation Date Approval Type: Q General 0 Provisional Seasonal Residence — used less than 6 mo./year: D. Operating Information 09/11/2009 Inspection Date 8" Sludge t.evel 08/28/2006 Start of Operation 0 Piloting 0 Yes ® Remedial Previous Inspection Date Pumping Recommended 0 Yes ®No DEPMicroFASTnew.doc - 10/19/o9 Page 1 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 11147 E. Field Testing Field Inspection Color: Q gray Q brown ® clear 0 turbid 0 other (specify): Odor: Q musty © earthy Q moldy 0 offensive 0 turbid Effluent Solids: ®no 0 some i pH 7.0 SU DO 6.8 mg/L. Turbidity 2.4 NTU 46 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken 0 Influent 0 Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 440 gpd Parameters sampled: Q pH 0 BOD Q CBOD 0 TSS 0 TN 0 Other (list below) Other 1 Other 2 Other 3 i G. Inspection and Maintenance Description of any maintenance performed since previous inspection and during this inspection Cleaned Filter, , , Checked Splash Recycle, Notes and Comments: DEPMicroFASTnew.doc - 10/19/09 Page 2 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 51/A Treatment and Disposal Systems 11147 H. Certification I certify:.l have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. David Koshiol 09/11/2009 Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use — by January 31 st of each year for the previous calendar year Piloting Use — within 45 days of inspection date t Provisional Use — by March 31st of each year for the previous 12 months General Use — by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, ,MA 02108 DEPMicroFASTnew.doc - lo/19/o9 Page 3 of 3 ,j , wi B10 8450 Cole Parkway m Shawnee, KS 66227 w Phone 913-422-0707 II Fax: 912-422-0808 11147 e-mail: onsite(aa)biomicrobics.com ta www.biomicrobics.com m 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For' Bio-Microbics Single Home FAST® System .INSTALLATION AUTHORIZED SERVICE PROVIDER 100 Candlestick Road Installation Address: 'North Andover, MA 01845 Name: Wastewater Treatment Services, Inc. Owner Name: Robert Montouri Mail Address: 100 Candlestick Road North Andover, MA 01845 Mail Address: 44 Commercial Street Raynham, MA 02767 City State Zip Phone: 978-682-9543 Fax e-mail 508-880-0233 508-880-7232 Phone Fax e-mail INSTALLATION INFORMATION Model No.: Serial No. Date of Installation Date of last pump out MicroFAST .5 27259 08/28/2006 8/1/200712:00:00 AM EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating X Audio Alarm Operating X if resent Blower(s) Air Inlet Filter Clean X Blower Hood Vents Clear X Excessive Noise ; X Excessive Vibration X Treatment unit(s) Unusual Odor Pum out Required:, X Primary Settling Zone 8" Aerobic Treatment Zone 13" EFFLUENT (optional) LIMIT RESULT Estimated Daily Flow 440 gpd. H (Standard Units Color Clear Temperature 66.5 Odor Earth Comments: TECHNICIAN SERVICE DATE David Koshiol 09/11/2009 September 3, 2008 North Andover Board of Health Building 20, Unit 2 - 36 1600 Osgood Street North Andover, MA 01845 Attention: Health Agent 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 Reference: FAST® Wastewater Treatment System - Serial Number: 27259 Attached please find the Field Inspection & Service Report with field test results for services performed on 08/14/2008 at the property of Robert Montouri located at 100 Candlestick Road - North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Robert Montouri Massachusetts DEP Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and 0&M Form for Title 5 UA Treatment and Disposal Systems 9449 A. Installation Robert Montouri Owner 100 Candlestick Road Facility Street Address North Andover 01845 City Zip Mailing address of owner, if different: 100 Candlestick Road Street Address/PO Box: North Andover MA 01845 City State Zip 978-682-9543 ext. Telephone Number B. Authorized Service Provider Wastewater Treatment Services, Inc. O&M Firm 44 Commercial Street Street Address Raynham City 508-880-0223 ext. MA State Telephone Number David Koshiol 2976 Certified Operator Name Certification Number C. Facility/System Information 27259 DEP ID Installation Date Bio-Microbics, Inc. Manufacturer ID Approval Type: Q General 0 Provisional Seasonal Residence — used less than 6 mo./year: D. Operating Information 08/14/2008 Inspection Date 13" Sludge Level 08/28/2006 Start of Operation Q Piloting 0 Yes 02767 Zip MicroFAST .5 Model Number ® Remedial ®No Previous Inspection Date Pumping Recommended 0 Yes ® No DEPMicroFASTnew.doc - 8/28/08 Page 1 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and OW Form for Title 5 I/A Treatment and Disposal Systems 9449 E. Field Testing Field Inspection Color: 0 gray 0 brown ® clear 0 turbid 0 other (specify): Odor: Q musty ® earthy 0 moldy 0 offensive 0 turbid Effluent Solids: ®no 0 some pH 7.0 SU DO 4.9 mg/L. Turbidity 3.0 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken 0 Influent Q Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 440 Parameters sampled: 0 pH 0 BOD 0 CBOD Q TSS Q TN 0 Other (list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection and during this inspection Cleaned Filter, , , , Notes and Comments: DEPMicroFASTnew.doc • 8/28/08 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 51/A Treatment and Disposal Systems 9449 H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods; have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. David Koshiol Operator Signature 08/14/2008 Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use — by January 31" of each year for the previous calendar year Piloting Use — within 45 days of inspection date Provisional Use — by March 31 $' of each year for the previous 12 months General Use — by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 DEPMicroFASTnew.doc • 8/2&oa Page 3 of 3 <4 1 N C 0 R P 0 R A T E 0 8450 Cole Parkway m Shawnee, KS 66227 m Phone 913-422-0707 m Fax: 912-422-0808 9449 e-mail: onsite -biomicrobics.com m www.biomicrobics.com m 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 100 Candlestick Road Installation Address: North Andover, MA 01845 Name: Wastewater Treatment Services, Inc. Owner Name: Robert Montouri Mail Address: 100 Candlestick Road North Andover, MA 01845 Mail Address: 44 Commercial Street Raynham, MA 02767 City State Zip Phone: 978-682-9543 Fax e-mail 508-880-0233 508-880-7232 Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pump out MicroFAST .5 27259 08/28/2006 8/1/2007 12:00:00 AM EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating X Audio Alarm Operating X if resent Blower(s) Air Inlet Filter Clean X Blower Hood Vents Clear X Excessive Noise X Excessive Vibration X Treatment unit(s) Unusual Odor X Pum out Required: X Primary Settling Zone 13" Aerobic Treatment Zone 14" EFFLUENT (optional) LIMIT RESULT Estimated Daily Flow 440 gpd. H Standard Units Color Clear Temperature 75.2 Odor Earth Comments: TECHNICIAN SERVICE DATE David Koshiol 08/14/2008 Date.. ........ tkoR TOWN OF NORTH ANDOVER OERMIT FOR WIRING This certifies that ....... ................ .................................................................... has permission to perfor ...... wiring in the building of ............................................. at./ ........ .......... , North Andover, Mass. FeV/ .............. Lic. Not ............. ............................. ....................... .......... 4 ELECTRICAL INSPE R Check # A. 6739 yy4�. v Official Use Only THE COMMONWEALTH OF MASSACHUSETTS Permit No. Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date / Vo _ To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Owner o Owner's N Is this permit in conjunction with a building permit Yes No (Check Appropriate Box) �} . Purpose of Building p, e Utility Authorization No. 10 ✓`e �� Existing Service 6?00 Amps / za Zf 0 Volts Overhead • Undgmd No. of Meters New Service A00 Amps /j 2-40 Volts Overhead (:Un:dg:mDd-No. of Meters Number of Feeders andAmpacity )Q'eY'n&He VNC1'`'gQ0UAJ/! •GP IC_c ALIJAL-i, 40M Alec. Location and Nature of Proposed Electrical Work Z�eA lie i s u to A %7Nl Ng OTHER: 1NJUtkANCE cCP/EHAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy inclupleted Operations Coverage or its substantial equivalen YES NO = have submitted valid proof of same to the OffsokyES 4 NO = If you have checked YES please indicate the ty rage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) {Expiration Date) Estimated Value of lectrl al jy��ork$ Work to StartO(� Inspection Date Resquested_ 0�0 0 Rough Final R^/ Signed under the Penal es of perjury: LIC. NO. u FIRM NAME / ^ - - NO. Bus. Tel No. Address Alt Tei. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) - Telephone No. PERMIT FEES S�°�o f7� 4D (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above In No. of Lighting Fixtures Swimming Pool gmd grnd Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices • Municipal • Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW -Signs Bailases Wiring, No. Hydro Massage Tuds No. of Motors Total HP 16 OTHER: 1NJUtkANCE cCP/EHAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy inclupleted Operations Coverage or its substantial equivalen YES NO = have submitted valid proof of same to the OffsokyES 4 NO = If you have checked YES please indicate the ty rage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) {Expiration Date) Estimated Value of lectrl al jy��ork$ Work to StartO(� Inspection Date Resquested_ 0�0 0 Rough Final R^/ Signed under the Penal es of perjury: LIC. NO. u FIRM NAME / ^ - - NO. Bus. Tel No. Address Alt Tei. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) - Telephone No. PERMIT FEES S�°�o f7� 4D (Signature of Owner or Agent) l� , V 1.�� w'F•{rw.'r•.... t"W. �C•. _,`..� .r, +,.�, �•t �j c ',w . ,�C: 'iC::ar .,... ..i , _�.�ir i�—".ii :•f'' _. �r..� _fi;/tlt .. ";-T..TI': °y1.>:: r _, �^ �O�-'•—ab (•"/jJ/////;��u'li', 'J �i ;-'4il�i i_Ec�`i MIJP - . I' r ��•?' :. 1(:l):. fr 71J I I .f'! .71 •fir[,,` . is tl' (',:'S .'.� itr ;>Af � .. .... __....__.. lJ%f ^',.J i.__""__... .._ ..___ .. ... ..r. .. t •r�'__�._ _ __. .. _.,. �_ __.. _- — l . t: Vie_ ^ _, i ., S, ;d�• _ ... , 3-raJr ?.S. 10 ,. ICS e r ,r r.' 1 Ia'(z aTv+C++.. %`�•, r,W 1•S ,...a .. .:1 ..t i'(,1H .+I .� , .• .. ,U ah1 «:Ti).^I .., a:!�i..'7, .+Tv"lY• i';f •,3 '.: -i. ak"n 1r,. rIx , ,. "r .7+"l' l� -,k* -illy '.Location` Sewer Connection Fee $ Water Connection Fee $ TOTAL $ on 07747194 49;18 Buil ragins ector 26.00 PAID Div. Public Works /7A; - Date M°RTh TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ Building/Frame Permit Fee $ of J ACNAcmUS foundation Permit Fee $ 1 Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ on 07747194 49;18 Buil ragins ector 26.00 PAID Div. Public Works PERMIT NO., 271 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K -4O. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ZONE SUB DIV. LOT NO. �) LOCATION oO �0 n �� �� PURPOSE OF BUILDING / OWNER'S NAME �A®4 O v NO. OF STORIES SIZE OWNER'S ADDRESS `/S� ,Q llJJv _ .BASEMENT OR SLAB ARCHITECT'S NAME a /Z- SIZE OF FLOOR TIMBERS 1ST z-<02ND©{C` 3RD BUILDER'S NAME((,/ SPAN DISTANCE TO NEAREST BUILDING Zoo( �-� DIMENSIONS OF SILLS POSTS f '-c DISTANCE FROM STREET �-, DISTANCE FROM LOT LINES - SIDES REAR / e GIRDERS AREA OF LOT L� , %'�,C FRONTAGE ! [► C HEIGHT OF FOUNDATION THICKNESS / IS BUILDING NEW SIZE OF FOOTING - X IS BUILDING ADDITION - IS BUILDING ALTERATION `-Ife a 51 MAT R:AL OF CHI I IL SOLID R FILLED LAND , / WILL BUILDING CONFORM TOR QUIREMENTS OF CODE IS BUILDING CO NECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING - ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FIL D 4'RVED BY /,,,BUILDING INSPECTOR DATE FILED SIGNATURE OF OWNER OR AUTHORIZED AGENT ' FEE A /-io ✓• PERMIT GRANTED OWNER TEL. IFCONTR. TEL. TCl is CONTR. LIC. A, (w% 1.0570 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER— DRY WALL — I — UNFIN. 3 BASEMENT AREA FULL FIN..B M TAREA _ 71 1/1 'L FIN. ATTIC AREA NO BMT FIRE PLACES _ , HEAD ROOM MODERN KITCHEN V 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING RETE SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMON �_— VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR ADEQUATE NONE - 5 ROOF 10 PLUMBING GABLEHIP BATH )3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ t ROLL ROOFING MODERN FIXTURES _ k TILE FLOOR TILE DADO r 6 FRAMING I 11 HEATING _ _ r�• - '3i1a ' WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR.___. WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS B'A'T ( 3rd I NOCHEATING 1 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** PLICANT: R(60((l Phone LOCATION: As=sessor's Map Nu.imber Parcel ✓ Sub,; 4.T _ion Lots; treez too a(C62�16k' ` St. Nu.:j--er ************************Ofi-coal Use RE MNENDATIONS OF TOWN AGENTS: / Date Arcroved �� Ad-_nis t.razcr Daze Re- ected 1Nb C*&ATek Daze Approved � q Tcwn Planner Daze Re; eczed Cc= an:S Fcc : Se=,z_... i::Si. e•:..., .. -.:east 'wazer ccnnecions r�•s se:rer - driveway pe=it F_re Decar--menz Dar -'a Ab�rcved Daze Re,ec ad Date Anprcved Dazs Rej ec �::-_ Recaived by Bui'_ding Ins:,ector Daze t a ,NIOCo I�A O � � N +.s,swa...r>�_,x �ar.�.sa:,.rw..,..._ v.x..wr..,,.a�w•..3.wi:::ws�+m, +:t+:e�.� �fi .s�b�tu`" m CDC coo d Z. 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